m MEMOIES OF CHARLES J. B. WILLIAMS, M.D., F.R.S. f Woodburytypc. I MEMOIRS OF LIFE AND WOEK CHARLES J. B. WILLIAMS, M.D. F.E.S. / PHTSICIAN-EXTUAOfeBfNAEY TO H. M. THE QUEEN FIRST PRESIDENT, AT THEIR FORMATION, OF THE PATHOLOGICAL SOCIETY OF LONDON AND OF THE NEW SYDKNHAM SOCIETY ; LAI'S PRESIDENT OF THE UOYAL MEDICAL AND CHIBUROICAL SOCIETY ; CONSULTING PHYSICIAN, FKOM ITS FOUNDATION, TO THK HOSPITAL FOR CONSUMPTION, BKOMl'TON J ETC. LONDON SMITH, ELDER, & CO., 15 WATERLOO PLACE 1884 All fights /v PREFACE. IN offering to the Profession and to the Public these memoranda of the life and labours of a hard-working physician, extending over a period of upwards of sixty years, I think that I am performing a duty, incumbent on all, to make known experiences, which have been neither few nor unsuccessful, in relation to the science and art of Medicine, and may not prove uninteresting in regard to its history. But I feel that some apology is due for the long delay which has postponed the publication to so late a period of my life. My excuse must be the state of my health. The narrative will show how a constitution, never robust, yet endowed with great activity of mind and body, suffered at times from overwork, especially during the ten years' tenure of the Professorship at University College, and that in the busy life which followed, there was no sufficient recovery from that overstrain, to enable me to fulfil the literary engagements which pressed upon me. Works called for and under- taken, for which materials had been long accumulating, were not completed ; editions out of print were unrenewed ; and during a period of upwards of twenty years, all available time and strength were devoted to the cares and responsibilities of a large consulting practice. One work I was enabled to produce, through the welcome assist- ance of my son Dr. Charles Theodore Williams. 1 I allude to that on ' Pulmonary Consumption,' noticed in Chap. XXXVII. It also has been for some time out of print. At the time of my retirement, nine years ago, I was too much wearied and worn to attempt any great work. But the rest and refreshment which God has vouchsafed to me during the interval, encouraged me a year ago to commence these Memoirs, which, through His continued mercy, I have been enabled so far to com- plete. Whether or not I may be spared to add a second volume to contain more strictly professional matters, some of which have 1 This son is now, through God's mercy, recovering from a severe and pro- longed attack of typhoid fever, (contracted at Naples), under which he has been laid up for the last two months. He had just visited his patients under treatment in high altitude in the Engadin. vi PREFACE. never been published, and others only partially, I leave in His hands. When I began this task, I was so much out of the habit of writing, that I fear the language of the early chapters will be found curt and constrained. Egotism was unavoidable ; but what I had to say was put into as few words as possible, with little regard to elegance of composition. In the free and independent manner in which I have thought it my duty to criticise public institutions, I have been actuated by no censorious or hostile feeling, but only by a sincere desire to correct .error and abuse, and to promote the 'honourable and efficient working of these bodies for the ends for which they were established, for their own cr,edit, and for the public good. Having lately been introduced to the eminent veteran chemist and philosopher, M. J. B. Dumas, Member of the Institute, who was interested in my observations on the Sun-spots, I took the oppor- tunity of showing him my pencil reminiscences of his contemporaries in the Academy of Sciences and at the Sorbonne ; and he recognised the likenesses as good in all but that of Thenard, which, he says, wants the tete de lion brow of the great chemist ; to whom M. Dumas acted as assistant at that time, 1825. There are few sur- vivors of that remote period to supply such testimony ; and I ana fortunate in finding one so distinguished. As the work is intended for the public, as well as for the pro- fession, it may be objected that in some parts the subjects and language are too technical to be interesting or intelligible to the general reader. If it be so, these may be passed over, without much impairing the general sense of the narrative. But in these days of expanding intelligence, there is an increasing inclination, as well as aptitude in the public mind, to get sound elementary views in every branch of knowledge ; and in none would such diffusion of informa- tion be more mutually beneficial between a profession and the public than in that of Physiology and Medicine. VILLA DU ROCHEB, CANNES, FRANCE March 7, 1884. CONTENTS. CHAPTER I. PARENTAGE, EARLY LIFE AND EDUCATION. PAGE Paternal Tuition Self-Instruction in Natural Knowledge, &c., preferred to School-life. Home Studies in Physics, Chemistry, Astronomy, &c. Brothers' School and College History Self to Prepare at Home for Medical Studies at Edinburgh. Home Amusements Stilting Poultry Language and Intercourse, Ac. Mother and Sisters . . 1 CHAPTER II. LIFE AND STUDENTSHIP IN EDINBURGH. I 2 1-1824. Journey. Besidence with Dr. Thomson. Studies Classics Chemistry Anatomy Difficulties Drs. Monro and Barclay. Plan of Teaching in Edinburgh. Notices of Professors. Dr. Brabant. Amusements. Return Home in Autumn. Church Attendance Rev. A. Alison and R. Morehead : Comparison with Dr. Chalmers. Second Year Private Studies Royal Medical Society Library Public Speaking. Remi- niscences of Students and Friends. Reminiscences of Professors- Sir R. Christison Dr. John Thomson Dr. James Hamilton Drs. Duncan, Senior and Junior Dr. Hope Dr. Alison . . . .10 CHAPTER III. LIFE IN EDINBURGH. ORIGINAL RESEARCHES ON THE CHANGES IN THE BLOOD BY RESPIRATION, ETC. 1823-1824. Discussion of Theories of Respiration and Animal Heat Objections to the Black-Crawford View, and that of Mr. Ellis Improvement on Views of Lagrange, &c. Arguments and New Experiments in Support Proof of Permeability of Membranes to Gases Action of Oxygen on Blood and Tissues Origin of Animal Heat Correction of Brodie's Experiments .'.'.'.'.'... . . .20 viii CONTENTS. CHAPTER IV. GRADUATION. LIFE AND STUDIES IN LONDON. 1824-1825. PAGE Graduation. Pedestrian Tour in the Highlands Professor Thomson at Glasgow Return Home. Life and Studies in London Sir Charles Bell's Lectures Sir B. Brodie Dr. Maton London Hospitals and Surgeons. Physicians dissatisfied with their Royal College. Amuse- ments and Reflections 26 CHAPTER V. LIFE AND STUDIES IN PARIS. 1825-1826. Journey to Havre To Rouen To Paris by Diligence Old French Roads Entry to Paris by Barriere de 1'Etoile Contrast of Old and Modern Paris. Study of French. Lodging and Living. Lessons in Drawing Utility of Science in the Study and Practice of Art Professorship of Natural Philosophy recommended to Royal Academy Empirical State of the Art of Painting. Fellow Students in Paris. Letters of Intro- duction Professor Majendie Experimental Research Sabbath Ob- servance. Dr. W. F. Edwards Academie des Sciences Sketches of Members De la Place Ampere Vauquelin Gay-Lussac Thenard Cuvier Humboldt, &c. Lectures of Arago at Observatory. Lessons in Italian. Visits to Theatres Talma and Duchesnois--Mdlle. Mars. Dupuytren at Hotel Dieu. Baron Larry at Val de Grace Roux and Boyer at La Charitfi 29 CHAPTER VI. STUDIES IN PARIS (continued}. WINTER SESSION. HOSPITALS AND LECTURES. 1825-1826. La Gharite Clinique of Laennec His Views and Position. Andral, Fils Clinique of Lerminier. Louis. Chomel. Lectures at the Sorbonne Thenard on Chemistry (with portrait) Gay-Lussac Physics (with portrait) Pouillet Physics (portrait) De Blainville Comparative Anatomy: 'successful Lecturer. Laennec with his Pupils Portrait His Teaching on Auscultation more dogmatic than rational Value of his discoveries His Stethoscope Its Use and Disuse Its true prin- ciples discussed Note, Author's and other improvements- Laennec's knowledge of Acoustics and of Pathology imperfect, but power of ob- servation quick and wide, and proficiency in his Art wonderful. Want of clearer knowledge of subject. Visits to Hospitals --Salpetriere, Enfans Malades and La Pitie Author's second attack of Whooping Cough: Remarks on nature and most effectual treatment Dr. Burger's observations in 1883 .40 CONTENTS. CHAPTER VII. FRIENDS IN THE COUNTRY AND IN LONDON. VISIT TO MADEIRA WITH A PATIENT. 1827. PACK Practice at Home, and among Belatives First Feelings of Anxiety and Responsibility. Good Friends and Connections at Heytesbury, &c. Dr. Fowler of Salisbury Dr. Brabant of Devizes Thomas Moore. Visit to London Dr. James Clark, and Dr. John Forbes Their Friendliness Their Criticisms of London Physicians and Practice Dr. Clark's Acquaintance with the Author's Aunt at Rome. Author to take Charge of a Patient going to Madeira for Throat Affection Con- sultation and Orders from his London Physicians Suggestion of Auscultation in vain In Charge of Patient at Falmouth Discovered to be Consumptive Perplexity about making it known Reference to London Physician without Answer Painful Reserve Voyage to Madeira in Fourteen Days in Sailing Brig Phosphorescence and other sea-sights Arrival at Funchal in Summer heat Removal to Camacha Patient attacked with Perforation of Pleura Struggle for Life Temporary Recovery Death six weeks after arrival Conclusion : and comparison with similar cases in 1871 Scenery of Madeira Return with the Widow Produce from the Island Wine matured in Eng- land Account rendered to Physicians in London 52 CHAPTER VIII. WINTER AT HOME. FIRST WORK ON AUSCULTATION, ETC. 1828. Attempt to explain Physical Signs by reference to Physical Laws and a sound knowledge of the Physiology and Pathology. Laennec's know- ledge Empirical rather than Rational ; and points in his Pathology questionable. Andral more enlightened. Laws of Acoustics not well-known Even Definitions of Sound imperfect. Attempt to explain the Nature and Properties of Sound Essay of Author at British Asso- ciation in Edinburgh, 1834 Nature of Vibrations Word ' Undulation ' objectionable Rational Study of Physical Signs more interesting and more instructive than Empirical Illustrations Crepitation of Pneu- . monia Metallic Tinkling, an Echo. Sir D. Davis introduces the Author to Sir Henry Halford to whom the Work is dedicated His Reception. Transactions with Publishers C4 CHAPTER IX. ENGAGEMENT AS TRAVELLING PHYSICIAN IN SWITZERLAND. DEATHS OF RELATIVES. MARRIAGE. 1929-1830. First Visit to Switzerland Panoramic View from the Dole, Summit of Jura Three Months at Vevay Excursion to Chanionix by Col de Balme Return by Tete Noire Incidents View of M. Blanc from x CONTENTS, PA OK Dfile (town) on Return. Death of Aunt (Mrs. Williams of Tidenham) Her Bequests. Marriage Engagement. Illness of two Sisters : Death of One Reflections on Ovarian Disease and its Mortality lessened by modern Surgery. Sudden death of Cousin, Wife of Sir David Davies Meeting with her Brother, Archdeacon Williams. Take House in Half Moon Street, Piccadilly. Reflections on Momentous Period of Life. Blessing of Affectionate Friends The Rev. John Hensman and his Wife at Clifton 69 CHAPTER X. ESTABLISHMENT IN LONDON. OCCUPATIONS. PROFESSIONAL PUBLICATIONS, WITH RECENT NOTES. 1830-1833. Visit to Aberystwith after Marriage. Arrival in London. Pass Examina- tion of the Royal College of Physicians. Attend Practice at St. George's Hospital. Become Member of Royal Institution, and introduced to Faraday. Engaged to Write for the ' Cyclopaedia of Practical Medicine,' by Drs. Forbes, Tweedie, and Conolly Notice of the Subjects, with Comments and Additions for Present Reading Branch tis, Catarrh and Coryza, with Recent Notes on Prompt Modes of Cure By Stimu- lants By the Drying Method By Opiates By Inhalation All with Results of the Author's Experience up to 1883 75 CHAPTER XI. AUTHOR'S ARTICLES IN ' CYCLOPEDIA OF PRACTICAL MEDICINE ' (continued), WITH RECENT COMMENTS AND SUGGESTIONS. Counterirritation explained and declared to be a Rational and Successful Mode of Medication Reply to Recent Objectors Recent Modifications. Rigollot's Mustard Leaves. Best Modes of Treating Blisters. Croton Oil. Dyspnoea : Analysed with Suggestions of Remedies for each Kind. Incubus: Analysed and Explained Treatment According to Cause. Irritation: Vague Use of Term by Previous Writers B. Travers, and Broussais Defined as a Pathological Principle, and Deserving Recogni- tion, although Ignored by the most Recent Writers. Obesity : Author's Treatment the same with that recommended ever since, but assisted by Division of Cases into Sthenic and Asthenic. Pneumonia, Post- poned 83 CHAPTER XII. PROFESSIONAL PROGRESS. RECREATIONS IN ART AND SCIENCE. Painting in Water Colours and Oils Landscapes Portrait of Author's Father in Oils. Researches on Low Combustion First Discovery in 1823 Pursued after Conversations with Faraday Proved to be Com- bustion, not Phosphorescence, and to affect most Combustible matters Thus proved to be a Law or General Fact Examples in Phosphorus, Sulphur, Arsenic, Potassium, and other Metals, Oils, Wax, Wood, Paper, &c. Occurring also with Gases and Vapours ; as with Spongy Platinum Nature of Light of Low Combustion Products of Low CONTENTS. xi Combustion Explains Spontaneous Combustion of Hay, Oiled Wool, month of March was cold throughout California, but that, as in other southern regions, I had reports of the presence of snow on some of the moun- tains, where it had never been seen before ; and this only in the second week in March, when sun-spots were absent, and when Cannes was struck with nlense and unprecedented cold. See Nature, April 12 and May 31, 1883. 152 CONTRACTILITY OF AIR-PASSAGES. lungs have both a self-contracting and self -expansive property. Haller, on the other hand, was led by experiments to deny that any independent rhythmical motions, corresponding with movements of respiration, are exhibited by the Inngs of animals, and J. Miiller has confirmed this negative result. Nay, within the last few years, certain writers in this country and in France, have denied altogether the muscular contractility of any part of the air-tubes. These negations are in opposition to the generally received opinion, derived chiefly from the examinations of Keisseissen, that the circular fibres of the air-tubes, from the trachea to their termina- tion, are muscular. Very few attempts have been made to solve this problem by experiment. Wernier and Wedemeyer succeeded only in exciting partial contractions in the smaller bronchi ; but with all their results, J. Miiller concludes that, "it is remarkable that there exists at present no direct proof of the contractility of the muscular fibres of the trachea and its branches " (Elem. of Physiology, translated by Baly).' The experiments are too long to be detailed here : if there is room they may be given in the second volume : but here are the chief general results. They were performed on the lungs and air-passages of recently killed animals, by attaching to the windpipe or bronch, a bent glass tube with coloured liquid (called a manometer) ; wherein any muscular contrac- tion would cause the liquid to rise in the tube. On passing a galvanic current across, or along, the air-passage's of the lungs, the liquid rose distinctly and repeatedly, until the muscular power was exhausted by continued stimulation ; after an interval of repose, it could be made to rise again ; thus proving beyond doubt the existence of irritable contractility in the bronchial fibres. The experiments were varied in different ways, and proved that the greatest amount of contractility resided in the large and middle-sized bronchi, and less in the smallest and in the trachea. It was found moreover that the contraction of the bronchi could be excited by mechanical and chemical irritation, as well as by galvanism ; causing the expulsion of frothy mucus. Irritations, electric, chemical, or mechanical, of the vagi nerves, had little or no effect on the bronchial fibres. Having thus established the important fact that the air- passages are endowed with muscular contractility, I sought ELECTED F.R.C.P. LONDON. 153 further to determine what influences would increase and what diminish this property ; and so to be led to discover a remedy for spasmodic asthma, which must depend on its excess. In animals killed by pithing, or by the poison of hydrocyanic acid, the contractile power remained in full force : but in those poisoned by belladonna or stramonium, this contractility of the tubes was almost destroyed, giving no signs of movement under galvanism. In animals poisoned by opium and by strychnia, it was impaired, but not destroyed ; confirming the fact, well known to the experienced practitioner, that these are inferior to belladonna and stramonium as remedies for the spasm of asthma. I was unable to be present at the reading and discussion of this Report at the Meeting of the Association at Glasgow : but I heard that it excited much interest, and was highly applauded, as an attempt to improve the practice of medicine by experimental research. The experiments were performed, with only one exception, after the death of the animals ; and therefore would not come under the insane denunciations of the anti-vivisectionists. And what was the exceptional half- hour's trial before death of one dog, in comparison with the prolonged sufferings of a patient in a bad fit of asthma, which we have in many cases been able to relieve, through the knowledge obtained in this investigation ? In the summer of 1840, 1 was nominated to the Fellowship of the Royal College of Physicians, an honour which I neither sought nor expected ; nor did I accept it without some hesi- tation. I have before alluded to a movement among the members of the College, (then termed licentiates) with the object of protesting against and resisting the illegal operation of some of its by-laws, which introduced restrictions in the mode of election of its members, not warranted or contemplated in the original or supplementary charters. 1 The subject is 1 There was an Association of the Licentiates for the purpose of petitioning Parliament on the subject of their grievances. Dr. Holroyd and Dr. James Somerville acted as secretaries : I was present at one full meeting, at which Sir James Clark, Dr. Neil Arnott, Dr. James Copland, Dr. James Johnson, Dr. Anthony Todd Thomson, Dr. George Gregory, and Dr. Charles Holland, took a very decided part. 154 COMPLAINTS AGAINST THE COLLEGE. too wide to be fully explained here ; and as some corrections have been made to mitigate the evils complained of, it may be inexpedient to open up the whole controversy ; but a few words of explanation will give some notion of how the matter stood at this time. The charters of the Koyal College of Physicians of London incorporate into one body all physicians in London and seven miles round, without making any division or distinction between the members of that body, except in the appointment of a President, four Censors, and eight Elects. But in course of time, this body proceeded to enact by-laws, making between those whom they admitted to their body, a division into Fellows or Socii, and Licentiates, or Permissi ; the former only having the privileges of Fellowship, and the latter being merely authorised to practise. The effect of this enactment was to degrade the Licentiates into an inferior order of physicians, and to monopolise to the Fellows the honours and government of the College. The distinction and exclusion was carried further, by restricting the Fellowship chiefly to graduates of Oxford and Cambridge ; and placing those from other uni- versities in the lower order of Licentiates. These encroachments had caused loud complaints, from time to time, on the part of the Licentiates, and in some instances led to appeals to courts of law ; with the general result of judgments, condemning the conduct of the College. For some years past, the College itself had admitted the necessity of abating some of its exclusiveness ; and had admitted to the Fellowship several Licentiates of eminence. But this very con- cession was objected to by the body of Licentiates, as stamping the inferiority of their class by taking out of it the best men ; and some of these thus chosen refused to accept the offer. Among these were my friends Sir James Clark and Dr. Neill Arnott ; and I had some doubts whether I ought not to follow their example. But on further consideration, I thought that, as these eminent recusants did not seem likely to make any exertions on behalf of the body of Licentiates, among whom they chose to remain, I could better promote the reform of the College, by accepting the Fellowship, and endeavouring to work to that end within the body. PRESIDENTS SURPRISE REST. 155 In making known to the Eegistrar of the College my accept- ance of the Fellowship, with full acknowledgment of the per- sonal compliment thus conferred, I intimated my intention to avail myself of my position to endeavour, on a fitting occasion, to bring about a reform of those abuses in the management of the College, against which, with other Licentiates, I had already remonstrated. It so happened, that the President, Sir Henry Halford, was with the Eegistrar at this interview ; and although quite friendly, he was not a little surprised at my presumption. ' Well now ! ' said he, ' look here, my young friend ; we give you the Fellowship what can you want more ? ' I abstained from debating the matter then with the courtly President ; but within twelve months I gave him an answer in open College. Dr. Hope was elected to the Fellowship at the same time as myself; and that we two alone should be selected for the honour, gave evidence, that whatever had been our personal disagreements, they had not injured our characters in the estimation of the College. The holidays of August 1840 were spent at our cottage, Ivy Eock, near Chepstow ; where my wife and children had been staying during the summer ; and the rest of mind, com- bined with increased and varied exercise of body, proved most welcome means of refreshment. 156 NEED OF BOOK ON 'PRINCIPLES? CHAPTEE XIX. PEEPABATIONS FOE WORK ON ' PRINCIPLES OF MEDICINE.' 1840-184:1. Want of such a Work Preliminary Investigations on the Circulation of the Blood in Minute Vessels Microscopic assistance from John Dalrymple and Joseph Toynbee. Author to give Gulstonian Lectures at College of Physicians This Subject Chosen and Delivered, Illustrated with Diagrams and Drawings Extracts, with Definitions of Congestion Determination of Blood and Inflammation Original Observations on the Contractility of Blood Vessels and on the Nature of these Three Forms of Hyperaemia, now for the first time demonstrated by experiment Properties and Nature of White Corpuscles W. Addison, the Author, Waller, and long after, Cohnheim Kecent Eeferences to these Researches Burden Sanderson, &c. THE next session, 1840-41,- was not less busy, but less strained under severe pressure, than that preceding. Lectur- ing was becoming easier work ; both from increased practice, and from a better arrangement of matter. But I found much need of text-books of reference ; especially on the Principles of Medicine, or General Pathology and Therapeutics. There were the ' Cyclopaedia ' and ' Library,' of Practical Medicine, and Copland's elaborate Dictionary, all copious enough on special diseases; but for the important subject of General Pathology, and the rational principles of Treatment, we had no work but that of Professor Alison, which, although excellent as far as it went, was too brief for our needs. More therefore was required of the lecturer ; and I soon arrived at the conclusion, that I must myself endeavour to supply the want by writing a book on the subject. But the subject itself needed much to clear it up much thought and consideration, to define and arrange what was already known, and further investigation, to extend knowledge in important questions still involved in obscurity. Among many topics which I found in confusion in lecturing on them last year was that of the pathology of the small blood-vessels, including the subjects of congestion, RESEARCHES IN PATHOLOGY. 157 determination of blood, and inflammation. On each of these I had begun to make regular researches, aided by the micro- scope ; and was soon rewarded by results, which threw much light on the matter. I was able to make diagrams of several of these observations in illustration of my lectures on the subject, which were thus rendered much more intelligible, and the phenomena were more satisfactorily explained. In microscopical examination, I got considerable assistance from two friends who were zealous observers at that time ; and I like to recall their pleasant memories, for they were both taken early from their promising and useful career. John Dalrymple was my next-door neighbour in Holies Street. He was introduced to me by my colleague Liston, on the occasion of the illness of a brother, Donald Dalrymple, whom I attended through a dangerous attack of pneumonia, and who was my warm and faithful friend until his death, soon after his entry on a successful parliamentary life, as member for Bath. John Dalrymple devoted much attention to diseases of the eye ; and was well skilled in the use of the microscope, having a first-rate one of the most modern construction. I had been working away with an old instrument, and with difficulty made out the state of the vessels in the frog's web. But when I saw the same object in my neighbour's microscope, all difficulty vanished; and the elliptical blood-discs, the pale corpuscles, and the variations in calibre of arteries, capillaries, and veins, were as plain as noonday. So I soon got new lenses put in my instrument by Powell and Lealand, and quite enjoyed the increased facilities. The other friend who aided me in this work, who became afterwards eminent in aural surgery, was Joseph Toynbee. I had known him at St. George's Hospital as a zealous co- operator with me in the inspection-room; and he now delighted me with his fine injections, as objects for the micro- scope, bearing on the subjects which I had in hand. His en- thusiasm in everything tending to the advancement of medical science, together with personal intimacy arising from my attend- ance on a most promising brother, who died early, made us fast friends, up to the period of his untimely death, from experimental inhalation of hydrocyanic acid. 158 GULSTONIAN LECTURES ON During this winter I was requested by the President of the College of Physicians to deliver the Gulstonian Lectures of that year. To be selected for this office so soon after my election to the Fellowship I took for a compliment ; for although only two Fellows were appointed from the Licentiates, there were several other young Fellows, who being graduates of Oxford or Cambridge had been promoted to the Fellowship in that year. Although, with little time at command, I would have preferred to postpone the engagement, I was glad of the opportunity of making known my new researches. The lectures were delivered in the spring, and were pub- lished in the ' Medical Gazette ' of the July following, with additional microscopic observations. They embrace topics fundamental to a great department of General Pathology ; and expanded into their sundry details and applications, occupy two hundred pages of the last edition of my ' Principles of Medicine.' The more original parts, which in my opinion have been hardly understood by subsequent writers, may find insertion in a second volume ; and I shall only briefly notice here one or two points connected with each of these condi- tions, congestion of blood, determination of blood, and inflam- mation, in which I claim originality, having been the first to establish their distinctions by direct observation. Of the forms of local hyper&mia (too much blood in a .part), congestion, is that icitli diminished motion of the blood : determination, is too much blood, with increased motion : in- flammation, is too much blood, with its motion partly increased, partly diminished. These are definitions : that is, brief characteristic designa- tions ; (not descriptions.) Of the physical causes of congestion, that from venous obstruction had been sufficiently recognised ; but experiment enabled me to demonstrate another, in loss of tone in capillaries and veins, producing their enlargement, without any enlarge- ment, or with diminution, of the supplying arteries : this would fulfil the definition ' too much blood, with diminished motion.' But what is the physical cause of determination of blood that is, too much blood with increased motion ? I claim to have been the first to give the true answer, when I pointed to en- VARIETIES CONGESTION DETERMINA TION. \ 59 largement of the arteries leading to the part as the direct physical cause of increased afflux of blood to the part. But what is the cause of this enlargement? Physiological experiment negatives the idea of increased action, or active dilatation of the arteries. They have no such properties. Besides the elasticity which resides chiefly in the outer coat, arteries have only the slow contractility of their middle coat, called tonicity ; l and the effect of increased action of this would be to contract the artery, and so to diminish the flow. Therefore, instead of increased action of the arteries, there must be diminished contraction, causing them to enlarge from the vis a tergo (heart and blood pressure), and so to become the channels of increased flow more blood ivith more motion. ' When the web of a frog's foot is gently irritated by an aromatic water, the arteries may be seen through the micro- scope to become enlarged, and to supply a fuller and more impulsive flow of blood to the capillaries and veins, which then all become enlarged too : the whole vascular plexus, including vessels which before scarcely admitted red corpuscles, then becomes the seat of a largely increased current. This is de- termination of blood."* Afterwards an additional factor in 1 It is to be regretted that English writers do not adhere to this expressive word tonicity, which was in use before I applied and defined it, as a primary physiological element, in the first edition of my Principles in 1843. The Germans more recently have introduced the term tonus ; a word signifying a state, rather than a property. 2 Principles of Medicine, 3rd ed. p. 263, and London Medical Gazette, July 16 and 23, 1841. On the differences which I endeavoured to trace between determination and inflammation, I am proud to quote the following passage from the most eminent modern writer on the subject ; the only one, Professor Virchow excepted, who has done me anything like justice. ' No experiment can be better adapted to show the complete distinction between determination of blood and inflammatory hypertemia than that described by Dr. Williams in the Gulstonian Lectures, to which I have already referred. Hunter had shown by his experiment that it is possible for the inflammatory blush to subside, leaving no trace, or the injured part to be flooded with blood, and then return to its original condition. But Hunter's attention was entirely fixed on the blood-vessels, to the action of which he attributed the whole process. For the purpose of separating Hunter's incipient enlargement of the vessels upon the first excitement of inflammation (Treatise on the Blood, etc., p. 279) from the definitive changes which followed it, Dr. Williams most judiciously adopted this method of graduated irritation of the web of the frog's foot, which was at that time the only field of experimental observation. He found that a weak solution of capsicum applied to the web, causes dilatation with acceleration of the movement of the blood (hyperaemia 160 INFLAMMATION INTIMATE NATURE. the process was discovered, when Bernard and Brown Sequard found that this vascular contractility is sustained by the power of the sympathetic nerves ; and that injury to these nerves had the same effect on arteries in connection with them, as direct stimulation of small arteries causing their enlargement, with increased flow. Inflammation I denned as too much blood in a part (local hypersemia) with motion partly increased, partly diminished. On examining, in a frog's web, a spot inflamed by the contact of a particle of capsicum, I saw a large and rapid motion of blood to and around the spot, (determination) and too much blood with motion impeded sometimes arrested, in the part most inflamed : fulfilling the terms of the definition. But attention to the contents of the blood-vessels revealed further changes ivithin them. Where the motion was retarded, were seen numerous white corpuscles, some rolling slowly at the margin of the blood stream, others stationary and sticking to the sides of the vessels (capillaries and veins). 1 And this production of white corpuscles, together with their adhesive character, serves to explain the characteristic feature which distinguishes inflammation from determination, and adds partial obstruction, or diminished motion. In my description of the nature and purpose of these leucocytes (as they have since been termed, and not quite correctly), I came nearer the truth when I called them ' spheroidal granular bodies of with increase of motion) in arteries and capillaries : but if the solution were strengthened, or the application several times repeated, the quickening soon gave way to slowing and commencing stagnation. (Princ. of Mcd. 3rd ed. pp. 240 and 263). The effect of the weak excitation was transitory, and the observation could be repeated any number of times on the same web. The stronger solution produced permanent damage of the tissue, resulting in inflammatory congestion, exudation, and stasis.' Lumleian Lectures on In- flammation, delivered before the Eoyal College of Physicians. By J. Burdon- Sanderson, M.D., LL.D., F.E.S., NEC SILET MORS? 223 record the names of Dr. Peacock and Dr. R. Quain, who worked long and effectively, in editing the Transactions, in addition to their official duties, successively as Secretary, Treasurer, and President. The seal of the Society is a medallion of the head of Dr. Matthew Baillie, with the motto (suggested hy myself), ' NEC SILET MOBS.' Long after the termination of my official connection with the Society during its first two years, I often was gratified by attending its meetings, and never without learning something new : this experience of its first president has been often re-echoed by his successors. 224 STUDENTS, ETC, CHAPTER XXVI. CONTINUED NARRATIVE. CENSORSHIP OF THE COLLEGE OF PHYSICIANS. DEATH OF LISTON. 1846-1848. Entries and Names of Students. Private Practice. Appointed Censor of College of Physicians Duties Examinations Visits to ' Poticaries.' Death of Listen Accelerated by Reckless Habits His Character and Skill Mr. Cadge's Account of his Illness and its Termination, asserting Absence of Physical Signs of Disease My Letter in 'Lancet,' describing Physical Signs found, and Serious Opinion formed Letter from Dr. Watson complaining of my Letter, and stating he also had found Signs Thought Gravely, and duly Warned Patient : further Upbraiding Me for Unfair Imputations Letter in Reply from Author, retracting Erroneous Statements derived from Mr. Cadge's Account, and disavowing any Intention of imputing Blame ; but repeating desire to vindicate Physical Diagnosis Letter of Satisfaction from Dr. Watson, with Assur- ance of uninterrupted goodwill Fulfilment proved by Mutual Amity and Friendship continued for upwards of Thirty Years. IN resuming the notice of events in the next two years it will be unnecessary to dwell on common details. The entries of new pupils in 1846-7 were 72. Professor's fees, 389Z. In 1847-8, new pupils, 77. Fees, 420Z. The names most noted in the examination book were : Henry Briggs, James Morris, Arthur S. Willocks, J. Ellerton, Thos. Park, J. Eussell Reynolds, Theophilus Taylor, Wm. Filliter, Geo. Wyld, Geo. W. New, Soorjo-Coomar Chucker- butty (Hindoo), Fred. J. Gant, Thos. J. Warburton. Fees from private practice amounted in 1846 to 2,171L and in 1847 to 2,749Z. There was also the accession of a small fee (25Z.) for the office of Censorship of the College of Physicians, which I held for these two years. The duties of this office were not onerous ; and although important and responsible, were generally rendered agreeable by the courteous and friendly feeling which prevailed at the Board. The most important CENSORSHIP OF COLLEGE OF PHYSICIANS. 22$ duties were the examinations for the membership, before the quarterly meetings of the College, conducted by the President, and four Censors. The President then was Dr. John Ayrton Paris, an able and well informed man, but getting rusty, and hardly keeping pace with the progress of the age. The Registrar was Dr. Francis Hawkins, and my colleagues in the Censorship, were Dr. (since Sir) George Burrows, Dr. Clen- dinning, Dr. Nairne, and Dr. Geo. Budd. A less important but not unamusing office of the Censor's board at that time, was to visit the apothecaries' shops at stated times, for the purpose of examining their drugs, ' that they ' (in the language of the Act) ' the said Physicians may and shall execute that search and view, and the due punishment of the Poticaries for any their evil and faulty stuff, according to the statute.' After our fulfilling the letter of this enactment by calling at Apothe- caries' Hall and a few of the druggists' shops in the city, and inspecting and tasting samples of their drugs, the day was concluded by a dinner at the Thatched House, where the President was ready to receive us. This absurd formality has been very properly discontinued. A more unpleasant duty attaching to the office of Censor was that of admonishing any physicians practising in London without the authority of the College. Although there was still much in the practices, and even in some of the by-laws of the College, which I did not approve of, and which I hoped would be altered, yet it was the existing authority, by law established, and in virtue of my office I was bound to uphold it, at least by warning, which was not meant in an unfriendly spirit : but I fear it sometimes became a cause of offence. This (1847) was the year of poor Listen's death, which was a great loss to the College and to the profession. We were always on friendly terms ; although there was not much community of sentiment between us ; and he did not except me from the jocular disparagement, with which he was in the habit of speaking of medicine and of doctors in general. His skill and manual dexterity in operative surgery, and the effica- cious simplicity of his methods of treatment, had gained for him the highest reputation and success, which surmounted Q 226 DEATH OF LISTON. the objectionable qualities of his character, which, if they were obnoxious to others, were quite as damaging to himself. There can be little doubt that the disease, which cut short his life at a vigorous age, was the result of the high feeding and violent exercise, which he made his habit ; and that its fatal issue was accelerated by his obstinate recklessness. He was not a man of intempterate habits ; but one, who lived regu- larly well, and, denouncing all messes and slops, fed almost entirely on meat and bread, with no other beverage than ale or wine. Then he made a constant habit of a long fast walk, such as to Hampstead or Highgate, and back, before his sub- stantial breakfast, and devoted all spare time which he could get, to boating, yachting, or horse exercise. These were his habits ; and he firmly believed that to them he owed the re- markable share of strength and activity which he enjoyed. The continued strain or high pressure led to a breakdown, comparatively sudden, in the full course of his energetic and successful career. I was absent from town at the commencement of his ill- ness ; and although he sent for me on my return, I did not continue to attend him, as he had placed himself under the care of Dr. Watson and Dr. Forbes ; and I did not see him for a month before December 7, when I heard of his death. The circumstances of Mr. Listen's illness and death were reported in the Lancet of December 11 by Mr. Wm. Cadge, his late House Surgeon; and became the subject of a correspon- dence in that journal, originating with a letter from me, and continued between Dr. Watson and myself. I think it right to republish the whole matter, for although it has been often referred to, it has been chiefly by quoting Dr. Watson's letter of reproof to me, without noticing my letter of defence, or Mr. Cadge's statement, the errors of which were the real cause of misunderstanding, and were all that I had to retract. 1 1 I purposely refrain from adding any fresh recollections or notes on the subject : let the recorded history speak for itself. I have only put in italics those passages in Mr. Cadge's statement, which Dr. Watson's letter proved to be erroneous, and which had caused me to write in my first letter a para- graph, which I afterwards retracted. MR. CADGE'S REPORT. 227 Death O/EOBEKT LISTON Esq. F.E.S. (From tlie ' Lancet,' December 11, 1847.) We have received the following succinct and interesting account from Mr. Cadge, his late house-surgeon at University College Hospital, who was in constant attendance upon him before his death, and who conducted the post-mortem examination. In the early part of the summer of the present year, Mr. Liston first complained of a feeling of constriction at the top of the wind- pipe, and a sense of choking when stooping forwards. It was also noticed by those constantly in his company, that he had a manifest, though slight, difficulty in swallowing. This difficulty appeared most palpably when swallowing the last drops of a glass of what- ever he was drinking. He occasionally remarked this himself, but seemed to think very slightly of it. He had also occasionally a most peculiar cough, harsh, dry, and grating ; this however was so seldom that it gave him little uneasiness : in short, he may be said, so far as appearances went, to have been in fair health. He lived, as usual generously, and took his customary long morning walks. It was late in July, that the first serious, and alarming symptom occurred, while receiving visits from patients at home, and when perfectly quiet ; he suddenly felt his mouth fill with fluid, and retiring into his dressing-room, he coughed up between thirty and forty ounces of florid arterial blood ; it was expelled almost without effort ; the blood was in one clot, and without froth or mucus fainting came on, and the haemorrhage ceased. He soon recovered, and remained quiet during the remainder of the day. Drs. Watson and Forbes visited him, and examined the chest ; but could detect nothing morbid either in the lungs or circulation ; the source of the bleeding was therefore very obscure. He himself hinted that there might be an aneurism ; but in the absence of all physical signs of such a lesion, the most favourable view was taken of the case, and it was conceived that it might be a salutary relief from a congested lung. From that moment he lost all sense of choking or con- striction in the throat, and was in fact better in health than previously. The only treatment adopted, was local abstraction of blood by cupping, spare diet, and less violent exercise. With these restrictions, he continued his ordinary avocations till the beginning of October, when the cough returned. It was at first thought to be a mere catarrhal affection from exposure to cold ; for some weeks he paid no particular attention to it, till it became more frequent and distressing, attended with expectoration, which was difficult, Q 2 228 DEATH OF LISTON. small in quantity, and of a rusty colour ; occasional dyspnoea super- vening. Drs. Watson and Forbes were again consulted. Blood-letting, counterirritation and confinement to the house, were had recourse to, and were followed by marked alleviation of his symptoms ; and on November 28 he resumed his professional occupations, and rode out on horse-back. December 1. While at the house of a patient, he was seized with what appeared to be a fit of spasmodic asthma : he returned home immediately, and soon recovered. In the evening he had a still more severe attack ; and from that period to the time of his death, he was unable to assume the recumbent posture. December 2. The dyspnoea returned, the usual remedies were administered but without much benefit : in one of the attacks he inhaled chloroform, but to no purpose : there was no constitutional disturbance or pain. December 3. Fits of dyspnoea somewhat less urgent : the great- est relief was obtained from opium : the physical signs were still obscure : percussion and auscultation pointed out no perceptible lesion of the lungs or heart ; but from the loud, noisy, prolonged aispirations, it was conjectured that the dyspnoea was dependent on mechanical pressure upon the trachea or bronchi. December 4. The breathing throughout the day was more laboured, with occasional fits of coughing and difficulty of deglu- tition : the pulse rose to 100, and became somewhat hard. In the evening Dr. Latham was associated in consultation. It was re- solved to take away more blood ; and the loss of twenty ounces afforded the greatest relief : the breathing became easier, the dysphagia diminished ; and with the aid of half a grain of muriate of morphia, he passed a quiet night. December 5 and 6. There was no particular difference in the state of the breathing ; but it was manifest that his strength was rapidly sinking. Sir B. Brodie saw him in consultation. He con- tinued however to get weaker, and died at half past ten o'clock on the evening of the 7th, soon after a paroxysm of dyspnoea. Post-mortem examination thirty-six hours after death. The thorax was opened by Mr. Cadge, in the presence of Sir B. Brodie, Drs. Watson, Latham, and Forbes, and Mr. J. Dalrymple. The lungs were found but slightly collapsed, congested throughout, but otherwise perfectly healthy: the pericardium contained about an ounce of transparent yellowish serum : the heart itself was healthy, save a slight atheromatous deposit in the mitral and aortic semilunar valves. On removing the subclavian vein and cellular tissue from AUTHOR'S LETTER. 