574730
4 It












NATURE IN DISEASE,
ILLUSTRATED IN
VARIOUS DISCOURSES AND                 ESSAYS.
TO WHICH ARE 'ADDED
MISCELLANEOUS WRITINGS,
CHIEFLY ON MEDICAL SUBJECTS.
BY JACOB BIGELOW, M. D.
PDYSICIAN AND LECTURER ON CLINICAL MEDICINE IN THE MASSACHUSETTS
OENERAL HOSPITAL; PROPFESOR OF MATBRIA MKDICA IN HARVIAID
UNIVERSITY; PNESIDKNT OP THE AMERICAN ACADEMY OF
ARTS AND SCIENCES; AND LATE PRESIDRBT OF
THE MASSACICSEITS MEDICAL SOCIETY.
BOSTON:
TICKNOR AND FIELDS.
MI DCC LIV.
I



Entered according to Act of Congress, in the year 1854, by
TICKNOR        AND    FIELDS,
In the Clerk's Office of the District Court of the District of Massachusetts.
BOSTO N:
THCIMTON AND TORBY, PRINTERS



PREPACE.
IT is observable to many physicians, that a change in the
mode of regarding the treatment of disease:has come over
the.medical world in this city and in various parts of the
United States, during the last quarter of a century. In
certain cases a practice of watching, guiding, and trusting
the salutary indications of nature, has taken the place of
more active interferences of art. Those men whose medical
career began at a period antecedent to that which has been
named, will recollect that the course then most prevalent
among the profession consisted in energetic and sometimes
annoying and painful applications of supposed remedies,
from the beginning to the end of diseases, whether those
diseases were amenable to such treatment, or totally incapable of being influenced by them. And, in some instances,
such active measures were promoted by influential teachers
of medical science, in the great schools of our country.
Nearly twenty years ago, the Discourse on Self-limited
Diseases, which stands at the head of this volume, was de

206365



iv


PREFACE.


livered before the Massachusetts Medical Society, at their
annual meeting, as an expression of opinions I had been led
to entertain, as to the influence of treatment on the event
of some morbid affections. Subsequent observation has not
tended to shake these opinions; and I have had the satisfaction to believe that many of my medical friends, for whose
judgment the public entertain the highest respect, have arrived at similar conclusions. As science has advanced, some
revision has become necessary of this as well as of some
other essays written long ago. But the general truth of the
positions then assumed has not been contradicted by later
experience of competent observers in the profession.
The exclusive pursuit of any profession frequently tends
to an undue exaggeration of its powers. What we have
been early taught to accept on authority, and what we have
been accustomed habitually to announce to others, may become engrafted on our own belief, so as to constitute an
unquestioned rule of practice. The necessity is, on this
account, more imperative, that inquirers for truth should
divest themselves of personal considerations, and seek for
rules of practice which are based on enlightened experience,
and impartial and reliable evidence.
I have given the title " Nature in Disease" to the present
collection of discourses and disquisitions, because a number
of the principal articles in its contents bear directly on that



PREAFCE. -                    V
subject. fBut I have taken advantage of the same occasion
to incorporate in this small volume some other miscellaneous
papers, chiefly on medical subjects, written or published at
various times, during a long and active professional life.
J. B..-BosroN,-Nov. 1, 1854.



ERRATA.
'Page 3, line 8 from top,  for give,      read gives.
"   19, "  5 from bottom, " ILIL 616,       "I. 651.
"   79, " 10 from top,     " affctions,  "   affections.
"6 235, "   6 from bottom, " Grat Britain, "  Great Britain.
"6 235, "  3  "     "      "L do novo,   "   de novo.



C-'


CONTENTS.
I                     Page
ON SELF-LIMITED DISEASES.....    1
ON THE TREATMENT OF DISEASE....  59
II.
ON THE TREATMENT OF DISEASE....  59
PRACTICAL VIEWS OF MEDICAL EDUCATION..  91
IV.
REPORT ON HOMEOPATHY..... 101
V.
ON THE MEDICAL PROFESSION, AND QU.CKERY.. 110
VI.
ON GOUT AND ITS TREATMENT.... 132
VII.
ON THE TREATMENT OE INJURIES OCCASIONED BY FIRE
AND HEATED SUBSTANCES.... 146
VIII.
ON THE BURIAL OF THE DEAD; AND THE CEMETERY
AT MOUNT AUBURN...... 171
IX.
REMARKS AND EXPERIMENTS ON PNEUMOTHORAX. 195



Viii                CONTENTS.
X.
ON THE PHARMACOPCEIA OF THE UNITED STATES. 231
XI.
ON THE MUCUNA PRURIENS: WITH REMARKS ON THE
IRRITABILITY OF DIFFERENT TEXTURES.. 266
XII.
ON THE POISONOUS EFFECTS OF THE AMERICAN PARTRIDGE, OR RUFFED GROUSE.... 272
XIII.
ON COFFEE AND TEA; AND THEIR MEDICINAL EFFECTS 289
XIV.
REPORT ON THE ACTION OF COCRITUATE WATER ON
LEAD PIPES; AND THE INFLUENCE OF THE SAME
ON HEALTH...... 315
XV.
ON THE HISTORY AND USE OF TOBACCO... 323
X VI.
ON THE EARLY HISTORY OF MEDICINE... 337
XVII.
ADDRESS DELIVERED BEFORE THE AMERICAN ACADEMY
OF ARTS AND SCIENCES, AT THE OPENING OF THEIR
COURSE OF LECTURES, OCTOBER 27, 1852.. 358



ON


SELF-LIMITED DISEASES:
A DISCOURSE DELIVERED BEFORE THE MASSACHUSETTS
MEDICAL SOCIETY, AT THEIR ANNUAL MEETING, MAY
27TH, 1835.
[At the beginning of this discourse, the customary obituary
notice was taken of eminent members of the society, deceased during the previous year.]
THE death of medical men is an occurrence
which eminently demands our attention, for it
speaks to us of our science, and of ourselves.
It reminds us, that we, in turn, are to become
victims of the incompetency of our own art. It
admonishes us, that the sphere of our professional exertions is limited, at last, by insurmountable barriers. It brings with it the humiliating
conclusion, that while other sciences have been
carried forward, within our own time and almost under our own eyes, to a degree of unprecedented advancement, Medicine, in regard
1



2


SELF-LIMITED DISEASES.


to some of its professed and most important
objects, is still an ineffectual speculation. Observations are multiplied, but the observers disappear, and leave their task unfinished. We
have seen the maturity of age, and the ardent
purpose of youth, called off from the half cultivated field of their labors, expectations and
promise. It becomes us to look upon this deeply interesting subject with unprejudiced eyes,
and to endeavor to elicit useful truth from the
great lesson that surrounds us.
In comparing the advances which have been
made, during the present age, in different departments of Medical science, we are brought to
the conclusion, that they have not all been cultivated with equally satisfactory success. Some
of them have received new and important illustrations from scientific inquiry, but others are
still surrounded with their original difficulties.
The structure and functions of the human body,
the laws which govern the progress of its diseases, and more especially the diagnosis of its
morbid conditions, are better understood now,
than they were at the beginning of the present
century. But the science of therapeutics, or the



SELF-LIMITED DISEASES.


3


branch of knowledge by the application of which
physicians are expected to remove diseases, has
not, seemingly, attained to a much more elevated standing than it formerly possessed. The
records of mortality attest its frequent failures,
and the inability to control the event of diseases,
which at times is felt by the most gifted and
experienced practitioners, give evidence that,
in many cases, disease is more easily understood, than cured.
This deficiency of the healing art is not justly
attributable to any want of sagacity or diligence
on the part of the medical profession. It belohgs rather to the inherent difficulties of the
case, and is, after abating the effect of errors and
accidents, to be ascribed to the apparent fact,
that certain morbid processes in the human
body have a definite and necessary career, from
which they are not to be diverted by any known
agents, with which it is in our power to oppose
them. To these morbid affections, the duration
of which, and frequently the event also, are
beyond the control of our present remedial
means, I have, on the present occasion, applied
the name of Self-limited diseases; and it will



4


SELF-LIMITED DISEASES.


be the object of this discourse to endeavor to
show the existence of such a class, and to inquire how far certain individual diseases- may
be considered as belonging to it.
By a self-limited disease, I would be understood to express one which receives limits from
its own nature, and not from foreign influences;
one which, after it has obtained foothold in the
system, cannot, in the present state of our knowledge, be eradicated, or abridged, by art,-but
to which there is due a certain succession of
processes, to be completed in a certain time;
which time and processes may vary with the
constitution and condition of the patient, and
may tend to death, or to recovery, but are not
known to be shortened, or greatly changed, by
medical treatment.
These expressions are not intended to apply
to the palliation of diseases, for he who turns a
pillow, or administers a seasonable draught of
water to a patient, palliates his sufferings; but
they apply to the more important consideration
of removing diseases themselves through medical means.
The existence of a class o0 diseases, like those



SELF-LIMITED DISEASES.


5


under consideration, is, to a certain extent,
a'ready admitted, both by the profession, and
the public; and this admission is evinced by the
use of certain familiar terms of expression.
Thus, when people speak of a 'settled disease,'
or of the time of 'the run of a disease,' it implies,
on their part, a recognition of the law, that
certain diseases regulate their own limits and
period of continuance.
It is difficult to select a perfectly satisfactory
or convincing example of a self-limited disease
from among the graver morbid affections, because in these affections the solicitude of the
practitioner usually leads him to the employment of remedies, in consequence of which, the
effect of remedies is mixed up with the phenomena of disease, so that the mind has difficulty in
separating them. [Note A.]   We must therefore seek for our most striking or decisive examples among those diseases which are sufficiently
mild, not to be thought to require ordinarily the
use of remedies, and in which the natural history of the disease may be observed, divested of
foreign influences.  Such examples are found
in the vaccine disease, the chicken pox, and the



6


SELF-LIMITED DISEASES.


salivation produced by mercury.   These are
strictly self-limited diseases, having their own
rise, climax, and decline; and I know of no
medical practice which is able, were it deemed
necessary, to divert them from their appropriate
course, or hasten their termination. [Note B.]
It may appear to some, that the distinction of
these diseases from others, is the old distinction
of acute and chronic. Yet on due inquiry, such
an identification is not found to be sustained,
for there are some acute diseases which, we
have reason to believe, are shortened by the
employment of remedies; while, on the other
hand, certain chronic cases of disease are known
to get well spontaneously, after years of continuance.
If the inquiry be made, why one disease has
necessary limits, while another is without them?
the reply is not uniform, nor always easy to be
made. Sometimes the law of the disease may
be traced to the nature of the exciting caupe.
Thus the morbid poison of measles, or of small
pox, when received into the body, produces a
self-limited disease; but the morbid poisons of
psora and syphilis may give rise to others which



SELF-LIMITED DISEASES.*


7


are not limited, except by medical treatment
[Note C.] Sometimes, also, the cause being
the same, the result will depend on the part,
organ., or texture which is affected. Thus if we
divide with a cutting instrument the cellular or
muscular substance, we produce a self-limited
disease, whi~ch,' although it cannot by any art be
healed within a certain number of days or
weeks, yet in the end gets well. spontaneously, by
one process, if the lips are in contact, - and by
another and slower process, if they are separated.* But if, on the other hand, we divide a
considerable artery, we have then an unlimited
disease; and the hemorrhage, or the aneurism,
which follows, does not get well, except through.the interposition of art.
The class of diseases under consideration,
comprehends morbid affections, differing greatly
from each other, in the time, place, and nature
of their spontaneous developments; so that
they may admit of at least three general
subdivisions. These may be called, 1st. The
simple; in which the disease observes a con*In one case, the disease is a solution of continuiity; in the
other, a solution of continuity and contact.



8


SELF-LIMITED DISEASES.


tinuous time, and mostly a definite seat; 2d,
The paroxysmal; in which the disease, having
apparently disappeared, returns at its own
periods; and 3d. The metastatic; in which the
disease undergoes metastasis or spontaneous
change of place. In the present state of our
knowledge, we have no difficulty in finding
examples of each of these subdivisions. There
are also other examples, in which the disease,
although capable of being in part influenced by
medical treatment, still retains a portion of its
original intractability, and has strong relations
to the class in question.
As a mode of directing our inquiries toward
these diseases, we may suspect those complaints
to be self-limited, in which it is observed that
the unwary, and the sceptical, who neglect to
resort to remedies, recover their health without
them. We may also suspect diseases to be of
this character, when we find opposite modes
of treatment recommended, and their success
vouched for, by practitioners of authority and
veracity. We may moreover attach the same
suspicion to cases, in which the supposed cure
takes place under chance applications, or incon



.SELF-LIMITED DISEASES.


9


siderable remedies; as in the' empirical modes
of practice on the one hand, and the minute
doses of the homceopathic method on the other.
Lastly, we may apprehend that cases are fatally
self-limited,* when enlightened physicians die
themselves of the diseases which they had labored to illustrate,--as in the case of Corvisart,
Laennec, Armstrong, and others. [Note D.]
In proceeding to enumerate more precisely
some of the diseases which appear to me to be
self-limited in their character, I approach the
subject with diffidence. I am aware that the
works of medical writers, and especially of
medical compilers, teem with remedies and
modes of treatment for all diseases,; and that
in the morbid affections of which we speak,
remedies are often urged with zeal and confidence, even though sometimes of an opposite
character. Moreover, in many places, at the
present day, a charm is popularly attached to
Swhat is called an active, bold, or heroic prac* In the following article on the Treatment of Disease, it has
been found convenient to divide diseases into the curable, the
self-limited, and the incurable. In a general sense, however,
the last term falls within the second.



10


SELF-LIMITED DISEASES.


tice; and a corresponding reproach awaits the
opposite course, which is cautious, palliative,
and expectant. In regard to the diseases which
have been called self-limited, I would not be
understood to deny that remedies capable of
removing them may exist; I would only assert,
that they have not yet been proved to exist.
Under the simple self-limited diseases, we
may class hooping cough. This disease has its
regular increase, height, and decline, occupying
ordinarily from one to six months, but in some
mild cases only two or three weeks. During
this period, medical treatment is for the most
part of no avail.  Narcotic appliances may
diminish the paroxysm, but without abridging
the disease. After hooping cough has reached
its climax, change of air sometimes appears to
hasten convalescence.  Also if inflammatory,
or other morbid affections, supervene upon the
pure disease, they may become subjects for
medical treatment.   With these exceptions,
hooping cough appears to be a self-limited
disease.
Most of the class of diseases usually denominated  eruptive fevers, are self-limited.



12


SELF-LIMITED DISEASES.


'has been particularly successful; for where the
writers have furnished us anything like definite,
'or numerical results, it does not appear that the
-mortality was less in their hands than it is,among those who pursue a more expectant,practice. The post mortuary appearances, which
in many diseases furnish useful lessons for prac~tice, are in scarlet fever extremely various and
-uncertain; and sometimes no morbid changes,
-sufficient to account for death, can be discovered
in any of the vital organs, or great cavities.
[Note E.]
Small Pox is another example of the class of
-affections under consideration, its approach and
-disappearance being irrespective of medical,practice. It may, at first view, appear, that
inoculation has placed artificial limits on this,disease. But it must be recollected, that inocu-lated small pox is itself only a milder variety
-of the same disease, having its own customary
-limits of extent' and duration, which are fixed,
-quite as much as those of the distinct and con4luent forms of the natural disease.
Erysipelas is an eruptive fever, having strong:analogies with those which have been detailed.



SELF-LIMITED DISEASES.


13


It is not certain, that art can very materially
affect either the duration or the extent of this
malady. If a physician is called to a case of
erysipelas, which is beginning to be developed
upon a part of the face; and if he is asked,
whether the disease will extend to the crown, or
the neck, or to the right ear, or the left,-he
cannot tell. And if he is asked to prevent it
from visiting either of these places, I know of
no satisfactory evidence that he can do it.
Erysipelas, however, in a great number of simple, or exanthematous cases, in subjects previously healthy, gets well without any treatment;
and in a great number of deep-seated and
phlegmonous cases, as well as those in which
vital organs are affected, it proves fatal under
the most approved methods of medical and
surgical practice. It is true, that patients have
recovered, under punctures, incisions, and cautery. It is also true, that they have died under
the same operations, so that it may be submitted as a doubtful point, whether we yet possess
adequate evidence, that erysipelas is not also a
self-limited disease.
It is a question of great interest to the medi



14


SELF-LIMITED DISEASES.


cal profession, to determine whether typhoid
fever is a disease susceptible of control from
medical means. On this subject no one now
doubts, that if the disease is once fairly established in the system, it cannot be eradicated by
art, but must complete a certain natural course,
before convalescence can take place.   But a
question still exists, whether this disease is
capable of being jugulated, or broken up, at its
outset, by the early application of remedies.
It must be allowed, that attacks of disease
resembling those of typhoid, sometimes speedily
disappear during the use of remedies; but it is
by no means certain that such cases are actually
cases of typhoid. The diagnosis of this disease,
during the first day or two, is extremely difficult, its character being similated by different
febrile and inflammatory affections; so that if a
patient, under the use of remedies, succeeds in
avoiding protracted disease, we are not justified
in saying, that the disease he has escaped was
typhoid or typhous fever. Andral, whose experiments on the different modes of treatment in
continued fever, are very extensive, has stated,
that in a number of cases, observed by him, in



SELF-LIMITED DISEASES.


15


which the fever was sufficiently intense, the disease ceased in twenty-four or forty-eight hours,
without any treatment, except that of rest and
a regulated diet.*
Moreover, in weighing the influence of treatment, it ought to be recollected, that during the
existence of any prevailing epidemic, mild cases,
partaking of a similar character to that of the
reigning disease, continually appear among the
less susceptible part of the community. Thus
cholera is attended by diarrhcea or cholerine,
influenza by mild catarrh, small pox by varioloid,
scarlet fever by slight sore throats or ephemeral
eruptions, &c. Now, although these cases are
in reality modified examples of the groave diseases which they accompany, yet I believe that
no well-informed physician will attribute the
mildness or shortness of their character to his
own particular practice.
On the other hand, it is certain that cases of
real typhoid do often come under active treatment at an early stage, without being broken
up, or disarmed of their appropriate conse

* Clinique III. 619.



16


SELF-LIMITED DISEASES.


quences. This particularly happens, when the
disease is endemic in families, so that successive cases begin, as it were, under the eye of the
attending physician, who has every possible
inducement to detect and prevent them, if he
can. In such families, indeed, it will soinetimes
happen, that febrile attacks of different kinds,
consequent upon fatigue and anxiety, and perhaps partaking of the typhoid character, will
take place among the friends and attendants of
the sick; and these may disappear speedily,
under rest and evacuations. But that grave
and specific typhoid fever will thus disappear, is
a point of which we as yet want proof. That
it sometimes fails to disappear, we have abundant proof.
Typhoid fever has, in many respects, a marked affinity with the class of eruptive fevers,
which are supposed to depend on a specific
morbid poison, and which no one pretends to
intercept, after the body has become infected
with them. Scarlet fever and measles, for example, when once established, require a certain
number of days to finish their course; so also
does the typhoid. Scarlet fever and measles



SELF-LIMITED DISEASES.


17


can, in most cases, be had but once during life;
but to this general rule there are exceptions.
The same is precisely true in regard to typhoid.
The contagiousness of scarlet fever is a point
of dispute among physicians; and so is that
of typhoid.  Scarlet fever is attended by an
eruption on the skin. Typhoid fever also has
for one of its most constant symptoms a red,
lenticular eruption, consisting of a few scattered rose-colored pimples, appearing chiefly on
the trunk, from about the sixth to the nineteenth
day of the disease. There also occurs, in most
subjects, a minute, vesicular eruption of sudamina, about the neck and elsewhere. In scarlet
fever, moreover, certain portions of the mucous
membrane unoergo morbid alterations, particularly on the tonsils, and other parts of the
fauces, and these frequently degenerate into
ulcers, affecting the subjacent textures. In like
manner, in typhoid fever, the mucous membrane
of the glandular patches in the small intestines,
which have been named after the anatomist
Peyer, undergo morbid changes, and these
changes are followed by ulcerations, and sometimes perforations of the intestine. This fact,
2



18


SELF-LIMITED DISEASES.


established by the researches of Louis and other
pathologists in Paris, has been abundantly confirmed by post mortem examinations made in
this country during the last few years.* If it
be objected to the proposed classification of this
fever, that the taches are sometimes few in
number, or wholly absent: it is equally true,
that the pustules of inoculated small pox are
likewise often very few, or absent; and that the
eruption of scarlatina sometimes wholly fails to
appear. The sore throat also in the latter disease is wanting, quite as often, to say the least,
as the morbid affection of Peyer's glands.
Before quitting the subject, I beg leave to
introduce the opinion of one or two medical
writers, in regard to the possibility of interrupting or breaking up this disease by means of art.
M. Louis, of whose researches in regard to
typhoid fever, it is but small praise to say, that
they are more exact and comprehensive than
those of any living writer, is of opinion that the
disease cannot be thus intercepted. 'Experience,' says he, 'has shown, that a well marked
typhoid affection is not capable of being broken
* 1835.



SELF-LIMITED DISEASES.


19


up.'* To this testimony of one of the most
eminent teachers in the French metropolis, it
may not be amiss to add that of an American
physician, whose opportunities for observing the
disease in different parts of New England were
extensive, and whose Essay on Typhus Fever
well merits an attentive perusal. The late Dr.
Nathan Smith, in the course of some remarks
on the possibility of interrupting this disease at
commencement, observes: 'During the whole of
my practice I have never been satisfied that I
have cut short a single case of typhus, that I
knew   to be such.' f
*  L'experience ayant montr6, que l'affection typhoide bien
caracteris6e, n'est pas susceptible d'etre jugul6e, ce qui n'est
guere moins vrai, d'ailleurs, suivant toutes les apparences, de
la peripneumonie et des autres maladies inflammatoires.' -
Louis, Gastro-entErite. IT. 612.
Andral says, in regard to the different modes of treatment in
typhus, ' Quelles que soient les methodes employ6es, il est un
certain nombre de cas ob, sans que ces methodes y prennent part,
la nature conduit la maladie a une terminaison heureuse ou
funeste. - Clinique III. 616, 617.
t At the time of the publication alluded to, the distinction between typhus and typhoid fevers had not been well made out.
The distinction is good, though writers of authority differ on the
subject.



ý20


20      SELF-LIMITED DISEASES.


Having said thus much, I leave the subject of
-the tractability of typhus and typhoid fever to
the light of future investigation.  It is but
Justice to state, that numerous and highly
respectable authorities are declared in favor of
the efficacy of art in shortening and mitigating
-these diseases; and it wviii be a source of.gratification to the friends of humanity and
-science, should it ultimately be settled, that
the active treatment now usually pursued at
the commencement of cases, is instrumental
in lessening their duration, severity, or dan-.ger.
Among the morbid affections which have
now been enumerated, may be found sufficient
-examples of continued diseases, which receive
limits from their own nature, and not from the
interference of art. Whether the number of
-these diseases may not be augmented by yad-,ditions from among other fevers, and acute
inflammations, I am not prepared to decide. It
is difficult, however, to withhold the belief, that
a more extended inquiry must probably serve to
multiply, rather than diminish, the number of



SELF-LIMITED DISEASES.


21


maladies to which this character will be found
appropriate.*
We come next to a second order of selflimited diseases, of which the term paroxysmal
is sufficiently descriptive. This term applies to
certain morbid affections, which recur in fits or
paroxysms, leaving the patient comparatively
well in the intervals, at the same time that the
paroxysms themselves can neither be foreseen,
prevented, nor, as far as we know, materially
abridged in their duration. At the head of this
subdivision stands Epilepsy, a disease which
has long been eminent as an opprobrium of
medicine, and for which, it is believed, the
healing art has not yet devised a cure. The
first attacks of epilepsy, especially while there is
any doubt as to the nature of the malady, are
usually made the subjects of active and various
treatment. But after the recurring paroxysms
have established the chardcter of the disease, if
* There is not room here to discuss the question whether
Pneumonia and other acute inflammations fall under the category
of self-limitation. Blood-letting, in proper cases, lessens the
severity and danger of these diseases. But it is not apparent
that it greatly abridges their duration. Dysentery may be
accounted a self-limited disease.



22


SELF-LIMITED DISEASES.


active medical practice is persevered in, it is
rather to satisfy the anxiety of friends, than the
judgment of the practitioner.
Angina pectoris, appropriately called by Dr.
Good, Sternalgia, is a paroxysmal disease, which
in many cases controls its own movements.
The anatomical character of this disease is not
uniform, and I may add, the same is true of its
medical treatment. And in this place it may
be proper to state, that various incurable lesions
of the heart, lungs, brain, and other viscera,
do not apparently destroy life by a regular,
undeviating march; but that as far as their
outward phenomena afford evidence, they seem
to proceed by alternate fits and pauses, undergoing, in their progress, all states, except that
of retrogradation.  This is apparently true
in regard to tubercle, carcinoma, ossification,
hypertrophy, and some other morbid alterations.
It is also even true in regard to old age itself.
Thirty years ago, we might have added gout
to the opprobrious- list under consideration. But
as we may now be said to possess the means of
shortening the paroxysms, by the use of certain
acrid narcotics; and as an abstemious life goes



SELF-LIMITED DISEASES.


23


far towards lessening the frequency and violence
of the recurrence, we may be justified in withdrawing gout from the place it would otherwise
occupy. [Note F.]
The diseases of mania and melancholy,
asthma, when it depends on emphysema of the
lungs, gravel in the kidneys, and the symptoms
produced by ascarides in the rectum, [Note G],
furnish other examples of maladies, which
manifest themselves in unforeseen paroxysms.
Cases, which bear the names of all the above
diseases, are undoubtedly relieved, and sometimes even removed by medicine; but it is
equally true, that other cases are wholly intractable, both as to their recurrence, their
duration, and their susceptibility of much
change from medical treatment. And it will
come to the recollection of many practitioners,
that they have, in the course of their lives,
believed themselves to have cured these diseases, when in fact they have only witnessed
the spontaneous subsidence of a paroxysm.
* The last subdivision of our subject includes
what may be called metastatic diseases. By
this term I wish to express certain morbid



24


SELF-LIMITED DISEASES.


affections, which pass by metastasis from one
part of the body to another, for the most part
independently of artificial influence. Of this
kind are certain cutaneous affections, more especially some which are chronic and hereditary.
Many persons pass a considerable portion of
their lives in  alternate annoyance from   a
disease of the skin, and from   its vicarious
substitute in some internal organ.    Others
again are afflicted with hemorrhagic, or purulent discharges, which at times disappear, only
to be succeeded by equally troublesome affections in a different part. Gonorrhcea cannot
be prevented from   occasional metastasis of
inflammation, and mumps are sometimes found
to undergo the same transition. But perhaps
the most remarkable example of a metastatic
disease is found in acute rheumatism.   This
morbid affection often begins to discover itself
in a limited and comparatively unimportant
part of the system. From    thence, in grave
cases, it travels by successive migrations from
joint to joint, and from limb to limb, till it has
visited nearly all the great articulations of the
body. It also attacks the organs of sense, and



SELF-LIMITED DISEASES.


25


the viscera which are essential to life. During
the course of these migrations, the attending
physician cannot foretell at any given stage,
what part will be next invaded by the disease,
neither can he protect any part from being thus
invaded; nor can he control the period, during
which the disease will reside in any particular
part previously to its next metastasis. Nevertheless acute rheumatism is susceptible of great
palliation though of little abridgment, and
after having run out its career, terminates in
spontaneous recovery; not, however, in some
cases, until it has laid the foundation of serious
organic derangements, especially of the heart..
I forbear to dilate on the structural lesions of
different organs, many of which can only be
cured by the extirpation of the part in which
they reside, thus sacrificing the' integrity of the
body to the preservation of life; and in which
extirpation cannot avail, when the seat of the
disease is in a vital part. I also pass over the
pestilential epidemics of plague, yellow fever,
malignant dysentery and     cholera; diseases
about which the medical profession have great
differences of opinion, and of which thousands



26


SELF-LIMITED DISEASES.


die annually, though hundreds of volumes have
been written for their preservation. [Note H.]
It may perhaps appear that the views which
have now been taken of the power of medicine,
in so large a class of diseases, are gloomy and
discouraging, and that an unworthy tribute is
paid to the labors of those physicians, who have
patiently studied, and ardently acted, for the
benefit of humanity. Such views, however, are
far from being the object of the present discourse. Were it permitted by the compass of
the subject under consideration, it would be a
very grateful task to enumerate those maladies
of the human frame, over which we have reason
to believe that medicine has obtained decisive
influence.  To a medical audience, it is unnecessary to recall the instances of pain relieved, spasms controlled, inflammations checked,
[Note 1], and diseased associations broken up,
under limitable diseases, by the agency of the
healing art. Were there no other trophy for the
medical profession to boast, it is sufficient to
know, that the diseases of small pox and syphilis alone would have entailed misery and extermination on a large portion of our species, had



SELF-LIMITED DISEASES.


27


not medical science discovered the prevention
of the one, and the successful management of
the other.
But that the usefulness of our profession may
extend, our knowledge must go on to increase;
and the foundation of all knowledge is truth.
For truth then we must earnestly seek, even
when its developments do not flatter our professional pride, nor attest the infallibility of our
art. To discover truth in science, is often extremely difficult; in no science is it more difficult than in medicine.  Independently of the
common defects of medical evidence, our selfinterest, our self-esteem, and sometimes even
our feelings of  humanity, may be arrayed
against the truth. It is difficult to view the
operations of nature, divested of the interferences of art, so much do our habits and partialities incline us to neglect the former, wid to
exaggerate the importance of the latter. The
mass of medical testimony is always on the side
of art. Medical books are prompt to point out
the cure of diseases. Medical journals are filled
with the crude productions of aspirants to the
cure of diseases. Medical schools find it incum



28


SELF-LIMITED DISEASES.


bent on them to teach the cure of diseases.
The young student goes forth into the world,
believing that if he does not cure diseases, it is
his own fault. Yet when a score or two of
years have passed over his head, he will come
at length to the conviction, that some diseases
are controlled by nature alone. He will often
pause at the end of a long and anxious attendance, and ask himself, how far the result of the
case is different from what it would have been
under less officious treatment, than that which
he has pursued; how many in the accumulated
array of remedies, which have supplanted each
other in the patient's chamber, have actually
been instrumental in doing him any good. He
will also ask himself whether, in the course of
his life, he has not had occasion to change his
opinion, perhaps more than once, in regard to
the ntanagement of the disease in question, and
whether he does not, even now, feel the want of
additional light.
Medicine has been rightly called a conjectural
art, because in many of its deductions, and especially in those which relate to the cure of
diseases, positive evidence is denied to us. We



SELF-LIMITED DISEASES.


29


are seldom justified in concluding that our
remedies have promoted the cure of a disease,
until we know that cases exactly similar in
time, place, and circumstances, have failed to do
equally well under the omission of those remedies; and such cases, moreover, must exist in
sufficient numbers to justify the admission of a
general law, on their basis. Nothing can be
more illogical, than to draw our general conclusions, as we are sometimes too apt to do, from
the results of insulated and remarkable cases;
for such cases may be found in support of any
extravagance in medicine; and if there is any
point in which the vulgar differ from the judicious part of the profession, it is in drawing
premature  and sweeping    conclusions, from
scanty premises of this kind. Moreover, it is
in many cases not less illogical to attribute the
removal of diseases, or even of their troublesome
symptoms, to the means which have been most
recently employed. It is a common error to
infer that things which are consecutive in the
order of time, have necessarily the relation to
cause and effect. It often happens that the last
remedy used, bears off the credit of having re



30


SELF-LIMITED DISEASES.


moved an obstruction, or cured a disease, whereas
in fact the result may have been owing to the
first remedy employed, or to the joint effect of
all the remedies, or to the act of nature, uninfluenced by any of the remedies.     We see
this remarkably exemplified in recoveries from
amenorrhcea, and from various irregularities of
the alimentary canal.
An inherent difficulty, which every medical
man finds to stand in the way of an unbiased
and satisfactory judgment, is the heavy responsibility which rests upon the issue of his cases.
When a friend, or valuable patient, is committed to our charge, we cannot stand by, as curious spectators, to study the natural history of
his disease. We feel that we are called on to
attempt his rescue by vigorous means, so that
at least the fault of omission shall not lie upon
our charge. We proceed to put in practice
those measures, which on the whole have appeared to us to do most good; and if these fail
us, we resort to other measures, which we have
read of, or heard of. And at the end of our
attendance we may be left in uncertainty,
whether the duration of sickness has been



SELF-LIMITED DISEASES.


31


shortened, or lengthened, by our practice, and
whether the patient is really indebted to us for
good or evil.    In the study of experimental
philosophy, we rarely admit a conclusion to be
true, until its opposite has been proved to be
untrue. But in medicine we are often obliged
to be content to accept as evidence the results
of cases, which have been finished under treatment, because we have not the opportunity to
know how far these results would have been
different, had the cases been left to themselves.
And it too frequently happens, that medical
books do not relieve our difficulties on this score,
for a great deal of our practical literature consists in reports of interesting, extraordinary, and
successful results, published by men who have
a doctrine to establish, or a reputation to build.
SFew authors,' says Andral, ' have published all
the cases they have observed, and the greater
part have only taken the trouble to present to
us those facts which favor their own views.' *
A prevailing error among writers on therapeu* Bien pen d'auteurs ont publiH tous les cas qu'ils ont observes, et la plupart ne se sont empress6s de nous transmettre
que les faits que caressaient loura idWes. - Clinique III. 618.



32


SELF-LIMITED DISEASES.


tics, proceeds from their professional, or personal
reluctance to admit that the healing art, as
practised by them, is not, or may not be, all
sufficient, in all cases; so that on this subject
they suffer themselves, as well as their readers,
to be deceived.   Hence we have no disease,
however intractable or fatal, for which the press
has not poured forth its asserted remedies.
Even of late, we have seen unfailing cures of
cholera successively announced in almost every
city, in which that pestilence unchecked has
completed its work of devastation!
It is only when, in connection with these flattering exhibitions, we have a full and faithful
report of the failures of medical practice, in
similar, and in common cases, setting forth not
only the truth, but the whole truth, that we
have a basis sufficiently broad to erect a superstructure in therapeutics, on which dependence
may be placed. Such, it must give the friends
of science gratification to observe, is a part of
the rigid method which characterizes the best
examples of the modern French school; and
such, it is not difficult to foresee, must ultimately be the only species of evidence on this sub



SELF-LIMITED DISEASES.


33


ject, to which the medical profession will pay
deference.
It appears to me to be one of the most important desiderata in practical medicine, to
ascertain, in regard to each doubtful disease,
how far its cases are really self-limited, and how
far they are controllable by any treatment.
This question can be satisfactorily settled only
by instituting, in a large number of cases,
which are well identified and nearly similar, a
fair experimental comparison of the different
active and expectant modes of practice, with
their varieties in regard to time, order, and
degree. This experiment is vast, considering
the number of combinations which it must involve; and even much more extensive than a
corresponding series of pathological observations; yet every honest and intelligent observer
may contribute to it his mite. Opportunities
for such observations, and especially for monographs of diseases, are found in the practice of
most physicians, yet hospitals and other public
charities afford the most appropriate field for
instituting them upon a large scale. The aggregate of results, successful and unsuccessful,
3



34


SELF-LIMITED DISEASES.


circumstantially and impartially reported by
competent observers, will give us a near approximation to truth, in regard to the diseases of the
time and place, in which the experiments are
instituted. The numerical method employed by
Louis in his extensive pathological researches,
and now adopted by his most distinguished
contemporaries in France, affords the means of
as near an approach to certainty on this head,
as the subject itself admits. And I may add,
that no previous medical inquirer has apparently
submitted to the profession any species of
evidence so broad in its foundations, and so
convincing in its results, as that which characterizes the great works of this author on
Phthisis and Typhoid fever.
In regard to acknowledged self-limited diseases, the question will naturally arise, whether
the practitioner is called on to do nothing for
the benefit of his patient; whether he shall fold
his hands, and look passively on the progress of
a disease, which he cannot interrupt. To this
I would answer,-by no means. The opportunities of doing good may be as great in these
diseases as in any others; for, in treating every



SELF-LIMITED DISEASES.


35


disease, there is a right method, and a wrong.
In the first place, we may save the patient from
much harm, not only by forbearing ourselves to
afflict him with unnecessary practice, but also
by preventing the ill-judged activity of others.
For the same reason that we would not suffer
him to be shaken in his bed, when rest was
considered necessary to him, we should not
allow him to be tormented with useless and
annoying applications, in a disease of settled
destiny. It should be remembered that all
cases are susceptible of errors of commission, as
well as of omission, and that by an excessive
application of the means of art, we may frustrate the intentions of nature, when they are
salutary, or embitter the approach of death when
it is inevitable. What practitioner, I would
ask, ever rendered a greater service to mankind,
than Ambrose Pare, and his subsequent coadjutors, who introduced into modern surgery the
art of healing by the first intention? These
men with vast difficulty succeeded in convincing the profession, that instead of the old method of treating incised wounds by keeping them



36


SELF-LIMITED DISEASES.


open with forcible and painful applications, it
was better simply to place the parts securely in
their natural situation, and then to let them
alone. In the second place, we may do much
good by a palliative and preventive course, by
alleviating pain, procuring sleep, guarding the
diet, regulating the alimentary canal,--in fine,
by obviating such sufferings as admit of mitigation, and preventing or removing the causes
of others, which are incidental, but not necessary, to the state of disease. In doing this, we
must distinguish between the disease itself, and
the accidents of the disease, for the latter often
admit of relief, when the former do not. We
should also inquire whether the original cause
of the disease, or any accessory cause, is still
operating, and if so, whether it can in any
measure be prevented or removed; as, for example, when it exists in the habits of life of the
patient, in the local atmosphere, or in the presence of any other deleterious agent. [Note K.]
Lastly, by a just prognosis, founded on a correct
view of the case, we may sustain the patient
and his friends during the inevitable course of
the disease; and may save them from the pangs



SELF-LIMITED DISEASES.     3


37


of disappointed hope on the one side, or of unnecessary despondency on the other.
lIt wviii be seen that, in the foregoing remarks,
a low estimate has been placed on the resources
of. art, when compared with those of nature.
But I may be excused for doing this in the
presence of an audience of educated men, and
the members of a society, whose motto is Natwrd duce. The longer and the more philosophically we contemplate this subject, the more
obvious it will appear, that the physician is but
the minister and servant of nature; that in cases
like those which have been engaging our consideration, we can do little more than follow in
the train of disease, and endeavor to aid nature
in her salutary intentions, or to remove obstacles
oiit of her path. How little, indeed, could we
accomplish without her aid! -lIt has been
wisely observed by Sir Gilbert Blane, that 'the
benefit derivable to mankind at large, from
artificial remedies, is so limited, that if a spontaneous principle of restoration had not existed,
the human species wvould long ago have been
extinct."


*Medical Logic, p. 49.



88


SELF-LIMITED DISEASES.


