THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 LOS ANGELES 
 
 GIFT OF 
 
 Mrs. George Gore 

 
 NATURE IN DISEASE, 
 
 ILLUSTRATED IN 
 
 VARIOUS DISCOURSES AND ESSAYS, 
 
 TO WHICH ARK ADDED 
 
 MISCELLANEOUS WRITINGS, 
 
 CHIEFLY ON MEDICAL SUBJECTS. 
 
 BY JACOB BIGELOW, M. D. 
 
 PHYSICIAN AXD LECTCUER ON CLIXICAL MEDICIJfE IV THE MASSACHCSE 
 
 GSNEKAT. HOSPITAL ; PROFESSOR OF MATERIA MKDICA IN HARVARD 
 
 UXI7ERSITT ; PKESIDEXT OF THS AMERICAS ACADEMY OF 
 
 ARTS AND SCIENCES J ASD LATE PKESIDKST OF 
 
 THE 1IASSACUCSEITS MF.DICAL SOCIETY. 
 
 BOSTON: 
 TICK NOR AND FIELDS. 
 
 MDCCCL1V.
 
 Entered according to Act of Congress, in the year 1854, by 
 
 TICK NOR AND FIELDS, 
 In the Clerk's Office of the District Court of the District of Massachusetts. 
 
 BOSTON: 
 
 ASI) TOKltr, PKIXTKRS
 
 -R 
 
 in 
 
 PREFACE. 
 
 IT is observable to many physicians, that a change in the 
 mode of regarding the treatment of disease has come over 
 the msdical 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 incapa- 
 ble 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- 
 
 922421
 
 iy 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 satisfac- 
 tion to believe that many of my medical friends, for whose 
 judgment the public entertain the highest respect, have ar- 
 rived 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 urtdue 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 be- 
 come 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. But 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. 
 
 BOSTON, Nov. 1, 1854.
 
 ERRATA. 
 
 'Page 8, tine 8 from top, for give, read gives. 
 
 " 19, " 5 from bottom, " III. 616, I. 651. 
 
 " 79, " 10 from top, " affctions, " affections. 
 " 335, " 6 from bottom, " Grat Britain, " Great Britain. 
 " 235, " 3 " " " do novo, " tie novo.
 
 CONTENTS. 
 
 - 
 
 ON SELF-LIMITED DISEASES ..... 1 
 
 II. 
 ON THE TREATMENT OF DISEASE .... 59 
 
 III. 
 
 PRACTICAL VIEWS OF MEDICAL EDUCATION . . 91 
 
 IV. 
 
 REPORT ON HOMCEOPATHY ... . ^101 
 
 V. 
 
 ON THE MEDICAL PROFESSION, AND QUACKERY . .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 PNEUMOTHORAI . 195
 
 Vlll CONTENTS. 
 
 X. 
 
 ON THE PHARMACOPEIA OF THE UNITED STATES . 231 
 
 XL 
 
 ON THE MUCUNA PRURIENS : WITH REMARKS ON THE 
 
 IRRITABILITY OF DIFFERENT TEXTURES . . 266 
 
 XII. 
 
 ON THE POISONOUS EFFECTS OF THE AMERICAN PAR- 
 TRIDGE, OR RUFFED GROUSE .... 272 
 
 XIII. 
 ON COFFEE AND TEA ; AND THEIR MEDICINAL EFFECTS 289 
 
 XIV. 
 
 REPORT ON THE ACTION OF COCHITUATE WATER ON 
 LEAD PIPES ; AND THE INFLUENCE OF THE SAME 
 ON HEALTH . . . . . .315 
 
 XV. 
 
 ON THE HISTORY AND USE OF TOBACCO . . .323 
 
 XVI. 
 
 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, 1652. . 358
 
 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, de- 
 ceased 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 profession- 
 al exertions is limited, at last, by insurmount- 
 able barriers. It brings with it the humiliating 
 conclusion, that while other sciences have been 
 carried forward, within our own time and al- 
 most under our own eyes, to a degree of un- 
 precedented advancement, Medicine, in regard 
 1
 
 A SELF-LIMITED DISEASES. 
 
 to some of its professed and most important 
 objects, is still an ineffectual speculation. Ob- 
 servations are multiplied, but the observers dis- 
 appear, and leave their task unfinished. We 
 have seen the maturity of age, and the ardent 
 purpose of youth, called off from the half cul- 
 tivated field of their labors, expectations and 
 promise. It becomes us to look upon this deep- 
 ly 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 de- 
 partments of Medical science, we are brought to 
 the conclusion, that they have not all been cul- 
 tivated with equally satisfactory success. Some 
 of them have received new and important illus- 
 trations 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 dis- 
 eases, 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. 
 
 branch of knowledge by the application of which 
 physicians are expected to remove diseases, has 
 not, seemingly, attained to a much more eleva- 
 ted 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 %iany cases, disease is more easily under- 
 stood, 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 be- 
 longs 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 in- 
 quire how far certain individual diseases may 
 be considered as belonging to it. 
 
 By a self-limited disease, I would be under- 
 stood 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 know- 
 ledge, 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 medi- 
 cal means. 
 
 The existence of a class ol diseases, like those
 
 SELF-LIMITED DISEASES. O 
 
 under consideration, is, to a certain extent, 
 aVeady 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, be- 
 cause in these affections the solicitude of the 
 practitioner usually leads him to the employ- 
 ment of remedies, in consequence of which, the 
 effect of remedies is mixed up with the phenom- 
 ena of disease, so that the mind has difficulty in 
 separating them. [Note A.] We must there- 
 fore seek for our most striking or decisive exam- 
 ples among those diseases which are sufficiently 
 mild, not to be thought to require ordinarily the 
 use of remedies, and in which the natural his- 
 tory 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 con- 
 tinuance. 
 
 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 cause. 
 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, which, 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 separa- 
 ted.* 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- 
 
 * la one case, the disease is a solution of continuity ; 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 homo3opathic 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 la- 
 bored 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 con- 
 fidence, even though sometimes of an opposite 
 character. Moreover, in many places, at the 
 present day, a charm is popularly attached to 
 what 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 4he 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 de- 
 nominated eruptive fevers, are self-limited.
 
 SELF-LIMITED DISEASES. 11 
 
 Measles, for example, is never known to be 
 cut short by art, or abridged of its natural 
 career ; neither can this career be extended or 
 the disease kept in the system beyond its 
 natural duration, by the power of medicine. 
 Scarlet fever, a disease of which we have had 
 much and fatal experience during the last three 
 years, is eminently of the same character. The 
 reasons, which induce me thus to regard it, 
 are the following. The writings of medical 
 observers agree in assigning to it a common, 
 or average period of duration, and this is con- 
 firmed by the observations of practitioners at 
 the present day. From this average duration 
 and character there are great natural deviations, 
 the disease being sometimes so slight, as to 
 attract the notice of none but medical eyes, 
 and sometimes so malignant, that treatment is 
 admitted to be hopeless. The modes of treat- 
 ment, which have had most testimony in their 
 favor, are various, and opposite. By Dr. Fother- 
 gill, stimulants were relied on ; by Dr. Currie, 
 cold water ; by Dr. South wood Smith, and 
 others, blood letting. But it is not satisfactorily 
 shown, that either of these modes of practice
 
 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 con- 
 -fluent 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 sim- 
 ple, or exanthematous cases, in subjects previ- 
 ously 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 cau- 
 tery. It is also true, that they have died under 
 the same operations, so that it may be submit- 
 ted 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 estab- 
 lished 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 diffi- 
 cult, 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 ex- 
 periments 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 dis- 
 ease 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 treat- 
 ment, 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 diarrhosa 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 grave dis- 
 eases 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 treat- 
 ment 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 succes- 
 sive 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 sometimes 
 happen, that febrile attacks of different kinds, 
 consequent upon fatigue and anxiety, and per- 
 haps 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 abun- 
 dant proof. 
 
 Typhoid fever has, in many respects, a mark- 
 ed 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 ex- 
 ample, 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 scatter- 
 ed 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 suda- 
 mina, about the neck and elsewhere. In scarlet 
 fever, moreover, certain portions of the mucous 
 membrane undergo morbid alterations, particu- 
 larly 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 some- 
 times 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 con- 
 firmed 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 dis- 
 ease 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 interrupt- 
 ing 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. ' Experi- 
 ence,' 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 montre, que Taffection typhoide bien 
 caracterisee, n'est pas susceptible d'etre jugulee, ce qui n'est 
 guere moins vrai, d'ailleurs, suivant toutes les apparences, de 
 la peripneumonie et des autres maladies inflammatoires.' 
 Louis, Gastro-enterite. II. 512. 
 
 Andral says, in regard to the different modes of treatment in 
 typhus, ' Quelles que soient les methodes employees, il est un 
 certain nombre de cas ou, sans que ces methodes y prennent part, 
 la nature conduit la maladie k une terminaison heureuse ou 
 funeste. Clinique III. 616, 617. 
 
 t At the time of the publication alluded to, the distinction be- 
 tween typhus and typhoid fevers had not been well made out. 
 The distinction is good, though writers of authority differ on the 
 subject.
 
 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 will 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 ad- 
 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 self- 
 limited 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 character 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, under- 
 going, 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 with- 
 drawing 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 some- 
 times even removed by medicine; but it is 
 equally true, that other cases are wholly in- 
 tractable, 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 dis- 
 eases, 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 espe- 
 cially 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 puru- 
 lent discharges, which at times disappear, only 
 to be succeeded by equally troublesome affec- 
 tions in a different part. Gonorrhoea 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. Never- 
 theless 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 dis- 
 course. 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 un- 
 necessary to recall the instances of pain reliev- 
 ed, spasms controlled, inflammations checked, 
 [Note I], 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 syphi- 
 lis alone would have entailed misery and exter- 
 mination 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 pro- 
 fessional pride, nor attest the infallibility of our 
 art. To discover truth in science, is often ex- 
 tremely difficult ; in no science is it more diffi- 
 cult than in medicine. Independently of the 
 common defects of medical evidence, our self- 
 interest, 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 interfer- 
 ences of art, so much do our habits and partial- 
 ities incline us to neglect the former, and 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 attend- 
 ance, 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 management 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 es- 
 pecially 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 reme- 
 dies ; 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 conclu- 
 sions, as we are sometimes too apt to dp, 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 judi- 
 cious 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, unin- 
 fluenced by any of the remedies. We see 
 this remarkably exemplified in recoveries from 
 amenorrhoea, 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 respon- 
 sibility which rests upon the issue of his cases. 
 When a friend, or valuable patient, is commit- 
 ted to our charge, we cannot stand by, as curi- 
 ous 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 ap- 
 peared 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, pr 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 treat- 
 ment, 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 con- 
 sists in reports of interesting, extraordinary, and 
 successful results, published by men who have 
 a doctrine to establish, or a reputation to build. 
 ' Few 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 peu d'auteurs ont public tous les cas qu'ils ont ob- 
 serves, et la plupart ne se sont empresses de nous transmettre 
 que les faits que caressaient leurs idees. 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 flat- 
 tering 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 super- 
 structure 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 ultimate- 
 ly 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 im- 
 portant 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 in- 
 volve ; and even much more extensive than a 
 corresponding series of pathological observa- 
 tions ; yet every honest and intelligent observer 
 may contribute to it his mite. Opportunities 
 for such observations, and especially for mono- 
 graphs 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 ag- 
 gregate of results, successful and unsuccessful, 
 3
 
 34 SELF-LIMITED DISEASES. 
 
 circumstantially and impartially reported by 
 competent observers, will give us a near approx- 
 imation 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 charac- 
 terizes the great works of this author on 
 Phthisis and Typhoid fever. 
 
 In regard to acknowledged self-limited dis- 
 eases, 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 opportu- 
 nities 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 frus- 
 trate 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 coadju- 
 tors, who introduced into modem surgery the 
 art of healing by the first intention? These 
 men with vast difficulty succeeded in convinc- 
 ing the profession, that instead of the old meth- 
 od 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 miti- 
 gation, and preventing or removing the causes 
 of others, which are incidental, but not neces- 
 sary, 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 ex- 
 ample, when it exists in the habits of life of the 
 patient, in the local atmosphere, or in the pre- 
 sence of any other deleterious agent. [Note K.J 
 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. 37 
 
 of disappointed hope on the one side, or of un- 
 necessary despondency on the other. 
 
 It will 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 Natu- 
 rd duce. The longer and the more philosophi- 
 cally 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 con- 
 sideration, 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 
 out of her path. How little, indeed, could we 
 accomplish without her aid! It 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 spon- 
 taneous principle of restoration had not existed, 
 the human species would long ago have been 
 extinct.' * 
 
 * Medical Logic, p. 49.
 
 38 SELF-LIMITED DISEASES. 
 
 The importance and usefulness of the medi- 
 cal profession, instead of being diminished, will 
 always be elevated, exactly in proportion as it 
 understands itself, weighs justly its own 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 under- 
 standingly the science of their respective voca- 
 tions. 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 for- 
 gotfen, that knowledge has for its only just and 
 lasting foundation, a rigid, impartial, and inflex- 
 ible requisition of the truth.
 
 40 
 
 SELF-LIMITED DISEASES. 
 
 NOTES. 
 
 NOTE A. 
 
 THE difficulty of discriminating between the 
 symptoms of disease, and the effects of treat- 
 ment, 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 re- 
 sulting 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. Constitu- 
 tional irritation, produced or kept up by an 
 inordinate use of vesicatories and other counter- 
 stimulants, 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 restric- 
 tions. I do not speak of these things as com- 
 mon 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 no- 
 tice, 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 pro- 
 gress 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 vol- 
 umes, 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 self- 
 limited diseases. Although syphilis, as it exist- 
 ed 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 the 
 anti-phlogistic method, which has been substi- 
 tuted, 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 treat- 
 ment ; and indeed, when it is wholly neglected, 
 as it sometimes is by the abject and the reck- 
 less, it results in the most deplorable conse- 
 quences, 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 con- 
 sumption. 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 common lesion in scarlatina, but the other 
 morbid appearances discovered in autopsies of
 
 44 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 bronchiae. In one case of thirty- 
 six hours duration, the chief morbid appearance, 
 in addition to the ulcerated throat, was an ex- 
 tensive 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 witnessed, there was slight 
 ulceration of the tonsils, but no lesion of any 
 important viscus could be detected, though dili- 
 gently sought for by our best pathological anat- 
 omists. Two similar cases have been stated to 
 me, and I find them also noticed by some wri- 
 ters 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 resid- 
 ing in different places, without personal inter- 
 course. 
 
 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 occur- 
 red, 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. 
 
 Tesiding in Tremont Place, five individuals had 
 scarlet fever, and three of them measles, nearly 
 at the same time. The circumstances are in- 
 teresting. One child had measles first, the dis- 
 appearance 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 
 under 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 catarrh al 
 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 circum- 
 stance 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 appre- 
 hended. 
 
 The sequelae or secondary effects of scarlet
 
 48 SELF-LIMITED DISEASES. 
 
 fever are extremely various. Rheumatic affec- 
 tions are among the most common. Dropsical 
 effusions are frequent, both in the cellular tex- 
 ture 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 
 sequelas, or with such as disappear spontane- 
 ously in their own time, without permanent 
 injury to the patient
 
 NOTES. 49 
 
 NOTE R 
 
 We have sufficient evidence that many cases 
 of gout, both in this country and Europe, have 
 had their paroxysms abridged by the use of 
 colchicum, 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 rhu- 
 barb. 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 
 followed by relief, and very probably this may 
 be true ; but such instances have not yet come 
 under my personal observation, where the ex- 
 periment has been fairly made in the acute dis- 
 
 NOTE G. 
 
 The natural history of the small ascarides is 
 curious, and not well understood. Many indi- 
 viduals 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, some- 
 times 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 sponta- 
 neously 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 
 found, however, in other parts, of the alimentary 
 tube. Many patients, immediately after a ces- 
 sation 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 diarrho3a. I have 
 .repeatedly known these consecutive events to 
 occur with great regularity for half a dozen 
 years, so much so that my inquiries are gene- 
 rally 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 de- 
 termine. 
 
 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 cathar- 
 tics 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 genera- 
 ting 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, par- 
 ticularly 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 exer- 
 tions which have been made, and are still mak- 
 ing by indefatigable and distinguished men, for 
 the control of what are called pestilential epi- 
 demics. 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. Neverthe- 
 less, after a certain term of years the diseases 
 are found to be fatal as before, and fresh inno- 
 vations in practice take the place of the old, 
 and excite confidence anew among the sanguine 
 and ardent members of the profession. The
 
 55 
 
 truth is, that no epidemic is equally malignant 
 in all seasons and places ; and from some un- 
 known 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. Reli- 
 ance, therefore, cannot be justly accorded to any 
 mode of treatment which has not had the testi- 
 mony 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 distin- 
 guished 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 mar- 
 ginal 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 decided, until it has been sub- 
 mitted more extensively to the test of compara- 
 tive numerical results. It is certain, that the 
 most distressing symptoms of acute inflamma- 
 tions are often arrested at once by remedies. 
 This happens, for example, from blood-letting 
 in croup and pleurisy, and from opium in stran- 
 gury and dysentery. If, however, the disease ia 
 fully established before the application of reme- 
 dies, it usually goes on to complete its course, 
 and in that case the remedies are palliatives 
 only. And if remedies be applied in the in- 
 cipient 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 satisfac- 
 tory. Leaving then, as undecided, the question 
 of positive duration in acute inflammations, we 
 do not risk much in asserting that their charac- 
 ter 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 sali- 
 vation 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 impu- 
 nity the influence of this cause; as in sea- 
 sickness.
 
 TREATMENT OF DISEASE: 
 
 AN INTRODUCTORY LECTURE, DELIVERED BEFORE THE MEDICAL 
 CLASS AT THE MASSACHUSETTS MEDICAL COLLEGE IN BOSTON, 
 NOVEMBER 3, 1852. 
 
 OF the sciences which have most occupied 
 the time and labor of mankind, a certain num- 
 ber lead by their investigations to clear and 
 positive results, and enlarge the amount of 
 human knowledge by the discovery and pro- 
 mulgation of absolute truth. Another portion 
 lead only to results which are probable or pre- 
 sumptive 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 conjec- 
 tural 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, as- 
 tronomy and portions of natural history, are 
 examples of exact sciences, the demonstrations 
 of which, when once made clear, may after- 
 wards 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 re- 
 ceive and apply them to practice. 
 