229 the arch of the aorta, the cause of death at once became apparent. An aneurism, as large as an orange, flattened from before back- wards, was seen pressing back the trachea ; it arose from the upper part of the arch, close behind the left carotid artery, at the origin of the innominata, which seemed almost to commence from the aneurismal pouch : the communication with the aorta was by a circular opening, as large as a halfcrown. On opening the trachea from behind, the mucous membrane was seen to be very dark and congested, and in its front part, where it was firmly connected with the tumour, there were three or four whitish prominences as large as split peas, situated between the rings : it was at first difficult to understand what these elevations really were : but on splitting up the pouch, and removing the fibrinous laminae, they were drawn from between the ring, leaving the latter quite bare, and the trachea perforated in three or four points ; they were in short, portions of the clot, which half filled the sac of the aneurism. The source of the haemorrhage and the cause of death was at once explained. In the next week, December 18, the Lancet contained the following letter. THE PHYSICAL SIGNS OF DISEASE IN THE CASE OF THE LATE MB. LlSTON. To the Editor of the Lancet. Sir, Having seen, and heard it stated in several quarters, that there were no physical signs of disease detected in the chest of my lamented colleague, I think it right, for the credit of physical diagnosis, as well as in justice to myself, to make known the results of my own examination of the case, which were (according to my custom) recorded in my note-book shortly after the examinations were made v On the attack of haemorrhage at the end of July, Mr. Listoii sent for me ; but unfortunately I was absent in the country, and did not return to town till three weeks after. My first examination was made on August 18 in the presence of Mr. Cadge (who was made acquainted with the signs, which I detected) and another friend of Mr. Liston, whose name I do not recollect. At this time Mr. Liston felt no ailment whatever, and had resumed his habits of daily active exercise. The following is the *hote of positive abnormal signs detected on exploration of the chest at that time. 230 SIGNS DETECTED AND WARNINGS GIVEN. ' Marked dulness above the left clavicle and scapula (on strong percussion) : large tubular breath and voice sound in the same space: tubular expiration above upper inner angle of right scapula.' The tubular sounds here mentioned were not of that slight muffled character, sometimes heard in the upper posterior regions of healthy chests (generally in thin persons) ; but were boldly marked, and obviously morbid signs ; and knowing the buoyancy of his spirits, and his propensity to dangerous exertions of strength, I hesitated not to state to my friend my conviction, that there was some disease in his chest, which if not dangerous from its extent, was so from its locality, in the vicinity of great blood-vessels ; the profuse haemorrhage, which had occurred, being a signal warning of such danger. The precise nature of the disease was not equally evident. There was obviously deep-seated consolidation, or com- pression, of the inner part of the apex of the left lung, causing the deep dulness between the clavicle and scapula, and large tubular sounds in the same region ; and the tubular expiration at the upper inner margin of the right scapula, implied a similar cause, but to less extent, operating on the right side : but whether the lesion was tuberculous or other deposit at the root of the lungs, extending towards the apex of the left, or a small aneurismal tumour, com- pressing these parts, or a morbid growth encroaching on them, could not at that period be determined. The occurrence of the profuse haemorrhage deterred me from suspecting the last to exist ; and not finding any unusual pulsation, or other signs of aneurism, I then inclined to the first of these alternatives. But my earnest cautions to my friend were grounded, not on the precise nature of the disease, which was doubtful, but on the presence and position of some disease, which was not doubtful, and which, considered in connection with the previous haemorrhage, was most alarming. But alas ! my warnings were little heeded ; and on several sub- sequent occasions on which we met in professional intercourse, he had always some feat of activity or strength to recount, in falsifi- cation of my diagnosis. At one of these times, he suggested to me, that a former fracture, and consequent overlapping of the ends, of the left clavicle, might cause the signs which I had heard : but my reply was, that this could not produce dulness or tubular sounds above the scapula. It is a poor consolation, but it saves me from self reproach, that I never said anything to countenance his dis- position to make light of his malady ; but uniformly asserted my conviction of its serious character. The second and last occasion on which he consulted me, was early in November, during the second of a series of attacks of US TOWS CASE- AUTHORS LETTER. 231 hoarseness, with cough and deficient expectoration, which continued to recur, until the last fatal attack in December. The result of my examination at this time (I think the first week in November, but the date is not inserted) is thus recorded : ' The same dulness in upper left, and an increase of tubular sounds, which are very loud above left scapula and at- inner margin of right scapula : something pressing on trachea ; but no obvious pulsation.' There was now evidently a tumour pressing on the trachea near its division ; for the tubular sound was different from that in the larynx ; and I expressed to him my fear that there would be either suppuration, haemorrhage, or increased dyspnoea, unless active means were used to reduce the internal swelling. I strongly urged him to be cupped to ten ounces above the left scapula, and to avoid every description of excitement or exertion. He did not follow this advice in any particular ; but, as he afterwards told me, got relief by strong exercise in riding a restive horse, which promoted ex- pectoration. After this I did not see him professionally, as he placed him- self under the care of physicians, who, both before and after this period, found no physical signs of disease, and who therefore took a more favourable view of the case than I did. The result is known, and I make no further comment on it ; but I cannot close this letter without drawing the attention of your readers to the paramount importance of the supra- and inter- scapular regions, as the field for physical signs of serious and deep-seated diseases of the lungs and great vessels. It has been the common mistake, since the time of Laennec, to search too exclusively below the clavicles ; yet in five-sixths of the cases of incipient diseases of the lungs, and in more than half the cases of aneurism of the arch of the aorta, the signs are heard at an earlier period, and more dis- tinctly, between the clavicles and scapulae, and within the scapulae, than in any spot below the clavicles. I am Sir yours faithfully, C. J. B. WILLIAMS. Holies Street, Cavendish Square : Dec. 1847. Letter from Dr. WATSON to Dr. C. J. B. WILLIAMS. Lancet (Dec. 25, 1847.) Henrietta Street, Cavendish Square : Dec. 1847. Dear Dr. Williams, More than one person came to me yester- day, to call my attention to a letter of yours published in Saturday's Lancet. On referring to it I perceive that you have done great injustice to Dr. Forbes and to me. I say to us in particular, because 232 DR. WATSON'S FIRST LETTER. we are the only physicians who had charge of poor Liston, both in the early and in the latter stages of his fatal illness ; and this Mr. Cadge's brief, and in some points imperfect statement, which I did not see till after it was printed in the Lancet, has made known. You are quite wrong in supposing and stating that we ' found no physical signs of disease,' and ' therefore took a more favourable view of the case than you did.' From the very first, my anticipations of its ultimate event (as many could testify) were most gloomy, and so, I know, were Dr. Forbes's. Soon after the haemorrhage, I noticed, and recorded in my note- book, which you are welcome to see, some imperfection in the breath sounds about the upper part of the left scapula, something not quite natural also at the summit of the right, and some appreciable difference in the voice in the two supraspinal fossae. I then went out of town and was absent five weeks. After my re- turn Mr. Liston called on me (on November 13) complaining of cough. He had then manifest shortness of breath. From that time ' physical signs ' were never absent. A very peculiar, rough, and loud respiratory murmur pervaded both lungs. At first I confess I apprehended, from this sound, the rapid multiplication of small tubercles ; for I had been informed that his mother, and also a sister, had died comsumptive ; and by these facts I inter- preted the previous haemorrhage. But very soon Dr. Forbes and I convinced ourselves of the presence of some obstacle in the large and primary air-passages, whence the remarkable sound was propagated. At that time Mr. Liston was bled, with relief, and the blood was distinctly buffed and cupped. For three weeks at least before his death our opinion (and that of everyone else who saw him in our presence) was clear, that some mechanical im- pediment existed about the bifurcation of the trachea, or in the first division of the bronchi. The inspirations were comparatively facile the expirations were long, noisy, and growling. Some dyspbagia was also detected, although the patient himself was reluctant to acknowledge it. Possibly (we thought) an enlarged bronchial gland, or some morbid growth, was exercising pressure there most probably, an aneurismal tumour. Of all this, if it were worth while, several witnesses might be called. From various phrases and sentences in your letter, which I need not cite, as well as from its whole tenour, an ordinary reader, unacquainted with the real facts of the case, could not fail to infer, that we did not as you had done, ' warn ' our patient ; that we 'countenanced his disposition to make light of his malady,' and LfSTOX'S CASE DR. WATSON'S STATEMENT. 233 ought therefore to stand ' self-reproached ; ' that we sanctioned his taking ' strong exercise in riding a restive horse ' which promoted expectoration, and that had the solemn and responsible office of advising and treating thib eminent surgeon been yours instead of ours, a different ' result ' might have been hoped for ; for you close your observations with these words ' After this, I did not see him professionally, as he placed himself under the care of physicians who, both before and after this period, found no physical signs of disease, and who therefore took a more favourable view of his case than I did. The result is known, and I make no further comment on it.' Now the real truth is (as his family can tell you) that our poor patient's imprudent acts were done in spite of our most earnest and reiterated remonstrances remonstrances so urged, as sometimes to make him almost angry with us, and especially with Dr. Forbes, who living near him, saw and expostulated with him more fre- quently than I had the opportunity of doing. Our entreaties to him to ' avoid every description of excitement and exertion,' were as pressing as yours could have been, only (from circumstances) much oftener repeated. We had even prevailed upon him, just before his sudden attack of severe dyspnoea, again to leave town for a while, that he might ensure the means of quietude. Much the same kind of treatment which you affirm would have been appro- priate, was counselled by us and adopted. He was cupped, twice, I think, bled twice from the arm, blistered, and kept on low diet. In short all the treatment that you would have recommended, we recommended ; all that could be positively known concerning the disease during life we knew as surely as yourself viz. : the certain existence of mechanical pressure about the lower part of the windpipe ; and all that could be reasonably conjectured of its material cause, we saw as clearly as you did viz., the probable existence of an aneurisrnal tumour. I hope I have satisfied you that you have been greatly misin- formed respecting the facts and practice, upon which directly or indirectly you have been pleased to comment in a tone of disparage- ment. Now was it courteous, or even fair, to publish what you have published, in reference to the physicians, who could be no other than Dr. Forbes and myself, without previously ascertaining from one or the other of us, whether the facts of the case really were as you understood them to be ? Would it have been charitable or generous so to exhibit our mistakes, even if you were sure that we had made them ? Do you indeed believe that if our lamented 234 AUTHOR'S REPLY TO DR. WATSON. patient had been entrusted solely to your care, and could be induced implicitly to obey your directions, the fatal ' result ' of his disease would have been prevented ? One more question I venture, in perfect amity to propose for your calm consideration. Is it consistent with your character with your high rank in our profession with your office (which presents you as an example to so many) in one of our great metro- politan schools of medicine thus publicly and needlessly, under profession of a zeal for science, to proclaim your own superior sagacity, and (by implication) the comparative ignorance or unskil- fulness of others, your contemporaries, pursuing in the same place, to the best of their humbler abilities, the same vocation with your- self, and in this instance, engaged in the peculiarly anxious duty of ministering to the relief of a professional brother. Would Baillie or Heberden have done this ? I remain yours truly, THOMAS WATSON. Letter from Dr. C. J. B. WILLIAMS to Dr. WATSON. Lancet (Jan. 1, 1848.) Holies Street, Cavendish Square : Dec. 27, 1847. Dear Dr. Watson, I assure you that I much regret that my letter in the Lancet has appeared to be unjust to you or Dr. Forbes, and I am most willing to retract any expressions, which may have wronged you. On a re-perusal of my letter, I cannot perceive that there is any allusion to you, direct or indirect, except in one sentence, and this I would willingly retract, even had your explanation not proved the information contained in it to be incorrect. The paragraph is quite detached, and may be well suppressed, without impairing the sense of the rest of the narrative, which when separated from it, will not, I trust, be liable to misinterpretation : it is as follows : ' After this, I did not see him professionally, as he placed him- self under the care of physicians, who both before and after this period, found no physical signs of disease, and who therefore took a more favourable view of the case than I did.' I repeat that I fully retract these expressions ; but I may be allowed to mention, in apology for my having used them, that so far as they related to the physicians, they implied nothing beyond what had already appeared in the Lancet of the week preceding my letter, and had been repeated in many of the public prints. Thus in the report of Mr. Liston's illness by his assistant Mr. Cadge, It is stated that ' nothing morbid either in the lungs or ERRORS RETRACTED REST RE-AFFIRMED. 235 circulation was detected ; ' and ' in the absence of all physical signs of such a lesion ' (aneurism) ' a favourable view was taken of the disease.' Again, so lately as the report of Dec. 8, it is men- tioned that ' the physical signs were still obscure,' &c. These reports corresponded with an impression generally abroad, with which I became the more acquainted from my position, as Mr. Liston's colleague, especially directing inquiries to me, and no one seemed to have been more completely under this erroneous im- pression than the patient himself, who, doubtless, blinded by his hopes, and disregarding what both you and I had told him, ex- pressed to several individuals, whom I could name, his satisfaction that auscultation had discovered no disease in his chest. That I should have been under the same mistaken impression with regard to your examinations, will appear less strange, when you recollect, that although the colleague of the patient, the physician whose aid had been first sought, and who had subsequently twice examined him, and detected positive indications of disease I was neither summoned to any of the consultations on the case, nor personally referred to by those in attendance, for any informa- tion or suggestion, which possibly I might have been able to supply ; therefore I remained in ignorance of the real result of your examinations ; and concluding the published (Mr. Cadge's) report to be correct, I unfortunately relied on it, in the obnoxious sentence, which it is now the chief object of this letter to cancel. The rest of my letter is entirely free from allusion to any sub- ject, but the case of the patient, with the diagnostic and practical inferences which I made when he consulted me. I do not feel that the general tenour of the letter at any time deserved the personal interpretation, which you have attached to it, and which has led you to propose to me a series of questions severely reflecting on my conduct. At all events my retractation of the only sentence which is personal, will, I trust, leave the communication, as it was intended to be, one of a simply scientific character, penned with the especial intention of describing the signs which I had detected, in an obscure case of disease, and of vindicating the credit of physical diagnosis. Nor can it be said to have been altogether unsuccessful in accom- plishing these objects, if we regard, not merely its own contents, but also the particulars which it has elicited from your pen, which are the more valuable, from the longer and more frequent opportu- nities which you had of investigating the disease. I remain, yours faithfully, C. J. B. WILLIAMS. 236 DR. WATSON SATISFIED WITH EXPLANATION. Letter of Satisfaction from Dr. WATSON to Dr. WILLIAMS. (From the Lancet, Jan. 8, 1848.) Dear Dr. Williams, I thank you for your candid, temperate, and satisfactory letter of explanation. If (as I am glad to know from your assurance) I misconstrued the meaning and spirit of your letter in the Lancet, my excuse must be, that I did so in common with every one of those who have spoken to me about it, and they have been many. Indeed it was the interpretation put upon it by some of my friends that first brought the letter under my own notice. It was especially the paragraph which you so frankly retract, with the addition of the next little sentence ' The result is known, and I make no further comment on it,' that (as it seemed to me) gave force and point to all which had preceded. But for this paragraph, I should not have thought of troubling you with any expostulation on the subject. I assure you that I did not know, until I saw it so stated by you in the ' Lancet,' that Mr. Listen had 'first sought your aid,' or that he had formally consulted you at all. On the very morning of the haemorrhage, he sent me a message, simply requesting that I would call upon him. I did so on my first going out, and found him recovered from the faintness produced by the loss of blood. But I was not then, nor at any time, informed that he had previously sent for you. I became aware, indeed, at a much later period, that his chest had been once examined by yourself, as well as by another physician, also his colleague in University College. But I believed that these examinations had been casually made upon some occa- sion of your officially meeting together. Had I known that Mr. Liston had desired your counsel in the first instance, I should have been, not willing merely, but anxious, in a case so painfully responsible, to obtain the comfort and advantage of your valuable assistance. Let me assure you, finally, that if, writing to you, as I did upon the spur of the occasion, I transgressed the just limits of self- defence, or so expressed myself as to cause unnecessary pain to your feelings, I am sorry for having done so. I trust also, and on my own part, am sure, that what has occurred in this very dis- tressful matter will not be suffered to impair the mutual respect and goodwill which had hitherto subsisted between us. I remain, yours truly, THOMAS WATSON. Henrietta Street, Cavendish Square : December 1847. DEA TH OF MR. JAMES JEXKIXS. 237 The generous spirit of mutual concession and amity, which marks the conclusion of this letter, was equally satisfactory to myself, and was loyally preserved between us during our subsequent friendship of thirty-five years unruffled by any further misunderstanding ; while it was promoted by much genial professional and social intercourse ; and my attach- ment to this good man was more than ever confirmed by his noble act in heading my defence against a mad onslaught made on me in later years. In July 1847 we had the affliction of losing my wife's father, Mr. James Jenkins of Chepstow at the age of 76 after a long life of consistent piety and well-doing. Long engaged in mercantile pursuits, he had latterly lived as a country gentleman, cultivating a little of his own land, and chiefly engaged in works of charity and public utility. Although always hospitable and genial to those around him, he pre- ferred a private life to one of publicity ; and it was not without reluctance that he accepted the offices of High Sheriff and Deputy Lieutenant for the county, that were pressed on him. By all ranks, high and low, and especially by his numerous relations and friends, and by the poor, he died, universally beloved and lamented. UNIVERSITY COLLEGE. CHAPTER XXVII. RETIREMENT FROM UNIVERSITY COLLEGE. 1848-1819. Unsettled State of University College in Surgical Department Class of Medi- cine Flourishing : but Health Failing. Limitation of Hospital Physicians' Term of Office. Increase of Income House Discomforts ^Residences in St. John's Wood Increase of Family Home Arrangements Eeligious Privileges. Increase of Students Names. Lectures Ill-reported in a Journal, and Disavowed. [Resignation of Professorship Last Appearance at Public Meeting Vote of Thanks Letter of Professor Grant. THE death of Liston was the indirect occasion of other dis- agreements in connection with University College, not like Watson's and mine, soon explained and happily adjusted, but long and bitter, and venting much angry feeling in the medical journals of that year, far from edifying to the public, or salutary to the Institution, in which they originated. I took no active part in them then, and shall not enter on the subject now : but I found it difficult by that impartiality to avoid giving offence ; and I cannot say that anything like general harmony was restored during the remainder of my connection with the College, or long after. The invitation of Professor Syme from Edinburgh, to supply the offices vacated by Mr. Listen's death ; the resignation of the Chair of Surgery by Professor Cooper ; the sudden abandonment of his new office by Mr. Syme, were the great disturbing events, which interrupted the smooth working of the Surgical School, and spoiled prospects, which had been most promising. The unsettled state of the Surgical School did not affect my department. On the contrary, on that and the following year I entered more pupils than I had in any year since the com- mencement ; and I "was well satisfied with the proficiency of the most industrious among them. I think that I had my- self greatly improved in the practice of lecturing ; and by SUCCESSFUL PROGRESS FAILING HEALTH. 239 concentration and arrangement, had been able to include a good deal of additional matter. A second edition of my ' Principles ' had been called for ; and this work not only enabled me to refer to ii, instead of giving the whole in the lectures, but it made the whole course more intelligible and interesting, as illustrating what was laid down in the ' Prin- ciples.' l But in the last two years, I began to find my health failing in various ways. All my life I had been an occasional sufferer from toothache. I was often in the hands of the original Samuel Cartwright of Old Burlington Street, famous as an expert extractor of teeth, and still more famous for preserv- ing them by one mode only stopping with gold. Two of my upper front teeth were beginning to decay forty years ago ; they were saved, and are still sound, with Cartwright's gold stopping. I have had many stoppings since, with various materials ; but none to last like that. But the toothaches which now visited me were attended by bad abscess of the jaw. I had also boils, sometimes carbunculous, breaking out 1 I introduce here a few of the closing remarks, with which I concluded my lectures in later years. ' Gentlemen, I now bring to a conclusion the longest course of lectures ever given in this country, amounting to upwards of 150 lectures and examinations. Yet so far have we been from exhausting our subjects, that many, I have had to treat in outline, rather than in detail. If lectures on the practice of medicine were to be given as fully as those on Anatomy and Physiology, two courses would be required instead of one. In fact, our subjects are never exhausted ; there is ever something new ; which, if studied with intelligence, is interesting in- teresting not only as a part of our business, and with the object of doing good, but as presenting beautiful illustrations of some of those general facts or properties, called laws, in physiology, pathology, and therapeutics. It is to make you understand these general facts or principles, that I have chiefly laboured ; because they are the very keys to the most useful knowledge of dis- ease and of its treatment. Mere details you can get from books, and, more abundantly and truthfully, from the book of Nature. But such details are incomprehensible and appalling without some key or clue, to open and pene- trate their mazes. I hope that you have now gained some such guiding prin- ciples, to help you through your remaining studies, and in the never ending study of practice, as to make you feel delight in pursuing them. Study is a desire, as well as a task ; and, although laborious, it is full of pleasure if pursued willingly and thoroughly. Practice is not different : it is always toil- some ; and if pursued unwillingly and imperfectly, it will be irksome and unsatisfactory ; but entered on and carried out cheerfully, and with the full earnestness and intelligence which it deserves, it will be delightful as well as useful and profitable.' 240 LIMITS TO HOSPITAL APPOINTMENTS. in various parts ; painful enough in themselves, and never seeming to me much bettered, by still more painful surgical treatment. Then sleep often failed me, and I was driven to seek relief in opiates, or other narcotics ; and was one night nearly poisoned by the green tincture of Indian hemp not from the largeness of the dose, for I think it was only twelve or fifteen drops, but from previous exhaustion, by pain and fatigue. It gave at first ease and sleep ; but then came a trance-like faintness, with irregular pulse and sensation of sinking, which lasted several hours. For some months I con- tinued ailing in various ways ; but not ill enough to be obliged to give up work. Fortunately it was not during the lecture season : but my private practice was now heavy; and I often had to refer my patients to friends who assisted me ; par- ticularly Dr. Eichard Quain and Mr. J. T. Clover, who from their position as resident medical officers of the hospital, knew my practice well, and were well qualified to continue my treatment. Nor were they losers in any way by their kind help, for I always insisted on their retaining the fees received during their attendance ; and these introductions were very useful to them in their subsequent career. But these failures of health were serious warnings to me, that I must lessen my field of labour. I had long entertained strong convictions, that hospital physicians ought not to con- tinue in office, when the claims of private practice encroach so much on their time and strength as to prevent them from performing their Hospital duties efficiently. At the request of Dr. Forbes, I wrote a review of the work of Dr. W. Stokes on the Chest, in the British and Foreign Medico- chirurgical Eeview ; I think in 1838 ; before I was myself a hospital physician, and in that article I had suggested that the appointment of Metropolitan Hospital Physicians should be limited to a term of ten or twelve years. This would be time sufficient to test their capacities. If a hospital physician profits by his position, and proves his abilities to the profession and to the public, private practice pretty surely follows, soon enough to make the hospital appointment no longer a neces- sity at the end of the term ; he then resigns the hospital to another, who is free to devote himself to it, and make the most FAMILY EVENTS. 241 of the office and its opportunities. If, on the contrary, a hospital physician in ten or twelve years fails to make his mark, and to prove his abilities to the profession or to the public, it is high time that he should vacate his office, and make way for a better occupant. If it be objected, this would be hard on the unsuccessful, and give no chance to second-rate men, however industrious and deserving, I reply, Hospital appointments are not for second-rate men. Only first- class men deserve them, and can work them for the best ; and through them only is the greatest amount of good to be achieved ; but even the best men, when from full occupation, or other cause, they fail to give their best time, and their best abilities, ought likewise to make way for others. These views on the true aristocracy in the profession, and the optimism of its objects, I foresaw I should soon have to carry out in practice. Although now in comparative affluence, (my professional income having reached 3,600Z. in 1848), neither my family nor myself were comfortable in domestic arrangements. The house in Holies Street had become too small for the family and household, who were for the most part at Brighton, or else- where in the country ; whilst the town house was devoted to the reception of patients, and bachelor quarters for myself. In 1847, I took a family house in Avenue Eoad, Kegent's Park, where our third daughter (the second was stillborn), and eighth child, was born, within sound of the lion's roar in the Zoolo- gical Gardens. In the following year, 1848, my family occu- pied a house in Upper Hamilton Terrace, St. John's Wood ; and there our youngest daughter was born ; completing the eight living children who composed our family. It pleased God, through many delicacies and trials, to spare them all to us, till March 12, 1880, when this youngest darling (Fanny) fell asleep in Jesus, and was interred in the cemetery of Cannes. The placing of my family in the suburbs, where I could see them almost daily, was a great improvement on the more distant separation, which for many years had much marred my domestic happiness : but I could not help looking forward to a time, when, less overwhelmed with engagements, I would R 242 FAMILY ASSOCIATIONS. LAST SESSION. have them all together with me in a family house in town, during part, at least, of the year. I was naturally fond of children, and greatly enjoyed entering into their pursuits and amuse- ments ; to say nothing of the deep and tender interest which a father must feel in their whole well-being, of body and mind. So it was a great gain to me, whenever, in a suburban resi- dence, I could have the elder ones with me at the early break- fast and morning prayer; and regularly enjoy the Sabbath rest and worship together, without the hurry and turmoil of travelling to and fro. Our places of worship in London were, Trinity Chapel, Conduit Street, under the Rev. H. H. Beamish, who was long my patient as well as my pastor : and in St. John's Wood, the church of the Eev. Mr. Fiske, Hamilton Terrace. In addition to the usual ministerial intercourse, I sometimes engaged Mr. Beamish and others of the clergy in the neighbourhood, to come to gatherings of a few of the students, who met together for prayer and Bible reading. The Rev. Dr. Chandler and the Rev. F. Baring, after Bishop of Durham, were among those who came to my house hi Holies Street for this purpose. Similar meetings were afterwards carried on under the title of the Christian Medical Association, at some of which it was my privilege to preside. Before the opening of the winter session of 1848-49, I had been led to the conclusion, that this was to be my last course of lectures. The entries were more numerous than in any pre- ceding year, except the first ; being 181, including several old pupils. My kind old friend and colleague, Dr. Robert Grant, who had been Professor of Comparative Anatomy since the foundation of the College, was also a regular attendant ; and it was wonderful to witness the zealous interest with which this veteran enthusiast in Biology listened to the applications of modern physiology to practical medicine. The names recorded in the examination book of this year are : Joseph Gamgee, John B. Scriven, James Stoate, Samuel Morris, John Langham, Paterson Allen, Richard Neale, Henry Hounsell, Walter Acton, Edw. Emra Earle, W. M. G. Hewitt, Geo. Thos. Jones, John Moore Swain, Henry Duncan Smith, Wm. Robinson, Chas. A. West. 1 RELATIONS WITH COLLEGE. LECTURE REPORTS. 243 I am quite aware that the names given in this and in pre- ceding lists, do not include all the students, who distinguished themselves, by either gaming honours at the final examina- tions, or by executing well the offices of clinical assistants and clinical clerks. But I possess no record of these ; and I fear to trust to my unaided memory to give a fuller detail. But I can unhesitatingly say that my relations with the students in general, and the most industrious and talented in particular, were always pleasant and cordial. It was this good under- standing with the students, which was my principal encourage- ment to continue in this arduous work, longer than was good for my health, or profitable to my interests. The increasing engagements of private practice, and occasional failures in my health, did in the last two years render the work of the College and hospital more and more difficult : but I never shrank from it. To the last I continued to give the full number of lectures, and to visit the hospital as regularly and punctually as I had always done. Of late years, I understand that the senior physicians have been relieved of their more onerous duties by junior assistants. I was never offered any assistance, nor did I ask for any : I did my own work to the end, cordially supported by the officials, house physician, clinical assistants, and clerks. From the authorities of the College I received little recognition or encouragement ; and the members of the Faculty were too much divided by the late differences to care much for any one who would not become a partisan. There was one annoyance, connected with the last two or three courses of lectures, which I delivered at University College : they were reported in the ' Medical Times,' and very badly reported. The then editor of that journal applied to me for leave to report the lectures, adding the modest request that I would correct the proofs : to the latter I returned a decided negative, as I was far too busy to do so, even if I approved of the lectures being published in this way. I did not refuse the admission of a reporter ; but I intimated that if the reports should prove incorrect, I should disavow them. At the same time I gave him the names of some of the senior students, who perhaps might be induced, by proper remuneration, to make n2 ; 244 PROFESSOR GRANT CONCLUDING MEETING. the necessary corrections. The reporter sent, was not a medi- cal man ; and of course his reports were full of blunders, from ignorance of the terms used. Instead of employing for the correction, one of the class, as I had suggested, the notes were revised by a medical man, who acted as sub-editor, but had never attended the lectures. Flagrant errors continued to appear ; and I had to insert in the journals a notice that these reported lectures were unauthentic and incorrect. It was not till these disavowals were repeated, and elicited some abusive rejoinders from the journal, that these parodied reports were discontinued. It was among my regrets, and among the evil results of overwork with which I was harassed during the latter part of my connection with the College, that I w r as un- able to authorise and superintend the publication of a course of lectures, which had cost me so much labour, and which had been undergoing revision and improvement in each of the ten successive years of their delivery. 1 I took leave of the College on the occasion of the public meeting for the distribution of prizes in May. When I 1 After I had sent my letter of resignation to Dr. Grant, the Dean of the Faculty for that year, I received the following private letter in reply. University College, London : March 24, 1849. Dear Dr. Williams, Although for some years past you have prepared me to expect at no distant period the cessation of your labours in our College, I must say that it was with extreme pain that I read to-day to a full meeting of the Faculty your note of this date announcing your final determination to tender to the Council at their next meeting, your resignation of the offices which for ten years you have held in our College and Hospital so much to the advantage of our Medical School, and of the sick poor in this district, and of the rising generation of our professional brethren. I had still hopes that the ample appreciation of your distinguished talents, learning, and skill by our discerning students, and the pleasure we feel in doing that which we know we can do well, and the large beneficence of your acts here towards suffering humanity, would have kept you longer amongst us. Although it can little interest you to know it, I trust you will permit me to say that besides my bereavement by the loss of an old colleague, in so many points of kindred sentiment, your resolution deprives me of all remaining hope, as an admiring auditor of your invaluable lectures on the nature and cure of diseases, of supplying hereafter the portion of your highly philosophical and profound views of pathology, which my delicate health has robbed me of during the severer part of this winter. I remain, my dear Sir, with great respect, your grateful pupil, ROBERT E. GRANT. Dr. Williams. I RETIREMENT WITH < THANKS. 245 appeared in my gown, as usual, I was told privately by the Dean, (Professor Grant) that I was not expected. ' Why not ? ' said I. ' Oh it is reported that you have cut the College, and will have nothing more to do with us.' In my letter of resignation, I had asked to be promptly relieved of the hospital duties, which continued during the summer ; but I had no idea of shrinking from the public completion of the duties which I had never failed punctually to perform. In his address, the Dean made a most flattering allusion to my services ; and the loss which he experienced in my retire- ment ; this was so well received, that it elicited from the chair- man, what seemed to be an impromptu proposal of a vote of the 'thanks of the meeting, which was passed ; and I have some satisfaction in recording this, as it was the only complimentary acknowledgment I ever received from the College for my ten years of constant devotion to its work, at much sacrifice of health and comfort. I must say, I felt relieved at the release ; and thankful above all to the Giver of all Good, who had be- stowed on me this place of usefulness and honour, and granted me strength to fulfil its duties, to the best of my abilities, and to the satisfaction of my own conscience. 246 THREE REMOVALS. CHAPTER XXVIII. CHANGE OF RESIDENCE TO UPPER BROOK STREET. VARIETIES. 1850-1851. Eeview of Three Removals. Attempt to Return to Social Habits Devotion to Practice necessary. Essay on Use of Cod-liver Oil History of its Intro- duction Trial and Success Example Sensation Caused by the Paper Complaint of Dr. Hughes Bennett Letter of M. Louis Curative Power ol the Oil in Liver Disease. Homosopathy, False, if Medicine True ' Like Cures like,' not Founded on Fact, and Infinitesimal Doses Absurd, Hypo- thetically and Practically Appeals to Experience, disregard the Spon- taneous Cures of Nature, and confound Sequences with Consequences Evils of Homo3opathy Proposal to Meet a Homoeopath in Consultation Refusal Hybrid Homoeopathy. THE termination of the connection with University College left me free to prepare for another change, which had long been desirable, removal to another habitation, in size and situation, more suitable to the needs of a large family : for a family house in town I longed to have, after having been subjected so many years to shiftings and separations. In two years I was so fortunate as to secure a house in Upper Brook Street, near to Hyde Park, which had been occupied by the Earl of Shaftesbury, before his father's death ; when he succeeded to the title and the residence in Grosvenor Square. By adding a portico and two bed-rooms, I made it quite adequate to our needs ; and so rejoiced in a, commodious habitation in one of the choicest and healthiest spots in London. This was my third and last move in London. Ten years I was in Half Moon Street waiting for practice. Eleven years in Holies Street getting into full practice. In Upper Brook Street, it pleased God to continue my life for twenty- four years, in possession of a large consulting practice. This was the commencement of this last period, of nearly a quarter of a century ; a period by no means uneventful ; for each year SOCIETY POSTPONED TO PRACTICE. 247 has its portion of important occurrences ; but marking less change in the course of life ; and therefore less, calling for record, or fit for publication. The concerns of a public body like a college or university are fit matters for publication ; and it might be better for the public, if its eye were more upon them. But the records of private practice belong to the secrets of private life, and as a general rule, should be held sacred by those who are admitted to its confidence ; with par- ticular exceptions, to be made only on sufficient grounds. I formerly mentioned, that the heavy tax on my time and mental labour, caused by my first undertaking the Profes- sorship in University College, obliged me to give up all evening visiting and amusements, including even most of the conver- sazioni and meetings of learned societies. Some relaxation of this restriction might now be made ; and the new indulgence proved very agreeable. But I soon found that health began to put in a veto. Having got into a habit of early hours, and great regularity, it was not to be changed with impunity. Evening meetings, however pleasant, were exciting, as well as fatiguing, and would drive away sleep from the overwrought brain : and a sleepless night was a bad preparative for the day's work, even moderated as work had now become. Then as the calls multiplied, which they did almost day by day, and the need of rest more urgently felt, the conviction was forced upon me that I still ought to avoid evening parties, and superfluous causes of excitement ; and reserve my powers mainly for the daily work of life. Society and the arts had then* charms, to which I was by no means insensible ; and scientific meetings seemed still more legitimate in their claims on my interest ; but above all were the claims of eight children, whose prospect of provision clearly lay in the preservation of my health, and in my steady devotion to a lucrative practice. In the first number of the London Journal of Medicine, January, 1849, appeared a paper ' On the use and administra- tion of cod-liver oil in pulmonary consumption.' This was my first public notice on this subject, in which I had been engaged for the last three years. My attention had been called to 248 USE OF COD-LIVER OIL EXAMPLE. cod-liver oil as a useful medicine in scrofula, by Dr. Darling, who practised for some time in partnership with Dr. Neil Arnott ; and I had met him repeatedly in consultation. But the oil which he employed was of the impure kind used by curriers, and so offensive that I could never get patients to take it. In 1841, Dr. Hughes Bennett published a little book recommend- ing the oil, on the authority of Dutch and German doctors. He gave me a copy, and urged me to try the light brown, as less offensive than the common kind. I did try it ; but this also proved too disgusting for my patients to persevere in its use. Soon afterwards, several chemists began to produce oil from the fresh livers of the fish, much more free from the rank smell and taste, so that it became an available medicine. This pure oil I began to use in 1846, and with such surprisingly good results, that in 1848, I was able to report as follows. ' I have prescribed the oil in above 400 cases of tuberculous disease of the lungs in different stages, which have been under my care in private practice, and of 284 of these I have notes. Out of this number the oil disagreed, and was discontinued, in only nine instances. In nineteen, it appeared to do no good ; while in the large proportion of 206 out of 234, its use was followed by marked and unequivocal improvement, varying in degree in different cases, from a temporary retardation of the progress of the disease and mitigation of distressing symptoms, up to a more or less complete restoration to apparent health.' It is unnecessary to give further details from this paper, as the evidence which it gives of the power of cod oil as a remedy in consumption has been fully confirmed and extended by subsequent experience, particularly that fully detailed and explained in the work on Consumption, by myself and my son, published in 1871. But two or three extracts and notes may serve to illustrate the history of .the subject. Of the eleven cases described, the following is a sample. Miss ret. 28, of consumptive family : first visited Sept. 3, 1847, with Mr. Sawyer of Pentonville. Had slight cough ever since taking cold baths in summer of 1846. A glandular swelling formed below the jaw, and continued until the last two months. In March, 1847, an eruption of purpura appeared; and as it sub- sided, the cough became more troublesome, and flesh and strength EFFICACY OF COD- LIVER OIL. 249 visibly declined. In the last two months she has become much worse, with distressing cough and shortness of breath, evening fever and night sweats, absolute loathing of food, and rapid ema- ciation. A week ago, expectorated a few teaspoonfuls of blood, with some relief to breath and cough. Now much emaciated, very tremulous and feeble, with rapid running pulse, difficult to count. There was complete dulness over more than half of the upper left chest, with mixture of large gurgling and pectoriloquy. Below less dulness, and moist crepitus only accompanied the respiratory move- ments. Breath weak, with moist crepitus, also above right clavicle ; and large tubular expiration loud at the root of the right lung. This patient seemed in so hopeless a condition, and had such foulness of tongue and delicacy of stomach, that I did not like to subject her to the annoyance of a trial of the oil ; and therefore prescribed an agreeable draught with nitric acid, and a linctus for the cough. I visited her again in a week, and found her no better, but obviously rapidly declining, with the same insuperable disgust at nourishing food. Considering that matters could not well be worse, I did then order the oil, and took my leave, fully expecting to hear of her death in a few weeks. However, I heard nothing of her for two months, when one of her sisters came to consult me about her own health. I learnt to my surprise that her sister was not only alive, but comparatively fat and well, having little to com- plain of but hunger, and ' that she could not be allowed the run of the house, to eat any and every eatable to be met with.' This marvellous restoration of the appetite followed the first few doses of the oil ; and the diminution of hectic, sweats, cough and expec- toration speedily ensued. In Jan. 1848 I was requested to see her, uot on account of any check in her progress, but for a temporary ailment. On entering the room, I looked round it twice before I could recognise my patient, so entirely was she altered in appear- ance ; and she was, unquestionably, the healthiest looking person present. The pulse was at 80, of moderate strength, and the tongue quite clean. The fair outside was not, however, matched by an equal improvement within. The duhiess and cavernous sounds still continued in the upper half of the left lung, but with much less gurgling of liquid ; and the short crepitus of the lower parts of this lung had given place to a harsh and somewhat rough breath sound. The tubular expiration remained in the right interscapular region ; but the breath sound was dry and clear above the right clavicle. This lady called on me a fortnight ago (Nov. 1848), having been well and active ever since ; only acknowledging a slight cough and short breath on exertion. The chest on examination manifested 250 SENSATION AMONG DOCTORS AND DRUGGISTS. continued improvement. She has continued steadfast in the use of the oil, and happily believes and feels the truth of what I tell her, that it is as the staff of life to her. This lady lived many years after ; a further history is mentioned in the work on Con- sumption. The paper proceeds to discuss the mode of operation of cod-liver oil, a subject comprehended in the second edition of the Principles of Medicine, then just published; and con- cludes with directions for the preparation and administration of the remedy, on a due attention to which its utility and success mainly depend. ' If the experience of the profession at large should accord with my own, and with that of those who preceded me in recommending the oil, our prognosis with regard to phthisis must undergo some modification. To what extent this modification may reach, cannot be determined, until such cases as those which I have recorded shall have been tested by years of time : but even now, when we re- peatedly find forms and degrees of disease, that former experience had taught us to be utterly hopeless and speedily fatal, retarded, arrested, nay sometimes even removed, and almost obliterated by varying processes of restored health, we must pause ere we, in future, pass the terrible sentence of" no hope," on the consumptive invalid. ' In conclusion, I repeat that further observations, and longer time are required to determine with accuracy the extent to which this