The importance and usefulness of the medical profession, instead of being diminished, will
always be elevated, exactly in proportion as it
understands itself, weighs justly its bwn powers,
and professes simply what it can accomplish.
It is no derogation from the importance of our
art, that we cannot always control the events of
life and death, or even of health and sickness.
The incompetency which we feel in this respect,
is shared by almost every man upon whom the
great responsibilities of society are devolved.
The statesman cannot control the destinies of
nations, nor the military commander the event
of battles. The most eloquent pleader may fail
to convince the judgment of his hearers, and the
most skilful pilot may not be able to weather
the storm. Yet it is not the less necessary, that
responsible men should study deeply and understandingly the science of their r6spective vocations. It is not the less important, for the sake
of those whose safety is, and always will be,
committed to their charge, that they should look
with unbiased judgment upon the necessary
results of inevitable causes.  And while an
earnest and inquiring solicitude should always



SELF-LIMITED DISEASES.        39
be kept alive, in regard to the improvement of
professional knowledge, it should never be forgotten, that knowledge has for its only just and
lasting foundation, a rigid, impartial, and inflexible requisition of the truth.



40


SELF-LIMITED DISEASES.


N OTES.
NOTE A.
THE difficulty of discriminating between the
symptoms of disease, and the effects of treatment, has undoubtedly led to much erroneous
practice, so that we cannot be too careful or
vigilant, in watching the consequences of our
own remedies. For a long time the effects resulting from an excessive use of mercury, were
mistaken for the phenomena of syphilis. The
arterial reaction, described by Marshall Hall,
which sometimes follows excessive blood-letting,
has been confounded with the arterial action of
disease requiring further depletion. Constitutional irritation, produced or kept up by an
inordinate use of vesicatories and other counterstimulants, has been made a reason for the
farther continuance of those applications. Much
acute and unnecessary suffering has been caused
by the prolonged application of sinapisms to the



NOTES.


41


tender skins of infants, and the limbs of dying
patients. The pains of hunger, resulting from
a too restricted diet, are most keenly felt by
convalescents from sickness; yet we sometimes
see the cries of infants, arising from this cause,
mistaken for signs of disease, and met by the
practitioner with medicines, and farther restrictions. I do not speak of these things as common occurrences, yet they have been sufficiently
so, to render it obvious that circumspection, on
the part of the practitioner, is necessary to avoid
them.
NOTE B.
The vaccine vesicle might, if it were desired,
be extirpated by the knife or caustic, although if
the vesicle be sufficiently developed to excite notice, the surgical remedy would be at least as bad
as the disease. In regard to medical remedies,
I have had occasion to observe their inefficiency
in cases where inflammatory diseases, requiring
treatment, have occurred during the progress of
cow pox. The depletive remedies employed
for the former diseases did not affect the progress of the vaccine vesicle. When this vesicle



42


SELF-LIMITED DISEASES.


is slow and diminutive, it is commonly owing
to the coexistence of some other cutaneous
affection.
In regard to mercurial salivation, although
the treatment proposed by Dr. Pearson and
others, may have been reiterated in many volumes, yet I believe that most practitioners of
experience find themselves obliged to rely upon
time and palliatives, aided by the withdrawal of
the cause.
NOTE C.
The modern introduction of the non-mercurial
treatment in syphilis, might almost lead us to
consider this malady also, as among the selflimited diseases. Although syphilis, as it existed in the days of Mr. Hunter, appears to have
yielded to mercury alone, so that this eminent
author regarded it as one of the distinguishing
traits of the disease, that it had no tendency to
spontaneous recovery; yet the experience of the
last twenty years has shown that syphilis, as it
now exists in all its prominent varieties, has
been cured in many thousands of cases, by a
treatment in which no mercury in any shape is



NOTES.


43


employed. Nevertheless, the treatment by th;
anti-phlogistic method, which has been substituted, requires, in order to be successful, more
or less depletion, abstinence, and positive rest,
conjoined occasionally with other remedies. So
that the disease still undergoes efficient treatment; and indeed, when it is wholly neglected,
as it sometimes is by the abject and the reckless, it results in the most deplorable consequences, of which our hospitals and almshouses
furnish sufficient and frequent examples.
NOTE D.
Corvisart died of a' disease of the heart;
Laennec and Armstrong of pulmonary consumption. Other examples may be found of
persons who were writers on the diseases of
which they afterwards died.
NOTE E.
Ulceration in the tonsils and palate is the
most commoh lesion in scarlatina, but the other
morbid appearances discovered in autopsies of



AA


SELF-LIMITED DISEASES.


cases of this disease are exceedingly various and
uncertain. Among those which I have observed,
or which have been noticed by my medical
friends in this city, are ulcerations in the larynx,
and inflammation of the mucous membrane of
the trachea and bronchim. In one case of thirtysix hours duration, the chief morbid appearance,
in addition to the ulcerated throat, was an extensive peritonitis with effusion of coagulating
lymph lining most of the abdominal cavity.
Serous effusions in and upon the brain have
been occasionally noticed, but most frequently
in the secondary forms of the disease. In the
child of an eminent physician in this city, whose
case and autopsy I witntssed, there was slight
ulceration of the tonsils, but no lesion of any
important viscus could be detected, though diligently sought for by our best pathological anatomists. Two similar cases have been stated to
me, and I find them also noticed by some writers on the disease. In these cases the poison
of the disease seems to destroy life, without
exciting inflammatory action.
Family predisposition appears to influence
the tendency to mortality in scarlatina.  In



NOTES.


45


some cases the children of a family all die in
rapid succession. A predisposition to take the
disease seems also affected by the same cause,
so that it sometimes operates during the same
season upon members of the same family residing in different places, without personal intercourse.
The latent period between the inception and
development of this disease appears subject to
great variation. I knew a patient to be taken
with scarlet fever in forty-eight hours after
arriving in this country by a passage of forty
days from Europe. In this instance, as no case
existed in the ship, the latent period must have
been less than two days, or more than forty.
Scarlatina and some other eruptive fevers
reciprocally affect the. development of each
other. During the prevalence of measles and
scarlet fever in this city in the winter and spring
of 1832, a considerable number of cases occurred, in which the two diseases, each preserving
its own distinctive character, were successively
passed through by patients, without quitting
their beds, yet the diseases were in no wise
blended, or intermixed. In the family of a lady



46


SELF-LIMITED DISEASES.


residing in Tremont Place, five individuals had
-scarlet fever, and three of them measles, nearly,at the same time. The circumstances are interesting. One child had measles first, the disappearance of which was immediately followed
'by scarlatina; both diseases proved mild, and
were completed in about twenty days. Another
-child had severe scarlatina with a bad throat,
the ulcers of which were not healed before the
-sixteenth day. After this the patient remained,stationary, with a quick pulse, and without
-return of appetite or strength for several days
more, when the eruption of measles appeared
kunder the cuticle which was desquamating from.scarlatina, and passed through its regular course.
A third child in the same family was affected
in a more singular manner. The eruption of
measles appeared first, with slight catarrhal
symptoms, and continued one day. It then
-vanished, and was in two days succeeded by
scarlet fever. This lasted about a week, and
when the patient was expected to get well, the,crimson eruption of measles reappeared, and
lasted three days more. In these cases the two
diseases, though probably coexisting in the



NOTES.


47


body at the same time, and in the last case
decidedly so, were never extant at once in an
active or characteristic form.  There was no
reason to suppose that the intensity of either
disease was diminished, or aggravated, by the
presence of the other.
Scarlet fever exists in some cases where its
presence is not suspected, as the following cases,
selected from a number of similar ones, may
show. A child, previously well, was taken in
fits at night, and died on the following morning.
As the disease was not epidemic at the time,
the nature of the complaint was not suspected
till a few hours before death, when another
child coming out with the eruption, this circumstance led me to an examination of the throat
of the first, which was found ulcerated. In
another case, a child was affected with a very
troublesome rheumatic stiff neck. On inquiry,
it was ascertained that a scarlet efflorescence
had existed on the preceding week, of which the
rheumatism was doubtless a sequel, though the
nature of the eruption had not been apprehended.     ~
The sequele or secondary effects of scarlet



48


SELF-LIMITED DISEASES.


fever are extremely various. Rheumatic affections are among the most common. Dropsical
effusions are frequent, both in the cellular texture and in large cavities. Anasarca and ascites
are not of uncommon occurrence. I have seen
hydrocele, which disappeared spontaneously in
a few weeks, and hydrocephalus which proved
fatal. Troublesome indurations of the parotid
and submaxillary glands often occur, and may,
or may not, be followed by suppuration. A
fatal induration of the whole anterior neck is
sometimes met with. This I have seen both in
the primary and secondary disease. A purulent
or sanious discharge from the ears occasionally
follows scarlet fever, and sometimes continues
long enough to destroy the organic texture, and
with it the sense of hearing, in one or both ears.
Erysipelas and roseola are among the other
pearances which I have seen to supervene upon
this uncertain disease. Fortunately, however,
the largest portion of cases are attended with no
sequele, or with such as disappear spontaneously in their own time, without permanent
injury to the patient.



NOTES.


49


NOTE F.
We have sufficient evidence that many cases
of gout, both in this country and Europe, have
had their paroxysms abridged by the use of
coichicum, and different species of veratrum.
Some individuals are fortunate enough to obtain
this effect under a moderate dose, which only
affects the bowels. But in most persons it is
necessary to take enough of the medicine to
produce vomiting and temporary prostration,
before the desired result can be obtained. 'This
effect is sometimes so severe that many patients
prefer the disease to the remedy, and in fact the
practice is hardly warranted in the case of very
feeble or aged persons.
Three cases have occurred to me, in which
gout has disappeared altogether under an entire
abstinence from spirituous and fermented liquids.
In one of these it is now thirteen years since a
paroxysm occurred, and in another seven years,
the individuals both enjoying good health, and
leading active lives. The third case was that
of a gentleman of this city, lately deceased at
seventy-six years of age, who had suffered more
4



50


SELF-LIMITED DISEASES.


than twenty years with gout, and was reduced
to use crutches. After commencing a course of
entire abstinence, the paroxysms began to abate
in violence, and for the last seven years of his
life he assured me he had not felt the sensation
of gout. In his last illness a slight chiragra
occurred after taking a dose of tincture of rhubarb. Some other cases are now in the progress
of trial, with apparent alleviation of the disease.
I have been told by others, that this plan of
treatment has in some instances failed to be
folldced by relief, and very probably this may
be true; but such instances have not yet come
under my personal observation, where the experiment has been fairly made in the acute disease.
NOTE G.
The natural history of the small ascarides is
curious, and not well understood. Many individuals are infested with them in childhood, but
get rid of them as they advance in years. Some,
however, are troubled with them during the
whole of a long life, though they are represented
as less annoying after middle age, than before.



NOTES.


51


They most commonly appear periodically, both
in children and adults, after intervals of from
three to six weeks. During the intervals they
are neither felt nor seen in the discharges.
Their periodical return is announced by a sense
of itching and burning at the extremity of the
rectum, felt principally in the evening, sometimes producing tumefaction, and eruption of
the neighboring skin. This irritation continues
to recur every evening for perhaps a week, or
more, and then ceases. During this time the
worms are discharged alive and active in every
alvine evacuation.  Cathartics and enemata
bring away vast numbers of them, but without
diminishing the annoyance occasioned by those
which remain behind. At length they spontaneously cease to appear, the irritation subsides,
cathartics no longer bring them to light, and the
inexperienced practitioner flatters himself that
the evil is remedied. Nevertheless, after a few
weeks, they again return in undiminished num.
bers, attended by the same phenomena as before.
Whether the new race are cotemporaries of the
old, or descendants from them, it is not easy to



52


SELF-LIMITED DISEASES.


tell; but the latter supposition seems most,probable.
It is commonly believed that the principal
residence of ascarides is in the rectum, because
they are most felt there.   They have been
lound, however, in other parts of the alimentary
tube. Many patients, immediately after a cessation of the annoyance in the rectum, are
visited by pain in the epigastrium, attended
with costiveness and clay-colored discharges.
This state continues for two or three days, and
is then followed by a bilious diarrhoea. I have
repeatedly known these consecutive events to
-occur with great regularity for half a dozen
years, so much so that my inquiries are generally directed towards this cause, when children
have complained of epigastric pains at regular
periods. Whether, in these cases, the worms.ascend to the duodenum and mouth of the
biliary duct, or whether the whole is an affair of
sympathy, future autopsies may perhaps determine.
The nidus of these animals, and perhaps the
food also, appears to be the mucus which lines



NOTES.


53


the alimentary canal. Buried in this substance,
they resist the effect of the most violent cathartics and vermifuges, oil of turpentine and croton
not excepted. If it be permitted to derive an
hypothesis from the phenomena which they
exhibit, it would be, that during a greater part
of the.time, they remain quietly embedded in
this mucus, deriving from it their habitation and
nourishment, being at the same time secured
from the effects of the peristaltic motion by
this and by the ahhesive power of suction; but
that at certain periods, perhaps at their generating seasons, they issue forth from this covert,
and mingle themselves in the contents of the
alimentary canal; in consequence of which they
are liable to be expelled with the common mass.
I have known ascarides to be eradicated by a
severe dysentery. In some cases they have been
totally removed by large injections of oil, particularly of lamp oil. But more frequently they
resist these and most other remedies for a series
of years. A temporary palliative may always
be found in small injections of weak salt water,
or even of an ounce or two of cold water.



54


SELF-LIMITED DISEASES.


NOTE H.
I would by no means undervalue the exertions which have been made, and are still making by indefatigable and distinguished men, for
the control of what are called pestilential epidemics. I would only be understood to state
that no one method of treatment, in the diseases
enumerated, appears to have acquired sufficient
credit with the profession generally, to be turned
in their hands to any great practical account.
The records of medical literature show, that a
period of ten years has seldom elapsed, without
the annunciation of some effectual mode of
practice, in some one of these diseases. And
what is more, the amount of evidence with
which these statements are supported, and the
pathological skill with which the indications are
explained, seem sometimes sufficient to shake
the incredulity of the most sceptical. Nevertheless, after a certain term of years the diseases
are found to be fatal as before, and fresh innovations in practice take the place of the old,
and excite confidence anew among the sanguine
and ardent members of the profession. The



NOTES.


55


truth is, that no epidemic is equally malignant
in all seasons and places; and from some unknown cause, the laws which affect its tendency
to death or recovery, are essentially different in
different climates at the same period, or in the
same climate at different periods.  This fact
must be known to those who have personal
experience in regard to these diseases, or who
are conversant in their epidemic history. Reliance, therefore, cannot be justly accorded to any
mode of treatment which has not had the testimony of a large number of years in its favor,
and this also under a proper variety of situations
and circumstances. Were it otherwise, these
diseases, in the hands of the medical profession,
would long ago have ceased to be pestilences.
NOTE I.
I am aware that some of the most distinguished French pathologists of the present day
incline to the opinion that many acute diseases,
or at least inflammations, are incapable of being
shortened in their duration, by art. [See marginal note, page 19.]  The opposite opinion



56


SELF-LIMITED DISEASES.


prevails very generally in this country and in
England, and it would be premature to consider
the question as.decide4, until it has been submitted more extensively to the test of comparative numerical results. It is certain, that the
most distressing symptoms of acute inflammations are often arrested at once by remedies.
This happens, for example, from blood-letting
in croup and pleurisy, and from opium in strangury and dysentery. If, however, the disease is
fully established before the application of remedies, it usually goes on to complete its course,
and in that case the remedies are palliatives
only. And if remedies be applied in the incipient stage, an uncertainty hangs over our
diagnosis, for the supposed pleurisy may have
been rheumatism, and the supposed croup may
have been catarrh, or laryngismus; for even the
physical signs require a certain maturity of
development in disease, to render them satisfactory. Leaving then, as undecided, the question
of positive duration in acute inflammations, we
do not risk much in asserting that their character is often essentially modified by treatment,
so that they are more easily supported by the



NOTES.


57


patient, and the apparent danger attending
them, diminished.   We must wait for the
modern spirit of accurate inquiry to furnish a
further light on this subject.
NOTE K.
As examples, it may be stated that the salivation produced by mercury gets well of itself,
provided the original cause is discontinued.
An issue made by caustic, or otherwise, gets
well after the original cause has ceased to
operate; but if an accessory cause is present,
such as the pressure of an irritating foreign
substance, it then fails to heal. The local
atmosphere may be considered as an original,
or an accessory cause, in those diseases which
are benefited by change of climate or situation.
A long train of diseases might be mentioned,
which are brought on, or kept up, by injurious
habits of life, and are relieved or cured, not by
medicines, but by a removal of the habit under
which they have been, or continue to be, induced.
Such are the diseases which attend on sedentary
life, intemperate indulgences, lactation, insalu



58         SELF-LIMITED DISEASES.
brity of diet, &c.  Sometimes a disease, the
cause of which is not removed, may disappear
in consequence of a new habit, by which the
system becomes capable of bearing with impunity the influence of this cause; as in seasickness.



ON THE


TREATMENT OF DISEASE:
AN INTRODUCTORY LECTURE, DELIVERED BEFORE THE MEDICAL
CLASS AT THE MASSACHUSETTS MEDICAL COLLEGE IN BOSTON3
NovEMB  3. 1852.
OF the sciences which have most occupied
the time and labor of mankind, a certain number lead by their investigations to clear and
positive results, and enlarge the amount of
human knowledge by the discovery and promulgation of absolute truth. Another portion
lead only to results which are probable or presumptive in their character, and which furnish
to mankind rules of action, in cases where better
lights cannot be obtained. To the former class
has been given the name of exact sciences, and
to the latter the name of presumptive or conjectural sciences.  Mathematics form   an exact
science, on the conclusions of which, when once



60


TREATMENT OF DISEASE.


known, there can be no difference of opinion.
In like manner, chemistry and mechanics, astronomy and portions of natural history, are
examples of exact sciences, the demonstrations
of which, when once made clear, may afterwards be modified and enlarged, but are never
fundamentally shaken. On the other hand, the
important sciences of ethics and politics, of
commerce and finance, of government, and
speculative theology, are inexact in many of
their principles, as is proved by the widely
different constructions under which men receive and apply them to practice.
It would at first seem that the exact sciences
were those most worthy the cultivation of intelligent minds, inasmuch as they lead to satisfactory, and therefore to gratifying results; and
because, in their more elevated departments,
they involve and require some of the highest
reaches of the human intellect. But in the
qpinions of mankind, as evinced by their practice, the opposite judgment prevails, and probably nine-tenths of the labor of educated and
intellectual men are employed on studies which
are, in their nature, uncertain and conjectural.



.TREATMENT OF DISEASE.


61


The cause of this great ascendancy in the
attention given to the inexact sciences, is to be
found in the vast and paramount importance of
their subjects, and also in the difficulty of consummating their great ends. It is much more
important to mankind to know how to avoid
anarchy and crime, war, famine, poverty and
pestilence, than it is to know that the planet
Saturn has a ring, or that a lily has six stamens,
that light can be polarized, or that potass can
be decomposed. Yet while the latter propositions are susceptible of absolute demonstration,
the former processes, which bear directly on
human happiness or misery, are frequently removed beyond our foresight or control. The
wisest men often fail to influence the destinies
of states, families, and individuals, and the
shrewdest calculators are baffled in regard to a
coming crop, a pecuniary crisis, a glut in the
commercial market, or a change in the public
morals. Nevertheless, the wise man, conscious
of superior talent, and the philanthropist desirous of the public weal, and even the interested
man who looks to his personal advantage and
progress, must give themselves and their ener



62


TREATMENT OF DISEASE.


gies to studies which involve the immediate
wants of their fellow-men, even though their
best directed efforts should fail of the desired
results. And the simple reason is, that if the
best qualified minds decline to undertake this
task, it will most assuredly be assumed by the
ignorant and presumptuous.
Preeminent among the inexact and speculative sciences stands practical medicine, a science
older than civilization, cultivated and honored
in all ages, powerful for good or for evil, progressive in its character, but still unsettled in its
principles; remunerative in fame and fortune
to its successful cultivators, and rich in the fruits
of a good conscience to its honest votaries. Encnrmbered as it is with difficulty, fallacy and
doubt, medicine yet constitutes one of the most
attractive of the learned professions.    It is
largely represented in every city, village, and
hamlet. Its imperfections are lost sight of in
the overwhelming importance of its objects.
The living look to it for succor -the dying call
on it for rescue.
The greatest boons and the most important
objects presented to our aspirations in this life,



TREATMENT OF DISEASE.


63


are not to be approached through paths which
are straight and unmistakable. The avenues
to most of them are shadowed by doubts or
clogged with incessant obstacles. Next to the
spiritual welfare of men, the preservation of
their lives, the peace and safety of their communities, the acquirement and preservation of
their worldly goods are among the objects
which take strongest hold on their desires.
Yet grave doubts are justifiable, whether any
precise means have yet been agreed upon by
which these desirable ends can with certainty
be attained. And if any one deems it a reproach on medicine that its cultivators have
not arrived at a common faith and practice, let
him consider whether the laborers in other fields,
however honest their intentions, are agreed in
their theological creeds and political platforms.
Considering the great importance of the objects of medicine, the frequent and earnest
appeals made for its assistance, and the vast
sums annually expended in its remuneration, it
is not surprising that disappointment and complaine often follow the failures, necessary or
unnecessary, of medical practice. 'Man is of



64


TREATMENT OF DISEASE.


few days and full of trouble.' Yet in the face
of this acknowledged truth, he requests and
expects that his physician will provide him with
many days, and remove at least his bodily
troubles. This expectation on his part is reasonable or otherwise, according to the circumstances under which it is made. It is unreasonable if his case is helpless, and he is merely
paying the debt of suffering and death which
hiscmortal nature exacts. But it is reasonable
and proper, if his complaint is of a curable kind,
or if, whether curable or not, his physician has
claimed and vaunted the power to remove it.
Most men form an exaggerated estimate of
the powers of medicine, founded on the common
acceptation of the name, that medicine is the
art of curing diseases. That this is a false definition, is evident from the fact that many diseases are incurable, and that one such disease
must at last happen to every living man. A
far more just definition would be, that medicine
is the art of understanding diseases, and of
curing or relieving them when possible. Under
this acceptation our science would, at least, be
exonerated from reproach, and would stand on



" TREATMENT OF DISEASE.


65


a basis capable of supporting a reasonable and
durable system f&r the amelioration of human
maladies.
Every young man who proposes to become a
member of the medical profession, should ask
himself whether he considers medicine a liberal
and honorable science, to be followed for the
good it may do to mankind, or as a dishonest
trade, to be pursued for the purpose of profiting
himself by the deception of his fellow-men. If
he accepts his profession in the first sense, he
will strive to understand his science in all its
bearings, and practise it with conscience and
fidelity; if in the latter, he will put his conscience aside, and study only the low arts which
entrap the credulous and unwary.
With the trade of medicine I have nothing to
do. Knowing that I address an ingenuous and
cultivated audience, composed mainly of young
men who are looking forward to an honest and
honorable place in professional life, I make no
apology for proceeding to express my belief of
the manner in which medicine should be practised and disease treated, for the reciprocal
5



66


TREATMENT OF DISEASEI


benefit of him who gives, and of him who
receives its aids.
Let no one deceive himself by believing that
success, stable, permanent, honorable success,
can be attained without knowledge of the great
principles of the profession and science of medicine.  This knowledge must consist in an
accurate acquaintance with the structure and
offices of the human body, and the laws of its
healthy condition. After these follows the science of pathology, involving the great and
fundamental art of diagnosis, by which the diseases of the human body are detected, and
distinguished rightly from  each other.  The
power of distinguishing diseases lies at the root
of all correct and enlightened practice, and
without it all medical action is empirical and
fortuitous. There is no more pernicious error
than for a physician to believe that he can prescribe safely for the symptoms of a sick man,
without understanding, in some measure, the
nature of his disease. Symptoms are of various
import, according to the seat of their origin and
the nature of their causes; and if taken alone
without a correct interpretation of these attend



.TREATMENT OF DISEASE.


67


ant considerations, they often lead to a wrong
result, or to no result at all. A patient not
unfrequently sends for a physician on account
of a certain symptom which is distressing him,
and which may be, for example, a pain in the
abdomen, or in the head. Now a pain in the
abdomen may arise from colic or peritonitis,
from rheumatism or neuralgia, from dysentery,
from calculus, carcinoma or strangulation. And
in like manner, a pain in the head may arise
from a multitude of different and even opposite
causes. Now it is well known that the kind of
treatment which is effectual in one case, is pernicious in another; and he who prescribes for
the symptom irrespectively of the cause, is quite
as likely to do mischief to his patient as good,
and quite as likely to destroy life as to save it.
If the question be asked, what makes a great
physician, and one who is appealed to by his
peers, and by the discerning portion of the public, for counsel in difficult cases, I would answer,
that he is a great physician who, above other
men, understands diagnosis. It is not he who
promises to cure all maladies, who has a remedy ready for every symptom, or one remedy for



,68


TREATMENT OF DISEASE..all symptoms; who boasts that success never
-fails him, when his daily history gives the lie to:such assertion. It is rather he, who, with just
-discrimination, looks at a case in all its difficulties; who to habits of correct reasoning, adds
the acquirements obtained from study and ob-;servation; who is trustworthy in common things
for his common sense, and in professional things
for his judgment, learning, and experience; who
forms his opinion positive or approximative,
according to the evidence; who looks at the.necessary results of inevitable causes; who
promptly does what man may do of good, and
-carefully avoids what he may do of evil. Examples are rare of this perfection, yet for an.approach to such a standard of professional
excellence, I would venture to direct your remembrance to the venerable ex-professor, fortunately yet among us, of the theory and practice
in this University.
Every citizen whose capacity is able to reach
the ordinary affairs of life, is aware that the
persons most capable of discharging the common offices, or of exercising the common arts
and duties of life, are the individuals who have,



TREATMENT OF DISEASE.


69


by talents, education and practice, become EXPERTS in those arts and duties; -and that, on
the other hand, those persons who profess to
have acquired knowledge by intuition, to have
become learned without labor, and to have
arrived by short cuts at results and qualifications
which demand years of preparatory training,
must be incompetent and treacherous sources of
reliance. And it is the general admission of
this truth which gives support and confidence
to the various professions, arts and callings, to
which men devote their lives.
A little machine called a watch is carried
about by most persons, and when this machine
has stopped or is out of order, they do not lay
their own ignorant hands upon it, but submit
the case to the skill of an expert, who is known
to be qualified to judge and act in such cases.
It is the duty of this artist when applied to, to
examine the interior of the watch, to ascertain
by the use of his skill, in what part the disease
is situated, and to apply to that part the appropriate remedy. If a spring or a chain is broken,
it must be restored; if the wheels are out of
gear, they must be put in place; if the hands



70


TREATMENT OF DISEASE.


only have caught, they have only to be liberated,
and if the pivots are dry and rough, they must
be oiled or cleaned;-and lastly, if the watch
has had a destructive fall, if it has been crushed
by being trodden on, if it has lain a month in
the salt water, or if it is worn out by running
steadily for threescore years and ten, then the
case is incurable, and the only palliative *advice
which the practitioner can render is, that the
owner should procure a new watch, or reconcile
himself to do without one.
But suppose there resides in the place a
watch doctor who prescribes for symptoms, and
who, among other things, has a remedy for the
symptom of stopping, and that this remedy consists in a certain kind of friction, shaking, or
manipulation, an ointment applied to the outside, or an invisible particle of some nugatory
substance inserted into the inside; and suppose
that one or two watches in a hundred which
had stopped by accident, should by accident
resume their motions under such treatment,
could anything but the most unmitigated folly
draw the inference that such a person is entitled
to become the accredited horologer to the community?



TREATMENT OF DISEASE.       7


71


What is so conspicuously true in the common
business of life, is only an example of what is
more vitally true in the practice of medicine.
If a man has had the misfortune to get a shot
or a stab in his body, he does not need a doctor
who administers a specific dose or a sovereign
plaster for holes in the body; he wants a man
who can tell 'him whether the wound has passed
inside or outside of his peritoneum, and whether
it is requisite for him to make his will, or to
make arrangements for pursuing his journey.
But the prescribing for symptoms in the dark.
is not the only instance in which false logic has
entered into medical reasoning. It is not less
absurd to suppose that disconnected events,
which have closely followed each other, have
therefore a necessary dependence upon each
other. Shrewd, practical men do not thus govern themselves in the common affairs of life.
A merchant about to send a ship to sea, endeavors to find a captain to take chargre of her
who understands navigation, who can keep his
run and determine his place, who studies the
weather and is on the lookout for a lee shore,
and who in emergencies can judgea whether it is



72


TREATMENT OF DISEASE.


necessary or not to cut away the masts or throw
over the cargo. But suppose a man appears,
and such have been, who announces that hle has
a specific bottle of oil with which he cures
tempests, and by pouring a teaspoonful of which
upon the waves, the storm is speedily made to
cease! Would any prudent owner intrust his
vessel to such a man and on such grounds, even
though he should produce a hundred certificates
that storms had stopped in half a day, or half
an hour after the application of his remedy?
For these certificates, if true, would only prove
that in a certain number of cases, a result had
followed by accident, which common sense, and
if necessary, a thousand opposite cases would
show had nothing to do with the pretended
cause.
What would be true of the apparent or al:
leged cure of a tempest at sea, is no less true of'
the pseudo-cures which every day take place in
diseases which are self-limited, paroxysmal or
recidivous in their character. There are doubtless living many men who believe themselves to
have been cured half a dozen times of various
diseases, of fevers and inflammations, of neu



TREATMENT OF DISEASE.


73


ralgia, rheumatism, gout and asthma; and each
time perhaps by a different remedy, but who on
the next imprudence or returning period, are
destined to find themselves feverish, neuralgic,
gouty, or asthmatic still.
Deceptions in medicine are occasioned not
only by the dishonesty of charlatans, but quite
as often by the well-meaning credulity of other
practitioners, whose intellect is impulsive, or
whose education has been unduly curtailed.
It is so flattering to a man's self-love to believe
that his chance shots have sometimes taken
effect, that physicians of regular position may
pass their lives in mere speculative and random
efforts at curing diseases, shutting their eyes
against their own failures, and not allowing
themselves to consider that in a certain portion
of successful cases which they had failed to
understand, the disease in truth got well without, or perhaps in spite of, their misdirected and
embarrassing practice.
Medicine is a great good and an unquestionable blessing to mankind, when it is administered by discriminating and intelligent hands
with sincerity and good judgment. It disap



74


74      TREATMENT OF DISEASE.


points expectation, and fails to accomplish its
mission, when the agent who dispenses it falls
into the mistaken resource of professing infallibility, and of raising hopes which he knows not
how to accomplish. No man is deemed to be
safe in his worldly affairs who is afraid to look
into his own pecuniary condition. Neither is a
physician safe in his practice or his reputation,
who is afraid to face the case of his patient in
all its bearings. That man is most to be relled
on who looks calmly and understandingly at
the emergency before him, who knows the import of signs, and deduces from them the probable tenor of coming events;- who is aware of
the great truth that all men must die, but is
also aware of the more gratifying truth that
most sick men recover; and xvho, in particular
exigrencies, inquires of his reason and his knowledge, in which of these two immediate categories his patient is placed, and how far the event
of the case is within his control. lie will then
interfere or he will wait, he will act or he will
forbear, as he only knows how who can form a
correct verdict from the evidence before him,



TREATMENT OF DISEASE.


75


and who knows the immeasurable good or
harm which hangs on medical practice.
The vulgar standard of medical character depends very much on the supposed successful
result of cases. But this is not the true standard, for the best physicians as well as the most
popular practitioners, often lose their patients,
and even their own lives, from common diseases;
while, on the other hand, the most injudicious
treatment, and the most reckless exposures are
not unfrequently survived. Laennec and Bichat,
two of the most distinguished lights of modern
medicine, died of the very diseases they were
themselves investigating. Preissnitz, the prince
of modern empirics, himself a robust peasant,
died of premature disease at the age of fiftytwo, in the midst of his own water-cure. It is
well known, that the most thronged and popular places of resort for grave, difficult, and
intractable cases, are those from which there
are most funerals. On the other hand, men
support life in certain cases under every extreme
of opposite treatment, under ultra-depletion and
ultra-stimulation, under heroic practice and
nugatory practice, under 'hot drops' and cold



76


TREATMENT OF DISEASE.


douches, under drachm doses of calomel, and
imponderable doses of moonshine. Clot Bey,
and his two or three associate Frenchmen,
entered a plague hospital at Cairo in the height
of the epidemic. They shut themselves up in
the concentrated atmosphere of the infection,
they remained in bed in contact with dying
patients, they wore the shirts of those who had
just expired, they inoculated themselves with
the secretions of pestilential buboes,-and all
to no purpose. They were alive some years
afterwards, and quarrelling with each other for
the glory of their hair-brained enterprise. Four
thieves in the plague at Marseilles freely prosecuted their robberies in the infected houses of
the dead and dying; and the aromatic vinegar,
which has immortalized their prophylactic practice, was very probably an impromptu invention
brought forward by them to procure their exemption from punishment.
The humility which we may learn from the
limited influence of our art on the health and
lives of mankind, is probably a far safer guide
to a correct practice, than the fanatical confidence with which unenlightened ultraists of



TREATMENT OF DISEASE.


77


every sect carry out their respective dogmas.
In a sphere of action where some good may
always be done, and where much harm often is
done, and 'fools rush in where angels fear to
tread,' it is well to consider some of the rules
which may lead an honest inquirer after truth
to the nearest attainment to a correct judgment
and practice.
Supposing, what I would fain wish might
always happen, that the physician is duly and
thoroughly imbued with knowledge of his science, the first great question which presents
itself in every case or emergency, is that which
involves the diagnosis. This being established,
the practitioner is enabled to avail himself of
the lights of reason and experience in regard to
a correct course of therapeutic proceeding. But
it often happens that the nature of the case
cannot be rhade out in one, or two, or three
interviews with the patient, and we are obliged
to wait for the gradual development of diagnostic symptoms, as a judge and jury in a like case
would be expected to postpone, or wait for the
arrival of witnesses. It is a mistaken pride
which leads physicians to commit themselves



78


TREATMENT OF DISEASE.


by an oracular guess at first sight, which the
events of the succeeding day may show to have
been erroneous. Moreover, if from the obscure
character of the case, or the imperfection of our
science, diagnosis is impossible, we should then
so generalize our treatment that we may include
what is possible of good, and exclude what is
probable of harm.
Having settled, as well as our means admit,
the pathological condition of our patient, the
next question is that which regards the probable
tendency of the disease if left to itself. Attention to this point is of high importance, since it
will prevent us from neglecting our patients in
grave and dangerous affections, as well as from
annoying them with useless appliances in short,
safe or unimportant cases. Many diseases are
insidious in their origin. The nervous imbecility which has its foundation laid in modern
schools, the slight cough and evening flush
which herald approaching phthisis, soon get
beyond the reach of medical means, unless seasonably detected by the wary eye of the practitioner. A simple discharge from the ear may
terminate in deafness, and an ulcer of the cornea



TREATMENT OF DISEASE.


79


in loss of sight. A protracted intermittent at
length undermines the health, and neglected
syphilis ends in a miserable death. Cases like
these require prompt and energetic interference
on the part of the practitioner. On the other
hand, diseases which are light in themselves,
and tend to speedy recovery, as common catarrh,
hooping cough, varicella, and a host of other
things, if they occur in healthy subjects, and
are not complicated with graver affctions, may
safely be left to themselves, or treated with the
mildest remedies and cautionary measures.
Another most important question, exercising
the hopes and fears of every practitioner, from
its connection with reputation, safety and life,
is that which relates to the curability of diseases. Is the disease amenable to medical
treatment, or not? If the case is of a recoverable character, and happily a great majority of
our cases are so, the physician should anxiously
and carefully have recourse to the recorded
authorities of his science, and to his own personal experience. In doing this he should beware of implicitly trusting those who have
published only the favorable side of their prac



80


TREATMENT OF DISEASE.


tice, preferring to build up a temporary reputation rather than to promulgate unpopular truths.
And in analyzing his own experience, he should
equally beware of hasty generalizations, of impressions made by remarkable examples, rather
than by aggregates of well observed and duly
arranged cases, from which alone impartial and
correct inferences are to be drawn.
In accordance with such views, we shall find
many cases which are, for the'most part, capable of being arrested or broken up by the interposition of remedies.  Thus the grave and
various symptoms which result from an overloaded stomach, are at once removed by the
action of an emetic, or sometimes of a laxative;
colic in like manner yields to opium or to purgatives; syphilis is cured by mercury, and
sometimes without it; and certain inflammatory
attacks apparently yield to seasonable depletion.
Moreover, in other cases which cannot be thus
arrested, but which, from their nature, must run
a destined course, it is generally admitted that
the safety of the patient may be promoted, or
perhaps the duration of the case abridged by
remedial treatment. This is believed to be true



TREATMENT OF DISEASE.


81


in regard to evacuations at the commencement
of febrile and inflammatory diseases, and to a
multitude of other remedies applicable in various cases. But on this subject it is extremely
difficult to obtain decisive and satisfactory
knowledge. It involves a question, the settlement of which is to be approached by extensive
and contrasted numerical observations, a large
portion of which yet remain to be made,
although we have valuable contributions' and
examples on many subjects.
On the other hand, when we know that a
case is self-limited or incurable, we are to consider how far it is in our power to palliate or
diminish sufferings which we are not competent
to remove. Here is a most important field for
medical practice, and one which calls for an
exceedingly large portion of the time and efforts
of every physician. When we consider that
most diseases occupy, from necessity, a period
of some days or weeks, that many of them continue for months, and some for years, and finally
that a large portion of mankind die of some
lingering or chronic disease, we shall see that
the study of palliatives is not only called for,
6



82


TREATMENT OF DISEASE.


but really constitutes one of the most common,
as well as the most useful and beneficent employments of a medical man.
In the use of efficient remedies, much depends
upon deciding the proper stage or time, to
which their employment is applicable. Some
curative agents can with propriety be used only
at the outset of the diseases, and if this opportunity is lost, the remedies are afterwards less
effectual, and perhaps even injurious.  Venesection in the early stage of certain acute diseases, may be productive of great good; in the
middle stages it is of less benefit, or of none at
all; and in the latter stages it is injurious and
inadmissible.  On the other hand, wine and
opiates, which are strongly contra-indicated in
the first stage, are afterwards not only tolerated
with impunity, but in certain cases are taken
with decided benefit.
But, gentlemen, the agents which we oppose
to the progress of disease, may, by excessive or
ill-timed application, become themselves the
pregnant sources of disease. Every prudent
practitioner is bound to consider the effect and
tendency of the remedy he is using, and to in



TREATMENT OF DISEASE.