 It would at first seem that the exact sciences 
 were those most worthy the cultivation of intel- 
 ligent minds, inasmuch as they lead to satisfac- 
 tory, 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 
 opinions of mankind, as evinced by their prac- 
 tice, the opposite judgment prevails, and proba- 
 bly 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 con- 
 summating 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 proposi- 
 tions are susceptible of absolute demonstration, 
 the former processes, which bear directly on 
 human happiness or misery, are frequently re- 
 moved 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 desi- 
 rous 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 specula- 
 tive sciences stands practical medicine, a science 
 older than civilization, cultivated and honored 
 in all ages, powerful for good or for evil, pro- 
 gressive 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. En- 
 cumbered 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 com- 
 munities, 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 re- 
 proach 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 ob- 
 jects 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 com- 
 plaint 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 rea- 
 sonable or otherwise, according to the circum- 
 stances under which it is made. It is unrea- 
 sonable if his case is helpless, and he is merely 
 paying the debt of suffering and death which 
 his mortal 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 Defi- 
 nition, is evident from the fact that many dis- 
 eases are incurable, and tjiat 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 for 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 con- 
 science 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 prac- 
 tised and disease treated, for the reciprocal 
 5
 
 66 TREATMENT OF DISEASE. 
 
 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 med- 
 icine. 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 sci- 
 ence of pathology, involving the great and 
 fundamental art of diagnosis, by which the dis- 
 eases 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 pre- 
 scribe 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 per- 
 nicious 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 pub- 
 lic, 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 reme- 
 dy ready for every symptom, or one remedy for
 
 Ob 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 difficul- 
 ties ; 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. Ex- 
 amples are rare of this perfection, yet for an 
 approach to such a standard of professional 
 excellence, I would venture to direct your re- 
 membrance to the venerable ex-professor, fortu- 
 nately 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 com- 
 mon offices, or of exercising the common arts 
 and duties of life, are the individuals who have,
 
 TREATMENT OF DISEASE. OiJ 
 
 by talents, education and practice, become EX- 
 PERTS 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 withput 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 appro- 
 priate 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 con- 
 sists in a certain kind of friction, shaking, or 
 manipulation, an ointment applied to the out- 
 side, 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 com- 
 munity ?
 
 TREATMENT OF DISEASE. 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 gov- 
 ern themselves in the common affairs of life. 
 A merchant about to send a ship -to sea, en- 
 deavors to find a captain to take charge 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 judge whether it is
 
 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 he 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 doubt- 
 less 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 feverfsh, 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 with- 
 out, or perhaps in spite of, their misdirected and 
 embarrassing practice. 
 
 Medicine is a great good and an unquestion- 
 able blessing to mankind, when it is adminis- 
 tered by discriminating and intelligent hands 
 with sincerity and good judgment. It disap-
 
 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 infalli- 
 bility, 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 relied 
 on who looks calmly and understandingly at 
 the emergency before him, who knows the im- 
 port of signs, and deduces from them the proba- 
 ble 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 who, in particular 
 exigencies, inquires of his reason and his knowl- 
 edge, in which of these two immediate catego- 
 ries his patient is placed, and how far the event 
 of the case is within his control. He 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 OP DISEASE. 75 
 
 and who knows the immeasurable good or 
 harm which hangs on medical practice. 
 
 The vulgar standard of medical character de- 
 pends very much on the supposed successful 
 result of cases. But this is not the true stand- 
 ard, 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 fifty- 
 two, in the midst of his own water-cure. It is 
 well known, that the most thronged and popu- 
 lar 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 prose- 
 cuted their robberies in the infected houses of 
 the dead and dying; and the aromatic vinegar, 
 whichrhas immortalized their prophylactic prac- 
 tice, was very probably an impromptu invention 
 brought forward by them to procure their ex- 
 emption 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 confi- 
 dence 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 sci- 
 ence, 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 made out in one, or two, or three 
 interviews with the patient, and we are obliged 
 to wait for the gradual development of diagnos- 
 tic 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. Atten- 
 tion 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 imbe- 
 cility 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 sea- 
 sonably detected by the wary eye of the prac- 
 titioner. 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 dis- 
 eases. Is the disease amenable to medical 
 treatment, or not ? If the case is of a recovera- 
 ble 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 per- 
 sonal experience. In doing this he should be- 
 ware 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 reputa- 
 tion rather than to promulgate unpopular truths. 
 And in analyzing his own experience, he should 
 equally beware of hasty generalizations, of im- 
 pressions 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, capa- 
 ble of being arrested or broken up by the inter- 
 position of remedies. Thus the grave and 
 various symptoms which result from an over- 
 loaded 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 pur- 
 gatives ; 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 vari- 
 ous cases. But on this subject it is extremely 
 difficult to obtain decisive and satisfactory 
 knowledge. It involves a question, the settle- 
 ment 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 con- 
 sider 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 con- 
 tinue 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 em- 
 ployments of a medical man. 
 
 In fhe 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 oppor- 
 tunity is lost, the remedies are afterwards less 
 effectual, and perhaps even injurious. Vene- 
 section in the early stage of certain acute dis- 
 eases, 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 counter- 
 act 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 employ- 
 ed 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 blood- 
 letting, 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 polyphar- 
 macy 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 considera- 
 tions, 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 unfortu- 
 nately, in other cases, it admits only of a choice 
 between evils; and in these cases not only the 
 knowledge and experience, but also the judg- 
 ment 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 unre- 
 moved causes of disease. Many morbid affec- 
 tions, 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 physi- 
 cian 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 instrue-
 
 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 phy- 
 sician 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 mor- 
 bid affections which we know, or have reason to 
 believe, are under the control of remedies, so 
 that they can be arrested, or abridged, in dura- 
 tion. For the most part, acute inflammatory 
 diseases, when not of fatal intensity, are mitiga- 
 ted 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, antispas- 
 modics 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 dis- 
 charges, are to be dealt with by removing the 
 cause when practicable, by diminishing vascular 
 activity, or by quieting the discharging sur- 
 faces with opiates, or contracting them with 
 astringents. There is one class of curable dis- 
 eases which are controlled chiefly by specific 
 remedies, being in some instances suspended, 
 in others radically removed. Thus, gout is re- 
 lieved by colchicum, and intermittents by qui- 
 nine 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, but 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
 
 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 ac- 
 knowledge 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 degen- 
 erations, malignant and chronic, by tubercle and 
 granulation, by atrophy and hypertrophy, soft- 
 ening and hardening, scirrhus, encephalosis 
 ossification, concretion, contraction and dilata- 
 tion, with their various consequences of phthi- 
 sis, emphysema, dropsy, epilepsy, paralysis, and 
 
 * See marginal note t page 19.
 
 TREATMENT OF DISEASE. 89 
 
 a multitude of intractable disorders, in which 
 organs are disabled, functions destroyed, and 
 life itself rendered incapable of continuance. 
 
 It is obvious that in the three foregoing classes 
 of disease, very different modifications of treat- 
 ment are required. In curable diseases, our 
 remedial measures should be prompt and ener- 
 getic in proportion to the emergency of the 
 case, and the certainty of benefit which is to 
 follow their employment. In self-limited dis- 
 eases, our treatment must be of the expectant 
 character. It consists in doing what we can 
 for the comfort and safety of the patient, avoid- 
 ing useless and troublesome applications, watch- 
 ing against accidents and complications, and 
 waiting for the salutary operations of nature. 
 In those maladies which are in their nature in- 
 curable, we are obliged to confine ourselves to 
 the palliation of suffering, and the removal of 
 causes which may aggravate the disease. 
 
 Such, I believe, is the true exposition of the 
 powers and duties of every medical man. The 
 dignity of our science, and the responsibility of 
 our profession, require that we should form just 
 views of the extent of our capacity and duty,
 
 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 sci- 
 ence 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 pro- 
 fessing 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 
 
 MEDICAL EDUCATION. 
 
 PUBLISHED BY VOTE OP THE MEDICAL FACULTY OF HARVARD 
 UNIVERSITY IN 1850. 
 
 THE undecided state of public opinion in re- 
 gard 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 sub- 
 mitted 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 subse- 
 quent 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 be- 
 come 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 Materia Medica there are some thousands 
 of substances and their compounds, which pos- 
 sess 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, with 
 organic lesions and functional disturbances, that 
 few of the most experienced pathologists can be 
 said to understand their whole science, or to be 
 always 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 ;' but it is not equally ap- 
 parent, that 'the causes by which these con- 
 ditions 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 rheu- 
 matism, of diabetes or Bright's kidney, of hyper- 
 trophy 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 dis- 
 tinct living professions ; it is not to be admitted 
 that the means or time of any ordinary course 
 of lectures can furnish full and complete instruc- 
 tion. 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 plau- 
 sible 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 consid- 
 eration to the older and more settled principles 
 of science. Medical men are liable to commit 
 the error of adopting premature opinions, un- 
 sound 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 de- 
 monstration the practical branches of science, 
 and they are most effective in places where the 
 facilities for such demonstrations can be com- 
 manded. Anatomy requires extensive exhibi- 
 tions by the teacher, and personal dissections by 
 the student. Chemistry and Materia Medica 
 require illustrations by specimens and experi- 
 ments. Pathology needs the aid of autopsies, 
 museums and the clinical demonstrations of 
 large hospitals. A knowledge of Obstetrics is 
 not perfected without apparatus and practice. 
 7
 
 PRACTICAL VIEWS 
 
 Surgery is acquired by witnessing numerous 
 operations, surgical diseases, illustrated expla- 
 nations, and by personal practice on the dead 
 body. Physical exploration is wholly demon- 
 strative. A knowledge of auscultation can no 
 more be acquired from books, or abstract lec- 
 tures, than a knowledge of music, or of individ- 
 ual physiognomy. 
 
 The intermediate period between lectures, 
 should be spent by students in active and origi- 
 nal 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 quali- 
 fied and situated, are more advantageous for 
 two thirds of the year, than either the fatiguing 
 jostle of overcrowded rooms, or the listless rou- 
 tine 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 educa- 
 tion 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 cita- 
 tions of doubtful authorities, prolix disserta- 
 tions on speculative topics, excessive minute- 
 ness in regard to subjects which are intricate
 
 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 HOMffiOTATHY: 
 
 MADE TO THE COUNSELLORS OF TI1E MASSACHUSETTS MEDICAL 
 SOCIETY IN FEBBUAEY, 1854. 
 
 THE committee appointed by the Counsellor? 
 of the Massachusetts Medical Society, to con- 
 sider the resolution of the Essex North District 
 Society,* and also that of Dr. Spofford, in rela- 
 tion to the subject of Homoeopathy, beg leave 
 to Report : 
 
 That the Massachusetts Medical Society was 
 incorporated mainly for the purpose of estab- 
 lishing a proper standard of medical education, 
 and of insuring a competent degree of knowl- 
 edge among those who should be authorized to 
 practise the profession of medicine in this Com- 
 monwealth, and they are not aware that the 
 Society possess any power to coerce men, after 
 
 * These resolutions contemplated dissolving the connection of 
 Homceopathists with the Society.
 
 102 REPORT ON HOMOEOPATHY. 
 
 they have been thus educated and qualified, to 
 embrace, or renounce, any theoretical opinions, 
 or modes of practice, which they may innocent- 
 ly believe, or which, not believing, they may 
 think it proper to profess. 
 
 In medical science there are certain funda- 
 mental laws relating to the structure and func- 
 tions 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 imperfec- 
 tion 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 individu- 
 als, and even the same individual in the course 
 of an ordinary life-time, may without dishon- 
 esty 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 HOMOEOPATHY. 103 
 
 ment than it was formerly supposed to be. 
 Where observations are impartially made by 
 competent persons, it is found that people re- 
 cover, and also that they die, under all the 
 ordinary modes of treatment. And the evi- 
 dence 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 defec- 
 tive power of judgment in the party who adopts 
 them. 
 
 The broadest division which has been recog- 
 nized 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 HO.MCEOPATHY. 
 
 To the last of these divisions Homoeopathy 
 really, though not avowedly belongs. Its char- 
 acter is, that while in reality it waits on the 
 natural course of events, it commends itself to 
 the ignorant and credulous by a professed intro- 
 duction into the body of inappreciable quanti- 
 ties 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 homoeopathic quantities of 
 almost every common substance known in 
 nature and art, without any appreciable conse- 
 quences being found to follow. And the pre- 
 tended exactness with which such nominal doses 
 are administered by homoeopathic 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 multi- 
 tudes, at least several times in a century. And 
 this will probably be the case, so long as prac-
 
 REPORT ON HOMOEOPATHY. 105 
 
 tical medicine continues to be, what it now is 
 to a great extent, a theoretical and conjectural 
 science. At the present period, among the sects 
 usually called irregular, the homoeopathic 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 disci- 
 ples. 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 pre- 
 dict that they will both be superseded in the 
 course of time by other systems, not more 
 rational or probable in themselves, but possess- 
 ing the attraction of greater novelty, or urged 
 upon the credulous with greater adroitness. 
 "When the world, and especially the unen- 
 lightened 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, homosopathy, that
 
 106 REPORT ON HOMOEOPATHY. 
 
 the censure of prejudice and credulity is to be 
 attached. The opposite system of active prac- 
 tice, carried to the extreme usually called heroic, 
 is alike chargeable with evil to the patients, 
 whenever it becomes the absorbing and exclu- 
 sive 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, 
 enough has been learned to show that extreme 
 measures, either of omission or of commission, 
 are not, when systematized as a whole, produc- 
 tive of benefit or safety to mankind. 
 
 It is quite probable that the prevalence, at 
 times, of eccentric and ultra-sectarian doctrines
 
 REPORT ON HOMOEOPATHY. 107 
 
 in medicine, is attributable to the exaggerated 
 value attached by physicians themselves to in- 
 cessant 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 case 
 may be. And when opposite modes of treat- 
 ment are urged upon the public by different 
 practitioners with reasonings equally specious, 
 it is not surprising that patients should some- 
 times 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 Med- 
 ical Society, should never be induced to give
 
 108 REPORT ON HOMOEOPATHY. 
 
 his counsel, or his aid in any shape, to empiri- 
 cism and dishonesty, whether it occur among 
 those who are within 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 'con- 
 sultation, 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 adap- 
 tation 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 HOMCEOPATHY. 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 man- 
 kind in the medical profession as unfulfilled 
 promises ; nothing so much strengthens this 
 confidence, as fair dealing exhibited in an earn- 
 est 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 influ- 
 ence 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 COL- 
 LEGE, 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. Ill 
 
 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 profes- 
 sional 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 under- 
 stood, but they must be preceded by a knowl- 
 edge of the subsidiary sciences, and must also 
 be confirmed by practical and clinical expe- 
 rience. 
 
 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 compe- 
 tent to exercise the multifarious profession of 
 medicine and surgery in all its departments. 
 As it often happens in this and similar cases r 
 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. In 
 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 for- 
 midable convulsive disease. He may be sum- 
 moned 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 corres- 
 ponding time in following the rounds of a coun- 
 try practitioner. It is not enough that he has 
 carelessly read the works of approved authors, 
 and has squeezed through the customary aca- 
 demic examination. If he has done only this, 
 it is more than probable that failure awaits on
 
 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 ar- 
 ranged 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 opera- 
 tors have had their first cases. He will perhaps 
 also remember, that some of the most distin- 
 guished 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 profes- 
 sion. 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 embarrass- 
 ment, 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 conve- 
 niently 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 prac- 
 tice at the age of twenty-one or of twenty -four. 
 But as far as he may prize a quiet conscience
 
 116 ON THE MEDICAL 
 
 and freedom from anxiety, the later age is in- 
 comparable the most secure. I would advise 
 any young man, who has completed his educa- 
 tion 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 pro- 
 fession, encumbered with debt, and bare of 
 acquirements and of means, is rather an imper- 
 ative 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 litera- 
 ture 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 remem- 
 bers 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 compendiurns 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 med- 
 ical 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 pres- 
 ent 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 gene- 
 ral adoption, an unfair and unfounded as- 
 sumption 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 phy- 
 sician, 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 post- 
 ponement 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 responsi- 
 bilities 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 Phila- 
 delphia, 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 busi- 
 ness, 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 pecu- 
 liar patronage or necessity, does not usually ob- 
 tain 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 per- 
 fect his knowledge, to fill the gaps in his expe- 
 rience, 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 prac- 
 tise. 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 unne- 
 cessarily to medical opinions which are founded 
 on equivocal or imperfect testimony. The pub- 
 lic 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 him- 
 self, 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 physi- 
 cian to cultivate, is a just and proper deportment 
 towards his professional brethren. As in all pro- 
 fessions in which men live by their heads rather
 
 PROFESSION. 123 
 
 than their hands, business is liable to be over- 
 done, 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 so 
 often entertained, which injure all the parties 
 concerned, and lower the estimation of the pro- 
 fession with the public. Harmony and a proper 
 esprit du corps, may uphold the dignity of even 
 an inferior profession ; but the public rarely re- 
 spect any class of men, the members of which 
 have no respect for each other. A friendly in- 
 tercourse with those whom we approve, is pro- 
 ductive of pleasure and advantage, and a gen- 
 tlemanly 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 ene- 
 mies ; 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 consider- 
 ed a necessary evil inherent in the constitution 
 of society. It exists in every walk and occupa- 
 tion of life, by the exercise of which men pro- 
 cure bread. The pettifogger in law, the Millerite 
 lecturer in theology, the demagogue in politics, 
 the system-monger in education, and the won- 
 der-worker upon the brains and bowels of infat- 
 uated 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 suc- 
 ceed 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 pre- 
 tensions of impostors. A celebrated author ob- 
 serves that 'many a popular error has flourished 
 through the opposition of the learned.' * By 
 
 * Mclntosh.
 
 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 dis- 
 cover uneasiness, resentment, or ill temper, the 
 public conclude that you are influenced by your 
 private interests. Besides, when you have en- 
 tered 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 dis- 
 abused 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 your- 
 selves 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 an- 
 other ; 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 dispas- 
 sionate 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 ob- 
 servation 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 dishon- 
 est 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 science, 
 weigh justly your own powers, and profess only 
 what you can accomplish. If you announce to 
 your patients that you will cure incurable dis- 
 eases, 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 unpo- 
 pular with a large and sagacious part of the 
 community, because they so frequently disap- 
 point the expectations they have allowed them- 
 selves to raise. You may safely undertake and 
 promise to cure diseases which you know to be 
 curable, to alleviate others which you know to
 
 128 ON THE MEDICAL 
 
 be not so, and to perform what art and science 
 can do towards conducting doubtful and dan- 
 gerous 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 com- 
 plicated instructions, and especially of over- 
 drugging 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 dan- 
 ger, 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 reme- 
 dies, 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 think- 
 ing 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 grat- 
 ified to find that they and their families can get 
 well without the lancet, the vomit and the blis- 
 ter, 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 avenues 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 situa- 
 tion of influence and distinction, which our his- 
 tory does not show to be within the reach of 
 our profession. But it is not to political, or 
 extra professional preferment, that the true phy- 
 sician should look. He should rather be con- 
 tented 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.
 
 GOUT AND ITS TREATMENT 
 
 GOUT, technically known by the names of 
 Arthritis and Podagra, is a painful, inflamma- 
 tory 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 abstemi- 
 ous classes. It seldom occurs in children, but 
 makes its appearance most commonly in middle 
 or advanced life, and affects men more frequent- 
 ly than women. 
 
 The most common place for the primary at- 
 tack 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 restless- 
 ness, 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 tender- 
 ness 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 cedematous and shining. On the fol- 
 lowing 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, costive- 
 ness, 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 sud- 
 denly terminates, as if by magic. The joint 
 continues swollen and osdematous 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 mark- 
 ed 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 cer- 
 tain 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 chirag-ra. 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 common- 
 ly 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, in- 
 terrupting 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 dyspnrea. 
 