agent can control or remove tuberculous disease of the lung ; but I would affirm as the result of extensive experience, confirmed by a rational consideration of its mode of action, that the pure fresh oil from the liver of the cod, is more beneficial in the treatment of pulmonary consumption, than any agent, medicinal, dietetic, or regiminal that has yet been employed.' I hope that I may not be judged conceited, if I say that this paper caused a great sensation among doctors and druggists, the effect being more lively in the trade, than in the profession. It was reprinted in the Pharmaceutical Journal, and circulated widely through town and country; and I had the mortification to see my name paraded among the bottles of the shops. This was a notoriety which I was far from coveting ; and I did feel annoyed at sharing a popu- GENERAL APPROVAL 251 larity with patent medicines and quacks. Having always testified an abhorrence of everything savouring of quackery, I began to meditate how I could best clear myself of such imputation. But further reflection and multiplying experience set me right, and banished my qualms. I had published nothing but what I knew to be truth, and truth which might be, and ought to be, useful to the community. In this view it became a duty to make it known for the public good, with- out too sensitively regarding censorious criticism. And I soon found that most of the world was with me. I not only received many congratulations from professional men on my success, 1 but patients came in increasing numbers to get the benefit of the new remedy ; I must correct that expression ; for new it was not, nor had I the merit of introducing it. Dr. Hughes Bennett 2 was five years before me ; Dr. Darling 1 I insert only the following letter, which is remarkable, as coming from a man whose large and gloomy experience had rendered him very sceptical of the power of any remedy in this destructive disease. Monsieur et honore Confrere, J'ai lu avec tant d'interet le memoire que vous avez publie sur le traitement de la phthisie par 1'huile de foie de morue, que je vous prie de me permettre de vous faire mes felicitations a ce sujet. Vous avez observe avec soin : vous avez ensuite analyse avec exactitude les faits soumis a votre observation ; c'est la seule maniere d'arriver a la v6rite ; et les vrais amis de la science ne peuvent que vous remercier d'un travail tres penible (?), et qui, s'il est continue^ ne peut manquer de produire de grands rSsultats. Mais ne vous arretez pas en si beau chemin, et s'il se peut (car ce sera le complement de votre travail), suivez les malades que vous avez traites, dont vous avez ameliore la position, pendant quelques annees ; ce sera le sujet d'un memoire, encore plus important que le premier, et qui vous 61evera tres haut dans 1'esprit de vos contemporains. Encore une fois, continuez vos travaux, et agreez, monsieur et honore con- frere, 1'assurance de ma tres-haute consideration. Louis, Me"d. de 1'Hotel-Dieu. Paris, le 26 Oct. 1849. The exhortation of M. Louis was not in vain ; and some of the results were recorded in our work on Consumption, in 1870, when the great champion of the numerical method had ceased to count. * Here, as on former occasions, I make a point of acknowledging the priority of Dr. Hughes Bennett in the recommendation of the cod-liver oil ; but I never succeeded in giving him satisfaction, as may be inferred from the following note appended to this paper : ' In a recent number of the " Edinburgh Monthly Journal of Medical Science," the Editor, Dr. Hughes Bennett (or some one writing under his direc- tion) accuses me of plagiarism, in adopting his explanation of the action of the cod-liver oil without acknowledgment. But this explanation, which is not 252 REASONS OF SUCCESS OF COD-LIVER OIL. thirty years, and Dr. Bardsley of Manchester fifty years, in re- commending cod-liver oil as a remedy. If any credit is due to me, it was in my proving that the fresh pure oil, which every one can take, is at least as efficacious as the impure oil, which very few could take, in my encouraging chemists to obtain it in that pure state ; and in my devising various means of facilitating the administration and securing the agreement of the remedy. These particulars, first given in this article in the London Journal of Medicine, were repeated more fully in subsequent publications (Principles of Medicine 3rd edition 1856, and Pulmonary Consumption &c. 1870), and require no further notice here ; but one passage relating to the peculiar influence of the oil on the digestive organs and liver, deserves to be quoted, as bearing on points which have escaped general attention. ' Unlike other oils or fats, cod-liver oil rarely disorders the stomach or bowels, or disturbs the function of the liver. If taken in any quantity, vegetable oils commonly purge ; and animal oils turn rancid in the stomach, causing heartburn, bilious attacks, and even jaundice. On the contrary cod-liver oil generally improves all the chylopoietic functions, and distinctly promotes the action of the liver ; so that, in several of the cases above narrated, the appetite and power of digestion are restored, and patients are enabled to take an amount and variety of food, beyond what they were accustomed to, even in health. I cannot help thinking that his, but quoted frqm Ascherson and other German writers (and is combined by Dr. Bennett with the notion of the oil acting by its iodine), is by no means that which I propose, as may be seen on reference to the text. The professed review which contains this accusation, betrays such gross misunderstandings of the work, which it criticises, and such a spirit of personal jealousy, that I do not think it needful to notice it.' I really do not know what first set Dr. Bennett in such violent opposition to me. I could not agree with all his views ; but in my dissent I was never aware of having said anything person- ally offensive ; yet in the review of my ' Principles,' above alluded to (the only unfavourable one, I believe, that had ever appeared), the general tone was that of such open hostility, accompanied by so much inaccuracy and misrepresenta- tion, that I thought myself called on to reply to it-. But on consulting Sir James Simpson, who had always been my excellent friend, and who was Dr. Bennett's colleague, and sometimes his friend also, his advice was, ' Just take no notice.' So I held my peace, and made no reply. Not so Professor Bennett ; for I have heard from several of his students, that he used to make a regular practice of ' pitching into me ' in his public lectures for many years. But peace to his ashes ! I knowjnot whether he has left any echoes against me on the walls of my Alma Mater. VARIED USES OF COD-LIVER OIL. 353 this peptic influence of the oil is due to its containing some biliary principle, which both favours its divisibility in the process of diges- tion, and promotes the natural secretions of the liver. The flow of bile, as indicated by the colour of the faeces, is generally free and uniform during its exhibition ; and I must not omit to notice another fact, which I believe to be connected with increased activity of the liver. I have in numerous instances remarked that the bulk of the liver (as determined by percussion) becomes augmented during its use, yet without tenderness, or other sign of disorder. In fact this seems to be a kind of useful hypertrophy, induced by the oil increasing the bulk and number of the hepatic cells, and supplying also a material more fitted for this secretion, because it has already within it some elements of biliary matter, which served a similar purpose in the liver of the fish, and this at a lower tempera- ture, and less favourable to the activity of the process. The obser- vation of this influence of cod-liver oil has led me to use it in several cases of functional and structural disease of the liver, marked by defective or depraved secretion ; and in some instances with most satisfactory results ; especially in one of habitual formation of gall- stones, which had resisted all kinds of treatment, and was rapidly destroying the health : the use of the oil has entirely stopped the attacks and has restored the patient to good health. ' It appears therefore that although other oils might be equally influential in promoting nutrition, and in preventing and removing the cacoplastic and aplastic exudations of scrofulous subjects, the oil from the cod's liver, and perhaps those from the livers of other fish, have the advantage in point of digestibility, and in promoting the action of the digestive and biliary organs. ' The case of recurrent gall-stones, above referred to, was that of a well known dignitary of the Church, and has been noticed in some journal, but I do not remember where. When he came under my care, his health and strength were rapidly declining, under the painful attacks, recurring with increasing frequency, accompanied by jaundice and rapid emaciation. The curative effect of the oil was marvellous and permanent. I heard of his death at a good old age only two or three years ago full thirty years after that illness. There have been many other abiding records of the efficacy of this invaluable remedial agent. The sensational exaggerations, attending on its first becoming popular, have subsided ; but. it has taken the high rank among the means 254 HOMCEOPATHY DOGMAS UNTENABLE. for strengthening health and resisting disease, which our im- proving knowledge of these problems assigns to it. My readers can have hardly failed to perceive that I am a believer in medicine. I hold it to be a corollary from this affirmation, that I disbelieve in what is called Homoeopathy. I have not room in these memoirs, to pursue the argument in detail : but I protest, in limine, against the fundamental dogmas of the homoeopathy of Hahnemann. I. ' Similia similibus medentur,' or, ' like cures like ; ' and II. ' Infinite- simal medication,' involving the paradoxical and gratuitous assumption, that an wifinitesimally small (or any small) quantity, shall have the reverse of the effect of a large quantity. So far as I know, both of these, as absolute propositions, are utterly untrue. I. Like cures like. Homoeopaths tell us that thus cow-pox cures or prevents small-pox ; that sulphur, which can produce an eruption like itch, thus cures itch. On the contrary, physicians know that cow-pox is really the same disease as small-pox, but in a milder form ; and that vaccination prevents the occurrence of small-pox, (not by like curing like, but) by anticipating it, by producing the same disease in a mild and harmless form. Physicians know also that sulphur cures itch (not by causing a new eruption, which it very rarely does, but) by killing the itch-insect, which is its true cause. Other examples adduced by homosopathists to prove that like cures like, can be equally set aside by the knowledge of the physician. II. In ' infinitesimal medication,' I can see nothing but an outrage on common sense. Take it hypothetically ; how can an increasing negation ever become a positive quality ? How can the diminution of a property ever attain an opposite action ? How can the large dilution of an agent effect a reversal of its operation ? I know that homosopaths give fictile replies to such hypothetical questions ; but the examples adduced in these replies, are more logically and simply ex- plained by the physician. But look at the practical working of this infinitesimal medication) and see if it does not spurn all HOMCEOPATHY A METAPHYSICAL FANCY. 255 control of appreciability through the most delicate tests, and fly into the mystical regions of innumerability and utter vagueness ! They pretend indeed to express in numbers their infinitesimal dilutions, and talk flippantly about their billionths and trillionths and decillionths of a grain, as if these were comprehensible numbers, and not mere abstractions of thought, belonging exclusively to the transcendental regions of mathe- matics and astronomy. To pretend that such practical non- entities are physical agents, capable of controlling the bodily powers in the treatment of disease, is more monstrous than the frauds of mesmerism and magic. If homoeopathy has any real agency, it is not physical, but metaphysical, through the mind and imagination, which is wonderfully active in atoning for the failures of all sorts of mockeries of medicine. Then, in defence, rises the fallacious argument of experimental success of homoeopathy, attested by a fallible public and by two or three fanciful peers, pacing in the tracks of post hoc, ergo propter hoc, and ignoring the beneficent hand of kind Nature, who cures many diseases, in spite of bad treatment, or of no treatment at all. Where statistical comparisons have been carefully made on a large scale, and with strict attention to all conditions, as in the hospitals of Vienna, the mortality has been proved to be much greater under homoeopathy, than under legitimate medicine. 1 It has fallen to my lot to meet with several instances, in which precious time has been lost, and life has been sacrificed, by the patients trusting to Homoeopathy in the early treat- ment of their illness. These remarks will sufficiently explain the following correspondence, which appeared in the Lancet, March 23, 1850. Dear Sir, I am very desirous of having your opinion in a case of suspected disease of the heart. The patient is the Hon. Mrs. residing at present with Lady , Square. Will you have the goodness to inform me at what hour on Monday it will be convenient for you to see her ? I think it right to state that Mrs. has been for many years a convert to homoeopathy, and that I, as you may possibly have 1 Homoeopathy, its Tenets and Tendencies. By Sir James Y. Simpson, M.D. and P. F.R.S.E. 1853. See also Dr. Routh's Fallacies of Homoeopathy, 1852. And Dr. Wood's Homoeopathy Unmasked. 256 REFUSAL TO CONSULT WITH A HOMCEOPATH, heard, practise that system of treatment. I mention this as you may have some objection to meet a Homoeopathic physician in con- sultation ; and I should much regret if I were the means of inducing you to do anything distasteful to you in ignorance of the ahove facts. I may however mention that it is as a matter of diagnosis rather than of treatment that your opinion is desired ; and that my friends Sir and Dr. have seen the case with me on former occasions. I remain, dear sir, your very obedient servant, . To Charles J. B. Williams, M.D. (Reply.) 7 Holies Street, Cavendish Square : Feb. 1850. Dear Sir, I am obliged to you for your courtesy in wishing to have my opinion on the diagnosis of the case of the Hon. Mrs. and for your candour in apprising me that she is under homeopathic treatment ; but under these circumstances, I must beg you to excuse my attendance. Believing as I firmly do, that the so-called ' homoeopathic system ' is an entire fallacy, and therefore calculated to do much injury to those on whom it is practised, I consider it to be my duty to do nothing that can, directly or indirectly, countenance or aid it ; and it appears to me, that to meet a homoeopathic physician in consulta- tion, and to assist in the diagnosis of a case, professedly under homoeopathic treatment, would have such an effect. I need scarcely add that I have no personal feelings in the matter. And hoping that you will soon return to the domain of legitimate medicine, I remain, dear sir, yours faithfully, C. J. B. WILLIAMS. To Dr. In speaking of Homoeopathy, I allude to that of its inventor, Hahnemann, professedly adopted and strictly followed by numerous disciples. We are told now that modern homoeo- paths no longer hold his characteristic doctrines, either of similia similibus, etc. or of infinitesimal doses. If so, they are no longer homoeopaths and if they retain the title, they de- serve to be denounced as swindlers, practising and obtaining money under false pretences. SCRIPTURE STUDIES. 257 CHAPTEE XXIX. MORE TIME FOE ATTENTION TO FAMILY, ETC. 1851-1852. Scripture Studies Education of our Children Juvenile Amusements. 1 World's Fair ' Crystal Palace in Hyde Park Triumph of Light and Knowledge Congress of Nations Patron, the Queen Prince Albert, Originator and Foremost Kepresentative of Future Progress Duke of Wellington, Representative of Historical Glory, and of Present Triumph of Duty and Honour. Death of the Duke of Wellington, 1852 Author Summoned Death before Arrival Account of his Last Illness Anecdote Invitation to Funeral Procession Reflections. ALTHOUGH my time was well occupied with a rapidly increas- ing practice, my retirement from the trammels of College and Hospital engagements, gave me more liberty in its disposal. Instead of having to hurry off to the lecture after an early breakfast, I could have my leisure repast with my elder sons, and a short time for Scripture reading and prayer, before the arrival of patients. Our Scripture study was that of the Greek Testament, of which I had already made a daily practice for some years ; and this was continued during the remainder of my life in London. Conscious that I had not sufficiently mastered Greek in early life, I had always a desire to know it better, not only on account of the beauty and rich- ness of the language, and its aptitude for supplying new words in literature and science, but above all, because it is the language of the inspired Word of Life, and thus may become a key to the most precious of all knowledge. When old enough, my daughters also joined in this study, with occasional assistance of a friend, a good Greek scholar, the Eev. Hugh McSorley, M.A. T.C.D. It is not to be expected that knowledge of Greek, derived from the study of the New Testament only, however prolonged, could be critical or profound ; but I can testify that it has enabled me to comprehend the exact mean- 258 EDUCATION OF SONS. ing of the Sacred Text more fully and satisfactorily than I could from any translation. The Eevised Version, I find on the whole a considerable improvement on the old : but it seems to me in many passages to fall short of the fulness of meaning conveyed by a more literal translation of the original ; although this may sometimes be difficult to express in English idiom. In recording the restoration of the fuller enjoyment of family associations consequent on my release from college engagements, and removal to a larger house, I am reminded to say a few words on my children and their education. Of five sons, of ages from fourteen downwards, the three eldest had been sent to preparatory schools, of which Mrs. Bartlett's of Sussex Square, Brighton, and Messrs. Adams and Langtry of the same town, deserve mention. With the eldest, James Thomas, private tuition seemed more suitable than school, as, like his father, he had more taste for tooling and technical matters, than for classical studies ; and he was placed with my old patient and friend, the Eev. Charles Bury, at Bon- church in the Isle of Wight. Later he was sent to the care of Dr. Wagner, a pastor near Stutgardt, where he made good progress in German and French. The second, Charles Theodore, who had done well at school, I sent to Harrow; but after a year of promising study, he had a severe attack of rheumatic fever, which rendered him unfit to return to school ; and I placed him, together with his next brother, Harry Samuel, under the able tuition of the Eev. Charles Bradley, of Southgate, the eldest of that well-known family, renowned especially for scholastic eminence. With him they remained for two or three years, to the great improvement of body and mind, until they entered the Universities : Charles at Oxford, Harry at Cambridge. They both passed a creditable career, and graduated with honours. Of the younger sons and daughters I may have occasion to speak later. It will be easily understood that this increased freedom and opportunity of enjoying the society of my family in their occupations and amusements, was a great improvement on the close college life in Holies Street. Fond as I was of my profession, and finding good cheer and encouragement in the BOYS* DIVERSIONS CRYSTAL PALACE. 259 success with which I pursued it, it was a very charming as well as refreshing change, to have now and then an hour or two of diversion, in a visit with my boys to the Polytechnic, the Botanic, and the Zoological Gardens ; and to enjoy the pleasure of watching on their minds the impressions produced by such objects, as used to delight me at their age : and they all had the same taste for natural history and natural science that I had. But there was this difference. They had such an abundance of these sights, hi London, and such numbers of books and pictures descriptive of them, that they soon became satiated, and lost their keen relish ; whereas I, in my dull country home, was in a state of semi-starvation, from paucity of objects, and scarcity of books. And I think I should have gone right mad, if I could have had a Polytechnic or a Zoological, brought to me at Heytesbury. But probably the poverty of the objects, became the means of driving the mind to greater effort, and the senses to examine more closely and search more deeply ; and so not only to find more, but to more fully exercise and strengthen the mind in the search. In this year, 1851, came the 'World's Fair; ' the First Great Exhibition in the Crystal Palace in Hyde Park. This was to be the great feast to all, young and old. I made a more careful study of this than of those succeed- ing : they were larger and grander ; but this was the first, and my impressions from it were stronger : particularly these ; that whilst Britain asserted her superiority in everything relating to mechanics and engineering, 1 her inferiority and 1 Among the interesting mementoes obtained at the closing of the World's Fair, there was one which deserves mention on account of the curious experi- ence which I had of it during its use. It was a spring bedstead, and I called it my sympathising bed. It was very cleverly constructed, of the best materials, and beautifully painted with flowers in enamel, to grace the Exhibition. The spiral springs were not cased in a canvas, but open, supporting the hair mattrass by alight jointed frame. So it formed a charming soft but elastic bed. But I had not slept on it for many nights, before I discovered in it another virtue which I did not anticipate. It was symphonic. Whether from toothache or other pain, or even from weariness or want of sleep, I was often in the habit of slightly moaning, as I lay. To my surprise my moans were answered, by a consonant note, from some of the springs of my new bed. Whatever the pitch of the moaning voice, it was answered by the corresponding vibrations of some portions of the metallic coils. So I moaned not alone, but heard a symphonic accompaniment to all my plaints. And I found it soothing, if not s 2 260 HISTORIC PERSONAGES OF THE WORLD'S FAIR: poverty in all objects of taste and decorative art was quite humiliating. This inferiority entirely disappeared in subse- quent exhibitions. The British manufacturers learned a great lesson from that first exhibition, and have since accom- plished gigantic strides of improvement. Another triumph, accomplished in that exhibition, excelled any of those which came after, the triumph of the genius of the scientific naturalist, over the gloomy conceptions of classical architecture. The substitution of Sir Joseph Paxton's crystal roof for the dark ceilings of the architect, was significant of the want of the age, which struggling out of mediaeval gloom, was crying for ' More light ! more light ! ' Besides the objective marvels of this First World's Fair, there was the grand historical fact of the congress of all nations, and the personal presence of the foremost represen- tatives of humanity from all quarters of the world to inaugurate the event. Her Most Gracious Majesty the Queen, in opening this exhibition, emblazoned this day as one of the most glorious in Her prosperous reign. Under Her, was an assemblage of the great, in every rank and sphere, who had joined to aid and celebrate this grand step of human progress ; but conspicuous above all, stood two most prominent personages whom, brief as this notice is, it is impossible not to name. Prince Albert the Good ; who was the first to conceive the bright thought of devising this World's Fair, and in maturing it } as in forwarding many other beneficent movements, fulfilled his mission of leading human progress and of ad- vancing the public good. Next stood, Field Marshal Duke of Wellington, hero of a thousand fights, conqueror of Europe ; the Historic Representative of past glory, the personification of the triumph of Duty and Honour. In little more than a year after this I was summoned to sympathetic, and beguiling, in the solitude of night watches. The sounds thus produced, are harmonic sounds, in unison, or other concord, with the first sound ; and may they not, even mechanically, tend to tranquillise discordant motions and feelings ? It would be absurd to associate such coincidental grumblings with the charms of music ; but we have not yet fathomed all the relations of vibrations, musical and other, with sensation, sleep, and other functions of the nervous system. I was sorry, when I left London, to lose my symphonic bed. I left it for an invalid son. DEATH OF DUKE OF WELLINGTON. 261 visit this Great Man at Walmer : but his spirit had fled before I arrived. On September 14, on calling at my house about 4 P.M. I found the following telegram : ' SOUTH EASTERN RAILWAY ELECTBIC TELEGRAPH. LONDON STATION. At 2.19 P.M., Tuesday, 14th day of Sept. 1852. Received the following message : From Name Lord Charles Wellesley Address Walmer Castle, Deal To Name Dr. C. J. B. Williams Address Late of 7 Holies Street, and now 49 Upper Brook Street, London Dr. C. J. B. Williams, late of 7 Holies Street, is requested to come to Walmer Castle immediately. Dispatched from London Office at 3.31 P.M.' I had never attended the Duke, nor had I any intelligence of his illness : in fact, I could only guess that the message related to him. The only way to ' come immediately,' was to wait for the next train, which was to start at 6 P.M. (I think). Had I taken a special train, it was doubtful that it would arrive sooner, and the message did not seem to warrant my taking that step. There was no message to stop my coming at London Bridge : but on the journey I heard a rumour of the Duke's death. On arriving at Walmer Castle, between 8 and 9, I learnt that His Grace had been dead several hours, I do not now remember how many, but the death must have taken place before I received the message in London. I heard from Lord Charles Wellesley the particulars of his illness, some of which I will relate, so far as I can remember them. The Duke was in his usual health the day before, Monday ; and had driven to Dover to meet a friend who was to arrive by steamer. The packet was behind time ; and the Duke walked with Lord Charles on the pier, seemingly quite well ; and as usual, plying the men with questions about what they were doing. His sight was so good that he described to Lord Charles what he could see on the French coast, 'where,' Lord Charles added, 'I could see nothing.' (Lord Charles's sight was defective : I saw him afterwards when he became blind, from the disease of which he died.) 262 HIS TOR YANECDO TE. The Duke was thus kept waiting ; and returned to dinner two hours after his usual time. He was very hungry, and ate hastily and heartily. I am not sure, but I think his valet told me that a meat pie and cold salad formed part of the dinner ; and I know that he mentioned that the Duke drank a great deal of water, but not a drop of wine or spirit. In the night he had a severe epileptic fit, to which he was liable ; and on recovering, desired his valet to send for Dr. Hulke, his usual medical attendant, who came and administered proper remedies, but I do not remember further particulars. I did not then see Dr. Hulke, but met him after at the funeral. We agreed in attributing the death to the consequences of the violent convulsive attack, brought on by an over-distended stomach. He lived, it is true, to a good old age : but it can hardly be doubted, considering how well he seemed to be the day before, that but for that long and exhausting fast, and the large and hasty meal of cold indigestible food, he might have avoided that attack and lived for a while longer. The Duke, although a strict disciplinarian, was wayward as a patient, and had Spartan notions against self indulgence of any kind. Dr. Eobert Ferguson told me that once the Duke complained to him of his feet getting cold in bed. ' I would advise your Grace,' said Dr. F. * to have a hot bottle in your bed.' ' Hot bottle ! Naw, naw ! I rub 'em rub 'em half-an-hour.' A good sample of the Iron Duke's endurance as well as natural sagacity. I have proved the benefit of imita- ting his perseverance : rubbing one's own feet, at first seems a feeble and fatiguing exertion, and with little result : but if you take a leaf out of the Duke's book, and go on rubbing for half-an-hour, or even a quarter of an hour, you will surely find not the feet only, but the whole body, in a glow. In reply to a letter which I wrote to the Marquis of Douro to express my own and my portion of a nation's condolence on our great loss, I received the following : 3 Upper Belgrave Street : Oct. 17, 1852. " Sir, It may be some slight compensation for the anxiety and pain that you must have felt as an Englishman, that you have the assurance that in your skill the utmost confidence was placed. INVITATION TO WELLINGTON FUNERAL. 263 " Providence willed that we should all be disappointed, and we are left to hope that his mission on earth has been fulfilled. I have the honour to be, sir, your obedient humble servant, DOUEO." Dr. Williams. I learned that I owed the honour of this distinguished, although disappointing, engagement, to the good opinion of my friend the Earl of Clanwilliam, who, occupying Deal Castle, was near neighbour to the Duke. A few days later I received the following invitation. Earl Marshal's Office, Parliament Street : Oct. 28, 1852. " The Earl Marshal has it in command to invite Dr. Williams to attend in the Proceeding to the Funeral of Field Marshal the Duke of Wellington. Dr. Williams will be accompanied in the same carriage by Dr. Hume and by the Chaplain General of the Forces and the Chaplain of the Tower." At 8 A.M. on the morning of the Funeral, November 18, by direction, I entered the Park by Buckingham Gate, and joined the procession of the carriages preceding the Funeral Car, and was joined by not those indicated in the Earl Marshal's letter, but Dr. Eobert Ferguson, (my old friend), and Dr. Hulke. That procession, its object, its composition one Illustrious Dead, and thousands of Living Mourners, the streets and houses crowded by millions, through which it passed, and the vast solemn edifice, which, serried with figures and furnitures of mourning, received the departed to his last Home these all formed a scene to be beheld once only in a lifetime, and once seen never to be forgotten ! A mighty nation, headed by its Beloved Queen, personally present in crowds of millions, and all other nations of the earth represented by their magnates and ambassadors appointed for the occasion were assembled to do homage to the memory of One Man, whose corpse was borne before them to the tomb. Our place in the Cavalcade was favourable for watching the procession through all the stages of its progress, which was from St. James's Park along the^ Birdcage Walk up Consti- tution Hill to Hyde Park Corner, Piccadilly, St. James's 264 PROCESSION REFLECTIONS. Street, Pall Mall, Charing Cross, Strand, Fleet Street and Ludgate Hill, to St. Paul's Cathedral. As the procession was slowly winding up Constitution Hill in sight of Apsley House and the bronze statue on the arch, the plaintive notes of the Dead March in Saul sounding from between the trees, we could not but be moved with the thought, that now he was passing for the last time by the way of his habitation at Hyde Park Corner, where, for forty years past, his familiar figure had been so often seen, seeming, as it were, to belong to the place but hencefor wards, ' the place thereof shall know him no more.' Our position in the Cathedral, was quite in the centre, on the ground floor, close to the funeral car ; with a crowd of Kings' sons, Princes, and Ambassadors, behind us, and with the fullest opportunity of seeing and hearing everything. I could not but be grateful and proud of the privilege of taking part in such an event ; but not without a humiliating thought of how little I merited the honour. PRIVATE PRACTICE. 265 CHAPTEE XXX. FULL ENGAGEMENT IN PRACTICE. PROFESSIONAL FRIENDS, &C. 1853-1857- Full private Practice More at home than in Families. Claims of Authorship In ' Principles ' assisted by Dr. Mann In ' Diseases of Chest,' assistance promised by Dr. Quain, but not rendered This work therefore postponed, and never published. Largest Eeturns from Private Practice Not in pro- portion to number of patients ; but continued with little abatement nearly 20 years. Heavy Family Expenses Losses by bad investments. Friends skilful in invention and use of remedies Mr. James Startin success in Skin Disease Sir James Simpson Enthusiasm and Fertility of invention Anaesthetics Inhalation of Carbonic acid gas Shortened his life by Overwork, but laid hold of, and held forth, the Light of Life Dr. Richard Bright Painstaking, Judicious, and Expert, in old and best remedies. Value of Pharmaceutical knowledge Mr. Peter Squire Successful in his Preparations and Works Vegetable Extracts Chamomile tea Jacob Bell Syrian Aid Medical Mission Pharmaceutical Society and Journal Patron of Art Mr. T. H. Hills. AFTER my establishment in my new residence in Upper Brook Street, my time was chiefly devoted to private practice, less laborious, and much more remunerative, than College and Hospital work. Morning consultations formed the chief part of the practice ; and for these I was at home from 9 till 1, and often detained till 2 or 3 P.M. Many of the patients were sufferers from chest disease, and many were new cases ; all requiring lengthened and minute examinations. From twelve to eighteen was the average attendance, which would occupy the whole time ; but occasionally the number of patients would rise to twenty, and even twenty- four, which would keep me at home till 3 or 4 o'clock. The visiting practice lay chiefly in consultations with other practitioners, which occupied the time through the rest of the afternoon. I had never a large family practice ; and therefore was rarely called out at late or 266 DEMANDS OF AUTHORSHIP. early hours. The families, who habitually employed me, were a few among the nobility, bankers, merchants and others of the upper ranks of the middle class, who generally were also my intimate friends. We did not mix much in society. The frequent ill-health of my wife, and the necessity for strict and regular living, which my past trying life had laid on me, interfered with much visiting ; and although they deprived me of much social enjoyment, these comparatively recluse habits reserved strength for what were absolutely necessary, professional occupations. And this work included, not only the private practice, to which I have been alluding, but also the duties of authorship. My office as public instructor did not terminate with the release from University College ; there was a call from the public for new editions Of my published works. The second edition of the Principles of Medicine was issued in 1848. Early in 1853, it was exhausted, and I had immediately to provide for its renewal. 1 But this was no easy matter ; involving the necessity of much reading of recent works in physiology and pathology, to bring the information up to the advances of the present day. This I could not do by myself without working at night more than in my state of health, and with fully employed days, would be safe. But I was most glad to find the needed help hi my old pupil and friend, Dr. E. J. Mann, himself the suc- cessful author of several elementary works in physiology and other branches of science. He zealously undertook, and faith- fully fulfilled his task to my great relief and satisfaction. But even with his able assistance, it took me nearly three years to complete this edition, including as it did much original matter, requiring much thought and careful delibera- tion. On this work I need not dwell longer, having already anticipated the subject in Chap. XXIII. 1 Princes Street, Soho : Feb. 17, 1853. My dear Sir, Since you favoured me with a call, I have had an order from India for 25 copies of your ' Principles of Medicine : ' I could only send 11 copies, and have now not one copy on hand. It is a pity such a work should be so long out of print ; particularly as it is recommended by several teachers to their classes. I am, Yours faithfully, JOHN CHUKCHILL. Dr. Williams, F.B.S. DISAPPOINTED OF ASSISTANCE. 267 A work from my pen on Diseases of the Chest, was another intended undertaking, and the more incumbent on me, as I had promised it to the profession more than ten years before, and the small volume, embracing only a part of the subject, had been also out of print for several years. I had a large amount of material, unpublished, or only partially published, accumulating for this object, and every year added to the stock. But with my increasing engagements, and weight of responsibility in private practice, I rather shrank from under- taking a great new work single-handed, and desired to find some one to join me in it. Dr. Eichard Quain had been in the habit of assisting me for several years, not only in his official capacity of House-Physician to the hospital, but also in private practice, when, from pressure of engagements, or from ill- health, I was unable to attend. I had also frequently deputed him to take charge of my patients in my absence, with the understanding, according to my rule, that he should retain the honoraria. He had not been my pupil in the class of Medicine, having followed the Course of Drs. Elliotson and Copland before my appointment ; but he was a regular attendant at my clinical lectures, and was quite conversant with my views and practice. He had been recently appointed Assistant Physician in the Hospital at Brompton, which gave him a wide field of experi- ence in diseases of the chest. What then could be more natural and fitting than that I should propose to Dr. Quain to join me in the production of this work on Diseases of the Chest ? This I did, also with the understanding that we should be equal participators in the profits. To this he assented with great apparent gratification and good will ; and the work was publicly announced in our joint names by Mr. Churchill, as preparing for publication. Writing for this work now became the occasional occupa- tion of my most leisure hours. It was less pressing than that for the ' Principles,' and could bear waiting. Still I intended steadily to proceed ; and had already written upwards of a hundred pages, when I began to question Dr. Quain as to his progress ; the answers were not satisfactory. This went on for months and years, without anything forthcoming on his part ; and the ultimate result has been, that although he has 268 DEVOTION TO PRACTICE. continued to be my confidential friend and assistant in prac- tice, to his own advantage, as well as to mine, he has given me no help in this or other literary work. The sequel (I know not if I may say the consequence) of the delinquency was that I soon also ceased to write ; and the work has been in abeyance ever since. Such is the fact; and it is not to the credit of my independence, or of my resolution, that, being disappointed of the promised co-operation, I have allowed the fruit of much labour and thought to remain buried and un- productive through the period of upwards of thirty years. I know not what excuse to make for Dr. Quain. For my- self, I can only plead that, being disappointed of his expected co-operation, I began to feel increasing inaptitude for more work than was positively necessary. I had good employment in practice ; and felt generally tired enough at the end of each day's work, to make me glad of rest. In fact neither in bodily health, nor in mental vigour, had I recovered from that ten years' strain, which I had struggled through; and friends were continually urging on me that I needed more rest. And more rest I did take. Postponing for the time the calls for re-publication, or fresh enterprise, I devoted myself entirely to the duties of my large practice, which occupied me from ten to fourteen hours in the day, and brought me a large income, of from four to seven thousand a year. Unfortunately I have mislaid the memoranda of the fullest years ; but I know that it never exceeded the latter amount. I had the credit of receiving much more ; perhaps from the numbers of patients who consulted me : many of these, however, came only once or twice, and I never saw them again. This kind of practice occupies much time and thought, involves great responsibility, and is by no means remunerative in proportion. I was one of the first to introduce the rule of demanding double fees for first consultations ; as justly due for the greater expenditure of time and skill, which they require ; and this practice has since become more general ; with the result of considerably increasing the incomes of consulting physicians of the present day ; but it was not sufficiently adopted in my time to give me its full benefit. Therefore my largest receipts, handsome as they were, did not equal those of fashionable physicians of GAINS LESSENED BY LOSSES. 269 olden times, nor of the two or three special favourites of the present day. Doubtless, my practice was much enlarged during the early years of my connection with University College ; but for the last two or three years, its heavy duties restricted the further increase ; and as soon as I was relieved of these, the augmentation went on rapidly, and did not abate during the succeeding twenty years, until infirm health and advancing age began to tell on me. It might be expected that so large an income, continuing for so many years, must have made me a rich man : but such was not the case ; and although I have always had reason to be thankful for a comfortable competency, circumstances have occurred to withhold anything like great affluence. The ex- penses of a large family (of whom five were boys) were heavy, and increased with the demands for education. But the greatest cause of limitation of my wealth was bad investment ; through which I sustained losses, amounting to more than I like to mention. I cannot acquit myself from the charge of imprudence and foolish credulity in these unfortunate transac- tions, which stamp my conduct, as largely wanting in worldly wisdom. Although in practice as well as in writing, always endea- vouring to pursue a rational method, I was also on the look out for useful knowledge resulting from mere experience, where that was sound and reliable. Much information on the use of medicines, and on the application of remedies, is to be gathered from the medical journals of the period : but I found great advantage of this kind, also from intercourse with a few able men who have a peculiar talent for finding out, and for happily applying, successful methods of treatment. I have already mentioned Sir Charles Locock, as excelling in this knowledge of remedies. Another, whose name I would record, as also that of a dear and valued friend, was Mr. James Startin, whose treatment in his special department, diseases of the skin, was far more successful than that of any other practitioner that I ever knew. His knowledge may not have been very scientific, or based on very exact pathological investigations: but he succeeded in curing aggravated and inveterate forms 270 FRIENDS CLEVER IN PRACTICE. of disease, that had baffled many other practitioners. He was the first to introduce the free use of glycerine in medicine ; and having traced acne, and other follicular diseases to fatty concretions, he successfully applied oil of turpentine and other essential oils to dissolve and disperse them. He was remark- ably ingenious and fertile of resource in the use of caustics, and in small surgical operations ; and had for cutaneous affections a variety of pigments, which seemed complicated and unchemical in their composition : yet they were nevertheless efficacious, not only in covering unsightly appearances, but also in soothing and in promoting a healthy action. I could not always equally approve of his internal remedies, some of which were much like those prescribed by Dr. H. Jephson of Leamington, combining tonics with aperients ; and I often heard complaints of their disagreement : but I must also add, that they sometimes wrought a cure, where simpler means had failed. Startin had great confidence in my medical skill ; and we were warmly attached by mutual obligations in friendly and professional intercourse. Another dear friend, whose communion used to delight me, also in connection with his earnestness and with the fertility of his resources, was Sir James Simpson, the dis- tinguished Professor at Edinburgh. I did not deserve his friendship at the beginning, for my intimacy with Dr. Evory Kennedy of Dublin, had led me to support him, Dr. Simpson's opponent, in the election to the Professorial Chair. Neverthe- less, I heard so much of Dr. Simpson's kindness in the family of my cousin, Archdeacon Williams, and of my youngest brother, with whom he was most intimate, that I could not but welcome him warmly, when he sought me out in his visits to London. And there was something so winning in his simple heartiness, and so charming hi his enthusiasm in the progress of our art, that our intercourse was ever after a source of much enjoyment and benefit. At one time he tried to per- suade me that it would be to my advantage to exchange my field of action, from London to Edinburgh ; and urged that a professorship in the latter university would be preferable to any similar office which London could offer : but with the much scantier prospects of private practice, and more con- JAMES SIMPSON. 271 tracted sphere of action, of Edinburgh, I could see nothing in the proposed exchange to tempt a man with a large family, and who had already been overstrained with professorial engagements. I was always intensely interested in Professor Simpson's anaesthetic discoveries, which I was enabled to announce in the later editions of my ' Principles,' as making an important addition to our therapeutic treasury. We had several discussions about the use of anaesthetics for other purposes, besides that of removing pain ; and on one of the last occasions on which I saw him, when he sent for me to see a patient with him at the Bridge of Allan, he had a number of asthma- tics at his house, trying to inhale carbonic acid gas, which he had found, in some cases, to give great relief to the breathing. I cannot say that my trials of this agent have proved successful. 1 Admirable and beneficent as were the enthusiasm and devotion, which marked the course of this most gifted and amiable man, there can be little doubt that they shortened his life. Under the highest motives he undertook more than he was able to perform, and may be literally said to have died like not a few others in our arduous profession, prematurely of over-work. But in his later years, his eager spirit found, and rejoiced in, a Treasure inestimably greater than all his, or any other human discoveries ; and he was enabled to bear wit- ness to its Precious Truths, and to hold forth to men its Divine Light as the greatest of all blessings, for Time and for Eter- nity. The tract, 'Dead in trespasses and sins,' which he sent me, and several passages in his Biography, by the Eev. Dr. Duns, reveal the higher life of this eminent Christian philo- sopher and physician, as ' casting down reasonings and every high thing that is exalted against the knowledge of God, and bringing every thought into captivity to the obedience of Christ.' 3 1 In connection with this subject I would mention that on calling on Dr. Brown SSquard in Paris last May (1883), he told me, that he had lately proved by experiment, that by introducing carbonic acid gas into the trachea, the sensibility and excito-motory power of the superior laryngeal nerve was quite abolished ; and that carbonic acid is therefore the proper anaesthetic for that nerve, and the fittest remedy for all spasmodic and painful affections of the ' glottis. But the experiment must be difficult, as it was necessary to supply air to the lung by another aperture, lower in the trachea. 