83


quire whether the means employed to counteract the existing disease, are not, in their turn,
likely to produce evil to the patient; and if so,
whether the evil will be greater or less than the
disease for which they are administered. The
sudden healing of an old ulcer, issue or eruption,
may be followed by symptoms more serious
in their character than those which have been
removed. Many remedial processes, if employed in excess, or with injudicious frequency,
result in permanent injury to the patient. The
habitual use of active cathartics, although
attended with temporary relief, seldom fails to
bring on or aggravate a permanent state of
costiveness. Large and often repeated bloodletting, tends to the establishment of debility
and anemia in some subjects, or of reaction and
plethora in others. Opium and other narcotics
are in themselves, if abused, fertile sources of
disease. The modern crying evil of polypharmacy and over-medication, is profitable to the
druggist, habitual to too many physicians, and
annoying, if not detrimental, to most patients.
On account of these and similar considerations, much discretion is needed on the part of



'84


TREATMENT OF DISEASE.


the physician to enable him to judge rightly of
-the kind of treatment which it may be safe and;proper to employ, and of the degree and amount,of that treatment, and of the requisite length of
time for its continuance. Medical practice, in
many cases, points to the direct substitution of
a positive good for a positive evil; but unfortunately, in other cases, it admits only of a choice
between evils; -and in these cases not only the
knowledge and experience, but also the judgment and common sense of the practitioner, are,put in indispensable requisition to lead him to:a correct issue.
It is wrong to suppose, as is often done, that
the opportunities for doing good in medicine,,are limited to the effect of specific remedies, or
to the application of drugs and instruments.
The enlightened physician surveys the whole
ground of his patient's case, and looks for the
presence of any deleterious agencies or unremoved causes of disease. Many morbid affections, which have resisted powerful remedies,
cease speedily on the discovery and removal of
their sustaining cause. This is the case with
"various specific complaints produced by particu



TREATMENT OF DISEASE.


85


lar drugs and stimulants when habitually used.
A child is often sick from an error in the diet,
health or habits of the nurse or mother. An
individual frequently suffers from the quality
and quantity of his habitual food or drink, or of
his exercise, air, occupation, or clothing. The
starved infant and the overfed gourmand, the
drunkard and the ascetic, the pale student and
the emaciated seamstress, require removal and
reform, not drugs and medicines. A patient
dies of phthisis in a confined office or a damp
northern climate, who might have enjoyed long
life in an active occupation or a more pure and
temperate atmosphere.   On the other hand,
men fall victims to the fevers and abdominal
diseases of the south and west, who might have
escaped disease by a timely removal to the north.
It is as necessary in many cases that the physician should inquire into the situation, diet,
habits and occupation of the patient, as that he
should feel his pulse or explore his chest. It
often happens that the disordered state of the
one cannot be corrected until the other has been
previously set right; and a little dietetic instruc



86


TREATMENT OF DISEASE.


tion, or even moral advice, is more serviceable
than a technical prescription.
In regard to their duration, their probable
issue, and their susceptibility of relief, the physician may profitably divide his cases into three
classes; those which are curable, those which
are temporarily self-limited, and those which
are incurable.* In the first class, or that of
curable diseases, are to be included those morbid affections which we know, or have reason to
believe, are under the control of remedies, so
that they can be arrested, or abridged, in duration. For the most part, acute inflammatory
diseases, when not of fatal intensity, are mitigated by depletion and the antiphlogistic regimen,
more or less actively enforced, according to the
degree of violence. Spasmodic diseases, on the
contrary, are influenced by opiates, antispasmodics and tonics, and by the removal of their
cause, when it can be discovered and remedied,
as in the case of dentition, indigestible food, &c.
Sympathetic   diseases are to be addressed
through the medium, organ, or texture which is
primarily affected. Thus, a headache depend* See note, page 9.



TREATMENT OF DISEASE.


87


ing upon a disordered stomach, or a hysteric
affection upon irregularity of the uterine func.
tion, are to be treated under this view of the
subject. Hemorrhages and other morbid discharges, are to be dealt with by removing the
cause when practicable, by diminishing vascular
activity, or by quieting the discharging surfaces with opiates, or contracting them with
astringents. There is one class of curable diseases which are controlled chiefly by specific
remedies, being in some instances suspended,
in others radically removed. Thus, gout is relieved by colchicum, and intermittents by quinine and bark. Scabies is cured by sulphur,
syphilis by mercury, goitre, as we are informed,
by iodine, and various chronic eruptions by
arsenic and corrosive sublimate. The foregoing
examples will serve to illustrate, not only the
power of medicine, bua also the great variety of
grounds which should govern medical practice,
and the importance of an intelligent diagnosis,
as well as a knowledge of therapeutic means.
In the next subdivision, or that of self-limited
diseases, we include those 'which receive limits
from their own nature, and not from foreign



88


TREATMENT OF DISEASE.


influences, and which, after they have obtained
foothold in the system, cannot in the present
state of our knowledge be eradicated or abridged
by art, but to which there is due a certain
succession of processes, to be completed in a,
certain time, which time and processes may
vary with the constitution and condition of the
patient, but are not known to be shortened by
medical treatment.'  Examples are. abundant,,
and are found in typhus and typhoid fever,
measles, small-pox, hooping cough, dysentery,
and many other diseases of lighter or graver
character.*
It is with regret that we are obliged to acknowledge the existence of a third class, that of
incurable diseases, which has been recognized
in all ages as the opprobrium medicorum. It
includes the long train of internal morbid degenerations, malignant and chronic, by tubercle and
granulation, by atrophy and hypertrophy, softening  and  hardening, scirrhus, encephalosis
ossification, concretion, contraction and dilatation, with their various consequences of phthisis, emphysema, dropsy, epilepsy, paralysis, and


* See marginal note t, 'age 19.



90


TREATMENT OF DISEASE.


and that we should not shrink from avowing
them to the world. Our science, imperfect as
it is, has achieved as much as any similar science for the prevention, alleviation, and removal
of the evils which it combats. Let us not bring
it into disrepute, by pretending to impossibilities,
by asserting what cannot be proved, and by professing what human art is unable to accomplish.
A new era will dawn upon medicine when its
faithful and enlightened cultivators shall more
constantly devote their time and their efforts to
enlighten the public mind in regard to the true
mission and powers of their science; and when
they shall leave to charlatans and fanatics, the
doubtful and dishonest game of unfounded
professional pretension.



PRACTICAL VIEWS


ON
MEDICAL EDUCATION.
PUBLISHKD BY VOTE OF THE MEDICAL FACULTY OF nARVARD
umvERsITY iN 1860.          1
THE undecided state of public opinion in regard to some of the fundamental points in a
course of medical education, including among
other things the portion of the term of pupilage
proper to be spent in attendance on lectures, is
thought to justify a further consideration of the
subject. In some of its relations, this subject
has already been discussed, in the Transactions
of the American Medical Association for 1849,
in two reports, pages 353 and 359, to which the
reader is particularly referred. The following
condensed, but more general view of the subject
of medical education, is now respectfully submitted to the members of the Association.



92


PRACTICAL VIEWS


Medical instruction should be adapted to the
power of students to receive and retain what is
communicated to them, and should be confined
to what is important to them in their subsequent life.
In modern times the constituent branches of
medical science are so expanded, that they are
not acquired by any physician in a life-time,
and still less by a student during his pupilage.
The same is true even of many individual
branches. It is not, therefore, to be conceded
that 'a scheme of scientific instruction should
embrace the whole science, and no part should
be omitted;' nor that 'a well-digested plan of
lectures embraces all" that is to be known and
taught.' Medical science has at this day become so unwieldy, and contains so much that is
unnecessary, at least to beginners, that the
attempt to explain to students the whole, is
likely to involve the result of their learning but
little.
In Chemistry, at the present time, a thorough
adept is unknown. No man living knows all
the recorded facts, or all that is to be known
and taught, in that science. Organic chemistry



ON MEDICAL EDUCATION.


93


alone fills large volumes, though yet in its
infancy.
In MAateria Medica there are some thousands
of substances and their compounds, which possess what is called a medicinal power. Yet it
is not probable that any physician effectively
reads the one half, or remembers one quarter, or
employs in his yearly practice one tenth, of the
contents of the common dispensatories.
In Pathology, so complicated and various are
the conditions attendant on the individual forms
of disease, and their relations with idiosyncracy,
temporary condition and external agency, withorganic lesions and functional disturbances, that
few of the most experienced pathologists can be
said to understand their whole science, or to be
alhiays competent to its successful application.
In Etiology, the theoretical literature of
causes has spread itself out to an extent which
is burdensome and unprofitable. It is true, that
'man, from his nature, is subject to suffering,
disease and death; 'I-but it is not equally apparent, that 'the causes by which these conditions are produced, are ascertainable.' We
know nothing of the vehicle of cholera or influ



94


PRACTICAL VIEWS


enza, nor is it probably in the power of any
physician, by any art or application of his
knowledge, to produce in a given healthy man
a case of common pneumonia or of acute rheumatism, of diabetes or Bright's kidney, of hypertrophy or of cancer, or even of a common boil,
or wart.
In Therapeutics, many hundred    volumes
exist, such as would not have existed, could a
knowledge of the cure of diseases be made so
easily tangible, that it could be spread before
the student in the three or five years of his
pupilage.
In Anatomy, general and special, microscopic
and transcendental;- in Physiology, with its
intricate ramifications; - in Surgery, of which
several subordinate specialities constitute*distinct living professions; it is not to be admitted
that the means or time of any ordinary course
of lectures can furnish full and complete instruction. Certainly it must be difficult to arrange
a course of lectures on any of the extensive
sciences which now constitute medicine, if it be
indeed true, that 'the teachers are not justifiable
in suppressing any portion.'



ON MEDICAL EDUCATION.


95


It is the business of lecturers in medical
schools, to condense and abridge the sciences
which they respectively teach, to distinguish
their essential and elementary principles, to sift
carefully the useful from the superfluous, and to
confine the scope of their teachings, as far as
possible, to what is true' and profitable, and
likely to be remembered and used by their
hearers. It is unfortunately too true, that, 'in
an extended system of instruction, there is much
that the student will not master, much that will
have escaped his attention, much which he
ought to know that he has not learned.' The
remedy appears to be, to teach him well what
he can and should master, and briefly to point
out to him the sources, fortunately abundant,
from which he may obtain the rest.
Much injury is done to the cause of true
learning by medical assumption, amplification,
and exaggeration, by premature adoption of
novelties, and by tenacity of theories, personal
or espoused. Students, in all former years,
have expended much time in learning, what it
afterwards cost them both time and trouble to
unlearn;-in acquiring, not merely the truths of



96


PRACTICAL VIEWS


science, but the crude announcements and plausible doctrines of sanguine or ingenious men.
How much time has been wasted in some of
our distinguished seminaries, in acquiring the
visionary and now neglected theories of Rush
and Broussais!
The most commonly exaggerated branch of
medical science is therapeutics. Enlightened
physicians well know that many diseases are
incurable, and that others are subject to laws of
duration, which cannot be interrupted by art.
Yet students sometimes return from medical
schools persuaded that their instructors know
how to cure a large part of these diseases, and
that if others are less fortunate, it is attributable
to their own fault.
Medical teachers should keep pace with the
progress of their respective sciences. Yet in
their haste for the promulgation of novelties,
they should not omit to give the proper consideration to the older and more settled principles
of science. Medical men are liable to commit
the error of adopting premature opinions, unsound practice and inconvenient changes of
language and nomenclature, sometimes from a



ON MEDICAL EDUCATION.


97


love of display, and sometimes from a want of
self-reliance, and a fear of being thought behind
the literature of their time.
The length of a course of lectures is not the
measure of its value to the student. A course
of lectures should not outlast the curiosity of
its hearers, nor their average pecuniary ability
to attend. Custom in this country has generally
fixed the limits of these things at about four
months. A comprehensive and judicious course,
confined to the enforcing of necessary points,
is far more profitable than a more discursive
course to a wearied and diminishing audience.
Lectures are chiefly wanted to impress by demonstration the practical branches of science,
and they are most effective in places where the
facilities for such demonstrations can be commanded. Anatomy requires extensive exhibitions by the teacher, and personal dissections by
the student. Chemistry and Materia Medica
require illustrations by specimens and experiments. Pathology neeas the aid of autopsies,
museums and the clinical demonstrations of
large hospitals. A knowledge of Obstetrics is
not perfected without apparatus and practice.
7



98


PRACTICAL VIEWS


Surgery is acquired by witnessing numerous
operations, surgical diseases, illustrated explanations, and by personal practice on the dead
body. Physical exploration is wholly demonstrative. A knowledge of auscultation can no
more be acquired from books, or abstract lectures, than a kilowledge of music, or of individual physiognomy.
The intermediate period between lectures,
should be spent by students in active and original study, approved and confirmed by regular
recitations, and by such opportunities as can be
commanded, for practical, personal experience.
Private schools for small classes, and the private
teaching of individuals, who are suitably qualified and situated, are more advantageous for
two thirds of the year, than either the fatiguing.
jostle of overcrowded rooms, or the listless routine kept up by the survivors of a passive class.
The usefulness of a medical school depends
not so much on the length of its session, as
upon the amount of education, preliminary and
ultimate, which it requires, the fidelity with
which it exacts its own professed requisitions,
and the train of healthy exertion, active inquiry



ON MEDICAL EDUCATION.


99


and rigid, methodical, self-regulating study, to
which it introduces its pupils. The longest
lectures are of little use to students who want a
common education, and whose medical education does not qualify them afterwards to observe,
to inquire, and to discriminate. The exacted
evidence of three years of well-conducted study,
is better than the exhibited ticket of a six
months' course.
The subjects most important to be well
taught in medical schools, are the elementary
principles which constitute the frame-work of
medical sciences, and the mode of thought and
inquiry which leads to just reasoning upon
them. After these, most attention should be
given to selecting and enforcing such practical
truths, as will most certainly be wanted by the
young practitioner, in his future career of
responsibility.
The things to be avoided by medical teachers
are technicalities, which are unintelligible to
beginners,- gratuitous assumptions and citations of doubtful authorities, - prolix dissertations on speculative topics,- excessive minuteness in regard to subjects which are intricate
P



100        ON MEDICAL EDUCATION.
and but little used, and therefore destined to be
speedily forgotten. To these may be added
controversies, superfluous personal eulogiums
and criminations, and all self-exaggeration,
personal or local.



REPORT ON HOMEO'PATHY:
MADE TO TIE COUNSELLORS OF THE MASSACHUSETTS MEDICAL
SOCIETY IN FEBRUARY, 1854.
THE committee appointed by the Counsellors
of the Massachusetts Medical Society, to consider the resolution of the Essex North District
Society,* and also that of Dr. Spofford, in relation to the subject of Homceopathy, beg leave
to Report:That the Massachusetts Medical Society was
incorporated mainly for the purpose of establishing a proper standard of medical education,
and of insuring a competent degree of knowledge among those who should be authorized to
practise the profession of medicine in this Commonwealth, and they are not aware that the
Society possess any power to coerce men, after
* These resolutions contemplated dissolving the connection of
Homoeopathists with the Society.



102


REPORT ON HOMCEOPATHY.


they have been thus educated and qualified, to
embrace, or renounce, any theoretical opinions,
or modes of practice, which they may innocently believe, or which, not believing, they may
think it proper to profess.
In medical science there are certain fundamental laws relating to the structure and functions of the body, and the morbid changes to
which it is subject, also regarding the signs by
which those changes are discovered,-upon
which all well-educated physicians are agreed.
But in certain provinces of medical science
such fundamental laws, owing to-the imperfection of our means of knowledge, cannot at the
present time be established. This is the case
with Therapeutics, or the art of treating or
curing diseases, in which the evidence required
by science is difficult to obtain, and in regard to
which writers and teachers, sects and individuals, and even the same individual in the course
of an ordinary life-time, may without dishonesty entertain great diversities of opinion.
The tendency of modern observation is such
as to lead us to the belief that disease is less
frequently under the control of remedial treat



REPORT ON HOMCEOPATHY.


103


ment than it was formerly supposed to be.
Where observations are impartially made by
competent persons, it is found that people recover, and also that they die, under all the
ordinary modes of treatment.   And the evidence collected from sources which are worthy
of reliance, is not so abundant or satisfactory as
to convince a reasonable man that any general
system of practice can be relied on for the cure
of all cases. Hence it is not surprising that
diversities, contrasts, and even extravagances
in practice, are embraced by the sanguine, the
credulous, the uninformed and the interested,
frequently based upon no better authority
than accident, imperfect observation, or defective power of judgment in the party who adopts
them.
The broadest division which has been recognized for centuries in the treatment of disease,
is that which resolves the whole subject into
the active and the expectant modes of practice.
The first employs various interfering agencies
in the management of the sick,-the last waits
more on the unassisted course of nature, - and
both have long had their exclusive advocates.



104


REPORT ON HOM(EOPATHY.


To the last of these divisions Homceopathy
really, though not avowedly belongs. Its character is, that while in reality it waits on the
natural course of events, it commends itself to
the ignorant and credulous by a professed introduction into the body of inappreciable quantities of medicinal substances. Now the nugatory
effect of such quantities is demonstrated by the
fact, that in civilized life every person is exposed
to the daily reception, in the form of solution,
dust or vapor, of homceopathic quantities of
almost every common substance known in
nature and. art, without any appreciable consequences being found to follow. And the pretended exactness with which such nominal doses
are administered by homceopathic practitioners,
is doubtless a fallacy, capable of producing in
the living body no other effects than those which
charlatanry has in all ages produced in the
minds and bodies of imaginative patients.
It is a fact much older than the institution of
this Society, that visionary systems of practice
have replaced each other in the faith of multitudes, at least several times in a century. And
this will probably be the case, so long as prac



REPORT ON HOMGEOPATHY.


105


tical medicine continues to be, whatf it now is
to a great extent, a theoretical and conjectural
science. At the present period, among the sects
usually called irregular, the homceopathic sect
prevails to a considerable extent in this country
and in Europe.    In the United States it is
exceeded only by the sect called Botanic, or
Thompsonian practitioners, which at the present
time, appears, of the two, to number most disciples. It is not probable that the faith of either
of these sects will be displaced by a return of
their followers to any more enlightened or
rational creed. Nevertheless, it is safe to predict that they will both be superseded in the
course of time by other systems, not more
rational or probable in themselves, but possessing the attraction of greater novelty, or urged
upon the credulous with greater adroitness.
When the world, and especially the unenlightened part of it, shall be settled in their
opinions on other sectarian subjects, we may
anticipate unanimity of opinion among them in
the science of practical medicine.
But it is not only to expectant medicine, in
the form of its counterfeit, homropathy, that



106


REPORT ON HOMEOPATHY.


the censure of prejudice and credulity is to be
attached. The opposite system of active practice, carried to the extreme usually called heroic,
is alike chargeable with evil to the patients,
whenever it becomes the absorbing and exclusive course of the practitioner. Physicians are
too often led to exaggerate the usefulness of the
doctrines in which they have been educated,
and especially of those by the exercise of which
they obtain their daily bread. In such cases
habit gets the ascendancy over enlightened
judgment, and the man of routine, or of narrow
views, asks himself, from day to day, what drug
or what appliance he shall next resort to, instead
of asking the more important question, whether
any drug or any appliance is called for, or is
properly admissible in the case.
In Medicine, as in the other inexact sciences
which deeply concern the welfare of mankind,
cnough has been learned to show that extreme
measures, either of omission or of commission,
are not, when systematized as a whole, productive of benefit or safety to mankind.
It is quite probable that the prevalence, at
times, of eccentric and ultra-sectarian doctrines



REPORT ON HOM(EOPATHY.


107


in medicine, is attributable to the exaggerated
value attached by physicians themselves to incessant activity in practice, and an assumption
of credit for particular modes of medication,, to
which, as such, they are not entitled. There is
often a want of openness in the intercourse of
physicians, both enlightened and ignorant, with
their patients, who are requested to believe that
their cure depends not in any degree on the
salutary influences of nature and time, but in
the rigid enforcement of a prescribed routine of
practice, either active or formal, as the ease
may be. And when opposite modes of treatment are urged upon the public by different
practitioners with reasonings equally specious,
it is not surprising that patients should sometimes adopt that which is least troublesome in
its operation. Neither is it surprising that they
should sometimes embrace even a deception,
which absolves them from their allegiance to an
unnecessarily severe or troublesome course of
treatment.
An honest and independent practitioner, and
especially a member of the Massachusetts Medical Society, should never be induced to give



108


REPORT ON HIOMECOPATHY.


Ihis counsel, or his aid in any shape, to empiri-.cism and dishonesty, whether it occur among
those who are with'in or without the pale of its
-membership. And no consideration of gain or.notoriety should induce those, whose age or
standing cause them to be resorted to for 'consultation, to lend their influence or countenance
to encourage either the delusions of those who,are honest, or the practices of those who are,not.
If quackery, individual or gregarious, is ever
to be eradicated, or even abated, in civilized,society, it must be done by enlightening the
'public mind in regard to the true powers of
medicine. The community must be made to
understand that there are certain things which
medicine can do, and certain other things which
it cannot do; that some diseases are curable by
-active interference, and others by time and,nature alone; that true medical skill lies in dis-.crimination and prognosis, and judicious adaptation of management, more than in assumed
therapeutic power, in regard to special agents;
and that he who professes to cure by medicine
a self-limited fever, is as much an impostor, or



REPORT ON HOM(EOPATHY.       109
deluded man, as he who pretends to do the same
thing with a fractured bone or incised wound.
Nothing so much shakes the confidence of mankind in the medical profession as unfulfilled
promises; nothing so much strengthens this
confidence, as fair dealing exhibited in an earnest requirement and fearless expression of the
truth. Such a course, by commending itself to
the sensible and enlightened, may be expected,
sooner or later, in some measure to influence the unreasonable and ignorant, - much
sooner, indeed, than a warfare carried on in the
arena of empiricism with its own weapons.



ON THE MEDICAL PROFESSION
AND QUACKERY.
AN INTRODUCTORY LECTURE, DELIVERED AT THE MEDICAL COLLEGE, BOSTON, NOVEMBER 6, 1844.
I Am about to address myself to an audience
of young men, a class of persons who, in our
new and active country, assume an influence,
and wear a responsibility, unknown in the older
communities of Europe. The sparse character
of our population, the call for active and efficient
men, the sure market which exists for talents,
and even for common ability and prudence,
have given a national precocity to our youth,
and a readiness in adapting themselves to new
and difficult spheres of action. I have heard
foreigners speak with surprise of the arrival, in
distant ports of Europe or India, of American
ships commanded, not as is usual, by weather



ON THE MEDICAL PROFESSION.


111


beaten veterans, but by beardless striplings.
The signs of our mercantile houses bear often
the names of very young men, and the avenues
of our professions are so crowded with them,
that perhaps no regulation is more liable to be
infringed than that which requires that professional candidates shall be twenty-one years of
age. Young men command the ranks of our
military corps and swell our political meetings.
Their voice is heard among us in the periodical
press and in the halls of legislation.
These precocious habits of our country have
of course been felt in the medical profession. In
most of the schools of Europe, medical honors
are not conferred until after a novitiate of four,
and more frequently five years, during which an
extensive circle of sciences is obliged to be
mastered, and to be approved by a series of
strict examinations. Not only are the essential
branches of medicine required to be fully understood, but they must be preceded by a knowledge of the subsidiary sciences, and must also
be confirmed by practical and clinical experience.
With us, on the other hand, the short period



112


ON THE MEDICAL


of three preparatory years devoted to regular
study and lectures, may be said to constitute
nearly the sum total of a medical education;
for the collateral requirements are so small that
their acquisition is often effected during the
same three years which are applied to the other
branches. And,a young man who has learned
to read and write, issues from the village school
or perhaps from the counter or the plough, and
in three years is licensed, and declared competent to exercise the multifarious profession of
medicine and surgery in all its departments.
As it often happens in this and similar casest
the newly-approved candidate sends forth his
anxious glance, directed not always to his own
deficiencies or the means of supplying them, but
to that common goal and object of a young
man's inquiry, which is to fill up, the measure of
his practical aspirations--an opening. By the
timely decease of some elderly practitioner, or
by the fortunate discovery of a rising settlement,
in some distant State, or on some promising
water-power, he finds himself, perhaps at short
notice, installed, under virtue of the acquiescent
silence of the small community in which he



PROFESSION.


113


lives, the constituted physician of the place. Inl
one month, perhaps in one week, he may be
called upon to diagnosticate organic lesion in a
case of life and death, or to treat the most formidable convulsive disease. He may be summoned to tie the femoral artery, or to decide and
act in a case of placental presentation. There
may be no consulting physician within many
miles, at least none who can arrive in season
for the emergency.
The safety then, and probably the lives of the
unfortunate constituents of this young man,
will depend upon the question whether he has,
or has not been' truly educated, whether his
mind and hand have been adequately trained
for the great occasions that await him. It is
not enough that he has suffered three years to
expire while taking his ease in the office of a
city physician, nor that he has passed a corresponding time in following the rounds of a country practitioner. It is not enough that he has
carelessly read the works of approved authors,
and has squeezed through the customary academic examination. If he has done only this,
it is more than probable that failure awaits on
8



114


ON THE MEDICAL


himself and disaster upon his patient. But if
his studies have been methodical, and conducted
with an eye to practical application; if he has
concentrated  his attention  upon necessary
points; if he has felt the earnest interest which,
more than anything else, imprints truth on the
remembrance; if he has gathered up and arranged his resources in reference to coming
emergencies; if he has gone over in anticipation
the difficulties of his profession, and planned his
own mode of extrication,-then he will find
that inexperience does not involve failure, and
that youth is not an insurmountable barrier to
success. He will recollect that the most emi.
nent physicians and the most successful operators have had their first cases. He will perhaps
also remember, that some of the most distinguished men in history have emerged from
obscurity while yet in youth; that not only
warriors, like Alexander and Napoleon, but
statesmen, like Pitt and Fox, and philosophers,
like Davy and Bichat, had achieved some of
their proudest laurels at the very entrance of
manhood.
Let it not be supposed, however, that I am



PROFESSION.


115


an advocate for the premature assumption, by
young men, of the responsibilities of our profession. Every medical student is to be considered
unfortunate, who by reason of poverty, or the
stress of other circumstances, is obliged to hurry
his probationary period to an early termination.
Too much time and attention are not often
bestowed on the business of preparation for
practice. The oldest and the best physicians
have had frequent cause to regret that they
were not better educated. But the superficial
student,,who rarely has the time and the will to
repair his early deficiencies, is haunted through
life by a round of perplexity and embarrassment, and degraded by a sense of his own
incompetency.
It should be borne in mind, that there is no
period of life in which time can be so conveniently spared from lucrative pursuits, as in
youth. After a man has atained to the age of
thirty, it is commonly of very little consequence
to him, as far as his fame and yearly receipts
are concerned, whether he had commenced practice at the age. of twenty-one or of twenty-four.,
But as far as he may prize a quiet conscience



116


ON THE MEDICAL


amd freedom from anxiety, the later age is incomparable the most secure. I would advise
any young man, who has completed his education at the end of his minority, that he should
devote two additional years, and if practicable,
a still longer period, to availing himself of such
advantages, both in study and practice, as may
prepare him for his future duties. And when,
as it often happens in our community, narrow
circumstances require that a young man should
live by his own exertions, this state of things,
instead of being a motive that he should crowd
himself prematurely into the ranks of the profession, encumbered with debt, and bare of
acquirements and of means, is rather an imperative reason that he should at once begin by
resolving to devote twice the customary number
of years, if necessary, to the double purpose of
keeping himself in an independent position, and
of placing himself at length, in point of maturity
of knowledge, on a par with his more favored
competitors.
It may not be improper, in this place, to offer
you some suggestions as to the mode in which
students may advantageously appropriate the



PROFESSION.             117
time of their pupilage in reference to the science
which they expect to acquire. Medical literature has become so vast a subject, that the
undirected student is apt to be lost in the maze
of books and sciences which seem equally to
press upon his attention. And he is likely to
fall into the pernicious error of thinking that he
must read a great deal, even though he remembers little.  The true object of a medical
pupilage should be, not to read, but to study,
to observe, and to remember; not to pass
superficially over the writings of celebrated
men, but to select those compendiums of the
several sciences, which contain a condensed
view of their essential and elementary facts,
which separate the wheat from the chaff, and
offer what is fundamental and useful, within a
compass which is capable of being impressed on
the memory. Most of the constituent sciences
which are nominally included in a modern medical education, are now so extensive, that the
cultivation of any one of them may afford
abundant occupation for a common lifetime.
Passing over the more elementary branches, I
may instance the theory and practice of medi



118           ON THE MEDICAL
cine,;the literature of which is a vast magazine
of rubbish, with a few gems imbedded in it,
accumulated in all time since the origin of
writing, and in such excess that no country in
Europe could probably furnish even a catalogue
of its own modern books. The history of this
extensive science contains a mixture of much
that is bad, with much less that is good. And
although in medical research the still small
voice of truth has from time to time made itself
heard for a season, yet it has as often been
drowned by the dogmas of the visionary and
the clamors of the interested. During the present century a host of theorists and gratuitous
reformers have replaced each other on the arena
of medical controversy. But we have seen that
while a truth in medical science, like the import
of the physical signs for example, struggles its
way through opposition and distrust into general adoption,-an unfair and unfounded assumption rarely survives long the life of the
individual whose own eloquence and obstinacy
were necessary to force it for a time upon the
public attention.
If we could purge the sciences of pathology



PROFESSION.


119


and therapeutics from the writings of men who
wrote merely because they had a reputation to
acquire or a doctrine to establish; and could
confine these sciences to the results attained by
those who sought directly and impartially for
the true and the useful; it is probable that the
whole subject would be brought within the
comprehension, not only of every physician, but
of every medical student. And from the recent
mode of conducting medical investigations,
which has commenced and is gradually gaining
foothold in all civilized countries, we may hope,
in our own day, to see near approaches to this
desirable result.
Every medical man, whether student or physician, owes a threefold duty, to himself, to his
competitors, and to his patients. To himself
he owes the cultivation of habits of order and
perseverance, a love of honesty and a desire of
knowledge. No man is successful in a learned
profession, who does not cultivate a methodical
disposition of his time. The neglect of an hour,
the omission of an engagement, and the postponement of what is necessary for what is
unimportant, have ruined many a good inten



120


ON THE MEDICAL


tion and many a promising prospect. Lord
Chesterfield says, that the Duke of Newcastle
lost half an hour in the morning, and spent the
whole day in running after it. This is a true
expression of the career of a busy but inefficient
man. He who is always driven, always in a
hurry, always late, and always with deficiencies
to be made up, is very likely to be always a
failure.  It is well known that the responsibilities of society are best and most easily
discharged by those who estimate the value of
small portions of time, who do things strictly
in their proper season and place, who provide
against contingencies, and distribute their day
in reference to what is, as well as to what may
be required of them.
But the best ordered arrangement of time,
and the most punctual habits of attention, do
not always succeed in our profession, except
through perseverance, and often through long
suffering. The public, especially in cities, are
slow in giving their confidence to strangers and
to young men. The late Dr. Physick, of Philadelphia, asserted that during the first three
years of his practice he did not pay for his shoe



PROFESSION.


121


leather; and a late very eminent physician of
this city once informed me, that he did not
earn his own board during three times that
period. The conservative principle which retards
the reception of young men into lucrative business, is the foundation of their security in after
life, for medical practice would not be worth
having, in a community whose love of change
should lead them to desert their former friends
and.counsellors, to run after every new comer.
Physicians usually come on to the stage and
move off of it, in company with the generation
to which they belong. In a large city, a young
physician, except under circumstances of peculiar patronage or necessity, does not usually obtain employment from families who are much in
advance of himself. But these families and their
medical attendants pass away, and he and his
cotemporaries become the standing practitioners
of their time. A preparatory period in the mean
time elapses, during which the candidate for
future honors has usually enough to do, to perfect his knowledge, to fill the gaps in his experience, and to give proofs to the community



122


ON THE MEDICAL


around him, that he possesses aptitude for the
common affairs of life.
Every physician is an inquirer during life,
and continues to learn something up to the last
year in which he may happen to study or practise. As the science advances, moreover, every
intelligent practitioner is obliged to replace some
of his former opinions with others, which he
finds to be better substantiated. We should be
careful, therefore, not to pledge ourselves unnecessarily to medical opinions which are founded
on equivocal or imperfect testimony. The public sentiment attaches a kind of disgrace to
frequent changes and recantations, and they
ought also to do the same to the course of any
man, who for the sake of consistency with himself, continues to maintain an erroneous and
exploded opinion.  Both these extremes are
avoided by the physician who reserves his assent
to any new opinion, until the evidence of the
case is satisfactorily made out.
One of the most difficult virtues for a physician to cultivate, is a just and proper deportment
towards his professional brethren. As in all professions in which men live by their heads rather



PROFESSION.


123


than- their hands, business is liable to be overdone, and a candidate who has not acquired all
the occupation that he wishes, is apt to regard
his competitors as stumbling-blocks, to be gotten
rid of by fair means, or foul. Hence arise the
jealousies, calumnies, and open hostilities 5o
often entertained, which injure all the parties,concerned, and lower the estimation of the profession with the public. Harmony and a proper
esprit du corps, may uphold the dignity of even
an inferior profession; but the public rarely respect any class of men, the members of which
have no respect for each other. A friendly intercourse with those whom we approve, is productive of pleasure and advantage, and a gentlemanly forbearance towards those with whom
we do not agree, will show that we are above
jealousy. A man is always to be suspected,
who tells you that he is surrounded with enemies; and one who is an habitual calumniator
of others, forces upon his hearers the conviction
that they in their proper turn are to come in for
their share of his animadversions.
I doubt if physicians do not sometimes injure
themselves and their cause, by showing too



124


QUACKERY.


great a sensitiveness in regard to the temporary
inroads of irregular practitioners.  Quackery
whether carried on by the audacious enterprise
of an individual impostor, or upheld by the
trumpeting of a fanatical sect, is to be considered a necessary evil inherent in the constitution
of society. It exists in every walk and occupation of life, by the exercise of which men procure bread. The pettifogger in law, the Millerite
lecturer in theology, the demagogue in politics,
the system-monger in education, and the wonder-worker upon the brains and bowels of infatuated audiences -what are all these but quacks
moving in their respective spheres, and fattening
upon the credulity of dupes. A certain portion
of mankind are so constituted that they require
to be ridden by others, and if you should succeed in unhorsing a particular impostor, it is
only to prepare the saddle for a fresh and more
unflinching equestrian. It is not good policy to
say or to write too much in regard to the pretensions of impostors. A celebrated author observes that 'many a popular error has flourished
through the opposition of the learned.'  By


0 Montosh.



QUACKERY.             125
throwing the gauntlet at an insignificant man,
you at once raise him to the dignity of being
your competitor, and acknowledge him as a
(foeman worthy of your steel.' And if you discover uneasiness, resentment, or ill temper, the
public conclude that you are influenced by your
private interests. Besides, when you have entered the arena of controversy, you will probably
find that the quack, who has his all at stake,
can afford more breath and time than you can
conveniently spare from your other occupations,
and in an active warfare, he may acquire two
partisans to your one. It is not long since the
exhibiter of a stuffed mermaid succeeded in
drawing down the popular indignation on an
unfortunate naturalist, who had ventured to
declare that it was made of a fish and a monkey.
The public generally require time to get disabused of a favorite error; and if too abruptly
assailed, they will sometimes hold on to it, as
the traveller did to his cloak when attacked by
the north wind.
In your demeanor in regard to quacks, you
should keep aloof from them, and trouble yourselves little about them. Admit the general



126


QUACKERY.


fact that the race always do, and must exist in
society; that they are wanted by the credulity
of a particular class of minds; that the fall of
one dishonest pretender, or one visionary sect,
is sure to be replaced by the elevation of another; therefore it little concerns you to know
what particular imposition has the ascendency
at any given time. When you are interrogated
in regard to a specific subject of this kind, you
should make a reasonable, cogent, and dispassionate answer, always avoiding the appearance
of warmth and especially of self-interest; and
you may be sure that a majority of the public
will be on the side of truth. As far as my observation extends, three quarters at least of the
families in Boston and New England, are in the
hands of regular practitioners. The remaining
fraction, more or less, consists partly of minds
so constituted that they require the marvellous
as a portion of their necessary food, and partly
of unfortunate beings, suffering the inevitable
lot of humanity, who having failed to obtain
relief from the ordinary resources of medicine,
seek for temporary encouragement in the dishonest assurances of any who will promise to cure



QUACKERY.


127


them. The first class is the dog in the fable,
catching at shadows; the last is the drowning
man catching at straws.
Above all, if you would discountenance
quackery, take care that you become not quacks
yourselves. Charlatanism consists not so much
in ignorance, as in dishonesty and deception.
In your intercourse with patients, cultivate a
spirit of fidelity, candor and truth. Endeavor
to understand yourselves and your science2
weigh justly your own powers, and profess only
what you can accomplish. If you announce to
your patients that you will cure incurable diseases, or cut short those which have a necessary
period of duration, you do not speak the truth,
you merely blind your patient, while you throw
the die for a fortuitous result, a game at which
the veriest mountebank may at any time beat
you. The profession as a body are often unpopular with a large and sagacious part of the
community, because they so frequently disappoint the expectations they have allowed themselves to raise. You may safely undertake and
promise to cure diseases which you know to be
curable, to alleviate others which you know to



129


ON THE MEDICAL


be not so, and to perform what art and science
can do towards conducting doubtful and dangerous cases to a happy issue. But this is all
you can accomplish or promise.   The skilful
mariner may steer his ship through a dangerous
navigation, but he cannot control the wind nor
arrest the storm. Nor would he gain reputation
by professing to do so.
It is hardly necessary that I should counsel
you not to neglect your patients, when you
can do anything for their welfare and security.
Neglect of outward attentions is not, I think, a
very frequent sin of physicians, inasmuch as
their interest very obviously lies in a different
course. But many practitioners fall into the
opposite error of over-attention to their patients,
of making them long, tedious or superfluous
visits, of hampering them with strict and complicated instructions, and especially of overdrugging them with remedies. There are some
patients, it is true, who like to be bled, blistered
and physicked; but the number is small, and in
most cases both the instinct of the child, and
the discretion of the grown man, cause them to
revolt against nauseous and painful inflictions.



PROFESSION.


129


When, therefore, you are called to take charge
of a case, ask yourselves how great is the danger, and what is the probable tendency of the
disease, if left to itself. If life is in question,
and you have reason to believe that the patient
may be rescued by prompt and energetic remedies, you should not hesitate to employ them.
But in common, trivial and safe cases, such as
afford a large part of a physician's occupation,
you should not allow a habit, or a hobby, to
lead you into the blind routine of always thinking that you must make your patients worse
before they can be better. I believe that much
of the medical imposition of the present day is
sustained in places where practice has previously
been over-heroic, and because mankind are gratified to find that they and their families can get
well without the lancet, the vomit and the blister, indiscriminately applied; and because the
adroit charlatan transfers the salutary influences
of time and nature, to the credit of his own less
disagreeable inflictions.
It is the duty of physicians to elevate their
profession, by maintaining in their individual
character a high moral rectitude, a just and
-        9



130


ON THE MEDICAL


honorable conduct, a devotedness to the welfare
of their patients, and an unceasing effort to
improve themselves and their science. If this
course is pursued by medical men, they can
hardly fail of becoming useful and respected
members of society. There is no country in the
world in which the avenueg to respectability
and distinction, to competency, and even to
wealth, are more open to physicians, than in the
United States. It has been observed that in
England, no medical man is ever permitted to
attain the aristocratic rank, which belongs to
birth, and which is occasionally accorded to
eminence in the military, political, legal and
financial professions. But in our country there
is no post of honor or emolument, and no situation of influence and distinction, which our history does not show to be within the reach of
our profession. But it is not to political, or
extra professional preferment, that the true physician should look. He should rather be contented to build up his own character within his
own sphere, as a man of knowledge, fidelity
and honor. The respect of the community, and
the attachment of friends, will always attend on



PROFESSION.            131
him who loves truth for its own sake, pursues
knowledge that he may be able to benefit
others, and deals justly with his fellow-men,
consenting that they, in turn, should deal justly
with him.