 When the disease has existed for a certain 
 length of time, there appears in some persons, 
 but not in all, a deposit of calcareous concre- 
 tions, known by the name of chalk stones, situ- 
 ated mostly in the cellular tissue, between the 
 outside of the joint and the skin. Sometimes,
 
 136 ON GOUT. 
 
 however, they penetrate the fibrous 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 parox- 
 ysms. 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 gene- 
 rally 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 predis- 
 position to their parents or ancestry. It does 
 not follow, however, that ail the children of 
 gouty progenitors have the disease. It some- 
 times 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 abste- 
 mious 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 some- 
 what 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 com- 
 mon subjects of the disease. Among persons 
 who are addicted to the excessive use of alco- 
 holic 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 appar- 
 ent in the system. Sometimes the viscera be- 
 come deranged, without obvious affection of 
 the joints, constituting irregular or concealed 
 gout. Thus the digestive tube may be affected 
 with nausea, want of appetite, pain, flatulence, 
 costiveness, or diarrhoea, acid eructations, and 
 even vomiting. In the thorax are sometimes 
 felt pain, dyspnoea 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 symp- 
 toms 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 dyspnoea, 
 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 im- 
 munity 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 pu- 
 berty. 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 particu- 
 lar 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 pain- 
 ful, or return with progressive severity, relief 
 must be sought from such means as are in 
 our power. Many expedients have been re- 
 sorted 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 ex- 
 cept 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 ob- 
 tained and lost a specific reputation. 
 
 The remedy which, in the present century, 
 has taken precedence of all others, is Colchi- 
 cum. 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 ef- 
 fects 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 im- 
 portant 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 ex- 
 ercise with total abstinence from vinous and 
 stimulating drinks. This method does not al- 
 ways succeed in confirmed chronic gout, but in 
 preventing the returns of the acute disease it 
 is eminently successful. And although in cer- 
 tain 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 some- 
 times even in the advanced stages of this mal- 
 ady, the recurring paroxysms are postponed, 
 mitigated, or totally prevented by entire absti- 
 nence from vinous and alcoholic stimulants. I 
 have the happiness to be able to allude to va- 
 rious 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 se- 
 verity, 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
 
 TREATMENT OF INJURIES 
 
 OCCASIONED BY 
 
 FIRE AND HEATED SUBSTANCES. 
 
 BEING PART OF A BOYLSTON PKIZE DISSERTATION FOR 1812. 
 
 THE application to living textures of sub- 
 stances which are heated beyond a certain tem- 
 perature, is followed by the phenomena of pain 
 and inflammation. The pain is of a peculiar 
 kind, resembling that from the continued appli- 
 cation of fire to the part ; the inflammation has 
 a great tendency to suppurate, and often leaves 
 a contracted cicatrix. 
 
 The communication of an excess of caloric 
 to animal bodies, whether living or dead, is fol- 
 lowed by certain changes. Of the fluids some 
 are coagulated, others are decomposed or even 
 vaporized, if the heat be sufficient. The solids 
 are in a greater or less degree expanded, disor-
 
 INJURIES BY FIRE. 147 
 
 ganized or decomposed ; according to their sus- 
 ceptibility 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 mortifica- 
 tion ; 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 accident- 
 ally kindled ; in intoxicated persons, who fall 
 into the fire ; and in those exposed by confla- 
 grations, 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 inflamma- 
 tion, have placed their reliance on the supposed 
 powers of specific remedies. In this way differ- 
 ent and opposite modes of treatment have been 
 adopted, whose apparent success or failure at
 
 148 TREATMENT OF 
 
 different times has occasioned disputes respect- 
 ing their comparative efficacy. After a variety 
 of trials have been made, and a multitude of 
 cases detailed, the practice still remains unde- 
 cided ; and methods of treatment diametrically 
 opposite enlist nearly an equal number of advo- 
 cates. 
 
 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 appli- 
 cations. 
 
 Mr. Kentish recommends that the injured 
 surface be in the first place washed and bathed 
 with rectified spirit of wine, spirit 6f turpentine, 
 or some similar application, which has been 
 previously heated as far as it can be borne with 
 the finger. After this bathing has been re- 
 peated 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 turpen- 
 tine. 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 cam- 
 phorated 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 Ef- 
 fects of Fire on the Human Body,' defends a 
 mode of treatment directly the reverse of the 
 former. This consists of the antiphlogistic regi- 
 men 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 pro- 
 cedure ; 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 agi- 
 tated with so much warmth and so little impar- 
 tiality, 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 re- 
 markable case of Boerhaave, who was violently 
 scalded by the bursting of Papin's digester, and 
 who got well under copious bleeding and purg- 
 ing, 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 de- 
 ductions from individual or insulated cases, 
 which do not afford sufficient room for a com- 
 parison 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 resemble each other, and in 
 what degree any application has actually expe-
 
 INJURIES BY FIRE. 151 
 
 dited or retarded the cure. According to the ca- 
 price 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 perni- 
 cious, according as the practitioner who watch- 
 ed their influence, was under the prejudices of 
 a favorable or unfavorable nature toward either 
 application. A second ground of error is like- 
 wise contained in the supposition that a single 
 and specific mode of treatment can be accom- 
 modated 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,
 
 152 TREATMENT OF 
 
 in the least, nearer to a decision. Though a 
 series of observations, by a faithful and intelli- 
 gent practitioner, is entitled to respect, yet 
 when two such courses present us with results 
 diametrically opposite, we are justified in doubt- 
 ing 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 cor- 
 responding parts of the same animal, which 
 should afterward be treated with different ap- 
 plications, that a chance would be afforded of 
 testing the comparative efficacy of these appli- 
 cations. With this view the following experi- 
 ments 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 ears 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 to- 
 gether. 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 100 of Fahrenheit ; the left in 
 a vessel of cold water, having its temperature 
 reduced by ice. In this way they continued 
 for three quarters of an hour, the temperature 
 of both vessels being kept as regular as possi- 
 ble 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 evi- 
 dently 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 im- 
 mersed, 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 stimulat- 
 ing 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.
 
 INJURIES BY FIRE. '155 
 
 Three hours afterward the ears were exam- 
 ined. The heat of both was much increased 
 but that of the right, to which the spirit of tur- 
 pentine had been applied, was evidently great- 
 est. 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 oint- 
 ment. 
 
 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 mortifica- 
 tion. 
 
 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 tem- 
 perate, became cool ; and the ears, which were
 
 156 TREATMENT OF 
 
 kept moist by the ointment and their own dis- 
 charge, became constantly cold. To this cir- 
 cumstance I attributed the formation of a con- 
 siderable slough, which came from the right ear 
 about the tenth, and from the left on the four- 
 teenth 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 sup- 
 puration, 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 com- 
 posed 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 sub- 
 stance. 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 appar- 
 ently 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 consid- 
 ered as free from fallacy. 
 
 1st. The evident increase of heat, pain, red- 
 ness, vesication, and gangrene, following the 
 application of oil of turpentine. Exp. n. and 
 in. 
 
 2d, The increase of most of the same appear- 
 ances, 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 remedies were applied to the same 
 subject, is extracted from the Medical and Phys- 
 ical 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, resinse flav. softened 
 down with the same : in order to try which
 
 160 TREATMENT OP 
 
 mode of treatment Ifforded the most immediate 
 ease to the patient, as well as the most expedi- 
 tious 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 oc- 
 casioning a smarting sensation on the back for 
 five or six hours. This mode of dressing was 
 continued for the space of two days ; but ob- 
 serving 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 satisfac- 
 tion from the superior comfort he felt in that 
 dressing compared with the former. The next 
 day the back appeared much less inflamed, con- 
 tinued 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 com- 
 plained of the great heat in the part during 
 the application of the oil of turpentine." '
 
 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, how- 
 ever, 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 appli- 
 cation 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 advo- 
 cates 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 princi- 
 pal are entitled to a separate attention. 
 11
 
 162 TREATMENT OP 
 
 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 ex- 
 cited, 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 tur- 
 pentine, is comparatively sedative in its opera- 
 tion on a part violently excited by a burn. The 
 above reasoning may amuse the imagination, 
 but does not satisfy the judgment. The anal- 
 ogy 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 vio- 
 lence, 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 hun- 
 dred, 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 inflamma- 
 tion and symptomatic fever, depletion and the 
 antiphlogistic regimen are resorted to as pre- 
 ventives; and this in a greater or less degree, 
 according as the subject is more or less ple- 
 thoric. 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 blood- 
 letting, 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 pletho- 
 ric 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. Ken- 
 tish ; 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 communi- 
 cated 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 im- 
 mersion 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 resolu- 
 tion ; 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 some- 
 thing respecting the use of alcohol, ether, and 
 proof spirit. These substances are often re- 
 commended in a vague manner, without refer- 
 ence 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 con- 
 trary, 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 ex- 
 tremes of treatment which have been adopted, 
 the result of both reason and experiment ap- 
 pears 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 de- 
 gree 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 violent burns, attended with blisters 
 and acute pain, a permanent relief is to be ex- 
 pected only from suppuration. This is pro- 
 moted, as in other cases of suppurative inflam- 
 mation, not by acrid stimulants, not by snow 
 and ice ; but by mild emollients and warm fo- 
 mentations or poultices. Though cold applica- 
 tions, 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 applica- 
 tions are discontinued; so that they must be 
 persevered in for a long time, until tardy sup- 
 puration appears in spite of them, before effec- 
 tual 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 considera- 
 ble 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 ex- 
 uberant granulations arise, they may be re- 
 pressed by gentle astringents, by pressure, or by 
 escharotics. Mr. Kentish recommends powder- 
 ed 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, ac- 
 cording to Mr. Kentish, by introducing pow- 
 dered 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 contrac- 
 tion 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.
 
 BURIAL OF THE DEAD. 
 
 The interest which the author has felt in the Cemetery at 
 Mount Auburn, the first of its kind in the United States, has in 
 a measure grown out of his personal connection with its foun- 
 dation and subsequent development. The project of Mount 
 Auburn was originally conceived, the preparatory meetings 
 called, the land selected and engaged, and the larger public 
 structures, the gate chapel tower and iron fence designed, 
 by himself at different times.* The pleasure of witnessing, 
 through so many years, the progressive improvement of this 
 beautiful spot, has been enhanced by the interest and active 
 co-operation of many of our distinguished and valued citizens. 
 
 While the subject was of recent agitation, the following Ad- 
 dress was delivered at the hall of the Masonic Temple, before 
 the Boston Society for the Promotion of Useful Knowledge. 
 
 THE manner in which we dispose of the 
 remains of our deceased friends, is a subject 
 which, within the last few years, has occupied 
 
 * Historical notices of Mount Auburn have been published 
 by Thacher, Walter, Dearborn, and others, also in the Daily 
 Advertiser, Sept. 9, 1851, and the Boston Atlas, Sept. 16, 1851.
 
 172 ON THE BURIAL 
 
 a greater share than formerly of the public at- 
 tention in our own vicinity. It involves not 
 only considerations which belong to the gene- 
 ral convenience, but includes also the gratifica- 
 tion of individual taste, and the consolation of 
 private sorrow. Although, in a strictly philo- 
 sophical view, this subject possesses but little 
 importance, except in relation to the conveni- 
 ence of survivors ; yet so closely are our sym- 
 pathies enlisted with it, so inseparably do we 
 connect the feelings of the living with the con- 
 dition 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 ex- 
 pect both reason and feeling to be satisfied. 
 
 The progress of all organized beings is to- 
 wards 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 con- 
 tinue 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 disor- 
 ganization, 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 them- 
 selves 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 decompo- 
 sition, 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
 
 OP THE DEAD. 175 
 
 been inclosed in golden urns, monumental for- 
 tresses 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 con- 
 nected 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 I. 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 obedi- 
 ence. 
 
 He died in July, 1307, and notwithstanding 
 his injunctions, was buried in Westminster 
 Abbey in October of the same year. It is re- 
 corded that he was embalmed, and orders for
 
 176 ON THE BURIAL 
 
 renewing the cerecloth about his body were 
 issued in the reigns of Edward III. 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 con- 
 temporaneous volume of the Gentleman's Mag- 
 
 ' Some gentlemen of the Society of Antiqua- 
 ries, 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 Janu- 
 ary 2, 1774, when in a coffin of yellow stone 
 they found the royal body in perfect preserva- 
 tion, 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 envel- 
 oped in the mantle 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 re- 
 mains 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 Claren- 
 don'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 con- 
 structing 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 aper- 
 ture 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 pub- 
 lished 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 Athense Oxonienses. 
 
 ' On removing the pall,' says the account, 
 ' a plain leaden coffin presented itself to view, 
 with no appearance of ever having been in- 
 closed in wood, and bearing an inscription, 
 " King Charles, 1648," in large, legible charac- 
 ters, 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 in- 
 ternal 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 com- 
 pletely full, and, from the tenacity of the cere- 
 cloth, great difficulty was experienced in de- 
 taching it successfully from the parts which it 
 enveloped. Wherever the unctuous matter had 
 insinuated itself, the separation of the cere- 
 cloth 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 dis- 
 colored. 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 immediate- 
 ly ; 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
 
 OF THE DEAD. 181 
 
 oval ; many of the teeth remained ; and the left 
 ear, in consequence of the interposition of the 
 unctuous matter between it and the cere-cloth, 
 was found entire. 
 
 ' It was difficult, at this moment, to withhold a 
 declaration, that, notwithstanding its disfigure- 
 ment, the countenance did bear a strong resem- 
 glance to the coins, the busts, and especially to 
 the picture of King Charles the First, by Van- 
 dyke, by which it had been made familiar to us. 
 It is true, that the minds of the spectators of this 
 interesting sight were well prepared to receive 
 this impression ; but it is also certain that such 
 a facility of belief had been occasioned by the 
 simplicity and truth of Mr. Herbert's Narrative, 
 every part of which had been confirmed by the 
 investigation, so far as it had advanced ; and 
 it will not be denied that the shape of the 
 face, the forehead, the eye, and the beard, are 
 the most important features by which resem- 
 blance is determined. 
 
 'When the head had been entirely disen- 
 gaged from the attachments which confined it, 
 it was found to be loose, and without any diffi- 
 culty was taken out and held up to view. The
 
 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 prob- 
 ably 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 appear- 
 ance which could have been produced only by 
 a heavy blow, inflicted with a very sharp instru- 
 ment, and which furnished the last proof want- 
 ing 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 distinguish- 
 ed personages has been less fortunate in its 
 result. The coffin of Henry VIII. was in- 
 spected 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 no- 
 thing to discriminate the personage contained 
 in it. 
 
 During the present century, the sarcophagus 
 of King John has also been examined. It con- 
 tained 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 par- 
 ticular 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 T11E 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 ani- 
 mals are found in situations where they have 
 remained frozen for years, and even for ages. 
 Not many years ago, the bodies of some Span- 
 ish 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 what- 
 ever convulsion of the globe may have trans- 
 ported 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 BURIAL 
 
 long, and weighed two hundred pounds each. 
 Two years after this event, Mr. Adams, being 
 at Yakutsk, and hearing of this event, under- 
 took a journey to the spot. He found the 
 animal in the same place, but exceedingly 
 mutilated by the dogs and wolves of the neigh- 
 borhood, which had fed upon its flesh as fast 
 as it thawed. He however succeeded in re- 
 moving 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 low 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 greatly 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 abdomen, and filling them with aro- 
 matic and resinous substances, particularly as- 
 phaltum, and enveloping the outside of the 
 body in cloths impregnated with similar mate- 
 rials. These impregnations prevented decompo- 
 sition 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 pre- 
 servation 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 cir- 
 cumstances, such as can befall but an exceed- 
 ingly small portion of the human 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 be- 
 come 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 o/ 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 hu- 
 manity 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 man- 
 Kind, 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 conti- 
 guity 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 occu- 
 pant 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
 
 192 ON THE BURIAL 
 
 three or four successive tiroes. Necessity 
 obliges a recourse at last to be had to the 
 neighboring country, and hence in Paris, Lon- 
 don, Liverpool, Leghorn, and other European 
 cities, cemeteries have been constructed without 
 the confines of their population. These places, 
 in consequence of the sufficiency of the ground, 
 and the funds which usually grow out of such 
 establishments, have been made the recipients 
 of tasteful ornament. Travellers are attracted 
 by their beauty, and dwell with interest on their 
 subsequent recollection. The scenes which, 
 under most other circumstances, are repulsive 
 and disgusting, are by the joint influence of 
 nature and art rendered beautiful, attractive, 
 and consoling. 
 
 The situation of Mount Auburn, near Boston, 
 is one of great natural fitness for the objects 
 to which it has been devoted. Independently 
 of its superior size, it may be doubted whether 
 any spot, which has been set apart for the 
 same purposes in Europe, possesses half the 
 interest in its original features. In a few years, 
 when the hand of taste shall have scattered 
 among the trees, as it has already begun to do,
 
 OF THE DEAD. 193 
 
 enduring memorials of marble and granite, a 
 landscape of the most picturesque character 
 wil be created. No place in the environs of 
 our city will possess stronger attractions to the 
 visiter. To the mourner it offers seclusion, 
 amid the consoling influences of nature. The 
 moralist and man of religion will 
 
 ' Find room 
 
 And food for meditation, nor pass by 
 Much, that may give him pause, if pondered fittingly.' 
 
 "We regard the relics of our deceased friends 
 and kindred for what they have been, and not 
 for what they are. We cannot keep in our 
 presence the degraded image of the original 
 frame ; and if some memorial is necessary to 
 soothe the unsatisfied want, which we feel 
 when bereaved of their presence, it must be 
 found in contemplating the place in which we 
 know that their dust is hidden. The history 
 of mankind, in all ages, shows that the human 
 heart clings to the grave of its disappointed 
 wishes, that it seeks consolation in rearing 
 emblems and monuments, and in collecting 
 images of beauty over the disappearing relics 
 13
 
 194 ON THE BUKIAL 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 harmo- 
 nious and ever changing face of nature reminds 
 us, by its resuscitating influences, that to die 
 is but to live again.
 
 REMARKS ON PNEUMOTHORAX : 
 
 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 auscul- 
 tation 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 descrip- 
 tive. This character may be recognized not 
 only in the respiration and cough, but frequently 
 also in the voice and the succussion and percus- 
 sion 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 re- 
 verberation. The first requires the presence of 
 liquid, the second may take place with only the 
 presence of air. The first includes all the varie- 
 ties of metallic tinkling which are heard in res- 
 piration, 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 con- 
 siderable 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 ap- 
 pears 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-pneumotho- 
 rax, in which there is no communication with 
 the bronchise ; 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 epigas- 
 trium 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, ex- 
 plains metallic tinkling on the principle of 
 reverberation or echo, produced in a cavity of 
 uniformly reflecting parietes by the communica- 
 tion of a sound, or of a soniferous impulse to 
 the air contained within it. He considers that 
 in common cases of pneumothorax communi- 
 cating 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 reso- 
 nance of air agitated upon the surface of a
 
 REMARKS ON PNEUMOTHORAX. 199 
 
 liquid contained in a preternatural cavity form- 
 ed in the chest.' * This explanation may have 
 been suggested by a note of M. Meriadec Laen- 
 nec in his edition of the great work of his rela- 
 tive, 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 en-, 
 tanglement of mucus. He thinks that the tink- 
 ling 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 Sur- 
 gical Journal, 1833, asserts that Laennec, and 
 also all who hold that metallic tinkling '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 com- 
 pressed. ' 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 ex- 
 planation of Laennec, and contends that metal- 
 lic 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 expla- 
 nation of metallic tinkling by the bursting of air 
 bubbles, as early as 1830.
 