2 2 Cor. x. 5. Revised Version. 272 DR. R. BRIGHT. MR. P. SQUIRE. Another eminent physician, whom it was my privilege and pleasure often to meet in consultation, was Dr. Eichard Bright, whose character commended itself to all by its earnestness and painstaking intelligence. He was a most judicious and expert practitioner, and deservedly gained the full confidence of his patients : but he used to confess himself to be some- what old-fashioned, and sometimes to twit me good-humouredly about my fondness for new remedies. Yet we were fully agreed in our belief in the utility and safety of the well- approved old ones ; against which inexperienced modern writers have been uttering groundless denunciations. But on my part, I always felt a strong desire to improve our pharmaceutical knowledge, not only by acquisition of new remedies, but also by more exact information of the true modes of operation of the old, and of the best methods of preparing and combining them. And with this view I found the advantage of cultivating the acquaintance of the most intelligent and advanced pharmaceutists, and I feel sure that I profited much by the information which I obtained from them. Foremost among them was my friend, Mr. Peter Squire, to whom British pharmacy is deeply indebted, not only for his standard work, ' Companion to the British Pharmaco- poeia,' which has gone through fifteen or sixteen editions, and has no equal for amount and exactitude of information, but also for the success of his work in vegetable pharmacy, par- ticularly in improving the preparation of extracts, so as to preserve their remedial properties. When I first began to practise, I had little faith in vegetable extracts ; for they were of doubtful efficacy, and all seemed much alike in their dark treacly aspect and empyreumatic odour : very unlike the herbs from which they were prepared. But when I came to see Squire's extracts, preserving most of the colour, odour, and characteristic taste of the fresh plant, I began to believe in them, and on trial proved their efficacy that of Taraxacum, for example. 1 1 My Father, although a parson, had a decided turn for physic ; and dande- lion was one of his favourite remedies for the ailments of a sedentary life. Among the recreations of our boyhood, I might have mentioned the holidays which were sometimes allowed us, for gathering the flowers of the dandelion. Many basketsful were collected, and pounded in a stone trough ; the expressed PHARMACEUTICAL FRIENDS. 273 I believe that the improvement consisted chiefly in avoid- ing a high temperature in concentrating the extract, and pro- moting evaporation by either diminished pressure, or more simply by an increased current of air. A similar plan is now adopted by most manufacturing druggists. Mr. Squire has been also very successful in improving the taste and action of opium, and of spirits of wine, by eliminating from them an offensive and injurious ingredient ; and he has made several valuable suggestions for the improvement of the processes in the National Pharmacopoeia. I often resorted to his advice in the choice and combination of my prescriptions with the view to avoid incompatibility and unnecessary nauseousness. Cito, tuto, etjiicunde, is a motto not to be neglected. I was very glad to see my old friend this summer enjoying a green old age, yet not losing his faith in physic, albeit of a very simple kind. When I congratulated him on his health and good looks, he told me that he takes every morning a cup of fresh made, but weak, chamomile tea. Jacob Bell was another pharmaceutical friend, whom I often saw ; and in fact attended him in his long distressing illness with laryngeal disease, of which he died. 1 He was introduced to me by my much valued friend, Thomas Hodgkin, on the occasion of our meeting with Sir Culling Eardley Smith, and Dr. Conquest, to form the Syrian Aid Medical Mission, when my friend Dr. George Whiteley, since of Cannes and lately deceased, was sent to Beyrout as the first medical mis- sionary. Jacob Bell was not much occupied with the details of Pharmacy ; but he took an influential and active part in the formation of the Pharmaceutical Society, and in conduct- ing the Pharmaceutical Journal, both of which have done much to elevate the knowledge of Pharmacy in this country. He was also an enthusiastic and munificent patron of art ; juice, was clarified by a short heating to simmering, and then strained and bottled, with the addition of a little spirit. This was my Father's Liquor Taraxaci of sixty years ago ; and he thought that a wineglassful in the early morning was of great use to himself and his bilious friends. Sir James Clark had also faith in this simple. 1 In the earlier part of his illness, the lungs were also extensively affected : but later the disease concentrated itself in the larynx, and the lungs became comparatively clear, showing after death only traces of former disease, in ad- hesions and granular indurations. T 274 MR- JACOB BELL. and his valuable bequests of paintings to the nation are well known. He gave me an early proof of the Horse Fair of Kosa Bonheur. His genial partner and successor Mr. T. H. Hills was an- other practical pharmaceutist of whom I often took counsel. He is also one always forward in every benevolent professional work. NEW SYDEXHAM SOCIETY MR. J. HUTCHINSON. 275 CHAPTER XXXI. NEW SYDENHAM SOCIETY. REMINISCENCES OF FRIENDS. 1858-1861. Formation of New Sydenham Society by Mr. Jonathan Hutchinson and others Author elected First President Society to supply translations and editions of modern works as the Old Sydenham did of old The more needed from the increasing number of Foreign publications Objects speci- fied Names of officers Society now consists of 3,000 members, and has issued 108th volume, besides many Coloured Plates. Old St. George's Friends. Dr. Chambers, Sir Benjamin Brodie, Mr. Caesar Hawkins, and Mr. H. P. Fuller His Exertions for rebuilding St. George's Hospital The Old Building and the Physician's Visit Fuller's zeal for the Building Fund Public Dinner with Duke of Wellington presiding The two palaces of Hyde Park Corner Mr. T. Hammerton Mr. Nussey Noble patients Countess of Pembroke and Family Sidney Herbert His anxieties and trials in public service during the Crimean War Destructive to his health His death in 1861 His noble character and achievements. Allusion to Miss Nightingale and her heroism in sickness as in health. Lumleian lectures assigned to Author by Dr. Mayo, President of the College of Physicians. Death of the Prince Consort Inexpressible loss to the Queen, to the country, to all Lesson to the pride of our Profession Message of Con- dolence from B. Med. Chir. Soc. Moved by Sir B. Brodie, seconded by the Author. IN the year 1858, I received a visit from Mr. Jonathan Hut- chinson, accompanied by Dr. George Johnson, Dr. G. Hilaro Barlow, and other gentlemen, to request me to accept the office of President of the New Sydenham Society which they proposed to form, for the purpose of facilitating the supply of useful medical literature, especially by translations of foreign works, and republications of scattered papers, and of editions out of print, at moderate cost by an annual subscription. The original Sydenham Society had already fulfilled this object for older writings, as those of Sydenham, Harvey, Hewson, and others, and with a satisfactory result : but the promoters of that society had considered their task fulfilled, and dissolved i 2 276 OBJECTS RULES OFFICERS. their body. Mr. Hutchinson and his friends thought that there was yet abundant need for a similar institution for more modern works ; and they proposed to establish it under the title of ' The New Sydenhain Society.' I fully concurred in the opinion of these gentlemen, and could not but feel hon- oured by their proposal to place me at the head of it. The increasing number of interesting and important works, issuing from the foreign press, made it most desirable that the best of them should be translated and brought within the reach of English readers. Germany especially was giving abundant evidence of her industry, and was getting ahead of France and England in scientific investigations ; yet her language was sealed to the great majority of English readers, myself among the number. I had made many resolutions to learn German, and tried to study the language on the occasions of long journeys to the country, but these attempts proved abor- tive. I was therefore quite prepared to promote the formation of the New Sydenham Society, from which was issued the following announcement ; ' The Society shall carry out its object by a succession of publications, of which the following shall be the chief: 1. Trans- lations of Foreign Works, Papers, and Essays of merit, to be reproduced as early as practicable after their original issue : 2. British Works, Papers, Lectures, &c., which whilst of great value, have become from any cause difficult to be obtained, excluding those of living authors : 3. Annual Volumes, consisting of reports in Abstract of the progress of different branches of Medical and Surgical science during the year : 4. Dictionaries of Medical Biblio- graphy and Biography.' The subscription was to be a guinea annually ; and the members were to receive four or five volumes each year, ac- cording to the number of subscribers. At the first annual meeting this number amounted to 1,820, which in two years increased to 3,000 ; and the society has continued to flourish ever since. The Vice-Presidents first appointed included the names of Sir Henry Holland, Dr. (since Sir T.) Watson, Mr. (since Sir Jas.) Paget, Mr. (since Sir W.) Fergusson, Sir Charles Hast- ings, Sir Jas. L. Bardsley, Dr. (since Sir James) Simpson, SUCCESS OF NEW SYDENHAM SOCIETY. 277 Drs. Ferguson, Mayo, W. Stokes, Acland, Cusack, Macfarlane, and Messrs. Solly, Sands, Cox, and Teale. The treasurer was Dr. Barlow, and the secretary Mr. Jonathan Hutchinson. The Council comprised thirty-two distinguished names in London and country. I took great interest in the proceedings of the Society, and regularly attended its meetings, not only during the two years of my presidency, but for some time after; and can hear testimony to the careful and conscientious manner in which the secretary and members of the Council carried on its work. Writing, as I now am, at Cannes, I am not able to give any particulars of its recent history ; but insert a note, in answer to my inquiry, lately received from my old friend, the Secretary, its original founder and most constant supporter. 15 Cavendish Square, W. : Sept. 18, 1883. ' Dear Dr. Williams, I believe the New Sydenham Society has now reached its 108th volume ; and it still has about 3,000 members. ' I am very glad to know that you have pleasant memories of your labours in its formation. Your advice and help, as our first President, were invaluable to us. Believe me yours very truly. JON. HUTCHINSON.' Besides the number of goodly volumes of the most recent works in medical literature, the Society has issued costly coloured plates of Skin Diseases, and other objects, Year-books of Progress, and a Dictionary of Medical Terms. Nor should I omit to mention, among the benefits resulting from this Society, the profitable employment of the numerous deserving writers, who have assisted, for the most part very creditably, in translating, editing, and annotating, the several publications. Some years ago, the Council of the New Sydenham Society paid me the compliment of sending me a portfolio with original photographic portraits of the five first Presidents of the Society, including my own, Sir Thomas Watson's, Sir James Paget's, Dr. Stokes', of Dublin, and Mr. Hilton's. I should have been glad to possess one also of the Secretary and Founder, as the most completely identified with the Society. 278 OLD FRIENDS CHAMBERS. BRODIE. HA WKINS. In my separation from St. George's Hospital I did not lose the interest and good opinion of my friends connected with it, whom I continued to meet in professional and social inter- course. Dr. Chambers fell into ill health, which compelled his retirement, and soon terminated in his death, after a short and brilliant career, in which this accomplished scholar, able physician, and noble-hearted gentleman, became valued by, and endeared to, many. Sir Benjamin Brodie was ever my true and faithful friend, and rejoiced in my success, which, he was so kind as to tell me, he had always anticipated. We often had occasion to meet in consultation ; and I was indebted to his good opinion for in- troduction to many patients, and among them, some members of his own family. His memory was wonderful for its power of recalling out of his vast experience, cases similar to those under present consultation ; and his well-known practical ability was grounded on a good knowledge of physical and chemical agents, guided by shrewd common sense ; albeit tinged with some veneration for remedies used by John Hunter and Sir Everard Home. Mr. Caesar Hawkins, with his amiable wife, had been among our earliest and most intimate friends, from the time of our first settling in Half Moon Street, where they also resided. They afterwards removed to the house in Grosvenor Street, formerly occupied by my old friend, Aylmer Bourke Lambert, some time President of the Linnean Society. I had always the highest opinion of Csesar Hawkins' surgical judgment and skill, and often profited by it for myself and family. In the steady careful exercise of the science and art of his profession, he has attained to its highest eminence, and held its most honourable dignities, and still, one of the few among my contemporaries, survives the honoured Father of English Surgery. Among the General Practitioners of the "West End fifty years ago, none was better known or respected that Mr. H. P. Fuller, of Piccadilly. 1 He was one of the Visiting Apothecaries 1 He received the soubriquet of ' Mahogany ' Fuller, from his having sub- stituted for his open apothecaries' shop, a mahogany front with shutters: a H. P. FULLER, ST. GEORGE'S, OLD AND NEW. 279 of St. George's Hospital ; and not limiting his services to the mere inspection of drugs, he busied himself in various ways in improving the Institution, and contributing to its support. Through his exertions mainly, were funds collected, for re- building the Hospital as it now stands. When I first visited it, in 1825, it was a very low brick building, with small windows, and a long, sloping, tiled roof; and with a corresponding interior of long, low, ill-lit, and worse ventilated, series of wards. The fields behind, where Belgrave Square now stands, were reedy and damp : little better than a swamp ! Yet here John Hunter had studied to heal wounds, and Brodie had struggled on through many sanitary difficulties. Concerning how some of the physicians did their work, I was told one story, but I do not authenticate it. The Phy- sician, a senior, did not think it necessary to see the patients : but once or twice a week took a seat in the board-room, and summoning the head nurse, heard her account of the patients ; wrote and directed what he thought needful, and then took his departure. The spread of London had afterwards drained and over- arched the marshy ground ; and then came Fuller and his host, levying their tax on high and low, and neither resting, nor giving rest, until they had raised the funds for rebuilding and furnishing the Hospital on its improved, but not yet perfect scale. I was present at one of the efforts to raise the wind a dinner at Willis's Eooms, with the opposite neighbour of Hyde Park Corner, the Duke of Wellington, in the chair. His Grace spoke very briefly, but cordially, and right to the purpose ; and the collection was liberal. 1 very creditable representation of a distinction due to a profession above a trade. From sixty to fifty years ago there was no more familiar equipage at the West End than tha,t of Mr. Fuller driving about in his white horsed dark green chariot, out of which, letting down steps with a cord, (before Broughams were known), he would bustle out in his dark-blue coat with gilt buttons, buff waistcoat, and always a glove in his hand. To match, there was his excellent partner, Thomas Hammerton, also with his metal buttoned blue coat, cheery countenance and pleasant Yorkshire brogue, bearing a very high repute for practical skill : and between them, they doctored half the nobility of the West End. 1 The occasion suggested to me something like a parody on the lines of Byron : ' I stood at Venice on the Bridge of Sighs,' &c. I stood at Hyde Park Corner ; on each side There rose a palace. On the north was one, 280 JOHN NUSSE Y. LADY PEMBROKE. Mr. Fuller's zeal for the good of St. George's Hospital was untiring ; and he was deservedly rewarded by living to see his son established as one of its physicians, and rising to great usefulness and eminence in the profession. But Dr. Fuller's career was short, for he died in the prime of life, obviously from overwork. Mr. Nussey, Mr. Tegart, and later, Mr. Illingworth and Mr. John Merriman, were also Visiting Apothecaries of St. George's, with whom I had much friendly and professional intercourse, and I attended members of their families. But they have all passed away with many others, leaving me to marvel at the mercy that has spared me so long. Nussey was great at the Apothecaries' Hall, having been repeatedly Master of the Worshipful Company. He was also Apothecary to the Royal Household ; and was in much esteem among the upper classes of the West End. In consultation with him, I was long in attendance on that excellent lady the Countess of Pembroke, daughter of Count Woronzow, and mother of the Honourable Sidney Herbert, of the Marchioness of Ailesbury, the Countess Clanwilliam, and the Viscountess de Vesci. During many years I saw much of this noble family and those connected with them. I have many letters from these, and other noble and eminent persons, expressive of satisfaction or appreciation of professional skill and attention ; but it would hardly b^ in good taste to publish them, even assuming that they are not confidential. I have already given expression to my feeling, that what takes place in private practice ought to be sacred ; and that when in the interest of science cases are published, names should never be given without express permission. But it is no breach of confidence to allude to the severe trials of health, both in mind and body, which one of the family just mentioned, Sidney Herbert, had to undergo about Raised by a grateful country for th' abode Of the Great Hero, who achieved her peace, In war triumphant, and in duty true. The other was a palace for the poor, The sick, the maimed, the halt, the blind, and such As seek for ease from woes of sinful flesh. The conqueror comes, the Hospital to aid, And spread new peace, in Christian love display'd. SIDNEY HERBERT. FLORENCE NIGHTINGALE. 281 this time during the fearful period of the Crimean War, for they were known to the public, and endured in a public service ; and I, who attended him during the early part of this time, can bear witness, how he was harassed ; as I had to follow him at any hour, from Belgrave Square to the War Office, and from the Office to the House of Commons, &c. when he ought to have been resting in his bed. He was a most reasonable, as well as a noble-hearted man, and in the ' weak piping times of peace,' did, as well as gave, credit to his doctor : but when came the strife of war and the fearful agonies of such a war with the crushing weight of dread responsibilities, and the shock of awful calamities befalling can it be won- dered at, that physical endurance gave way ; and that the j)ower of medicine could be of little avail, even had he been able to persevere with it. So long as he continued under my care, I did my utmost to urge him to withdraw, from some at least, of the burdens which were bearing him down. His retiring from the House of Commons was one step of partial relief, followed by temporary improvement of health. After- wards, as he showed signs of a new disease, (of which it was presumed that I could know nothing), he fell into- other hands, and I did not see him again until I was summoned to his death-bed at Wilton in August, 1861. I shall have occasion to advert to the noble character and achievements of this hero of official life, in extracts from lectures on passages in the sanitary discipline of the army to be given further on, when another celebrated name will appear in the same history, that of Florence Nightingale. On her return from the Crimean War, this heroic lady placed herself under my care, and I had the pleasure and privilege of advising her for several years. As usual, I refrain from making known any details of private history ; but I cannot withhold the tribute of my admiration of her patient endurance of suffering, and her self-forgetting devotion to thoughts for the good of others, which persisted in spite of weakness, as they had triumphed over the opposition and difficulties which she encountered in the years of her activity and health. In September 1861, Dr. Mayo, then President of the College of Physicians', requested me to deliver the Lumleian 282 DR. MAYO. LUM LEI AN LECTURES. Lectures for the next year. Being very much occupied in practice, I hesitated about undertaking additional work at that time. In a second note he urged me to comply with his re- quest and suggested as a subject, ' An inquiry as to the rationale of the effects of remedies ' which had been recommended for consideration by a vote of the Fellows. ' This,' Dr. Mayo added, ' unless modified by more caution than we are liable to exhibit, is very likely to lead to very speculative methods in actual practice. Modified by practical conclusions from the experience of a man like yourself, whom no one will venture to call empirical, these inquiries may be rendered innocuous, and directed into right channels.' In a few days came the following note, the third on this subject : ' Dear Dr. Williams, There is no one, of or about your standing at the College, (or under), who can do such justice to the Lumleiaii Lectures as you, or who can by the method as well as by the sub- ject matter, so benefit the College in the way which I adverted to in my last note to you. You cannot be at a loss for subject matter ; but it is in the method of treating it that I want an example such as you can set. I beg to consider you as having accepted the office. ' Sincerely yours, ' T. MAYO. ' Wimpole Street : Sept. 23.' I did accept the office, but I did not see my way to adopt the subject which he proposed. ' An inquiry as to the rationale of the effects of remedies,' would require an experimental investigation, such as I could not undertake without a hospital, and with so little spare time at my disposal. The Lumleian Lectures are generally designed to treat on therapeutics, or the art of healing in some aspect; and it occurred to me that my large experience might supply the material for taking stock of our attainments in the healing art, by reviewing our successes and failures in various diseases, extending the survey to Preventive, as well as to Curative, Medicine. The subject will be resumed in the notice of the delivery of the lectures in the following year, and of their publication at a later date, when an opportunity will occur of referring to the good deeds of the eminent individuals lately named Lord Herbert and Miss Nightingale. DEATH OF H.R.II. PRIXCE CONSORT. 283 Before the year closed another death occurred spreading a gloom of sorrow through the land most deep and desolating on our widowed Queen, bereft of the loving Partner of her Life so wise, so talented, and so good discreet and gentle councillor of Her Throne beloved by all. Her sorrow too was shared, and brought a grief in every household home : Albert the Good is gone ! For my part, I felt the stroke as a lesson humiliating to the pride of our profession. I was entering on the momentous subject of successes and failures in medicine, full of confidence in the great preponderance of success ; when here came a disastrous failure, in defiance of the most matured experience, and the profoundest skill, with unlimited resources of wealth and comfort. The opprobrium, if any, seemed to lie less in the fatal issue of a disease, little controllable by art, and little resisted by a frame, previously weakened by uncommon anxiety and responsibility ; than in the occurrence at all of such a disease known to take its origin only from filth and corruption, and which might have been prevented by effective measures of Sanitation. At the Eoyal Medical and Chirurgical Society, a special meeting was held to draw up a message expressive of the dutiful and profound condolence of the Fellows of the Society with Her Most Gracious Majesty the Queen on the grievous and irreparable loss which her Majesty and the country had sustained in the death of His Eoyal Highness the Prince Consort. The resolution was moved by Sir Benjamin C. Brodie, Serjeant- Surgeon to Her Majesty, now stricken with blindness; yet when led in, with his former animation, and in his old style of anecdote, he recounted from his personal knowledge, touching instances of the late Prince's intelligence and kindly feeling. I was requested (I understood by Sir B. Brodie's wish) to second the motion, w r hich I did in very few words ; because I felt, as all must feel, how impossible it was adequately to contemplate much more to express the amount and preciousness of the loss, individual and manifold, present and future, which Her Majesty and the country sus- tained by this most afflictive bereavement ! 284 LIFE AND WORK IN TOURS. CHAPTEE XXXII. HOLIDAY TOURS. 1860-1870. Relations of Holiday tours to Life and Work Difficulties in Home Tours from weather, &c. North Wales. Scotland Lochnagar and Eastern Highlands Skye Bute and Arran. Ireland Glengariffe. Hornburg and the Khine Tours to Swiss Mountains Effects of mountain climbing, good and bad Clothing, shoes, &c. Tours with Sons Bernese Oberland Zermatt Monte Eosa from Val Anzasca Monte Moro, a lesson. Tours with Daughters more suitable for moderate mountaineering Places named for excursions Visits to Italian Alps Val Tournanche and the Matterhorn St. Theodul Pass Alpine view from Becca di Nona Courmayeur. Visit to Pyrenees Illness at Luchon. Letter in blank verse, descriptive of Tour to Bernese Oberland, Grimsel, Ehone Glacier, and pass of Simplon to Domo d'Ossola after Storm in Val d'Aosta. IN compiling these ' Memoirs of Life and Work,' it occurs to me that I may fairly include Holiday Tours as belonging to both Life and Work, but the predominance of life over work is necessary to entitle the tour to the epithet, holiday : with labours lighter and a life more free. We hope in a holiday tour not merely to be in vacation, but to enjoy life in a new and amusing way. But to those, who like myself, have to seek refreshment of mind and body, and recruit lost strength, it is very important to make a judicious choice in the direction and management of the tours, and this was not what I was always able to do. During my connection with University College, I seldom found time enough for a tour on the Continent ; but the four or five weeks' holidays were usually passed at Ivy Bock near Chepstow, with short excursions to North Wales, Scot- land or Ireland. Of these it may be generally said that they were too much hurried to afford much rest or enjoyment. There was beauty and variety enough in the scenery each country having its distinctive characters and peculiar charms TOURS IN. WALES AND SCOTLAND. 285 on which, had I more space, I would delight to dwell. But in all of them the traveller is often thwarted by the unpro- pitious weather which predominates in these British Islands. In Wales and in Scotland he has also to encounter hordes of tourists, which beset the way, crowd up the inns, and tempt the rapacity of natives, ever ready to make the most of their harvest. In Ireland, if the travellers are fewer, the car-drivers and guides are more importunate ; and for inexhaustible floods of rain, I know nothing to equal the Wicklow Mountains, and the Lakes of Killarney, unless it be the Argyllshire Highlands and the Isle of Skye. Of three visits of several days, to the latter, two were spoilt by incessant rain. In a carriage drive from Dingwall to Gairloch, by Kinlochewe and Loch Maree, we had three successive days of combined rain and sunshine such as I never witnessed before or since the rain never ceasing, yet the sun almost always shining. I have not space to describe individual tours ; but I will notice only a few passages of the most remarkable, beginning with the earlier excursions in our own country. In one of our visits to North Wales, two daughters and myself made the ascent of Cader Idris ; from the summit of which I made a sketch of the Snowdon range of mountains to the north with the sea and the Isle of Man in the distance. Columnar basaltic rocks rising around a small tarn, made a characteristic foreground. Bad weather prevented our ascent of Snowdon : but I got a good sketch of the mountain from Capel Curig. In pouring rain a party, including myself, with a son and daughter, ascended Lochnagar, in the Aberdeen Highlands. As we neared the summit, the rain ceased : the clouds cleared away and gave us a splendid view of the whole Cairn Gorm range ; with patches of snow on Ben-Muich-Dhui. The Linn of Dee, the Linn of Quoich, and especially the desolate Glen Derry, with its bleaching carcases of contorted pines, afforded fine objects for sketching, which I executed in neutral tint and sepia. But the most striking and extraordinary scenery in Scot- land, is that of the Isle of Skye, especially Glen Sligachan and the Cuchullin Hills, Loch Scavaig, and the Quiraing. I made 286 SA' YEGLENGA RIFFEHOMDO URG. careful panoramic sketches of all these mountains ; which although little above 3,000 feet in height, are so perpendicular and rugged, as to vie in grandeur with loftier Alpine heights. Then the Quiraing, a group of rugged and stupendous basaltic steeples surpassing anything of its kind that I have seen elsewhere with, by way of contrast, one, flat-levelled into a gigantic table, with a table-cloth of bright green sward ! In short, throughout that strange group of Western Isles, geogenic nature seems to have indulged in the most fantastic freaks of rocky conformation ; including Staffa and its Fingal's Cave. From a hill behind Eothesay, in the Isle of Bute, I found a charming view of the Isle of Arran, with its crest, the Goatfell : in the middle ground, two lakes ; one higher, of fresh water, on Bute land itself ; the other, lower, a land-locked patch of sea : a nice lesson of perspective, to mark the height of each. Of all parts of Ireland visited, the most favourable impres- sion was made by Glengariffe, beyond Bantry Bay, both for beauty and scenery, and for its eligibility as a winter residence for invalids. The mildness of its climate is evident from the luxuriance of its myrtles, rhododendrons and other tender shrubs. No doubt rain falls in abundance, as in all parts of Ireland : but its propinquity to the sea, and its drier soil, render it much less damp than Killarney and other inland parts. Our earlier excursions to the Continent during the holiday, were directed to the Ehine, by the circumstance, that my wife was recommended to resort to Hombourg for the waters, and repeated her visits for several years. The air there is clear and bracing, and the walks and drives in the tirwoods pleasant enough. Not less so the early morning music in the Spa Garden ; albeit then supported by the gambling tables of the Cursaal. But the change was insufficient. The place was not high enough, often too warm ; the air always too much poisoned with tobacco smoke to be refreshing or invigorating. So I gained no good until, with one or two of my sons, I got on to Switzerland, and began to climb the paths, and breathe the air, of the mountains in all its freshness and purity. There was hardly time to do this thoroughly without a longer holiday, and devoting the whole time to the tour. EFFECTS OF MOUNTAIN CLIMBING. 287 As my occupations in London gave me little opportunity for walking or horse exercise, not much could be accomplished in this way at the commencement of each tour ; but I found the advantage of persevering within moderate limits, with the result of gradually improving breath and strength, until at the end of the time I could manage mountains up to six or seven thousand feet without difficulty. But this was my limit : if I exceeded these heights I became overtired and ill ; and had to rest for several days to recover. The fact was plain that I was not in vigorous health, and could bear only moderate amounts of exertion. But the practice of those limited efforts of hill-climbing did good, and brought the health and bodily powers into a better condition than could have been obtained either by rest only, or by more ordinary kinds of exercise in a flat country. To make the most of a Swiss tour for the purpose of im- proving health, I found it was best to ride or drive to the mountains ; but up and down the mountains, to use one's own legs as much as possible. There is always a great deal of puffing and panting in the steeper ascents more at first, less afterwards with breathing at the rate of 40 to 50 in the minute, and with the necessity of frequent halts to get wind ; but it is just these quickened and supplementary efforts of the breathing machine, that do good, by fully inflating the air cells, sweeping out the London smut and dust, and in brisking the capillary circulation, to the removal of conges- tions and obstructions, resulting from a close and sedentary life. 1 Then there is the increased heat and perspiration, often profuse, resulting from the arduous efforts ; these are not other- wise than beneficial, if judiciously managed, with the proper variation in clothing, in the chills of the mountain heights. In making the ascent, with due consideration of the present weather, it is well to be lightly clad, and even open one's collar freely; but always to have ready against the chills of the heights, and even of halting not only proper shawls 1 Of course it is assumed that there is in the mountain climbing tourist no serious unsoundness in heart or lungs to make the exertions hazardous. Yet the recent experience at Davos, proves that even with small amounts of dis- ease, and those not in an active state, regulated mountain exercise is both safe and salutary ; but this is only under judicious superintendence. 288 EQUIPMENT. INDIA-RUBBER SHOES. or wraps, but two or three dry silk handkerchiefs to thrust under the body- clothes, to dry the perspiring skin. Being rather short of breath from disuse and being out of condition, I found the ascents always arduous ; but being strong in the legs, the descents were easy and delightful ; and being very surefooted, I seldom found any too steep. But in the matter of footing, I found reason to adopt a plan of my own, which added greatly to my comfort and security in mountain-climbing. Instead of the heavy, iron-clouted Alpine- boots or shoes, which are not only clumsy, but fatiguing, and very prone to slip on rock and glacier I wore shoes of stout Indian rubber fabric, with soles thickened and roughened. They may be procured at most of the India- rubber shops. They have a light woollen lining; but for warmth I found it useful to add inner cork soles, with their usual fleecy covering. Of course they are to be worn with thick Shetland, or well knit woollen, socks. The advantages of these India-rubber shoes may be summed up under three heads : 1. Their ease and lightness, never causing sore feet or corns. 2. Their being quite waterproof, and impervious to wet of grass, melting snow, and bog. 3. The safe footing they afford on rocks and glaciers : where iron and hard leather would slip, the caoutchouc clings, like a cat's paw. The only surface on which they are apt to slip, is on a moist clay or earth of such, the wearer must beware, with alpenstock in hand. It might be supposed that they would soon wear out, or be cut to pieces by stones and rocks : but their elasticity and toughness gives them such wonderful endurance, that they last where iron and leather wear down and break. One pair has generally served me for two yearly tours. My early tours in Switzerland were with two of my sons generally Charles, (since the Doctor) and Harry, (afterwards solicitor) ; and when they were young in mountaineering, and I could keep pace with them, we made good company, and got on well. Thus we did the Bernese Oberland ; including Miirren ; the Wengern Alp ; the Great and Little Scheideck ; Kandersteg, and the Gemmi ; the Grimsel and the Glacier of the Rhone : my sons, mostly on foot : self, more commonly on horse or mule back. In after years, we all improved in TOURS WITH SONS MONTE MORO. 289 climbing ; but my sons soon outstripped me ; and when, at Zermatt, I found the Eiffel and the Gorner Grat enough for my powers, they were content with nothing short of the Cima di Jazi or Monte Kosa. Another year my climbing ambition met with a lesson, in the attempt to cross the Monte Moro from the Italian side. One of the most lovely and striking sights in the Alps is that of Monte Eosa at sunrise from the Ponte Grande, in lovely Val Anzasca. Eich with festoons of fruit and foliage, the valley lies still in the grey of dawn. At its upper end the mountain mass is seen all white and cold ; when sud- denly, a tinge of roseate light shines forth from its highest peaks, to glow and spread through its vast expanse of snow, till the whole mount reveals a lovely vision of the light of heaven, gleaming on earthly darkness. But our ascent was from Macugnaga, the mountain-hemmed upper end of Val Anzasca, over the Monte Moro pass, of upwards of 9,000 feet. Grand and soul-stirring as the view was, I was thoroughly beaten before I got down to the desolate valley of Saas, where I was glad to go to bed in the first inn 1 came to, at the Matt-Mark See, and required the clothes^ of three beds to make me warm. The next day, still feeling cold and exhausted, I could only walk down to Saas, to wait for my sons, who had been making the ascent of one of the Mis- chabel-Horner. They became enterprising Alpine climbers ; and Harry joined the Alpine Club. I quite understand the attraction of this pursuit ; but could never see the wisdom of indulging in it too far, or of gambling with dangers to life and limb for the sake of pleasant excitement. Dutiful and affectionate as my sons had been, in after tours I found it more suitable to take my daughters, as com- panions : they were not likely to out-walk me, for they were not strong climbers ; but whilst they enjoyed their lower rambles, among the flowers and ferns, I could continue the moderate ascents, which I found to do me so much good. It was thus that we made, in successive years, the following halting places, centres for excursions in the most beautiful scenery, and all within our reach. Glarus, and the Klonthal and Linthal, with Shididberg u 290 TOURS WITH DAUGHTERS BECCA DI NONA. and the foot of the Todi. Engelberg, with the Triibsee Alp, and the Joch-pass, under the Titlis ; Reichenbach, with Rosen - laui, the Brunig, and the Grimsel. Seelisberg, with itskulm, and the lake and mountains of Uri, the grandest part of Lake Lucerne. On the opposite side, Axenstein and the Frohn Alp ; Thusis and the Via Mala. In the Engadin, Samaden or Silvaplana for residence, with excursions to Morteratsch glacier, Val Roseg, Piz Languard, and the Maloya and Ber- nina passes. In the Italian Alps, Bormio, with excursions to Santa Caterina, La Scala, and the Stelvio pass. To describe all we did and saw at these places during our holiday tours, would fill a large volume. But I am tempted to mention two or three other spots, on the Italian side, which are little frequented, and yet present some of the grandest Alpine views that I know. I may remark of these Italian Alps, that they generally enjoy much finer weather than the Swiss Alps ; and repeatedly I have been driven to them by the ceaseless rain and cloud of the north. Chatillon in the Val d'Aosta, is rather too warm for long residence; but from it, you ascend by the Val Tournanche to Breuil, at the south of the Matterhorn, and with new and remarkable aspects of that wonderful mountain cone ; loftier than those from Zermatt, as the valley is so much lower. Here I came with my beloved youngest daughter (since gone), and after sleeping at Breuil, with the huge tusk rising above us, to the music of ' the cattle of a thousand hills,' we ascended to the Matterjoch, or Pass of St. Theodul, a height of nearly 11,000 feet, the greatest that I ever accomplished : but it is often crossed by travellers of both sexes. The view is more singular than beautiful, with the great white dome of the Breithorn to the right, and the rocky angular Matterhorn to the left ; to the south the snowy peak of the Grivola, or Corne de Cogne, stood forth, a marking feature of the Italian Alps. From Aosta, with a son, I made the ascent of the Becca di Nona, above 10,000 feet in height, easily accomplished on horseback, and from this obtained the finest southern view of the Alps which I ever saw. The whole Pennine range, from the Mont Blanc in the west to beyond Monte Rosa in the east, stood grandly before us, with the Matterhorn and Monte Rosa FEVER AT LUCHON. ALPINE INSPIRATION. 291 the central objects, in prominent proportions. Panoramic views were sketched on grey paper in Indian ink and white. I do not recommend Cournaayeur, at the upper end of the Val d'Aosta, as a good place for getting views of the Mont Blanc. You are too close under the mountains, which seem to be turning their backs on you ; and the Cramont, the mountain opposite, is not high enough, although near 9,000 feet ; and moreover very fatiguing to ascend, its turf being steep and slippery, and inaccessible to horses. I made one tour in the Pyrenees ; but not with a happy result ; for I was laid up with fever at Bagneres de Luchon for a month, with some doubt for a time as to the issue ; by God's mercy, I got through it, under the kind care of Drs. Lambron and Bagnall, but did not recover from the weakness for several months. The roads are excellent in the Pyrenees, and car- riages and horses good ; but the air is not bracing enough, nor the ground generally high enough, to prove invigorating to pedestrians. The mountain air in Switzerland often so exhilarated me that I found it difficult to limit the language of my conversa- tion to prose. Being constrained by my companions not to derange the colloquial proprieties by my effusions, they found vent in the following lines, addressed to my youngest daughter on her return to school, after her first visit with me to Switzerland. Fan, dearest ! can you e er forget the scenes Of varied beauty, which in all degrees Of grandeur, sweetness, and sublimity, We traversed and enjoyed ? First, floating on Thun's azure wave, 1 neath Niesen's towering culm, O'ertopped by spotless snow of Bliimlis-Alp : Next on we track Liitschinen's double stream, The right to rocky walls of Lauterbrun, Glistening with Staubacb and its echo falls, These from the Jungfrau, that from Miirren's heights : The left, or black Liitschine, to Grindelwald, O'ertowered by mountain giants, Eiger, Monch, Sclireckborn, and Wetterhorn, down whose dark sides 1 By steamer from Thnn to Interlaken. 292 METRICAL REHEARSAL OF TOUR. The winding glaciers pour their solid flood Of crevassed ice, with skirt of rough moraine. Then on, o'er Brientz lake to Keichenbach, Whose foaming feath'ry sprays were on that night Illumed by magnesium light of many hues ; ' A weird and fairy scene, but too theatrical For the wild Alps, where Nature ought to reign. Next day the sky was threatening ; but bright beams Broke through the clouds, and tempted us to mount For Eosenlaui's height, with Haslis vale Fading beneath us, whilst in front there rose, Looming athwart the mist, the Engelhorn, And Wellhorn's massive towers : but envious rain Now poured in torrents and disguised the view ; Still peered that wondrous icemount, Eosenlaui, Hiding in clouds its crest, the Wetterhorn : Yet was its ice so clear and blue, that we Appeared like spectres in its azure cave : And coming out, there seemed a sunshine bright : 2 But no, alas! the rain was pouring still : So back rode Fanny, dripping down the hill. Next morning smiled upon us, 'twas of those When Nature crowns and decks herself with gems And vesture from her choicest wardrobe's store ; When an unclouded heaven pours down bright rays, And earth respondent mingles hers in air, Their dazzling softened, but yet, wearing still A thousand hues of varied loveliness, Which mark them heav'nborn, albeit tinged on earth : And like as with two mirrors' magic power, Thus heaven and earth reciprocally shine, Eeceive, reflect, renew, and multiply The ceaseless beauties of each other's face ! And vain might search the Eye to find a spot Of blank, deformity, where beauty is not ! Oh ! after storms, how such a day delights ! On such a day we crossed the Grimsel pass : And how we gazed on its stupendous heights, 1 The Falls of Eeichenbach and Giesbach are often illuminated at night with coloured lights. 2 After the blue light of the ice cavern, the outer light seems yellow like sunshine. HAN DECK GRIMSEL RHONE GLACIER. 293 Of massive granite towering o'er our heads ! Or yawning deep in chasm beneath our path ; As where the Aar and silver Aerlenbach Gush down the Handeck's fall, in deaf ning roar, And raise a cloud of iridescent spray. Nor were the gentle charms of ferns and flowers Wanting among the rocks, in varied form : Straw- and blueberries too, to Fanny dear. But as we mount in Ober Hasli Thai, The scene grows desolate : the stunted fir Alone survives the withering hurricane, That howls at times athwart that savage glen, O'er tracts of naked granite, ground and grooved ' By ancient glacier action : ' so 'tis said ; Yet the same grooves, I saw around the sides Of lofty cliffs, in horizontal lines, As if from weather wearing of the rock. There, in a vale of rocks, rugged and bare, Stood Grimsel's Hospice ; an unsightly pile, Welcome to strangers. J knew it too well, To breathe its tobacco fumes, or feed its fleas ! ' So o'er the Grimsel-col we sped our way By Todten-See name quite appropriate. This desolation left ; now greets our view The Mayenwand, that sunny slope of flowers, Cleft by a steep and rugged path. Beneath, The great Khone glacier spreads its fan-shaped flood Of rugged ice, fed by the endless snows Of lofty Galenstock. That milky stream, Gushing from glacial caves and crevasses, Is infant Rhone, rushing in rapid course Down its long vale, swelled by the tribute flood, Of countless rills and torrents from the heights, Whose snowcapped tops we see in long array To the far distance, lost in azure haze. So near this icy cradle of the Rhone, We slept that night, from fleas and smoking free. The morrow's sky looked threatening ; and the clouds, Which gathered dark upon the mountain's brow, Poured down their floods before we entered Viesch : 1 A former experience at the Grimsel Hospice. 294 OVER THE SIMPLON. GORGE OF GONDO. Malapropos ! for hence we hoped to mount The Eggischhorn, and view the vast expanse Of Aletsch glacier, and its iceberg sea. So disappointed, on we jogged to Brieg In an einspanner ; for we left our steeds At Oberwald. Next day at early dawn, In the high banquette of a diligence, We slowly mounted up the Simploii road : That wondrous work of engineering art, Which Titan like, seems to invade the skies. And as each zigzag lifted us aloft, Leaving the sunlit Valais far beneath In a faint fairy landscape ; watching still, We hoped to see the giant Alps beyond : But the great Aletsch, Jungfrau, Eiger, Monch, Finster-aar, Viescher-horns, all still were wrapt In the dark clouds that hid them yestereen. But we in sunshine basked ; 1 and the deep blue Of Italy without a fleck, in front Brightened our scene, and decked the graceful forms Of Mount Leone and the White Fletschhorn. Nor do the heavens thus brilliant shine in vain Upon ungrateful earth : for as we quit The northern summit, the Kaltwasser bleak, Passing the' Hospice, gain the southern slope, The greener verdure, and the flowers more bright, The trees more varied, and of statelier growth, The floating butterfly, the lizard brisk, All tell the balmy air of Italy. Yet not all soft and gentle ; as we wind Down to the gorge of Gondo, a deep chasm In adamantine cliffs of giddy height, In whose dark depths the struggling road is wrought By galleries tunnelled through the solid rock ; First one side, then the other; while beneath, Diveria's torrent roars in ceaseless strife. Nor is this strife from danger always free, For mighty storms at times have swollen the flood, And riven the rocks asunder, swept and crushed Unlucky travellers in this awful gorge. 