ON


GOUT AND ITS TREATMENT.
GoUT, technically known by the names of
Arthritis and Podagra, is a painful, inflammatory disease, appearing by paroxysms, affecting
chiefly the smaller joints, but liable to change
its seat to various more important organs. It
is hereditary in its character, and affects the
luxurious more than the laboring and abstemious classes. It seldom occurs in children, but
makes its appearance most commonly in middle
or advanced life, and affects men more frequently than women.
The most common place for the primary attack of gout is in the first joint, or ball, of the
great toe of one foot. The patient, in many
cases without previous indications of illness,'is
surprised at being awakened in the middle of



ON GOUT.


133


the night, or a little later, by intolerable pain in
that joint, with much febrile heat and restlessness, commencing, perhaps, in a slight chill.
The toe-joint soon becomes swollen, tense and
red. Sometimes the ankle, heel, or instep is
similarly affected.  There is exquisite tenderness on the slightest pressure, or motion of the
part. This state of things continues from six to
twenty-four hours, after which a remission of
pain takes place, with gentle perspiration, and
tendency to sleep. The inflamed joint, however,
continues to increase in swelling, and at length
becomes medematous and shining. On the following night the pain and fever return, and so
continue to do for a week, more or less, during
which there is thirst, want of appetite, costiveness, and scanty high-colored urine depositing
a red or lateritious sediment on cooling.
The paroxysm lasts ordinarily from three to
ten days, at the end of which time the pain suddenly terminates, as if by magic.  The joint
continues swollen and wedematous for a few
days, with itching and exfoliation of the cuticle,
but the patient returns to his accustomed health



134


ON GOUT.


with perhaps an unwonted degree of vigor and
alacrity.
A precursory stage in most persons takes
place in advance of the paroxysm. It is marked by a deranged state of the appetite and
digestion, by heartburn, nausea, flatulence, and
offensive alvine discharges, also by languor,
headache, low spirits and disturbed sleep.
The first paroxysm of gout is the almost certain prelude to others, which are to follow after
an interval of some months or years, according
to the predisposition and habits of life of the
patient. Some persons escape with two or
three paroxysms only during life; others have
an annual visitation, and others are attacked
once in two or three months. The frequency of
the paroxysms goes on increasing, until in some
patients there is hardly any respite, unless for a
few months in summer. The later paroxysms,
however, are often more supportable, but the
general health is more impaired than in the
earlier attacks.
In the later attacks both feet are liable to be
affected in succession, and the inflammation,
after having left one foot may return to it again.



ON GOUT.


135


The small joints of the hand are also subject to
the invasion, constituting the variety of gout
called chiragra. In inveterate cases, there is
scarcely any joint of the body which may not
participate in the extension of the disease.
Effusion generally takes place into the synovial
cavities, and adjacent cellular tissues.
When the disease has become thus confirmed,
it is usually called chronic gout. This commonly follows the acute form, but in some cases
may become gradually established without it.
In chronic gout the affected limbs are disabled
for exercise, they become painful at night, interrupting sleep, and are moved by the patient
with difficulty and caution.  There is also a
general deterioration in the strength and spirits,
the patient looks worn, sallow and haggard, the
digestive powers are deranged, and there is
often palpitation and dyspncea.
When the disease has existed for a certain
length of time, there appears in some persons,
but not in all, a deposit of calcareous concretions, known by the name of chalk stones, situated mostly in the cellular tissue, between the
outside of the joint and the skin. Sometimes,



136


ON GOUT.


however, they penetrate the fibrbus textures and
the cavities of the joints. These concretions
are fluid, or semifluid, when first effused, but
become gradually solid by the absorption of
their fluid parts.  They finally become hard
and friable, resembling common chalk in their
appearance. In their more fluid state they are
formed of hydrated lithate of soda, but the
solid concretions consist mainly of lithate of
soda, with some phosphate of lime.
The chalky concretions are liable to grow
with the return of every paroxysm. In bad
cases the skin finally gives way, and a chalky
serous fluid is discharged. This is afterwards
replaced by a kind of chalky pus, and in this
manner a part of the chalk escapes, but never
the whole, owing to its entanglement in the
cells and textures. Persons have been known
to write their names with the denuded chalk
protruding from the knuckles. Sometimes the
apertures close over and cicatrize, but are liable
to break out again during subsequent paroxysms. Chalk stones are most common in the
joints of the hands and feet, which they distort
in an unsightly manner. They may, however,



ON GOUT.


137


appear in any part which happens to be the
seat of gouty inflammation.
Persons who are subjects of gout are also
liable to gravelly complaints, and to calculus
both of the kidneys and bladder. The urine is
found not only to contain urea and the other
solids in excess, but deposits lithic acid and
lithate of soda. The nephritic complaints generally supervene after the gout has lasted some
time, and the paroxysms of the two complaints
rather alternate than coincide with each other.
In regard to the causes of gout, it is, in the
first place, an hereditary disease. A majority
of persons affected with it can trace the predisposition to their parents or ancestry. It does
not follow, however, that all the children of
gouty progenitors have the disease. It sometimes leaps over one generation and appears in
the next, and it is frequently kept off in those
who are disposed to it, by an active and abstemious life. When gout and gravel affect the
same person, it often happens that some of the
children inherit the one, and some the other
disease, alone.
Gout rarely if ever appears before puberty.



138


ON GOUT.


In the statistical accounts collected by Sir C.
Scudamore, it appears that the greatest number
of first attacks came on between the ages of
thirty and forty.  But although the number
which begun in persons above forty was somewhat smaller, it is evident that if averaged upon
the whole number of persons actually living,
above that age, the proportion would be greater.
Gout occurs more frequently in men, than in
the female sex. Yet women are by no means
exempt from it, and in them it is most apt to
appear after the cessation of the catamenia.
The stout and corpulent, of both sexes, are
more liable to it, than those of the opposite
conformation.
The cause which is undoubtedly most active
in the production of gout is a luxurious life,
with the free use of vinous liquors. Persons
who take little exercise, and indulge largely in
the pleasures of the table, especially in animal
food and fermented drinks, are the most common subjects of the disease. Among persons
who are addicted to the excessive use of alcoholic liquids, it is observed that gout occurs
much more frequently in those who consume



ON GOUT.


139,


wine and malt liquors, than in those who are
intemperate in distilled spirits. The disease is
more common in England than in this country,
and occurs much more frequently among the
wealthy and luxurious, than among the poorer
and laborious classes.
There are various exceptional forms, under
which the gouty diathesis may become apparent in the system. Sometimes the viscera become deranged, without obvious affection of
the joints, constituting irregular or concealed
gout. Thus the digestive tube may be affected
with pausea, want of appetite, pain, flatulence,
costiveness, or diarrhcea, acid eructations, and
even vomiting. In the thorax are sometimes
felt pain, dyspnma and palpitation, and in the
head, vertigo, diminution of sight and hearing,
with headache, and sometimes numbness and
lethargic heaviness. The spirits are excessively
dejected, and the mind peevish and irritable.
Sometimes the gouty inflammation attacks the
eye, the fauces, or the urethra, producing symptoms imitative of various diseases.
The name of retrocedent gout is applied,
when the disease, by a sudden metastasis, dis



140


ON GOUT.


appears at once from an inflamed joint, and
attacks some internal organ with violent and
alarming symptoms. The part most commonly
seized is the stomach, in which there is sudden
pain, with perhaps nausea and vomiting, and
great anxiety and distress. The heart may also
be attacked with syncope and urgent dyspncea,
or the brain with symptoms of apoplexy and
paralysis.
The prognosis of gout is not unfavorable in
the early stages, and so long as it keeps to the
extremities. But the retrocession of the disease
to the stomach, the heart, or to the brain and its
membranes is fraught with considerable danger.
The prevalent notion that gout secures an immunity from other diseases, is now generally
admitted to be founded in error. All that can
be said to be true is, that many anomalous
symptoms, both local and constitutional, which
depend on concealed or atonic gout, and which
may have harassed the patient for a long time,
suddenly give way, when the gout declares
itself in the form of a regular paroxysm in the
foot.
In its diagnosis gout is principally liable to



ON GOUT.


141


be confounded with rheumatism. The following
circumstances will serve to distinguish them.
Gout affects the small joints, principally of the
great toe.  Acute rheumatism attacks chiefly
the large ones, and often many at a time. In
gout, the inflamed joint is of a vivid red color,
it afterwards becomes cedematous, and ends
with peeling off of the cuticle. In rheumatism
the joints are less red, and the cuticle does not
desquamate. Gout is more paroxysmal in its
character, and alternates with intervals of ease,
more than rheumatism. The chalky deposits
are characteristic of gout, the acid perspirations
of rheumatism. Gout is hereditary, affects the
luxurious and indolent, and appears after puberty. Rheumatism is less distinctly hereditary,
and may affect persons of all ages, classes and
occupations.
The above diagnostic marks appear to me to
constitute a legitimate distinction between the
diseases of gout and rheumatism.    It is but
just however to state, that these distinctive
characters are liable to numerous exceptions,
and that some of the best French pathologists,
such as Chomel, Grisolle and Requin, deny the



142


ON GOUT.


diversity of the two diseases. And experienced
physicians are sometimes at a loss to which of
these forms of disease they shall assign particular cases which exhibit the characteristics of
both.
The treatment of a first paroxysm of gout
may be expectant and palliative, for it is not
certain how soon spontaneous resolution will
arrive, and the patient, not without reason, is
taught from day to day to look for relief and
restoration to health. Little, therefore, need be
done except to open the bowels with some
effectual laxative, and to apply flannel with
camphorated oil, or some opiate liniment. But
when paroxysms are protracted and very painful, or return with progressive severity, relief
must be sought from such means as are in
our power.   Many expedients have been resorted to, a large portion of which are liable
to serious objections.  Immersion of the foot
in cold water has afforded great relief to the
pain, but is liable to drive the gout to vital
organs. Bleeding has been found to mitigate
the inflammatory action, but is inadmissible except in the most robust and plethoric. Leech



ON GOUT.


143


ing the afflicted joint is an useful palliative,
but even this has its limits of expediency.
Various purgative mixtures have in turn obtained and lost a specific reputation.
The remedy which, in the present century,
has taken precedence of all others, is Colchicum. This drug, supposed to be the basis of
a French gout medicine called eau medicinale,
has justly acquired reputation for the power of
putting an immediate stop to the paroxysm.
Five grains of the powdered root, or three
of the powdered seeds, or from thirty to forty
minims of the wine of colchicum root, may
be taken three times in a day by a vigorous
adult. If the medicine is good, it commonly
purges in twenty-four hours, and sometimes
produces vomiting, with prostration of strength,
small pulse, and cold perspiration. These effects give evidence of the full action of the
medicine, but are not always necessary to the
cure of the gouty paroxysm. They disappear
after the colchicum is omitted.
But the arresting of the paroxysm does not
involve the cure of the disease. This more important result requires the avoidance of the



144


ON GOUT.


cause of the evil. The prevention of future
paroxysms can only be expected from a careful
and rigidly abstemious regimen, and this course,
I am happy to believe, will be found effectual
in a great majority of cases. I have known
various examples of persons who had been
severely and repeatedly attacked with gout, yet
who have been able to ward off subsequent
attacks indefinitely, by combining a life of exercise with total abstinence from vinous and
stimulating drinks. This method does not always succeed in confirmed chronic gout, but in
preventing the returns of the acute disease it
is eminently successful. And although in certain cases where the structure and secretions
have become radically changed by the arthritic
diathesis, there is little hope of perfect cure
from any treatment, yet in the early, and sometimes even in the advanced stages of this malady, the recurring paroxysms are postponed,
mitigated, or totally prevented by entire abstinence from vinous and alcoholic stimulants. I
have the happiness to be able to allude to various cases of gentlemen well known in this
city, in some of whom gout has been heredi



ON GOUT.             145
tary, in others of long duration and great severity, as in those already cited on page 49, in
whom an almost perfect exemption from gout,
of indefinite continuance, has followed an entire
avoidance of stimulating liquids.
10



INJURIES BY FIRE.


147


ganized or decomposed; according to their susceptibility of change and the quantity of caloric
received. These processes in the living body
being incompatible with its healthy condition, a
morbid state of the part affected necessarily
ensues. This state is marked by pain, redness,
swelling, vesication, suppuration, or mortification; according to the degree and extent of the
injury suffered.
The distressing effects of these injuries, when
they exist in an extensive degree, are exceeded
by few diseases. Very dangerous cases often
occur in children, whose clothes are accidentally kindled; in intoxicated persons, who fall
into the fire; and in those exposed by conflagrations, or by explosions of gunpowder, steam
boilers, and the inflammable gases of mines.
The peculiar appearance of a burnt surface has
commonly been supposed to require a peculiar
treatment; and many practitioners, instead of
resorting to the general remedies of inflammation, have placed their reliance on the supposed
powers of specific remedies. In this way different and opposite modes of treatment have been
adopted, whose apparent success or failure at



148


148        TREATMENT OF


different times has occasioned disputes respecting their comparative efficacy. After a variety
of trials have been made, and a multitude of
cases detailed, the practice still remains undecided; and methods of treatment diametrically
opposite enlist nearly an equal number of advocates.
The two modes of treating burns and scalds,
which have recently acquired the greatest share
of notice, are those of Mr. Kentish and of Sir
James Earle. The former of these consists in
the use of stimulant, the latter of cooling applications.
Mr. Kentish recommends that the injured
surface be in the first place washed and bathed
with rectified spirit of wine, spirit of turpentine,
or some similar application, which has been
previously heated as far as it can be borne with
the fingrer.  After this bathing has been repeated two or three times, the whole is then to
be covered with plasters made of common
basilicon or resinous ointment, thinned to the
consistence of a liniment with spirit of turpentine.  This dressing is to be continued for
twenty-four hours, after which its place may be



INJURIES BY FIRE.


149


supplied with some less stimulating substance,
such as proof spirit or laudanum, with the
coldness taken off. At the end of forty-eight
hours, Mr. K. observes, the inflammation will
generally be found to have disappeared, at
which time the part may be dressed with camphorated oil, with Goulard's cerate, or with
cerate of lapis calaminaris.
The internal treatment recommended by Mr.
Kentish is also stimulant. Wine, ale, alcohol
or laudanum, are advised to be used according
to circumstances.
Sir James Earle, in a publication, entitled
'An Essay on the Means of lessening the Effects of JFire on the Human Body,' defends a
mode of treatment direcdy the reverse of the
former. This consists of the antiphlogistic regimen internally, together with the application of
cold in the form of water, snow, or pounded ice,
to the part affected. Sir Walter Farquhar and
Dr. Kinglake advocate the same mode of procedure; and the cases related to substantiate
the happy effect of the cooling treatment are
not less numerous than those in favor of the
terebinthinate remedies.



150


TREATMENT OF


The disputes on the comparative efficacy of
the foregoing plans of treatment have been agitated with so much warmth and so little impartiality, that the reader of them is like to end his
inquiries in scepticism rather than conviction.
Inconsistent and opposite facts are often stated,
and the same cases distorted to prove both
points of the dispute.  For instance, the remarkable case of Boerhaave, who was violently
scalded by the bursting of Papin's digester, and
who got well under copious bleeding and purging, is cited by one as an instance of a speedy
and fortunate cure, and by another as a tedious
and difficult recovery, which might have taken
place in half the time under a different mode of
treatment.  The source of this uncertainty
seems, firstly, to consist in making practical deductions from individual or ipsulated cases,
which do not afford sufficient room for a comparison of the effect of different remedies. Such
is the idiosyncrasy of different constitutions, and
so deceptive the appearance of different injuries,
that it is often impossible to pronounce in what
degree two cases rescmble each other, and in
what degree any application has actually expe



INJURIES BY FIRE.


151


dited or retarded the cure. According to the caprice or prejudice of practitioners the account of
a case may be warped and colored in such a
manner as to prove any point of a dispute that
is wished. For example, should any one come
forth as the advocate for a negative mode of
treating burns, which should consist in letting
them alone, or in leaving the process to nature;
there is no doubt that in due time he would be
able to collect a sufficient number of apparently
satisfactory cases to answer all his purposes.
The multitude of cases brought forward by Mr.
Kentish and his opponents, in the aggregate,
seems only to prove, that oil of turpentine and
cold water are both salutary, and both pernicious, according as the practitioner who watched their influence, was under the prejudices of
a favorable or unfavorable nature toward either
application. A second ground of error is likewise contained in the supposition that a single
and specific mode of treatment can be accommodated to all states and degrees of the injuries
occasioned by fire.
It is obvious that many more cases may yet
be detailed, which will not bring the question,



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152        TREATMENT OF


in the least, nearer to a decision. Though a
series of observations, by a faithful and intelligent practitioner, is entitled to respect, yet
when two such courses present us with results
diametrically opposite, we are justified in doubting the validity of the ground on which they
are founded.
It occurred to me, that could a measure be
devised, of inflicting two equal burns on correspondingr parts of the same animal, which
should afterxvard be treated with different applications, that a chance would be afforded of
testing the comparative efficacy of these applications. With this view the following experiments were instituted, which, though not so
numerous and complete as could have been
wished, will not, it is hoped, be thought alto.
gether inapplicable to the object for which they
were attempted.
EXPERIMENT I.
The two eats of a full grown rabbit were
immersed in water, heated near to the boiling
point. Particular care was taken to immerse
both ears at the same instant, to plunge them



INJURIES BY FIRE.


153


to the same depth, and to withdraw them together. In this way two scalds were obtained,
as nearly as possible, equal; since they were
inflicted by the same substance at an uniform
temperature, applied for an equal extent and
length of time to parts corresponding to each
other, equidistant from the centre of circulation,
and both appertaining to the same subject.
The animal was now suspended on his back,
with his right ear immersed in a vessel of warm
water, at about 1000 of Fahrenheit; the left in
a vessel of cold water, having its temperature
reduced by ice. In thiý way they continued
for three quarters of an hour, the temperature
of both vessels being kept as regular as possible by the occasional addition of warm water
and of ice. The two ears were then wiped dry
and covered with common resinous ointment.
2d day. - The right ear, to which warm
water had been applied, was red and opaque,
but the skin remained sound; the left was evidently more inflamed, and contained several
small vesications and excoriations. The heat of
both was somewhat above the natural standard.
3d day.- The cuticle had separated from



154


TREATMENT OF


both ears to some extent, but most from the
left, to which the cold application had been
made. A small slough likewise separated from
this ear.
4th day.- Additional portions had separated
from both ears, but most from the left.
From the fifth to the eighteenth day both
ears continued in a state of ulceration.  The
tip of the ears having been the first part immersed, and the last withdrawn, was of course
the most intensely scalded, and sloughed off
from both to some extent. The left ear, which
had undergone the cold treatment, suffered most
by gangrene, and was several days later than
the other in healing.
EXPERIMENT II.
The two ears of a rabbit were immersed in
scalding water as formerly. The right ear was
covered as far it was scalded with the stimulating ointment of Mr. Kentish, made of basilicon,
thinned to the consistence of a liniment with
oil of turpentine. To the left ear was applied
a saponaceous liniment, composed of equal
parts of lime water and olive oil.



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155


Three hours afterward the ears were examined.  The heat of both was much increased
but that of the right, to which the spirit of turpentine had been applied, was evidently greatest. The pain of this ear was likewise evinced
by the animal lopping it or laying it on its
back, while the other was carried upright.
Some small blisters had risen on this ear, but
none were observed on the other.
2d day. - Both ears were preternaturally
warm and red, the right continuing more so.
They were now covered with resinous ointment.
3d day.- A part of the tip of the right ear
separated, and some of the remainder appeared
destitute of sensation. The left was red and
inflamed, but with no appearance of mortification.
4th and 5th days.- More of the right ear
came off. The left was ulcerated, but without
any appearance of gangrene.
6th-8th days.- The ulceration continued
without any slough from the left ear. About
the 9th day, the weather, which had been temperate, became cool; and the ears, which were



156


TREATMENT OF


kept moist by the ointment and their own discharge, became constantly cold. To this circumstance I attributed the formation of a considerable slough, which came from the right ear
about the tenth, and from the left on the fourteenth day. Both ears soon after healed.
EXPERIMENT III.
The ears of a rabbit being equally scalded as
before, the right was covered with Mr. Kentish's
ointment, while the left was immersed in cold
water with ice for three quarters of an hour.
The left was then covered with basilicon, which
ointment. on the second day was applied to
both.
2d day. - The right ear was blistered, and
discharged a considerable quantity of serum or
pus. The left was in a similar situation, but in
a less degree.
3d.day. - Both ears were in a state of suppuration, but the right much the worst; the
discharge from this ear being general, from the
other partial.
The right ear continued to appear the worst
during the recovery, which was not complete



INJURIES BY FIRE.


157


before the 30th day. The loss of substance by
sloughing was not great from either ear, but
was least from the left.
EXPERIMENT IV.
A fourth rabbit was dipped in the same
manner with the others; afterwards one ear
was immersed in water, the other in proof
spirit at the temperature of the room. The
scalds, however, proved to be slight, as nothing
ensued but a trifling redness and opacity in the
parts immersed, which disappeared in two or
three days, and nearly at the same time from
both. This experiment would not have been
mentioned, did it not serve to show the ground
for fallacy, which arises from comparing the cases
of different individuals. Had the result of this
case been contrasted with any of the former, on
presumption that the injuries received were
equal, a very erroneous deduction might have
been the consequence.
The foregoing experiments were conducted
on a plan, which, I conceive, were it pursued to
a considerable extent, would approach as near



158


TREATMENT OF


to demonstrative certainty, as any subject in
conjectural science of medicine is capable of
arriving. A desire of the truth, however, obliges
me to state the difficulties which remain, and
which may seem to detract something from the
weight of the experiments.   The ear, which
was the part subjected to experiment, is composed chiefly of cartilage and skin; it is remote
from the centre of circulation, and its powers of
life comparatively feeble. Possibly a different
mode of treatment may suit this part, from that
which agrees with muscles and cellular substance. This is not to be considered as very
probable, since the living animal fibre is apt to
exhibit similar phenomena in any part of the
body under the influence of the same disease.
If any peculiarity existed in the ear, it was
probably that of being less susceptible of the
action of stimuli. A trial would have been
made with some more central part, had the
operation been equally convenient. A second
imperfection in these experiments was caused
by the accession of cold weather, which apparently occasioned a more extensive gangrene,
than would have ensued under the use of the



INJURIES BY FIRE.


159


remedies, without this circumstance. It did
not, however, occur during the first days, so
that the following appearances may be considered as free from fallacy.
1st. The evident increase of heat, pain, redness, vesication, and gangrene, following the
application of oil of turpentine. Exp. ii. and
III.
2d. The increase of most of the same appearances, where cold water was used in contrast
with warm. Exp. I.
As comparative cases come within the plan
of these remarks, the following case, in which
different rerriedies were applied to the same
subject, is extracted from the Medical and Physical Journal, vol. 18, page 209.
'Samuel James, aged forty, had his face,
hands and back most severely burnt by the
explosion of hydrogen gas in a coal mine.
The cold application was used to the face and
hands; the warm oil of turpentine, according to
Mr. Kentish's plan, (originally recommended by
Heister,) was applied to the back, and dressed
afterward with unguent, resinm flav. softened
down with the same: in order to try which



160


TREATMENT OF


mode of treatment afforded the most immediate
ease to the patient, as well as the most expeditious cure.  According to the patient's own
account, the pain of the hands and face was
immediately relieved by the cold application,
but he complained of the oil of turpentine occasioning a smarting sensation on the back for
five or six hours. This mode of dressing was
continued for the space of two days; but observing a considerable degree of inflammation
remaining from the terebinthinate application,
that dressing was changed for the neutralized
cerate, which the patient did not observe, his
eyes being closed by the great tumefaction of
the face; but he expressed the utmost satisfaction from the superior comfort he felt in that
dressing compared with the former. The next
day the back appeared much less inflamed, continued gradually getting better, and was cured
in three weeks. " I am confident," says Dr.
Evans, the relater of the case, "the back would
have gotten well sooner under the cooling plan
of treatment; for the patient constantly complained of the great heat in the part during
the application of the oil of turpentine."'



4 INJURIES'BY FIRE.


161


In a variety of cases which have occurred
under my own observation, it has not been
practicable to contrast the effects of different
dressings; so that little of a decisive nature
can be gathered from them. In one case, however, which I witnessed, of a very severe and
extensive burn in a child aged ten years, which
was occasioned by the clothes taking fire, and
which afterward terminated fatally; the application of the oil of turpentine in the form of a
liniment produced the most violent aggravation
of pain, which did not cease before the patient
was thrown into convulsions. Instances of the
same effect have been mentioned to me by
several medical friends.
Most writers, who appear as principal advocates of any mode of practice, feel obliged to
produce something like a theory or rationale,
which shall account for, or at least apply to the
facts and phenomena adduced. Accordingly,
Mr. Kentish and the others have not omitted
to back their catalogue of cases with a train of
reasoning illustrative of the propriety of their
special applications. Of these the two principal are entitled to a separate attention.
11



162


TREATMENT OF


OF THE STIMULANT PLAN.
In defence of the oil of turpentine and other
stimulant applications, Mr. Kentish states the
following as a law of the system. 'That any
part of the system having its action increased
to a very high degree, must continue to be excited, though in a less degree, either by the
stimulus which caused the increased action, or
some other having the nearest similarity to
it; until, by degrees, the extraordinary action
subsides into the healthy action of the part.'
It has also been urged by supporters of the
plan, that a lesser stimulus, as the oil of turpentine, is Comparatively sedative in its operation on a part violently excited by a burn. The
above reasoning may amuse the imagination,
but does not satisfy the judgment. The analogy of almost every subject in medicine and
surgery teaches us, that a part already highly
irritated. receives no benefit from an additional
stimulus, which must tend only to increase the
sum  of the irritation.  If a man bruise his
finger, do we, by way of expediting the cure,
proceed to bruise it again, but with less violence, because 'it must continue to be excited



INJURIES BY FIRE.


163


in a less degree,' ' until the extraordinary action
subsides into the healthy action of the part?'
Or if a man has received an hundred lashes,
shall a surgeon prescribe ninety more, because
ninety lashes are less stimulating than an hundred, and therefore comparatively sedative?
The propriety is just the same, when we irritate
with acrid spirit of turpentine a part already
suffering violent pain and inflammation, as well
as increased sensibility, from a burn. Though
the spirit of turpentine applied to a healthy
surface is less injurious than fire, yet if we
apply the one to a part already injured by the
other, we only inflict a double evil, or produce
an aggregate of the mischief of both.
With regard to the internal stimulant plan
of Mr. Kentish, it is advocated on a ground
not less exceptionable.  He assumes it as a
fact, that 'a healthy, vigorous man' suffers less
by a burn of the same extent, than ' a man of
an irritable habit;' and from thence he infers
that strength resists the ill consequences of
these injuries, while weakness promotes them;
and that therefore, in all cases, 'we should
make the system as strong as we can immedi



164


TREATMENT OF


ately on the attack.' Whether this principle
be just may very properly be questioned, since
it is an admitted fact, that from   ordinary
mechanical injuries, a vigorous, plethoric man
suffers a higher degree of inflammation, than
one whose strength and quantity of blood are
less, and whose powers of reaction of course
are more feeble. When a common injury takes
place, which is capable of producing inflammation and symptomatic fever, depletion and the
antiphlogistic regimen are resorted to as preventives; and this in a greater or less degree,
according as the subject is more or less plethoric. For instance, if a vigorous men receive
a contusion on any part of his body, so violent
as to endanger suppuration or gangrene, we
prevent or mitigate these symptoms by bloodletting, purging, and abstinence. Now if the
same man had received a burn on the same
part, endangering the same symptoms, ought
our practice to be different? Is the system so
revolutionized as to require opposite treatment,
because an injury is caused by fire instead of
mechanical violence? Or is a stout and plethoric patient, with a full, hard, and frequent pulse,



INJURIES BY FIRE.


165


to be stimulated with brandy and laudanum,
because his fever originated in a burn? It is
certainly the height of empiricism to prescribe a
specific mode of treatment for a disease, merely
from its name. A rational treatment is always
dependent on circumstances, and is stimulant
or sedative, according to the constitution of the
patient, the state of the pulse, and the condition
of the system.
OF THE COOLING PLAN.
Sir James Earle, and Dr. Kinglake, the former
in his Essay, and the latter in the Medical and
Physical Journal, have advocated a mode of
treatment precisely opposite to that of Mr. Kentish; yet, like him, they seem to have erred in
pursuing a favorite remedy to extremes. The
general and continued application of cold to a
part injured by a burn or scald, is resorted to,
from a belief of its tendency to abstract the
excess of caloric from the part, and to restore
the equilibrium. This belief is a just one, so
far as it applies to the application of cold for a
short time, immediately after the injury from a
heated substance is received; but the continued



166


TREATMENT OF


application of it for hours and days on the same
principle, is altogether unphilosophical, and has
been sufficiently refuted in the treatise of Mr.
Kentish. Every particle of caloric communicated to the living body by a hot substance,
may be abstracted in one minute by plunging
the part affected in cold water; and if this immersion be continued, the temperature will soon
be reduced below the natural standard. It is
true that on withdrawing the affected part, its
temperature will soon rise to the former pitch;
but this increased temperature can be nothing
more than animal heat, a little increased by the
violent action of the part, as happens in most
cases of inflammation. As to the common
phrase of 'killing the fire,' by which is meant
only the relief of pain that takes place at the
commencement of resolution or suppuration;
this cannot be hastened by cold applications,
except in slight cases which admit of resolution; whereas, in cases where blisters have
arisen, and suppuration is about to take place,
its progress is only retarded by the employment
of cold.
With regard to the antiphlogistic regimen,



INJURIES BY FIRE.


167


nothing more need be said, than that its use or
omission must be determined altogether by the
state of the system.
It may be proper in this place to say something respecting the use of alcohol, ether, and
proof spirit. These substances are often recommended in a vague manner, without reference to the mode of their application, although
on this circumstance depends their efficacy. If
a part of the body be washed with cold spirit,
or a thin cloth wet with spirit be applied, the
rapid evaporation which takes place, renders
the effect powerfully refrigerant. On the contrary, if the part be immersed in spirit, or the
spirit be applied warm, or with a thickly folded
cloth, its operation is unquestionably that of a
stimulant.
After considering at length the opposite extremes of treatment which have been adopted,
the result of both reason and experiment appears to be, that the two extremes are alike
injudicious when pursued in their full extent,
and neither of them suited to the varieties of
burns and of constitutions.  An intermediate
plan of treatment, which shall vary according



168


TREATMENT OF


to circumstances, and be dependent on the decree and state of disease, is undoubtedly the
most deserving of attention.
In slight burns where no vesications take
place, and where resolution appears practicable,
we should resort to cooling applications, either
water or of spirit; since in this way the most
speedy relief is generally given to the pain, and
likewise, as in other inflammations, resolution
is accelerated. The preparations of lead, or any
other discutient, may be added when thought
proper. In all cases of burns and scalds it may
be expedient to make one application of cold
water as soon as possible after the injury, to
abstract the heat from the clothes, skin, &c.,
and prevent the spreading of its effects.
In more iolent burns, attended with blisters
and acute pain, a permanent relief is to be expected only from  suppuration.  This is promoted, as in other cases of suppurative inflammation, not by acrid stimulants, not by snow
and ice; but by mild emollients and warm fomentations or poultices. Though cold applications, by benumbing the nerves, may afford a
temporary relief of pain, yet this returns with



INJURIES BY FIRE.


169


equal or increased violence when these applications are discontinued; so that they must be
persevered in for a long time, until tardy suppuration appears in spite of them, before effectual relief is given. In the first experiment on
the rabbits, the ear which was immersed in cold
water fared worse than its fellow, which was
dipped in warm. In the treatment of burns
tending to suppuration, perhaps no application
is better than a liniment of lime water and oil.
This is very gently soothing and astringent,
and by its saponaceous quality unites with the
discharge, and  is thus more generally and
equally applied than any unctuous substance
would be in its place.
In very violent burns, where the life of a part
is destroyed, or where the inflammation is so
great as to render mortification to a considerable extent probable, our treatment must depend
on the state of the system and the appearance
of the part. If marks of active inflammation
are present, with increased heat and force of
circulation, a sedative and depleting plan is to
be followed, until the violent action has abated.
On the contrary, if the inflammation be of the



170


INJURIES BY FIRE.


passive kind, with diminished action of the
part, and atony and prostration of strength in
the system, we may then depend on stimulants
and antiseptics. It can be only in burns of this
kind that Mr. Kentish's method of treatment
is admissible in any extent.
In the subsequent treatment of burns, if exuberant granulations arise, they may be repressed by gentle astringents, by pressure, or by
escharotics. Mr. Kentish recommends powdered chalk, but this I have found insufficient
when mixed with a third part of burnt alum.
Pure alum answers the purpose perfectly well.
The separation of sloughs is facilitated, according to Mr. Kentish, by introducing powdered chalk into the cavities between them and
the living parts.
The contraction of the cicatrix is often an
unpleasant consequence of burns. It may be
obviated in a degree by a proper position of
the cicatrizing part. Sometimes the contraction is so great as to impede circulation; in
which case it is necessary to divide the newly
formed skin in different places, thus allowing it
room to expand.



172 -

ON THE BURIAL


a greater share than formerly of the public attention in our own vicinity. It involves not
only considerations which belong to the general convenience, but includes also the gratification of individual taste, and the consolation of
private sorrow. Although, in a strictly philosophical view, this subject possesses but little
importance, except in relation to the convenience of survivors; yet so closely are our sympathies enlisted with it, so inseparably do we
connect the feelings of the living with the condition of the dead, that it is in vain that we
attempt to divest ourselves of its influence. It
is incumbent on us therefore to analyze, as far
as we may be able, the principles which belong
to a correct view of this subject; since it is
only by understanding these, that we may expect both reason and feeling to be satisfied.
The progress of all organized beings is towards decay. The complicated textures which
the living body elaborates within itself, begin
to fall asunder almost as soon as life has
ceased. The materials of which animals and
vegetables are composed, have natural laws and
irresistible affinities which are suspended during



OF THE DEAD.


173


the period of life, but which must be obeyed
the moment that life is extinct.  These continue to operate, until the exquisite fabric is
reduced to a condition, in no wise different
from that of the soil on which it has once
trodden. In certain cases art may modify, and
accident may retard, the approaches of disorganization, but the exceptions thus produced
are too few and imperfect, to invalidate the
certainty of the general law.
If we take a comprehensive survey of the
progress and mutations of animal and vegetable
life, we shall perceive that this necessity of
individual destruction is the basis of general
safety. The elements which have once moved
and circulated in living frames do not become
extinct nor useless after death; they offer themselves as the materials from which other living
frames are to be constructed. What has once
possessed life is most assimilated to the living
character, and most ready to partake of life
again. The plant which springs from the earth,
after attaining its growth and perpetuating its
species, falls to the ground, undergoes decomposition, and contributes its remains to the nour



174


ON THE BURIAL


ishment of plants around it. The myriads of
animals which range the woods, or inhabit the
air, at length die upon the surface of the earth,
and, if not devoured by other animals, prepare
for vegetation the place which receives their
remains. Were it not for this law of nature,
the soil would be soon exhausted, the earth's
surface would become a barren waste, and the
whole race of organized beings, for want of
sustenance, would become extinct.
Man alone, the master of the creation, does
not willingly stoop to become a participator in
the routine of nature.  In every age he has
manifested a disposition to exempt himself, and
to rescue his fellow, from the common fate of
living beings. Although he is prodigal of the
lives of other classes, and sometimes sacrifices
a hundred inferior bodies, to procure himself a
single repast, yet he regards with scrupulous
anxiety the destination of his own remains;
and much labor and treasure are devoted by
him to ward off for a season the inevitable
courses of nature. Under the apprehension of
posthumous degradation, human bodies have
been embalmed, their concentrated dust has



OF THE DEAD.


175


been inclosed in golden urns, monumental fortresses have been piled over their decaying
bones; with what success, and with what use,
it may not be amiss to consider.
I have selected a few instances, in which
measures have been taken to protect the human
frame from decay, which will be seen to have
been in some cases partially successful, in
others not so. They will serve as preliminaries
to the general considerations which are connected with the subject.
One of the most interesting accounts of the
preservation of a body, the identity of which
was undoubted, is that of the disinterment of
King Edward.1. of England. The readers of
English history will recollect that this monarch
gave, as a dying charge to his son, that his
heart should be sent to the Holy Land, but
that his body should be carried in the van of
the army till Scotland was reduced to obedience.
He died in July, 1307, and notwithstanding
his injunctions, was buried in Westminster
Abbey in October of the same year. It is recorded that he was embalmed, and orders for



176


ON THE BURIAL


renewing the cerecloth about his body were
issued in the reigns of Edward IIl. and Henry
IV.   The tomb of this monarch was opened,
and his body examined in January, 1774, under
the direction of Sir Joseph Ayloffe, after it had
been buried four hundred and sixty-seven years.
The following account is extracted from a contemporaneous volume of the Gentleman's Magazine.
'Some gentlemen of the Society of Antiquaries, being desirous to see how far the actual
state of Edward First's body answered to the
methods taken to preserve it, obtained leave to
open the large stone sarcophagus, in which it is
known to have been deposited, on the north
side of Edward the Confessor's chapel. This
was accordingly done on the morning of January 2, 1774, when in a coffin of yellow stone
they found the royal body in perfect preservation, inclosed in two wrappers; one of them
was of gold tissue, strongly waxed, and fresh,
the other and outermost considerably decayed.
The corpse was habited in a rich mantle of
purple, paned with white, and adorned with



OF THE DEAD.


177


ornaments of gilt metal, studded with red and
blue stones and pearls. Two similar ornaments
lay on the hands. The mantle was fastened on
the right shoulder by a magnificent fibula of
the same metal, with the same stones and
pearls. His face had over it a silken covering,
so fine, and so closely fitted to it, as to preserve
the features entire. Round his temples was a
gilt coronet of fleurs de lys. In his hands,
which were also entire, were two sceptres of
gilt metal; that in the right surmounted by a
cross fleure, that in the left by three clusters of
oak leaves, and a dove on a globe; this sceptre
was about five feet long. The feet were enveloped in the manile and other coverings, but
sound, and the toes distinct. The whole length
of the corpse was five feet two inches.'
This last statement, it will be observed, is
the only point in which the narrative appears
to disagree with history. We are generally
given to understand that Edward I. was a tall
man; and that he was designated in his own
time by the name of Long-shanks. Baker, in
his Chronicle of the Kings of England, says of
12



178


ON THE BURIAL


him that he was tall of stature, exceeding most
other men by a head and shoulders. I have not
been able to find Sir Joseph Ayloffe's account
of the examination, and know of no other mode
of reconciling the discrepancy, but by supposing
a typographical error of a figure in the account
which has been quoted.
Edward I. died at Burgh-upon-Sands, in
Cumberland, on his way to Scotland, July 7,
1307, in the sixty-eighth year of his age.
Another instance of partial preservation, is
that of the body of King Charles I., who was
beheaded by his subjects in 1649. The remains of this unfortunate monarch are known
to have been carried to Windsor, and there
interred by his friends without pomp, in a hasty
and private manner. It is stated in Clarendon's History of the Rebellion, that when his
son, Charles II., was desirous to remove and
re-inter his corpse at Westminster Abbey, it
could not by any search be found. In constructing a mausoleum at Windsor in 1813,
under the direction of George IV, then Prince
Regent, an accident led to the discovery of this
royal body. The workmen, in forming a sub



OF THE DEAD.