 REMARKS ON PNEUMOTHORAX. 201 
 
 Magendie, in his lectures quoted in the Lan- 
 cet of 1835, says : ' The causes which produce 
 the tlntement metallique, are not by any means 
 well understood. Suppositions have been made, 
 (they are made and abandoned with surprising 
 facility in medicine,) but when we come to ex- 
 amine 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 suffi- 
 ciency 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 pro- 
 duced in the operation. Water was then drop- 
 ped 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 him- 
 self 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 pneumotho- 
 rax, the air in the pleura is moderately com- 
 pressed, yet metallic tinkling is known to be 
 also produced in large tubercular cavities of the 
 lungs, which communicate freely with the at- 
 mosphere, 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 reflect- 
 ed 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, there- 
 fore, 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 pow- 
 erful 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 pro- 
 duce a slight and barely audible sound, by rub- 
 bing 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 wa- 
 ter, 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, con- 
 veys the sound of metallic tinkling to the walla 
 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 imper- 
 fectly explained, and therefore open to further 
 inquiry, I have made some experiments in con- 
 nection 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, De- 
 cember 28th, 1836. He had been troubled with 
 cough and dyspnrea, during most of last year, 
 increased during summer. Yesterday, after ex-
 
 CASES OF PNEUMOTHORAX. 205 
 
 posure to cold during perspiration, had a sudden 
 increase of cough and dyspnoea with pain shoot- 
 ing from side to side, and hoarseness. Now, 
 skin hot and dry, face flushed, pulse 98, respira- 
 tion 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. Bron- 
 chophony well pronounced in same place. Sup- 
 plementary puerile respiration in left back. 
 Hoarseness amounting to aphonia, cougli fre- 
 quent, painful, with dyspnoea. About |ii. of 
 muco-purulent sputa daily. Costive ; sleeps 
 little. 
 
 January 2d, 1837. Has rested and felt some- 
 what better for two days. In right back respi- 
 ration 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. Dyspnoea and cough more easy. Per- 
 cussion of right back tympanitic to base of 
 chest ; right back when viewed vertically much 
 more prominent to the eye than left ; semi- 
 circumference an inch greater ; intercostal spaces 
 prominent, the anterior ones level in supine pos- 
 ture. In erect posture, base of right chest less 
 resonant than when lying on face or left side. 
 
 9th. Paroxysms of great dyspno3a, 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, iss. 
 
 llth. Rested better ; pulse 104 ; anterior 
 right chest tympanitic on percussion, with in- 
 audible respiration from top to base ; voice 
 scarcely audible through parietes at same place s
 
 CASES OF PNEUMOTHORAX. 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 re- 
 tort 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 expecto- 
 rate unless he turns upon his left side, after 
 which movement the pus flows freely. 
 
 12th, 13th. Many turns of violent and suffo- 
 cative dyspnoea ; metallic tinkling softer. Res- 
 piration in right back very feeble, in left back 
 puerile. 
 
 14th, 16th. Breathes with more ease. Some 
 ounces of purulent sputa raised each day. Am- 
 phoric or metallic respiration, voice and cough, 
 with metallic tinkling more rare and feeble. 
 Right anterior chest quite resonant on percus- 
 sion, to the extreme base of the chest on inspi- 
 ration, but about an inch less in extent at expi- 
 ration. 
 
 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 en- 
 larged ; intercostal spaces obliterated, this side 
 measuring an inch more than the left, opposite 
 the lower end of the sternum. Percussion reso- 
 nant, 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 adhe- 
 sions 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 de- 
 tached flocculent masses of lymph. The lung 
 being inflated in situ, air issued freely from be- 
 hind 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 adhe- 
 sions. Lung large, somewhat emphysematous r 
 upper and lower lobes tuberculous, a cavity ca- 
 pable of holding i. in the upper part of the 
 lower lobe. Air passages of natural size, some 
 redness in right bronchi. Glands at bifurca- 
 tion 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 coagu- 
 lated, with some fibrin ; in left auricle the same y 
 but no separate fibrin. 
 
 Abdomen. Liver of average size, rather dark 
 and friable, pushed down so as to reach the um- 
 bilicus, compressed so that its superior and 
 anterior surfaces formed a right angle. Gall 
 bladder containing v. 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 faint- 
 ed, and in the night had coughing and retching; 
 raised without pain ss. more or less of frothy 
 blood ; has had much cough since, mostly in the 
 night, with scanty expectoration of frothy mu- 
 cus; 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 ; 
 urine high colored ; feels very weak ; tongue 
 clean for 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 dyspnoea requiring 
 him to maintain a stooping posture ; five or six 
 dejections ; pulse 132 sitting up ; dyspnoea 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 ; respira- 
 tion 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 whis- 
 per ; feet and ankles cedematous ; whole left 
 chest, both front and back, very resonant ; respi- 
 ration amphoric, with metallic tinkling loud and 
 musical in the whole left back below spine of 
 scapula, and whole left front from clavicle down- 
 wards. 
 
 2d. Slept pretty well in the same posture as 
 last night; two dejections; countenance anx- 
 ious; skin warm, with profuse perspiration; 
 pulse 144 ; tongue white in centre, livid, moist ; 
 respiration 30, laborious ; voice better than yes- 
 terday ; amphoric resonance diminished ; metal- 
 lic tinkling as yesterday. 
 
 3d. Slept pretty well in his chair, as before ; 
 pulse 128; respiration 32, somewhat less labori- 
 ous, 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 ;
 
 CASES OP PNEUMOTHORAX. 213 
 
 resonance continues to the very base of chest ; 
 respiration vesicular, but feeble about spine of 
 scapula ; amphoric in lower half of back ; natu- 
 ral 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 reso- 
 nance in natural respiration; in forced respira- 
 tion 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 labori- 
 ous ; about iss. 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 scapulae ; im- 
 mediately over and above scapulse, 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 scapulae 
 and for an inch or two below, then amphoric for
 
 214 CASES OF PNEUMOTHORAX. 
 
 a space about the breadth of the hand, inaudible 
 at base ; no resonance or tremor of voice disco- 
 vered 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 ; ii. 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 whole of the reso- 
 nant space in back. Natural respiration vesi- 
 cular about scapulae, with sonorous rale ; below 
 scapulae, amphoric resonance. In front, metal- 
 lic 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 la- 
 bored than for the last two or three days.
 
 CASES OF PNEUMOTHORAX. 215 
 
 Tongue cleaner, rather less livid ; nearly |ii. 
 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 unac- 
 companied by tinkle. 
 
 8th. Kept awake by difficulty of breathing. 
 Cough less ; expectoration about i. adhesive 
 purulent mucus. Countenance much distressed, 
 pulse 132 ; tongue more coated ; respiration 32, 
 labored. Hair, skin and clothing wet with per- 
 spiration. In natural respiration very little 
 sound perceived, except some amphoric reso- 
 nance and occasional metallic tinkling. Per- 
 cussion, when leaning much forward, flat on 
 lower rib, resonant above ; when sitting up, 
 flat on four lower ribs. A peculiar metallic 
 ringing sound perceived by ear applied to ster- 
 num, when the back is percussed. 
 
 llth. In chair all night; slept none from 
 dyspnoea; some pain in left chest ; two dejec- 
 tions ; countenance much distressed ; coughs 
 little ; expectoration pretty easy ; ii. 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 natu- 
 ral 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. Counte- 
 nance 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 sibi- 
 lant rale both in front and back. Forced respi- 
 ration, either in speaking or other effort, ampho- 
 ric. Coughed but little ; less than i. adhesive, 
 white, frothy, mucous sputa. Immediately after 
 rising, loud, ringing, amphoric resonance in res- 
 piration, 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 dyspnrea; three dejections. Dis- 
 charge from bowels thin and watery ; counte- 
 nance 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, inter- 
 costal spaces on a level with ribs ; above, inter- 
 costal spaces projecting, resonant. In ordinary 
 respiration, amphoric resonance loud and dis- 
 tinct 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 dis- 
 tressed ; feels better ; pulse 108 ; respiration 36, 
 moderately labored. Inspiration and expiration 
 nearly equal. Percussion flat below line, a fin- 
 ger's breadth below nipple, resonant above. 
 Same ringing sound as before, on percussion. 
 Sounds of fluid readily distinguishable on sue
 
 218 CASES OF PNEUMOTHORAX. 
 
 cussion, heard with ear at a distance of a foot 
 from chest. Moderate amphoric resonance in 
 ordinary respiration. Two sides of chest nearly 
 equal on measurement ; left mamma more prom- 
 inent to the eye than right, intercostal spaces 
 protruding slightly. After some fatigue, am- 
 phoric resonance, ringing. Ribs of left chest 
 scarcely raised in respiration. 
 
 15th. Slept pretty well, mostly in sitting 
 posture; three dejections. Breathing more dif- 
 ficult when he attempted to lie down. Coun- 
 tenance anxious and distressed ; skin quite cool, 
 wet with perspiration ; large sudamina about 
 clavicles ; respiration 36, laborious. Inspiration 
 quicker than expiration. Cough little. Percus- 
 sion about spines of scapulae still equal on both 
 sides. Ordinary respiration amphoric and ring- 
 ing; when a little forced, voice and percussion 
 ringing as before. Sound of fluid on succussion 
 heard at distance of several feet. 
 
 17th. Slept most of night in sitting posture 
 and recumbent, lying on back or right side. 
 Countenance much distressed ; respiration quite 
 laborious ; inspirations quick ; pulse 112. 
 Tongue moist, slight coat on lobes, very slightly
 
 CASES OF PNEUMOTHORAX. 219 
 
 livid ; skin cool and moist. Pain near left nip- 
 ple 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. Ring- 
 ing sound on percussion perceptible when per- 
 cussion 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 side dull over whole 
 space below pectoral muscles. The air rushed 
 out from a perforation on left side, as detailed 
 in Experiment I. Left pleura universally in- 
 flamed, mostly red and roughened, and lined 
 with a soft, bluish-white false membrane of 
 variable thickness, separable in some places into
 
 220 CASKS 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 des- 
 titute of air, having a coat of lymph, and ad- 
 hering 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 enter- 
 ed a large bronchus. This opening communi- 
 cated immediately with a superficial cavity an 
 inch long by half an inch broad, and which con- 
 tained 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 iss. 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 Pey- 
 er's plates, towards the end of the ilium, but no 
 ulcers. Other viscera mostly natural. 
 
 CASE III. 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
 
 422 CASES OF PNEUMOTHORAX. 
 
 with slight pains in the chest, emaciation, loss 
 of strength, and some hectic symptoms, but 
 does not recollect much cough. Being consid- 
 ered 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. Dyspnoea by no means 
 urgent, decubiture dorsal, pain and stricture 
 across both hypochondria, and none felt else- 
 where ; pulse 80. Left chest tympanitic, respi- 
 ration inaudible ; a slight metallic tinkle heard 
 singly at each inspiration and expiration. Pul- 
 sations of heart feeble in cardiac region, stronger 
 on right side. On the follqwing day, without 
 any great aggravation of dyspnoea or distress, 
 he became much prostrated, with a small, irreg- 
 ular pulse, cold sweats, and diminished sensi- 
 bility, and died on the succeeding night. By 
 his own testimony and that of his friends, his 
 cough had been slight, and the dyspnoea at no 
 time urgent. 
 
 Autopsy, sixteen hours after death. The
 
 CASES OF PNEUMOTHORAX. 223 
 
 whole anterior chest resonant, the left tympa- 
 nitic. On perforating the left chest through 
 water, great quantities of air escaped. [See Ex- 
 periment L] The quantity of sero-purulent 
 fluid was not estimated, water having been 
 thrown into the chest for the sake of the ex- 
 periment. The left lung was adherent supe- 
 riorly 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 
 bronchise 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 some- 
 what thickened at their roots with slight vege- 
 tation. Liver depressed, dark purple, flaccid. 
 GaU-bladder healthy. 
 
 I consider the last case as noticeable for the 
 absence of any great dyspnoea or distress, after 
 the signs of pneumothorax 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 pneu- 
 mothorax 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 cylin- 
 der 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 be- 
 fore. No air in this instance escaped, but the 
 water was immediately sucked into the chest 
 by the atmospheric pressure.
 
 EXPERIMENTS. 225 
 
 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, ac- 
 companied 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 ex- 
 isted during the patient's life. 
 
 This experiment was repeated in the exam- 
 ination 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 tiniformly produced, but when two quarts 
 or more were introduced, a bubbling only was 
 heard, without metallic resonance. Similar re- 
 sults 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 percus- 
 sion were both found to produce the same me- 
 tallic sounds in the dead body as during life in 
 Case II. Metallic sounds elicited by percussion 
 somewhat resemble those occasionally yielded 
 by 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 pneumo- 
 thorax, 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 pneurnotho- 
 racic. 
 
 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 con- 
 tinued so as to produce bubbles, a sharp tink- 
 ling 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 in- 
 creased by farther inflation. Succussion of the 
 bladder produces a similar effect. It is neces- 
 sary 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 am- 
 phoric 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. 
 
 \. There must be a cavity, the walls of which 
 are preternaturally susceptible of vibration.
 
 REMARKS. 229 
 
 This takes place when the pleura is pathologi- 
 cally 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 metal- 
 lic tinkling, is a forcible or sudden disturbance 
 of the 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 dis- 
 turbance ; 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 tink- 
 ling are transmitted from the liquid to the solid 
 parietes, and thence directly to the ear, without
 
 230 REMARKS ON. PNEFMOTH0RAX. 
 
 any necessary agency of an echo, or reverbera- 
 tion of air in the cavity. This is shown partic- 
 ularly 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 rever- 
 berations of the air in a vibrating cavity, with- 
 out sonific impulse of the liquid. The same is 
 true of metallic modifications of the voice, and 
 of the cough when there is no tinkling. Metal- 
 lic 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 PHARMACOPEIA 
 
 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 expres- 
 sion and inter-communication, if we possessed, 
 for example, but one nosology, but one system 
 of natural history, but one language of chem- 
 istry 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 teach, 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. Some- 
 times under the sanction of governments, some- 
 times 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 suffi- 
 ciently 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 conflict- 
 ing 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 men- 
 tioned, needs retrenchment quite as much as 
 extension ; and were it not for the fact, that 
 certain nomenclatures have become incorpo- 
 rated 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 deli- 
 cate 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 sci- 
 ence, but as a medium of communication for
 
 234 ON THE PHARMACOPOEIA 
 
 two extensive professions, particularly needs 
 simplicity and precision of language. It like- 
 wise requires that its expressions should be 
 generally intelligible, an advantage which can- 
 not 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 phar- 
 macopoeia, 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 diffi- 
 culty. 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 per- 
 fection is not to be expected in a pharmaco- 
 peia, there will always be found a spirit of
 
 OP THE UNITED STATESr 23 
 
 hypercriticism, ready to consider trivial defects, 
 as reason^ 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 promotive of public convenience than 
 a number of more learned and perfect ones 
 existing simultaneously. The late autocrat, Al- 
 exander, ordered his Scotch body-surgeon, Sir 
 James Wylie, to prepare a Pharmacopeia Ros- 
 sica, which he introduced by an ukase through- 
 out 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 com- 
 pound 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 pharmacopeia 
 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 PHARMACOPOEIA 
 
 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 al- 
 chemy 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 dul- 
 cis, 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. 237 
 
 of its character was to produce a reconcilia- 
 tion of extremes, the mitigated dragon of anti- 
 quity has become a mild chloride of mercury. 
 
 On the other hand, when a nomenclature has 
 been perfectly arbitrary and divested of scien- 
 tific relations, it has been proportionally dura- 
 ble and constant. Like the words engrafted on 
 a national language, its origin may be vague 
 and accidental, yet the public convenience pre- 
 vents 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 lan- 
 guage 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 pharmacopoeias 
 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 calo- 
 mel and camphor, have never yielded to any 
 periphrastic method of expressing the same 
 things. Corrosive sublimate refuses to be mod-
 
 238 ON THE PHARMACOPEIA 
 
 ernized, and the salts of Epsom and Rochelle 
 maintain their ground against all chemical in- 
 terference. The combined learning of two hem- 
 ispheres is unable to prevail against copperas 
 and cream of tartar, and the manufacturer and 
 me'rchant 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 dura- 
 bility of the other, though very desirable, Would, 
 from the nature of the subject, be impossible. 
 Yet an approach may be made to the advan- 
 tages 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. 239 
 
 It appears to us, that the stability of pharma- 
 ceutical 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 com- 
 munity. 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 ap- 
 pears that a uniform system is extensively es- 
 tablished 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, syno- 
 nyms, 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 PHARMACOPOEIA 
 
 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 apoth- 
 ecaries and deceive physicians, if not to kill 
 patients. It is to be regretted that, in the dif- 
 ferent pharmacopoeias which have been pub- 
 lished 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 formulae 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. 241 
 
 exclusive fitness or virtue ; and we may perhaps 
 get a true idea of their value from the consid- 
 eration, 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 con- 
 tinue 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. 
 Pharmacopoeias, 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 pharmaco- 
 poeia. This, it was confidently hoped, by intro- 
 ducing a current language throughout the coun- 
 try, would do away the confusion which then 
 prevailed, and offered to the parties concerned a 
 facility of intercommunication, corresponding to 
 16
 
 242 ON THE PHARMACOPOEIA 
 
 that which results from a common system of 
 coinage, or of weights and measures. A nu- 
 merous 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 cir- 
 cumstances in which they were placed. Com- 
 ing 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 experi- 
 ment 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 pharmacopoeia, 
 which should be better than any which pre- 
 viously 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. 243 
 
 that of introducing order in the place of con- 
 fusion, 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 Pharmacopoeia, 
 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 
 Pharmacopoeia, 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 owe own country. 
 The last plan was decided on by the conven- 
 tion, under the expectation, doubtless, that it 
 would be more acceptable to their constituents. 
 A programme of a pharmacoposia prepared by 
 the College of Physicians in Philadelphia, was 
 adopted as the groundwork, and, after being
 
 244 ON THE PHARMACOPO3IA 
 
 variously modified and augmented, was referred 
 to a committee, with instructions to publish it. 
 
 It must necessarily happen that a work ema- 
 nating 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 satisfac- 
 tion to any of them, would be in some respects 
 imperfect, disconnected, and redundant. Nev- 
 ertheless, 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 re- 
 form and perfection, rather than the over- 
 throw of the work. But several of the journals 
 thought otherwise, and the pharmacopeia 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 
 
 ranee of the commentator, rather than the de- 
 fects of the book, produced a reprobation of its 
 contents. Nevertheless, the pharmacopoeia was 
 received, willingly by some, and reluctantly by 
 others, and became, we have reason to believe, 
 the prevailing standard, or at least more preva- 
 lent 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 suffi- 
 cient unanimity of sentiment would have pre- 
 vailed, to direct into one channel whatever 
 amount of skill and experience might be vol- 
 unteered for its improvement, either by socie- 
 ties or individuals. It appears that numerous 
 societies, in different parts of the Union, feeling 
 an interest in the revision and confirmation of 
 the pharmacopoeia, had appointed delegates to 
 attend the expected convention at Washington, 
 in 1830. A part of the delegates thus desig- 
 nated 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 PHARMACOPOEIA 
 
 the appointed time, and having organized a 
 convention of such delegates as were present, 
 and invited a cooperation of other medical gen- 
 tlemen 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 meet- 
 ing in New York, where they also proceeded 
 to take measures for republishing the pharma- 
 copoeia, having likewise invited the cooperation 
 of other medical gentlemen of note. Out of 
 this want of concord have risen up two phar- 
 macopoeias, 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. 247 
 
 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 par- 
 ties, (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 re- 
 ceived as the national standard. And here, if 
 it be asked what constitutes fitness or excel- 
 lence in a pharmacopoeia, we should answer 
 simply, that such a work ought to contain and
 
 248 ON THE PHARMACOPCEIA 
 
 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 cor- 
 respondence between its own parts. In these 
 respects, we think the Washington Pharma- 
 coposia has greatly the advantage of its com- 
 petitor. We observe in its list of materia med- 
 ica, 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 nu- 
 merous, 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-
 
 OF THE UNITED STATES. 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 latter work, knowing the 
 difficulties which attend this species of compo- 
 sition, and entertaining a high respect for the 
 character of the gentlemen concerned, we for- 
 bear 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 improve- 
 ments 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 augmenta- 
 tion.
 