1 A contrast not uncommon in passing from Switzerland to Italy. ITALIAN SCENERY DOMO D'OSSOLA. 95 Emerge we from it into'gentler scenes. The cliffs, still lofty, open, and let down The genial sunbeam on each shelf of soil, Bedecked with flowrets, and with creepers green, Which hang from rock to rock in festoon 'd sprays, Sparkling with gem-like verdure mid the shade. And see ! pours down that mighty slab of stone A lovely waterfall not dashing down In mad- and shapeless torrents, but in streams Of liquid crystal gliding o'er the rock And crossing each other in their slanting fall Trace out a brilliant sheet of trellis-work Like graceful pattern'd lace of pearly silk. 1 Isella past, the scene grows richer still, Tho' interspersed with nature's fiercer forms ; The beetling rock, and over-hanging cliff Eise fringed and mantled with gigantic trees - r The spreading chestnut, and the stalwart oak, The spicy walnut, and acacia bright ; And many more ; while fruits in clusters hung, Grapes, Figs, and Melons, with gigantic Gourds In lavish bounty on each side the road. 'Tis thus the grand and beautiful combine In sweet Val Vedro, till it opening spreads In the luxuriant vale of Ossola : Italian quite ! at hand the trellised vines, In festooned clusters overhang the walls, Ensconced with shrines and saints in colours gay. Beyond, the landscape rich with hill and dale, With villas speckt, and campaniles white, All blended in harmonious loveliness By the blue haze of soft Italian air. Then as we enter Domo d'Ossola, Antique arcades, porches, and oriels quaint, And walls with frescoes gay the country tell. That eve, (the dinner done, with luscious fruits, And Asti sparkling,) we strolled up a hill, By a paved road between the vineyard walls ; With divers chapels on the steep ascent, For rest, and prayer for pious passers by ; We hoped to see the sunset gild the tops 1 I learnt afterwards that this fall is called ' Cascade de la Dentelle.' 296 COL D> ION VAL D'AOSTA. Of some high Alps, which erewhile were in view With scattered snow crests : but there intervened The darkening violet forms of nearer hills, Which haste the twilight shades. So soon the vale Changes its lively tints for evening gloom, Broken hy glimmering lamps : while vesper bells Blend their tones softened with the teeming thrill Of grasshoppers, which fills the air around. VlEW OF THE VAL D'AOSTA FROM THE COL D'lON, AFTER A STORM. Crossing from Val de Lys to Val d'Aoste, Two lofty ridges must be scaled : the first The Eanzola, was wrapt in darkening clouds, Which welcomed us with rain and biting hail ! Brussone past, the Col d'lon was reached In brilliant sunshine ; and the scene that burst On our enchanted sight, transcends the power Of pen or pencil to portray its beauty ! The height was moderate ; 7,000 feet : But 'neath us lay, far as the eye could reach The lovely Val d'Aosta, vale of the sun ! For richness, Eden's garden, stored with flowers And fruits and trees by Nature's lavish hand : But now by distance blent in azure hues, Like some vast lake of lapis lazuli, Fainter as further on the eye surveys, Until it melts in the blue vault of heaven ! On either side gigantic mountains rise In long array, and ever varying form ; Their tint a sapphire blue, but on their limbs And wreathing their snowy summits, still there hang The relics of the storm, bright fleecy clouds, Erewhile so dark, but now surpassing snow In dazzling brilliancy ; as if to atone For the dark veiling gloom they caused before. To return to practical and utilitarian prose. Thus in suc- cessive years, profiting by improving experience, I found these holiday tours truly refreshing and invigorating to body and mind ; and I returned to London work with renewed ALPINE SUMMER QUARTERS. 297 courage and strength. In later years I made more point of studying the places which we frequented, in relation to their character and capacities for benefiting invalid travellers during the summer months. Some results of these studies were published, first in the ' British Medical Journal,' ' and afterwards in my son's little book on ' Climate.' 2 I have more in reserve for another volume, if I am spared to publish it. 1 'Notes on Alpine Summer Quarters for Invalids,' Brit. Med. Journ. Nov. 1869. 2 ' The Climate of the South of France, &c.' By Charles Theodore Williams, M.A., M.D. 2nd ed. 1870. 298 SUCCESS AND FAILURE IN MEDICINE. CHAPTER XXXIII. LUMLEIAN LECTURES AT THE ROYAL COLLEGE OF PHYSICIANS, DELIVERED IN 18G2 ; WITH NOTES IN 1872. Subject Sketches of Success and Failure in Medicine Designed to set forth Objects of Medicine Grounds of its Success Art uncertain : public expect fore-knowledge and success where sometimes unattainable Overpowering diseases baffle all art Examples Making Medicine Failure Causes of Failure -Intensity of Disease Errors in Art. Objects of Medicine Detec- tion, estimation, prevention, cure, or mitigation of Disease Eesults in Failure and Success : Grandest Successes in Complete Prevention and Cure. Prevention of Disease Highest Grade of Success Too little appreciated. Vaccination ; Greatest Triumph of Our Art. Disease in British Army Awful Mortality Successful Prevention exemplified Lord Herbert's Eoyal Commission Greatest Success in India. Florence Nightingale's Work in Crimea Her invaluable aid in the Great Sanitary Regeneration of the British Army. IN 1862 I delivered the Lumleian Lectures at the College of Physicians on the subject already mentioned, Successes and Failures in Medicine. This was chosen not merely to illus- trate from the results of individual experience what the healing art had done, and what it had failed to do ; but also to direct attention to the causes of failure, and the grounds of success. With this view, I endeavoured to represent in a tabular form the chief Causes of Failure of Medicine, and in another table, epitomising the Objects of Medicine, to indicate the means by which these failures are to be avoided, and success in various degrees to be attained. Such a subject, to be treated syste- matically, would extend far beyond the limits of three Lectures : but it was hoped that by Sketches, such an outline might be given as would prove more accurate and instructive, than the vague notions prevalent on these matters, not only among the public but in the profession. No authentic report of these Lectures was published until 1871, when they appeared UNCERTAINTY OF MEDICINE. 299 in the ' Medical Times and Gazette ' with additional notes up to that date. From these I here insert extracts, which relate chiefly to the Successes and Failures of Preventive Medicine ; matters inte- resting and intelligible to the public as well as to the profession. Sketches of Success and Failure in Curative Medicine, drawn chiefly from my own practice, I propose to reserve for a second volume, to be devoted to more strictly professional subjects. SKETCHES OF SUCCESS AND FAILURE IN MEDICINE. To one long engaged in the practice of Medicine, there are few conclusions more striking than the general one of the uncertainty of the art. His whole career seems to be made up of a series of failures and successes. He may deem himself fortunate if the successes preponderate over the failures, or, at least, if by their magnitude and prominence, they throw these latter into the shade. Of course, much may be said of the imperfections and shortcom- ings of the art ; and more still may be urged on the intractability of disease, and the inevitability of death. It is not to be supposed that we are to make our patients immortal. But it is not unrea- sonable on the part of the public to expect us to say what we can cure, and what we cannot cure, and to look for results more or less in accordance with our predictions ; and it is equally reasonable on our part to point out that although in many instances we can fulfil these expectations, yet in others the powers of health and disease of life and death may be so nicely balanced, that it is impossible to predict the result with any certainty. And this can- did avowal of failure in our prognostic powers is more safe and more honest than bold guesses at the result, which may be denounced as sheer gambling with the chances of life and death. In truth, the fair appreciation of success and failure in Medicine will depend much on the intelligence of the community. No doubt, of late years, the public mind has become more enlightened, and can distinguish between organic and functional disease, and will not expect great achievements in the former, where structure and mechanism are extensively injured. But neither the public nor the professional mind is always alive to the equal impotence of Medicine, in those terrible disorders in which a noxious ferment, brewing in the living blood, converts its life-giving stream into a channel of deadly poison, which arrests and perverts the functions, and reduces the whole body to a mass of corruption. Observe a bad case of malignant scarlatina, from the first 360 CAUSES OF FAILURE. proclaiming the overpowering virulence of its poison. Note the overwhelming languor, headache, and loss of appetite ; then the rigor, followed by unequal reaction and abnormal heat, with extreme prostration of body and mind ; the pulse, first fluttering and un- equal, then frequent, liquid, or thready ; the stupor, or muttering delirium, dim eye, dusky rash, dark, congested, and swollen throat, secretions (if any) murky and offensive in the extreme. What is such a case but one of inevitable death ? A person plunged into boiling water, or poisoned with a large dose of prussic acid, is not more hopelessly beyond the reach of art. All Medicine there is powerless all failure I And it may be well if two, three, or more of the family are not swept off by the irresistible pestilence. Look, again, at an instance of unmodified petechial or purpural small-pox, with its livid congestions and blood-oozing tissues, showing the poisoned state of the blood ; the eruption copious, but flat-spreading, with no protective margins of fibrin, so that the whole body becomes speedily imbued with the fatal poison, with no power to resist it. Medicine here is all failure ! The full-blown plague comes like the blast of death itself ! So, too, of cholera and other diseases in their most malignant forms, the destroying force is so strong that the powers of life, and the agents by which we support them, offer little or no resistance. In all such cases Medicine proves a failure. Sometimes, likewise, we find other kinds of disease baffle us by their intensity, their extent, the vitality of the organ attacked, or the destructiveness or malignancy of the morbid process. Thus, severe inflammation attacking vital organs, especially when rapidly proceeding to alteration of structure ; organic disease, mechanically or otherwise injuring important functions ; and even functional disorders, when intensely affecting a vital organ as the heart or the medulla may overmatch our remedial powers, and make Medicine a failure. CAUSES OF FAILURE IN MEDICINE. I. From overpowering nature of disease fExtent ) (Extent ) I Vitality (of part involved. 1 Malignancy. Structural, from-,.., .. Malignancy. \Destructiveness. /Intensity. n - j _. I Duration. Functwnal, frorn-^ , . (e.q., syncope, shock, ; Vitality of organ { ^^ &c< OBJECTS OF MEDICINE. /Strength of poison. '01 /Strength of poison. Blood-poisoning ' Defective power of resistance and elimina- ( tion. i Diagnosis. I Prognosis. II. From Error in-; /Drugs. I Therapeutics J Diet. I * j \ (Kegimen. This table brings before us a classification of the chief causes of failure in Medicine. The first class includes those already noticed, in which the amount or the intensity of the disease exceeds the powers of nature and art to overcome it ; and the consideration of this limit to our art may well keep us humble. But, that we may be heedful as well as humble, the table warns us that failure may arise also from errors on our own part, in diagnosis, prognosis, and in treatment. Such errors, although more or less the common lot of humanity, are to be held up as avoidable ; and it is our obvious duty to watch and guard against them with all possible vigilance and energy. Now, in order to avoid as much as possible these causes of failure, and to aim at achieving the greatest attainable amount of success, it may be profitable to go back to Principles, and survey in the abstract the chief OBJECTS OF MEDICINE. In the fulfilment of these, are comprehended the elements of success ; and we may hope- fully and profitably comment on this side of the picture for our encouragement. OBJECTS OF MEDICINE. Preliminary [Detection Diagnosis i and (distinction Valuation Prognosis - and calculation of disease < of powers of - f Health and disease. Cure I of disease. SUCCESS A. Prevention) Final J Mitigation and retardation of disease. I Prolongation and utilisation of life. . SUCCESS B. ( Alleviation of suffering. The preliminary objects of Medicine the distinction and appre- ciation of the true nature of disease, and of its relation to the health-force of the body are of the highest importance to the 302 CURE AND PREVENTION. scientific Physician, inasmuch as they are generally fundamental to his success in the final object, the treatment of disease. Dia- gnosis is not the mere detection of disease as a name, or a distinct entity ; it is such a knowledge as enables one to discern disease in all its characters and bearings, in relation to other diseases, and in relation to the powers of health remaining in the body. Such a knowledge, combined with that supplied from past experience of similar cases, will furnish us with the surest means of prognosti- cating the result ; and further, conjoined with a due acquaintance with the powers of remedial agents, will prove the means of attaining to the grand final object, the cure of disease. So, too, prognosis does not consist in a mere empirical obser- vation of good and bad signs, such as any experienced nurse or shrewd attendant, however ignorant, might exercise with some rude semblance of success. Scientific prognosis is to be founded on a careful valuation and calculation of the relative powers of disease and of health in the system, and, by the light of past experience, estimating and striking the balance between them. It is by such a rational and circumspect procedure, that we may hope to escape those errors in prognosis and diagnosis, which we have classed among the causes of failure in Medicine. Proceeding next to the final objects of Medicine, obviously the greatest are the COMPLETE CUBE AND ENTIBE PREVENTION OF DISEASE, the substitution of life and health, for disease and death. To accomplish these is to achieve the GRANDEST SUCCESSES of oiir art. To restore a person from an extreme of suffering and weak- ness, from frightful disorders of body and mind, from a dangerous struggle with death itself, to a state of ease, health, and strength, is indeed the best work of the Physician. But he must expect often to divide the credit with nature, or the sound constitution of the patient ; and it surely is not less creditable to his sagacity and prudence, if his interference consists mainly in watching for, and promoting, the health-restoring processes of nature, rather than in a random exhibition of empirical remedies. These GREAT SUC- CESSES may be looked for in cases of acute disease, fevers, inflam- mations, and in a large proportion of functional disorders; and they are the more signal, the more intense and aggravated the disease has been. Such cases are, however, more commonly within the scope of the ordinary family Practitioner than of London Physicians. These, especially the consulting class, have hardly a fair share of curable cases. They are rarely called in till danger is imminent, too often not till hope is past, and disease triumphant ; and if they PREVENTIVE MEDICINE. SUCCESSES. 303 now and then do get the credit of rescuing a case from impending death, more frequently they have the melancholy office of endorsing a death-warrant, sometimes reserving in their own breasts the secret regret that they had been called in too late. But there is also a secret success that will now and then gladden the heart of the consulting Physician, and give him the inward satisfaction of doing good, although he would fain conceal it from public notice. It is where Medicine has hitherto failed through error in diagnosis or treatment (see table of failures), and it is not too late to retrieve the error. The Physician confidentially instructs the previous attendant, alters the treatment, and thereby transfers the case from the list of failures to that of successes. It cannot be questioned that the prevention of disease deserves to take rank among the NOBLEST AIMS OF MEDICINE, and we may well award the HIGHEST GRADE OF SUCCESS to the signal manner in which the mortality, in certain localities and in certain classes of persons, has been reduced by proper attention to the dictates of sanitary science. The lives thus to be saved may be counted by hundreds and by thousands. Yet how little of individual gratitude does the sanitarian reap from all his beneficent labours ! If he, who showed how to draw lightning from the clouds and send it harmless to the earth, was hailed as a public benefactor, not less should those who point out how to stop the risings of the noisome pestilence, whether in the air we breathe, in the water we drink, or in the ground we tread, or to render it comparatively harmless by processes of cleanliness, ventilation, or purification. I lately had occasion to advert to malignant small-pox, as one of the terrible forms, in which a death-plague defies the power of art. Honour, then, to the man who found the way to stay that plague ; who discovered that the seeds of this very malady, by being transplanted to another soil, might be so mitigated, without destroying their identity as to produce a trivial and harmless degree of the same disease, which should yet prove a protection against the invasion of the malignant forms ! This PREVENTIVE SUCCESS is, indeed, a triumph of our art perhaps the greatest that it has ever achieved. Does not, then, the DISCOVERER OF VACCINATION well merit a foremost place of honour ? And if we raise in our public forum to the gaze of the admiring multitude, statues of the heroes of a hun- dred battles, whose good deeds and glories great as they undoubt- edly are have been achieved through the horrible scenes of the battle-field, amid bloodshed and death, suffering and slaughter, lamentation and woe, shall we banish into obscurity the image of 304 PREVENTIVE SUCCESSES IN BRITISH ARMY. OUR IMMORTAL JENNER, 1 whose priceless discovery whose bloodless victory over disease has been the means of SAVING MORE LIVES than all that were sacrificed, and of PREVENTING MORE MISERY than all that was perpetrated, in the battles of Napoleon, Nelson, and Wellington ? To displace the statue of such a BENEFACTOR OF MANKIND is an outrage on humanity and a disgrace to an enlight- ened age ; but, alack ! it is too much in keeping with the ignorant and senseless caprices of many of a so-called upper class, who pretend to set up the monstrous absurdities of homoeopathy and mesmerism, in opposition to the facts and reasonings of science ! Another example of SIGNAL SUCCESS IN THE PREVENTION OF DISEASE AND. DEATH, may be found in the statistical returns of the British army during the last ten years. The writings of Sir John Pringle and others had directed the public attention, a century ago, to the necessity of sanitary regulations for the preservation and efficiency of the lives of soldiers and sailors men thrown together in large numbers under circumstances in various ways trying to the health; and the well-known fact that the history of our armies generally comprised also the history of various pestilences, which they carry in their train, could not be disputed. Those best acquainted with the details of past sieges and campaigns knew also that the ravages made by these foes within the camp were, often tenfold nay, more than a hundredfold greater than those inflicted by the arms of the enemy. But the destructiveness, not merely of war but of military life during peace also was never fully felt, until made known by the searching statistical records, first devised by Sir James MacGrigor, afterwards digested into reports, by Dr. Graham Balfour and Lieutenant (now Major-General Sir A.) Tulloch, and finally ex- tended and completed by the Eoyal Commission of 1857, of which Lord Herbert was president. Who could have supposed that the annual mortality of the army in this country in time of peace was more than double that of the general male population of the same age? and, still more, that the Footguards, consisting of picked men, selected for their healthiness and robustness, should annually die off at the rate of 20*4 per thousand, whilst the ordinary mortality does not exceed 9'8 ? Yet these were disgraceful facts, arising from official carelessness and ignorance through a series of years, until hundreds and thousands of valuable lives were sacrificed, an 1 Allusion is here made to the statue of Dr. Jenner, which had just been erected in Trafalgar Square, close to the College of Physicians, but was after- wards removed to an obscure site in Kensington Gardens. CRIMEAN HORRORS. CONSEQUENT REFORMS. 305 incalculable amount of public money wasted, and a stigma of obloquy was cast on a noble branch of the national service. In vain did many of the more intelligent and enlightened Medical officers endeavour to make their representations at head- quarters, why such mortality occurred, and how it could be prevented. In such appeals to those in authority they generally only got snubbed, and were told to hold their tongues and mind their own business ! If such were the fatal results of the criminal indifference and ignorance of the governing classes during peace, can we wonder at the harvest of disaster, disease, and death, which resulted in the trying times of war? The horrors of the Crimean campaign are still fresh in our memories. And who is there among us that has not heard of the prominent features of that eventful period which bear 011 our present subject? of the unheeded warnings of the Director- General and other experienced Medical men ? of the hasty equipment of the expeditionary force, and its foretaste of suffering from the neglect of sanitary precautions on the voyage, and in the camp before Varna? of the inadequacy of the supplies for the sick and wounded at Alma? of the perils and privations of Balaklava, aggravated as they were by desolating storms, intense cold, and still more by the blundering of officials, through which the troops were kept without food and clothing, and were consequently soon deci- mated by starvation aaid disease ? of the further ravages of zymotic pestilence in the Crimea and at Scutari, from almost total want of proper sanitary arrangements on board the transports, in the camps, and in the Hospitals ? The amount of mortality from disease alone was something appalling during the first seven months of the Crimean campaign, rising to the rate of 60 per cent, per annum of the whole army a mortality greater than that of the great plague of London in its population ! And observe, all this awful sacrifice of life was from preventible ca^lses, as you may judge from the sequel, which will serve us as a present illustration of the successes of Medicine. During the last five months of the Crimean campaign the mortality among the troops did not exceed 11 '5 per thousand per annum, which is considerably below the average mortality of the army at home in time of peace. And that this remarkable improvement was really due to better management, and not to in- creased healthiness of the climate, is obvious, from the fact that at this very period in the contiguous French army, fever and other zymotic diseases were still making fearful ravages. The reform thus accomplished at last, was brought about through much tribulation. The British nation was aroused to x 306 SIDNEY HERBERTS ROYAL COMMISSION. sympathy and indignation at the sufferings and destruction of its army, denounced by one of the Ministers in the Government, as ' horrible and heartrending.' The public, through the agency of the ' Times Commissioner,' vied with the now earnest and lavish War Minister, in sending abundant supplies to the Hospitals and to the camp, where the more enlightened Medical officers, now freed from the trammels of red tape and official obstructiveness, and aided and strengthened by able special commissioners, 1 were carrying on their sanitary measures with the vigilant superintendence of that guardian angel of the British army, Miss Nightingale, with her band of devoted assistants. Thus was the residue of the army saved, and the reinforcements sent out were preserved in health and efficiency. So prosperously ended the Crimean campaign. But where was the security that the lesson thus taught would be remembered any more than those to be learnt from former wars, which had to struggle through similar disasters those of Walcheren and the Peninsula, for example ? There was none ; and if no further change had been made in the system, in all probability the results of experience and the dictates of science and common sense would have soon been set aside by the spirit of official obstinacy and military arrogance which would surely prevail in the War Department as hitherto administered. But, thanks to Sidney Herbert's Eoyal Commission of 1857, 2 a change was made in the system the administration of the army has been put on such a footing as to secure a constant attention to sanitary matters in future ; and the short period which has since elapsed enables me to record such satisfactory results, both in peace and war, as to fully entitle them to a foremost place among the SUCCESSES OF MEDICINE. Thus, during the last three years, since the reformed system has been in operation, the annual mortality of the Footguards at home has been reduced from 20 to 9 in 1,000, and that of the infantry of the line from 17*9 to 8*5, and even so low as 5 in Aldershot and Shorncliffe. 1 Two commissions were sent out to the Crimean army at this date one respecting supplies for troops and sick, presided over by Sir John MacNeil : the other under Dr. Sutherland, for carrying out sanitary improvements in the hospitals and camps of Scutari and before Sebastopol. - The members of this Koyal Commission were the Bight Hon. Sidney Herbert, M.P. ; Augustus Stafford, M.P. ; Major-General Sir H. Storks ; Dr. Andrew Smith, Director-General ; Mr. Alexander ; Sir J. Phillips ; Sir Ranald Martin ; and Dr. Sutherland. After the lloyal Commission issued its report, several commissions were appointed to give practical effect to its recommenda- tions. SUCCESSES FOUNDED ON MEDICAL SCIENCE. 307 And in proof of the success in war, I will quote a passage from one of Miss Nightingale's summaries : ' The crowning testimony of the great national importance of the new system of sanitary ad- ministration inaugurated by Lord Herbert, is to be found in the last Chinese expedition, when his reforms were first practically tested. An expeditionary force was sent to the opposite side of the world, into a hostile country, notorious for its epidemic diseases. Every required arrangement for the preservation of health was made, and with the result that the mortality of this force, including wounded, was little more than three per cent, per annum, whilst the " con- stantly sick " in Hospital were about the same as at home. Let us contrast this great success with what happened during a former war in China. The 26th Cameronians, a " total abstinence" regiment, and one of the finest and most healthy in the British service, was landed at Chusan 900 strong, and left to its fate without any sanitary care. In two months only twenty men could be got together.' I claim for Medical science the chief credit in supplying the foundation for these successes ; and had the voices of the more enlightened and intelligent Medical officers of the army been listened to long ago, much good might have been done, and much evil averted sooner. But, as before said, these voices were silenced by military despotism and official indifference ; and it was not until, strengthened and re-echoed by new and awful experience, they reached the ears, touched the heart, and convinced the understand- ing, of one high in rank and authority, that they became strong enough to bear down the opposition and obstruction that beset them on every side. Lord Herbert had already considerable experience in War-Office administration, when the disasters of the Crimea occurred and opened his eyes to its utter inefficiency. From that time forward, both in office and out of office, in public and in private, he devoted his whole life and best energies to the ex- amination of the details of every department, to searching out all defects, and to finding and providing adequate remedies. At the head of that before-named Royal Commission of 1857, supported by competent Medical and other advisers conversant with the various subjects to be examined, he summoned the most eminent or best- informed witnesses, and in replies to upwards of ten thousand questions, with voluminous appendices, was amassed an enormous amount of information on all connected topics ; the results of which were embodied in a most masterly report, concluding with a series of practical recommendations, which have since been in great measure adopted and carried out with a success exceeding the highest expectations. Prominent among these recommendations was 308 ARMY MEDICAL OFFICERS ON RIGHT FOOTING. that to place the Medical officers on a proper footing as guardians of the health of the army, to be consulted and deferred to for the pre- vention as well as for the cure of disease ; and thus for the first time the Medical service became a power in the army, efficient and successful in some proportion to its dignity and deserts. This great work Sidney Herbert conscientiously and nobly ac- complished ; but, alas ! at the sacrifice of his health and life. Note added in 1871. Another great loss, which occurred about the same time, was that of Mr. Alexander, the Director- General, who, with great personal labour, first brought the new sanitary regulations into operation. Happily Lord Herbert's successors, in conjunction with Dr. Sutherland and other surviving members of the Barrack and Hospital Improvement Commission, have continued the arrangements under the authority of the present Army Sanitary Commission, which comprises representatives of the War Office, Eoyal Engineers, Office of Works, Local Government Act Office, and India Office, together with the Army Medical Department. The most important field of operation of this Sanitary Com- mission at present is in India, where it was introduced under the direction of Lord Stanley, now Earl of Derby. Here it has already begun to achieve great successes in the prevention of disease, and bids fair to accomplish still greater triumphs hereafter. An annual report of the measures adopted is now published by the India Board ; and the following extract from the last report will serve as a sample of what may be done. ' In the year 1857 Sir Eanald Martin addressed two letters to the Chairman of the Court of Directors, recommending that all British soldiers, available from the duties of the plains, should be per- manently cantoned in the hill regions of the country, to diminish the high mortality then prevalent among themamounting during fifty-six years of this century to 69 per 1,000 per annum. In a letter dated March 27, 1870, alluding to the adoption of Sir E. Martin's recommendation, Dr. Cuningham states that Dr. Bryden had sent in a table showing the results for working parties in the hills during the past seven years. 1 The result is that the death- rate per annum is only just over 4 per 1,000. That the removal to the hill ranges, everywhere to be found throughout India, should reduce the death-rate from 09 to 4 per 1,000 is, indeed, a most patent and wonderful fact. It is the greatest triumph ever achieved 1 It may, however, be questioned whether the greater salubrity of ' working parties ' may not be in some measure due to their exercise in the open air as well as to the altitude. MISS NIGHTINGALE'S SUCCESSFUL WORK. 309 over the external causes of disease everywhere prevalent in the plains of Hindostan.' Report, &c., p. 5. But there was one other chief agent in the commencement and completion of the great and successful work, (of the Crimean campaign), whose name I cannot pass over, although, being neither Medical, military, nor even masculine, her share in the matter is little known or even suspected. In all that relates to nursing and providing for the sick army in the East, the name of Florence Nightingale is as a household word ; suggestive of devotion so noble, of self sacrifice so chivalrous, that it might seem romantic if it had not been so substantial and practical in its beneficence. But the army and the country owe to Miss Nightingale much more than the devoting of years of day and night toil in watching, nursing, and superintending in the Hospitals and camps of Scutari and the Crimea. With a vigilance untiring, a rare intelligence, and a memory never failing, this gifted lady saw and comprehended all the multitudinous wants and requirements of the army, in Hospital, in camp, and in barrack ; in war and in peace, in sickness and in health. She noted the complete failure of the existing system of administration, and how much was necessary to reform it in every department. At the end of the campaign in 185G, when Miss Nightingale returned home with weakened frame and broken health, her Queen and her country were ready to welcome her back to honour and to repose. But no, Miss Nightingale had a further mission to fulfil ; and instead of accepting titles or honours for herself, the boon which she asked was for the issue of that Eoyal Commission, with Sidney Herbert at its head, which has been the means of bringing about those reforms which she knew to be so much needed. Instead of seeking her own ease and rest after labours almost superhuman, she ceased not to work on for this end, by taking a chief part in suggest- ing the course of the inquiries, and in obtaining the requisite evidence, in ways and to an extent which her vast experience and knowledge enabled her alone to do. Well, therefore, may we rank the name of Florence Nightingale with that of Sidney Herbert, foremost among the authors of the great sanitary regeneration of the British army, which has now made it, beyond comparison, the best-provided and the healthiest army in the world. Note added in 1871. Miss Nightingale's labours did not cease here: through all the intervening time, in spite of much bodily 310 MISS NIGHTINGALE. suffering and failing strength, numerous proofs of her superior in- telligence and experience may be found in the workings and reports of various Government Commissions and public institutions con- nected with the army, Hospitals, and sanitary science. Even in the last Annual Keport of the Progress of Sanitary Measures in India, Miss Nightingale's words of criticism, direction, and encouragement are deservedly brought forward as those of the highest authority and importance. CHAPTEE XXXIV. FAMILY HISTORY. PERSONAL PROSPECTS. FRIENDS. 1860-1870. Marriage of Eldest daughter Notices of other Children. Personal Health and Warnings Limitation of Prospects Offices Eefused. Need of Representa- tion of the Profession in Parliament. Thomas Wakley as a Journalist Need of Reform in Hospitals. The Lancet Its objects and early history Opposition and Support Author and others prejudiced against it. Mr. Wakley's courtesy Popularity in House of Commons, attested by several MM.P. T. S. Duncombe Hon. H. FitzRoy, &c. Mr. Wakley's illness His Gentleness and Geniality Nature of disease Retirement abroad necessary, for rest as well as climate Improvement during winter Death from accidental hromorrhage in spring. Entitled to foremost rank as Medical Reformer Promoter of Improvements of Knowledge and Educa- tion -and Advocate of the Interests of the Profession. IN 1862, our eldest daughter, Sophia Janet, was married to the Rev. S. Christopher Morgan, eldest son of the Rev. Samuel Morgan, Vicar of Chepstow. This happy union has been since blessed with six children, three sons and three daughters, the eldest of whom is now 20 years of age. After holding a curacy for a short time in Gloucestershire, my son- in-law has been Vicar, successively, of Aldershot, of Christ Church, Greenwich, of Roxeth, Harrow, and of Swansea, S. Wales. The last important and responsible charge, he has now held seven years ; and he has taken his degree of Doctor of Divinity. These Memoirs are not intended to include details of Family matters, but a brief notice of the history of my other children, will not be irrelevant to that of my own Life. My eldest son, after a varied course of private tuition in Germany and Geneva, studied for Civil Engineering at King's College, London, and was articled to Mr. H. Conybeare of Abingdon Street, Westminster : (Burkenshaw and Conybeare). After fulfilling the term of pupillage, he was employed by the 312 HISTORY OF CHILDREN. same engineer in the construction of railways in Ireland and Wales. Unhappily he fell into ill health which entirely dis- abled him from active employment, and terminated fatally in November, 1882. My second son, Charles Theodore, after taking his degree in arts at Oxford, studied Medicine at St. George's Hospital and in Paris. He then took his Doctor's degree at Oxford and became Member of the Koyal College of Physicians, London. Showing some signs of delicacy of the chest, he passed two winters in the South of France and Italy, and there per- sonally acquired the local knowledge which supplied the materials of his first little book on Climate, published in 1857.~ This residence in the South, with other measures, was happily quite successful in re-establishing his health, and he has continued to reside and practise in London ever since. My third son, Harry Samuel, during part of his time at Cambridge, resided at the Observatory with Professor Challis. In 1861 he was elected scholar of St. John's College, and in 1862 graduated as 22nd Wrangler. He afterwards entered the office of Messrs. Capron & Co., solicitors, of Savile Place, (in which a son of my old friend, Dr. Brabant, was a partner), and in due time he practised as solicitor ; during several years in amicable partnership with my old patient and friend, Mr. Owen Alger of Bedford Eow. My fourth son, Arthur David, evinced a great desire to go into the Eoyal Navy, but, although well instructed by Dr. Burney, he failed to satisfy one of the examiners who re- quired him to go through the multiplication table in French. Through the kindness of a friend he got an appointment as midshipman in the Indian Navy, in which he served two or three years and had some adventures with piratical tribes in the Indian seas. Finding his health beginning to suffer, he gave up the service, returned to London, and entered the office of Messrs. Liddell & Gordon, Civil Engineers, and attached himself to that line of business, in which he has continued ever since. My youngest son, Ernest Jenkins, suffered early from severe catarrhal attacks, complicated with asthma, and some- times inflammatory earache, which he thought were aggravated SONS AND DAUGHTERS. 313 by cold at one of the schools at which he was pursuing his education. He was afterwards placed under the private tuition of the Rev. C. F. Childe, of Holbrook (formerly my patient), where he was carefully treated and taught. But the ear attacks ended in deafness, which all the kindness and skill of my excellent friends Toynbee, Hinton, and Dolby, suc- cessively, failed to remove. One winter he passed at Hyeres with my good friend and old patient (arrested phthisis), Dr. G. Griffith, with much benefit to his asthmatic affection. The state of his health interfering with all close application, he devoted himself much to Natural History, and passed a year at the Eoyal Agricultural College at Cirencester, in the study of Scientific Farming. In 1866 he emigrated to Buenos Ayres, and passed two years in the prairies of the Argentine States, wholly occupied in superintending cattle farms, riding wild horses, catching them with the lasso, and other adven- turous and invigorating pursuits. He returned much im- proved in general health and strength; but very little in hearing. Soon after he took a small farm in Shropshire; and succeeded wonderfully in the management of it : but in two or three years his health again began to suffer so much from the climate, that he was obliged to give up the farm, and again go abroad. This he did in a voyage to Teneriffe and the Cape of Good Hope, where he bought a horse and rode through South Africa to Natal, where he passed several months in vigorous health. Returning to this country, he suffered still in bad weather, but much less than formerly. A winter passed in Egypt with his youngest sister ; and sometimes accompanying his mother in her visits to the south of France, have contributed to raise his condition above that of an habitual invalid. Our two youngest daughters, Harriett Amelia, and Fanny Catharine, in their early years were educated at home, with the aid of several governesses in succession, English, French, and German. But their education was chiefly carried on and completed at the well-known and highly valued school of Mrs. Umphelby at Belstead, near Ipswich, where they re- mained many years. More recently two of my granddaugh- ters have had the advantages of the judicious training of 3 H WARNINGS OF ILL-HEALTH. the same estimable lady. After my daughters leaving school, as may be anticipated, I took good care that they should have further good instruction in drawing, for which they both had remarkable talents. They proved very successful, and became excellent artists ; Amelia in landscapes ; Fanny in flowers. The latter (whom we have since lost) was also very musical, with a powerful voice (mezzo-soprano, including contralto notes) ; and her mother secured for her lessons from several eminent teachers. I made a point also of their being well taught in riding, (with a very successful result) as conducive to health as well as to enjoyment. (It is still the favourite exercise of my surviving daughter, who mounts her beautiful chestnut Arab on every possible opportunity, some- times still accompanied by her aged Father.) Both our daughters were delicate in health, and at times caused us much anxiety. They both suffered but in different ways from the cold of the English climate ; and in subse- quent winters I deemed it prudent to send them abroad with their mother, who had already found it necessary to avoid the cold and damp of this country. To pass from family to personal matters. The additional mental labour, caused by the preparation of the Lumleian lec- tures, was not without an unfavourable effect on my health. Although I had no longer the prostrating attacks of vertigo and swooning, from which I sometimes suffered during the heavy work connected with University College, I often had noises in the ears and head, and sometimes confusion of thought after more than usual mental exertion or anxiety, and a feeling of nervousness and depression, which was not natural. For many at least twenty years, I was constantly worried more or less with tinnitus all sorts of noises in the left ear, the hearing of which was never so good as that of the other : and these noises were always greatly increased under the circumstances of mental fatigue or bodily ex- haustion ; and diminished by rest and by moderate exercise in the open air. In the latter part of each holiday excursion, and for a month or two after, I was most free from them. I generally disregarded these symptoms, unless very severe ; OFFICES REFUSED. AMBITION MODERATED. 315 and then the feeling seemed overwhelming, and compelled quietude. Often too, I suffered from want of sleep ; waking at, or soon after midnight, and passing hours of watchful- ness the mind over-active with any distressing or anxious thoughts. 1 I could not but interpret these symptoms as warnings, against undertaking unnecessary work. I there- fore postponed the complete publication of the lectures which I had delivered. I refused the Senior Censorship of the College of Physicians, and the office of Harveian Orator ; and I replied in the negative to the question whether I would be willing to undertake to deliver the address in Medicine at the meeting of the British Medical Association to be held in London. I was quite conscious that in refusing to avail myself of these opportunities for further distinction, I was abandoning my chance of attaining to the highest honours of the Profession : but I considered the warnings which I had received, of instability of health, a sufficient reason for moderating my ambition, and for limiting my expectations to the realising of an adequate provision from my present lucrative practice, with the hope, at no distant period, to with- draw to the enjoyment of rest, solaced by social blessings and the resources of art and science, and made peaceful and happy in the faithful contemplation of the Finished Work of Grace. It was in accordance with the view which I had been led to entertain with regard to my future, that in 1867 (I think) when Dr. Murchison and several other Fellows of the College of Physicians asked me to allow my name to be proposed for the office of President, my reply was, that having doubts as to 1 Various soporifics, and sundry dietetic and regiminal expedients were tried, with variable success : but the most successful remedy for persistent sleepless- ness, I found to be a mental one, at the mention of which, I doubt not, many will exclaim I mean, reading in bed. Dispensing with bed-curtains, with due precautions to make the candle safe, (self -extinguishing, if need be), it should be placed on a pedestal behind the head of the reader, as he lies on his right side, with back to the light, which falls on the book or pamphlet before him ; which should be amusing or interesting, but not exciting. My common experi- ence was that thus the mind, gently and pleasantly occupied by subjects, which drive away worrying and wakeful thoughts, becomes calmed in half an hour or so I begin to feel sleepy put out the candle, and fall asleep 1 But I cannot recommend the plan without again emphatically enjoining the proper precautions and limitations in its use. 316 WANT OF REPRESENTATION IN PARLIAMENT. the state of my health, I could take no active part in the matter ; at the same time, if elected, I should not shrink from accepting the honour, or from the endeavour to fulfil the duties of the office. I understood that it was a great relief to Sir James Alderson when he found that I was not likely to be an active opponent. His friends were on the alert, and secured a large majority of votes for his re-election. I do not remember how many votes were recorded for me perhaps twenty or thirty but several other Fellows told me, after the election, that they would have voted for me, had they known that my name would be proposed. I had been still more decided in declining the proposal which had been made to me some years previously by some of the graduates of the University of London, that I should be put in nomination for the representation of that University in Parliament. The position and duties of a Member of Parlia- ment would have been quite incompatible with my necessary occupations. Being then asked to recommend an eligible candidate belonging to our profession, I named Sir Charles Locock, as a competent man ; of liberal politics, and no longer embarrassed with the claims of practice, as he had retired with a large fortune. I gave these gentlemen a letter of introduction to Sir Charles ; he entered into negotiation with them, and was declared a candidate, but further arrange- ments prevented his election. It is much to be regretted that the Medical Profession is not more adequately represented in Parliament. What is needed is not merely the presence in the House of one or more members who are or have been medical men, and who may occasionally and irregularly speak on subjects connected with the Profession ; but one, well acquainted with the past history and present state of the medical institutions of the country, and who is sufficiently known and respected, to possess the confidence of a large portion, if not a majority, of the members of the Profession. Such a representative, always well informed and accurate in his subject, and speaking with corresponding decision and a certain amount of self- assertion, would always command the attention of the House, THOMAS WAKLEYTHE LANCET. 