179


terraneous passage under the choir of St.
George's Chapel, accidentally made an aperture in the wall of the vault of King Henry
VIII. On looking through this opening it was
found to contain three coffins, instead of two,
as had been supposed.   Two of these were
ascertained to be the coffins of Henry VIII,
and of one of his queens, Jane Seymour. The
other was formally examined, after permission
obtained, by Sir Henry Halford, in presence of
several members of the royal family, and other
persons of distinction. The account since published by Sir Henry, corroborates the one which
had been given by Mr. Herbert, a groom of
King Charles's bedchamber, and is published
in Wood's Athenme Oxonienses.
'On removing the pall,' says the account,
'a plain leaden coffin presented itself to view,
with no appearance of ever having been inclosed in wood, and bearing an inscription,
1" King Charles, 1648," in large, legible characters, on a scroll of lead encircling it. A square
opening was then made in the upper part of
the lid, of such dimensions as to admit a clear



180


ON THE BURIAL


insight into its contents. These were, an internal wooden coffin, very much decayed, and
the body carefully wrapped up in cere-cloth,
into the folds of which a quantity of unctuous
matter, mixed with resin, as it seemed, had
been melted, so as to exclude, as effectually as
possible, the external air. The coffin was completely full, and, from the tenacity of the cerecloth, great difficulty was experienced in detaching it successfully from the parts which it
enveloped. Wherever the unctuous matter had
insinuated itself, the separation of the cerecloth was easy; and where it came off, a correct
impression of the features to which it had been
applied, was observed.  At length the whole
face was disengaged from its covering. The
complexion of the skin of it was dark and discolored. The forehead and temples had lost
little or nothing of their muscular substance;
the cartilage of the nose was gone; but the left
eye, in the first moment of exposure, was open
and full, though it vanished almost immediately; and the pointed beard, so characteristic of
the period of the reign of King Charles, was
perfect.  The shape of the face was a long



182


ON THE BURIAL


back part of the scalp was entirely perfect, and
had a remarkably fresh appearance; the pores
of the skin being more distinct, and the tendons
and ligaments of the neck were of considerable
substance and firmness. The hair was thick at
the back part of the head, and in appearance
nearly black. A portion of it, which has since
been cleaned and dried, is of a beautiful dark
brown color. That of the beard was a redder
brown. On the back part of the head it was
not more than an inch in length, and had probably been cut so short for the convenience of
the executioner, or perhaps by the piety of
friends soon after death, in order to furnish
memorials of the unhappy king.
'On holding up the head, to examine the
place of separation from the body, the muscles
of the neck had evidently retracted themselves
considerably; and the fourth cervical vertebra
was found to be cut through its substance
transversely, leaving the surfaces of the divided
portions perfectly smooth and even, an appearance which could have been produced only by
a heavy blow, inflicted with a very sharp instrument, and which furnished the last proof wanting to identify King Charles the First.'



OF THE DEAD.


183


The foregoing are two of the most successful
instances of posthumous preservation.  The
care taken in regard to some other distinguished personages has been less fortunate in its
result.  The. coffin of Henry VIII. was inspected at the same time with that of Charles,
and was found to contain nothing but the
mere skeleton of that king. Some portions of
beard remained on the chin, but there was nothing to discriminate the personage contained
in it.
During the present century, the sarcophagus
of King John has also been examined. It contained little else than a disorganized mass of
earth.  The principal substances found, were
some half decayed bones, a few vestiges of
cloth and leather, and a long rusty piece of
iron, apparently the remains of the sword-blade
of that monarch.
The rapidity with which decomposition takes
place in organic bodies, depends upon the particular circumstances under which they are
placed. A certain temperature, and a certain
degree of moisture, are indispensable agents in
the common process of putrefaction, and could



184


ON THE BURIAL


these be avoided in the habitable parts of our
globe, human bodies might last indefinitely.
I shall be excused for dwelling a short time
on the influence of some of these preservative
agents. Where a certain degree of cold exists,
it tends powerfully to check the process of
destructive fermentation, and when- it extends
so far as to produce congelation, its protecting
power is complete. Bodies of men and animals are found in situations where they have
remained frozen for years, and even for ages.
Not many years ago, the bodies of some Spanish soldiers were found in a state of perfect
preservation among the snows of the Andes,
where they were supposed to have perished in
attempting to cross those mountains, nearly a
century ago; their costume and some historical
records indicating the probable period of their
expedition. At the Hospice of the Grand St.
Bernard in the Alps, some receptacles of the
dead are shown to travellers, in which, owing to
the effect of perpetual frost, together with the
lightness of the atmosphere, but little absolute
decay has taken place in the subjects deposited
during a lapse of years. But the most remark



OF THE DEAD.


185


able instance of preservation by frost of an
animal body, is that of an elephant of an
extinct species, discovered in 1806 in the ice of
the polar sea, near the mouth of the river Lena,
by Mr. Michael Adams. This animal was first
seen by a chief of the Tonguse tribe, in the
year 1799,.at which time it was imbedded in a
rock of ice about one hundred and eighty feet
high, and had only two feet, with a small part
of the body, projecting from the side, so as to
be visible. At the close of the next summer,
the entire flank of the animal had been thawed
out. It nevertheless required five summers, in
this inclement region, to thaw the ice, so that
the whole body could be liberated. At length,
in 1804, the enormous mass separated from the
mountain of ice, and fell over upon its side,
on a sand bank. At this time it appears to
have been in a state of perfect preservation,
with its skin and flesh as entire as when it had
existed antecedently to the deluge, or to whatever convulsion of the globe may have transported animals apparently of the torrid zone to
the confines of the Arctic circle. The Tonguse
chief cut off the tusks, which were nine feet



186


ON THE DURIAL


long, and weighed two hundred pounds each.
Two years after this event, Mr. Adams, being
at Yakutsk, and hearing of this event, undertook a journey to the spot.   He found the
animal in the same place, but exceedingly
mutilated by the dogs and wolves of the neighborhood, which had fed upon its flesh as fast
as it thawed. He however succeeded in removing the whole skeleton, and in recovering
two of the feet, one of the ears, one of the
eyes, and about three quarters of the skin,
which was covered with reddish hair and black
bristles. These are now in the museum at St.
Petersburg.
The foregoing facts are sufficient to show
that a Jow degree of temperature is an effectual
preventive of animal decomposition.  On the
other hand, a certain degree of heat combined
with a dry atmosphere, although a less perfect
protection, is sufficient to check the destructive
process.  Warmth, combined with moisture,
tends areatly to promote decomposition; yet if
the degree of heat, or the circumstances under
which it acts, are such as to produce a perfect
dissipation of moisture, the further progress of



OF THE DEAD.


187


decay is arrested. In the arid caverns of Egypt
the dried flesh of mummies, although greatly
changed from its original appearance, has made
no progress towards ultimate decomposition,
during two or three thousand years.    It is
known that the ancient Egyptians embalmed
the dead bodies of their friends, by extracting
the large viscera from the cavities of the head,
chest and abdorhen, and filling them with aromatic and resinous substances, particularly asphaltum, and enveloping the outside of the
body in cloths impregnated with similar materials. These impregnations prevented decomposition for a time, until perfect dryness had taken
place. Their subsequent preservation, through
so many centuries, appears to have been owing,
not so much to the antiseptic quality of the
substance in which they are enveloped, as to
the effectual exclusion of moisture.
In the crypt under the cathedral of Milan,
travellers are shown the ghastly relics of Carlo
Borromeo, as they have lain for two centuries,
inclosed in a crystal sarcophagus, and bedecked
with costly finery, of silk and gold. The preservation of this body is equal to that of an



188


ON THE BURIAL


Egyptian mummy, yet a more loathsome piece
of mockery than it exhibits, can be hardly
imagined.
It will be perceived that the instances which
have been detailed are cases of extraordinary
exemption, resulting from uncommon care, or
from the most favorable combination of circumstances, such as can befall but an exceedingly small portion of the htiman race. The
common fate of animal bodies is to undergo
the entire destruction of their fabric, and the
obliteration of their living features in a few
years, and sometimes even weeks, after their
death.  No sooner does life cease, than the
elements which constituted the vital body become subject to the common laws of inert
matter. The original affinities, which had been
modified or suspended during life, are brought
into operation, the elementary atoms react upon
each other, the organized structure passes into
decay, and is converted to its original dust.
Such is the natural, and, I may add, the proper
destination of the material part of all that has
once moved and breathed.
The reflections which naturally suggest them



OF THE DEAD.


189


selves in contemplating the wrecks of humanity,
which have occasionally been brought to light,
are such as lead us to ask, of what possible
use is a resistance to the laws of nature, which,
when most successfully executed, can at best
only preserve a defaced and degrading image
of what was once perfect and beautiful? Could
we, by any means, arrest the progress of decay,
so as to gather round us the dead of a hundred
generations in a visible and tangible shape;
could we fill our houses and our streets with
mummies, - what possible acquisition could
be more useless, what custom could be more
revolting? - For precisely the same reason the
subterranean vaults and the walls of brick,
which we construct to divide the clay of humanity from that of the rest of creation, and to
preserve it separate for a time, as it were for
future inspection, are neither useful, gratifying,
nor ultimately effectual. Could the individuals
themselves, who are to be the subjects of this
care, have the power to regulate the officious
zeal of their survivors, one of the last things
they could reasonably desire would be, that the
light should ever shine on their changed and
crumbling relics.



190


ON THE BURIAL


On the other hand, when nature is permitted
to take its course, when the dead are committed
to the earth under the open sky, to become
early and peacefully blended with their original
dust, no unpleasant association remains.  It
would seem as if the forbidding and repulsive
conditions which attend on decay, were merged
and lost in the surrounding harmonies of the
creation.
When the body of Major Andre was taken
up, a few years since, from the place of its in.
terment near the Hudson, for the purpose of
being removed to England, it was found that
the skull of that officer was closely encircled by
a network, formed by the roots of a small tree,
which had been planted near his head. This
is a natural and most beautiful coincidence.
It would seem as if a faithful sentinel had
taken his post, to watch, till the obliterated
ashes should no longer need a friend. Could
we associate with inanimate clay any of the
feelings of sentient beings, who would not wish
to rescue his remains from the prisons of mankind, and commit them thus to the embrace of
nature?



OF THE DEAD.


191


Convenience, health and decency require that
the dead should be early removed from our
sight. The law of nature requires that they
should moulder into dust, and the sooner this
change is accomplished, the better. This change
should take place, not in the immediate contiguity of survivors, not in frequented receptacles
provided for the promiscuous concentration of
numbers, not where the intruding light may
annually usher in a new tenant, to encroach
upon the old. It should take place peacefully,
silently, separately, in the retired valley, or the
sequestered wood, where the soil continues its
primitive exuberance, and where the earth has
not become too costly to afford to each occupant at least his length and breadth.
Within the bounds of populous and growing
cities, interments cannot with propriety take
place beyond a limited extent. The vacant
tracts reserved for burial grounds, and the
cellars of churches which are converted into
tombs, become glutted with inhabitants, and
are in the end obliged to be abandoned, though
not perhaps until the original tenants have been
ejected, and the same space has been occupied



194     ON THE BURIAL OF THE DEAD.
of humanity. This can be fitly done, not in
the tumultuous and harassing din of cities,
not in the gloomy and almost unapproachable
vaults of charnel houses; - but amidst the
quiet verdure of the field, under the broad and
cheerful light of heaven, - where the harmonious and ever changing face of nature reminds
us, by its resuscitating influences, that to die
is but to live again.



REMARKS ON PINEUMOTHORAX:
WITH CASES, AND AN EXPERIMENTAL INQUIRY INTO THE CAUSES
OF THE METALLIC SOUNDS HEARD IN THAT DISEASE.
[From the American Journal of Medical Sciences, 1839.]
THE sounds which are heard during auscultation in  cases of pneumothorax, especially
when life has been prolonged for a considerable
time under the disease, have a character, of
which the term metallic is eminently descriptive.  This character may be recognized not
only in the respiration and cough, but frequently
also in the voice and the succussion and percussion of the chest. The sound is either sharp
and tinkling, or it is prolonged, reverberating
and ringing, according to the kind of action
under which it is produced. In both cases the
mechanical condition of the chest is apparently
the same.



196


REMARKS ON PNEUMOTHORAX.


The sounds of pneumothorax, as will appear
from the experiments detailed at the end of
this article, are divisible, with relation to their
causes, into those of impulse, and those of reverberation. The first requires the presence of
liquid, the second may take place with only the
presence of air. The first includes all the varieties of metallic tinkling which are heard in respiration, which also take place after speaking
and coughing, and which may be abundantly
produced in many cases by succussion of the
chest. When well developed it is sharp, silvery
and musical, resembling the note of short brass
wires in certain children's toys. The second
class, that of reverberating sounds, includes the
varieties of amphoric breathing, and may be
imitated by inflating a recent bladder to a considerable degree of tension while in contact with
the ear, or less perfectly by blowing into a glass
or metallic vessel. When a sudden impetus is
given to it by coughing, this sound becomes
more intense, ringing and metallic. The voice
also at times acquires the metallic resonance.
If percussion be performed on the distended
chest, while the ear is applied to its parietes, a.



REMARKS ON PNEUMOTHORAX.


197


ringing sound is communicated, having more or
less of a metallic character.
Metallic tinkling of the chest, although one of
the most marked of the physical signs, appears
not to have been fully explained in regard to
the immediate cause by which it is produced.
Various hypothetical solutions have at different
times been offered, but all of them have been
objected to, or seem liable to objections, on the
score of insufficiency; and no one of them appears at this time to have obtained a general
assent. A brief summary is sufficient to present
the leading features of the different modes in
which this phenomenon has been accounted for.
The only explanation given by Laennec of
this sound is by him considered applicable to
cases of what he calls simple hydro-pneumothorax, in which there is no communication with
the bronchiae; a form of the disease, however,
the existence of which has been doubted by
some subsequent writers. Laennec says that if
a patient happen to raise himself suddenly in
bed, and a drop of fluid fall fron the upper part
of the cavity of the pleura into the fluid beneath,
it produces a sound like that occasioned by a



198      REMARKS ON PNEUMOTHORAX.
drop of water let fall into a flask three quarters
empty, and this sound is immediately followed
by a distinct metallic tinkling. A similar sound
he says may be heard by ausculting the epigastrium of a person who is swallowing water in
minute quantities. This explanation has been
adopted by various subsequent writers, as a
general mode of accounting for the phenomenon
of metallic tinkling.
Dr. C. J. B. Williams, author of valuable
works on diseases of the lungs and pleura, explains metallic tinkling on the principle of
reverberation or echo, produced in a cavity of
uniformly reflecting parietes by the communication of a sound, or of a soniferous impulse to
the air contained within it. He considers that
in common cases of pneumothorax communicating with a bronchus, if the fistulous opening
be small, metallic tinkling will be produced, but
if large, or if several such openings exist, there
will be only amphoric resonance.
Dr. Thomas Davies, in his lectures at the
London Hospital on diseases of the chest, says:
' The metallic tinkling is caused by the resonance of air agitated upon the surface of a



REMARKS ON PNEUMOTHORAX.


199


liquid contained in a preternatural cavity formed in the chest.* This explanation may have
been suggested by a note of M. Meriadec Laennec in his edition of the great work of his relative, who says that the sound in question
appears to depend upon the vibration of a gas
upon the surface of a liquid.
Dr. James Houghton, author of the article
Pneumothorax in the Cyclopedia of practical
medicine, adopts the idea of an echo, which he
derives both from the dropping of fluid in a
cavity, and from the entrance of air through a
fistulous opening. The latter variety, he says,
appears to be manifestly the echo of the air
forced into the cavity, reverberating against its
hollow parietes; and the sound, he thinks, is
more particularly caused by the bursting of
minute air bubbles at the orifice of the fistula,
formed as the air traverses the latter by the entanglement of mucus. He thinks that the tinkling will be more or less loud and distinct in
proportion as the fistulous opening is larger or
smaller.


* London Medical Gazette, Vol. XV.



200      REMARKS ON PNEUMOTHORAX.
Mr. Guthrie, in the London Medical and Surgical Journal, 1833, asserts that Laennec, and
also all who hold that metallic tinlding 'depends
entirely on the passage of air through a hole in
the lung into the cavity of the thorax,' have
been mistaken, and in opposition to this he
mentions that to produce the sound in question,
the air in the cavity must necessarily be compressed.  I do not,' says he, 'deny the facts of
the air, the hole in the lung, or the fluid; but I
believe that to produce the sounds of the Jews'
harp (metallic tinkling) the air in the cavity
must be greatly compressed.'
M. Beau, a French writer on the causes of the
respiratory bruits, is not satisfied with the explanation of Laennec, and contends that metallic tinkling is produced by a bubble of air,
which having traversed the fluid, bursts upon
its surface. He founds his opinion on the fact,
that he has never witnessed metallic tinkling,
when the communication with the external air
was above the level of the fluid. Dr. Spittal, of
Edinburgh, seems to have suggested this explanation of metallic tinkling by the bursting of air
bubbles, as early as 1830.



REMARKS ON PNEUMOTHORAX.


201


Magendie, in his lectures quoted in the Lancet of 1835, says: ' The causes which produce
the tintement metallique, are not by any means
well understood. Suppositions have been made,
(they are made and abandoned with surprising
facility in medicine,) but when Wve come to examine them, we find nothing but mere theories
without any shadow of proof.' He tells us that
the supposition that a drop of liquid sticks to
the upper part of a cavity and then falls into
the fluid below, is mere hypothesis, which may
or may not be true. He also denies the sufficiency of the explanation that the tinkling is
caused by a bubble which traverses a fluid, and
bursts upon its surface.  His objections are
grounded on an experiment, which he proceeds
to repeat in presence of his class, showing the
insufficiency of both these causes to produce
metallic tinkling. In a dead subject, a quantity
of fluid amounting to about half a pint was
thrown into the chest. A perforation was then
made through the pulmonary tissue, so as to
establish a communication between the bronchi
and cavity of the chest. A quantity of air was
then forced in through the trachea, so as to enter



202


REMARKS ON PNEUMOTHORAX.


the pleural cavity. No metallic sound was produced in the operation. Water was then dropped in through an opening in the upper part of
the chest upon the fluid below, but this also
produced no tinkling.  Another orifice was
made in the lung beneath the surface of the
fluid, and air injected as before. A bubbling
sound, or craquement' was heard in the chest,
'but nothing of a metallic or tinkling character
could be perceived. Magendie considers himself as having disproved the explanations to
which his experiments relate, but he does not
offer any new one of his own.
In regard to M. Guthrie's explanation, which
supposes the necessity of compressed air being
-present, this has been effectually set aside by
the fact, that although in extreme pneumothorax, the air in the pleura is moderately compressed, yet metallic tinkling is known to be
also produced in large tubercular cavities of the
lungs, which communicate freely with the atmosphere, and therefore are not subject to any
compression whatever.
The solution of this phenomenon given by
Dr. Davies, and Laennec Junior, that it is caus



REMARKS ON PNEUMOTHORAX.


203


ed by the resonance of air, agitated upon the
surface of a liquid, seems to be too vague and
unsupported to require particular attention.
In'regard to the explanations given by Drs.
Williams and Houghton, which ascribe metallic
tinkling to an echo, or reverberation of air from
the sides of a cavity, the solution seems to me
to be neither adequate nor very probable. Echo
is the secondary sound produced by the reflected vibrations of the atmosphere. It becomes
powerful only when many reflections converge
towards the same point. Air, moreover, is a
feeble conductor of sound, when compared with
liquid or solid bodies. It is unnecessary, therefore, to suppose that one of the most striking
sounds heard in auscultation, is produced by the
secondary movement of a feeble conductor,
when we have between the ear and the place of
impulse, the direct agency of a much more powerful conductor, viz. a liquid. To elucidate
this point, let any one perform the following
experiment. Into a large earthen or porcelain
bowl, pour a few ounces of water. Then produce a slight and barely audible sound, by rubbing or snapping together the ends of the nails



204


CASES OF PNEUMOTHORAX.


of the thumb and finger. If this sound is made
in the air in any part of the cavity of the bowl
above the water, it remains feeble, but if the
nails be immersed below the surface of the water, the sound instantly becomes augmented to
many times its former intensity, and it will be
particularly intense to the ear of an ausculter
applied to the outside of the bowl. Here, then,
is a parallel case. The liquid in Pneumothorax
and not the air, as will hereafter be seen, conveys the sound of metallic tinkling to the walls
of the chest, and these transmit it to the ear of
the ausculter, constituting an uninterrupted
chain of vibrations.
Considering the subject as being yet imperfectly explained, and therefore open to further
inquiry, I have made some experiments in connection with the following cases, which I hope
will not be found irrelevant to the question.
CASE I.-J. B., cordwainer, aged forty-four,
entered the Massachusetts general hospital, December 28th, 1836. He had been troubled with
cough and dyspncea, during most of last year,
increased during summer. Yesterday, after ex



CASES OF PNEUIMIOTHORAX.


205


posure to cold during perspiration, had a sudden
increase of cough and dyspncea with pain shooting from side to side, and hoarseness. Now,
skin hot and dry, face flushed, pulse 98, respiration short, quick, 50 per minute, cough hard,
with viscid frothy mucous sputa. Complains of
pain in head and across hypochondria increased
by upward pressure or cough, tongue white,
costiveness, dysury with frequent micturition.
29th, 31st. Percussion dull on right back,
sufficiently resonant on left. Respiration very
feeble in right back, with a slight bronchial
sound opposite spine of right scapula. Bronchophony well pronounced in same place. Supplementary puerile respiration in left back.
Hoarseness amounting to aphonia, cough frequent, painful, with dyspncea. About 3ii. of
muco-purulent sputa daily.  Costive; sleeps
little.
January 2d, 1837. Has rested and felt somewhat better for two days. In right back respiration nearly inaudible, but voice and cough
distinctly amphoric.
4th. By degrees the respiration in right back
has grown more audible, and amphoric. Per



206


CASES OF PNEUMOTHORAX.


cussion resonant. In left back voice natural,
respiration puerile. Purulent sputa, one to three
ounces.
5th, 8th. Metallic tinkling in right back, at
lower edge of scapula, slight and few, heard on
each day. Amphoric respiration; voice and
cough audible from summit to base of right
chest. Dyspncea and cough more easy. Percussion of right back tympanitic to base of
chest; right back when viewed vertically much
more prominent to the eye than left; semicircumference an inch greater; intercostal spaces
prominent, the anterior ones level in supine posture. In erect posture, base of right chest less
resonant than when lying on face or left side.
9th. Paroxysms of great dyspncea, obliging
him to get out of bed. Breath, voice and cough
amphoric from summit to base of right back.
Frequent metallic tinkling. Resonance of front
and back, of right side on percussion. Purulent
sputa, 5iss.
11th. Rested better; pulse 104; anterior
right chest tympanitic on percussion, with inaudible respiration from top to base; voice
scarcely audible through parietes at same place,



CASES OF PNEUMOTIHORAX.


207


but towards base amphoric.    Respiration in
right back feeble, but amphoric, accompanied by
continual metallic tinkling, frequent and rapid,
resembling the boiling of a fluid in a glass retort or flask.  Respiration highly puerile in
whole left back; slight gurgling under clavicle.
Very great exhaustion and anhelation, after
rising to cough. Generally unable to expectorate unless he turns upon his left side, after
which movement the pus flows freely.
12th, 13th. Many turns of violent and suffocative dyspncea; metallic tinkling softer. Respiration in right back very feeble, in left back
puerile.
14th, 16th. Breathes with more ease. Some
ounces of purulent sputa raised each day. Amphoric or metallic respiration, voice and cough,
with metallic tinkling more rare and feeble.
Right anterior chest quite resonant on percussion, to the extreme base of the chest on inspiration, but about an inch less in extent at expiration.
From this time he continued delirious, with
occasional twitching of muscles; respiration
high and rapid; inaudible, or amphoric, in right



208


CASES OF PNEUMOTHORAX.


front; faint metallic impulses and mucous rales
till the 21st, when he died.
Autopsy, two and a half hours post mortem. -
Emaciation not great; right side of thorax enlarged; intercostal spaces obliterated, this side
measuring an inch more than the left, opposite
the lower end of the sternum. Percussion resonant, for a quarter of the semi-circumference,
flat behind. Succussion of the chest gives a
distinct metallic sound from the motion of fluid.
The right chest when perforated through water
(see Experiment I.), discharged much air, and
subsided gradually.
Thorax. Right pleura with strong old adhesions at apex, and along mediastinum; elsewhere
covered with false membranes, mostly free, soft,
whitish, recent. Its cavity contains nearly two
quarts of opaque sero-purulent fluid, with detached flocculent masses of lymph. The lung
being inflated in situ, air issued freely from behind the base near the spine, but the orifice
could not subsequently be identified, on account
of the rupture of cavities made in removing the
adherent lung from  the chest.  Right lung
greatly compressed, condensed, and nearly de



CASES OF PNEUMOTHORAX.


209


void of air, the upper lobe half destroyed by an
abscess, a cavity an inch square in the upper
part of the lower lobe, and tubercles scattered
through all. Left pleura with some old adhesions. Lung large, somewhat emphysematous,
upper and lower lobes tuberculous, a cavity capable of holding gi. in the upper part of the
lower lobe. Air passages of natural size, some
redness in right bronchi.  Glands at bifurcation of trachea healthy; those in upper part of
thorax and the cervical enlarged and moist, but
not tuberculous.
Pericardium  contained about an ounce of
turbid serum, with flocculi of recent lymph;
heart healthy; right auricle slightly adherent;
blood in right side partly liquid, partly coagulated, with some fibrin; in left auricle the same,
but no separate fibrin.
Abdomen. Liver of average size, rather dark
and friable, pushed down so as to reach the umbilicus, compressed so that its superior and
anterior surfaces formed a right angle. Gall
bladder containing Pv. of very dark viscid bile.
Stomach sufficiently healthy, except some small
14



210


CASES OF PNEUMOTHORAX.


red spots about the small curvature. Mucous
membrane of small intestines healthy.
CASE II.-I. C., aged forty-four, sailor, entered
the hospital May 28th.* He was previously in
the house three months ago with cough, and
slight tuberculous signs. He now reports that.he kept at work continuing pretty well until
May 24th, when he had headache and dizziness
in the afternoon, referred to having got wet in,the rain the night before; in the evening fainted, and in the night had coughing and retching;
raised without pain 5ss. more or less of frothy
blood; has had much cough since, mostly in the
night, with scanty expectoration of frothy mucus; cough and long inspiration have caused
pain in the right side, and across the chest; has
had no other pain, no chills nor flushes; but has
perspired considerably; has had little appetite
and:much:thirst, bowels have been open daily;
prine high colored; feels very weak; tongue
clean, fo.r most, part, a' little coated at roots;
pulse 118.
"* This case was most of the time under the care of Dr. Hale.



CASES OF PNEUMOTHORAX.'


211


29th. Slept better than out of, house, but
coughed considerably towards morning.
30th. 'Rested badly from' great dyspnoea,
which came on between nine and ten last night;
bathed in: a sweat; pulse 96;' mucous rale in
the throat;' amphoric sound in' respiration below
left scapula; percussion resonant in the: same
place;, respiration puerile on the other side; lies
on the right, much distressed by lying on the
back or left side. Half a pint of thin mucous
fluid sputa, frothy on top and opaque.
31st' Rested 'badly from dyspncea requiring
him to maintain a stooping posture; five or six
dejections; pulse 132 sitting up; dyspncea now
less' urgent;[ a highly' distinct metallic tinkle
heard in the left chest, disappearing when he
stoops forward,. returning as he bends back.
Just below the angle of the left scapula strong
amphoric respiration with clear metallic tinkle.
In.axillary region sound as of striking a brass
vessel with a nail; great resonance of the left
chest, both behind and in front, on percussion.
Strongly puerile respiration in the right back.
June 1st. Slept half the night, by intervals,
sitting up and stooping forward. No dejection;



212


CASES OF PNEUMOTHORAX.


pulse 144; tongue moist, thick coat on centre,
livid; countenance distressed, anxious; respiration 32, laborious; no pain when at rest, but on
motion sharp pain through the left chest, below
the region of the heart; speaks only in a whisper; feet and ankles cedematous; whole left
chest, both front and back, very resonant; respiration amphoric, with metallic tinkling loud and
musical in the whole left back below spine of
scapula, and whole left front from clavicle downwards.
2d. Slept pretty well in the same posture as
last night; two dejections; countenance anxious; skin warm, with profuse perspiration;
pulse 144; tongue white in centre, livid, moist;
respiration 30, laborious; voice better than yesterday; amphoric resonance diminished; metallic tinkling as yesterday.
3d. Slept pretty well in his chair, as before;
pulse 128; respiration 32, somewhat less laborious, except after coughing; unable to lie down;
cough not frequent, but paroxysms long and
severe; percussion every where very resonant
in left chest except for a small space about spine
of scapula, where it is only equal with the right;



GASES OF PNEUMOTHORAX.


213


resonance continues to the very base of chest;
respiration vesicular, but feeble about spine of
scapula; amphoric in lower half of back; natural respiration without metallic tinkle; after
coughing large and musical tinkle; in front no
respiration heard below line one inch below
nipple, above that metallic tinkle for the space
of two or three inches, and above amphoric resonance in natural respiration; in forced respiration metallic tinkle over whole left chest; no
resonance of voice; in right chest respiration
puerile.
4th. Slept pretty well in posture as for the
last four nights; countenance less distressed;
pulse 124; cough less difficult, but still laborious; about 5iss. of adhesive muco-purulent
sputa; skin moist and warm; resonance of left
back less than for some days past, though still
greater than natural except about scapulm; immediately over and above scapulm, percussion
nearly or quite equal in both backs; on two
lower ribs of left back percussion resonant while
leaning forward, flat on leaning backwards;
respiration in left back vesicular about scapulm
and for an inch or two below, then am phoric for



214


CASES OF PNEUMOTHORAX.;


a space about the breadth of the hand, inaudible
at base; no resonance or tremor of voice discovered either in back or side; metallic tinkling
in front as before; also in back after cough.
Sudamina above and about clavicles.
5th. In bed most of. the night lying on right
side; slept two or three hours; four or five de.
jections; countenance improved; 3ii. of adhesive
muco-purulent sputa; pulse:108; tongue.clear
at edges, moist, coated. in centre; percussion
resonant down to sixth rib in left, chest; flat
immediately below; equal in both backs over
scapulae, and for two fingers' breadth below;
below that much more resonant on left side;
down to last rib, while leaning forward. When
leaning back, more dull in the.whple of the resonant space in back. Natural respiration vesicular about scapule, with sonorous rale; below
scapule, amphoric resonance. In, front, metallic tinkle after cough; metallic tinkle also in
back. No resonance of voice at base of chest.
7th. In chair all night; slept three hours at
intervals; five dejections; countenance more
distressed; pulse 132; respiration' 36, more labored than for the last two or three days.


- -<,,-,-'--3%^



CASES OF PNEUMOTHORAX.


215


Tongue cleaner, rather less livid; nearly 3ii.
adhesive sputa; coughs, he thinks, about once
an hour;"percussion dull in back on lower rib,
when leaning forward; respiration amphoric
both in front and back; natural breathing unaccompanied by tinkle.
8th. Kept awake by difficulty of breathing.
Cough less; expectoration about 5i. adhesive
purulent mucus. Countenance much distressed,
pulse 132; tongue more coated; respiratibn 32,
labored. Hair, skin and clothing wet with perspiration.  In natural respiration very little
sound perceived, except some amphoric resonance and occasional metallic tinkling. Percussion, when leaning much forward, flat oh
lower rib, resonant above; when sitting up,
flat on four lower ribs.  A peculiar metallic
ringing sound perceived by car applied to sternum, when the back is percussed.
11th. In chair all night; slept none from
dyspncea; some pain in left chest; two dejeetions; countenance much distressed; coughs
little; expectoration pretty easy; 3ii. of adhesive
muco-purulent sputa; pulse 144; percussion
flat below nipple, also in back below corres



-216


CASES OF PNEUMOTHORAX.


ponding line, resonant above; sonorous rale
in whole front chest. No other sound in natural breathing. Amphoric resonance in back,
feeble in natural breathing, loud and musical
after cough. After speaking, metallic tinkling
in front.
12th. Lay on couch all night without having
head much raised. Could lie on left side as
well as right, the first time for several weeks.
Rested very well, but did not sleep much; one
dejection; respiration 36, somewhat labored,
but less so than for several days past. Countenance less distressed; pulse, after waking, 108;
tongue much less livid, moist, with a broken
coat in centre. Percussion of left chest (still
lying on left side) quite resonant, except at most
dependent part of side, where it is flat.  In
natural respiration, the only sound heard is sibilant rale both in front and back. Forced respiration, either in speaking or other effort, amphoric. Coughed but little; less than 5i. adhesive,
white, frothy, mucous sputa. Immediately after
rising, loud, ringing, amphoric resonance in respiration, and especially in cough, heard both in
back and front. Limit of flat sound on sitting,



CASES OF PNEUMOTHORAX.


217


on a line an inch below   the nipple.   Same
metallic ringing sound on percussion of chest as
before.
13th. In erect posture most of night; slept
little from  dyspncea; three dejections.  Discharge from bowels thin and watery; countenance moderately distressed; perspiration not
excessive; pulse 116, tolerably full; respiration
36, high, laborious. In erect position, resonance
on percussion extends down to one finger's
breadth below nipple. Below this line, intercostal spaces on a level with ribs; above, intercostal spaces projecting, resonant. In ordinary
respiration, amphoric resonance loud and distinct in upper part of chest. A ringing sound,
on percussion, as before. No metallic tinkling
heard. Abdomen full, moderately resonant.
14th. Slept very well, lying down, on either
side; four dejections. Countenance less distressed; feels better; pulse 108; respiration 36,
moderately labored. Inspiration and expiration
nearly equal. Percussion flat below line, a finger's breadth below nipple, resonant above.
Same ringing sound as before, on percussion.
Sounds of fluid readily distinguishable on sue



-CASES OF PNEUMOTHORAX.


219


livid; skin cool and moist. Pain near left nipple if. he lies on left side; no pain when at rest
in any other Position. Very little cough, ~ii.
frothy mucous sputa.' Line of flat sound level
with nipple; respiration in right chest loud and
coarse. Sounds in left chest as before.- Ringing sound on percussion perceptible when percussion is on same surface with ear, in erect
position.
18th. At six and a half A. M. found lying
on back with shoulders raised, breathing quick
and with tracheal rale. Eyes closed; pulse very
small and feeble; extremities cold.' Died soon
after.
Autopsy, eight hours post mortem. Body not
much emaciated, skin livid, lower extremities
cedematous.
Left chest quite resonant to a line with axilla;
flat behind this'line. Right sidedull over whole
space below pectoral muscles. The air rushed
out from a perforationwon left side, as detailed
in Experiment I. Left pleura universally inflamed, mostly red and roughened, and lined
with a soft, bluish-white false membrane of
variable thickness, separable in some places into



220


CASES OF PNEUMOTHORAX.


layers, containing about five pints of thin, puru.
lent, inodorous liquid, with coarse masses of
lymph lying loose in the depending parts. Left
lung collapsed very small, fleshy, bluish-black,
pressed against spine and ribs, and nearly destitute of air, having a coat of lymph, and adhering behind superiorly. A rounded fistulous
opening was found, half a line in diameter, and
situated on the posterior surface of the lower
lobe, an inch and a half below its summit.
Through this orifice air issued, if blown into
the trachea, and a probe pressed upwards entered a large bronchus. This opening communicated immediately with a superficial cavity an
inch long by half an inch broad, and which contained a whitish, friable, opaque substance. No
other cavity was found, but small tubercles and
gray granulations in various parts of this lung.
The bronchi contained bloody fluid, were pale,
thin and polished, excepting that which led to
the cavity, and which was thickened, darker,
and less polished.
Right lung universally adherent by pale, soft,
friable, recent membrane, forming bands below,
some of them an inch long, among which were



CASES OF PNEUMOTHORAX.


221


cavities, containing gviii. of reddish fluid. This
lung contained many tubercles, and a cavity an
inch long at its apex.
In front of the neck was a tumor, occasioned
by an abscess situated between sterno-hyoid
muscles, containing 5ss. of pus, with a lining of
tuberculous-looking matter.
Pericardium pushed to the right side, more
than two-thirds of it beyond the median line.
Heart healthy, except perhaps slight hypertrophy
of left ventricle, which measured five-eighths of
an inch thick at base, and five-sixteenths at
apex. Weight, nine and a half ounces.
Liver somewhat enlarged, rather dark, pushed
down within an inch or two of the umbilicus.
Small intestines tuberculous, especially on Peyer's plates, towards the end of the ilium, but no
ulcers. Other viscera mostly natural.
CASE IIL- A. C., a young gentleman, aged
twenty, called me to visit him June 28th, having
just returned from a journey to the South. He
reported, that two years previously he had had
a 'lung fever,' since which time his health has
not been good. Last summer he was troubled



222Q


CASES OF PNEUMOTHORAX.,


with slight pains in the chest, emaciation, loss
of strength, and some hectic symptoms, but
does not recollect much cough. Being considered phthisical by,his physician, he had been
advised to pass the winter in the southern'states.
My first visit was made to him on the second
day after his return,, and one day before his
death.. I found him thin and feeble, barely able
to sit up, with a hot skin and circumscribed
redness on his cheek. Dyspncea by no means
urgent, decubiture dorsal, pain. and stricture
across both hypochondria, and none felt elsewhere; pulse 80. Left chest tympanitic, respiration inaudible; a slight metallic tinkle heard
singly at each inspiration and expiration. Pulsations of heart feeble in cardiac region, stronger
on right side. On the following day, without
any great aggravation of dyspncea. or. distress,
he became much prostrated, with a small, irregular pulse, cold sweats, and diminished; serisibility, and died on the succeeding night. By
his own testimony and that of his friends, his
cough had been slight, and the dyspncea at no
time urgent.
Autopsy, sixteen hours after death.  The



CASES OF PNEUMOTHORAX.