 250 ON THE PHARMACOPOEIA 
 
 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 Phar- 
 macopoeia of 1820, a work having many incon- 
 veniences and defects, but at the same time 
 many claims to approval. In its general out- 
 line, say they, and prominent features, it will 
 bear a favorable comparison with the best phar- 
 macopoeias of Europe, and it is only in filling 
 up, that improvement is demanded, or admis- 
 sible. The changes therefore which have been 
 made under the authority of the late conven- 
 tion, embrace the materials and minor arrange- 
 ments, 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 pe- 
 culiarly qualified by their previous studies, and 
 the whole has passed the examination of phar- 
 maceutists of acknowleged eminence in their 
 profession. 
 
 Considering how difficult it is to induce per- 
 sons 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 perfect- 
 ing 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 pre- 
 sent us with results more deserving of the 
 public confidence. 
 
 In pursuance of the plan of the former edi- 
 tion, and for reasons which it is not necessary 
 here to repeat, the pharmacoposia is written out
 
 252 ON THE PHARMACOPOEIA 
 
 on opposite pages in Latin and in English. 
 The classical latinity of the London Pharma- 
 copoeia is adopted as a standard, and, by keep- 
 ing this in view, a unity of style is preserved 
 throughout the book. We see no cause to be 
 dissatisfied with the general purity and ele- 
 gance of this language, though in one case, we 
 observe, the convention have erroneously fol- 
 lowed the London example, in using the geni- 
 tive 'rosmarini,' and ablative 'rosmarino,' in- 
 stead of the undoubted rorismarini, and rore- 
 marino, 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 mod- 
 ern 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, however, to avoid great 
 circumlocution, a pharmaceutical name is re- 
 tained in the place of a more expressive chemi- 
 cal appellation, as in the case of alumen, hy- 
 drargyrum, 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 O1S THE PHARMACOPO3IA 
 
 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 American 
 Pharmacopeia. These names being interna- 
 tional 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 practi- 
 cable cases, a single word for the name of the 
 drug, leaving its nature and origin to be de- 
 fined in the opposite column. This peculiarity 
 of the American Pharmacopoeia 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 pharmacopeias, to express vegetable sub- 
 stances, are either unwieldy in their length, or 
 improper in their application. Thus the drug 
 assafoetida is called by the Edinburgh college 
 gummi resina ferulae assafcetidae, a name which
 
 OF THE UNITED STATES. 255 
 
 is highly descriptive, but inapplicable to com- 
 mon use. By the London college it is called 
 assafoetidae gummi resina ; but as the term as- 
 safoetida alone is not the name of any plant, 
 in any botanical system of the present day, 
 the whole name is incorrectly composed. The 
 , simple name of the drug, assafoetida, is un- 
 doubtedly better than either. In like manner 
 columbo may be called by the simple name 
 colomba, or by the circuitous name cocculi 
 palmata radix, but not calumbse radix, for there 
 is no such plant as calumba. The American 
 Pharmacopoeia has another advantage in using 
 simple names, whenever the drug happens to be 
 derived from several plants, as camphor, senna, 
 rheum, and aloe, or from several animals, ich- 
 thyocolla. In the present edition, a slight vari- 
 ation is made from the former, in using the 
 Latin name of the article always in the singular 
 number, as cantharis, caryophyllus, prunum, 
 instead of cantharides, &c. This method pre- 
 serves uniformity, and is supported by the 
 usage of Celsus in similar cases. 
 
 As in the former edition, the materia medica 
 list is divided into two columns, the first of
 
 256 ON THE PHARMACOPOEIA 
 
 which contains the officinal name of each ar- 
 ticle, in Latin and English, together with oc- 
 casional synonyms, while the other defines the 
 substance intended, and gives explanatory ref- 
 erences. This part of the work gives evidence 
 of a laudable degree of care and research, yet 
 we notice a few minor things deserving of re- 
 mark. The substance called lupulin, derived 
 from the hop, is defined ' strobilorum pollen.' 
 As the word pollen has, in vegetable physi- 
 ology, a specific meaning, it would have been 
 better to have used some other name to ex- 
 press powder. In the Latin, lupulia, as used 
 by the New York convention, is more conso- 
 nant 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 impor- 
 tant part of the work, have devoted to it a
 
 OF THE UNITED STATES. 257 
 
 greater share of their attention. 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 phar- 
 macopoeia 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 re- 
 mould and shape them, so as to produce a 
 harmonious whole. In the present edition an 
 effort has been made to supply these deficien- 
 cies, 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 princi- 
 ples are stated to have governed the choice of 
 formulse, independent of their intrinsic merit, 
 which, when superior, has always been allow- 
 ed 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 preva- 
 17
 
 258 
 
 ON THE PHARMACOPCEIA 
 
 lence in this country, and the sanction of the 
 majority of the British pharmacopeias. It is 
 considered highly desirable, that uniformity in 
 the preparation of medicines should everywhere 
 prevail, for the benefits accruing from the mu- 
 tual interchange of the medical writings of 
 different civilized nations, must be greatly af- 
 fected by any material difference in the nature 
 or composition of the remedies employed. This 
 remark is especially applicable to Great Britain 
 and the United States, and to all countries 
 where the English language is generally used- 
 It is a duty, therefore, say the convention, which 
 we owe to the cause of pharmacy, to throw our 
 weight into the scale which already preponde- 
 rates, and thus contribute to the production 
 and maintenance of the desired uniformity. 
 
 In those cases where the chemical formulae 
 of the original pharmacopoeia have been found 
 to be defective or objectionable, their place has 
 been supplied by more accurate and practicable 
 rules, founded on a course of careful investiga- 
 tions. In this way the economy and uniformity 
 of certain processes is greatly promoted. New 
 preparations, which have been brought to light
 
 OF THE UNITED STATES. 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 chem- 
 istry has been enabled to extort from vegetable 
 drugs. Retrenchment has been freely exercised 
 in lopping off many of the superfluous formu- 
 las, which a necessity for hasty compromise had 
 caused to be introduced into the pages of the 
 old pharmacopoeia ; and, among other articles 
 dismissed is the acetum opii, or black drop, a 
 revived piece of antiquity, wasteful in its com- 
 position, 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 mor- 
 phia are better than the natural meconate. We 
 have seen delirium tremens brought on under
 
 260 ON THE PHARMACOPEIA 
 
 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 in- 
 gredient 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 encum- 
 ber 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 hypercritical pedantry 
 of Dr. Paris. We admit that adjuvants will 
 help, and that corrigents will correct; never- 
 theless, we find that castor oil, ipecac, and 
 opium will often do their duty without either. 
 In admitting the influence of chemical consid- 
 erations 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-
 
 OF THE UNITED STATES. 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 con- 
 sider those substances medicinally incompati- 
 ble, which, if mixed out of the body, occasion 
 a precipitate, or a change of color. What in- 
 compatible, 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 circum- 
 stance, although of great consequence in strict- 
 ly chemical compounds, is less so in arbitrary 
 mixtures ; and in the administration of simpler 
 medicines its importance diminishes still fur- 
 ther. 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 PHARMACOPEIA 
 
 spoonfuls. Nay, that physician must possess 
 uncommon shrewdness, who, even after appor- 
 tioning 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 pro- 
 portion of .two to one, or vice versa, and of 
 such changes we propose to take notice. The 
 vinum antimonii, which in the old edition con- 
 tained four grains to the fluid ounce, in this 
 edition contains but two, and is therefore re- 
 duced 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,
 
 OF THE UNITED STATES. 263 
 
 and we apprehend that a glass or two of Tene- 
 riffe wine would do no good to a man in apo- 
 plexy 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 am- 
 monia 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 consen- 
 taneous in its parts as the American Pharma- 
 copoeia, we would willingly have dispensed 
 with such names as pulvis aromaticus and 
 pilulae cathartics composite. 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 PHARMACOPEIA 
 
 count, since in that instance, as well as in the 
 case of objectionable formulas, the evil may 
 generally be remedied by extemporaneous pre- 
 scription. Every man has his particular taste 
 and judgment, and de gustibus non disputan- 
 dum. In the wine of antimony, to which we 
 have objected, the evil is remedied by extem- 
 poraneous solutions in water, which are far 
 preferable to those in wine. Even though a 
 pharmacopoeia should arrive at the highest and 
 most unquestioned point of excellence, still 
 physicians woukl suit themselves with formulas 
 of their own, adapted to particular cases. We 
 apprehend that most practitioners pass their 
 lives in ignorance of half the contents of phar- 
 maceutical 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 pharmacopoeia. 
 
 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 pharmacopoeias 
 with which we are acquainted ; that it is better 
 suited to the wants of the American commu- 
 nity 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 produc- 
 tion 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 ; ancl that if, 
 as the edifice grows old, it shall be found to 
 need repairs, enlargement, or modern decora- 
 tions, still that its foundations may not be 
 wantonly assailed, and that its walls may stand 
 as a landmark and a barrier against the confu- 
 sion of fluctuating language.
 
 ON THE MUCUNA PRURIENS 
 
 WITH REMARKS ON 
 
 THE IRRITABILITY OF DIFFERENT TEXTURES. 
 
 THE Dolichos pruriens of Linnaeus, now call- 
 ed Mucuna pruriens, and, in English, Cowhage, 
 is a climbing plant of the West Indies, the pods 
 or seed-vessels of which are covered with stiff, 
 sharp bristles, or spiculse. I have examined 
 these bristles in a microscope, and find them to 
 be extremely acute, hollow, and apparently cov- 
 ered on the outside with little warts or vesicles. 
 
 It is well known that when these bristles are 
 rubbed on the skin, they excite an intense and 
 violent itching, which lasts for a considerable 
 time. They have been sometimes indiscreetly 
 used as a counter-irritant, applied to the skin, 
 by spreading from four to six grains on lint, and
 
 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 papu- 
 lae followed, which increased in size for a week, 
 and at length terminated in pustules, which re- 
 quired 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 spiculee. After 
 attempting in vain to relieve the trouble by a 
 poultice, recourse was had to a mixture of Plas- 
 ter of Paris and water, which was poured and 
 suffered to harden upon the skin. When with- 
 drawn from the skin, it extracted and brought 
 with it the spiculas, 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 be- 
 lieve, 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 anthel- 
 mintic properties of this medicine, after it should 
 have undergone the process of digestion in the 
 stomach, I performed with it a number of expe- 
 riments. A parcel of the spiculae of full strength
 
 ON THE MUCUNA PRURIENS. 269 
 
 were soaked in blood-warm water for about ten 
 minutes. On withdrawing them, they were 
 found softened, apparently deprived of their 
 venom, and wholly incapable of irritating the 
 skin when rubbed upon it. Another portion 
 was tied up in a muslin bag, and forced into the 
 stomach of a cat. At the end of ten minutes an 
 emetic was administered, which brought up the 
 bag with the spiculaB so far digested that they 
 could not be made to give the slightest irritation 
 to the skin. I am therefore obliged to conclude 
 that the vermifuge action attributed to cowhage 
 was in reality due to the cathartics which fol- 
 lowed its use. 
 
 Within a few weeks past,* I have noticed 
 another curious property of the dolichos, that it 
 stimulates the skin, but does not stimulate the 
 mucous membrane. Applied to the hand, for 
 example, it immediately causes violent itching; 
 but if rubbed on the inside of the lip, or tongue, 
 it excites no sensation beyond the ordinary me- 
 chanical stimulus. In like manner the effect on 
 the outside and inside of the cheek are wholly 
 
 * January, 1844.
 
 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 medi- 
 cine. 
 
 It is a field of interesting inquiry to ascertain 
 how far particular morbid poisons and stimu- 
 lants 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 stim- 
 ulating 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 su- 
 perficial 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 gonor- 
 rhoea, 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 said to have occasioned death by 
 suffocation when applied to the fauces or throat. 
 It is possible that the morbid poison of scarla- 
 tina, and of some other diseases which affect 
 simultaneously the skin and mucous membrane, 
 may possess the same universality of action.
 
 ON THE 
 
 POISONOUS EFFECTS 
 
 or 
 
 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 west- 
 ern States, and " Ruffed Grous" by Wilson, Nut- 
 tall, and Audubon, appears to inhabit the conti- 
 nent 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 subter- 
 minal 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 drum- 
 ming 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 illu- 
 sive 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 Oc- 
 tober. 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 hap- 
 pen 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, accompa- 
 nied 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 re- 
 covered. 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. Put- 
 nam) 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 imper- 
 ceptible. There was drowsiness approaching 
 to insensibility, nausea and vomiting. Spiritu- 
 ous 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 contrac- 
 tion 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 III. A man aged sixty, who had al- 
 ways 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, avoid- 
 ing the dark meat and the parts contiguous to 
 it. About an hour afterwards he went to church, 
 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 ' poison- 
 ed,' 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 club- 
 room, 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 ' trance- 
 like' 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 lan- 
 guid 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. 279 
 
 passing a restless night with much thirst. It 
 was remarked that others- of the family ate the 
 white meat of the same bird without any disa- 
 greeable consequences. 
 
 CASE VI. A female,. whx> had eaten at 12 
 o'clock of the white and black meat of a par- 
 tridge, in half an hour was taken- with pain in 
 the chest and throat, nausea, weaker-ess and loss 
 of sight. "Was seen by her physician at 4 P. M. 
 Her pulse was 54, and hardly perceptible. After 
 taking brandy and water and half a drachm of 
 ipecac, her pulse improved in strength, but was 
 still 54 only. Her mind remained clear, and 
 the most remarkable symptoms were the blind- 
 ness and slow and feeble pulse. 
 
 CASE VII. An elderly gentleman, of full 
 habit, breakfasted in part on a partridge. In 
 two hours he was seized with dizziness, partial 
 loss of consciousness, and violent pain extend- 
 ing through the abdomen to the back. When 
 visited by Dr. H. J. Bigelow, he was found on 
 his hands and knees, cold, faint, partly insensi- 
 ble and nearly pulseless. The pain having sub-
 
 280 ON THE POISONOUS EFFECTS OF 
 
 sided, returned at intervals, causing him to call 
 often to have his back rubbed. After an emetic 
 he was much relieved, and rallied slowly in 
 the course of the afternoon. 
 
 CASE VIII. For this and the two following, 
 I am indebted to Dr. Morrill Wyman. 
 
 A very athletic and active man, aged fifty, at 
 times making very great and long-continued 
 exertion and eating freely, February 14, 1849, 
 took supper at 7 P. M. ; ate two roasted par- 
 tridges, with ale and other liquors. At 8 o'clock 
 felt somewhat heavy, and thinking he had eaten 
 too much supper, proposed to go to the bowling 
 alley for exercise. In a few minutes perceived 
 that the lights in the room had a blue tinge, the 
 fire also ; asked if any new kind of burning 
 fluid had been used, and immediately fell, with 
 loss of consciousness. Just previously to the 
 loss of consciousness, had pain in the back of 
 the neck, extending down along the spine and 
 into the arm. In ten or fifteen minutes partially 
 recovered, then again unconscious ; muscles 
 of limbs completely relaxed; face very pale; 
 respiration four to six times per minute ; pulse
 
 THE AMERICAN PARTRIDGE. 281 
 
 18 to 22 ; hands and feet cold and moist ; 
 groaned frequently ; vomited freely and spon- 
 taneously, 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 min- 
 utes, 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 suspect- 
 ed the partridge of being the cause of his trou- 
 bles. Soon after, found himself at the bottom 
 of a steep declivity, having lost his conscious-
 
 282 ON THE 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 mus- 
 cular power. Time elapsed between first symp- 
 toms 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 nausea- 
 ted, 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 occasion- 
 ally some difficulty of breathing, a catching of 
 the breath. In the morning was quite well. 
 
 Neither of these individuals have eaten par- 
 tridges since. 
 
 The principal and most characteristic symp- 
 toms were loss of consciousness ; relaxation of 
 the muscles, and in one instance of the sphinc- 
 ters ; 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 circum- 
 stances 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 symp- 
 toms, 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 vol- 
 untary motion. Respiration has been slow, 
 sometimes to a great degree. In the circulating 
 system there has been syncope, feeble and some- 
 times irregular action of the heart ; weak, slow, 
 and sometimes imperceptible pulse ; cold sur- 
 face, 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
 
 THE AMERICAN PARTRIDGE. 285 
 
 knowledge, proved fatal. The remedies usually 
 and properly resorted to, are a prompt emetic, 
 accompanied or followed by stimulants, if the 
 prostration is urgent. Free spontaneous vomit- 
 ing not unfrequently removes the difficulty be- 
 fore the physician arrives. Acrid stimulants, 
 such as a teaspoonful of mustard, may serve the 
 double purpose of a quick emetic and an in- 
 citant to the depressed vital powers. Spirits, 
 and other diffusible stimulants, are indicated by 
 the sinking condition of the patient, but the 
 anxiety of friends often leads to their excessive 
 administration, for which the patient pays by a 
 prolonged continuance of his narcotism. Fric- 
 tion and external warmth are indicated and 
 generally 'desired by the patient. 
 
 The flesh of the partridge is justly esteemed 
 as a great delicacy, and is abundantly sold in 
 the markets of this and many other cities. 
 Audubon says of it : { In my humble opinion it 
 far surpasses as an article of food any land bird 
 we have in the United States, except the wild 
 turkey.' It is in its best condition in the fall of 
 the year, and continues to be common through-
 
 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 occa- 
 sionally 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 poi- 
 sonous 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 found- 
 ed, 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 con- 
 cerned in producing the noxious effects in ques- 
 tion, for this circumstance would be generally 
 detected by the taste, and the incipient putres- 
 cency 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 weath- 
 er, 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
 
 288 THE AMERICAN PARTRIDGE. 
 
 the same person has sometimes been affected 
 twice, that a majority of persons, partaking of 
 the same partridge, escape unharmed, when 
 others are poisoned, and that individuals are 
 found who cannot eat lobster, mackerel and 
 certain other kinds of food without suffering 
 symptoms approaching in character to those 
 already described.
 
 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 incapa- 
 ble 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 
 10
 
 290 ON COFFEE AND TEA. 
 
 all civilized nations has shown them to be 
 innocent, when used at proper times and in 
 moderate quantities, while, like all other medi- 
 cinal substances, they are capable of abuse, if 
 taken under improper circumstances or to an 
 excessive degree. 
 
 As these two substances have a close affinity 
 to each other, possessing properties not known 
 to exist in any other plant, they are properly 
 associated with each other as a class under the 
 name of anthypnotics. Should any plant be here- 
 after found to possess qualities similar to those 
 of coffee and tea, it would doubtless acquire an 
 immediate value, and perhaps be in the same 
 request as these imported articles. The subject 
 is an interesting one for future inquiry, and al- 
 ready an identity in the active alkaloid principle 
 has been asserted for some species of Ilex and 
 Paullinia, consumed by the inhabitants of South 
 America. 
 