317 and become somewhat of a power in the State. The only M.P. who seems to me to have ever attained to anything like this position was the late Thomas Wakley. The early part of his career, as a censorious and radical journalist, was very different from that of his later years as a very popular member of Parliament and coroner for the Metropolitan county. The journal, which he created, and which made Jtiin, in spite of its early ribaldries and abusive personalities', was interwoven with a web of truth and justice which gave strength to its attacks and gained the attention and support of the public ; notwithstanding the bitter opposition and per- secution from old corporations and long-established monopolies brought in array against it. I suppose it is the common lot of radical reformers, who go to the very roots of the evils which they seek to eradicate, to get some contamination of language and spirit from the foulness and corruption of the dirty soil into which they penetrate. At all events it is very hard for human nature to be set to discover and denounce the delinquencies and abuses of its fellows, without being tempted into censoriousness of spirit and violence of language, which render the work of reform the reverse of gentle or peaceful. When I first came to London, the ' Lancet ' was already a power, which had made itself felt : relished by the profession at large, which has rather a democratic taste, and hailed as champion of their rights, received with curious interest by the public, which is alive to anything strong or sensational : but by the aristocracy of the Profession, including the accused Hospital authorities and Corporations branded as malignant and revolutionary ; and to be opposed in every possible way, private and public. To be suspected of connection with the ' Lancet,' was to be tabooed by societies and respectable bodies ; and woe to the student going in for examinations, if he were supposed to have supplied it with reports ! Neverthe- less the Journal continued to increase in circulation ; and no wonder ; for over and above the censorious and scurrilous matter, which served for sauce, it supplied useful food for the minds of its readers, in copious medical news and reports of lectures. Wakley showed his ability as an editor, not only in his own slashing and incisive articles in which he attacked 318 WAKLEY'S PARLIAMENTARY POPULARITY. abuses and held up to ridicule and condemnation the in- efficiency and neglect of institutions and of their officers, but also in his gathering around him a staff of really clever and well-informed men, who could supply to his pages the most recent knowledge, and guide his councils by the scientific spirit of progress, required by the forward movements of the times. At St. George's Hospital I was in the anti-' Lancet ' camp, and was strongly prejudiced against that journal. In fact I never read it ; and all my support and contributions were be- spoken by Dr. Macleod, physician of the Hospital, in behalf of the 'London Medical Gazette,' which he edited, and which was said to have been started in opposition to the ' Lancet.' At University College, Mr. Wakley's sons were my pupils, and I soon began to receive from him marks of courtesy and confi- dence. He placed several members of his family under my care, and he recommended a number of patients to consult me. Among these were several Members of Parliament. They familiarly called him 'Tom Wakley,' and all testified how much he was liked and respected in the House by all parties. Of these Parliamentary friends I recollect particularly Thomas Slingsby Duncombe, his colleague for Finsbury ; the Hon. Henry FitzEoy, Mr. Speaker Denison (since Lord Ossington), and the Eight Hon. Dr. Lushington. Mr. T. S. Duncombe, (who also was familiarly known as ' Tom Duncombe ') was a great sufferer from habitual asthma 'pulmonary emphysema, with frequent spasmodic and catarrhal exacerbations. He was an able man and had been a power- ful popular orator. I set him up for a time, and he was able to resume Parliamentary duties. But in an English climate there was no chance of escape from relapses, and he would not go abroad. He struggled on for a few years, and before his death fell into the hands of quacks. The Hon. Henry FitzEoy (son of Lord Southampton), although he had mitral valvular disease of the heart, became so much better after treatment, that he was able to work efficiently as Under Home Secretary several years under Lord Palmerston. He introduced the Sixpence-a-mile Cab Act, and other useful legislative measures; but fell a victim to his HIS FRIENDS HIS ILLNESS AND DEATH. 319 official zeal in superintending the drainage of the Serpentine. He caught intermittent fever ; and when I went to see him at Brighton, I found him dying. The damaged heart, although it failed not under the trials of light ordinary work, could not rally from the depressing power of the malarious poison. I attended Mr. Denison, the Speaker, several years, and also his brother the Bishop of Salisbury. Their nephew, Lord Albert Conyngham (afterwards Lord Londesborough), was also long my patient. A son of Dr. Lushington made a wonderful recovery from a very long illness from deep-seated abscess of the lung. Although I had these repeated proofs of Mr. Wakley's goodwill towards me, I knew little of him personally, till he consulted me for his own health in the autumn of 1861. I was agreeably surprised with the gentleness and geniality of his manners, and the homely simplicity of his conversation. His ill-health had impaired the vigour of his expression ; but there was an earnestness in his look, with an occasional twinkle of his eye, showing forth the workings of energy and of humour in his nature. The hopeful courage and self-confi- dence, which had borne him up through life against any amount of opposition and difficulty, did not forsake him in the danger which now threatened him. I have not the notes of his case by me ; but so far as I can recollect, it was one of inflammatory origin, rather than of tuberculous consumption : but it certainly went on to the formation of cavities, which rendered the prospect of the future very serious : and the more so, as his sanguine temperament and active mind tended to make him impatient of the restrictions necessary for any chance of recovery. These considerations further pressed the expediency of his being sent abroad for the winter, for the sake of seclusion and rest, as well as for the milder climate. In the balmy air and quiet of Madeira he so far improved as to pass the winter fairly without any material increase of disease. His death, which took place in May, \vas from haemorrhage, brought on, after a boating excursion, by a fall in landing on the steep sloping beach, (which I remember well, and the difficulties experienced in landing). The occur- rence shows that he was still in possession of considerable 320 WAKLEYA FOREMOST MEDICAL REFORMER. activity and strength, and suggests the probability that his ardent temperament was still apt to lead him beyond the bounds of prudence. Without doubt the works of Thomas Wakley entitle him to the foremost rank as a great Medical Eeformer ; and the successful results of his labours in correcting abuses and neglects of institutions, and in promoting and improving the means of medical education and diffusion of knowledge, have earned for him the gratitude of the Profession and of the Public. No one has ever so consistently and successfully defended the rights and best interests of the Medical Profes- sion in Parliament, in Courts of Law, and through the Press ; and if in his early life, his daring and asperities raised against him a host of enemies, they were mostly pacified, and many converted into friends, in his later years, when the beneficial fruits of his efforts became apparent. 321 CHAPTEE XXXV. COUNTRY JOURNEYS AND COUNTRY PRACTITIONERS. Medical attendance from a distance to be considered a luxury rather than necessity, and therefore highly remunerated. Difficulties of long Journeys before Railway times New Forest George Tatum of Salisbury Maurice of Marlborough Lord and Lady Ailesbury, &c. Journeys to and near Man- chester W. J. Wilson Dr. Bardsley. Liverpool Birmingham Leeds Torquay, and various other country Journeys and Consultations with local Practitioners. Journeys to sundry Noble Families Dukes of Bedford and Rutland ; Marchioness of Londonderry ; Admiral Lord Lyons, Ac. During long country journeys, mind ought to rest, in preparation for the special consultation. Unreasonable requisitions for distant visits. Constant Patients and Long Friendships Hambro Family through three genera- tions. Mr. E. Marjoribanks and Family. Sir James K. Shuttleworth. Dr. R. Ferguson. Absurd notion that physician's skill must be limited to one class of diseases. Instances of health and life sacrificed by persons at- tempting occupations beyond their powers : Duty of Physicians towards such. Mr. John Stuart Mill, and Lord Lytton a Contrast. / JOURNEYS to distant places in the country form a noteworthy item in the engagements of London Consulting Physicians, and a considerable amount of this kind of practice fell to nay share. Having early through my works obtained some re- putation for skill in diagnosis, I was often named by country practitioners when people in affluence required further advice for an object of solicitude, too ill to travel. Highly qualified and able as country practitioners now are, the demand for still more eminent skill, sought from a distance, should be viewed as one of luxury rather than of necessity ; and as a rule should be limited to those who can afford to pay liberally for it. The London Physician or Surgeon ought to require a high rate of remuneration, not only to recompense him for his supposed higher skill, and for the time during which he is taken away from his patients at home, but also in justice to the country practitioners, who ought not to be damaged by 322 NEW FOREST SALISBURY NORTH WILTS. the competition of the low fees of consultants coming from a distance. The scale of fees for long journeys has been already mentioned in Chapter XXIV. The difficulties of some of my early country journeys form a contrast with the facility and speed of those of later years. I think in 1842 I had to visit a patient in the New Forest, Hampshire, to meet my friends, Messrs. Tatum and Moore of Salisbury. The rail was open to Southampton with tele- graphic communication to London, and one of the first messages sent was that to summon me for "this journey. From Southampton I took a post-chaise through the Forest, but such was the state of the road, that after much flounder- ing through ruts and mud, the chaise got stuck in a hole, and could not be moved. I started off to walk the remaining distance of two or three miles, but in half an hour was over- taken by the chaise, which, by aid of some peasants, had been dragged out of its slough, and I found my friends with the patient awaiting my arrival. The consultation over, I started off hoping to catch the night train from Southampton. But I had not proceeded far, when, on sharply turning a corner, down came the chaise with a crash, from the breaking of a spring. It was getting dark ; and w r e were several miles distant from any place where a conveyance could be procured, and I thought I should have to trudge it on foot ; when for- tunately a carriage with lights drove up, in which were my friends, Tatum and Moore, posting to Salisbury. I joyfully joined them, and was just in time to catch the mail coach, which joined the rail at Basingstoke : the line to Salisbury being still unfinished. After it was completed, I had many more visits to patients at Salisbury and its neighbourhood, under the care of my good friend George Tatum, brother of my faithful old ally, of Paris and St. George's, Thomas Tatum, who died of paralysis, after lingering several years, with little more than half a life. Many visits did I make also in North Wilts meeting my friend Maurice of Maryborough, who had the best practice in that neighbourhood. Several times I had to see the Marquis and Marchioness of Ailesbury at Savernake, in Marlborough Forest, and once their nephew, the present Admiral Earl READING MANCHESTER. 323 Clanwilliam. These visits were very satisfactory and gave me good repute in that country. I ascribe much of their success to the careful and judicious manner in which Maurice entered into my views and carried them out in practice. His brother at Beading was another skilful practitioner, with whom it was always satisfactory to hold consultation. The same may be said of Mr. Ceeley of Aylesbury, to whom we owe the first demonstrative proofs of the identity of smallpox and cowpox. Karly in my career, I was called to consultation in Man- chester and its vicinity ; and my friend Mr. W. J. Wilson, in large practice there, told me how without reference to my subsequent successes, my first visit had made a favour- able impression. Not for the purpose of display, but because I really needed them I was in the habit of bringing with me, not only a stethoscope, but also test-tubes and a few chemical reagents for the examination of the state of the secretions, &c. This has been done as a matter of course in later years : but it was not so forty years ago ; and when the shrewd Lancashire manufacturer, to whom I was called, not ignorant of the value of chemical knowledge, saw me going through the details of a thorough technical overhauling, and comparing it with the character of former examinations he exclaimed, ' That's what I call cluing business ! ' But I repeat, this practice of thorough and careful scrutiny has long become general : only I was a little beforehand with it. Often afterwards I had consultations with the intelligent physicians and surgeons of that great industrial metropolis; and a large clientele from thence found me out in London. 1 1 The following note from Sir James Bardsley is an example : Manchester: Februarys:!, IPALL MALL GAZETTED AND DR. HUNTER. these pretensions were garnished by a specious display of chemical terms, and, by a reference to distinguished chemical authorities, well devised to deceive the ignorant. No well- informed medical man could be thus deluded : but Dr. Hunter specially warns his readers against the whole profession, as prejudiced, as well as incompetent. Eventually his advertise- ments attracted a great many patients, and he had establish- ments for carrying on his method of treatment in Scotland and Ireland as well as in London. It was not long before I heard more of this pretender from patients who had consulted him, and it was by no means to his advantage. Only one of these thought he found some temporary benefit from the inhalations ; some got no good, and others became worse : but all complained of the charges, which were a guinea for the first consultation, and 5L per month afterwards. 1 It was the spirit of extortion thus mani- fested, taking advantage of the alarms of deluded patients, together with the combined craft and ignorance discovered in the pretended invention, that aroused the indignant feelings of an independent journalist, who publicly denounced the offender in no measured terms in the pages of 'the ' Pall Mall Gazette ; ' and describing his advertisements as fallacious and unprincipled, full of false and exaggerated statements, calcu- lated to terrorise the public, to discredit medical practice in general, and to puff off his own vaunted remedies, which were really as destitute of efficacy as they were the outcome of ignorance and error, concluded by strongly warning the public against the whole concern. Dr. Hunter could not do otherwise than bring an action for libel, against the responsible publisher of the ' Pall Mall Gazette,' who undertook to defend the action, pleading ' not ' 1 This is a high charge for a class of cases which are chiefly chronic, and do not require frequent visits. Setting aside acute cases, or serious aggrava- tions, where more constant attendance is necessary, I seldom saw my con- sumptive patients, after one or two first visits, more frequently than once a month ; and often much less frequently. I daresay other physicians can echo my experience when I mention further that many times have I been brought prescriptions of mine, dated many years before, which have been in constant use ever since, without the patient having paid a second visit. In such cases the druggist has drawn a much larger profit than the physician. But the latter has his reward in the abiding faith of the unseen patient. ACTION FOR LIBEL DR. HUNTER'S PAMPHLET. 335 guilty, and further, that the alleged libel was true in substance and in fact.' Together with several other London Physicians, I was summoned as witness for the defence ; and although such an engagement in a Court of Law was far from agreeable, involv- ing both anxiety and responsibility, and occupying much time, I did not shrink from what seemed to be a plain public duty, to support a public-spirited journal in a righteous endeavour to expose fraud and ignorance, and to uphold the dignity and interests of the Medical Profession. It would occupy too much space to give the details of the trial, which were copiously reported by the journals of the period : and I shall chiefly confine myself to the part which I took in it. The pamphlet of Dr. Hunter, extracts from which formed the substance of the numerous advertisements appear- ing in the daily and weekly newspapers, was a curious com- pound of pretension and ignorance. He professed that he had discovered that tubercles, the cause of consumption, con- sisted of matter with an excess of carbon, resulting from in- adequacy in the respiration to supply oxygen sufficient to carry it off. In support of the notion of the excess of carbon in tubercle, he quotes the analysis of Scherer, who found in tubercle nearly 54 per cent, of carbon : but Dr. Hunter over- looks the same chemist's analysis of protein and other animal principles, which contain nearly 56 per cent, carbon; actually more than tubercle so that Scherer is against him. Under the same erroneous notion that tubercles arise from defective respiration, he ascribes the power of bronchitis to produce them, to its impeding respiration : overlooking the well-known fact that other disorders which impede respiration, more, and for a longer time, than bronchitis, ' are remarkably exempt from the formation of tubercles. Thus asthma, spasmodic or habitual, malformations of the heart, and distortions of the spine, all of which greatly interfere with the oxygenation of the blood, seem in some measure incompatible with a tuber- culous tendency. Dr. Hunter's notions in /xitJiolo/ii/ thus proving so erro- neous, nothing more satisfactory is to be found in his tJn'm- tics, or means of cure. They are described in the pam 336 EXAGGERATIONS AND ERRORS TRIAL. phlet too vaguely to be intelligible or practicable by another medical man : but much efficacy is ascribed to the use of remedies by inhalation, and especially those which are said to supply oxygen : but no explanation was given how this was to be accomplished, nor directions for carrying out the plan. Thus the method of treatment vaunted as being so much more successful than any other, was kept secret and confined to the practice of Dr. Hunter and his assistants. The extensive prevalence of the disease, proving fatal to one-fourth of the adult population the insidiousness of its approach with few premonitory symptoms are dwelt on in exaggerated and alarming terms, and the fearful description winds up with a solemn warning against all ordinary methods of cure, which are denounced as irrational and ineffectual. On the assumption that the disease in consumption is local, confined to the lungs, Dr. Hunter maintains that reme- dies ought to be directed at once to the lungs ; and on the assumption that tubercle, the cause of consumption, is dele- terious through its containing an excess of carbon he insists that the proper method of treatment is by the inhalation of air or vapours with an increased supply of oxygen. Medical men know well that both these assumptions are contrary to facts ; abundant evidence to that effect came out in the trial. On the 27th of November, 1866, in the Court of Queen's Bench, the Lord Chief Justice (Cockburn), with a special jury, had before him the case of Hunter v. Sharpe, an action for libel against the ' Pall Mall Gazette.' The defendant pleaded ' not guilty ; and further, that the alleged' libel was true in sub- stance and in fact.' Mr. Coleridge, Q.C., Mr. Serjeant Ballan- tine, and Mr. Hume Williams were counsel for the plaintiff; Mr. Karslake, Q.C. and Mr. Fitzjames Stephen were counsel for the defendant. Mr. Coleridge stated the plaintiff's case to the jury, handed in the libel, and called as witnesses, the plaintiff, Robert Hunter, M.D. of the University of New York, and Licentiate of the Medical Board of New York ; Dr. Melville, M.D. Edin- burgh ; and Dr. McGregor, M.D. Edinburgh ; assistants of Dr. Hunter ; and six persons, who had been Dr. Hunter's patients. After these respectively had given their evidence and had EVIDENCE FOR DEFENCE PLAINTIFFS ERRORS. 337 been cross-examined, Mr. Karslake addressed the jury for the defence, and then, on the third day of the trial, called, as first witness : (Taken principally from the Eeport in the ' Lancet.') Dr. Williams, F.R.S., F.E.C.P., Senior Consulting Physician to the Brompton Hospital for Consumption, who stated that he had paid particular attention to diseases of the lungs, and had read Dr. Hunter's book, which contained, he said, many exaggerations and misstatements. The statement in the book that consumption arose entirely from imperfect respiration was as much opposed to the truth, as a statement could well be. It was a remarkable fact that many of the diseases in which respiration was most imperfect were unusually free from tubercular deposition. The subjects of habitual asthma were nearly always free from tubercle ; the same remark also would apply to spasmodic asthma. There was a similar class of cases connected with malformations and disease of the heart, in which there was imperfect respiration and yet no tubercles. In cases of great distortion of the spine there was often very imperfect respiration, yet in these tubercle was very uncommon. Again, the statement in Dr. Hunter's book that carbon was a poison, inimical to health, and that it was the source of consumption, was entirely erroneous. Carbon was the same as charcoal, a remarkably inert substance ; and was often formed in the lung tissue in considerable quantities without doing any harm. And the statement that it is the true cause of tubercle was unwarranted assumption. Dr. Hunter appealed to chemical analysis to prove the large amount of carbon in tubercle ; but its proportion, 54 per cent., was not greater than in other animal matters. Other constituents of the blood and of the body contained as much, and even more, carbon. There were other statements entirely contrary to fact. The statement that catarrh leads to consumption generally, was a gross exaggeration. It could not be denied that catarrh might develop the disease in persons predisposed to it. But in a common cold there was a liability to cough and an increase of the pulse ; and many persons were subject to nervous cough from accidental causes, and also to quickening of pulse. The statement as to mischief in the lungs being undoubtedly indicated by a ' hacking cough, with slight shortness of breath, especially if associated with an acceleration of 10 to 15 beats per minute of the pulse, etc.,' was absurd. The Lord Chief Justice said the whole passage should be looked at, not isolated expressions. z 338 ERRORS AND EXAGGERATIONS. The entire passage was read : ' In consumption the pulse keeps pace with the shortness of breath. In health the pulse should range from 60 to 68, the average being about 64 beats in a minute. If therefore you have a hacking cough and slight shortness of breath on exertion, accom- panied by an increase in the frequency of the pulse of 10 or 15 beats per minute, you cannot doubt the existence of mischief in the lungs, and should instantly set about its removal.' The witness stated that he had perused the entire chapter, and indeed the whole work, and his opinion was that the passage read was erroneous, and that the general tendency of the work was unduly to alarm the public, and that it contained many statements grossly exaggerated, if not entirely unfounded. His attention was then directed to another passage : ' We do not always find apparent loss of flesh in the first stage of consumption. In young women particularly I have very often found the lungs severely affected, while they still retained their colour and plumpness. But, as a rule, if we reduce the matter to a certainty by weighing, we shall find a few pounds of difference between their present and their former weight. If, with the loss of weight, there is a disposition to sigh, a dark discolouration below the eyes and a quickened pulse, with some heat in the hands, set it down as almost certain that the lungs are affected.' The witness stated that though there was some degree of truth in the first sentence, the latter part of the passage was very erro- neous, and calculated to produce a false and alarming impression. The symptoms described were often met with in cases where there was no such affection of the lungs. His attention was then pointed to a passage in which it was stated : ' The weekly bills of mortality point us to the startling fact that of those who have passed the age of puberty, fully one in every four persons we meet with in the great thoroughfares of business and pleasure, is under the ban of this terrible disease, and destined to fall a sacrifice to it unless saved through the prompt adoption of more rational means than those usually employed.' The witness stated that he considered this to be a gross exag- geration and far too alarming. He was then asked as to a passage which ran thus : From these facts the reader can understand that one of the great objects of treatment is to subdue the catarrhal condition of the mucous membrane. How can this be accomplished ? It is no treatment for a local disease in the lungs, to pour down cod-liver oil and tonics into the stomach, for they never reach the parts ACTION OF COD-OIL AND OF INHALATIONS. 339 affected ; and, besides, such medicines possess no properties capable of effecting cure, if they did. No physician will pretend that cod- liver oil, or any cough mixture, or any tonic ever compounded, has power to remove tubercle, purify the blood, or heal the mucous membrane, even if directly applied. How, then, in the name of reason, can they accomplish these objects when they are applied to a distant and healthy part ? ' The witness said this was entirely erroneous in both fact and reasoning. There was abundant evidence that such medicines did reach the lungs and every part of the body where the blood circu- lated. The Lord Chief Justice. Then, you would say that cod-liver oil had a beneficial action upon the lungs by the oily matter being brought into immediate contact with every part of the lungs ? Witness. As one mode of action, but it has other modes of operation : in generally promoting nutrition, for instance ? The Lord Chief Justice. In other words, you think that if the lungs could be got at locally, it would do good to apply the oil to their surface ? Witness. Well, that I should doubt. It is through the blood that it is believed to effect good, because the deposit and changes of tubercle depend upon the circulation of the blood in every part of the lungs ; and it is in the blood thus circulating, that the oil acts, and is believed to be very beneficial. The witness then had his attention drawn to a passage in an essay prefixed by the plaintiff to his book : ' The conclusion is that pulmonary complaints are curable, even after they have reached a compound stage, when treated by properly regulated, and adapted inhalations of oxygenated and medicated vapours ; and I cannot but regard it as a contribution to medical science of inestimable importance to mankind, and one destined to exert a more beneficial influence on the practice of medicine than any discovery of modern times.' The witness stated that he had been for 30 years in the habit of using inhalation in such cases, and that it had been used in the Brompton Hospital for many years. It was no novelty, but was common in his own practice, and he believed in that of many of his brethren. He regarded it as a valuable auxiliary, but as subordinate to the use of medicines taken into the stomach in the ordinary way. Inhalation, he said, was transient in its effects ; and though, no doubt, the substance inhaled reached the air-passages, and even the blood, it was in such minute quantities that the effect was not enduring. Inhalations too were uncertain in their operation. z 2 340 PLAINTIFF'S 'INHALATIONS' EXPOSED. Sometimes they would produce little or no effect, and sometimes, on the contrary, strong, and even baneful effects ; so that they required to be administered with great care, and with personal super- vision of the patient : and their beneficial operation, at the best, was limited, because transient. Take, for instance, asthma, the disease in which it might be supposed likely to be useful : although the inhalation of stramonium for its cure had been long known, indeed it was in common use all over the world, yet it was transient in its operation ; whereas that same drug when administered through the stomach, was far more beneficial in its effects. In fact, the pro- fession, having long been acquainted with inhalation, and having tried it with all kinds of drugs and in all kinds of cases and in all kinds of ways, had concluded that it was neither so very efficacious, or permanent in its operation, as was at first expected, and there- fore they assigned it less importance than Dr. Hunter claimed for it. Asked as to the modes of inhalation, he stated that, though he had tried inhaling instruments, he had not found them so efficacious as the more simple mode of putting the matter to be inhaled in a jug of very hot water, throwing a cloth over the head while held over it the result of which was that the patient inhaled with ease by both nose and mouth. As to the plaintiff's ' inhaler ' he had found it impossible to make out what it was. Neither his instru- ment, nor his method was described in his book. The witness was then directed to the passage in which the plaintiff described his system : ' The medicines which it is necessary for the patient to inhale are of four kinds first, expectorants, to expel the mucus; second, sedatives, to allay irritation ; third, astringents, to diminish secre- tion ; and fourth, alteratives, to change the action of the diseased membrane.' He was asked whether he could collect from this the plaintiff's system, so as to understand distinctly what it was, and he declared that he could not ; it was so utterly vague and indefinite as to the drugs to be used, their proportions and combination, or the means employed for inhalation. And this remark he applied to the book as a whole. There was nothing in it which was sufficiently clear and definite to enable a medical man to understand the treatment and to apply it. He found in particular no directions which would guide any one in the administration of oxygen ; nor indeed up to this moment could witness collect, even from the plaintiff's evidence, that he ever really administered oxygen at all. The process described by the plaintiff, was, he believed, one that would not really disengage free oxygen. Chloric acid, which the plaintiff said CAUSE AND CURABILITY OF CONSUMPTION. 341 he used, would no doubt, if decomposed, give out oxygen and chlorine ; but if these were inhaled together, the chlorine would be such an irritant to the lungs, as to prevent inhalation being con- tinued ; and if they were mixed with other substances, then these would absorb the oxygen ; so that in either case no free oxygen would be inhaled at all, and the process was useless. In some cases, he said, the real inhalation of oxygen would be dangerous in pulmonary disease for reasons which he explained. Consumption always comprised a tendency to inflammations, of which bronchitis was one, and the effect of oxygen being to increase the stimulating effect of the air on the lungs, he should fear its effects in increasing the tendency to inflammation. So far, therefore, from thinking as the plaintiff stated in his book, that the great thing in every case was to inhale oxygen, it would be in many cases extremely injurious ; and so far from the received modes of treatment by regular prac- titioners having failed, as the plaintiff represented, to diminish the mortality by consumption, he stated that the plaintiff's estimate of the mortality was most exaggerated, and that the average duration of the disease now was five years, whereas it used to be two. Mr. Coleridge in cross-examination. Do you consider con- sumption curable or not ? I consider it curable in certain forms and degrees. The Lord Chief Justice. In what forms and degrees ? In the incipient stage, or when the disease is limited in extent. Mr. Coleridge. Beyond that it is incurable ? When it is ex- tensive and far advanced, no doubt it is incurable. Then it is all the more important to treat it as early as pos- sible ? Certainly, provided it exists. (A laugh.) But it is all the more important to treat for it as soon as it is suspected to exist ? Yes, no doubt. The witness was then challenged upon his opinion as to a passage in which the plaintiff stated, ' All observation and experience unite to prove that the root of the malady is in the lungs, and that tubercles are but the fruit of imperfect respiration ; ' and he repeated that this was as untrue as any statement could possibly be. He was then asked as to another passage ' Tuberculous deposits are the invariable results of insufficient performance of the respiratory function and rebreathed air ; ' and he was asked whether this pro- position was as false as the other ; and if not where was the dif- ference. The witness pointed out that the distinction was, that in the one case there was the mere imperfection of respiration ; whereas in the other the latter passage there was a further corruption caused by the air having already passed through the lungs. The 342 CROSS-EXAMINATIONS. witness was then told that the latter proposition was from Dr. MacCormac's work on consumption, and he said he did not alto- gether dispute it. There might however, he added, be imperfect respiration without consumption, and he quite denied that con- sumption always had for its cause, imperfect respiration. There was, he said, no evidence that imperfect respiration caused or preceded the deposit of tubercle, though of course after consumption had gone on respiration would often be interfered with : consumption, however, was often found without previous imperfect respiration. He also declared it to be a total mistake to state that the cause of consumption was the absence of oxygen or the excess of carbon in the blood, and the passage stating that carbon retained and not sufficiently discharged was ' deposited as tubercle ' was quite in- correct. The cause of consumption might be in the unhealthy condition of various functions of the body ; respiration was only one of them ; but it was utterly incorrect to represent absence of oxygen or imperfection of respiration as the sole cause. The insufficiency of oxygen, no doubt, might be one of several co-operating causes, leading to that deteriorated state of the system which resulted in consumption. Air which had been breathed or respired was positively pernicious. Asked whether oxygenation of the blood was not of great importance and went on in the lungs, he said of course it was ; but the oxygen, to be beneficial, would be absorbed into the blood, and pass through the whole system, thus rendering all the functions of the body active by its presence. He denied the pro- position of the plaintiff that consumption is only the consequence of a carbonaceous condition of the blood. Mr. Coleridge. What do you consider the cause of consumption ? Dr. Williams. A degraded condition of the material of the blood ; that is, such a deteriorated condition of it that it no longer makes good flesh. Mr. Coleridge. And is not that the result of a carbonaceous con- dition of the blood and the deficiency of oxygen ? Witness. On the contrary, many eminent pathologists are of opinion that an excess of oxygen may lead to consumption. Mr. Coleridge. Ah, you may have too much of a good thing, no doubt ; but is it not a cause of consumption ? Witness. Not a direct cause. It may tend to that general deterioration of the blood which is the real source and cause of consumption, but is not a direct cause of it. Mr. Coleridge. Then your distinction is between direct and indirect ? Witness. No : between a sole cause and a co-operating cause. CATARRH INHALATION NOT NEW. 343 The plaintiff states in his book that consumption is ' only the conse- quence of a carbonaceous condition of the blood.' The witness was then challenged with the plaintiff's statement ' Catarrh is the first step towards consumption,' which he had declared to be grossly exaggerated. Even when colds were chronic and neglected they did not necessarily lead to consumption. A catarrh might be neglected and go on for a whole winter, and might pass away in summer, or might be prolonged for years, and become what was called an ' old man's cough.' It often happened that colds were unavoidably neglected ; and yet happily they did not lead to consumption. If, indeed, there was a consumptive tendency, or if the cold were combined with other deteriorating in- fluences there might be danger ; but he entirely protested against such a broad statement as that ' Catarrh was always the first step to consumption.' So he entirely differed from the statement that deaths caused by consumption were one-fourth of the whole number of deaths caused by disease. That might have been supposed, half a century ago, when the bills of mortality were not kept so accurately as they are now, but it was not believed to be the case now. So of the statement that ' one-fourth of the persons we meet with are under the ban of this terrible disease.' It is nearer the truth to say that the deaths from tuberculous consumption amount to one in 8 or 9 deaths from all causes. He particularly objected to the passage : ' If, therefore, you have a hacking cough and slight shortness of breath, etc. you cannot doubt the existence of mischief in the lungs.' This, he said, was a great exaggeration, as these were very common symptoms in persons not at all consumptive. Asked about inhalation, the witness repeated his statement that it had been used as a means of cure for 30 years ; and Sir C. Scudamore as long ago as that, had published a treatise on the subject, although it had not been found very successful. Iodine inhalation, and other forms of inhalation, however were still in use ; but their value was problematical. He knew of no considerable physician who treated his patients exclusively by inhalation ; but it was well known and used, and there have been fifty forms of inhaler in- vented and used, Hemlock, stramonium, opium, camphor, and many other drugs were thus used. The real inhalation of oxygen had been practised in London to a considerable extent not exclusively for diseases of the chest, but for them amongst others. Fifty years ago Dr. Beddoes, of Bristol, used it ; and it was originally suggested by Sir Humphry Davy. An institution had been actually estab- lished for the purpose ; but the process had fallen into disuse. As to the plaintiff's process of inhalation of oxygen, it was utterly 344 OTHER WITNESSES VERDICT, impossible to discover it from his book. There was no mode in which oxygen could be brought into the lungs except in the form of gas. He found from inquiries of the plaintiff's patients that no such instrument was used as could sup'ply oxygen separately as a gas- holder. In re -examination Dr. Williams stated that the efficacy of the treatment for consumption had greatly increased of late years, especially since cod-liver oil had been introduced in its purer forms ; and it was now used to a greater extent than ever. (The evidence and cross-examination of this witness occupied the whole of the third and part of the fourth day of the trial.) Other witnesses examined for the defence were Dr. Eisdon Bennett, Dr. Cotton, Dr. W. 0. Markham, Dr. Quain, Dr. George Johnson and Dr. W. Odling. They all expressed their general con- currence in the evidence of Dr. Williams, and added further impor- tant testimony of a similar kind. Mr. Karslake's address for the defendant was commenced on the fourth day and concluded on the fifth. It was followed by Mr. Coleridge's reply for the plaintiff. On the morning following, the Lord Chief Justice summed up at great length ; and the Jury after two hours' deliberation found a verdict for the Plaintiff : DAMAGES ONE FABTHING. This verdict although nominally for the plaintiff, by assign- ing as damages the lowest coin in the realm, signified how little he deserved from the protection of the law, and leaves him chargeable with all his own costs in the action. The public press generally concurred in the justice of the decision. ' The Times ' concludes its comment with these words : ' We should fail in our duty if we did not express the conviction that such a verdict entirely meets the justice of the case, and that our contemporary (the " Pall Mall Gazette ") is entitled to the thanks of the public for a courageous attempt to protect their interests.' The medical journals acknowledged the benefit conferred on the medical profession by the trial, in exposing false and fraudulent pretentions and practices, and in upholding the moral and scientific character of the genuine art. A word or two of remark on the principal personages in this trial. Mr. Coleridge (now Lord Chief Justice of England) although renowned for eloquence and argumentative power, appeared to me to be very deficient in exactitude of knowledge COMMENTS ON COUNSEL AND JUDGE. 345 and in aptitude for mastering the details of his case. In fact in technical matters he seemed to glory in professing his ignorance ; and when dealing with them, he did not always come off well. In cross-examining me he propounded in a pompous tone this question, ' Have you taken into account the vital capacity of the lungs ? ' Dr. W. ' What do you mean by vital capacity ? ' Mr. C. ' Ah ! that's what I want you to tell us; I don't know anything about it.' Dr. W. ' Well, I suppose you mean vital capacity in the sense used by Dr. John Hutchinson, who invented an instru- ment called a spirometer, to measure the quantity of air which a person could blow into it at a breath ; that quantity was a measure of what Dr. Hutchinson called the vital capacity of the chest. Having thus explained to the Jury what vital capacity means, what further question have you to ask about it ? ' But the learned counsel had nothing more to say. Another time, when I was under examination, and was speak- ing of the operation and good effects of cod-liver oil in tuber- culous disease, Mr. Coleridge rose to his full height with a book in hand, and said in a solemn voice, 'Are you aware that Dr. MacCormac declares " that not all the oil of all the codfish that swim in the mighty ocean can avert for a single instant tubercular decay ? " Dr. W. ' That, I know, is his opinion ; valeat quantum.' Mr. C. ' And so we must say of your opinion valeat quantum.' Dr. W. ' Undoubtedly ; I do not agree with those who object to the use of cod-liver oil.' Mr. Karslake (afterwards Sir John and Attorney- General) on the other hand was remarkable for the care with which he studied his briefs, and spared no pains to make himself thoroughly acquainted with the subject, however technical it might be. And his arguments and examinations were equally satisfactory and to the point. But for earnestness and concentration I never knew any one to equal the Lord Chief Justice Cockburn. He had been a patient of mine, and was personally interested in the subject of chest complaints. I was quite amused at the closeness of his attention when I was giving evidence, taking copious notes and stopping me when I went on too fast. His summing-up address to the jury proves how thoroughly he had entered 346 IMPORTANT RESULTS OF TRIAL. into and mastered all the details of the subject and weighed them in all their bearings in the judicial balance. A short- hand report was published in the * Pall Mall Gazette ' of December 3, 1866, and filled 10 columns. The trial was one of great interest and importance to three Professions, Medicine, Law, and Journalism, which are under proportionate obligations to the proprietor of the ' Pall Mall Gazette ' for the courage and liberality with which he went through it. 347 CHAPTEE XXXVII. JOINT WORK ON CONSUMPTION CASE OF EAEL ST. MAUR. 1868-1870. Work on Pulmonary Consumption in conjunction with Dr. C. T. Williams. His assistance in statistics of cases. His joining me in practice. His marriage. Case of Earl St. Maur his illness and Death. Action for Libel brought by Author against Duke and Duchess of Somerset ending in com- plete retractation and apology. Abridged statement of Authentic Facts. History. Lord St. Maur's first visit and examination, Sep. 21. Duchess of Somerset's visit, Sep. 27. Opinion stated, and that further investigation and constant watching needed. Appointment made, Sep. 29 Further grounds for anxiety and cause for watchfulness Arrangement for constant medical attendant, Sep. 30 Summoned at 9 A.M., went immediately, and heard of a very dangerous attack, in which another Doctor called in (con- tradiction of false statements and charges in libel) attack subsided, but fears confirmed as to nature of case Directions given and nurse provided. At noon, message of complaint, replied to with directions. At 3 P.M., after calling at St. George's Hospital for the medical attendant, found patient as before, but in a few minutes attacked with laryngeal suffocation, threaten- ing instant death only chance in Tracheotomy Surgeon sent for : on his arrival necessity of operation announced to Duchess as only means of saving life temporary relief but soon proved fruitless by signs of pressure below opening from aneurism of aorta. Retrospect and reflections on history and termination. Author astonished by false accusations of the Duchess, who refuses to permit an inspection. Writes to the Duke : no reply. Reasons for bringing action against the Duchess for libel on Author. Retractation and apology for libel. Extract from speech of Mr. Hawkins. Verdict for Plaintiff with full Costs. Preface to ' Authentic Narrative.' Declaration in vindication of Dr. Williams by London Physicians and Surgeons. Letter from Dr. Williams to thank the profession for universal sympathy and support. THE Hunter trial attracted much attention especially in the medical profession ; and although the verdict was nominally for the plaintiff, yet the petty award of damages, and the publication of the overwhelming evidence against his preten- sions and modes of procedure, were sufficient to answer the 348 PROJECTED WORK ON CONSUMPTION. object of the defendant and to put an end to the stigmatised practice. Had the language of the censure been a little more moderate, it would have equally effected its purpose, with the probable result of getting a verdict altogether for the de- fendant. The prominent position in which I was placed as principal witness, I could not but take as complimentary : and it was very satisfactory to me that my evidence was supported by that of the eminent witnesses who followed me. I was especially gratified by the corroboration and further explana- tion of my statements on the chemistry of the subject, by the authority of the distinguished chemical Professor, Dr. Odling, the lucidity of whose evidence was highly applauded by the Lord Chief Justice. I received several letters congratulating me on the manner in which I had represented at the trial the most correct and advanced knowledge of the subject, and evaded the quibbles of cross-examination. I was specially invited by the Editor of the Lancet to supply that journal with a summary of my views and experience on the treatment of Consumption. And in truth the whole subject of Consumption had been brewing in my mind for many years, and the occasion of this trial had so stirred it up to increased activity that in spite of disinclination to resume again the arduous work of publication, I did deliver myself of several articles drawn from the numerous records of my experience. But I was by no means satisfied with this partial and ephemeral mode of disposing of the subject. I had been led, by large experience, to certain general conclusions respecting the nature of the disease and the best methods of treatment ; and the increasing success of the results gave me confidence in them. But I felt the need of more exact methods of deal- ing with vast numbers of facts than by trusting to mere general conclusions. It was necessary more exactly to classify and to count the facts, as well as to observe and record them ; and to make the inferences the result of calculation, rather than of vague impression. I was always quite aware of the value of the numerical method, in dealing with large numbers of facts or cases ; and ASSISTANCE OF DR. C. T. WILLIAMS. 