223"


whole anterior chest resonant, the left tympanitic.  On perforating the left chest through
water, great quantities of air escaped. [See Experiment I.]  The quantity of sero-purulent
fluid was not estimated, water having been
thrown into the chest for the sake of the experiment. The left lung was adherent superiorly and posteriorly, and had tubercles and
cavities in its upper lobe. The lower part of
the same lobe was indurated by tuberculous
infiltration, and had about the color of gray
hepatization. No communication between the
bronchie and chest was detected except those
produced in the cavities torn in the separation.
Right lung healthy, excepting a few tuberculous
lumps in its upper lobe. The heart was very
small and flaccid, and was pushed almost
wholly into the right chest. Mitral valves somewhat thickened at their roots with slight vegetation. Liver depressed, dark purple, flaccid.
Gall-bladder healthy.
I consider the last case as noticeable for the
absence of any great dyspnaea or distress, after
the signs of pncumothorax were so distinct as
to lead to an unequivocal diagnosis of that dis



224


CASES OF PNEUMOTHORAX.


ease. I have seen similar cases where the pneumothorax was partial, owing to the adhesions
of the lung preventing collapse, a case not
wholly uncommon.
EXPERIMENT I.-Previously to the autopsies
of the patients who were the subjects of Cases
I. and II., a glass cylinder, open at both ends,
was pressed into close contact with the chest, so
as to hold water. Some ounces of that fluid
were poured in, and a perforation was made
through it, into the cavity of the chest on the
distended side. Immediately a large volume of
air escaped from the chest, bubbling upwards
through the water. In the third case, no cylinder being at hand, a superficial cavity was made
out of the dissected integuments of the chest,
and filled with water. Through this water a
perforation of the chest was made on the left
anterior surface. The air rushed out, producing
strong ebullition, as in the former cases. The
experiment was then repeated on the right side,
and the perforation made through water as before. No air in this instance escaped, but the
water was immediately sucked into the chest
by the atmospheric pressure.



225


EXPERIMENTS.


EXPERIMENT II.- Artificial respiration was
produced in the body of the subject of Case II.,
by inflating the lungs through the trachea, and
expelling the air by pressure on the abdomen.
At each inflation, a most distinct, clear and
abundant metallic tinkling was produced, accompanied with more or less amphoric sound,
and could be sustained ad libitum by repeating
the inflation.  The sound was recognized by
several of the medical gentlemen attached to
the hospital,* as being the same which had existed during the patient's life.
This experiment was repeated in the examination of the body of the patient in Case III.
It produced amphoric sound, but no tinkling.
The latter symptom, it will be observed, was
but feebly perceptible in examinations during
life.
EXPERIMENT III.- Through an aperture in
the anterior part of the chest in the subject of
Case II., a catheter was introduced and air
blown through it into the cavity of the left
pleura.  While the end of the catheter was
* Among the gentlemen present were Drs. Hale, Strong,
Bowditch and Sargent.
15



226


CASES OF PNEUMOTHORAX.,above the level of the fluid, a strong amphoric
-buzzing was communicated to the ear of an ob-server in contact with the chest. But when the
end of the instrument was pushed below the
surface of the liquid, and the latter made to
'bubble by continuing the inflation, an exquisite
-metallic tinkling was heard at the explosion of
each bubble, resembling, as it had done in
'life, the sound of a little bell or musical wire.,In the subject of Case III. this experiment
-was repeated, and varied by pouring into the
'chest different quantities of water. When a
few ounces only were present, metallic tinkling
-was uniformly produced, but when two quarts
-or more were introduced, a bubbling only was
heard, without metallic resonance. Similar results were also obtained by pouring a small
stream, or letting fall drops of water from above
upon the liquid in the chest.
EXPERIMENT IV. - Succussion and percussion were both found to produce the same metallic sounds in the dead body as during life in
Case II. Metallic sounds elicited by percussion
somewhat resemble those occasionally yieldedby the heart, and, as has been observed by



EXPERIMENTS.


227


Bouillaud, these may be imitated by percussing
the back of the hand pressed closely upon the
ear, or by closing both ears with the palms of
the hands, and walking on a carpet in a still
room.
EXPERIMENT V.- In the body of a person
recently dead from accident, having no pneumothorax, a repetition was made of several of the
foregoing trials.  Air and water were forced
into the chest, the former so as to distend the
cavity and render percussion quite resonant.
Ebullition of the fluid was then produced by
blowing through a tube inserted between the
ribs and pushed below the surface. The only
result was a bubbling noise, having not the
slightest metallic character. It will be observed
that this was nearly a repetition of Magendie's
experiment, and it probably failed to produce
metallic sound for the same reason as in that
case, viz. that the patient was not pneumothoracic.
EXPERIMENT VI.- A bladder, and afterwards
a stomach, each containing a few ounces of
water, were inflated until thoroughly distended.
Whenever the inflating tube was pushed below



228


CASES OF PNEUMOTHORAX.


the surface of the liquid, and the inflation continued so as to produce bubbles, a sharp tinkling was heard upon the explosion of every
bubble, by the ear applied as in, ausculting to
the outside of the bladder. In this experiment
the sound becomes more exquisitely metallic, in
proportion as the tension of the bladder is increased by farther inflation. Succussion, of the
bladder produces a similar effect. It is necessary that a recent bladder should be used, the
texture and elasticity of which are not altered
by drying. When the orifice of the tube is
above the surface of the water) also when no
water is present in the bladder, an intense amphoric sound is produced during inflation; and
if saliva or other liquid, in small quantities, is
blown through the inflating tube, a more feeble,
or submetallic tinkling is produced.
From the foregoing experiments and cases,
we may infer that the following agencies are
concerned in producing metallic sounds of the
chest.
1. There must be a cavity, the walls of which
are preternaturally susceptible of vibration.



REMARKS.


229


This takes place when the pleura is pathologically distended, so as to overcome the obtuse or
muffling effect of the contiguous soft organs,
such as the lung, diaphragm  and intercostal
muscles. Some time is probably necessary to
prepare the parts for this pathological resonance,
since it fails to appear post mortem in healthy
chests submitted to experiment. It should be
added, that when metallic sounds appear in
simple phthisis, there are cavities of the lungs,
the walls of which are in a state of tubercular
induration,
2. The, immediate or exciting cause of metallic tinkling, is a forcible or sudden disturbance
of th~e liquid in a vibrating cavity like that
described.  The explosion of bubbles of air
from beneath the surface of the liquid, appears
to be the most common cause of such a disturbance; but it may also take place when a
part of the liquid is thrown upward in the act
of coughing and falls back upon the remainder.
The same occurs in succussion of the chest.
3. The vibrations which yield metallic tinkling are transmitted from the liquid to the solid
parietes, and thence directly to the ear, without



230


REMARKS ON PNEUMOTIIORAX.


any necessary agency of an echo, or reverberation of air in the cavity. This is shown particularly by the experiment of the bowl, page 203.
4. A minor, or submetallic tinkling, having no
musical resonance, may be produced by slight
impulses given to the air in the cavity, such as
the breaking of bubbles of mucus at orifices
above the surface of the liquid.
5. Amphoric resonance is produced by reverberations of the air in a vibrating cavity, without sonific impulse of the liquid. The same is
true of metallic modifications of the voice, and
of the cough when there is no tinkling. Metallic percussion seems also to depend upon the
vibrations of air independently of liquid, and
may be produced in some other cases when we
strike upon a tense cavity in which a certain
quantity of air is confined.



ON


THE PHARMACOPcEIA
OF THE
UNITED STATES OF AMERICA.
[FROM THE AMERICAN JOURNAL OF MEDICAL SCIENCES FOR 1831.]
IF the medical and scientific world were
restricted to the most simple modes of expression and inter-communication, if we possessed,
for example, but one nosology, but one system
of natural history, but one language of chemistry and pharmacy, it is obvious that the books
which treat of those sciences would be greatly
simplified; that the labor of learners would be
abridged, and much confusion prevented among
those who respectively teacr, or cultivate, these
departments of knowledge. Of this fact the
public are so well aware, that attempts have



232


ON THE PHARMACOPCEIA


been many times made to establish in these
sciences standards of definite expression. Sometimes under the sanction of governments, sometimes from the influence of popular writers or
teachers in science, and sometimes from the
conventional authority of delegated bodies, a
common language, has been introduced, and
obtained a degree of currency, which, though
seldom universal, has, nevertheless, been sufficiently extensive to produce a full proof and
conviction of its utility.
Unhappily, however, in those studies, the
subjects of which are most multifarious and.
complex, and which therefore stand most in
need of precision in their nomenclatures, an
inexplicable confusion of language still exists.
Mineralogy, zoology, and botany, particularly
the two latter, in themselves no trifling subjects
of labor, have been rendered to most persons
absolutely insurmountable, by the cumbrous
load of synonyms, which has been gradually
accumulating upon them, under the agency
of successive reformers. The Latin language,
once the common medium of intercourse for the
learned of all countries, has itself become a sort



OF THE UNITED STATES.


233


of Babel, furnishing, not unfrequently, a dozen
incongruous names for the same object. And
since neither Napoleon nor Nicholas, nor any
general congress for the pacification of Europe,
has taken in hand the reconciliation of conflicting terminologies, the republic of names still
remains at the mercy of every innovator whose
new colors may attract partisans and disciples,
and increase the anarchy already existing.
It is therefore sufficiently evident, that the
language of the sciences which we have mentioned, needs retrenchment quite as much as
extension; and were it not for the fact, that
certain nomenclatures have become incorporated with books more useful than themselves,
it would be a happy circumstance, if all of
them, save one, could be consigned to oblivion.
To determine what one in each particular case
should supersede all the rest, might be as delicate an affair as to elect a president of the
United States. But it is not the less true, that
one, even though deficient and unacceptable,
would be far better than many.
Pharmacology, considered not only as a science, but as a medium of communication for



234


ON THE PHARMACOPGIA


two extensive professions, particularly needs
simplicity and precision of language. It likewise requires that its expressions should be
generally intelligible, an advantage which cannot be secured, except by the introduction of
a general standard, regulating the names as
well as the selection and modification of its
subjects. On this ground, it is presumed, there
is no variance of opinion. But when we arrive
at the question, what the standard shall be, and
who shall appoint it, the charm of unanimity is
very apt to dissolve.
It is not difficult to frame a competent pharmacopceia, which shall be abundantly adequate
to the wants of the medical community. But
to devise a plan by which its general adoption
shall be secured, is a task which experience has
proved to be attended with no ordinary difficulty. Local partialities, and an unwillingness
to receive the supposed dictation of others,
have, in more cases than one, frustrated the
best contrived plans for promoting a general
accommodation.   And since indisputable perfection is not to be expected in a pharmacopcnia, there will always be found a spirit of



OF THE UNITED STATES.


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hypercriticism, ready to consider trivial defects,
as reasons for rejecting a public good.
We hold it to be a maxim, that one standard
of pharmacy, if sanctioned throughout a whole
country, even though it be an imperfect one, is
far more prornotive of public convenience than
a number of more learned and perfect ones
existing simultaneously. The late autocrat, Alexander, ordered his Scotch body-surgeon, Sir
James Wylie, to prepare a Pharmacopceia Rossica, which he introduced by an ukase throughout his extensive dominions.  This work, a
copy of which has reached us, appears to be
sufficiently respectable. But, without entering
into its particular merits or demerits, we will
venture to presume that the subjects of his
hyperborean majesty have been enabled to compound and swallow their drugs with equal effect,
and far less trouble, than those of the king of
Grat Britain, speaking in the tongues of three
different colleges.
If the business of making a pharmacopceia
could be commenced do novo, without reference
to any of the standards now existing, the great
question presented with regard to nomenclature



236


ON THE PHARMACOP(EIA


would be, whether names should be scientific,
that is, in some measure descriptive of the
origin, character, and composition of medicines;
or whether they should be arbitrary, having no
such reference or import. In the former case,
the names would be more expressive, and better
suited to the dignity of science; in the latter
they would be more permanent, from not being
connected with any fluctuating medium.
To illustrate these positions, let us observe
the revolution through which a single substance
has been obliged to pass, in order to keep pace
with the progress and improvements of science.
Since the discovery of calomel, that article has
been reformed by at least a score of successive
appellations. In the figurative language of alchemy it was known by the names of draco
mitigatus, aquila alba, manna metallorum, &c.
As chemistry grew somewhat more definite as
a science, this substance became mercurius dulcis, and mercurius dulcis sublimatus.  Under
the regime of Lavoisier and his cotemporaries,
it was a muriate and a submuriate; and after
Davy and Gay Lussac, became a chloride and
a proto-chloruret. Lastly, as if the gentleness



OF THE UNITED STATES.


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of its character was to produce a reconciliation of extremes, the mitigated dragon of antiquity has become a mild chloride of mercury.
On the other hand, when a nomenclature has
been perfectly arbitrary and divested of scientific relations, it has been proportionally durable and constant. Like the words engrafted on
a national language, its origin may be vague
and accidental, yet the public convenience prevents it from falling into disuse; and though
it might, perhaps, be susceptible of reform, yet
the benefit would not compensate the trouble.
In regard to pharmacology, there is one language alone which has remained permanent
amidst mutations, and which a hundred years
have not been able to shake from its basis -
we mean the language of commerce. This
language, which is for the most part arbitrary
and accidental, has seen many pharmacopceias
rise and fall, and is now quite as likely as any
one of them to last for a century to come.
The simple names of opium and alum, of calomel and camphor, have never yielded to any
periphrastic method of expressing the same
things. Corrosive sublimate refuses to be mod



238


ON THE PHARMACOP(EIA


ernized, and the salts of Epsom and Rochelle
maintain their ground against all chemical interference. The combined learning of two hemispheres is unable to prevail against copperas
and cream of tartar, and the manufacturer and
merchant still continue to make, sell and buy
their tartar emetic without troubling themselves
to inquire whether it is a ' tartrate,' or a ' cream
tartrate,' or neither. Nay, in some instances
the vulgar appellations have turned the tables
upon the classical and scientific, and the homely
name of potash has dictated to the learned their
more elegant potass and potassium.
To combine in practice the expressiveness
and precision of one language with the durability of the other, though very desirable, would,
from the nature of the subject, be impossible.
Yet an approach may be made to the advantages of both, by adopting, in the first instance,
a descriptive language founded on the existing
state of science at:the time, and afterwards to
declare it perpetual, or at least to establish it
in force during a long term of years. We should
thus possess a medium of communication in
itself entitled to respect, and rendered more
valuable by the prospect of being permanent.



OF THE UNITED STATES.


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It appears to us, that the stability of pharmaceutical language is a consideration of quite as
much importance as its improvement.   Great
changes, in regard to any prevalent system, can
seldom be effected without doing violence to
established habits and preferences of the community.   An apothecary, whose drawers are
labelled with the legitimate nomenclature of
the day, and a physician, who for a score of
years has employed a uniform phraseology in
his prescriptions, are not compensated by any
trifling advantage, for the risk and trouble of
an entire change. Wherever, therefore, it appears that a uniform system is extensively established in any country, it is incumbent on
the friends of science to oppose all unnecessary
deviation from the rules it prescribes.  If the
general progress of other sciences has been such
as to require that pharmacy should be made to
keep pace with them, its improvement ought to
consist as far as possible in additions, synonyms, and commentaries, but not in great or
violent changes. It is fortunate for the science
of anatomy that its distinctive names have
been handed down from one generation to an



240


ON THE PHARMACOPCEIA


other with so little alteration; and we believe
no reformer at the present day would obtain
many proselytes, who should propose to abolish
its nomenclature, because pia mater, os sacrum,
ossa innominata, and similar names are absurd,
misplaced, or unscientific.
In regard to preparations and compositions,
it may often happen that improvements are
necessary in pharmacy, to promote the economy
and uniformity of certain results. Such changes
are highly proper, provided they do not interfere
materially with the standard of strength which
has been previously current. But great changes
in the strength of medicines may generally be
regarded as pernicious, serving to perplex apothecaries and deceive physicians, if not to kill
patients. It is to be regretted that, in the different pharmacopoeias which have been published among us, there are operative medicines
bearing the same name, in some of which the
strength is double that of others. As to the
more complex medicinal formulie which crowd
our books, it will be found that most of them
owe their place in the shops to some fashion, or
some traditional celebrity, rather than to any



OF THE UNITED STATES.


2-41


exclusive fitness or virtue; and we may perhaps
get a true idea of their value from the consideration, that if, by any means, the knowledge
of the whole of them should be lost, it is not
probable, in the doctrine of chances, that one in
fifty would ever be reinvented. Yet, since the
prevailing traffic requires that they should continue to be made and sold, it is important for
those who consume them, that they should be
exempt from fluctuations of character.
In the United States, previous to 1820, there
was no uniformity of pharmaceutical language.
Pharmacopceias, indeed, had been adopted by
medical bodies, in Massachusetts and some
of the other States; and Dispensatories, both
foreign and native, had been published among
us. But in the year referred to, an effort was
made, by which the consent of a great majority
of the medical institutions of the country was
obtained, for a plan of a national pharmacopceia. This, it was confidently hoped, by introducing a current language throughout the country, would do away the confusion which then
prevailed, and offered to the parties concerned a
facility of intercommunication, corresponding to
16



242


ON THE PHARMACOP(EIA


that which results from a common system of
coinage, or of weights and measures. A numerous and highly respectable delegation was
appointed, from most of the principal States, a
part of whom met in the city of Washington,
at the appointed time.
It may here be proper to inquire what such a
convention could reasonably be expected to do,
and what it was their duty to do, under the circumstances in which they were placed. Coming together from remote places, and holding
their session at an inconvenient sacrifice of time
and expense, it was not to be anticipated that
they would institute an original investigation of
the whole subject. The ordeal of an experiment upon every doubtful subject, would have
involved a labor of months, and perhaps of
years. It would not reasonably be expected
that they would produce a pharmacopceia,
which should be better than any which previously existed.  A debating assembly would
be far less likely to do this, than a competent
individual in his closet.  Yet the convention
possessed the power to confer a great good; a
power which no individual is likely to obtain,



OF THE UNITED STATES.


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that of introducing order in the place of confusion, and law instead of anarchy.
Under these circumstances, it was incumbent
on them to produce, or sanction, some standard
of pharmacy which should be adequate to the
wants of the community. It was not very
material what one, among many standards,
they should adopt as their basis. They might
have selected the Edinburgh Pharmacopceia,
which, though prolix in its expressions, was at
that time more current than any other in the
country. Or they might have taken the London
Pharmacopceia, dogged as it has been by Mr.
Phillips, and this would have served very well
as the groundwork of a useful book. Or they
might endeavor to frame a system of their own,
which, in some respects, might be superior to
its predecessors, or at least better adapted to
the customs and wants of our own country.
The last plan was decided on by the convention, under the expectation, doubtless, that it
would be more acceptable to their constituents.
A programme of a pharmacopoeia prepared by
the College of Physicians in Philadelphia, was
adopted as the groundwork, and, after being



244


ON THE PIIARMACOP(GIA


variously modified and augmented, was referred
to a committee, with instructions to publish it.
It must necessarily happen that a work emanating from so many disconnected sources, a
part of whose contents must, from the nature
of the case, be the result of compromise among
the parties concerned, rather than of satisfaction to any of them, would be in some respects
imperfect, disconnected, and redundant. Nevertheless, if it was on the whole better suited
to the occasion than any other work actually
existing, the public were bound to receive it
"with complacency, as the only standard which
could ever become general among us. And if
criticisms were needed to point out the faults
which it contained, they should have been
made in a spirit of manliness and liberality,
such as would have promoted the gradual reform and perfection, rather than the overthrow of the work. But several of the journals
thought otherwise, and the pharmacopceia was
obliged to undergo an ordeal, the severity of
which far exceeded its deserts. The spirit of
criticism was pushed with a zeal not according
to knowledge, and in many instances the igno



OF THE UNITED STATES.


245


rance of the commentator, rather than the defects of the book, produced a reprobation of its
contents. Nevertheless, the pharmacopceia was
received, willingly: by some, and reluctantly by
others, and became, we have reason to believe,
the prevailing standard, or at least more prevalent than any other throughout the United
States.
It was to be hoped that, when the period
should arrive which had been assigned by the
convention for a revision of this work, a sufficient unanimity of sentiment would have prevailed, to direct into one channel whatever
amount of skill and experience might be volunteered for its improvement, either by societies or individuals. It appears that numerous
societies, in different parts of the Union, feeling
an interest in the revision and confirmation of
the pharmacopmeia, had appointed delegates to
attend the expected convention at Washington,
in 1830. A part of the delegates thus designated were, agreeably to the provisions made in
1820, returned to the presiding officer of that
year. But a greater number, who had not been
formally returned, proceeded to Washington at



246


ON THE PHARMACOPCEIA


the appointed time, and having organized a
convention of such delegates as were present,
and invited a cooperation of other medical gentlemen of eminence then in the city, proceeded
to take measures for the republication of the
work. In the mean time, a part of the delegates
who had been officially returned to the former
president, influenced either by convenience, or
by the smallness of their numbers, determined
not to convene at Washington, but held a meeting in New York, where they, also proceeded
to take measures for republishing the pharmacopceia, having likewise invited the cooperation
of other medical gentlemen of note.  Out of
this want of concord have risen up two pharmacopceias, neither of which can strictly claim
to be, by lineal descent, the legitimate heir of
the original work; one, proceeding from a body
not formally declared elected to the convention
at Washington; the other, from a body who did
not convene at Washington at all. We regret,
during the long period of preparation, in which
the proceedings of each party must have been
known to the other, at least in a degree, that
some compromise was not effected, so that the



OF THE UNITED STATES.


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objects of both might be effected, with less
trouble to themselves, and less expense to the
public. It was not indeed in the power of the
delegates at Washington to correct the original
defect in their mode of election, but it was in
the power of the delegates. of New York to
have gone to Washington, and there to have
invited the cooperation of the other delegates
present, especially as they appear not to have
been afterwards fastidious in associating with
their own body undelegated individuals. Even
after the original meetings had taken place, a
slight spirit of conciliation in one or both parties, (we know not which was wanting in this
respect,) would have produced harmony and
unity in the end.
As things now are, it appears to us that the
two works must stand upon their respective
merits, as pharmaceutic compositions; and the
public are called on to decide whether either,
and if either, which one, is entitled to be received as the national standard. And here, if
it be asked what constitutes fitness or excellence in a pharmacopceia, we should answer
simply, that such a work ought to contain and



248


ON THE PHARMACOPGEIA


identify the medicines which are commonly
used by physicians, that its preparations should
be scientifically composed, that its language
should conform to the most current language
of the day, and that it should be complete as
a system in itself, that is, should have a correspondence between its own parts. In these
respects, we think the Washington Pharmacopoeia has greatly the advantage of its competitor. We observe in its list of materia medica, comparatively few alterations of names,
and these are made mostly in conformity to the
present language of chemistry. In the New
York edition the changes are exceedingly numerous, the new names being taken partly from
the London Pharmacopoeia, and partly invented
for the occasion, so that the book has the aspect
of an edition of some other work, rather than of
the American Pharmacopoeia. The'references
to authors, which are considered necessary by
most pharmacologists, to identify the substances
intended, are wholly omitted in this work. In
regard to completeness and accuracy, the work
of the Washington convention is prepared with
much care and science, and with a correspond



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249


ence of its different parts. In the New York
edition we find a want of unity, such as attends
hasty preparations, and a discordance often
recurring between the names of the articles
themselves and those of their preparations.
In regard to the Iatter work, knowing the
difficulties which attend this species of composition, and entertaining a high respect for the
character of the gentlemen concernedL we forbear to fill our pages with commentaries on its
redundancies and discrepancies. We shall not
therefore complain because Burgundy pitch is
inserted twice under different names, in the
materia medica, nor because the sulphates of
quinine and morphine, figs, prunes, and' some
other articles required in the preparations, are
not inserted in the materia medica at all. These
things must be corrected with their pens, by
those who may employ the book. On the other
hand, we are happy to perceive some improvements on the edition of 1820, in the greater
accuracy of the chemical nomenclature, and in
the introduction of some useful formulas. We
think however that retrenchment, in the old
work, was much more needed than augmentation;



250


ON THE PHARMACOPCEIA


Believing that the pharmacopoeia produced
by the Washington convention, being a more
elaborate, accurate, and finished work, will
eventually become the standard of the country,
we propose to enter somewhat more at large
into the consideration of its contents. This we
shall endeavor to do with the impartiality which
the subject ought to receive.
In their preface this convention express their
reasons for adopting as their basis the Pharmacopoeia of 1820, a work having many inconveniences and defects, but at the same time
many claims to approval. In its general outline, say they, and prominent features, it will
bear a favorable comparison with the best pharmacopoeias of Europe, and it is only in filling
up, that improvement is demanded, or admissible. The changes therefore which have been
made under the authority of the late convention, embrace the materials and minor arrangements, without extending to the general plan.
In preparing for the press the present revised
edition, the new convention inform us that
much labor has been expended, and every part
of the work submitted to the most strict and



OF THE UNITED STATES.


251


rigid scrutiny. Every accessible pharmaceutic
authority has been consulted, and the accuracy
of processes has been frequently tested by a
practical investigation; the several departments
have engaged the attention of individuals peculiarly qualified by their previous studies, and
the whole has passed the examination of pharmaceutists of acknowleged eminence in their
profession.
Considering how difficult it is to induce persons of the necessary competency to engage in
gratuitous labors with perseverance and fidelity,
we are happy that the individuals concerned in
the present revision have devoted themselves
with such singleness of purpose to the perfecting of the work. From our knowledge of the
amount of labor actually bestowed on it, and
from the internal evidences which it bears of
extensive inquiry and precise examination, we
doubt whether any future convention will present us with results more deserving of the
public confidence.
In pursuance of the plan of the former edition, and for reasons which it is not necessary
here to repeat, the pharmacopeia is written out



252


ON THE PHARIMACOP(EIA


on opposite pages in Latin and in English.
The classical latinity of the London Pharmacopceia is adopted as a standard, and, by keeping this in view, a unity of style is preserved
throughout the book. We see no cause to be
dissatisfied with the general purity and elegance of this language, though in one case, we
observe, the convention have erroneously followed the London example, in using the genitive 'rosmarini,' and ablative 'rosmarino,' instead of the undoubted rorismarini, and roremarino, sanctioned by Horace, Columella, and
other classics.
In regard to names, the convention informs
us in their preface, that for reasons which they
discuss at length, they have adopted the modern chemical nomenclature, in which the names
are expressive of the composition of bodies.
This was in most cases done by the framers
of the former pharmacopoeia, but in the present
edition an attempt has been made to bring the
nomenclature more completely in accordance
with the best scientific usage. Thus we have
chloride of sodium, instead of muriate of soda;
ferrocyanate of iron, instead of prussiate of iron,



OF THE UNITED, STATES.


253


&c. In a few instances, holwever, to avoid great
circumlocution, a pharmaceutical name is. retained in the place of a more expressive chemical appellation, as in the case of alumen, bydrargyrum, ammoniatum, &c. In conformity
with the present language of chemistry, the
proportional composition of bodies, it appears,
is intended to be expressed, and we have,
among other things, a bicarbonate of potass,
and a bicarbonate of soda. But this intention
is not always executed throughout the work,
which seems to us a defect in uniformity. The
substance called by this convention sulphate of
copper is a bisulphate, and ought so to be
called in a chemical nomenclature, since there
is another sulphate, composed of one equivalent
of acid and one of peroxide of copper, which
is precipitated by adding pure potass to the
solution of the bisulphate above mentioned, in
a quantity insufficient for separating the whole
of the acid.
We know not for what reason it has been
thought proper to omit, as synonyms, certain
commercial names of common usage, while
others, of much less frequent occurrence, are



254


ON THE PHARMACOPCETA


retained. The student of pharmacy who would
know what is meant by Epsom salt, Glauber's
salt, blue vitriol, and other names which meet
him in the daily price current, must seek for
information in other books than the AmericanPharmacopceia. These names being international and long established, cannot, we think,
with propriety, be given up in a work of general
pharmacy.
In the nomenclature of substances derived
from the vegetable kingdom, the work before
us adheres to the simple and appropriate plan
of the first edition, that of using, in all practicable cases, a single word for the name of the
drug, leaving its nature and origin to be defined in the opposite column. This peculiarity
of the American Pharmacopceia is one of its
leading excellences, and one which the New
York convention seem to have acted unwisely
in abandoning. Most of the names used in
other pharmacopceias, to express vegetable substances, are either unwieldy in their length, or
improper in their application. Thus the drug
assafcetida is called by the Edinburgh college
gummi resina ferule assafcetidae, a name which



256


ON THE PHARMACOPOGIA


which contains the officinal name of each article, in Latin and English, together with occasional synonyms, while the other defines the
substance intended, and gives explanatory references. This part of the work gives evidence
of a laudable degree of care and rese4rch, yet
we notice a few minor things deserving of remark. The substance called lupulin, derived
from the hop, is defined I strobilorum pollen.'
As the word pollen has, in vegetable physiology, a specific meaning, it would have been
better to have used some other name to express powder. In the Latin, lupulia, as used
by the New York convention, is more consonant to morphia and quinia than lupulina. We
see no reason for giving up spermaceti, the
universally received name, both in chemistry
and commerce, and substituting cetaceum of the
London college, a word which is neither more
classical, nor more definitive. Scabious, applied
to erigeron, is a provincial misnomer, that name
belonging only to scabiosa.
In regard to preparations, the convention
considering this the most extensive and important part of the work, have devoted to it a



OF THE UNITED STATES.


257


greater share of their attentibn. They inform
us that examination has been carried into all
its parts, and not a single process has been
allowed to escape a close scrutiny. One of the
most prominent defects of the original pharmacopoeia was a want of uniformity, both in
the manner of conducting the processes, and in
the style of describing them. This arose from
the variety of sources from which materials
were drawn, and the want of due time to remould and shape them, so as to produce a
harmonious whole. In the present edition an
effort has been made to supply these deficiencies, and to produce uniformity of language, as
well as correspondence and unity of design, in
the different parts of the work. In the selection
of the process for each preparation, two principles are stated to have governed the choice of
formulr, independent of their intrinsic merit,
which, when superior, has always been allowed a predominating influence.  When two or
more methods of preparing the same compound,
equally meritorious in themselves, have come
under consideration, that has been preferred
which has united in its favor the widest preva17



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259


by the uncommon progress of pharmaceutic
investigations, during the last dozen years, are,
in various instances, inserted.  Such are the
preparations of iodine, quinine and morphine.
The convention, however, have shown a wise
forbearance, in not crowding their book with
the host of new articles, often, we apprehend,
more curious than useful, which modern chemistry has been enabled to extort from vegetable
drugs. Retrenchment has been freely exercised
in lopping off many of the superfluous formulas, which a necessity for hasty compromise had
caused to be introduced into the pages of the
old pharmacopceia; and, among other articles
dismissed is tlj acetum opii, or black drop, a
revived piece of antiquity, wasteful in its composition, and utterly uncertain in its strength,
the place of which is now better supplied by
the acetated tincture of opium, and the acetate
of morphia. For ourselves, by the way, we
lean to the opinion, that opium, to produce its
full benefit, must be opium still, and we are
not sure that any of the artificial salts of morphia are better than the natural meconate. We
have seen delirium tremens brought on under



260


ON THE PHARMACOP(EIA


the use of denarcotized laudanum. If the crude
drug were cumbersome from the bulk necessary
to form a dose, as in the case of cinchona, it
would be highly useful to reduce its active ingredient into a smaller compass. But this is
not the case with many of the narcotics.
Very complex medical formulas, such as
abound among the old writers, and still encumber the pages of many of the pharmacopoeias,
we deem to be a superfluous appendage to
medical science. One of the greatest modern
improvements is found in the simplification of
medical prescriptions. The art of prescribing
appears to us a more simple affair than it has
been represented by the hypercitical pedantry
of Dr. Paris.  We admit that adjuvants will
help, and that corrigents will correct; nevertheless, we find that castor oil, ipecac, and
opium will often do their dfity without either.
In admitting the influence of chemical considerations in the exhibition of medicines, it is
important to recollect that the stomach has a
chemistry of its own, and that the digestive
organs exert a material control over the force
of ordinary chemical agents, separating ele



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261


ments which have strong mutual attractions,
and dissolving bodies which are insoluble in
common menstrua.    We ought by no means
to consider medicines inert in proportion as
they are.insoluble, for we have a proof to
the contrary in calomel. Nor are we to consider those substances medicinally incompatible, which, if mixed out of the body, occasion
a precipitate, or a change of color. What incompatible, we would ask, destroys the effect of
opium, strychnine, or cantharides?
Another consideration which has great weight
with writers on chemistry and pharmacy, is the
exactness and precision of the quantities em.
ployed in their preparations. This circumstance, although of great consequence in strictly chemical compounds, is less so in arbitrary
mixtures; and in the administration of simpler
medicines its importance diminishes still further. Practical physicians know, that a degree
of accuracy, approaching nearer than within a
fifth or sixth part of the amount desired for
producing a given effect, is seldom attainable.
Apothecaries divide their pills and powders by
the eye, and patients take liquids by drops and



262


ON THE PHARMACOPOEIA


spoonfuls.  Nay, that physician must possess
uncommon shrewdness, who, even after apportioning his dose by the most accurate weight
and measure, can foretel with certainty how
or when, how much or how often, it is going
to operate. The stomachs of different patients,
and those of the same patient at different times,
vary more, if possible, than the samples of the
same drug in commerce.
On these accounts we feel but little concern
for the changes which the convention have
thought proper to make in the character or
strength of preparations and compositions, so
long as they do not exceed the limits above
mentioned. But in a few cases we observe
that the strength has been altered in the proportion of two to one, or vice versd, and of
such changes we propose to take notice. The
vinum antimonii, which in the old edition contained four grains to the fluid ounce, in this
edition contains but two, and is therefore reduced in strength one half. We object to this
change, because the stimulating character of the
menstruum is incompatible with the indications
for which antimony is generally administered,



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263


and we apprehend that a glass or two of Teneriffe wine would do no good to a man in apoplexy or incipient fever. The wine, indeed,
ought to bear as small a proportion as possible
to the operative medicine, and if the London
college is followed in lessening the proportion
of antimony, it should also have been followed
in diluting the wine largely with water. The
vinegar and syrup of squill are increased to
twice their former strength, a change in itself
of no consequence, when the public shall have
learned to regulate the dose. Liniment of ammonia is reduced to one quarter of its former
strength.  Can this preparation ever be too
strong for the purposes to which it is applied?
In a work so generally uniform and consentaneous in its parts as the American Pharmacopceia, we would willingly have dispensed
with such names as pulvis aromaticus and
pilulm  catharticm  composita.  These names
designate nothing that is not common to a
thousand other combinations.
A few things are omitted in this edition,
which we would have willingly seen retained;
but we are not disposed to cavil on this ac



264


ON THE PHARMACOP(EIA


count, since in that instance, as well as in the
case of objectionable formulas, the evil may
generally be remedied by extemporaneous prescription. Every man has his particular taste
and judgment, and de gustibus non disputandum. In the wine of antimony, to which we
have objected, the evil is remedied by extemporaneous solutions in water, which are far
preferable to those in wine. Even though a
pharmacopceia should arrive at the highest and
most unquestioned point of excellence, still
physicians would suit themselves with formulas
Sof their own, adapted to particular cases. We
apprehend that most practitioners pass their
lives in ignorance of half the contents of pharmaceutical works. For ourselves, not being
particularly given to hyper-practice, we should
feel a strong sentiment of pity for the patients
of that physician whose yearly rounds involved
the application of the whole pharmacopceia.
To conclude,- having indulged somewhat
freely in our remarks on the national work
produced by the convention at Washington,
we proceed to make the amende honorable, by
declaring our conviction, that it is on the whole



OF THE UNITED STATES.


265


superior to any of the European pharmacopceias
with which we are acquainted; that it is better
suited to the wants of the American community than any work of the kind which has been
published among us; that it has emanated from
a larger delegation, and has undergone a more
rigorous supervision, than any similar production of the day; and that, therefore, it ought
to become the standard of the United States.
In conformity with the views expressed in the
first part of this article, we also hope, that, to
relieve the profession from the annoyance of
incessant fluctuations, the contents of this book
will be respected by all future conventions as
something solid and permanent; and that if,
as the edifice grows old, it shall be found to
need repairs, enlargement, or modern decorations, still that its foundations may not be
wantonly assailed, and that its walls may stand
as a landmark and a barrier against the confusion of fluctuating language.



ON THE MUCUNA PRURIENS.


267


confining it with adhesive plaster. The result,.
within my observation, has been an exceedingly
uncomfortable itching and burning of the part,
which on the second day became universally
red and inflamed. A copious eruption of papule followed, which increased in size for a week,
and at length terminated in pustules, which required a second week to pass into scabs. In
one patient two or three large prominences like
boils, continued for ten days after the rest of the
part was well.
The irritation produced by cowhage appears
to me greatly to exceed that which attends the
application of flies or of tartar emetic. One
patient, a woman, assured me she got no rest
for two nights. On examining the skin, it was
found in a state of great inflammation, exquisite
tenderness, and stuck full of the spicul. After
attempting in vain to relieve the trouble by a
poultice, recourse was had to a mixture of Plaster of Paris and water, which was poured and
suffered to harden upon the skin. When withdrawn from the skin, it extracted and brought
with it the spiculae, to the great relief of the
patient. The same experiment, however, prov



268


ON THE MUCUNA PRURIENS.


ed inapplicable to a man whose breast was
covered with hairs, and did not admit of the
process.
Cowhage was introduced into practice, I believe, by Dr. Chamberlain, who has published a
small work upon it, strongly recommending it
as a remedy for worms. Reasoning probably
a priori, he supposed that a substance which
occasions so much irritation to the human skin,
would act in a similar manner upon the bodies
of worms in the alimentary canal. Finding
that when mixed with honey or molasses, it
could be swallowed with impunity, this author,
and subsequent writers of Dispensatories, have
recommended its use as a remedy for worms, in
the dose of from five to ten grains. When
strong cathartics have followed its employment,
worms in some cases have been brought to light,
but I apprehend not more frequently than in
cases where no cowhage has been given. Many
years ago, having occasion to doubt the enthelmintic properties of this medicine, after it should
have undergone the process of digestion in the
stomach, I performed with it a number of experiments. A parcel of the spiculm of full strength



270


ON THE MUCUNA PRURIENS.


different. It is this fact, probably, and not the
sheathing quality of the mucilage or syrup in
which it is taken, that enables patients at all
times to swallow it with impunity, as a medicine.
It is a field of interesting inquiry to ascertain
how far particular morbid poisons and stimulants confine their action to particular textures.
As far as my observation extends, the cutaneous
poisons which produce eruptions on the skin
independent of any acrimony, or general stimulating quality, such as the Rhus vernix, &c.,
for the most part confine their action to the true
skin or dermoid texture, and do not inflame the
mucous membrane, so that they have often been
eaten with impunity. Were it otherwise, effects
highly dangerous to life would occur from the
inflammation of the trachea and other mucous
passages, if an action should take place in them
at all correspondent in violence to that which is
seen upon the skin. But there is another class
of poisons which affects the mucous membrane,
without incommoding the skin, at least by superficial contact.  Such is the effluvium  of
roses and that of new hay, which always affect



ON THE MUCUNA PRURIENS.


271


certain persons with catarrhal symptoms. Such
is also the poison of syphilis and that of gonorrhcea, which are believed not to.act through the
cuticle, but which develop their activity as soon
as they are brought in contact with a mucous
surface.
There are other poisons, which seem alike to
influence the dermoid and mucous tissues. The
sting of a bee or wasp immediately inflames the
skin, and it is s'aid to have occasioned death by
suffocation when applied to the fauces or throat.
It is possible that the morbid poison of scarlatina, and of some other diseases which affect
simultaneously the skin and mucous membrane,
may possess the same universality of action.