 The prevailing fondness for coffee and tea is 
 probably an acquired taste, like that for tobacco 
 and alcohol. The flavor of both these articles 
 in their crude state is disagreeable to most 
 persons not already initiated in their use. But
 
 ON COFFEE AND TEA. 291 
 
 the discovery in modern times of their second- 
 ary 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 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.
 
 292 ON COFFEE AND TEA. 
 
 Bruce, in his Travels in Abyssinia states, that 
 the Gallse, 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 in- 
 troduced 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 coffee 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 ' succeed- 
 ed in convincing the people that roasted coffee 
 was not a coal, upon which they were again 
 opened. In later years the use of coffee be- 
 came 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 di- 
 vorce. 
 
 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 constitu- 
 tion, without impairing its stimulant or medi- 
 cinal activity. A peculiar alkaloid, called caf- 
 feine, 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 ali- 
 mentary fermentation, takes off the feeling of 
 distension and heaviness occasioned by over- 
 eating, counteracts in some degree the fumes 
 of wine, and produces a lightness and hilar- 
 ity of mind, more moderate but more per- 
 manent than that occasioned by vinous or 
 spirituous 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 pro- 
 motive of watchfulness, and enables us to resist 
 for a long time the approaches of sleep. Stu- 
 dents, whose lucubrations occupy a consider- 
 able 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 arti- 
 cles, but from the change of diet, and the want 
 of the customary stimulus of coffee and tea. 
 The Turks and Arabians consume large quan- 
 tities 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
 
 296 ON COFFEE AND TEA* 
 
 which every practitioner should remember, that 
 perhaps no antidotal substance exerts so pow- 
 erful an agency in counteracting the effect not 
 only of opium, but of alcohol and the whole 
 tribe of narcotics as a -seasonable draught of 
 strong coffee. 
 
 Many complaints have been ascribed to the 
 frequent and excessive use of coffee, such 
 as tremors, headache, vertigo, and some more 
 serious disorders. These complaints are most 
 apt to appear when coffee has been taken 
 alone, without a sufficient quantity of nourish- 
 ment accompanying it. It is common for 
 physicians, in the course of practice, to hear 
 complaints of a sinking at the stomach, uni- 
 versal trembling of the limbs, and a loss of 
 muscular power, coming on at eleven or twelve 
 in the morning, and incapacitating the patient 
 for business. These complaints I have, in more 
 than half the instances which have come under 
 my notice, been able to trace to a cup or two 
 of strong coffee, or perhaps tea, taken for break- 
 fast without a particle of nourishment, or at 
 least without a sufficient quantity to support 
 the system, during and after the stimulant ope-
 
 ON COFFEE AXD 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 Linnaeus THEA, is a 
 native of Japan, China, Tonquin, and Assam. 
 Linneeus 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 distin- 
 guishes 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, vary- 
 ing 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 coun- 
 tries 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 prepara- 
 tion. 
 
 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 com- 
 merce, 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 be- 
 longs 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 anti- 
 quarian 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 Kosjusvo, 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 exam- 
 ple, imposed on himself privations and mertifications of every 
 kind, living in the open air, and devoting the days and nights
 
 ON COFFEE AND TEA. 299 
 
 When the plants have attained their third 
 year, the collection of the leaves is commenced. 
 It is repeated every year until the trees are 
 seven or eight years old, after which they are 
 cut down, that they may shoot up afresh from 
 the roots, a process which increases the quan- 
 tity of leaves. 
 
 The leaves are carefully picked oft', one by 
 one. In Japan, the best kind, called imperial 
 tea, is collected at the end of February, or the 
 beginning of March, before the leaves are fully 
 unfolded. This tea is scarce and dear, and is 
 
 to prayer and contemplation. After several years, however, 
 being worn out with fatigue, he fell asleep against his will ; 
 and, that he might faithfully observe his oath, which he thought 
 he had violated, he cut off his eyelids, and threw them on the 
 ground. Next day, having returned to the same spot, he found 
 them changed into a shrub which the earth had never before 
 produced. Having eaten some of the leaves of it, he found his 
 spirits exhilarated and his former vigor restored. He recom- 
 mended this aliment to his disciples and followers. The repu- 
 tation of tea increased, and after that time it continued to be 
 generally used. Kaempfer, in his Amanitates Exotica, gives 
 the life with a portrait of this saint, so celebrated in China 
 and Japan. There is seen at the feet of Darma a reed, which 
 indicates that he had traversed the seas and rivers.' Sigmonl 
 on Tea, p. 12.
 
 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 un- 
 folded 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, de?- 
 pend 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 em- 
 ployed 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-
 
 ON COFFEE AND TEA. 301 
 
 formed by the Chinese in buildings erected 
 for general use. Several pounds of the leaves 
 fresh gathered are placed in a large shallow pan 
 of thin iron, and heated over a furnace, the ope- 
 rator shaking and turning them with his hands 
 until they begin to crackle. The heat thus ap- 
 plied deprives the leaves of their juice, and with 
 it of the inebriating and deleterious properties 
 which they possess while green. After the 
 leaves are thoroughly roasted, they are taken 
 out with wooden shovels and delivered to the 
 rollers. These persons roll them rapidly and 
 with a regular motion, with the palms of their 
 hands, upon tables covered with fine mats, until 
 they acquire the form in which we see them 
 imported. This operation produces an almost 
 insupportable burning in the hands, which is 
 aggravated by a yellowish inflammatory juice 
 pressed out from the leaves. Nevertheless, it 
 is necessary to continue the operation until the 
 leaves are completely cold, for they cannot be 
 rolled except when hot, and in order that they 
 should not unroll, it is necessary that they 
 should cool under the hands. The more rapid
 
 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. 
 Ksempfer assures us that the tea brought into 
 Europe is always 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. It 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 owing to verdigris, with which it thus be-
 
 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 cop- 
 per ; 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 com- 
 mon 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 per- 
 haps 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 obser- 
 vations ; 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 intro- 
 duction of tea. It was entitled Cornelia Bontekoe, Tractaat 
 van he.t excellence Kruyd Thee. Although this work was, 
 from the extravagance of its commendations on tea, severely 
 kandled by some of the critics, it was translated into many lan- 
 guages, 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 innu- 
 merable ills to which man is subject would not only be dimin- 
 ished, 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 Com- 
 pany. 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. Etmuller recom- 
 mended tea as a fine stomachic cephalic and antinephritic. 
 Pechlin wrote a dialogue on tea, which he entitled Theojihi/us 
 Bibaculus, and several poets indulged themselves in its praise. 
 Petit wrote a poem ; Peter Francius, two Anacreontics ; Hein- 
 rich, 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 irrita- 
 tion after fatigue, or forms a more grateful repast. It contrib- 
 utes to the sobriety of a nation ; it imparts all the charms to 
 society which spring from the enjoyment of conversation, with- 
 out that excitement which follows upon a fermented drink. 
 Sigmond, p. 94. 
 
 The introduction of tea-drinking into England has been as- 
 cribed to Lord Arlington and Lord Orrery, and the year 1666 r 
 the anntis mirabilis of Dryden, has been assigned as the exact 
 date ; but in the diary of Mr. Pepys, secretary to the Admi- 
 ralty, 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 Parliament,, 
 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 j which were visited twice daily by 
 
 20
 
 306 
 
 ON COFFEE AND TEA. 
 
 various and contradictory. Such is the diver- 
 sity of temperaments and constitutions, that it 
 cannot otherwise happen than that an article of 
 
 officers, whose duty it was to ascertain what quantity had been 
 made. 
 
 From An exact Description of the Growth, Quality, and 
 'Virtues of the Leaf Tea, by Thomas Garway, in Exchange 
 Alley, near the Royal Exchange, in London, Tobacconist, 
 and Seller and Retailer of Tea and Coffee ; published about 
 1660. 
 
 ' Tea is generally brought from China, and groweth there 
 upon little shrubs and bushes, the branches whereof are well 
 garnished with white flowers, that are yellow within, of the big- 
 ness and fashion of sweet-brier, but in smell unlike, bearing 
 thin green leaves, about the bigness of scordium, myrtle, or 
 euinack, and is judged to be a kind of sumack. The said leaf 
 is of such known virtues, that those very nations, so famous for 
 antiquity, knowledge, and wisdom, do frequently sell it among 
 themselves for twice its weight in silver ; and the high estima- 
 tion of the drink made therewith hath occasioned an inquiry 
 into the nature thereof, amongst the most intelligent persons of 
 all nations that have travelled in those parts, who, after exact 
 tryal and experience by all wayes imaginable, have commended 
 it to the use of their several countries, and for its virtues and 
 operations, particularly as followeth, viz. 
 
 ' The quality is moderately hot, proper for winter and sum- 
 mer. The drink is declared to be most wholesome, preserving 
 in perfect health until extreme old age.
 
 ON COFFEE AND TEA. 307 
 
 diet which is taken by one person with impu- 
 nity, and even with benefit, shall in another 
 occasion disagreeable and even serious conse- 
 
 4 The particular virtues are these : 
 
 ' It maketb. 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 obstruc- 
 tions. 
 
 'It is good against tipitude, distillations, and cleareth the 
 sight. 
 
 4 It removeth lassitude, and cleanseth and purifieth acrid hu- 
 mors, and a hot liver. 
 
 4 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. 
 
 4 It vanquisheth heavy dreams, easeth the frame, and strength- 
 eneth 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. 
 
 4 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.
 
 308 ON COFFEE AND TEA. 
 
 quences. Dr. Cullen considered tea as decid- 
 edly narcotic and sedative in its effects ; but 
 the most superficial observer must see that tea 
 
 ' It (being prepared and drank with milk and water) strength- 
 eneth the inward parts, and prevents consumption ; and power- 
 fully assuageth the pains of the bowels, or griping of the guts, 
 and looseness. 
 
 ' And that the virtues and excellences of this leaf and drink 
 are many and great, is evident and manifest by the high esteem 
 and use of it (especially of late years) among the physicians and 
 knowing men of France, Italy, Holland, and other parts of 
 Christendom ; and in England it hath been sold in the leaf for 
 six pounds, and sometimes for ten pounds the pound weight ; 
 and in respect of its former scarceness and dearness, it hath been 
 only used as a regalia in high treatments and entertainments, 
 and presents made thereof to princes and grandees till the year 
 1657. The said Thomas Garway did purchase a quantity there- 
 of, and first publicly sold the said tea in leaf and drink, made 
 according to the directions of the most knowing merchants and 
 travellers in those eastern countries ; and upon knowledge and 
 experience of the said Garway's continued care and industry in 
 obtaining the best tea, and making drink thereof, very many 
 noblemen, physicians, and merchants, and gentlemen of quality, 
 have ever since sent to him for the said leaf, and daily resort to 
 his house in Exchange Alley aforesaid, to drink the drink 
 thereof. 
 
 1 And that ignorance nor envy may have no ground or power 
 to report, or suggest, that what is here asserted, of the virtues
 
 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 dry- 
 ness. 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 satis- 
 faction 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, 
 Tiz. Bontius, Riccius, Jarricus, Almeyda, Horstius, Alvarez 
 Semeda, Martinivus in his China Atlas, and Alexander de 
 Rhodes in his Voyage and Missions, in a large discourse of the 
 ordering of this leaf, and the many virtues of the drink ; printed 
 at Paris, 1653, 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.' Sig- 
 mond, p. 96, &c.
 
 310 
 
 ON COFFEE AND TEA. 
 
 consequences. This property, however, is of a 
 volatile nature, and is lost in the process of 
 drying and by a few months' age. 
 
 A crystalline, volatile, salefiable substance 
 has been found in tea by chemists, and by them 
 named Theine. It is said to exist in combina- 
 tion with tannic acid in the leaves, and to be 
 identical in its chemical composition with caf- 
 feine, the alkaloid found in coffee. Its chemical 
 character has led Liebig to suppose that, when 
 used as an article of diet, it may promote the 
 formation of taurine, a peculiar compound in 
 the bile. 
 
 Tea, as it is brought to us in its dry state, 
 has the effect of creating a lightness and ex- 
 hilaration of mind, an increased action of the 
 stomach in the process of digestion, and, above 
 all, a vigilance and increased power of mental 
 exertion. Dr. Johnson is recorded to have made 
 the teapot the companion of his lucubrations, 
 and to have taken immense quantities of its 
 contents, to sustain the energies of his powerful 
 mind during the prodigious labors which he 
 accomplished. In its other properties tea is 
 astringent and antiseptic. It visibly produces
 
 ON COFFEE AND TEA. 311 
 
 no injurious effect upon the generality of per- 
 sons 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 salu- 
 brious. 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 dur- 
 ing 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 pro- 
 mote 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 di- 
 minish 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 conse- 
 quences 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 ner- 
 vous 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 think- 
 ing. 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 symp- 
 toms, however, are the effect of some peculiarity 
 in the constitution, a great mobility of the ner- 
 vous system, and generally of a slender, en- 
 feebled and effeminate frame. They may, how- 
 ever, arise in all persons from an excessive use, 
 either as it respects the quantity or strength of
 
 ON COFFEE AND TEA. 313 
 
 the tea, or the want of nourishment taken at 
 the same time. I believe the number of per- 
 sons will be found to be exceedingly small, who 
 cannot take tea in moderate quantities and ac- 
 companied by food, without any inconvenience 
 whatever. 
 
 The inquiry is very often made of physicians, 
 Which is the most wholesome article of food, 
 coffee or tea ? The prejudices of most persons 
 are ranged on one side or the other of this ques- 
 tion, and even practitioners themselves are apt 
 to fall into one or the other extreme. One of 
 the oldest and most distinguished physicians of 
 this city,* being asked what was the difference 
 in effect between tea and coffee, replied, that 
 ' One is poison, and the other not.' A physi- 
 cian of equal eminence, in Philadelphia,! de- 
 cided on the properties of the two with equal 
 positiveness, taking, however, the opposite side 
 of the question. The truth is, that there are 
 scarcely any two substances in the materia 
 medica which bear a closer relation, or more 
 nearly resemble each other, in their properties, 
 
 * Dr. S. Danforth. t !>* B - s - Barton.
 
 314 
 
 ON COFFEE AND TEA. 
 
 than coffee and tea. Tea is more astringent 
 than coffee, and coffee of the strength com- 
 monly 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.
 
 REPORT 
 
 ON THK 
 
 ACTION OF COCHITTJATE WATER 
 ON LEAD PIPES; 
 
 AND THE INFLUENCE OF THE SAME ON HEALTH. 
 [From the American Journal of Medical Sciences for 1852.] 
 
 THE committee appointed by the Society of 
 Medical Improvement in Boston, for investiga- 
 ting the question of the occurrence 6f any dis- 
 eases attributable to the presence of lead in the 
 aqueduct water introduced into the city, from 
 the Cochituate Lake, report as follows: 
 
 That from an extensive inquiry among physi- 
 cians, and also from the bills of mortality, they 
 are led to believe that the health of the city of 
 Boston has been uncommonly good during seve- 
 ral years since the introduction of Cochituate 
 water, and they have not learned that any
 
 316 
 
 ACTION OF COCHITUATE WATER 
 
 well-marked cases of the diseases usually attrib- 
 uted 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 coat- 
 ed 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 water- 
 buckets 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 expo- 
 sure 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 com- 
 pounds 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 reliable 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 sub- 
 stances 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 speci- 
 fic 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 re- 
 cords 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 delete- 
 rious 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 ence- 
 phalopathy. Of these the committee have not 
 been able to learn that there has been any sen- 
 sible 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 work- 
 men 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 gene- 
 ral term used by some writers to express cerebral 
 disease, and including coma, delirium, convul- 
 sions, &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 com- 
 mon 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 ob- 
 servers 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. Mil- 
 ler, 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 com- 
 missioners 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, there- 
 fore, to conclude that the danger from lead in 
 towns supplied with water, has been overrated ; 
 and that, with a supply from the Water Com- 
 panies, not less frequent than daily, no danger 
 is to be apprehended from the use of the present 
 distributing apparatus, with any supply of mod- 
 erately 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 cer- 
 tain 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 cir- 
 cumstances, the soft water of lakes and rivers 
 may contain organic 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 suscep- 
 tible 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 hap- 
 piness 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 COCHITUATE WATER. 
 
 annually multitudes of our species. Neverthe- 
 less, 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 inconsider- 
 able risk which it may involve of occasioning 
 disease. From the present state of our knowl- 
 edge, we are authorized to conclude that the in- 
 surance on a citizen of Boston, New York, Phil- 
 adelphia, 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.
 
 ON THE 
 
 HISTORY AND USE OF TOBACCO. 
 
 MOSTLY FROM THE AMERICAN MEDICAL BOTANY, VOL. I. 
 
 IT is a remarkable law of the animal economy, 
 that the power of use and habit is capable of 
 reconciling the system to bear with impunity 
 what in its unaccustomed state proves deleteri- 
 ous or even fatal. It is a fact that many sub- 
 stances in the Materia Medica lose their effect 
 after the continuance of their use for a certain 
 length of time, so that if we would realize their 
 original operation, we must increase their dose 
 in proportion as the body becomes accustomed 
 and insensible to their stimulus. This is par- 
 ticularly exemplified in the narcotics. Several 
 of these substances, which at first are not only 
 nauseous and disgusting in their sensible quali- 
 ties, but highly injurious in their influence upon
 
 324 HISTORY AND USE OF TOBACCO. 
 
 health, are so changed in their effect by habit- 
 ual use, as to become to those who employ 
 them an indispensable comfort and a first-rate 
 luxury of life. 
 
 In its external and sensible properties, there 
 is no plant which has less to recommend it than 
 the common tobacco. Its taste in the green 
 state is acrid, nauseous and repulsive, and a 
 small quantity taken into the stomach excites 
 violent vomiting, attended with other alarming 
 symptoms. Yet the first person who had cour- 
 age and patience enough to persevere in its use, 
 until habit had overcome his original disgust, 
 eventually found in it a pleasing sedative, a 
 soother of care, and a material addition to the 
 pleasures of life. Its use, which originated 
 among savages, has spread into every civilized 
 country ; it has made its way against the de- 
 clamations of the learned, and the prohibitions 
 of civil and religious authority, and it now gives 
 rise to an extensive branch of agriculture, or of 
 commerce, in every part of the globe. 
 
 Tobacco was in use among the aborigines of 
 America, at the time of its discovery. They 
 employed it as incense in their sacrificial fires,
 
 HISTORY AND USE OF TOBACCO. 325 
 
 believing that the odor of it was grateful to 
 their gods. The priests of some tribes swallow- 
 ed the smoke of this plant to excite in them a 
 spirit of divination, and this they did to a de- 
 gree which threw them into a stupor of many 
 hours' continuance. When recovered from this 
 fit of intoxication, they asserted that they had 
 held a conference with the devil, and had learn- 
 ed from him the course of future events. Their 
 physicians also got inebriated with the smoke, 
 and pretended that while under the influence of 
 this intoxication they were admitted to the 
 council of the gods, who revealed to them the 
 event of diseases. 
 