349 when I had clinical clerks and assistants, I largely employed them in this work : but I had no great aptitude for it myself, and rarely had time for it. But happily now my son Dr. Charles Theodore Williams came to my aid, and manifested both talent and taste for the work. He had been appointed assistant physician to the Hospital for Consumption at Brompton, and had been for some years assisting me in practice ; seeing patients in my absence, as Dr. Quain had done previously. He was therefore advantageously placed for acquiring experience himself, and for becoming familiar with many of my patients and with my methods of treatment. During my whole professional life, I had been in the habit of keeping concise (but accurate) notes of all but trivial cases entering them in little books suitable for the pocket ; and I had already between two and three hundred of these little books, containing about a hundred cases in each ; amounting in all to between twenty and thirty thousand cases. To properly select, assort, tabulate, and calculate these, was a work of great labour, which I could not have accomplished by myself ; but my son could devote much time to the work ; and soon began to get at important results, which could not have been attained without this methodical system of study. For example, on the subject of the duration of life in consumption, my general conclusion, drawn from partial calculations and limited numbers of cases, was that during my experience, this length of life had increased from two years, the same as that given by Laennec and Louis iv five years; this was the number stated in my Lumleian Lectures, and repeated in the Hunter Trial. From a larger number of cases more care- fully collected and calculated, and corrected up to the latest date of history, my son found the average duration of life in 1,000 phthisical patients under my care during a period of twenty-two years, reached to nearly eight years in those that eventually died ; and to above eight years in those who yet survived : a considerably longer duration than any hitherto on record. My son drew up an elaborate paper on the sub- ject, which was discussed at the Eoyal Medical and Chirurgical Society of London, and published in the fifty- fourth Volume of their Transactions. 350 SOWS MARRIAGE. Having now happily found in my son the assistance which I had so long needed and wished for, I was in a position to entertain the proposal urged on me by Messieurs Longman & Co., to publish a work on Pulmonary Consumption, which was accordingly announced as forthcoming, in our joint names. Owing to the interruption of extraordinary events, to be noticed in this chapter, the book was not completed till the summer of 1871, and it will be referred to in the memoirs of that period. At present I have a few words to say on the happy associa- tion with which God has blessed me in my son's adopting the same profession from his own choice, and in our being united in the same pursuits and interests. For some years he re- mained with me in the same house, but in 1868 he married, and occupied a small house very near me in Park Street. His wife is a daughter of Mr. Gwyn Jeffreys, F.E.S., a name eminent in the scientific world, especially in connection with his researches in Conchology, of which he has long been one of the foremost and most successful cultivators. Mrs. Gwyn Jeffreys, her accomplished mother, was a lady well known and much esteemed in a large circle of society; and the young couple began life with happy and encouraging prospects. My son was already well known through his little work on the ' Climate of the South of France, &c.,' which had reached a second edition ; and several contributions from his pen had appeared in the Transactions of the Pathological and other Societies. At a later date he drew from my case books and his own a large stock of information on the results of climate in Consumption, which enabled him to show by the numerical method the actual value of climate in the treatment of patients, and to classify the forms of Consumption suitable for each variety of health-resort. CASE OF EARL ST. MAUR LIBEL. 351 The case of the illness and death of the Earl St. Maur, with notice of the action for Libel brought by Dr. Williams against the Duke and Duchess of Somerset, and ending in a verdict for the Plaintiff, and a complete retractation and apology from the Defendants. 1 This is an abridgment of a pamphlet, published after the trial, to supply an authentic statement of the facts of the case, which would have been proved by evidence in court if the trial had been allowed to proceed. I regret that so much space should be occu- pied by it ; but I feel it due to myself that my character should be entirely cleared from every imputation arising from this, the only serious attack that has ever been made on it. The language of the libel is too gross for publication and may well be consigned to oblivion ; but extracts from it, and allusions to it will be enclosed in brackets. Earl St. Maur, only son of the Duke of Somerset, consulted me by appointment on the 21st of September, 1869. He brought a letter from Dr. Fairbank of Windsor, describing the case, which he considered to be emphysema of the lungs. Lord St. M.'s account of himself was that his breath was not short generally, and he had always been used to active exer- cise, but on running long or fast the breathing would become noisy like that of a ' roaring ' horse. During the last year, when residing at Tangiers, in Morocco, he was in the habit of riding fast for several hours daily, under the notion that it would improve his breathing powers. On one occasion, when something put him in a violent passion, he put his horse to full speed, which brought on a severe fit of palpitation, and his breath had been shorter ever since. For the last three months he had an occasional dry cough, and frequently a pain in the centre of the chest. He had still persevered with active exercise, chiefly walking, under the idea that it would prevent his breath from getting shorter. About six weeks 1 Counsel for Plaintiff, Sir John Coleridge, Q.C., Solicitor-General, and Sir John Karslake, Q.C. Counsel for Defendants, Mr. Hawkins, Q.C. I had chosen Sir J. Karslake as the counsel in whom I had entire con- fidence : but I was privately advised by high authority to retain also the Solicitor-General, who by office was entitled to precedence. I know that Sir John Karslake thoroughly mastered the details of the case, and I had reason to regret that he could not act as leading counsel. 352 HISTORY. SYMPTOMS OBSCURE. ago, on making a few passes with a rapier, he was suddenly seized with what he called ' extreme oppression, spasm, and panting,' and when he recovered from .this there followed frequent cough and shortness of breath. He sent for Dr. Fairbank, and under his treatment gradually improved ; but breath was still short on exertion, with occasional attacks of increased difficulty in the morning. Had lost strength and colour. Pulse now 80, weak, unsteady. On careful examination of the chest, I found no signs of the emphysema mentioned by Dr. Fairbank. Breath sound distinct in every part, especially the inspiration, which was louder and harsher than usual. No prolonged expiration, wheeze or crepitus. Above left scapula breath and voice tubular* Heart sounds very weak, slight venous murmur in neck. As these signs, especially the natural motions, shape, and percus- sion sounds of the chest and the absence of prolonged expira- tion or wheeze disproved to me the presence of emphysema, I concluded that the condition mentioned by Dr. Fairbank was a temporary one, and had now passed away. But there remained the loud inspiratory sound throughout the chest, and the tubular sounds above the left scapula; and I sus- pected that these were due to the same cause some con- solidation in, or tumor pressing on, the inner part of the summit of the left lung. But the signs were too equivocal to guide to any definite opinion at that time ; and in prescribing for the patient, and in explaining to him his symptoms, I referred principally to the weakness of the circulation, pre- scribing quinine and iron by day, and an anti- spasmodic at night, to counteract the tendency to spasmodic breathing, which he still occasionally felt in the mornings. The Duchess of Somerset had written to caution me not to alarm the patient, and that she would call later to hear my opinion. I therefore did not explain to him the nature of his case, but advised him generally, and enjoined quiet and moderation in exertion. The Duchess did not call as she promised ; but a few days after, sent a messenger with a letter, requesting me to write to her son to dissuade him from going into Wiltshire which he intended to do. On my inquir- ing of this messenger how Lord St. Maur was, I learnt that SECOND EXAMINATION. 353 he was better, but sometimes still had slight attacks of diffi- cult breathing described as being in the throat and of a choking character. This account again suggested to my mind the possibility that these attacks might be of the nature of laryngeal spasm, excited by the pressure of a tumor on the windpipe and inferior laryngeal (or recurrent) nerves within the chest, and such tumor would account for the tubular sounds which I had found above the left scapula. I wrote to the Duchess that I expected to see her Grace to explain my views, and that I must see her son soon again, because his case required further investigation. I also wrote to him to the same effect, and advising him not to go into Wiltshire. On the 27th of September I received from the Duchess a letter announcing her intention of calling on me, and she came that day at 2 P.M. In an interview of nearly an hour, I explained the result of my examination, and made many inquiries as to the previous health and habits of the patient. I stated that I found no signs of emphysema, but indications of some disease at one part of the lung, which might be from consolidation in it, or something pressing on it, either of which might cause cough and short breath, and might prove serious ; but did not appear active at present. The more prominent symptoms were those of weakness of the heart and system generally, for which I had prescribed a tonic, nutri- tious diet, and careful and quiet living. The Duchess asked numerous questions about climate and plans for the winter to which I could only reply conditionally, in consequence of the uncertainty of the disease ; but I urged on her Grace the absolute necessity of my seeing the patient again as soon as possible, as his case required further investigation, and more constant watching. It was thereupon agreed that he should be brought to my house at 4 P.M. on the 29th. On the morning of that day a letter from the Duchess came to say that there had been a ' bad attack of breathing ' that morning and Lord St. M. would not be able to come to my house, and requesting me to call in Dover Street at six P.M. I called at that hour, and found him just arrived. He was fatigued, weak, and with an unsteady pulse. He told me that, two days before, he had been again (in spite of the A A 354 FURTHER SUSPICIONS AND INCREASED CAUTIONS. warnings from Dr. Fairbank and myself) endeavouring to improve his breath by exercise, and had walked continuously for three hours and a-half ; that he was so much exhausted that he could eat no dinner, and took only soup and mulled claret. Next morning, on awaking, he was attacked with a severe fit of difficult breathing, which ' almost suffocated him.' He had felt exhausted and weak ever since, and had been able to take very little solid food. This morning he awoke feeling faint, and on rising had another severe attack of ' choking ' difficulty of breathing, which so much weakened him as to oblige him to postpone his journey for two hours. He said that he had borne the journey pretty well. On listening to the chest, I heard the inspiratory sound loud in every part, and somewhat harsh in tone, especially at the upper parts of the chest, as if from some constriction of the trachea; but there was no laryngeal stridor, or even hoarseness (such as would be present in laryngitis). The tubular sounds were still distinct above and within the left shoulder-blade, but I could neither hear nor feel abnormal pulsation in any part, which would give conclusive evidence of the existence of aneurism. Still the increased harshness and almost tracheal character of the breath-sound in the upper parts of the chest, and the recurrence of fits of difficult breathing, which, from the last description, seemed more clearly to have been laryngeal (in the throat), increased my suspicion as to the existence of an intrathoracic tumor. 1 I expressed my apprehensions to the Duchess, and proceeded to explain that her son's condition was so serious as to require much more care and attention than he had hitherto received. I ascertained that he had seen no medical man since his visit to me on the 21st. I told the Duchess that in future he must be constantly watched by a medical attendant close at hand, as he was likely to require prompt and frequent aid in the attacks which had been 1 A tumor within the chest, which, by pressing on the windpipe, may cause cough and more or less permanent difficulty of breathing, by impeding the passage of air to the lungs ; and by pressing on certain nerves which regulate the muscles which open and shut the glottis (or opening into the top of the windpipe) may also cause spasm of the glottis, a more severe difficulty of breathing in fits, which, when intense and prolonged, often prove fatal. SUDDEN SUMMONS AND PROMPT ATTENDANCE. 355 increasing in severity. I urged that he must be strictly restrained from all exertion, not only from the long walks which had been so injurious to him, but even from the exer- tion of going up and down stairs, and therefore that all his apartments should be on one floor. I pointed out the need of his having frequent supplies of such food and light wine as he was able to take. His inability to eat much solid food had added to his weakness, and I advised that more of the soups and such nutriment should be supplied. To prevent the faintness which seemed to have brought on the severe spasm on the morning of this day, I recommended that some egg- flip (an egg beaten up with a dessert spoonful of brandy and a little boiling water added) should be given him on first awaking in the morning. In reference to my requisition that Lord St. Maur should have more regular and constant medical attendance, the Duchess asked me to find for him an experienced medical man to reside in the house. I replied that it might not be easy to find one immediately, but that I would make inquiries, and, if possible, get one to come on the next day (Sept. 30) in time for my visit, which I arranged to be at three o'clock. I told the Duchess that Lord St. Maur must not return to Bulstrode, as he was obviously very weak, and required rest ; and it was necessary that I should have a further opportu- nity of investigating his case, which was still one of some obscurity. The Duchess showed me a back room on the ground floor where a bed might be prepared for him. It was small but lofty, and I said it would do for the present; and having prescribed a tonic of ammonia and citrate of iron, and an anti-spasmodic pill of stramonium and compound galbanum, I took my leave. On the morning of the 80th of September, at a quarter before nine, a message was brought to me, written on a scrap of paper, to the effect that Earl St. Maur had fallen on the floor in a fit of difficult breathing. I immediately went up- stairs for a bottle of chloroform, and then taking a cab I arrived in Dover Street before nine. (As this contradicts a chief charge in the libel that Dr. A A2 356 LARYNGEAL ATTACK. Williams was sent for soon after eight and did not come till twelve I think it well to mention that my statement can be proved by the testimony of two of my servants, who received the message, and two of my daughters, who were at breakfast with me when the message was given to me, and saw me leave the house. My return to my house at ten can be attested by two of my servants. Also Dr. Hardinge, in a letter to me, writes : ' I was sent for about 8.15 ; you came about 9.' This tho- roughly demonstrable fact, that I went as soon as I received tlie summons, entirely refutes the charges of neglect made and reiterated several times throughout the libel. There are several other errors with regard to time; showing that the mind of the Duchess must indeed have been a ' chaos ' when she wrote the libel.) On my arrival, I learned that Lord St. Maur had passed a quiet night, and on awaking at eight, the egg-flip had been brought to him, and it appeared that enough water had not been added, for it was too strong; and, in swallowing it, he coughed, and, hastily reaching to ring the bell (which was at some distance), the spasm attacked his throat with such diffi- cult breathing, that he fell but of bed on the floor, where he was found by the servant almost insensible. I found Dr. Hardinge, who, as he resides near, had been called in ; and he told me that after applying the fumes of sulphuric and chloric ether, mixed with chloroform, to the nostrils, the spasm soon relaxed, and the patient regained his consciousness. I asked Dr. Hardinge, ' Was the breathing laryngeal, like in spasm of the glottis ? ' He replied, ' Yes, as in laryngitis.' This confirmed my previous suspicions ; and I told Dr. H. that I feared that the attacks were caused by a mediastinal tumor, probably aneurismal, pressing on the windpipe and recurrent (or inferior laryngeal) nerve. I added that the cause could not be laryn- gitis, as there had been no previous symptoms of that inflam- mation, but only several milder fits of dyspnosa like that just passed. To this Dr. Hardinge made no reply; and after a few minutes' further conversation, during which I said that I was glad he had been able to give prompt assistance, and give me an account of the attack, we parted on quite friendly terms. ABSURD IMPUTATIONS. 357 (I mention this, because the Duchess, in the libel, has taken up and dwelt much on a strange misconception that I had quarrelled with Dr. Hardinge, and ' behaved icith womanish rudeness ' to him, which is totally without foundation. When I first saw him, I did not recognise him, not having met him for many years, but when he told me who he was, I recollected him, and spoke to him as an old acquaintance. So far from being annoyed at finding him with my patient, I thought it most natural that, residing so near, he should be called in at this sudden attack, even before any message reached me ; and I should have advised his continued attendance for the same reason, but that, at the request of the Duchess, I was in a few hours to bring a competent medical attendant to remain con- stantly with the patient. Dr. Hardinge, in a letter to me dated 19th November 1869, writes : ' / assure you I teas not at all aware of any incivility on your part -when I met you on the 30th September, at the Duchess of Somerset's ; indeed, my feeling on the subject teas quite the contrary, and I have said so.' Yet this fancied rudeness on my part towards Dr. Hardinge seems to have originated the erroneous notion which pervades the libel, that I entertained and acted under a feeling of jealousy or rivalry towards him, and that I sacrificed the life of the patient to this feeling a charge than which nothing could be more absurd or more utterly without foundation. It is well that such charges have now been ' utterly, absolutely, and un- reservedly withdrawn.') I remained after Dr. H.'s departure, and found the patient quite free from cough and spasm, lying on his left side, with his head quite low, and able to speak in a weak voice. The pulse was steady, and the breathing tranquil, but it was now accompanied with a laryngeal sound. He told me that he had neglected to take the anti-spasmodic pill the night before, but had slept pretty well, and felt no difficulty of breathing until the too strong egg-flip set him coughing, and as he was alone, he made a great effort to reach the bell-rope, which brought on the spasm, under which he fell out of bed, and lost his recollection, remaining on the floor till Dr. Hardinge arrived. He said he was now quite easy, and I did not think it right to disturb him with any further examination. 358 DANGER OBVIOUS CAUTIONS. The Duchess seemed so fully aware of the serious nature of this formidable attack, that it appeared to me quite unne- cessary to make a formal announcement of it. In fact, the patient had obviously been in a dangerous crisis ; and now that that danger had passed away, instead of converting alarm into terror by dwelling on it, I considered it my duty to calmly point out what could be done to guard against its return, and especially to avoid all such occurrences as those which seemed to have provoked the spasm in this instance swallowing a too stimulating liquid, and making a sudden violent effort to ring the bell. Accordingly, I advised that his food should be re- stricted to bland and soft kinds of nutriment, in small quan- tities, and at short intervals, particularly specifying mild soups and broths, milky food, and only diluted wine. I also directed that he should not again be left alone, as he was in the morn- ing, but that he should be constantly watched and attended to. The Duchess then asked me to recommend a nurse, which I did ; and an experienced one was in the house within an hour from that time. The assurance that Dr. Hardinge gave me, that Lord St. Maur's attacks were, as I had already inferred, of the nature of laryngeal spasm, increased my suspicions that the disease from which he was suffering was a deep-seated tumor in the chest, most probably aneurism, which, by pressing on the windpipe, caused the habitual shortness of breath, cough, and pain of the chest, which had existed for several months ; and also produced the harsh inspiratory sound which I had noticed on the 21st and 29th ; and, by pressing on the left recurrent nerve, caused the fits of laryngeal spasm, the first of which was probably the severe attack which occurred after sword exercise early in August, and the last of which was that which had just taken place, and was witnessed by a medical man for the first time. Being thus gradually led nearer to the inference that Lord St. Maur was the subject of a formidable and intractable disease, I had to consider how I could best perform the painful duty of fully communicating my fears to the Duchess and other relatives. I had already begun to prepare her Grace by saying that I feared that the cause of the attack was a tumor ANXIOUS CONSIDERATIONS. 359 in the chest, pressing on the windpipe and its nerves, and I again expressed this apprehension this morning; but I had not explained the formidable nature of the suspected malady, and of the fearful results to which it would probably lead. On consideration, I thought it better to defer the complete an- nouncement of my opinion of the probable nature of the case until my visit in the afternoon, when I expected to have an opportunity of further examination. Another reason for this delay, was that the Duchess, although greatly alarmed at the morning attack, supposing her son to be dying, yet asked me no questions as to the reality or amount of danger, and as her Grace complained of con- fusion in her head, her heart complaint, and the fatigue and anxiety which she had gone through in the last two hours, I judged it unadvisable prematurely to increase her alarm. Further, there appeared to be no relative or friend with her to comfort or support her, only servants, and those few and by no means efficient. In the afternoon, I expected that there would be the comfort of having a medical attendant constantly at hand, to give aid and direction in all the serious contingen- cies which the suspected disease might entail in its course. These considerations led me to defer till the afternoon the full announcement of my opinion. Did the nature of the malady and the particular course of this case justify me in this delay ? Could the speedily fatal result have been foreseen, or had it been even probable, the unfavourable opinion should have been announced without consideration of feelings or convenient seasons. But, in addition to the uncertainty as to the correct- ness of this opinion, my experience and reading with regard to cases of the supposed disease enable me to affirm, with some confidence, that so speedily fatal a result could NOT have been foreseen ; and that it was not a probable, but an exceptional result. Even the most rapidly fatal of intrathoracic tumors, aneurisms of the aorta, commonly last, with symptoms more or less urgent, for several weeks, and sometimes for months, before they destroy life ; and other tumors, glandular and malignant, are usually still slower in their course. In Lord St. Maur's case, on the other hand, except one severe attack in August, for which he saw Dr. Fail-bank only three times, 360 ARRANGEMENTS AND LAST VISIT there had been no urgent symptoms until after his long walk on the 27th of September, only three days ago. There had been only a few slight attacks before this period ; and in the last two days there had been only one on each morning, more severe certainly, but in each case it had passed off without any special treatment. Even the much more formidable spasm of this morning, intense and dangerous as it must have been, yielded readily to the simple remedy of applying to the nostrils the vapour of ether and chloroform ; and might be ascribed rather to the aggravating circumstances that brought it on, than to the advancement and extent of the organic disease. By the careful avoidance of all such circumstances, I had reason to hope that the attack might be averted, at least till the following morning, that being the time of the day in which it had hitherto occurred. Therefore, not anticipating any early return of the dangerous symptoms, I judged it safe, and more considerate to the feelings of the Duchess, to defer the full announcement of my opinion, and of the nature and prospects of the case, till the afternoon. After watching the patient for some time, and observing his tranquillity and the ease of his breath, I prescribed a composing anti- spasmodic mixture of Valerian, ether, and chloroform, and left him about ten, promising to return soon after three, when I expected to provide his special medical attendant. About noon, when I was engaged with my morning patients, the following note (unsigned) was brought from the Duchess : 20 Dover Street. DEAR DB. WILLIAMS, St. Maur has vomited much, and got hardly anything down. He complains of faintness. I immediately wrote in reply, to the effect that if the breathing was easy, the vomiting had probably been a relief ; and that the faintness would subside on giving chicken broth, and arrowroot with a very little brandy, in small quantities, at frequent intervals. As the symptoms did not indicate danger, and I was engaged in important consultations, I did not think it necessary to visit the patient before the time appointed, and I sent word to that effect. BEFORE SUDDEN ATTACK. 361 As soon as I had finished with my morning patients, I drove to St. George's Hospital to find a medical attendant for Earl St. Maur. After making inquiries, Mr. Jones, the resi- dent medical officer, strongly recommended to me Mr. Barker, who had formerly been house surgeon, and had subsequently had much experience in both medicine and surgery. To him I mentioned that I suspected intrathoracic tumor in the case, which he would have charge of; and appointed him to meet me in Dover Street at half-past three. I arrived in Dover Street about a quarter after three. The Duchess told me that she expected me at twelve, and that she had again sent for Dr. Hardinge, and that he remained a long time expecting me to come. I reminded her Grace that both this morning and on the evening before, I had fixed the time of my visit at or soon after three, and that I had been so much engaged with important consultations that I could not come before. Her only reply was, ' My head is so confused, I am losing all my memory.' Her Grace said that Lord St. Maur had had no return of the difficult breathing, and that the vomiting soon ceased. She did not tell me what remedies Dr. Hardinge had used, but said that he had expressed his opinion that the case was one of laryngitis. On this I remarked that I did not think that he would hold that opinion if he were made aware of the previous history, and of the total absence of the usual symptoms of inflammation of the larynx. 1 But I neither expressed nor felt any displeasure or dissatisfaction at his having been again called in ; and so far from being jealous of him, if his presence could be a comfort to the Duchess in my absence, and before the 1 I really did not at that time suppose that Dr. Hardinge could maintain this opinion, formed only from this day's observation of the case, when the recent attack made the patient unable to bear a proper examination. The whole previous history of the case, the absence of hoarseness or other per- manent affection of the voice, except in and after the paroxysms of dyspnoea, the absence of any laryngeal cough or breathing, and of pain or tenderness in the larynx, and the possession of a clear, strong voice, completely negative the notion that the case was one of laryngitis. Many of the most eminent physicians and surgeons in London, who were to give evidence at the trial, unanimously agreed on this point, that whatever doubt might remain as to the true nature of the disease, it certainly could not be laryngitis or laryngeal ulcer. 362 DESPERATE SUFFOCATION. arrival of the permanent medical attendant, I was rather pleased than otherwise that he had been there. I found the patient stronger, and able to sit up in bed. He told me that the vomiting was brought on by his drinking too much mulled claret a beverage not ordered by me, and not proper for him, if made, as usual, hot with spice. On making a further slight examination of the front of the chest, I heard still the slight laryngeal sound noticed in the morning, and the harsh inspiratory sound down the chest. I also with one finger gently touched the outside of the larynx, asking if it was tender. He replied quietly, ' a little on the left side.' The breathing was then quite tranquil. Finding his pulse flagging, I advised him to take some chicken broth, and I went into the adjoining room to Mr. Barker, who had just arrived. I believe that the Duchess alone was with the patient. After I had been three or four minutes conversing with Mr. Barker, we were hastily called to Lord St. Maur, whom we found struggling with the most severe laryngeal spasm that I ever witnessed. He was breathing with tremendous eifort, with a tight hissing noise in the larynx, and throwing his arms about in great distress. In a hoarse whisper, he said, ' Do something for me, or I shall die.' These were his last words. Immediately after, the eyes were fixed in a wide stare, with pupils largely dilated, 1 and the whole powers and consciousness seemed concentrated in the violent efforts to breathe through the almost closed glottis. I tried to give him ether and water, which was at hand, but now the swallowing was difficult, and soon I could get nothing into his mouth. Mr. Barker and I then plied the nostrils with ether vapour from a handker- chief, which is well known to be the most effectual way of applying it. Seeing no symptoms of relief, and feeling sure that the spasm must soon end in suffocation, I said to Mr. Barker, ' Tracheotomy is the only chance.' He assented, and, going 1 This remarkable dilatation of the pupils continued till the patient's death ; but after the operation I observed one pupil (I think the left) much more dilated than the other, and I pointed this out to Mr. Holmes, as having been described as a symptom of intrathoracic tumour, pressing on portions of the great sympathetic nerve. Dr. John Ogle, Medico-Chirurg. Trans., Vol. 42, 1852. TRACHEOTOMY ONLY CHANCE. 363 outside the door, I begged him to go as quickly as possible for the nearest, operating surgeon of eminence, mentioning Mr. Caesar Hawkins and Mr. Pollock, in Grosvenor Street, as the nearest which I could think of. On his way, Mr. Barker recollected Mr. Holmes, of Clarges Street, as nearer. In the meantime, I was doing all that I could do to sustain life ;' applying ether vapour to the nostrils ; wetting the throat and upper chest with ether, and covering it with my hands to cause a strong burning sensation on the surface ; pressing the chest at each expiration to help the now shortening breath : for the insensibility was now complete, the face ghastly pale and covered with cold sweat, the pulse very weak and irregular, w'hilst the hissing noise in the larynx showed that the spasm was as tight as ever. Then returned Mr. Barker, and an- nounced ' Mr. Holmes, surgeon to St. George's Hospital,' who was accompanied by Mr. T. H. Smith, surgeon, of John Street, Berkeley Square. As these gentlemen, breathless with haste, went to the other end of the room to make preparations for the operation, I turned to the Duchess, who was behind me, and said, distinctly and emphatically : ' The only chance of MI ring his life is by making an opening in the windpipe, and Mr. Holmes is come to do this.' 2 1 The nurse can attest this, in refutation of the assertion in the libel that ' Dr. W. did nothing, said nothing,' &c. She also, as well as myself, positively denies the truth of the statement that we ' let the patient drop back like a log of wood.' 2 The nurse (Mrs. Burfoot) who was with me, tending the patient, distinctly heard me say these words, and can attest the fact. It may be asked why I did not earlier apprise the Duchess of the proposed operation before Mr. Barker went for the surgeon. One reason for not doing so was, that I was so en- grossed in watching, and, so far as was possible, ministering to the almost dying patient, that I dared not turn from him for one instant to explain and discuss the question of the operation. A second reason was, that I really thought that it would be more painful and agitating to her Grace's feelings to be told of the operation beforehand, and to be kept in dreadful anxiety lest the surgeon should not arrive in time, than to be made acquainted with this last resource of art only on the arrival of the surgeon, with the certainty that his aid was at once available. When after death the Duchess reproached me with not having asked her permission for the performance of the operation, I re- minded her Grace of my having given her this intimation. Her Grace was understood, both by Mr. Holmes and myself, to admit the fact, her Grace's complaint simply being, ' But you did not tell me it was an operation.' I replied to this effecj;, ' was this a time for explanations when your son was, so far as we knew, dying ? ' 364 RELIEF ONLY PARTIAL. I then turned round immediately to attend to the almost dying patient, and I did not hear the Duchess make any reply there was neither word nor sign of objection and im- mediately the Duchess joined us in giving directions for the operation, and for moving the bed on which the patient lay, to the window at the other end of the room. When the incision was made into the windpipe, the patient showed not the least sign of feeling, as all the surgeons can testify. His features were unchanged, and his hand, which I held, was motionless. Little more than an ounce of blood flowed from the wound a trifling amount for this operation. At first little air passed by the opening. Mr. Holmes then applied his lips to the wound to suck out any blood that might have flowed into the trachea, but little came. After a few minutes, the air passed more freely, and the laryngeal breath- ing ceased, and there was now a manifest improvement in all the symptoms. The pulse improved in strength and steadi- ness. The livid pallor of the lips and cheeks gave place to a little colour. The face and hands, which had been quite cold and clammy, regained some warmth. There was no return of consciousness. Still I was grieved to see that the relief, although apparent, was by no means so complete as it usually is in successful cases of tracheotomy. The breathing was still laborious ; ! the spaces between the ribs and above the collar-bones (techni- cally termed the intercostal and supra- clavicular spaces) were drawn in at each inspiration, proving that there was an ob- struction in the windpipe below the artificial opening such, in fact, as could be produced only by an aneurismal or other tumor pressing on the lower part of the windpipe. I expressed to Mr. Holmes my fears thus unhappily confirmed, and that we must not look for complete or permanent relief, and he 1 Messrs. Holmes, Barker, and Smith all attest that the breathing was still laborious. Mr. Barker observed the drawing in of these intercostal and supra- clavicular spaces. Mr. Holmes remembers observing that the first intercostal or infra-clavicular space was drawn in. This laborious state of breathing made it necessary to supply air as pure and fresh as possible from the open window, as in all cases of extreme difficulty of breathing. The exposure to cold thereby, (complained of in the libel,) was too short to be injurious, and was counteracted by warm flannels, which were applied as soon as they could be procured. DEATH RETROSPECT. 365 took the same view, both as regards the existence and nature of the obstruction, and the probable result. The spasm of the glottis had been completely relieved. There was no longer the hissing noise in the throat ; and by a lighted match we found that air passed both by the wound and through the nostrils, but there was an insufficient supply of air to the lungs. The jaws were no longer firmly clenched, and some power of swallowing was regained, so that I was enabled to give in spoonfuls warm chicken broth, and brandy and barley water ; l and these supplies had a manifest effect in restoring strength to the pulse and warmth to the surface, after intervals of flagging, which recurred several times. About an hour after the operation, the closure of the jaws returned, and prevented the supply of nourishment : we endeavoured to remedy this by introducing a cork between the teeth, but with only partial success ; and the flagging of the pulse and inequality of the respiration became more evident. At about a quarter after five, there was a slight indication of returning consciousness. The patient turned his head first on one side, then on the other, and the Duchess then spoke to him a few words in a loud voice, and he looked round with something like intelligence. 2 But this was but the flickering of the lamp before its final extinction, for hi a few minutes the pulse became weaker and slower, and then stopped ; and lastly the respiration slackened, and, after a few gasps, ceased, about an hour and twenty minutes after the performance of the operation. On taking a retrospect of this melancholy history, thus 1 (The assertion in the libel that I clicked tlie patient ivith chicken broth is an absurdity ; as every medical man knows that the artificial opening below in the windpipe rendered choking that is, stopping the breath in the throat impossible. It was equally false that I ' choked every effort to speak.' There was neither power to speak, with a hole in the windpipe, nor even conscious- ness, to make the effort.) 2 The partial or complete restoration of intelligence shortly before death has been noticed in several diseases. Supposing this case to have been one of aneurism of the arch of the aorta, and that the suffocation was brought on by the sudden swelling of the aneurism, that swelling would diminish when the failure of the heart's power reduced the arterial pressure ; and with this diminution there might be a partial recovery of consciousness. 366 FATAL TRUTH PROGRESSIVELY REVEALED. terminating in death with such awful rapidity, I can explain its course and its symptoms throughout, only on the sup- position that there was an aneurism 1 of the arch of the aortl'niin>i ni;iriini, trichomanes, and potypoditvm. Maidenhair, too, I brought in abundance from certain calcareous springs near Isola Bella. For the first three or four years after coming abroad, I had no lack of bodily strength for such exertions ; and I am sure the exercise was very beneficial and carried off morbid tendencies, which had been increasing during a long sedentary life. But in later years strength and activity have declined more than mental vigour ; and I have entirely given up the long walks and rides that I used to delight in. Of course this is the effect of age : I have to be very thankful that my sight and mental faculties show no signs of failure. For some years after my retirement, I gave my mind an almost complete rest, so far as regards professional or scientific writing. The only exception was in a not very profitable con- troversy with poor Dr. Leared on the sounds of the heart. With curious ingenuity he seemed to have got into a wrong groove on this subject, and fell foul of a statement of mine, which I considered to represent the views commonly received, for which, in connection with my experiments on animals, I claimed originality. I deem it unnecessary to notice the matter further here, as it has been already discussed (see Chapter XVI.), but some new facts and arguments may find place in a second volume. We were welcomed with much cordiality by many friends at Cannes, several of them old patients ; and my name was well known from my having sent so many visitors there. Mr. and Mrs. Woolfield (he was designated ' Prince of Cannes ' by dear Dr. Edward Forbes, who introduced me) had been residents coeval with Lord Brougham, and always led the H H 2 468 INCREASE AND IMPROVEMENTS. hospitalities, and by founding and fostering the first English church, and in other ways, had promoted a happy Christian in- fluence on the English colony at Cannes. Now there were three English churches, all well filled in the season ; and a Presby- terian service well supplied' by the Free Church of Scotland. There was indeed such an abundance of agreeable and friendly English society, which has increased year by year, that we hardly seem to be abroad, except for the brilliant skies and almost uninterrupted fine weather. The increase of the. place during the nine years of our residence is something extraordinary, hotels and villas having much more than doubled in number, and new boulevards and streets formed in every direction. On these I dwell not : but one feature of development deserves especial notice the exten- sion of carriage roads around, over, and beyond all the neigh- bouring hills, which supply drives and rides unsurpassed for extent, variety, and beauty of scenery, of land, sea, and moun- tain. I know of no place in Europe to equal it. I speak not from actual measurement, but I do not think I exceed the reality in saying that there are eighty miles of good roads for riding and driving within six miles of Cannes. Another great advantage of Cannes is its abundant supply of pure water, through the Siagne river canal, from a distance of sixteen miles. No such favourable report can yet be made of its drainage. Cannes, in common with all continental towns, has no complete system of drainage ; but in the last two years partial attempts have been made to develop one, and the present Mayor and Town Council have made many earnest endeavours to improve the sanitary state of Cannes. At the request of the English physicians practising at Cannes, I published in the ' British Medical Journal,' on the 4th of February and 4th of November, 1882, statements on this subject ; which represented the state of matters up to those dates, and the measures which had been and were to be adopted in the way of improvement. Typhoid fever had shown itself; but its amount had been much exaggerated ; and it had been traced to defects in drainage and other evils which might be rectified. There was formed a ' Commission d'Hygiene ' under the presidency of DRAIAAGE STILL DEFECTIVE. 469 the Mayor, to consider all questions relating to the public health ; to take all steps necessary for its preservation ; to bring the law to bear against all nuisances, and offences ; and to carry out any further measures in the way of cleansing and drainage necessary for the security of the town and its vicinity. In 1882 the Mayor visited Paris, London, and other parts of England, for the purpose of obtaining the most recent informa- tion on the subjects of drainage, disposal of sewage, &c. And in the following year Captain Douglas Galton, C.B. F.K.S., visited Cannes for the purpose of advising the municipality in their efforts to improve the town. After full inspection and con- sultation with the medical residents, he drew up an able report, embodying a full consideration of the subject with details of plans for the thorough drainage and purification of the town and neighbourhood. These plans have been since under deliberation, and steps have been taken towards carrying them into effect ; but financial and other difficulties stand in the way and render their complete fulfilment a work of time. Yet the time must not be long ; and if the most strenuous efforts are not honestly and energetically made, the reputation of Cannes for salubrity will assuredly suffer. I have had recent experience of a most flagrant offence in the defilement of streams denounced in the following extract from one of my former papers in the ' British Medical Journal.' ' ' Various endeavours have been made, and are still carried on, to prevent the contamination of the ruisseaux, or streamlets, one or more of which run down the valleys between the numerous little rocky hills on which Cannes stands. These little brooks carry off the surface water ; and, in the rainy season, convey a considerable stream, which, in some places, is used by laundresses for washing linen. In dry weather, they cease to run ; and the water, stagnating in pools, is apt to become offensive, especially if containing soap- suds. Several of these brooks have been cleared of stones and holes, and the beds narrowed by masonry into smooth gutters, in which there can be no stagnation. A public laundry, well supplied with water from the canal, has been built at the back of the town, 1 If the offence here referred to is not promptly rectified, I shall consider it my duty to publish in the English journals a warning against the parties guilty of such outrages on the public health. 