ON THE


POISONOUS EFFECTS
OF
THE AMERICAN PARTRIDGE, OR RUFFED GROUSE.
THE Tetrao umbellus of Linnaeus, variously
called Partridge in the northern and eastern
States, Pheasant in Pennsylvania and the western States, and " Ruffed Grous" by Wilson, Nuttall, and Audubon, appears to inhabit the continent from Hudson's Bay to the Gulf of Mexico,
and from the Atlantic to the Mississippi. It is
a handsome bird of the Gallinaceous tribe, with
mottled plumage, the tail 18-feathered, speckled,
and barred with black, and with a black subterminal band. The male has a ruff of broad
black feathers on the sides of the neck, the
female a smaller ruff of a dusky brown. Its



THE AMERICAN PARTRIDGE.


273


favorite resorts are mountainous regions covered
with evergreen trees, and in more cultivated
countries it often frequents apple-trees, which
are secluded or concealed by woods, having a
fondness for the buds of this tree. It is well
known to residents in the interior, by the drumming noise which in the pairing season it makes
with its wings, and also by the stratagem with
which the mother protects her young by an illusive demonstration of surrendering herself in
their place.
The partridge is quite common in the eastern
States, and constitutes one of the most frequent
kinds of game in our markets. The flesh is
much prized for the delicacy of its flavor, and is
in its greatest perfection in September and October. It feeds in summer on wild berries, and
at other seasons on the leaves, buds, and seeds
of various plants.
It is generally known, that although vast
numbers of these birds are every year consumed
with impunity, yet instances now and then happen of persons being apparently poisoned or
made sick with alarming symptoms, soon after
swallowing their flesh. The following cases are
18



274    ON THE POISONOUS EFFECTS OF
selected from among a larger number, which
have been observed by myself or my medical
friends, and of which a part are in the records
of the Society of Medical Improvement.
CASE I.- A gentleman of this city having
dined at Worcester in part upon partridge, took
the cars for Boston half an hour afterward.
In an hour after entering, he was taken with
sensations like those of sea sickness, accompanied with dizziness and great prostration of
strength. With difficulty he got his head out
and vomited from the window of the car. He
continued faint, cold, dizzy, and unable to sit
up, with ringing in the ears and imperfect vision.
He was conveyed to his house in a sinking and
nearly insensible state. When I first saw him,
he was cold and moist, with a slow intermittent
and very feeble pulse, difficult comprehension,
and sluggish utterance. He had vomited again
with some relief. His vision was partially recovered. Stimulants had been given him, with
hot applications and frictions to the surface,
under which he gradually recovered.



THE AMERICAN PARTRIDGE.


275


CASE II. - A lady of delicate health took at
dinner a small piece of the breast and leg of a
partridge.  Two hours afterward she became
suddenly very faint, and her physician (Dr. Putnam) was called. She was found by him in a
sitting posture on the bed, supported by two
assistants, with the body bent forward.  The
surface was generally cold, countenance pale
and sunken, and voice feeble.    There was
slight, frequent convulsive action of the muscles.
The pupils were dilated, with loss of vision.
Pulse irregular, feeble, at times nearly imperceptible. There was drowsiness approaching
to insensibility, nausea and vomiting. Spirituous stimulants were given and ipecacuanha,
with warmth, friction and sinapisms externally.
Soon after free vomiting took place there was
evident amendment. The sensibility returned,
questions were comprehended, but the answers
were slow and laborious. In the course of two
or three hours vision was restored with contraction of the pupils and intolerance of light, with
a remaining sense of numbness and uneasiness
in the head.



276    oN THE POISONOUS EFFECTS OF
CASE IL.-A man aged sixty, who had always been healthy, but within a few months
troubled with shortness of breath, which his
physician attributed to some affection of the
heart, ate the white meat of a partridge, avoiding the dark meat and the parts contiguous to
it. About an hour afterwards he went to chhrch,
where he was shortly taken with a sensation of
distress at the stomach, which he referred to
the disagreement of his food. He endeavored
to resist this annoyance, and kept his seat for
some time, but at length his sight totally left
him, he became faint, and fell. He was carried
out of church, and laid on his back in the open
air. At this time there was no pulse, and the
respiration was hardly perceptible.   These
symptoms were at first attributed by those
around to the suspected disease of the heart,
but in the course of ten minutes he began to
revive. The first word he uttered was 'poisoned,' and the second, 'the partridge.' He soon
began to revive, sat up, got upon his feet with
assistance, but had lost all power over his legs,
and was unable to stand. He was now put
into a carriage, some pressure was made upon



THE AMERICAN PARTRIDGE.


277


the stomach, and he began to vomit. Ipecac
and warm water were given him      until the
stomach was fully evacuated. He remained
somewhat delirious for a few hours, but on the
following day was restored to his customary
health.
CASE IV.- A gentleman, twenty-six years of
age, dined at 5 P. M. on soup, boiled tongue and
potatoes, and ate the leg and part of the breast
of a partridge. He afterwards went to a clubroom, and remained till 8. On going out at
this time he became chilly, and felt a sharp
pain through the temples. He repaired to a
shop for some soda-water, and while standing
there was affected with vertigo and a 'trancelike' feeling. This was followed by ringing in
the ears, and a remarkable sense of coldness,
mostly in the back of the neck and shoulders.
He was unable to get warm at the fire, and the
sensation given to bystanders by his head was
compared to that of the contact of a stone jar.
He had taken hot spirit and water, and was
sitting up when seen by Dr. Holmes at 9 o'clock.
At this time the voice and expression were



278    ON THE POISONOUS EFFECTS OF
natural, mind a little excited, vision dim at
times and once or twice quite lost, pupils widely
dilated and equal, contracting but slightly on
the approach of a light, hands rather cold, pulse
76, regular, small but not thready, no nausea nor
vomiting. Took wine of ipecac, and threw off
freely portions of food. In the course of half
an hour was thoroughly relieved, but was languid and costive next day.
Two or three other persons, as it appeared,
had partaken of the same partridge without
obvious inconvenience.
CASE V.--A gentleman, aged seventy-four,
of full habit and subject to gout, ate at breakfast
the black meat of one partridge. In an hour or
two he went to church, where he soon became
sick, faint and dizzy. On being carried home
he was found in a state approaching that of
collapse, pale, livid, cold, nearly pulseless, and
without vision. His appearance was that of a
dying man with glazed eyes and gasping for
breath. Had repeated nausea, but vomited
fluids only.  Took stimulants, principally hot
gin and water, and gradually recovered, after



THE AMERICAN PARTRIDGE.


281


18 to 22; hands and feet cold and moist;
groaned frequently; vomited freely and spontaneously,, and afterwards under the influence
of mustard flour mixed with warm water. Warm
blankets and bottles of hot water were applied
to the epigastrium and limbs, and in the course
of two hours he had recovered his consciousness
and drank warm tea. Slept well during the
night. In the morning was quite well.
CASE IX.-Same individual. February 23,
1850, went into the country in the morning and
rode till 3 o'clock, P. M.; then sat down in the
open air and ate a part of a partridge, but it
was so bitter that the remainder was thrown
away; drank a wine-glass of brandy. Took
railroad train, and on leaving it in thirty-five
minutes walked from fifteen to twenty minutes, when (about one hour after eating the
partridge,) had pain in the back of the neck and
limbs. Passed a house, and observed that the
lights appeared blue, and immediately suspected the partridge of being the cause of his troubles. Soon after, found himself at the bottom
of a steep declivity, having lost his conscious



282    ON TIHE POISONOUS EFFECTS OF
ness and rolled down a bank. Got up, and
walked to a house; again noticed the blue
lights. In attempting to take a glass of cold
water again lost his consciousness and fell; was
carried home, and after taking mustard' flour,
vomited and was soon relieved. Before vomit.
ing, respiration very slow and not more than half
the usual number of inspirations. Pulse 42 per
minute; hands and feet cold and the face pale.
During the periods of loss of consciousness,
which did not continue more than five minutes
at a time, the limbs were quite powerless. The
recovery was sudden, and the action energetic;
speech impeded, apparently from want of muscular power. Time elapsed between first symptoms and relief by vomiting, from an hour and
a half to two hours.
CASE X.-Mrs. W., aged forty-five, ate for
dinner, two days before the date of the last case,
a part of a roasted partridge, bought at the
same time with that used by her husband.
This, also, was extremely bitter, and only a
small quantity eaten. After dinner walked a
mile to a conservatory; when near the conserv



THE AMERICAN PARTRIDGE.


283


atory felt weak; pain in both back of neck and
limbs.  Felt faint in the conservatory, and
obliged to return to the open air; was nauseated, but did not vomit. Immediately walked
towards home; found her limbs unsteady, obliged
to run and then stop and support herself by the
fence; was compelled to lie down, but did not
lose consciousness; was carried home. The pain
in the back of the neck and limbs continued till
9 o'clock, when she went to bed. Had occasionally some difficulty of breathing, a catching of
the breath. In the morning was quite well.
Neither of these individuals have eaten partridges since.
The principal and most characteristic symptoms were loss of consciousness; relaxation of
the muscles, and in one instance of the sphincters; paleness; cold feet and hands; slow and
infrequent respiration, and slow and infrequent
but regular pulse. The act of vomiting was
followed by almost immediate relief.
To these cases may be added a number more,
the outlines of which have been communicated
by different medical friends.



284    ON THE POISONOUS EFFECTS OF


From a general analysis of the symptoms
produced, it appears that under certain circumstances the flesh of the partridge acts as a direct
sedative poison, impairing the functions of the
brain, and, in connection, those of the digestive
and circulating systems. The cerebral symptoms, in a majority of cases, have been vertigo,
loss of sight, tinitus aurium, and in bad cases
general loss of the power of sensation and voluntary motion.   Respiration has been slow,
sometimes to a great degree. In the circulating
system there has been syncope, feeble and sometimes irregular action of the heart; weak, slow,
and sometimes imperceptible pulse; cold surface, and pale or livid complexion.  In the
digestive system there is oppression, nausea
with tendency to vomit, and in many cases pain
in the abdomen extending through to the back.
In more rare cases pain has been felt in the
head and limbs.
The foregoing morbid symptoms have mostly
appeared within two or three hours after taking
the food. But instances have occurred in which
persons have been taken before leaving the table.
The poison of the partridge has never, to my



286    ON THE POISONOUS EFFECTS OF
out the winter. We have hardly any species of
game which is sought for with more avidity, or
consumed, in proportion to its size, in greater
numbers. As a general rule, it is, and may be
taken with perfect impunity.
The fact that the meat of the partridge occasionally proves poisonous, has given rise to
much speculation in regard to the cause. The
point most generally admitted respecting it, is,
that its bad effects chiefly, if not always, take
place in winter, when the ground is covered
with snow. This circumstance has given rise
to a popular belief that the noxious quality in
the meat of the bird is attributable to some poisonous food on which, in winter, it is driven to
subsist.  And a prevalent suspicion has been
fixed upon the mountain laurel (Kalmia latifolia),
on the buds and leaves of which the partridge
has been supposed to feed in cold weather.
But this suspicion appears to be not well founded, since I have observed in experiments made
purposely, that the leaves of the kalmia are not
particularly poisonous, when taken into the
human stomach in any quantity which the bird
would be likely to devour; and the crops, when



THE AMERICAN PARTRIDGE.


287


examined in winter, are found to contain leaves
and fragments of most of the wild evergreen
plants which are in verdure at that time. I
have found among other things portions of
leaves of Pyrola, Gaultheria, Smilax, Coptis,
Mitchella- also buds of Azalea, alder and apple
tree, which latter appears to be a favorite food
with the partridge.
It is, furthermore, not very probable that the
common process of putrid decomposition is concerned in producing the noxious effects in question, for this circumstance would be generally
detected by the taste, and the incipient putrescency so often recognized in game is usually
corrected by the antiseptic effect of the gastric
juice.
More probable solutions of the difficulty are,
1. That the bird is affected with some disease
at the time of its death. 2. That some slow
chemical change, not putrefactive, may take
place when the flesh is long kept in cold weather, as observed by my friend Dr. Cabot. 3. That
the idiosyncrasy of individuals renders some
persons intolerant of this species of food. This
latter supposition is sustained by the facts, that



ON   COFFEE       AND     TEA;
AND THEIR MEDICINAL EFFECTS.
THE articles Coffee and Tea have been so
long and so generally introduced as luxuries of
the table, that they are now viewed by the
world as materials of diet and nutrition, and
not in their proper light, as substances incapable of nourishing the body in any considerable
degree, and depending for their value on an
effect which is simply medicinal. If any one
doubts whether they should be referred to the
class of aliments, or to that of medicines, let
him try the experiment of supporting life upon
coffee or tea alone, and he would probably find
that his term would not be much prolonged
by such an expedient. Yet, when taken in
combination with nutritious food, both these
articles exert a salutary and useful influence
upon digestion and health. The experience of
19



ON COFFEE AND TEA.


291


the discovery in modern times of their secondary effects, and the agreeable influence which
they exert on the brain and nervous system,
has created for them a general demand and
consumption throughout the world.
COFFEE.
Coffee is the product of the Coffcea Arabica,
a small tree which grows native in Arabia and
several warm countries of the old continent,
and is now cultivated extensively in the West
Indies and tropical parts of the continent of
America. The fruit of this tree is a roundish
oblong berry, containing two seeds, the form
and appearance of which are sufficiently familiar,
constituting the common coffee which is brought
to this country.
The use of coffee was unknown to the Greeks
and Romans, and does not appear to have been
known in the Asiatic countries as late as the
time of the Crusades in the thirteenth century,
although its first introduction into Europe was
from Arabia. It seems to have been earliest in
use in Ethiopia, where it has been drunk by
the natives for a great length of time. Mr.
I,  d



292


ON COFFEE AND TEA.


Bruce, in his Travels in Abyssinia states, that
the Gallm, a wandering nation of Africa, in
their incursions on Abyssinia, being obliged to
traverse immense deserts, and wishing to be
encumbered with as little baggage as' possible,
take with them a mixture of coffee and butter
rolled up into balls, and carried in a leathern
bag. One of these, about the size of a billiard
ball, keeps them, they say, in strength and
spirits during a day's fatigue. Coffee was introduced into Mecca, Medina and Cairo about
the middle of the fifteenth century, and two
coffee-houses were opened at Constantinople
in 1554. Both at Cairo and in Turkey it had
to encounter political and religious opposition;
the dervises affirmed that roasted cofihe was
nothing but a coal, and that the eating of coals
was forbidden by the laws of their prophet.
So that the coffee-houses were obliged to be
shut up until 'a more sensible mufti' succeeded in convincing the people that roasted coffee
was not a coal, upon which they were again
opened. In later years the use of coffee became extremely prevalent throughout the east.
Houses for selling it were established in all



ON COFFEE AND TEA.


293


parts of the Turkish empire; it was introduced
into private families, and the refusal of a
husband to supply his wife with coffee was
reckoned among    the legal causes of a divorce.
In Europe coffee was introduced into France
and England about a century and a half ago.
So rapid was the progress of a taste for it after
it became known, that in eight years from its
introduction, it had become in England a subject
of public revenue.
Coffee has seldom been used in its raw
state, except sometimes as a fanciful addition
to certain liqueurs and ices. A decoction of raw
coffee is disagreeable to the taste, but appears
to possess properties analogous to those which
it exhibits after being roasted.  The roasting
of coffee improves its flavor, and occasions
considerable changes in its chemical constitution, without impairing its stimulant or medicinal activity. A peculiar alkaloid, called caffeine, is detected in both raw and roasted coffee.
It is considered by chemists to be identical
with theine, found in tea and in a few other
vegetables. An aromatic oil, which has been



294


ON COFFEE AND TEA.


called caffeone, is produced during the process
of roasting.
During the extensive trial which has been
made all over the world, as to the effect of
coffee upon the health, no small diversity of
opinion has existed in regard -to its specific
powers. Of the properties ascribed to it, two
seem better established than any others. These
are its property of assisting digestion, and that
of obviating drowsiness.  Coffee, when taken
into the stomach, usually creates a pleasing
sense of vigor in that organ, it moderates alimentary fermentation, takes off the feeling of
distension and heaviness occasioned by overeating, counteracts in some degree the fumes
of wine, and produces a lightness and hilarity of mind, more moderate but more permanent than that occasioned by vinous orspirituous liquors.  The custom derived from
the French of drinking coffee after dinner, is
beneficial, and powerfully promotes the process
of digestion. It is known to epicures of most
countries, that a cup of strong coffee, at the
end of some hours spent at the table, enables
them to continue their functions, both of body



ON COFFEE AND TEA.          295
and mind, to a greater extent than would have
been done under any other assistance.
It is well known that coffee is strongly promotive of watchfulness, and enables us to resist 
for a long time the approaches of sleep. Students, whose lucubrations occupy a considerable portion of the night, find a great increase
of the vigilance and vigor of their faculties,
derived from the use of both coffee and tea.
In fact, the long habit of drinking these articles
renders us so dependent on them, for the power
of keeping the mind awake and active, that a
change from them to any other kind of diet
creates in most persons, at least for a time, a
drowsiness and dulness of intellect. Hence it
is common to hear milk and chocolate accused
of creating sleepiness, an effect which arises, not
from any real soporific influence in those articles, but from the change of diet, and the want
of the customary stimulus of coffee and tea.
The Turks and Arabians consume large quantities of coffee, because it acts as an antidote
to the stupefying effect of opium, to the abuse
of which those nations are generally addicted.
It has already been mentioned, and is a fact



ON COFFEE AND TEA.


297


ration of these active liquids. I have generally
found these complaints to be most effectually
relieved by the simple remedy of eating, and
cured either by increasing the quantity and
quality of nourishment taken in the morning, or
by exchanging the coffee for cocoa, chocolate or
milk.
TEA.
The tea tree, called by Linnweus THEA, is a
native of Japan, China, Tonquin, and Assam.
Linnmus believed that there were two distinct
species of this genus, producing the green tea
and the black, to which he has given the names
of Thea viridis and Thea bohea, and distinguishes them by the number of petals in their
flowers, the one having six petals, the other
nine. But subsequent observers have found the
number of these organs to be uncertain, varying from three to nine; and travellers in China
and Japan, as well as various distinguished
botanists, have arrived at the opinion, that the
different kinds of tea brought from those countries are the product of a single species, subject
only to varieties from the influence of soil, cli



298


ON COFFEE AND TEA.


mate, time of gathering, and mode of preparation.
The tea plant is a small evergreen tree or
shrub, of the height of six        or eight feet.     It
grows in the valleys, and on the sloping sides
of mountains, with a southern exposure. In
Japan it is planted around the borders of fields
without regard      to  the kind     of soil, while in
'China, where it is an important article of commerce, whole fields are covered          with it, and
cultivated with the greatest care."
* The origin of the employment of tea as a beverage amongst
"the Chinese, is wrapped in the obscurity which generally belongs to ancient usages; and a fabulous tale is narrated, as to
its introduction, which has had credence even amongst the
better informed inhabitants of the empire, whilst, as is usual.with fables, it has been imagined to have some allegorical
allusion, which, if explained, would satisfy the lover of antiquarian lore. The tale is thus related by one of the compilers
of a history of China: -
' Darma, a very religious prince, and third son of an Indian
king, named Rosjusvo, is said to have landed in China, in the
year 510 of the Christian era. He employed all his care and
thought to diffuse throughout the country a knowledge of God
and religion; and, being desirous to excite men by his example, imposed on himself privations and mortifications of every
kind, living in the open air, and devoting,the days and nights



300


ON COFFEE AND TEA.


drunk by the grandees and rich people only.
The second gathering is made a month later,
taking indiscriminately the leaves that are unfolded and those which are not. Finally, a
month after this, is made the third and last
gathering, consisting of leaves fully grown,
which furnish the poorest and lowest priced
teas, consumed by the common people. It is
now pretty well understood that the different
sorts of tea imported into this country, from
the finest green teas to the poorest bohea, depend for their difference of quality very much
upon the time of their gathering.
The process of gathering, drying, and rolling
the leaves is very laborious, and is in some
instances conducted with the most superfluous
nicety. In Japan, where a particular mountain
is appropriated to raising tea for the exclusive
use of the emperor, the shrubs are washed and
cleansed from dust every day; the men employed in gathering the leaves are obliged to
bathe themselves two or three times a day, and
to wear gloves in the performance of their
occupation.
The drying and rolling of the leaves is per



302


302      ON COFFEE AND TEA.


the cooling, the better they are rolled, and on
this account the workmen agitate the air with a
kind of fan  But, in spite of this precaution, a
great number of the leaves unroll themselves,
and are obliged to be separated and roasted,
and rolled several successive times before they
are in order to be packed.
In order that the tea should keep well, it
must be inclosed in vessels which are air-tight.
Kawmpfer assures us that the tea brought into
Europe is alwvays injured in quality, and never
retains the fine flavor and delicate perfume
which it has in its own country. The Japanese
inclose their tea in vessels of tin, which, if large,
are placed in savin boxes having their cracks
closed with paper within and without. The tea
imported to this country from China, it is well
known, comes in tight wooden chests, lined
with sheet lead hermetically soldered. lIt is
packed in these chests by the Chinese, by
stamping it down with their bare feet.
Some writers have asserted that the tea is
roasted upon plates of copper, and that its color
is owincr to verdigris with which it thus be0D



ON COFFEE AND TEA.


303


comes impregnated. But those travellers who
are most entitled to credit, affirm that the plates
are, without exception of iron; and Dr. Lettson,
after a great number of experiments made with
chemical tests, never detected any trace of copper; so that this suspicion appears to be void of
foundation.
Among the Chinese tea is drunk in a variety
of ways. Some use it as we do, in the form of
an infusion; others take it in the form of fine
powder mixed with boiling water. The common or laboring people are said to use it in
decoction, several handfuls of the ordinary kinds
of tea being boiled in a kettle of water until the
strength is extracted. This is taken by them as
their common drink for assuaging thirst, and
diluting meals.
Tea was first introduced into Europe by the
Dutch, before the middle of the seventeenth
century, and several physicians of eminence,
either from conviction of its utility, or perhaps for the more substantial reason of a
pecuniary reward, published warm eulogies in
its favor. From this time its adoption was
rapid in all the countries of Europe, and it is



304


ON COFFEE AND TEA.


now   a common article of diet with           both rich
and poor.*
* Nicolaus Tulpius was about the first medical man who
wrote professionally upon tea, but his were not original observations; they were the opinions of the most eminent men he
had collected to give to the world. But in 1678 appeared the
first edition of a book which speedily ran through three large
impressions, and had a considerable influence upon the introduction of tea. It was entitled Cornelio Bontekoe, Tractaat
van het excellenste Kruyd Thee. Although this work was,
from the extravagance of its commendations on tea, severely
handled by some of the critics, it was translated into many languages, and quoted as the highest authority. He pronounced
tea to be the infallible cause of health, and that if mankind
could be induced to drink a sufficient quantity of it, the innumerable ills to which man is subject would not only be diminished, but entirely unknown. He thinks that two hundred cups
daily would not be too much. He is said to have been rewarded
for his judgment by the liberality of the Dutch East India Company. Heydentrik Overcamp, who wrote the life of Bontekoe,
states that his inducement to write was to recommend himself to
his fellow-citizens, and to defend himself against his colleagues,
who did not follow his theory or his practice. Etmiiller recommended tea as a fine stomachic cephalic and antinephritic.
Pechlin wrote a dialogue on tea, which he entitled Theophilus
Bibaculus, and several poets indulged themselves in its praise.
Petit wrote a poem; Peter Francius, two Anacreontics; Heinrich, a Doric Melydrion; and our poet-laureate, Tate, joined the
melodious bards. Whilst it met with so much approbation, there



ON COFFEE AND TEA.


305


In regard to     the medicinal qualities of tea,
and its general influence upon the health of
those who take it, reports and opinions are
were likewise those who were not equally satisfied with its
"merits. Boerhaave, Van Swieten, and others, attempted to stem
the tide that was setting in its favor, but they have proved
themselves incapable of resisting the general impression; for
no beverage that has ever yet been introduced sits so agreeably
on. the stomach, so refreshes the system, soothes, nervous irritar
tioa after fatigue, or forms a more grateful repast. It contributes to the sobriety of a nation; it imparts all the charms to
society which spring from the enjoyment of conversation, without that excitement which follows upon a fermented drink. -
Sigmond, p. 94.
The introduction of tea-drinking into England has been ascribed to Lord Arlington and Lord Orrery, and the year 1666,
the annus mirabilis of Dryden, has been assigned as the exact
date; but in the diary of Mr. Pepys, secretary to the Admiralty, the following is registered, -  I sent for a cup of tea, a
Chinese drink, of which I had never drank before.' In the
diary of Henry, Earl of Clarendon, there is a memorandum, -
' Pere Couplet supped with me, and after supper we had tea,
which he said was really as good as any he drank in China.'
The first historical record, however, is an act of Parliame t,
passed in the year 1660, 12 Carl. II. c. 23, which enacts that a
duty should be laid of eight pence per gallon on all tea made
and sold in coffee-houses; which were visited twice daily by
20



ON COFFEE AND TEA.


307


diet which is taken by one person with impunity, and even with benefit, shall in another
occasion disagreeable and even serious conse'The particular virtues are these:SIt maketh the body active and lusty.
'It helpeth the headache, giddiness and heaviness thereof.
'It removeth the obstructions of the spleen.
'It taketh away the difficulty of breathing, opening obstructions.
'It is good against tipitude, distillations, and cleareth the
sight.
'It removeth lassitude, and cleanseth and purifieth acrid humors, and a hot liver.
'It is good against crudities, strengthening the weakness of
the ventricle or stomach, causing good appetite and digestion,
and particularly for men of corpulent body, and such as are
great eaters of flesh.
' It vanquisheth heavy dreams, easeth the frame, and strengtheneth the memory.
"* It overcometh superfluous sleep, and prevents sleepiness in
general, a draught of the infusion being taken; so that, without
trouble, whole nights may be spent in study without hurt to the
body, in that it moderately healeth and bindeth the mouth of the
stomach.
' It prevents and cures agues, surfets and fevers, by infusing
a fit quantity of the leaf, thereby provoking a most gentle vomit
and breathing of the pores, and hath been given with wonderful
success.



ON COFFEE AND TEA.


309


has very little in common with other narcotics.
The excitement which it produces upon the
mind and upon the organs of digestion is of a
durable and permanent kind, and it never, like
other narcotics, leaves the system in a state of
somnolency     and intoxication.      These remarks
are to be understood of tea in the state in which
we consume it, that is, the state of perfect dryness. In its green or recent state, it is said to
possess a decided narcotic quality, capable of
producing     intoxication   and    other deleterious
and excellences of this precious leaf and drink, hath more of
design than truth, for the justification of himself and the satisfaction of others, he hath here enumerated several authors,
who, in their learned works, have expressly written and asserted
the same and much more, in honor of this noble leaf and drink,
viz. - Bontius, Riccius, Jarricus, Almeyda, Horstius, Alvarez
Semeda, Martinivus in his China Atlas, and Alexander do
Rhodes in his Voyage and mJissions, in a large discourse of the
ordering of this leaf, and the many virtues of the drink; printed
at Paris, 1663, part x. chap. 13.
* And to the end that all persons of eminency and quality,
gentlemen and others, who have occasion for tea in leaf, may be
supplyed, these are to give notice, that the said Thomas hath
tea to sell, from sixteen to fifty shillings in the pound.' - Sigmond, p. 96, &c.



ON COFFEE AND TEA.


311


no injurious effect upon the generality of persons who take it from infancy to old age. It
is remarked by Desfontaines, that no vegetable
is known, the infusion of which can be drunk
so often and in such large quantities, without
disgust. The Chinese regard it as highly salubrious.  They mix with it neither milk nor
sugar, but drink it pure, sometimes holding a
piece of sugar in the mouth. The constant
use which this people have made of it for so
many ages seems to prove that, when rightly
prepared, it is destitute at least of injurious
properties. Professor Kalm states, that tea is
the best corrector of bad water, and that he
derived from it great comfort and benefit during the illness and inconvenience of a long sea
voyage. It is, in fact, one of the best remedies
for slight sea-sickness.  An extract made of
tea is in high repute as a medicine in China,
and is said to remove obstructions and promote perspiration.  Dr. Lettsom  found that
tea given in fine powder, in doses of thirty
grains once in three or four hours, produced
nausea and diaphoresis, and appeared to diminish the heat accompanying inflammatory



312


ON COFFEE AND TEA.


complaints. The finer and more green is the
tea, the more powerful are its specific effects.
Nevertheless, a variety of injurious consequences have been ascribed to tea, and many
no doubt have arisen, either from its abuse, or
from the idiosyncrasies of those who have been
the subjects of its influence. Some persons
complain that, after taking freely of tea, a nervous agitation of the whole frame commences.
The hands tremble, so as to be incapable of
writing; the limbs experience a loss of power,
and perform their office with difficulty; at the
same time a confusion of ideas incapacitates
the mind for any close or active train of thinking. There are even some persons, in whom
tea produces great nausea and sickness, with
spasmodic.pains of the stomach and bowels,
and an uncontrollable agitation of spirits on the
least hurry, noise or disturbance. These symptoms, however, are the effect of some peculiarity
in the constitution, a great mobility of the nervous system, and generally of a slender, enfeebled and effeminate frame. They may, however, arise in all persons from an excessive use,
either as it respects the quantity or strength of



814


ON COFFER AND TEA.


than coffee and tea. Tea is more astringent
than coffee, and coffee of the strength commonly used is somewhat more stimulating
than tea, - otherwise the differences which
have been ascribed to them have mostly arisen
from the accidental opinions of individuals,
whose taste and idiosyncrasies have rendered
them fond of the one and averse to the other.



316     ACTION OF COCHITUATE WATER
well-marked cases of the diseases usually attributed to lead, have occurred, which were not
traceable to some other cause than the use of
Cochituate water drawn from leaden pipes.
It appears from the experiments of Professor
Horsford, that the water of the Schuylkill and
Croton rivers, and of Jamaica and Cochituate
lakes, acts upon the surface of the lead so as to
take up a small portion of that metal during the
first two or three days of its contact. But after
a few days the surface of the lead becomes coated with an insoluble compound which protects
the lead for the most part from the further
action of the water. Nevertheless, traces of lead
are reported to have been found by various
chemists in specimens of some of these waters,
when greatly reduced by evaporation.
In consequence of the extensive use made of
lead for various economical purposes, no person
in civilized society can expect to escape from
the reception of that metal in minute quantities
into the body. The presence of lead in the
paint of dwelling-houses and furniture, of waterbuckets and other culinary apparatus, in vessels
made of leaden alloys or soldered with the same,



ON LEAD PIPES.


317


in the lining of tea-chests, in flint-glass, and in
the glazing of coarse pottery, furnishes but a
part of the examples which indicate our exposure to receive this metal in our daily food. To
these examples it may be added that physicians
give lead to their patients sometimes for weeks
successively, and apply solutions and solid compounds of the metal to absorbing surfaces for
longer periods; that persons are known to carry
shot and bullets in their flesh during a long life;
and, finally, that rtliable chemists testify that
lead naturally exists in the solids and fluids of
man, and in those of some of the animals on
which he feeds.
From all these facts we are authorized to
draw the conclusion that in the present state of
our knowledge, the presence of lead in a very
minute amount, like the presence of other substances in infinitesimal quantities, is inopera.
tive upon the living body.
It is a general law known to medical men,
and to which there are not many exceptions,
that diseases and symptoms produced by specific metallic agents, such as mercury, lead, and
arsenic, do not cease until after the withdrawal



318     ACTION OF COCIIITUATE WATER
of those agents. But it appears from the records of the Massachusetts General Hospital,
during the last twenty years, as well as from
the private experience of physicians, that many
cases of lead colic and paralysis, acquired.by
persons who work in that metal, have got well
under the daily use of water delivered from
leaden pipes. This would not probably have
been the case did the water contain any deleterious amount of lead in solution or suspension.
The principal diseases ascribed by Tanquerel,
and some subsequent writers, to the presence of
lead, are colic, paralysis, arthralgia, and encephalopathy. Of these the committee have not
been able to learn that there has been any sensible increase in this city since the introduction
of Cochituate water. Of lead colic, but one
case has entered the hospital during the last
two years, which is a smaller proportion than
the average of the preceding twenty years. Of
lead paralysis there have been but two cases
within the same period, both occurring to workmen in lead. Of arthralgia or pain in the joints
or limbs directly traceable to lead, it is believed
there have not been a sufficient number of cases



ON LEAD PIPES.


319


at any time to attract extensively the notice of
our physicians. As to encephalopathy, a general term used by some writers to express cerebral
disease, and including coma, delirium, convulsions, &c., there is apparently no more reason
for attributing it to lead, than consumption,
fever, or any other common disease which may
happen to occur among lead workmen.
It is obvious to a medical reader, that many
of the cases detailed by writers on lead diseases
are coincidences rather than "consequences; and
therefore do not furnish a ground for general
laws. Such is the case when persons have been
supposed to have contracted lead diseases by
sleeping in newly-painted apartments, where,
unless the lead were volatile, it could not leave
the walls to enter the bodies of the patients. It
is also the case when solitary examples of common diseases are ascribed to lead, when it is
known that they more frequently result from
different causes. It is also often the case when
the reports of credulous and incompetent observers are received as scientific authority.
In a late ' English Report by the Government
Commissioners on the Chemical Quality of the



320


ACTION OF COCHITUATE WATER


Supply of Water to the Metropolis,' of London,
made in 1851, by Drs. Th. Graham, W. A. Miller, and A. W. Hoffman, men of high standing
in the scientific world, an investigation is made
of the condition of the various waters now
supplied to that city. In this Report, the commissioners state (page 32) that 'no recent or
authenticated case can be cited of the health of
any of the numerous towns lately supplied with
soft water, being affected by the use of leaden
distributing tubes.'  Again, on page 33, the
commissioners say: 'We are disposed, therefore, to conclude that the danger from lead in
towns siupplied with water, has been overrated;
and that, with a supply from the Water Companies, not less frequent than daily, no danger
is to be apprehended from the use of the present
distributing apparatus, with any supply of moderately soft water which the metropolis is likely
to obtain.'
On the present occasion it is by no means
intended to deny the well-known fact, that certain acid liquors, also that the water of certain
springs and wells, may and do act upon and
even dissolve lead in such quantities as to prove



ON LEAD PIPES.


321


injurious to human health. It is also possible
that at certain seasons, and under certain circumstances, the soft water of lakes and rivers
may contain organi6 or other products, which
may take up in solution a minute portion of
the pipes through which they pass. And it may
even be conceded as possible, that a few susceptible and predisposed individuals will get lead
diseases while using this water. Nevertheless,
lead is a very convenient material to be used in
aqueducts. It is more cheaply manufactured,
more conveniently applied, and more readily
repaired, than any other material. And while
this is the case, mankind will not be prevented
from employing it. The general law derived
from the experience of the large cities of this
country and of Europe is, that its employment
for the conveyance of soft water is safe. To
this law the few recorded cases of disease, if
genuine, must be regarded as exceptions. And
it should be borne in mind, that nearly all the
great agents which minister to the physical happiness and improvement of man, are fraught
with more or less danger. Ships and railroads,
fire and water, food, drink and medicine destroy
21



322    ACTION OF COCHIJTUATE WATER.
annually multitudes of our species. Nevertheless, all these agents increase every year in use,
with the increase of wealth: and civilization.
And as a humble example under the same law,
it is not probable that the leaden aqueduct will
be abandoned, on account of the inconsiderable risk which it may involve of occasioning
disease. From the present state of our knowledge, we are authorized to conclude that the insurance on a citizen of Boston, New York, Philadelphia, or London, against lead colic, is
probably worth much less than his insurance
would be on a voyage across the Atlantic, or
on a railroad for twenty miles.



326;


HISTORY AND USE OF TOBACCO.


up to it, as a solace for the miseries of life. Its:
use became so general and so excessive, that in
many countries the constituted authorities, both
of church and state, found it necessary to interpose, and to stop the extravagant indulgence in
it by severe prohibitions. James the First of
England, besides writing a book against, it,
called his 'Counterblast to Tobacco,' gave
orders that no planter in Virginia should cultivate more than one hundred pounds. Pope
Urban the Eighth published a decree of excommunication against all who took snuff in the.
church.. Smoking was forbidden in Russia
under penalty of having the nose cut off. In
Switzerland a tribunal (Chambre du tabac) was
instituted for the express purpose of trying
transgressors in tobacco.  A Turk, who was
found smoking in Constantinople, was conducted through the streets of that city with his pipe
transfixed through his nose.
Even in, this country, where the use of tobacco originated, we find our puritanic ances-.
tors guarding against its,, abuse by salutary.
statutes. ' In the old Massachusetts colony laws
is an act laying a penalty upon any one ' who,



HISTORY.AND USE OF TOBACCO.


327


shall smoke tobacco within,twenty poles of any
house;' or who, shall' take tobacco in any inn
or common victualling house, except in a private room, so as that neither the master of the
said house nor any other guest shall take offence
thereat.' In the earliest records,of Harvard
University soon after its foundation, is a regulation of this kind: ' No scholar shall take tobacco, unless permitted: by, the president, with the
consent, of their parents and:guardians, and on
good reason first given by a physician, and then
in a sober and private manner.'
While the legal authorities in various parts of
the world took upon them to control the abuse
of this fascinating weed, the literati of different
countries entered warmly into the discussion of
its merits and its faults. Among its advocates
were Castor Duranti and Raphael Thorius, both
of whom wrote Latin poems expressly in its
praise. The performance of the latter is entitled
a (Hymn to Tobacco,' and is very lavish in
ascriptions to this plant, which he styles the
' gift of heaven and the ornament of earth.' So
warm were the prejudices of its advocates, that
it obtained the reputation of a general panacea,



328     HISTORY AND USE OF TOBACCO.
and the catalogue of diseases which it was
announced to cure, amounted almost to a
complete nosology.
But the opinions of its adversaries were not
less extravagant upon the other extreme. It is
remarkable that in the days of its first general
introduction, no man spoke about it with coolness and indifference, but every one warmly
espoused its censure or its praise. Camden, in
his Life of Queen Elizabeth, says, that men used
tobacco every where, some for wantonness and
some for health's sake; and that 'with insatiable desire and greediness, they sucked the stinking smoke thereof through an earthen pipe,
which they presently blew out again at their
aostrils;- so that Englishmen's bodies were so
delighted with this plant, that they seemed as it
were degenerated into barbarians.'
Dr. Venner, in a work entitled Via recta ad
vitam longamn, published at London in 1638,
gives a brief summary of the injuries done by
tobacco.  'It drieth the brain, dimmeth the
sight, vitiateth the smell, hurteth the stomach,
destroyeth the concoction, disturbeth the humors
and spirits, corrupteth the breath, induceth a



330     HISTORY AND USE OF TOBACCO.
Such were the commotions excited by the
introduction and spreading of an article, the use
of which has now become so common as scarcely to attract notice. This article is the product
of several species of Nicotiana, but chiefly of
the N. tabacum or Virginian tobacco, and the
N. rustica, sometimes called English tobacco,
and being the sort which Sir Walter Raleigh
introduced at the court of Queen Elizabeth.
Another species, N. fruticosa, is said to have
been cultivated in the East prior to the discovery
of America. The Indians on the banks of the
Missouri and Columbia rivers cultivate for use
the N. quadrivalvis of Pursh and Nuttall. It
has been remarked that the tobacco of warm
climates is more mild in its flavor, while that
raised in colder latitudes is more strong and
pungent. The Bengal tobacco, of which the
sheroots are made, is one of the most mild in its
properties. After this is the West India tobacco which affords the Havana cigars. Next is
the tobacco of our Southern States, and lastly
the tobacco raised in the northern parts of the
Union, which is the most acrimonious and pungent of all.