 In 1559, tobacco was sent into Spain and 
 Portugal by Hernandez de Toledo, and from 
 thence it was carried into France as a curiosity 
 by Jean Nicot or Nicotius, ambassador at the 
 court of Lisbon, whose name is now immortal- 
 ized by its application to this genus of plants. 
 From this period the use of tobacco spread 
 rapidly through the continent, and in half a 
 century it was known in most countries in Eu- 
 rope. The rich indulged in it, as a luxury of 
 the highest kind ; and the poor gave themselves
 
 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 inter- 
 pose, 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 cul- 
 tivate more than one hundred pounds. Pope 
 Urban the Eighth published a decree of excom- 
 munication 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 conduct- 
 ed through the streets of that city with his pipe 
 transfixed through his nose. 
 
 Even in this country, where the use of to- 
 bacco 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 pri- 
 vate 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 regula- 
 tion of this kind : ' No scholar shall take tobac- 
 co, 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 cool- 
 ness 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 insatia- 
 ble desire and greediness, they sucked the stink- 
 ing smoke thereof through an earthen pipe, 
 which they presently blew out again at their 
 nostrils ; 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 long-am, 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
 
 HISTORY AND USE OF TOBACCO. 329 
 
 trembling of the limbs, exsiccateth the winde 
 pipe, lungs and liver, annoyeth the milt, scorch- 
 eth the heart and causeth the blood to be adust- 
 ed. In a word, it overthroweth the spirits, 
 perverteth the understanding, and confoundeth 
 the senses with sudden astonishment and stu- 
 piditie of the whole body.' 
 
 A poetical philippic, called ' Tobacco batter- 
 red,' was published in the reign of King James, 
 by Joshua Sylvester, in which he compares to- 
 bacco to gunpowder, and pipes to guns ; making 
 the mischief of the two equal. But the most 
 celebrated of all invectives against tobacco was 
 the Counterblast' of King James I. That 
 weak monarch gave vent to his prejudices 
 against this herb in a publication, in which he 
 professes to disprove all the alleged grounds for 
 the toleration of tobacco, and warns his subjects 
 in a most earnest manner not to sin against 
 God, and harm their own persons and goods, 
 and render themselves scorned and contemned 
 by strangers, who should come among them ; 
 by persevering in a custom loathsome to the 
 eye, hateful to the nose, and baneful to the 
 brain.'
 
 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 scarce- 
 ly 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 tobac- 
 co 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 pun- 
 gent of all.
 
 HISTORY AND USE OF TOBACCO. 331 
 
 Chemists have extracted from tobacco a color- 
 less liquid alkaloid, which they have called Ni- 
 cotine. It is acrid to the taste and smell, forms 
 neutral compounds with acids, and is intensely 
 poisonous in minute quantities. Nicotianine, 
 another product, is a concrete volatile oil, like 
 camphor, and resembles tobacco in its proper- 
 ties. 
 
 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 quan- 
 tity 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 sus- 
 pended 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 rec- 
 tum of a dog, produced violent symptoms, and 
 a repetition of the experiment killed him.
 
 332 HISTORY AND USE OP 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 repu- 
 tation 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 observa- 
 tions of Sir John Sinclair, render it improbable 
 that when moderately taken, it has much influ- 
 ence in wearing out the constitution, or abridg- 
 ing the usual period of life. But like all other 
 narcotics its excessive use or abuse must impair 
 the health and engender disease. Of the differ- 
 ent 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 com- 
 plaints 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 epi- 
 lepsy cured by the external use of tobacco. A 
 cataplasm was applied to the stomach for seve-
 
 334 HISTORY AND USE OF TOBACCO. 
 
 ral days about half an hour before the expected 
 return of the paroxysm. A violent impression 
 was produced each time upon the system, the 
 paroxysm prevented, and the diseased associa- 
 tion apparently broken up. Two cases of obsti- 
 nate and dangerous intermittent were intercept- 
 ed in the same manner by a decoction of half a 
 drachm of tobacco in four ounces of water, 
 thrown up as an enema, a short period before 
 the time of the expected paroxysm. 
 
 The tobacco enema was formerly recommend- 
 ed in colic, nephritic complaints, &c. In later 
 years it has been extensively employed in aiding 
 the reduction of strangulated hernia. But since 
 the introduction of ether and chloroform in the 
 treatment of this disease, the use of tobacco has 
 been little resorted to. 
 
 When the infusion is not used, an injection 
 of tobacco smoke into the rectum frequently 
 produces the same consequences. The smoke 
 may be made to penetrate farther than any 
 liquid, and it is equally efficacious, from the 
 activity of the volatile parts. It was formerly 
 much used in the restoration of persons appa- 
 rently dead from drowning, but of late years it
 
 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 occa- 
 sions in ordinary cases, it is probable that its 
 employment in cases of asphyxia from drown- 
 ing, must assist in extinguishing rather than in 
 rekindling the spark of life. 
 
 Tobacco has been employed with some suc- 
 cess 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 dis- 
 ease has sometimes been overcome. 
 
 This powerful medicine is reported to have 
 been also employed with some palliative effect 
 in hydrophobia and certain other spasmodic dis- 
 eases. Its internal use however requires great 
 caution, since patients have in various instances 
 been destroyed by improper quantities adminis- 
 tered 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 resort- 
 ed to by medical men, only in restricted doses 
 and on occasions of magnitude*
 
 EARLY HISTORY OF MEDICINE. 
 
 FROM A REVIEW OF MILLER'S DISQUISITIONS ON THE HISTORY OP 
 MEDICINE, PUBLISHED IN THE NEW ENGLAND JOURNAL OF 
 MEDICINE AND SCRGERT, APRIL, 1812. 
 
 IT is commonly understood that the history 
 of medicine has already been traced with suffi- 
 cient 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 desidera- 
 tum at the present day, yet there are undoubt- 
 edly parts of it which are still susceptible of 
 correction or enlargement. Dr. Edward Miller, 
 the author of the present disquisitions, appris- 
 es us that he has been induced to attempt
 
 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 extraor- 
 dinary advancement made of late years in 
 Sanscrit literature. By means of this last we 
 are informed that, long previous to its intro- 
 duction 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 re- 
 search Professor Miller has attempted to culti- 
 vate, and the fruits of his oriental inquiries are 
 to constitute a second volume of Disquisitions. 
 In the mean time, the present volume, contain- 
 ing general archaeological remarks, with specu- 
 lations 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 in- 
 formation 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 inter- 
 woven in early ages with mystery and super- 
 stition, should reach us in a state capable of 
 affording much satisfaction. The few tradi- 
 tions handed down to us from the primitive 
 ages, afford matter for speculation to the cu- 
 rious, but yield no certainty to the accurate. 
 
 Dr. Miller, seemingly aware of the difficul- 
 ties attendant on this part of his subject, has 
 thought proper to commence the present un- 
 dertaking with a sort of history a priori, or 
 presumptive history, of medicine in its primaeval 
 state. He begins with stating the progress of 
 observation and reasoning, which would natu- 
 rally 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 su- 
 preme honors of antiquity. Afterwards comes 
 the knowledge of practical physic, of anatomy 
 and of surgery, in proportion as men became
 
 340 
 
 ON THE 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 inju- 
 ries occasioned in war or elsewhere. 
 
 After this we are presented with an interest- 
 ing 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 expa- 
 tiates 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 com- 
 promises by endeavoring to prove, from tradi- 
 tion 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 au- 
 thor gives proofs of extensive and assiduous 
 research. 
 
 Before quitting the general subject of the 
 Primaeval 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 scat- 
 tered 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 ac- 
 corded. The ascription of this honor is traced 
 to several causes, such as the obscurity which 
 hangs over the beginning of all arts ; the vene- 
 ration which savage tribes entertain for the 
 character of their leaders ; and the policy which 
 would lead these chiefs to maintain their as- 
 cendency, 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
 
 HISTORY OF MEDICINE. 343 
 
 have been chiefly surgical, is illustrated by 
 various accounts of the therapeutic exploits 
 performed by several individuals. These are 
 Chiron, Esculapius, Machaon, Podalirius, Achil- 
 les, Teucer, &c. &c. &c. The claims for medi- 
 cal distinction are, indeed, so numerous that 
 they may be said to amount to no distinction 
 at all, since every man whose name has been 
 handed down to us as holding a rank in a 
 tolerable degree above the vulgar, would seem 
 entitled to enrolment among the faculty. Chi- 
 ron the Centaur is stated to have been precep- 
 tor to nearly all the heroes who figured in the 
 Argonautic and Trojan expeditions. Now as 
 Chiron was one of those universal geniuses, 
 who was competent to exercise the arduous 
 and multiform functions of warrior and necro- 
 mancer, of horse-breaker, musician, and doctor, 
 it must be supposed that those who received 
 the supreme honors of his school, were not 
 ushered into the world without a smattering 
 of these various accomplishments. Hence the 
 crew of the Argo might, on emergency, be con- 
 sidered a crew of the faculty ; and the council 
 of warriors in Agamemnon's camp required
 
 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 pro- 
 ficiency in medicine was ever made among 
 them, beyond what a rude individual would 
 naturally attain in the science of self-preserva- 
 tion. The boasted achievements performed by 
 their distinguished personages apparently con- 
 sisted in some trifling and obvious operations, 
 or else in such exaggerated and miraculous 
 performances, as distance all possibility of be- 
 lief. 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: 
 
 'IijTQOf yog 'vj ( g noAltov, 'avrcc^ios aHltav, 
 
 'lag T' ixro^vtiv, 'tTri T' i'jTtta yaQuaxa naocuv. 
 
 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, in- 
 deed, 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 dis- 
 cover, 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 appli- 
 cations. 
 
 But, with such humble and obvious opera- 
 tions as these, the ancient physicians could not 
 have sustained their elevated rank in society, 
 and substantiated their claims upon immortal- 
 ity. 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 pecu- 
 liar 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 bene- 
 fited by the exertion of this happy talent. It 
 is impossible to say how far the bounds of sci- 
 ence might have been enlarged by so mighty a 
 genius, had not Pluto taken alarm at his pro- 
 gress, 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 be- 
 come 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 medi- 
 cal worthies were either inconsiderable and real, 
 or else preternatural and counterfeited. We 
 have additional ground for this belief, on find- 
 ing that frequently, when emergencies occurred, 
 opening a fine field for medical practice, the
 
 HISTORY OF MEDICINE. 347 
 
 champions for physic were totally idle or inef- 
 ficient. When a pestilence broke out among 
 the Greeks at the Trojan war, we find them 
 with all their heroic and priestly medicine, re- 
 sorting 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 the 
 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 in- 
 formed by Galen, that when a sore was obsti- 
 nate and could not be healed up, it was cus- 
 tomary 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 himself.' 
 
 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 ma- 
 lignant ulcer. Galen informs us on this subject, 
 that of the phagedaena, or eating ulcer, there 
 were different species, called the Chironian and 
 Telephian : ' Harum species qusedam sunt, quse 
 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 languish- 
 ing 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 OP 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 him- 
 self for his own case. Witness the following 
 lines : 
 
 ' The draught prescribed fair Hecamede prepares.' 
 
 And again, 
 
 'This for the wounded prince the dame prepares.' 
 
 Unfortunately, however, there is no sort of au- 
 thority 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 Ma- 
 chaon, and this, too, for the sole purpose of 
 assuaging their thirst. 
 
 Toici it iii'x* xvxtito 'tVTiHuxauof 'Exa/u^Sy. II. ).. 023. 
 Tio d' ixti ovv nivovt* cufirtjv nolvxayxia dirfJav.* 641. 
 
 It is a little remarkable that the learned pro- 
 fessor 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.
 
 350 ON THE EARLY 
 
 for his book, and overlook such words as rotat, 
 atpwiv, aifi and T< ; or imagine them to be meant 
 for Machaon individually. We are much in- 
 clined to suspect that he placed undue reliance 
 on the translation, when we find him leaving 
 off his Greek in the middle of a sentence, and 
 observing that ' It might be difficult in English 
 poetry to discover a translation more distin- 
 guished for a happy mixture of precision and 
 elegance, than the above version of Pope.' 
 
 One more of these worthies, and then we 
 have done with ' heroic medicine.' We pre- 
 sume that the name of Achilles will not yet 
 descend to oblivion, even though our author 
 should fail in his attempts to dub him also a 
 doctor of medicine. Nevertheless Achilles, it 
 seems, was a pupil of Chiron ; he cured the 
 Wound of Telephus with the rust of his spear, 
 and the plant Achilkea, or yarrow, had the honor 
 to be named after him. But it ought not to be 
 forgotten, that the circumstance of his pupilage 
 was common to most of the pre-eminent heroes 
 of his time, and that in the cure of Telephus he 
 had scarcely any merit. Telephus cousulted the 
 oracle, and was told that his wound could only
 
 HISTORY OF MEDICINE. 351 
 
 be healed by the same spear which had occa- 
 sioned it. Accordingly he applied to Achilles, 
 whose spear had done the mischief, and re- 
 quested 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 Achillsea, 
 we presume its name has as much to do with 
 medicine, as that of the plant JefFersonia. 
 
 We now come to consider the second depart- 
 ment 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 cus- 
 toms 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 Proetus, of real or pretended mad- 
 ness, that he might gain the hand of one of his 
 patients, together with her kingdom, in mar- 
 riage ; 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 es- 
 tablished 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 im- 
 provements 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 classifi- 
 cation, 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 OP 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 men- 
 tion only the names of Circe, Medea, Angitia, 
 Agamede, Helen and Oenone** 
 
 The last portion of our author's work em- 
 braces the history of medicine in Egypt and 
 the East; and on this subject our limits com- 
 pel us to be more brief. The advantages pos- 
 sessed by the Eastern countries over European 
 Greece for the early cultivation of science, are 
 said to have been the coalition of their inhabi- 
 tants into large and mighty empires, instead 
 of petty states and communities ; and also the 
 peculiar nature of their ecclesiastical institu- 
 tions, 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 j'and their imperfect arts might be exercised by 
 all those who were endowed with a certain portion of intelligence 
 Medicine therefore existed before there were any regular physi- 
 cians.' 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 con- 
 tained 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 instru- 
 ments, 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 relig- 
 ious 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 scrip- 
 tures 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 pow- 
 erful check to improvement, and kept the sci- 
 ence of medicine long in a state altogether 
 stationary. 
 
 Of the other peculiarities in Egyptian prac- 
 tice, the following are among the most remark- 
 able. The art was made altogether hereditary, 
 so that ' he who was born a physician was pro- 
 hibited 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 disor- 
 ders of the eyes, some of the head, some of 
 the teeth, some of the abdomen, &c. The 
 vast number of individuals who were engag- 
 ed 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 au- 
 thorities 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 pro- 
 ficiency 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 mor- 
 bific principle in the air. In the Materia Medi- 
 ca 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. 5
 
 ADDRESS 
 
 DELIVERED BEFORE 
 
 THE AMERICAN ACADEMY OF ARTS AND SCIENCES, 
 
 AT THE OPENING OF THEIR COUESE OF LECTUBES, 
 OCTOBEB 27, 1852. 
 
 AT a meeting of the American Academy of Arts and Sciences, 
 June 22, 1852, 
 
 Mr. Agassiz, in behalf of the committee appointed to consider 
 the best means of increasing the Academy's publication fund, 
 reported, that the committee were unanimous in recommend- 
 ing that a course of public lectures of a popular character be 
 given by Fellows of the Academy during the ensuing winter ; 
 that the President be requested to commence the course by an 
 Address setting forth the objects and aim of the course ; and 
 that each section of the Academy appoint one of its number to 
 deliver one lecture upon some special subject belonging to, and 
 prominent in, the section's sphere of research. 
 
 IT has been a serious question whether amid 
 the general sadness which hangs as a cloud over
 
 ACADEMY OP ARTS AND SCIENCES. 359 
 
 our city, which has seemed to check the ordinary 
 current of affairs, and to darken the very atmos- 
 phere of social intercourse,* the pre-arranged 
 exercises of this place should not be suspended 
 in solemn and silent respect to the unusual oc- 
 casion. But we are bound by circumstances to 
 perform that which at this time we would not 
 have wished to do. And leaving to the public 
 voice the expression of that general emotion, to 
 which no limited occasion can afford utterance, 
 we shall proceed in the attempt to execute the 
 more humble duty that has been set before us. 
 I am instructed in behalf of the American 
 Academy of Arts and Sciences to report to you 
 this evening on the character and condition of 
 that institution, and the objects of the present 
 course of lectures. If it were possible that a 
 Society which has existed in your midst for two 
 or three generations, and which from time to 
 time has numbered among its members many 
 of the most enlightened and valuable of our cit- 
 izens, could be in any measure unknown, I 
 might safely rely on the more gifted laborers 
 who are to follow me in this field, for the vindi- 
 
 * The death of Daniel Webster.
 
 360 ADDRESS BEFORE THE AMERICAN 
 
 cation of its character and name. And if the 
 present occupation of this lecture room were a 
 question of doubtful propriety, I might briefly 
 say that the Academy needs, nay, more, that it 
 deserves your countenance and support, and that 
 this is the place and the manner in which your 
 kind regards have been solicited towards the 
 encouragement of its labors. But as the quiet 
 operations of Science have not the wide-spread 
 notoriety which attends the more absorbing 
 questions of peace and war, of property and 
 'privilege, of safety and of danger, there is reason 
 for attempting a more detailed consideration of 
 the objects and results of our Academic Incor- 
 poration. 
 
 Academies in the higher use of the term, phi- 
 losophical and learned societies, exist and have 
 long existed in every country of civilized Eu- 
 rope. In common with Colleges and Universi- 
 ties they are designed to cultivate and dissemi- 
 nate scientific truth, but unlike those institutions, 
 the usual province of the modern Academy is to 
 investigate rather than to teach, to bring together 
 experts from the various walks of science, litera- 
 ture and art, to accumulate for the benefit of the
 
 ACADEMY OP ARTS AND SCIENCES. 361 
 
 whole the researches and observations of all, to 
 aid and to encourage the different inquirers on 
 their respective tracks, and to furnish vehicles for 
 what is true, and ordeals for what is unsettled, 
 in the progress of human knowledge. 
 
 One of the early fruits of the restoration of 
 arts and letters in Italy was the perception of 
 the great advantage attending the combination 
 of effort in Academic institutions. In that 
 country were the first efficient examples of 
 learned bodies cooperating for their common 
 good, and bringing their united efforts to bear in 
 the promotion of the arts and sciences. From 
 Italy the principle of Academic association 
 spead to England, Germany, and France, and 
 in all those countries, noble institutions, having 
 their foundation in the earnest quest of truth, 
 and supported by the zeal and learning of the 
 best men of their times, have been sent down to 
 the present age, marking their way by many 
 high developments of human intellect, and noble 
 achievements of human science. Some of them 
 which for two centuries have enjoyed the sun- 
 shine of royal and public patronage, now find 
 themselves entrenched in ample halls, surround-
 
 362 ADDRESS BEFORE THE AMERICAN 
 
 ed by the machinery of modern science, dispens- 
 ing rewards with princely prodigality, offering 
 seats of which the prospective vacancy fills with 
 ambition the learned of foreign countries, throw- 
 ing lustre on the cities of their respective estab- 
 lishment, 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 ex- 
 amples 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 conduct- 
 ed. The Royal Academy of France, often 
 known par excellence as the Academy, not only 
 under its original name, but under the subse- 
 quent appellations of National and Imperial
 
 ACADEMY OF ARTS AND SCIENCES. 363 
 
 Institute, has during a long period of years, sus- 
 tained an almost uninterrupted preeminence in 
 the republic of letters. The labors of this body 
 have cast a flood of light on modern science, 
 and its assembled savans have formed a tribunal 
 from whose scientific sentence there seemed no 
 appeal. Yet even this institution, under the 
 occasional supineness of its' members, and the 
 influence of royal favoritism, has more than 
 once been a mark for the shafts of cotempora- 
 neous criticism. The poet Piron, affecting to 
 define his own humble position by an epitaph, 
 says, ' Here lies Piron, who was nothing at all, 
 not even an Academician.' 
 
 In the year 1779, in the midst of the exhaust- 
 ing and yet unfinished contest of our Revolution, 
 with humble resources, but with confidence of 
 future promise, the American Academy of Arts 
 and Sciences was founded by an association of 
 citizens of Massachusetts. The fathers of our 
 Commonwealth, well aware that the lights of 
 liberty and learning are jointly conducive to the 
 stability of free government, gave their sanction 
 and in many cases their individual efforts to 
 construct the foundation of an ample edifice.
 
 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 Gushing, of Chaun- 
 cey and Cooper, of Hancock, of Lowell, of Sedg- 
 wick, Strong and Sullivan, and about fifty 
 others, all of them names already registered in 
 the annals of their country's service, or distin- 
 guished 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 
 honor 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 under- 
 taken by any people, and which required the 
 utmost attention of those who were entrusted 
 with our public concerns, they immediately ad- 
 verted 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 im- 
 portant 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 pred- 
 ecessors solace and assure themselves by a pro- 
 spective 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 im- 
 provements 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 diffu- 
 sion of knowledge, which expands the mind and 
 engages it to noble and generous pursuits, 
 they have a stimulus to enterprise which the 
 inhabitants 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 over- 
 fed with fuel, nor at all times watched with 
 vestal vigilance, it has at least never been suf- 
 fered 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 for- 
 eign 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 mathe- 
 matics 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 conjec- 
 tured 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 monot- 
 onous ages of incomprehensible existence, are 
 presented in these memoirs, living and jumping 
 before the reader. Flocks of swallows, black- 
 ening 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,
 
 368 ADDRESS BEFORE THE AMERICAN 
 
 rendered famous perhaps with the tradition of 
 former engulphments of their species, and then 
 are seen no more. A cloud settles on the 
 mystery of their wintry existence, and the won- 
 der was that when they appeared in the follow- 
 ing spring, their sleek and glossy plumage bore 
 no traces of the deep mud under which they 
 were believed to have slept out their hyberna- 
 tion. 
 
 The riches of our vegetable kingdom and the 
 importance of establishing a more thorough and 
 practical knowledge of its different portions, did 
 not escape the attention of the pioneers of our 
 natural history. Great difficulties beset the 
 early botanists in the prosecution of their inqui- 
 ries, from the novelty of the subject, the paucity 
 of books, and the difficulty of maintaining cor- 
 respondence with foreign scientific authorities, 
 in those cases where books are insufficient and 
 knowledge to a certain extent must be ocular 
 and traditionary. Yet the Rev. Dr. Cutler, of 
 our State, has culled for himself an enduring 
 garland from a field in which it would appear 
 that the harvest was plenteous, but the laborers 
 were few.
 
 ACADEMY OF ARTS AND SCIENCES. 369 
 
 The valleys of New England are not the seat 
 of antiquities and hieroglyphic records, yet in* 
 the earlier volumes of the Transactions there is 
 more than one account of the memorable in- 
 scription on our far-famed Dighton rock. This 
 curious relic of the scattered and now fast dis- 
 appearing aboriginal inhabitants of our country, 
 is copied and described by various persons, and 
 hypothetically explained by the late excellent 
 Judge Davis of this city. Whatever be the 
 mystery it involves, a hunting scene or a relig- 
 ious rite, an achievement of war or of conquest, 
 the pages of the Academy offer a faithful fac- 
 simile for the use of foreigners and of posterity, 
 who may happen to find themselves called and 
 competent to its perusal. 
 
 But by far the most ambitious among the 
 early speculations of the Academy, is the theory 
 of Governor Bowdoin, then President of the In- 
 stitution, on the existence in the universe of an 
 all-surrounding orb. That distinguished gentle- 
 man and scholar, after various speculations on 
 the supposed waste of material light from the 
 surface of the sun, and the danger to all mate- 
 rial bodies from their own unresisted gravity 
 24
 
 370 ADDRESS BEFORE THE AMERICAN 
 
 attracting them towards each other, published 
 an elaborate memoir, entitled ' Observations 
 tending to prove by phenomena and scripture, 
 the existence of an orb which surrounds the 
 visible material system, and which may be 
 necessary to preserve it from the ruin to which, 
 without such a counterbalance, it seems liable, 
 by that universal principle in matter, gravita- 
 tion.' 
 
 The author satisfies himself by a train of 
 ingenious reasoning, of the sufficiency of his 
 theory to prevent the apprehended catastrophe. 
 He deals not only with the necessities of such 
 an arrangement to produce stability in our uni- 
 verse, but draws supernumerary arguments from 
 the presence of the milky way, the blue color of 
 the firmament, and lastly from various corrobo- 
 rative texts of scripture. 
 
 History is silent in regard to the extent of the 
 impression made upon the world by the promul- 
 gation of this comprehensive theory. The orb 
 is supposed to have been standing several years 
 after the announcement of its character and 
 office, and when it fell, the Academy, nothing 
 daunted, proceeded to prosecute its celestial in-
 
 ACADEMY OF ARTS AND SCIENCES. 371 
 
 vestigations with a zeal and tenacity of purpose 
 prophetic of its future more elevated destiny. 
 
 tenacem propositi 
 
 si fractus illabatur orbis 
 
 Impavidum ferient ruinae. 
 
 Should any one incline to disparage the 
 labors of our predecessors on account of their 
 honest and earnest, though sometimes misdi- 
 rected inquiries for truth, he will find parallel 
 examples in the early history of every learned 
 body in Europe of a century's standing. The 
 first publications of the oldest philosophical 
 societies contain speculations on the transmuting 
 of metals, projects for perpetual motion, schemes 
 for raising water without power, and for flying 
 in the air by machinery, credulous inquiries 
 about secret poisons and fabulous natural pro- 
 ductions. They did not think it beneath them 
 to investigate extravagant rumors, and they 
 often propounded interrogatories with this view, 
 to foreign ambassadors, missionaries, merchants 
 and navigators. The Royal Society of London 
 sent many grave inquiries to Sir Philberto Ver- 
 natti, then resident in the Indies, in hopes 
 to solve some of the difficulties which were
 
 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, vine- 
 gar, oil, milk, honey, wax, thread, and needles.' 
 The answer here is more encouraging, ' The 
 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 what- 
 ever 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 were denied 
 to their upward expanding tendencies. And 
 when at length, with the Reformation, the revi- 
 val of letters and the introduction of the print- 
 ing 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 prac- 
 ticable 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 histo- 
 ry of science throughout the world. It has been 
 the era of the Herschels and Laplace, of Lavoi- 
 sier and of Davy, of Cuvier, of Watt, and a host 
 of gigantic minds, whose conquests over un- 
 known regions will never be obliterated from 
 the map of science. During this period of pro- 
 gress, the small number and limited opportuni- 
 ties of the scientific men of our own hemisphere 
 have been such as to render them lookers-on, 
 recipients and dispensers, rather than origina- 
 tors 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. 375 
 
 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 lag- 
 ging 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 excit- 
 ing, warming, illuminating all within the circle 
 of his influence. By his side walked the accom- 
 plished Pickering, laborious, erudite, modest, a 
 votary of learning for its own sake, whose capa- 
 cious 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 per- 
 formances. 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 i,t 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 con- 
 dition, 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 gather- 
 ings, 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 re- 
 sources of the treasury, and now brings the 
 institution before the public of this city, a solici- 
 tor 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 phenom- 
 ena. Not the premature speculations of unqual- 
 ified reasoners on more expanded subjects. 
 Not the repeated lessons received with un- 
 questioning 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 investiga- 
 tions 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 Univer- 
 sity, numbering among the teachers of that sem- 
 inary a large portion of its most accomplished 
 and efficient members, making the pages of its 
 publications a vehicle for the light which ema- 
 nates from the observatory, the apparatus, the 
 collections of that venerable seat of learning, 
 aided moreover by the naturalists, the philoso- 
 phers 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 knowl- 
 edge 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 au- 
 thority of this Academy. The plants of Cali- 
 fornia 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 investiga- 
 tion and judgment. The fossil bones of gigan- 
 tic 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
 
 ACADEMY OF ARTS AND SCIENCES. 379 
 
 forests, have received their first description in 
 this city. 
 
 The pages of our Transactions offer the faith- 
 ful impress, not elsewhere found, of the foot- 
 prints of colossal birds and mysterious reptiles, 
 transferred from the banks of our own rivers, 
 where, awaiting the perusal of the naturalist, 
 they have lain for unknown ages, stereotyped in 
 stone. It is fresh in our recollection, that when 
 the credulity of the popular voice, not without 
 the assent of men of science, had given a ficti- 
 tious reality to a monster compounded of con- 
 tributions levied from many individuals, and 
 when this deception gained foothold not only in 
 our own greatest city, but afterwards in one of 
 the enlightened capitals of Germany, the doubt 
 was removed and the deception made man- 
 ifest by the scientific sentence of one of this 
 Academy. 
 
 A few years ago a call was made by the Le- 
 gislature of this Commonwealth for researches 
 into the various departments of its indigenous 
 natural history. This call was promptly and 
 ably responded to, and the reports returned on 
 the geology, the forest trees, the fishes, the in-
 
 380 ADDRESS BEFORE THE AMERICAN 
 
 sects, and the other invertebrata of Massachu- 
 setts, 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 develop- 
 ment, 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 writ- 
 ten 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 direc- 
 tion, 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 mes- 
 senger 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, me- 
 chanic, and microscopic science, and to the 
 natural history of the globe and of its inhabi- 
 tants. 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
 
 382 ADDRESS BEFORE THE AMERICAN 
 
 arduous production of our mathematicians, will 
 stand in the foremost rank of similar authori- 
 ties. I might bring before you the perfected 
 turbine wheel, and the elaborate cordage ma- 
 chinery, as examples of the mechanical ability 
 and inventive genius of our academicians ; and 
 I might cite many instances of energetic coope- 
 ration with other bodies, in the magnetic ob- 
 servations, in meteorology, in the coast survey, 
 and in the general advancement of geographi- 
 cal and philosophic knowledge. 
 
 Conspicuous above other sciences, for the 
 vastness of its objects, and the amount of in- 
 tellectual effort which it has called into being, 
 stands Astronomy, one of the earliest, the most 
 difficult, and most successful studies of the hu- 
 man mind. For many years the discoveries of 
 its observers, and the results of its analysts, 
 have, by the common consent of central and 
 northern Europe, been chronicled in one place 
 in the city of Altona, in the astronomical jour- 
 nal of the eminent Professor Schumacher. But 
 Schumacher is dead, and his divided mantle 
 has fallen upon the shoulders of more than one 
 competent successor. The only journal in the
 
 ACADEMY OF ARTS AND SCIENCES. 383 
 
 English language, now devoted to pure astro- 
 nomical science, regularly reporting, with dis- 
 criminating 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 per- 
 ceive, 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 al- 
 ready 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 Sat- 
 urn ? Who has not wondered at this excep- 
 tional feature of the known universe, and plant- 
 ed himself in imagination on the surface of that 
 distant sphere, that he might seem to contem-
 
 384 ADDRESS BEFORE THE AMERICAN 
 
 plate the radiant arch that spanned its unknown 
 firmament ? Yet this remaining anomaly of the 
 visible creation, this marvel and study of mod- 
 ern astronomy, has been destined to reveal its 
 structure at our own observatory. And the 
 necessity of its fluid nature, and the laws by 
 which it is sustained, have been deduced from 
 the observations, and established by the pro- 
 found analysis of our own astronomers. 
 
 Need I call up before this audience the re- 
 cent fame of that far ulterior planet, which, 
 since the creation of the world, has held its dim 
 and undetected course around the verge of our 
 solar system, until at length its remote presence 
 so weighed upon the instructed sense of the 
 Parisian philosopher, that it was felt and known 
 even before it was seen? And need I say that 
 this object of absorbing interest, this wonder of 
 its time, after justifying in some measure the 
 rival claims to its discovery of the three most 
 enlightened nations of Europe, came at last to 
 receive the determination of its true orbit, posi- 
 tion, mass and motion from the geometers of 
 our own Academy ? 
 
 I have said enough to show, that the Ameri-
 
 ACADEMY OF 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 as- 
 sert that, in the different sections of this Acade- 
 my, 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 regu- 
 larly 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 embarrass- 
 ed by financial deficiencies. Yet such is the 
 25
 
 386 ADDRESS BEFORE THE AMERICAN 
 
 uniform excess of its expenditures over its lim- 
 ited 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 investi- 
 gations. So far from enjoying the promptness 
 and amplitude of appearance which attend the 
 productions of similar institutions abroad, it has 
 happened, more than once, that the discoveries 
 of our scientific men have had to wait, until 
 they were actually superseded by the same dis- 
 coveries abroad, because the printed pages and 
 the illustrations of the engraver could not be 
 commanded at the requisite time. 
 
 As a nation we are proud of whatever con- 
 tributes to our national glory. We are boastful 
 of our growth, our political progress, our victo- 
 ries, our annexations. We are proverbially sen- 
 sitive, even in small matters, to questions of 
 precedence and subordination, and we give our 
 undivided sympathy even to a national contest 
 of locksmiths. The triumph of nautical skill 
 in a distant boat race binds this Union more 
 firmly together, by the common thrill of exulta- 
 tion 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 appre- 
 ciating 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 nour- 
 ished among us seeds capable of a redundant 
 harvest. 
 
 I have thus, ladies and gentlemen, endeavor- 
 ed to present to your favorable notice, the char- 
 acter 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 per- 
 mitted, even to the drone in the hive, to cause 
 the air to vibrate in honor of the labors of his 
 more efficient colleagues.
 
 INDEX. 
 
 
 Page 
 
 
 Page 
 
 ABSTINENCE in Diet, 
 
 144 
 
 Cochituate Water, 
 
 318 
 
 Academy American, Ad- 
 
 
 Cofiee, 
 
 289 
 
 dress, 
 
 359 
 
 Colchicum, 
 
 143 
 
 Acute Rheumatism, 
 
 24 
 
 Cutaneous Diseases, 
 
 24 
 
 Amphoric Resonance, 
 
 230 
 
 
 
 Ajiatomy and Surgery, 
 
 94 
 
 Definition of Medicine, 
 
 64 
 
 Andre, Major, 
 
 190 
 
 Detrimental Practice, 
 
 40 
 
 Angina Pectoris, 
 
 22 
 
 Detrimental Remedies, 
 
 82 
 
 Ascarides, 
 
 50 
 
 Diagnosis, 
 
 67 
 
 Auburn, Mount, 171, 
 
 192 
 
 
 
 
 
 Earle, Sir James, 
 
 149 
 
 Blane, Sir Gilbert, 
 
 37 
 
 Education, Medical, 
 
 91 
 
 Borromeo, Carlo, 
 
 187 
 
 Edward I. King, 
 
 175 
 
 Botanic Practitioners, 
 
 105 
 
 Egyptian Medicine, 
 
 254 
 
 Bowditch, Nathaniel, 
 
 374 
 
 Electricity, 
 
 381 
 
 Burial of the Dead, 
 
 171 
 
 Elephant, frozen, 
 
 185 
 
 Burns and Scalds, 
 
 146 
 
 Epilepsy, 
 
 21 
 
 
 
 Erysipelas, 
 
 12 
 
 Causes, Removal of, 
 
 57 
 
 Esculapius, 
 
 246 
 
 Chalk Stones, 
 
 135 
 
 Etiology, 
 
 93 
 
 Charles I. King, 
 
 178 
 
 Exact Sciences, 
 
 59 
 
 Chemistry, 
 
 92 
 
 Exaggeration, Medical, 
 
 95 
 
 Clot Bey, 
 
 76 
 
 Expectant Practice, 
 
 103
 
 390 
 
 INDEX. 
 
 Fire, Injuries by, 
 
 146 
 
 Metastatic Diseases, 
 
 23 
 
 
 
 Mount Auburn, 171, 
 
 192 
 
 Gout, 49, 
 
 132 
 
 Mucuna Pruriens, 
 
 266 
 
 Grecian Medicine, 
 
 342 
 
 Mummies, Egyptian, 
 
 187 
 
 Harmony among Physi- 
 
 
 Neptune, Planet, 
 
 384 
 
 cians, 
 
 123 
 
 Nomenclature, 
 
 237 
 
 Henry VIII. King, 
 
 183 
 
 Numerical Method, 
 
 34 
 
 History of Medicine, 
 
 838 
 
 
 
 Homoeopathy, 
 
 101 
 
 Organic Remains, 
 
 380 
 
 Hooping Cough, 
 
 10 
 
 
 
 
 
 Paroxysmal Diseases, 
 
 21 
 
 Incurable Diseases, 
 
 88 
 
 Partridge, Poison of, 
 
 272 
 
 Inefficacy of Treatment, 
 
 75 
 
 Pathology, 
 
 93 
 
 Pestilential Epidemics, 25. 54 
 
 Kentish, Mr. 
 
 148 
 
 Pharmacopoeia Ameri- 
 
 
 Kinglake, Dr. 
 
 148 
 
 can, 
 
 231 
 
 Kings, Relics of, 
 
 178 
 
 Pickering, John, 
 
 375 
 
 
 
 Plague at Cairo, 
 
 76 
 
 Lead, Exposure to, 
 
 316 
 
 Pneumothorax, 
 
 195 
 
 Lead Pipes for Water, 
 
 315 
 
 Practical Medicine, 
 
 62 
 
 Lectures, Medical, 
 
 97 
 
 Precocious Habits, 
 
 111 
 
 Louis, 
 
 34 
 
 Priestly Medicine, 
 
 351 
 
 
 
 Private Schools, 
 
 98 
 
 Materia Medica, 
 
 93 
 
 
 
 Measles, 11 
 
 ,43 
 
 Quackery, 108, 
 
 124 
 
 Medical Education, 
 
 91 
 
 
 
 Medical Profession, 
 
 111 
 
 Rabbits, Experiments on, 
 
 152 
 
 Medical Reasoning, 
 
 29 
 
 Rational Practice, 
 
 35 
 
 Metallic Tinkling, 197, 
 
 224 
 
 Remedies, 
 
 56
 
 391 
 
 Remedies, excessive, 
 
 82 
 
 Textures, Susceptibility 
 
 
 Rheumatism, Acute, 
 
 24 
 
 of, 
 
 269 
 
 
 
 Theories in Medicine, 
 
 118 
 
 Scarlet Fever, 
 
 11 
 
 Thomsonian Sect, 
 
 105 
 
 Self-limited Diseases, 
 
 1 
 
 Tobacco, History of, 
 
 323 
 
 Small Pox, 
 
 12 
 
 Treatment of Disease, 
 
 59 
 
 Success of Treatment, 
 
 26 
 
 Typhoid Fever, 
 
 14 
 
 Symptoms, prescribing for 
 
 , 79 
 
 
 
 Syphilis, 
 
 42 
 
 Vinous Liquors, 
 
 188 
 
 Tanquerel on Lead, 
 
 318 
 
 Watch, Illustration by, 
 
 69 
 
 Tea, 
 
 297 
 

 
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