HISTORY AND USE OF TOBACCO.


331


Chemists have extracted from tobacco a color:
less liquid alkaloid, which they have called Nicotine. It is acrid to the taste and smell, forms
neutral compounds with acids, and is intensely
poisonous in minute quantities. NVicotianine,
another product, is a concrete volatile oil, like
camphor, and resembles tobacco in its properties.
Among the substances used by Sir Benjamin
Brodie in his experiments on vegetable poisons,
was an empyreumatic oil of tobacco prepared
by Mr. Brande by distilling the leaves of tobacco
in a heat above that of boiling water. A quantity of watery fluid came over, on the surface of
which was a film of unctuous substance, which
he calls the empyreumatic oil. Mr. Brodie
found that two drops of this oil applied to the
tongue of a young cat with an interval of fifteen
minutes occasioned death. A single drop suspended in an ounce of water and injected into
the rectum of a cat, produced death in about
five minutes. One drop suspended in an ounce
and a half of mucilage and thrown into the rectum of a dog, produced violent symptoms, and
a repetition of the experiment killed him.



332


HISTORY AND USE OF TOBACCO.


Tobacco has been used both as a luxury and
prophylactic, and as a medicine. In the former
cases it has not been taken internally, but only
kept in contact with absorbing surfaces. It is
well known, that to the mouth it is applied in
substance and in smoke; and to the nose in the
form of powder. The opinion which at one
time prevailed of its power to prolong life and
to secure immunity from diseases is now pretty
fully abandoned. It has no prophylactic reputation except as a preservation for the teeth,
and in some degree as a protection against the
contagion of epidemics. In both these cases it
has acquired a certain degree of confidence,
though it is probably inferior to many other
substances for both these purposes.
As to its effects upon longevity, the great
frequency of its use, and the facts and observations of Sir John Sinclair, render it improbable
that when moderately taken, it has much influence in wearing out the constitution, or abridging the usual period of life. But like all other
narcotics its excessive use or abuse must impair
the health and engender disease. Of the different modes of using tobacco, it is probable that



HISTORY AND USE OF TOBACCO.


333


smoking is the most injurious, and the most
capable of abuse, since in this process the active
principles of the tobacco are volatilized with the
smoke, and are extensively applied to the lungs
as well as the mouth and nose and fauces.
As a medicine, this plant has been employed
in a variety of ways for the alleviation and cure
of diseases.  Externally it has been applied
with benefit in tinea capitis and in some complaints occasioned by the presence of insects.
In the form of a cataplasm applied to the pit of
the stomach it occasions severe vomiting. The
prostration of strength and other distressing
symptoms which attend this application, must
prevent its general employment. Still it may be
remembered as an auxiliary in some cases where
other emetics have failed to operate. A surgeon
in the U. S. Army informed me that the soldiers
had an expedient to exempt themselves from
duty, by wearing a piece of tobacco under each
armpit, until the most alarming symptoms of
real illness appeared in the whole system.
Dr. James Currie has recorded a case of epilepsy cured by the external use of tobacco. A
cataplasm was applied to the stomach for seve



-HISTORY AND USE OF TOBACCO.


335


-has gone more into disuse. From the sedative
effect of tobacco, the tendency to syncope and
the great prostration of strength which it occasions in ordinary cases, it is probable that its
'employment in cases of asphyxia from drowning, must assist in extinguishing rather than in
rekindling the spark of life.
Tobacco has been employed with some success in the locked jaw, both of warm and cold
climates, by enemas of the infusion and of the
smoke.   These applications generally produce
syncope and deathlike sickness in the patient,
but by prudent management of them, the disease has sometimes been overcome.
This powerful medicine is reported to have
been also employed with some palliative effect
in hydrophobia and certain other spasmodic diseases. Its internal use however requires great
caution, since patients have in various instances
been destroyed by improper quantities administered by the hands of the unskilful or unwary.
Notwithstanding the common use and extensive
consumption of tobacco in its various forms, it
must unquestionably be ranked among narcotic
poisons of the most active class. The great



336     HISTORY AND USE OF TOBACCO.
prostration of strength, excessive giddiness,
fainting, and violent affections of the alimentary
canal, which often attend its internal use, make
it proper that so potent a drug should be resorted to by medical men, only in restricted doses
and on occasions of magnitude.



ON THE


EARLY HISTORY OF MEDICINE.
FROM A REVIEW OF MILLER' S DISQUISITIONS ON THE HISTORY OF
MEDICINE, PUDLISUED IN THE NEW ENGLAND JOURNAL OP
MEDICINE AND SURGERY, APRIL, 1812.
IT is commonly understood that the history
of medicine has already been traced with sufficient accuracy in all ages and countries, where
authorities for its elucidation are extant. The
labors of Le Clerc, Friend, Haller, and Cabanis,
seem to have left very little to be wished in this
department of science. But, although a general
history of medicine is by no means a desideratum at the present day, yet there are undoubtedly parts of it which are still susceptible of
correction or enlargement. Dr. Edward Miller,
the author of the present disquisitions, apprises us that he has been induced to attempt
22



338


ON THE EARLY


them, partly from some singular traits which he
thought he had discovered in the medicine of
the early Greeks, and partly from the extraordinary advancement made of late years in
Sanscrit literature. By means of this last we
are informed that, long previous to its introduction into Europe, the science of healing had
made very considerable progress in Hindostan;
yet to commemorate its 'details, or appreciate
its merits, has never yet been the task of any
historian in medicine. This new field of research Professor Miller has attempted to cultivate, and the fruits of his oriental inquiries are
to constitute a second volume of Disquisitions.
In the mean time, the present volume, containing general archbeological remarks, with speculations on the primitive physic of Greece and
Egypt, is submitted to the ordeal of the public.
It must be exceedingly obvious that, prior to
the introduction of letters, no very definite information can be expected with regard to the
state of medical practice in any country. If
the traditionary account of the most important
and notorious events, such as battles and sieges,
the rise and fall of heroes and of empires, is



HISTORY OF MEDICINE.


339


involved in necessary uncertainty; we cannot
expect that a complex science, closely interwoven in early ages with mystery and superstition, should reach us in a state capable of
affording much satisfaction. The few traditions handed down to us from the primitive
ages, afford matter for speculation to the curious, but yield no certainty to the accurate.
Dr. Miller, seemingly aware of the difficulties attendant on this part of his subject, has
thought proper to commence the present undertaking with a sort of history a priori, or
presumptive history, of medicine in its primmeval
state. He begins with stating the progress of
observation and reasoning, which would naturally be made by the early and rude nations, in
regard to the phenomena of life, health, disease
and death. He details' the manner in which a
gradual acquaintance would be formed with
the nutritious, medical and deleterious effects of
the various productions of nature; and from
hence assigns to the Materia Medica the supreme honors of antiquity. Afterwards comes
the knowledge of practical physic, of anatomy
and of surgery, in proportion as men became



340


ON TIIE EARLY


habituated to watch the progress and cure of
diseases, to butcher and dissect brute animals,
to sacrifice, eat, or embalm their own species,
and to inflict or remedy the wounds and injuries occasioned in war or elsewhere.
After this we are presented with an interesting account of that tract of territory, which we
have reason to believe contained the earliest
tribes of our species. To this region, composed
chiefly of Egypt, Ethiopia, Turkey, Arabia,
Persia, and India, Dr. M. gives the collective
name of the Primceval Chersonese.'    He expatiates on the exuberance of its soil, the variety
and value of its productions, its inducements
for agriculture, and facilities for commercial
intercourse. He represents that six races or
stems have, from time immemorial, occupied
this ample and favored' portion of the earth's
surface. These are the Chinese, the Hindus,
the Tartars, the Iranians, (or Assyrians,) the
Arabs, and lastly the Nilotic tribes, or those of
Egypt and Ethiopia. Among these he assigns
*' This application of the term Chersonese, we think, rather
stretches its ancient signification.



HISTORY OF MEDICINE.


341


an undoubted claim for priority of civilization
to three nations, the Hindus, the Iranians, and
the tribes inhabiting the banks of the Nile.
The individual claims of these three he compromises by endeavoring to prove, from tradition and history, from identity of language, &c.,
from conformity of religious and philosophical
opinions, and, lastly, from similitude of corpo-,real structure; that they were only separate
branches of one and the same individual family
or race of men. In this investigation the author gives proofs of extensive and assiduous
research.
Before quitting the general subject of the
Primreval Chersonese, we are made minutely
acquainted with its natural productions, or
those articles which must have constituted the
earliest food, and medicine of man.
We now come to the particular history of
medicine in early Greece, as it existed during
the traditionary ages. On collecting the scattered rays of information respecting this period,
chiefly from the poets, our author alights on a
curious circumstance, which he makes the basis
of this chapter, viz., " That, for its first discove



342


ON THE EARLY


ries and improvements, medicine in Greece
appears indebted almost wholly to two orders
of men, from whom such benefit was not likely
to be derived, viz.:
'1. The chiefs or sovereigns of its different
small communities.
'2. The priests or ministers of religion.'
Upon this ground the author proceeds to
give us two dissertations on the heroic and
the priestly medicine of Greece; -and first, of
'heroic medicine.'
On this subject we are told that scarcely a
royal or distinguished personage, during the
traditionary period, can be named, to whom
some degree of medical skill has not been accorded. The ascription of this honor is traced
to several causes, such as the obscurity which
hangs over the beginning of all arts; the veneration which savage tribes entertain for the
character of their leaders; and the policy which
would lead these chiefs to maintain their ascendency, by the display of every species of
personal merit or skill, that of medicine being
not the least imposing. The practice of these
heroic physicians, which the author believes to



344


ON THE EARLY


only a change of occasion to resolve them into
a jury of doctors.
We have already intimated that any accounts
now extant, respecting the medicine of the early
Greeks must be extremely unsatisfactory. We
may now add, that, from the few authorities
we have, it may be doubted whether any proficiency in medicine was ever made among
them, beyond what a rude individual would
naturally attain in the science of self-preservation. The boasted achievements performed by
their distinguished personages apparently consisted in some trifling and obvious operations,
or else in such exaggerated and miraculous
performances, as distance all possibility of belief.  The heroic or surgical practice among
them was confined chiefly to the extraction of
weapons and the dressing of wounds.    The
highest praise which Homer has bestowed on
the medical or surgical profession is contained
in the following lines:
'IiTroq yaq 'a;',Q nAolwv, 'arrac Lo~ a2wv,
Vg axmraountr, 's7rl r' 'tma q-paxa thaet ov.
Which amount to simply this, - that 'one



HISTORY OF MEDICINE.


345


doctor is worth a host of other men, to cut out
arrows, and apply mild dressings.' And, indeed, whenever he tells us of such a man being
actually engaged in practice, it is commonly in
one or the other of the above processes. Now
it could require no great depth of intellect to discover, that if a barbed arrow stuck in the flesh,
it could most easily be removed by excision,
and that if a wound became dry and painful
from exposure to the air, it might be made more
comfortable by covering it with emollient applications.
But, with such humble and obvious operations as these, the ancient physicians could not
have sustained their elevated rank in society,
and substantiated their claims upon immortality. It became necessary, in order to secure
complete ascendency over the public mind,
that they should profess an intercourse with
the gods, a knowledge of mysterious charms
and incantations, and other special gifts peculiar to jugglers in all nations since their time.
Very surprising stories are told of Melampus,
Polyidus, and Chiron.   These, however, are
small when compared with the feats of Escu



:346


ON THE EARLY


lapius, the prince of physicians, and the deified
inventor of medicine. Esculapius, in addition
to many other astonishing powers, was gifted
with a very remarkable faculty, peculiar to
himself, of raising at pleasure the dead to life.
Not less than six or seven instances are on
record of distinguished corpses that were benefited by the exertion of this happy talent. It
is impossible to say how far the bounds of science might have been enlarged by so mighty a
genius, had not Pluto taken alarm at his progress, and presented a memorial to Jupiter,
humbly showing, that if a stop was not put
to the career of this officious mortal, people
would soon cease to die, and hell would become a desert; whereupon Jupiter interposed,
and killed the wonder-working doctor with his
thunderbolts.
There is reason to believe, from what has
been said, that the cures effected by these medical worthies were either inconsiderable and real,
or else preternatural and counterfeited. We
have additional ground for this belief, on finding that frequently, when emergencies occurred,
opening a fine field for medical practice, the


I



HISTORY OF MEDICINE.


347


champions for physic were totally idle or inefficient. When a pestilence broke out among
*the Greeks at the Trojan war, we find them
with all their heroic and priestly medicine, resorting not to their drugs and preparations, not
to any regular system of practice, but simply
to superstitious prayers, rites and atonements..The Argonauts, with Esculapius at their head,
required the aid of a sorceress, before they
could administer an opiate to the dragon that
watched their fleece. Chiron died of a wound
or ulcer in the leg, and Achilles of one in tIe
heel. Such disasters as these last were not to
be expected, after what Dr. Miller tells us in his
account of Chiron: - 'So celebrated was he in
tradition for the cure of ulcers, as we are informed by Galen, that when a sore was obsti.
nate and could not be healed up, it was customary in later times to call it a Chironian
ulcer, intimating, by the expression, that it was
an ailment of such malignity, as to baffle the
skill even of Chiron h-imself.'
Now, we conceive, it was no compliment to.the Centaur to name only incurables after him.
We also conceive that, between Galen and Dr.



348


ON THE EARLY


Miller, the origin of the term Chironian ulcer
may have been mistaken, and that it may be
derived, not from the skill of Chiron in curing
malignant ulcers, but from the circumstance of
his having languished and died under a malignant ulcer. Galen informs us on this subject,
that of the phagedena, or eating ulcer, there
were different species, called the Chironian and
Telephian: ' Harum species quaedam sunt, qum
Chironia et Telephia dicuntur.'  In another,place he tells us that the Telephian ulcer was
so called from Telephus, who was afflicted with
it. Now the case of Chiron was not dissimilar
to that of Telephus, as both their maladies were,occasioned by the wound of a spear, only Te-lephus got well, whereas Chiron, after languishing with his lame leg for nine days, either
died, or was made into a constellation; for all
which the reader may consult Ovid. Fastorum
V. 379 - 414.
Machaon, the son    of Esculapius, when
wounded at the siege of Troy, retired with
Nestor to his tent, where they took from the
hands of a woman a farrago of onions, cheese,
meal, honey, and wine. From Pope's transla



HISTORY OF MEDICINE.


349


tion of this account in the Iliad, which Dr. M.
has quoted, we are led to suppose that this
potion was a prescription of the physician himself for his own case.    Witness the following
lines:
' The draught prescribed fair Hecamede prepares.'
And again,
' Thisfor the wounded prince the dame prepares.'
Unfortunately, however, there is no sort of authority in the original for the above expressions,
and it appears that Hecamede prepared the
draught, probably of her own invention, to treat
her master Nestor, as well as his guest Machaon, and this, too, for the sole purpose of
assuaging their thirst.
Torat 4i TreXIax. xvxusi 'iLi~U xy.alpo; 'Exap"Idl. II.?. 623.
Tw J' izra o'v ntrorr' aiT flrq novzeayxia &L iar'. 641.
It is a little remarkable that the learned professor should copy out the whole Greek passage
* The translations of this passage by Cowper and Dacier are
correct. Chapman has the same inaccuracy with Pope.



HISTORY OF MEDICINE.


351


be healed by the same spear which had occasioned it. Accordingly he applied to Achilles,
whose spear had done the mischief, and requested his medical assistance. Achilles at first
refused, saying that he was no physician, but
afterwards was prevailed on to scrape the rust
of his spear into the wound, which in due time
got well. With regard to the plant Achillkea,
we presume its name has as much to do with
medicine, as that of the plant Jeffersonia.
We now come to consider the second department which Dr. Miller has made in the physic
of Greece, viz. his Priestly medicine. As he
has shown that the medicine of heroes was
chiefly surgical, he now makes it equally clear
that that of priests and conjurors was mere
' practical physic.' For this he gives us all the
presumptive evidence which can arise from the
natural ascendency of priests and wizards over
the public mind, and from the analogy of customs in all the barbarous nations in the world.
He gives us, however, only two instances of
priest-physicians in Greece, viz. Melampus and
Orpheus; of whom Melampus appears to us to
have been only a fortune-hunter, who cured the



352


ON THE EARLY


daughters of Prcetus, of real or pretended madness, that he might gain the hand of one of his
patients, together with her kingdom, in marriage; while with regard to Orpheus, there is
very little authority for his having practised
physic in any particular instance, and his high
reputation is sufficiently supported by the established fact, that
' He played so well, he moved Old Nick.'
On considerations like the foregoing we are
disposed to ascribe to the ancient Greeks the
credit of very little real proficiency in the art
of healing.  From   similar motives we doubt
the correctness of Dr. Miller's belief, that Greece
was indebted for its first discoveries and improvements in medicine solely to two classes of
men, viz. the chiefs or sovereigns, and the priests
or ministers of religion. Unwilling, however,
to interfere with the doctor's ardor for classification, we only suggest, for a second edition of
his work, the propriety of adding a new class or
department in primitive physic, to be called the
department of old women, or of female medicine.



HISTORY OF MEDICINE.


353


These early practitioners of physic we think he
has treated with unmerited neglect, for we will
engage, where he produces one instance in
Greece of a priest skilled in medicine, that we
will furnish two of females possessing the same
accomplishment., It is sufficient now to mention only the names of Circe, Medea, Angitia,
Agamede, Helen and Oenone.*
The last portion of our author's work embraces the history of medicine in Egypt and
the East; and on this subject our limits compel us to be more brief. The advantages possessed by the Eastern countries over European
Greece for the early cultivation of science, are
said to have been the coalition of their inhabitants into large and mighty empires, instead
of petty states and communities; and also the
peculiar nature of their ecclesiastical institutions, in which an hereditary priesthood was
placed in possession of all the facilities and
* 'In these early ages all the knowledge of the tribe formed a
common stock; and their imperfeot arts might be exercised by
all those who were endowed with a certain portion of intelligence
Medicine therefore existed before there were any regular physiCians.' - Cabanis's Revolutions of.Med. Science.
23



354


ON THE EARLY


inducements for scientific speculation.  The
invention of letters, or alphabetic characters,
Was among them an early auxiliary to the
cultivation of the sciences, and medicine was
not the last to profit by so signal an advantage.
Some of the earliest lettered productions contained copious treatises on the healing art as an
integrant portion of their contents.
The very ancient and celebrated personage
Thoth, or, as he is called by Dr. Miller, Tot, and
who is the same with Hermes, or Mercury of
the Greeks, seems to have been the founder of
medicine in Egypt. His writings, afterwards
held sacred, were divided into forty-two books,
six of which treated of medical subjects, viz.
one of anatomy, one of diseases, one of instruments, one of medicaments, one of disorders of
the eyes, and one of diseases of women. While
the higher orders of Egyptian priesthood were
employed in the study and execution of religious and philosophical offices contained in the
former books, a second or inferior class were
busied in the study and practice of healing.
The Pastophori, for so the cultivators of physic
were called, were bound to make themselves



HISTORY OF MEDICINE.


355


intimately acquainted with the medical scriptures of Thoth, and so long as their practice
was strictly conformable to these, no blame was
incurred by them. On the contrary, if any
practitioner ventured to deviate in the least
from these sacred rules, he became responsible
with his own life for the safety of his patient.
This circumstance must have furnished a powerful check to improvement, and kept the science of medicine long in a state altogether
stationary.
Of the other peculiarities in Egyptian practice, the following are among the most remarkable. The art was made altogether hereditary,
so that 'he who was born a physician was prohibited equally by Heaven and by law from
abandoning the occupation of his ancestors.'
The profession was also subdivided into minute
departments, so that each particular disease had
a separate healer. Some took charge of disorders of the eyes, some of the head, some of
the teeth) some of the abdomen, &c.    The
vast number of individuals who were engaged in some branch of medical practice, led
to the assertion of Homer and Herodotus,



356


ON THE EARLY


that in Egypt every man met with was a
physician.
What were the particular modes of practice
enjoined by Thoth it is impossible now to
know, for the books of the Pastophori have
long since been lost. Dr. Miller, however, has
industriously attempted to glean whatever authorities were afforded respecting them, from
their successors in art and science, the Greeks.
He has told us that the Pastophori, and even
the kings, were wont to immolate and dissect
beasts and human victims, but with what proficiency in anatomy it is not known. In the
science of diseases they appear to have had
some idea of critical days, to have divided
disorders into acute and chronic, and to have
ascribed their pestilential distempers to a morbific principle in the air. In the Materia Medica they seem to have been acquainted with
many efficacious articles, together with their
most useful forms of composition.
Having now run through the contents of this
volume, we would observe that, in general, it
is far from being an uninteresting production.
The extent of the author's researches, and the



HISTORY OF MEDICINE.        357
ingenuity of his deductions, will afford some
novelty and instruction to most readers. His
predominant fault is a disposition to annex an
undue consequence to circumstances which are
doubtful or unimportant. We think he might
profit by the observation of Cabanis, that in a
subject where materials to compensate inquiry
are wanting, 'the friends of truth should not
lose their time in forming vain conjectures,
however learned they may happen to be.'



362


ADDRESS BEFORE THE AMERICAN


ed by the machinery of modern science, dispensing rewards with princely prodigality, offering
seats of which the prospective vacancy fills with
ambition the learned of foreign countries, throwing lustre on the cities of their respective establishment, and connected by little resemblance,
save that of etymology, with the simple pre.
ceding groves of Plato and Arcesilaus.
Academic institutions have differed widely
from each other in the object as well as the
comprehensiveness of their pursuits. Not only
does the history of literature furnish many examples of Academies of Sciences and the Arts,
but there are well-known like institutions of
Belles Lettres, of Language, of Inscriptions, of
Painting, Sculpture and Architecture, of Music,
of Antiquities, and of many subordinate branches
of useful and of elegant learning. Of course
the value of membership in any of these bodies
has depended on the character of the institution
itself, and the principles on which it is conducted. The Royal Academy of France, often
known par excellence as the Academy, not only
under its original name, but under the subsequent appellations of National and Imperial



364


ADDRESS BEFORE THE AMERICAN


Among the constellation of worthies enrolled as
its first members, we find the names of the two
Adamses, of Bowdoin and Cushing, of Chauncey and Cooper, of Hancock, of Lowell, of Sedgwick, Strong and Sullivan, and about fifty
others, all of them names already registered in
the annals of their country's service, or distinguished as proficients in the learning of their
time.
The preface to their first publication states
that the Legislature was called on to sanction
the society on a liberal and extensive plan, and
to establish it on a firm basis. 'And to the
honot of our political fathers,' say they, 'be it
spoken, that although the country was engaged
in a distressing war, a war the most important
to the liberties of mankind that was ever undertaken by any people, and which required the
utmost attention of those who were entrusted
with our public concerns, they immediately adverted to the usefulness of the design, entered
into its spirit, and incorporated a society with
ample privileges.'
But the approval of the Legislature was but
a small offset to the difficulties against which



ACADEMY OF ARTS AND SCIENCES.   365
the new association had to contend. 'The
country being young,' say they, ' few among us
have such affluence and leisure as to admit of'
our 'applying much time to the cultivation of
the sciences.' And in another place, 'many important European discoveries have been in a
great measure useless to this part of the world,
in consequence of a situation so remote from
the ancient seats of learning and improvement.
And of such publications as have reached this
country, the smallness of the number has greatly
limited their usefulness, as but few have had the
opportunity for perusing them.'
Under such disadvantages, so unlike the state
of things now, well might our courageous predecessors solace and assure themselves by a prospective view of the harvests they were sowing
for their descendants. ' Settled,' say they, ' in
an extensive country, bordering upon the ocean,
and open to a free intercourse with all the
commercial world,-a country comprehending
several climates and a rich variety of soils,
watered and fertilized by multitudes of springs
and streams, and by many grand rivers,-the
citizens have great opportunities and advan



366    ADDRESS BEFORE THE AMERICAN


tages for making useful experiments and improvements whereby the interests and happiness
of the rising empire may be essentially advanced.
At the same time enjoying, under a mild but
steady government, that freedom which excites
and rewards industry and gives a relish to life,
--that freedom which is propitious to the diffusion of knowledge, which expands the mind and
engages it to noble and generous pursuits,they have a stimulus to enterprise which the
i-nhabitants of few other countries can feel.'
Such were the principles and the auspices
under which was kindled the small dim light of
our Academy. Although it was not often overfed with fuel, nor at all times watched with
vestal vigilance, it has at least never been suffered to go wholly out, and, after glimmering
with uncertain yet increasing rays for two-thirds
of a century, it has at length grown to be an
acknowledged beacon in science, a light to
the philosophic of our own country, a western
star to whose unshadowed brilliancy and true
monitions the European world now looks with
interest and respect.
The early labors of the Academy were in



ACADEMY OF ARTS AND SCIENCES.    367
keeping with its early professions. They did
not trench deeply on fields appropriated by foreign explorers, but rather turned their inquiries
to the capacities of their own country, to the
improvement of its practical advantages and the
knowledge of its natural history.  With the
exception of a few limited papers in mathematics and astronomy, the first volumes of the
Transactions are occupied with such objects as
the cultivation of corn and the engrafting of
trees, examination of springs of water, and
reports on diseases of cattle, speculations on
natural caves, recorded earthquakes and conjectured volcanoes. Narratives are given of the
appearance of water-spouts, and of remarkable
devastations of lightning on trees, rocks and
dwelling-houses. Fossil frogs, 'that under the
cold stone' were believed to have passed monotonous ages of incomprehensible existence, are
presented in these memoirs, living and jumping
before the reader. Flocks of swallows, blackening the air with their numbers, abandon the
joyous, twittering, feather-chasing career of
their summer life, and with ominous solemnity
assemble on the banks of some stagnant pool,



372    ADDRESS BEFORE THE AMERICAN
weighing upon them. The first of these was,
' Whether diamonds and other precious stones
grow again after three or four years in the same
places where they have been digged out.' The
catagorical answer to this question is, 'Never.'
Another inquiry is, ' Whether in the island of
Sombrero there be found such a vegetable as
Master James Lancaster relates to have seen,
which grows up to a tree, shrinks down when
one offers to pluck it, and would quite shrink
unless held very hard.' Sir Philberto replies,
that he ' cannot meet with any that ever heard
of such a vegetable.'
Again they inquire, 'Whether the Indians
can so prepare that stupefying herb Datura, that
they may make it lie several days, months,
years, according as they will have it, in a
man's body, and at the end kill him without
missing half an hour's time.'
The 29th question is, ' Whether there be a
tree in Mexico that yields water, wine, vinegar, oil, milk, honey, wax, thread, and needles.'
The answer here is more encouraging, 'Tle
Cocos trees yield all this, and more.'
In the inquisitiveness and credulity which



ACADEMY OF ARTS AND SCIENCES.    373
marked these early stages of scientific inquiry,
we have at least the gratifying assurance, that
our philosophic fathers did not close their ears
against the reception of knowledge, from whatever quarter it might proceed. They were just
emerging from the deep intellectual darkness,
which for long ages had brooded over the world.
They were the survivors of many generations,
among whom to inquire had been a crime, to
reason had been a heresy, and to experiment a
satisfactory evidence of intercourse with the
powers of darkness. Secretly, and by stealth
and stratagem, the germs of science had here
and there been nourished into visible life, but
the air and the sunlight of heaven w~re denied
to their upward expanding tendencies.  And
when at length, with the Reformation, the revival of letters and the introduction of the printing press, a veil was lifted from the moral and
material world, no wonder that inquiring eyes
were dazzled and strong heads were turned with
the startling developments of the solar system,
the circumnavigation of the globe, and the practicable intercourse of men and nations with each
other.



374    ADDRESS BEFORE THE AMERICAN
The comparatively short period during which
the American Academy has existed, has been
one of advanced and rapid progress in the history of science throughout the world. It has been
the era of the Herschels and Laplace, of Lavoisier and of Davy, of Cuvier, of Watt, and a host
of gigantic minds, whose conquests over unknown regions will never be obliterated from
the map of science. During this period of progress, the small number and limited opportunities of the scientific men of our own hemisphere
have been such as to render them lookers-on,
recipients and dispensers, rather than originators of new discovery. For many years the
publications of this Academy were so sparse and
inconsiderable as to induce serious question from
some foreign scientific bodies, whether the usual
exchange of printed transactions were worth
keeping up. There was a long period, during
which the late venerated Bowditch seemed to
be the almost solitary pillar on whose support
the Academy relied for its character and position
in the philosophic world. And to his praise be
it said, that while engaged in the surpassing
labors which have constituted the monument



ACADEMY OF ARTS AND SCIENCES.    370
of his living and posthumous fame, he never
shrunk from identifying his name with a small,
and then almost obscure institution of his native
country. Punctual in his attendance on its
meetings, earnest in his appeals to the lagging industry of its members, foremost in every
movement for its prospective welfare, pouring
into its vacant pages the overflowings of his
own exuberant mind, he was not only a centre,
but a central fire; not only attracting but exciting, warming, illuminating all within the circle
of his influence. By his side walked the accomplished Pickering, laborious, erudite, modest, a
votary of learning for its own sake, whose capacious and cultivated mind, affluent in various
lore, seemed poor only to his own aspiring and
comprehensive genius.
By these men, more than all others, in the
day of its obscurity, was this Academy cherished
and upheld. They did not feel authorized to
boast much of its history nor of its existing performances. They were not vainglorious of their
own share in whatever of reputation it might
have happened to acquire. But they felt and
expressed that in it was contained the germ of



476


ADDRESS BEFORE THE AMERICAN


future development, that to a certain extent it
had books, and endowments, and position, that
it was their duty and that of their cotemporaries
to cultivate its capacities, to improve its condition, and at least to preserve it unimpaired,
until the increasing population and wealth in
our country, and correspondent increase of the
men and means of science, should impart to it a
vigorous vitality, like that which sustains the
older institutions of Europe.
We do not assume too much in saying that
this period has at length arrived. The thinly
attended meetings, few and far between, in
which a quorum was with difficulty convened,
perhaps only to spend an hour in debating a
by-law or electing a foreign fellow, have been
replaced by monthly and semi-monthly gatherings, in which the time is often too short to give
utterance to the accumulated researches of the
members. The demand for publication of new
and important matter outstrips the limited resources of the treasury, and now brings the
institution before the public of this city, a solicitor for the hearing of its claims. What is it
that this Academy, through its members, is now



ACADEMY OF ARTS AND SCIENCES.    377
performing? What is it that it asks the means
of publishing to the world? Not the meagre
and uninteresting record of every-day phenomena. Not the premature speculations of unqualified reasoners on more expanded subjects.
Not the repeated lessons received with unquestioning docility from the higher sources of
transatlantic wisdom. It now rather sits in
judgment on unsettled questions of European
science, and pushes its own unaided investigations beyond the previous bounds of human
knowledge. Its researches during the last five
or six years have been such in magnitude and
importance that they may without disadvantage
be brought into comparison with those of many
of the time-honored institutions of the old world.
Closely connected with our distinguished University, numbering among the teachers of that seminary a large portion of its most accomplished
and efficient members, making the pages of its
publications a vehicle for the light which emanates from the observatory, the apparatus, the
collections of that venerable seat of learning,
aided moreover by the naturalists, the philosophers and the annalists of other societies among



378    ADDRESS BEFORE THE AMERICAN
us, it has established an influence which could
not well be now spared from the republic of
science.
We may say, without fear of contradiction,
that there are few branches of physical knowledge which have not been illustrated or enlarged
by the members of this body, and when difficult
labors are to be performed, or difficult problems
to be solved, no source of information in our
country has been deemed more reliable, or more
frequently been put in requisition, than the authority of this Academy. The plants of California and New Mexico have repeatedly come
here to be named and described.   The late
exploring expedition sent to this city a large
portion of its collected treasures, for investigation and judgment. The fossil bones of gigantic quadrupeds are accumulated in our midst
with a completeness and abundance such as is
found in no other place; and they are presented
to the world with an amplitude of scientific
delineation, seldom, if ever, surpassed. Huge
limbs and heads of undescribed troglodytes,
exceeding those of man which they counterfeit,
and whose race is now     living in African



380    ADDRESS BEFORE THE AMERICAN
sects, and the other invertebrata of Massachusetts, were in the highest degree creditable to
those Academicians from whose labors they
emanated. Some of these subjects are yet
waiting the results of this course of lectures, to
give their illustrations to the public.
The incipient mysteries of organic development, the structure and transformations of the
animalcular world, the scarce visible organisms
which fill our waters with busy and effective
life, the unknown generations which have written with their own remains the history of
preceding nature, have often been drawn from
obscurity, their laws and limits studied, and
many of their new and unknown forms for the
first time described and arranged by one of our
adopted members, whom we may well place in
the foremost rank of living naturalists. And as
if to indicate the claim to notice of what might
seem a humble department of zoology, we have
been taught from the same indefatigable source,
that since the period of man's existence on this
globe, a vast peninsula, constituting nearly an
entire State of this Union, has been raised from
the bottom of the ocean and added to the previ



ACADEMY OF ARTS AND SCIENCES.    381
ous continent by the silent conspiring agency of
coral polypes.
When we turn our inquiries in another direction, we find that the study and knowledge of
the electric power has not deserted the country
of Franklin. This mighty agent, before which
men trembled in former ages, believing, in their
alarm, that Jove was wielding his bolts, or 'that
spirits were riding the Northern light,'- has
become, in philosophic hands, the docile messenger of thought over our vast country, and
the faithful monitor of danger in our cities, and
seems about to reveal the very measure of its
velocity to the persevering interrogations of
members of this Academy.
I should weary you with detail, were I to
recount the various contributions made among
us to mathematical, chemical, economical, mechanic, and microscopic science, and to the
natural history of the globe and of its inhabitants. I might say that the tornado which last
year swept over a neighboring district, has left
on our pages an impress more minute than ever
whirlwind left before. I might say that the
forthcoming nautical almanac, the joint and



ACADEMY OF ARTS AND SCIENCES.   383
English language, now devoted to pure astronomical science, regularly reporting, with discriminating exactness, the advances made in
that department of knowledge, and enriched by
contributions from both sides of the Atlantic,
as well as from its own editor, is now published
in this country, and issues periodically from the
press of Cambridge in Massachusetts.
It has not been in vain that public liberality
has provided our University with instruments
capable of penetrating the depths of space. It
has found in that place eyes adequate to perceive, and minds competent to analyze, the
abstruser revelations of astronomical science.
The meetings of this Academy have heard the
announcement of new celestial bodies, and the
assignment of unexpected laws to others already familiar to the European world. Who
is there, from the schoolboy to the sage, who
has not dwelt and gazed and speculated on the
mysterious ring that surrounds the planet Saturn? Who has not wondered at this exceptional feature of the known universe, and planted himself in imagination on the surface of that
distant sphere, that he might seem to contem



ACADEMY PF ARTS AND SCIENCES.    385
can Academy of Arts and Sciences has earned
for itself a position among similar institutions
of the world; and although, from the necessary
limits of the occasion, I have not been able to
take fitting notice of other investigations made
here for the advancement of knowledge and
other worthy achievements in the parallel walks
of literature, yet without arrogance I might assert that, in the different sections of this Academy, embracing the great departments of modern
research and cultivation, men are now found
competent to perceive truth, and qualified to
return light, on the varied objects of human
science.
It is not necessary to say, that the meetings
of such a body afford a nucleus, around which
are attracted and concentrated the contributions
of most of our scientific men. And the regularly published proceedings of this body are the
vehicle through which are given to the world
the results of their labors.
It ought not then to be said that, in this
enlightened community, the efforts of so active
and efficient an institution should be embarrassed by financial deficiencies. Yet such is the
25



386    ADDRESS BEFORE THE AMERICAN
uniform excess of its expenditures over its limited income, that the Academy is not able to
procure the books wanted for the information
of its members, nor to issue the publications
which should give utterance to its own investigations. So far from enjoying the promptness
and amplitude of appearance which attend the
productions of similar institutions abroad, itbhas
happened, more than once, that the discoveries
of our scientific men have had to wait, until
they were actually superseded by the same discoveries abroad, because the printed pages andthe illustrations of the engraver could not be
commanded at the requisite time.
As a nation we are proud of whatever contributes to our national glory. We are boastful
of our growth, our political progress, our victo.
ries, our annexations. We are proverbially sensitive, even in small matters, to questions of
precedence and subordination, and we give our
undivided sympathy even to a national contest
ot locksmiths.  The triumph of nautical skill
in a distant boat race binds this Union more
firmly together, by the common thrill of exultation which vibrates from Maine to Texas.



ACADEMY OF ARTS AND SCIENCES.    387
Have we then no place for the rising, star of
science? Shall we avert our eyes from the
dawning light, because its rays do not fall on
us from the accustomed east?   Have we no
encouragement for those, our countrymen, to
whom the old world is beginning to yield its
reluctant honors? Are we incapable of appreciating the value of scientific progress, and the
importance that our own country should not be
last in the general march of improvement which
characterizes the present age? Such has not
been the character and usage of this our city.
Such could not have been the expectation of
those who, in adverse times, planted and nourished among us seeds capable of a redundant
harvest.
I have thus, ladies and gentlemen, endeavored to present to your favorable notice, the character and claims of the Academy of Arts and
Sciences. In the course of lectures which is to
follow, the Academy will speak for itself. I am
aware that it is presumptuous for one absorbed
in the cares of a responsible profession, who
has added little to the common storehouse of
indigenous science, to appear as the advocate



388 ADDRESS BEFORE- AMERICAN ACADEMY.
and representative of so distinguished a body.
But I am impressed with the importance of the
occasion, and obey the commands which have
been laid upon me; and I will shelter myself
under the belief, that it may sometimes be permitted, even to the drone in the hive, to cause
the air to vibrate in honor of the labors of his
more efficient colleagues.



390


INDEX,


Fire, Injuries by,
Gout,                49,
Grecian Mediciue,
Harmony among Physicians,
Henry VI[I. King,
History of Medicine,
Homoeopathy,
Hooping Cough,
Incurable Diseases,
Inefficacy of Treatment,


146    Metastatic Diseases,
Mount Auburn,
132    Mucuna Pruriens,
342    Mummies, Egyptian,


123
183
388
101
10


Neptune, Planet,
Nomenclature,
Numerical Method,
Organic Remains,




23
171, 192
266
187
384
237
34
880


88
75


Paroxysmal Diseases,     21
Partridge, Poison of,   272
Pathology,               93
Pestilential Epidemics, 25, 54
Pharmacopceia Ameri

Kentish, Mr.           148
Kinglake, Dr.          148
Kings, Relics of,      178
Lead, Exposure to,     316
Lead Pipes for Water,  315
Lectures, Medical,      97
Louis,                  84
Materia Medica,         93
Measles,            11, 43
Medical Education,      91
Medical Profession,    111
Medical Reasoning,      29
Metallic Tinkling, 197, 224


can,
Pickering, John,
Plague at Cairo,
Pneumothorax,
Practical Medicine,
Precocious Habits,
Priestly Medicine,
Private Schools,
Quackery,


231
375
76
195
62
111
851
98
108, 124


Rabbits, Experiments on,
Rational Practice,
Remedies,


152
35
56









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