470 WORST EVILS. CAPTAIN G 'ALTON'S PLANS, and has done much to prevent the practice of washing in the streams. ' But a more serious cause of contamination of these streams has been the too common, although illegal, practice of allowing drains from kitchens, and, what is worse than all, from cesspools, to be discharged into them ! If I were asked to point out the most potent cause of insalubrity in Cannes, I would answer, without reserve, the escape of the contents or effluvia of cesspools into the houses and into the ruisseanx. Individual houses are poisoned by the leakage of cesspools under or near them, or by the entrance of their effluvia through inefficient water-closets ; or through untrapped, imperfect, or unveiitilated soil-pipes, leading from the closets to the cesspools. But if, by overflow or leakage, through neglect or design, the contents of cesspools are discharged into an open ruisseau, the offensive matter grossly defiles the stream, which diffuses its stench and pernicious effects throughout its long mean- derings, with aggravated activity where it lingers or stagnates in its course.' Captain Galton would abolish cesspools altogether; and connect all closets directly with drains : but until a complete plan of drainage comes into operation, cesspools cannot be dispensed with ; and they may be made quite safe and effective, if of adequate size, and careful construction, with strict provi- sion for their being regularly emptied and cleansed, and the most absolute prohibition enforced against their ever being allowed to defile the streams. In the case of villas and hotels, with a garden of some size, there is no difficulty in disposing of the contents of the cesspools. Once or twice in the year, or oftener, if necessary, they are to be poured into trenches of sufficient size, and covered with a depth of eighteen inches or more of earth. This effectually deodorises and disinfects the sewage, and appropriates it to the fertilisation of the soil. A great mistake, commonly made here, and still more in Switzerland, is to spread the sewage-matter on the surface of the ground, with- out burying it so poisoning the air with its fcetor, and im- poverishing the manure in its fertilising properties. The adoption of Moule's earth-closet system would supersede cesspools, water-closets, and their nuisances, altogether ; and USEFUL INSTITUTIONS. ASTRONOMICAL STUDIES. 471 would be, for the outlying villas with gardens, the best possible supplement to an improved drainage of the town of Cannes. There are several most useful beneficent institutions which deserve the support of the English visitors at Cannes, and engaged the interest of members of my family. ' Les Amis des pauvres,' for aiding and relieving the industrious poor in cases of sickness or distress, is admirably carried on by a committee of ladies, and does much good at a small cost. Schools have been greatly needed in this country, for the education of the children has been much neglected, and very many of the adult population, and not the poorest only, can neither read nor write. This evil is diminished by the communal schools which are now generally established : but as no religion is taught in them, earnest Christians may be expected to aid the Protestant schools, which have been established chiefly by the efforts and contributions of English visitors. The infant school has been particularly successful: the children being taught by aid of music, singing, gesticulations, and drilled movements, in a manner that engages attention and amuses as well as in- structs. These institutions are supported not only by sub- scriptions, but by concerts and fancy bazaars, for which ladies' talent and industry are taxed for drawings, fancy- work, trap-door spiders' nests, and numbers of pretty devices in flowers and other natural products of land and sea all suggestive of ingenious and tasteful employment for truly useful objects. It is unnecessary to notice further the various occupations found for the agreeable leisure now at my disposal and which never hung heavy on my hands. But in the last two years, in addition to daily meteorological observations of which I keep a register, I brought out my old telescope of ' sixty years since ' (see Chapter I.), and took an occasional look at the heavenly bodies. I had another larger and more complete instrument : but this I gave to my third son Harry, who, having been a pupil of Professor Challis, and being a Fellow of the Royal Astronomi- cal Society, was more likely to turn it to a good account. 1 But 1 He has, however, been better employed. He has retired from the practice of the law ; and has entirely devoted himself to visiting and teaching among the poor in a needy district of his brother-in-law's enormous parish of Swan- sea; where he has established a school with upwards of 200 children. 472 COMET OF 1882. the smaller instrument was a remarkably good one, and having had it repaired and fitted with a new eye-piece by Browning, it answers my purpose very well. I have also a field binocular and a small aluminium mountain telescope by Pillischer. The first astronomical object that riveted my attention was the splendid comet of last year. Travelling and bad weather prevented my seeing it till October 20, when I was astonished at its magnitude and brightness : and after making careful observations and drawings, sent one with the following description to ' Nature,' in which it appeared in the number for October 26, 1882. ' For several mornings past we have bad fine views of the comet first seen in England by Mr. A. Common. I enclose a sketch taken this morning, as accurate as I could make it with materials at band. ' It is chiefly remarkable (1) for the crescentic end of the tail, the lower or eastern born being longer than the other ; (2) for the distinctness of the shadow in the space beyond the tail shadow obviously projected by the comet. Such a shadow I have never seen in any of the comets which have been under my observation during the last fifty years, nor do I recollect to have seen it described. ' I presume that the propinquity of this comet to the sun is tbe reason why the shadow is unusually visible, in contrast to the luminosity around it : but probably the peculiar clearness of our atmosphere renders tbe phenomenon plainer than it may be in England. In any case the appearance is interesting, in relation both to tbe nature of cometary matter, and to tbat of ligbt and shade in space. ' C. J. B. WILLIAMS.' Villa du Eocher, Cannes, France : October 21. The woodcut in the journal was not a good copy of the drawing, particularly in omitting all appearance of the re- markable shade beyond the tail. The reality of this shadow was questioned by Major Herschel in a subsequent number : and in that for November 30 the following appeared. ' Since my first communication, with sketch of the comet, on October 21, which appeared in " Nature," vol. xxvi. p. 622, I have had good views on 21 out of 81 days. The fine weather and clear atmosphere of this place give exceptional facilities for the continued and frequent observations which are needed to obtain a knowledge OBSERVATIONS SHADOW BEYOND TAIL. 473 of so anomalous and surprising an object. Some windows of my villa command an extensive sky and sea view (including at times the mountains of Corsica, 130 miles distant), and from my bedroom sometimes even from my bed I have been able to watch the comet with case for from a quarter of an hour to an hour, on each of those twenty-one days ; using only a good field binocular in occasional aid of a strong natural sight. I have more powerful telescopes, but for this object they give no help ; and I ana not astronomer enough to avail myself of other instruments. ' The comet was seen in all its brightness on October 20, 21, 23, and 24, with its nucleus like a star of first magnitude, but elongated and nebulous its tail beginning with slender stem, slightly curved, with downward convexity, and gradually expanding to its extremity, the diameter of which was about five times that of the head. The lower, slightly convex margin, was brighter, and more defined ; but a strong nebulous light pervaded the length and breadth of the tail, shaded along the upper margin in gradually diminishing haze. The tail ended in an elongated crescent, the lower or eastern horn of which was longer than the other. Both horns were prolonged in faint lines, hardly perceptible, a few degrees further (as noticed by your correspondent Mr. Larden). No such prolongation could be seen from the hollow of the crescent, which terminated by a narrow fringe of diminishing light, beyond which was an oval patch of shade, obviously darker than any other portion of the visible sky. This appeared to me nothing else than a shadow projected by the comet on the space beyond the end of its tail. I cannot admit the correctness of Major Herschel's suspicions, " that this impression was produced by contrast only " (" Nature," vol. xxvii. p. 4). The still greater contrast between the brightness of the lower margin and the adjoining sky produced no such shade there at that time : later I shall allude to such a shade appearing there also. The ultra- caudal patch was obviously darker than any other spot of the sky : so it appeared to me, and my experience in landscape painting has given me some skill in appreciating lights and shades. I am quite aware of the difficulty of physically explaining the existence of light and shadow in the vacuity of space, but this is a question of pure observation, to which I invite further attention. Two of your correspondents, Mr. Larden of Cheltenham, and Mr. Cecil of Bournemouth, describe "a black rift in the sky," and " a strong apparent shadow " behind the comet seemingly in confirmation of my observation. ' When the comet was next seen, after an interval of bad weather, on the 29th, it had lost in dimensions, but still more in brightness, 474 COMET CHANGES OF A MONTH. and its form was changed. The upper margin from the head up- wards had expanded and become more feathery ; so had the end of the tail, which had lost its crescentic form ; the shadow beyond had quite disappeared, and was replaced by an ill-defined luminosity, losing itself in the darkness of the sky. The lower margin of the tail had lost less of its brightness and definition ; and now if there was a shadow anywhere, it was along this edge, down even to the head of the comet ; but the shade was much less marked than had been that beyond the tail, and I might have ascribed it to contrast but that it was not present when this margin was brighter and the contrast greater. This shadow is noticed by Mr. Cecil in " Nature," vol. xxvii. p. 52. ' The comet was well seen on October 30 and 31, and November 2, 3, 4, 6, and 7, gradually diminishing in brightness and in the definition of its outline, its light being now further paled by moon- light. So faint was it that I am not surprised at Major Herschel's description of its non-appearance in the London sky of November 5 ; but I cannot help " suspecting " that this was due not to moon- light only (as the testimony of others proves), but also to the gas-lit haze of the London atmosphere, which from fifty years' experience I know to be, at its clearest, quite sufficient to mask a faded comet, even although the brighter light of stars may still remain visible. On the 8th the comet was seen before moonrise, more distinct, although pale and hazy in outline ; lower margin still the brightest, with a slight attendant shade. It was seen every day (except the 13th, 14th, and 15th) until the 22nd, with little other changes than that it was gradually becoming fainter, although stih 1 a conspicuous object in the dark sky from 2 to 5.30 a.m. On the 21st I made a careful portrait of it in oils, with its attendant stars, by the side of one that I had painted from the sketch taken October 21, when it was in its glory. The alteration which has taken place in the month is such that it now seems the mere ghost of its former self. The comparison strikes one as showing how much more it has lost in brightness and compactness, than in length and breadth. Is not this in exact conformity with what has been ascertained (see " Nature," vol. xxvii. p. 58), that the comet has been receding more rapidly from the sun than from the earth ? C. J. B. WILLIAMS.' Cannes, November 23. In a subsequent number, December 28, further observations were reported up to December 21, that the comet was becoming smaller and much fainter, with tail visible only in the absence TRANSIT OF VENUS PAINTED AT SUNSET. 475 of the moon, about 8 long, and its nucleus like a nebulous star of the third magnitude. In the same number was the following account of the transit of Venus as seen from my villa on December 6. ' TRANSIT OF VENUS, December 6. 4 In the morning here the sky was clear, and the sun remarkably free from spots. I noticed only 4 small ones on the disk : quite a contrast to the monstrous appearance a month ago. ' Being neither equipped nor qualified for technical astronomical observations, I did not attempt to do more than to give a popular demonstration of the transit of Venus to between 80 and 40 friends interested in the phenomenon. My experience of star-gazing was chiefly obtained upwards of 50 years ago, before I became otherwise occupied ; and then I found for myself, that the best way of studying solar phenomena, whether eclipses or spots, was by projecting on white paper or cardboard, the image of the sun from the telescope, focussed a little beyond the point for direct vision through the dark eye-glass ; extraneous sunlight being shut out by a. napkin suspended around the telescope. In this way with a small achromatic of 32 inches focal length, and 2^ inches aperture, we saw well all the chief features of the transit (which I need not describe, as this has already been done by more competent observers), and this without fatigue to the eyes, or the unnatural colouring, inseparable from look- ing through the telescope with darkened glasses. Further, as the time of sunset approached, at about 3.30 p.m., we had in our camera view the additional charm of the colours of the objects in view. As, in the Italian sky the golden orb sank with the dark planet spot ou its disk, under brightly tinted clouds, shaded off in streaks of tender grey into the azure above, with the blue rose-tipped moun- tains of the Esterels beneath, the scene was one as fascinating in beauty as it was interesting in science. All these tints appeared distinctly, albeit faintly, in the telescopic image on the card. ' One point was remarkable, that whilst the shades of the moun- tains were all blue, the dark round spot of the planet on the sun was almost black. It was the darkest object in the field of view. Partly, but I hardly think entirely, this may be explained by its being higher, and less subjected to the decomposing power of the lower atmospheric layers. I have endeavoured to represent in water- colours this view of the transit of Venus. C. J. B. WILLIAMS.' Cannes, December 21. 476 ASTRONOMY IN YOUTH AND OLD AGE. This original kind of reminiscence of a very rare event was exhibited at the conversazione of the Eoyal Society in London last siunmer, together with the oil painting of the comet above mentioned. Several of the preceding observa- tions have been translated into French in M. Flammarion's ' L'Astronomie.' Thus the desultory studies of my early youth have not been without fruit, even in old age. More than sixty years had elapsed between my earliest and latest astronomical exercises. Some observations on the sun-spots are of more permanent importance, and must be reserved for another chapter. 477 CHAPTER XLV. DISAPPEARANCE OF SUNSPOTS, COINCIDENT WITH INVASION OF EX- TREME COLD. MORNING AND EVENING SUNGLOWS. 1883-84. In March 1883 sunspots disappear - Sudden severe cold Unprecedented snow- storm and destruction of trees and plants by cold Eise of temperature with return of sunspots. Facilities for observing sun at Cannes Second coincidence of same phenomena in December Previous observations nega- tive. Reasons for supposing that spots increase the sun's heat speculative From observation Mr. J. F. Campbell's ' Thermograph.' Morning and evening sunglows Inferred to be many miles high. Clouds of icedust? Phenomena Objective and subjective Green moon proved to be subjective. Mr. Lockyer's sensational expansion of Mr. Meldrum's hypo- thesis of Volcanic dust. Better explained by Mr. Preece and Mr. Crookes Such dust actually found- but its opacity a difficulty Probably icedust formed in addition and by its optical properties explaining increase as well as diversity of light and colour. Promoted by cold of night and winter. Indications of spectroscope. High nimbus. Professional publications not undertaken expecting due credit from other authors Disappointed. Dr. Quain's Dictionary of Medicine Author's letter complaining of his work being ignored Consequent determination to write these Memoirs. Dr. Quain's reply. Conclusion of secular chapters. AFTER the disappearance of the comet, my attention was drawn to the spots on the sun, which were at this time generally in great numbers, it being a majriminn period, which occurs in every ten or eleven years. But on February 28, 1883, I was surprised to find the sun without a spot. On March 3, I observed again, and still found no spot. The next day began a fall of temperature of 6 Fahr., with a high wind from the north-east, which continued till March 7, when there came on a heavy snowstorm, covering the ground to the depth of eight inches, and causing great destruction in my garden, bearing down and breaking many valuable trees and shrubs. This was followed by a .fall of temperature to 5, G, and 7 degrees below freezing, even in my sheltered situation : in 478 UNPRECEDENTED COLD AND NO SUNS POTS. more exposed places it fell 4 and 5 degrees lower. Such cold had not visited Cannes before for 60 years ; and it was the more remarkable as the previous part of the winter had been quite mild, only two or three times reaching the freezing point. This severe weather lasted till the middle of March, when the sunspots began to reappear, and the average temperature to rise in proportion. The destruction caused by this sudden and quite unexpected visitation of cold was unprecedented. Hundreds of geraniums, heliotropes, and other tender plants were killed in my garden, which usually here bear the winter well. A fine Datura, which had been constantly flowering summer and winter, perished ; and a noble india-rubber tree 15 feet high, with its fine fleshy green bronze leaves, was turned in one night to a spectre of black rags. Extensive injury was done to the orange, lemon, and olive trees throughout the country. Enough has been said to show that this sudden invasion of intense cold was an extraordinary event ; and the coincidence of it with the absence of sunspots was at least re- markable and deserving of attention, and as such I published in ' Nature ' of April 26 an account of it with a meteorological diary during the period. On May 31 a second report appeared in the same journal carrying on the observations till the middle of May, when I left Cannes. Erom March 19 to that time I have made sketches of the sunspots on 49 days. The spots had appeared in varying but considerable numbers ; and the temperature had continued steadily to rise with the season. Evidence was adduced that the intense cold in March was not confined to the Eiviera, but had been felt throughout Europe and even in North Africa and America. Observations of the sun not being easy in England, they were not resumed till on my return to Cannes on October 1, and some idea may be formed of our weather from the fact, that from October 1 to December 1, drawings were taken of the sunspots on 54 days ; and that the spots were always present in fair proportions of numbers or size, until the last week in November, when they disappeared in an unusual manner. During November they have generally numbered from 12 to 28, some very large, with umbra and penumbra, and sometimes faculse. On November 29 there were ten : November 30, seven : COINCIDENCE OF COLD AND NO SUNSPOTS. 479 December 1, six : December 2, two : December 4, one : Decem- ber 5, NONE. On the two following days (6 and 7) only one very small spot had appeared on the eastern limb. Tempera- ture had fallen from November 29, inin. 45 Fahr. max. 58'8 to December 7, min. 36 max. 49'8. But the chill in the air exceeded the indications of the sheltered thermometer; and although the barometer was rising, snow was predicted. The prediction was verified, for on the night of the 6th was a storm of lightning and thunder, with hail and snow, which covered all the surrounding hills ; even the Esterels, close to the sea, on which snow hardly ever lodges in the severest winters. Another winterly sign on this day, was the appearance of several flocks of wild fowl migrating in the sky. This resembled only the extraordinary cold of the second week in March, and like it, was heralded by a disappearance of sunspots. But this time it did not last long enough to bring hard frost on the earth in this mild climate. On December 8 the sunspots began to return in increasing numbers and size ; and the temperature rose as follows. December 9, min. 46*8, max. 50'2 ; Decem- ber 10, min. 42'2, max. 50'9. After this the sunspots and temperature varied little in proportion, till the 17th, wiien the spots diminished in size rather than in number, being from 7 to 12, but quite small : and the temperature was, 17th, min. 37-9, max. 53 c -4 ; 18th, min. 36-l, max. 51-8 ; 19th, min. 30-2, max. 51-7 ; 20th, min. 35'9, max. 50'4. On this day, however, a fresh group of 10 or 12 spots appeared on the eastern limb, which on the 21st were large, with white areolse, and the minimum temperature rose to 43 0< 3 on the 21st, and 47'8 on the 22nd. Without taking account of this last instance, we have thus the evidence of two remarkable coincidences of absence of Hunspots and invasion of extraordinary terrestrial cold. The first in the second \veek in March : the second in the first week in December. Further observations will be required to prove that these facts stand in relation of cause and effect : but there is an increasing probability in the hypothesis that the sunspots have a direct influence on the earth's heat. Opinions of natural philosophers hitherto have greatly varied as to whether sunspots increase or diminish the sun's 4 8o DO SUNSPOTS INCREASE HEAT? heating power. Professor Young in ' The Sun ' quotes these words of Balfour Stewart written in 1878 : ' It is nearly, if not absolutely impossible, from the observations already made, to tell whether the sun be colder or hotter, as a whole, when there are most spots on his surface.' Dr. Young cites further opinions on both sides, without arriving at any definite con- clusion. My previous impressions on the subject were worth little, inasmuch as they were not founded on sufficient facts, observed by others or by myself. Nevertheless I had the impression that the sunspots are concerned in increasing the sun's heat. Most observers, from the time of Sir W. Herschel, seem to consider the spots as holes in the photosphere, through which the darker interior of the sun shows itself. But because darker, is it necessarily less hot ? If light and heat were identical, or their vibrations mutually convertible, such might be the inference, but as light and heat have different modes of origin and transmission, it is quite possible that the heat of the spots though darker may exceed that of the photosphere. There are various signs of energy and activity in the history of sun-spots which seem to betoken the working of a fiery force. They have been observed to appear suddenly, as if by explosion : their forms as represented by Langley, Secchi and others, exhibit turns and sweeps suggestive of ideas of prodigious rending and motion ; and movements have been actually seen, in parts flying asunder, and bright patches rushing at the rate of a hundred miles in a second ! l What notion seems more probable than that they indicate stupendous stirrings and stokings of the solar furnace ? And then the vast domelike clouds of faculse which often hover over and around the most active spots, how likely to be enormous bodies of magnesium or other metallic vapour in a state of vivid ignition ! But all these are but speculations and surmises, and carry no weight : nevertheless, they set me on observing, in my humble way, facts within ruy own reach. I am quite aware that observations have been already extensively made on the subject of the sunspots, and hitherto with little but negative results : but I would venture to suggest that the inquiry has 1 Dr. Young's ' The Sun,' p. 117. OBSERVATIONS PROVING SPOTS HOTTER. 481 been under taken on too vast and distant a scale, to the neglect of simple, close, frequent, and if possible, daily scrutiny. Eernote as the sun is, we know that its rays reach the earth in about eight minutes of time, and that we can feel and measure their direct power, as well as estimate their indirect and circuitous influences ; and this most readily in sunny climes, where the sun and the earth are more constantly face to face, with least of cloud, fog, or other terrestrial veil, to intervene. So it is that in this sunny land, even with simple means, we may get to know the source of light and heat, and to estimate its power, better than can those in cloudy countries with the most costly apparatus and the most profound calcu- lations. Thus if, here at Cannes, in six days, on an average, in every week, I can observe and count the sunspots, in con- nection with careful registration of the temperature and weather, I may hope to learn more than more highly skilled scientists in less favoured lands. Here at Cannes also, my friend Mr. J. F. Campbell of Islay, has been able, in many consecutive hours of uninterrupted sunshine, to measure the solar heat from day to day, and to prove that certain parts of the solar disk (the spots included) are hotter than other parts. ' KESULTS. After working a new art for some years, it was discovered, 1. that an area in a solar image, focussed on a sensitive screen, in the propor- tion of f , is much hotter than the rest, as proved by colours which record temperatures. 2. It was clearly proved that sunspots, while within the hot area, radiate much more heat than the rest of the area. Spots were seen to draw hot traces repeatedly. 3. The same spot, when outside of that hotter area, radiates less heat than the rest of the visible sun.' ' Mr. Campbell further informs me that he actually measured the heat of the sun on the spotless day, December 5, which I have recorded, and that it did not rise higher than 1100 Fahr. ; while on many previous days, with many spots, it reached 1600 and upwards. This was measured by his 'Pictorial Thermometer,' which marks degrees of heat by 1 Thermography. By the Author of ' Frost and Firo. 1883. P. 343. Wakeham, Church Street, Kensington. I I 482 HEAT VARYING WITH SPOTS. certain changes of colour in Prussian blue, Scheele's green, and other pigments. In a letter received January 15, 1884, he writes, ' I have twice proved with my pictorial thermometer, that some of the spots seen on the hot area, were much hotter than the rest of the solar image.' . . . ' While big spots were passing, the tem- perature rose : while there were no spots, or minute spots only, the temperature fell.' Thus we have already accumulated several direct observa- tions in support of the proposition which I have advanced, that sunspots, in proportion to their size and number, increase the sun's heating power, and that their great diminution or disappearance reduces that power, and is a direct cause of terrestrial cold. My daily observations are continued ; and I have already succeeded in correctly predicting the changes of temperature 6 or 7 days beforehand. 1 Still many further observations are needed, and on a larger scale, to establish these propositions on a satisfactory basis. THE EXTRAOEDINAEY MORNING AND EVENING SuN- GLOWS. As these remarkable appearances were first noticed before the time of the disappearance of the sunspots in the beginning of December, I was led to suspect that they had some connec- tion, but I soon had to give up that idea, as they have daily continued to recur under varying circumstances of sunspots and temperature. My first record is on November 30. ' Large red glow in the west, half an hour after sunset, which had not been red.' December 1. ' Same vivid glow in east half-hour before sun- rise, crimson first, then passing into orange, and disappearing before sunrise, which was not redder than usual.' These two observations deserve attention, because they give the simplest view of this unusual glow, without the complications which appeared after, when clouds confused the scene. I thus reasoned This glow must be caused by the sun's rays lighting up something very high in the atmosphere half an hour (or 1 Thus on December 20 (after having given an intimation to the Pall Mall Gazette of the cold on the 18th and 19th) I telegraphed ' More spots appear- ing, expect warm weather,' which followed and continued to the year's end. CAUSE OF SKY GLARES. 483 more) before or after sunriso or sunset. I guessed the height at 30 or 40 miles, but this is a matter which astronomers may compute. The colours, consisting of reds and yellows, the least refrangible rays, are such as may be expected to best find their way through a translucent but refracting medium : and what can this medium be at a height above the ordinary region of even clouds ? At first I was inclined to think it must be ice-dust, deposited from the air, through the unusual intensity of the cold caused by the absence of sunspots, and which would first and most affect the loftiest regions of the' atmosphere bordering on space. High and dry as the air there must be, any remnant of water or ice vapour which it may hold in solution would be condensed into ice by the more intense cold ; and a nimbus or haze of the finest possible ice- dust would be formed, of brilliant optical properties, sparkling in crystal prisms and facets, refracting or reflecting each ray from the realms of light. Such a cloud of ice- dust would explain the abundant effulgence of light accompanying these glows, or as they may better be termed glares. The sun may have set with a very moderate radiance, and the grey shade of twilight seems to be commencing, when there rises a new light above the western horizon soon rising in height and kindling to a glare, first golden, then orange, and passing through different tints of red and crimson, until gradually extinguished by the shades of night. The above description I believe to represent the constant or essential features of the phenomenon ; but they become infinitely diversified and complicated by the presence of clouds in various forms, reflecting new lights and producing new colours, objective and subjective, and even involving the moon and stars in novel colours as if in a scene of phantasmagoric enchantment. The pages of ' Nature ' were loaded with long elaborate descriptions of numbers of these chromatic puzzles, with very little attempt to solve their mystery or trace them to their true physical causes. I was more successful in the following observation. On December 2, a day of minimum sunspots, half an hour after sunset a bright glow of deep red light gradually arose above the west and south-west horizon to a height of 484 GREEN MOON ALL 'MY EYE: VOLCANIC DUST. 30, blending above with purple clouds, whose edges reflected a rosy light. In the blue -grey sky a little above was the moon, three days old, appearing plainly of a pea-green colour. Guessing that this was only a subjective phenomenon, pro- duced on the retina as the colour complementary to the adjoin- ing red glare, I shut out this glare by looking at the moon through a telescope : it then presented its own bright cream colour without a tinge of green ! Yet after this observation, which the editor of ' Nature ' refused to insert in his journal, I saw a further controversy about the green moon. 1 The long article by Mr. Norman Lockyer, which appeared in the ' Times ' early in December, advocating Mr. Meldrum's hypothesis, that the strange atmospheric phenomena were caused by volcanic dust in the air, derived from the eruption of a volcano near Java created a great sensation, and various powers of the press were employed to strengthen the impres- sion. The article being written for the public, was graphic and striking in description of the prodigious catastrophe and effects of the eruption of Krakatoa, but attempted no scientific detail, nor to explain how what took place in August could continue to produce such world-wide consequences in Decem- ber. It attributed to the supposed volcanic dust an imponder- ability and ubiquity incomprehensible. The submarine vol- cano might by the explosive power of steam (which has no limit) project the dust into the highest region of the atmo- sphere, but what could keep it there and spread it over the world in defiance of gravitation ? Answers were supplied by Mr. Preece and Mr. Crookes, wiiose suggestions in the ' Times ' removed from my mind the chief objections to the Meldrum hypothesis. Mr. Preece writes : ' If we assume that the mass of volcanic matter projected with such force into the atmosphere in the Straits of Sunda was highly electrified, then it must have been electrified with the same sign as that of the earth viz. negative. Therefore when the force of pro- jection had exhausted itself, the cloud of matter would be subject to two other forces besides gravity the repulsion of the electrified 1 It is probably different with the green sun, and the blue sun, described by several observers, and which I have never seen : but they could be easily tried by the telescopic test. ELECTRIFIED DUST. BUT WHY GLARE? 485 earth, and the self repulsion of each particle of electrified dust. The first would determine the tenuity of the cloud ; for the lighter the particles, the further would they be repelled, and the heavier the particles, the quicker they would descend. It is quite possible to conceive that they might be so minute, and so highly electrified, as to reach the highest confines of our atmosphere, where they would remain as long as they remained electrified. The second re- pulsive force would cause the particles to spread out continuously in a horizontal plane until they would cover an area determined only by their quantity.' ' Times,' December 14, 1883. Mr. Crookes refers to his paper read to the Royal Society in 1879, in which he showed that at a rarefaction of a millionth of an atmosphere, two pieces of electrified gold leaf repelled one another at a considerable angle for 13 months without loss of charge. Such a rarefaction exists in the atmosphere at a height of 62 miles above the earth's surface, and renders the attenuated air a non-conductor of statical electricity, and therefore quite capable of retaining the self- repellent property of particles of dust, which are much smaller and lighter than the pieces of gold leaf ; so these electrified particles, once projected 50 or 60 miles above the earth's surface, might remain there for many years. It seems then quite possible that matter from an exploding volcano may reach the highest regions of the atmosphere, and in form of the subtlest dust remain and spread there by virtue of its electric state, in opposition to the forces of gravi- tation and aggregation. And some remarkable evidence has come forward that such matter has been found in the deposit collected from snow and rain. Mr. MacPherson at Madrid and others in various localities have described traces of mineral matters resembling those from volcanoes. But I still find a difficulty in understanding how volcanic dust (of which powdered pumice stone may be supposed to be a rough type), a comparatively opaque matter, can produce the extraordinary exaggerations of light as well as of colour, which are displayed by these glows or glares. Half an hour or more after sunset, when twilight is beginning, the western sky is lighted up with a new illumination, which enables one to read for many minutes later, and the varying hues, although 486 PROBABLY ICE-DUST ALSO. they may be said always to have a dinginess in their aspect, are flaring colours, impressing strongly the organs of vision, and thus producing secondary or complementary hues on other light objects. I incline strongly to the notion, before ex- pressed by others as well as by myself, that a cloud or nimbus of ice-dust is the chief cause of the phenomena, its formation being promoted by the presence of the volcanic dust. A similar view has been entertained by Mr. Aitken as to the more ready formation of fog and cloud in the presence of particles of soot or smoke, and not without reason. But the formation of water-cloud in the highest regions of the atmosphere must have this characteristic, that the particles of water must be extremely fine, and in the state of perfectly dry ice. Fine because the watery vapour at these heights is extremely scanty ; and frozen because the temperature there is far below the freezing point, and the more so during the night, when the sun's rays are withdrawn. I do not know and I doubt that any one exactly knows what is the state of water in a frozen cloud. Probably it is a crystalline dioptric solid of extreme minuteness, and possessing decided powers of refraction and reflection with respect to light. Much of this ice-dust must be continually forming and melting away in the regions above the line of perpetual snow, and doubtless is concerned in producing various atmospheric phenomena, particularly those of sunrise and sunset. The approach of winter cold will obviously increase the manifestation of these phenomena. So likewise if volcanic or any dust be present in the higher regions, increasing the tendency to the deposition of ice-dust, it will manifest its action most at the time of the loss of heat at sunset and on approach of winter. This consideration may explain why these appearances in the skies did not command general attention till the approach of the cold season, espe- cially in the sudden increase of cold at the disappearance of the sunspots early in December. And should there again recur a disappearance of sunspots with great lowering of temperature, there would in all probability be an increase in these atmospheric manifestations. I am not well versed in the indications of the spectroscope, and may be in error, but NO PROFESSIONAL LITERARY WORK. 487 I cannot understand how some experts with that instrument seem to deny the presence of water in any form in the high colour clouds because there is no rain-band in them. I fancied that the rain-band indicated moisture, which can have no existence in regions so high and dry. Throughout this month, January 1884, the barometer has been high, and there have been no signs of rain ; but there is often an appearance of haze in the blue sky ; and in mornings and evenings, apart from the glows, many forms of slight nimbus and cirrus may be discerned high in the atmosphere. The glows display themselves usually in a bank of nimbus from 10 to 30 high, often with two or three rays, as if from the sun many degrees below the horizon. I commend all these natural phenomena to the attention of amateurs, and especially the study of sunspots, which seems likely to prove very useful as well as interesting. It may have been inferred from the contents of this and of the preceding chapter, that since my retirement, I had undertaken little professional work; and that I made no attempt to republish new editions of former works which have long been out of print, although much of the matter contained in them was of such permanent interest that it could hardly be said to be out of date, and during the interval there had accumulated no small amount of new and original matter. But I found such comfort and refreshment from repose from everything like taskwork, that I thought that my mind, which had certainly been overstrained in past years, needed longer rest. I flattered myself too, that my past works would not be altogether forgotten ; and that justice would be done to them at least by some of the many whom I had taught, and several of whom had now become teachers and authors. But in this expectation, I was for the most part doomed to dis- appointment. What was taught in the schools was every one's property, and required no recognition, which was reserved only for the most recent novelties, however frivolous their character. Some years ago Dr. Quain mentioned to me the project of the Dictionary of Medicine which he had engaged to edit, and asked me to write some articles for it. But this was a kind 488 DR. QUAINT DICTIONARY. AUTHOR IGNORED. of work very different from that in which we were at one time agreed to write together ; and I could not find in writing con- tributions to a ponderous compilation under not the most genial restrictions as to matter and manner, a sufficient in- ducement to emerge from my retirement. In February 1883 I received from Dr. Quain a note to say that he was sending me by private hand a copy of his Dictionary of Medicine, and in a few days I received it, and after a brief inspection of the book gave expression to some of my feelings in the following letter. ' Cannes : February 7, 1883. ' MY DEAR QUAIN, I am obliged to you for making me a present of a copy of your Dictionary of Medicine, and I congratulate you on having brought to a completion what must have been a work of enormous labour. You are so good as to say, " It will be one of my greatest sources of satisfaction and pleasure in having 'brought it to an end, if it should meet with your approval." ' I doubt not that in the details of this great mass of work by so many able and experienced writers, I shall find much to approve of and to learn from : but I must confess to a predominant feeling of painful surprise, on glancing through several subjects with which my name has been identified during the last 50 years, at not finding it once mentioned. I refer especially to the articles on the heart, lungs and pleura, and physical examination, with the exceptions of my son's articles on asthma and phthisis. Yet you must know, as well as any one, how much I had done to clear up these subjects, even before 1840 when the last edition of my work on the chest was published ; and how in subsequent years I continued to teach, lecture, and publish on the same subjects. ' No doubt there have been many other labourers in the same field, and it would be impossible to mention them all : but if any deserve record, it is those which have succeeded in generalising the subject, and making its facts intelligible. Now this I claim to have done (to mention one instance) with regard to the physical diagnosis of valvular disease of the heart, and to have placed it on a compre- hensible basis. ' Another subject in which no reference is made to my observa- tions, is on determination of blood and inflammation : yet both Virchow and Dr. Burdon Sanderson insist on their importance as bearing on the nature of inflammation. ' It is my belief that none of the writers of the articles in question DR. QUA/WS EXPLANATION. 489 in your Dictionary, have ever read my works on the subjects ; and I can hardly blame them, as these books have been so long out of print : but you must have read them, and might have directed attention to them, as you have obviously done to your own papers on various topics. ' I do not forget your friendly offices on many occasions, nor the kindly help that my son has received from you in return for what I was able to do for you at the early part of your career. But aged as I am, I see that I must rely on my own efforts, if God spares me, to leave behind me some record of my humble efforts to fulfil my mission. 'Meantime I remain, dear Quain, ' Your shelved old Friend, 'C. J. B. WILLIAMS.' 'Dr. Quain, ' Harley Street, London.' And the result was the determination to write these Memoirs, which through God's mercy are now brought to a conclusion with the full consciousness of many errors and im- perfections of thoughts, words, and actions in the life narrated, and of no exemption from the human weakness of egotism the great snare of the autobiographer in the narrative. If not in his Dictionary, in the following letter (for which I thank him), my friend Dr. Quain seems to express his desire to take me down from the shelf. ' 67 Harley Street : September 4, 1883. ' MY DEAR DR. WILLIAMS, In the letter which you wrote to me from Cannes several months ago when acknowledging the receipt of a copy of the Dictionary of Medicine which I had the pleasure of sending to you, you blamed me for allowing your work to be ignored by writers on several subjects to a knowledge of which you have contributed : and you said that by my having allowed this silence as regards the mention of your name, I have shelved an old friend. In this statement is comprised a charge of ingratitude and of a want of appreciation of your work. ' There is no friend whom I have ever had to whom I owe more than to yourself and for this I have felt, do feel, and have always expressed my gratitude. Intimately familiar with your work and with your teaching, I have always spoken of you as the principal founder of our modern school of Pathology, and I have often been led to compare your position in this science with that of Miiller in the science of Physiology. Your charges against me, then, so en- 490 DR. QUAIWS LETTER. tirely opposed to the feelings and sentiments of many years duration, caused me the deepest pain a pain increased by every subsequent mental reference to the subject Hence the delay in replying to your letter. However, the ordeal has sooner or later to be met, and I shall try to put, in as few words as possible, all that I have to say in reference to the immediate subject of the Dictionary. The work is the absolute property of Messrs. Longmans, and I was bound to carry out as far as possible the plan on which the proposal for the publication of the Dictionary was based. It was to be a work which should present the Practitioner with a condensed view of the present state of Medical Science without reference to the agencies by which this had been arrived at. In the directions issued for the guidance of the several writers, the following paragraph occurs. " The articles are not meant as a rule to include much historical matter, frequent reference to authorities, or the discus- sion of unsettled opinions." Having obtained the services of the best available writers in each subject, my duty coinciding with my inclination was to interfere as little as possible with the several authors leaving to each the responsibility of his own work. Some- times it was necessary to ask writers to condense their work or to sanction its being done, sometimes to alter it, but I confess that it did not occur to me to point out to any one that reference should be specially made to the name of any particular individual, feeling satisfied that each writer would do all that was needed for the com- pleteness of his work. If I had thought that you were anxious about reference being made to your name, most certainly your wish should have been fully gratified, equally so had I felt it to be neces- sary but to me your work has always seemed to me so important and so complete constituting a large part of the modern history of Pathology and Physical Diagnosis, that I should as little have ex- pected a reproach from you for not mentioning your name in con- nection with these subjects as from the shade of Harvey for not mentioning his name in connection with disorders of the circulation, or of Laennec because no reference is made to his name in connec- tion with the stethoscope and auscultation. ' I can only repeat now my assurance that had I known your feelings on the subject, your name should have been mentioned so far as lay in my power, whenever and wherever it could be done. At the same time, dear Dr. Williams, let me remind you that I earnestly begged of you to write for me the articles Pathology and Physical Diagnosis. In these articles, had you assented to my re- quest, you would have had the most favourable opportunities of bringing forward the essential features of your previous work. PAST PRESENT FUTURE. 491 ' In conclusion let me add that whatever you may feel or say on this subject, I shall hope to remain in the future, as in the past, ' Your grateful faithful friend, 'KlCHABD QUAIN.' Whilst the readers of the Dictionary reap the benefit of the imperative utilitarianism of the 'present writers,' I trust that my readers will not find it unpleasant to recur to the records of the past, nor unprofitable to draw from them in- struction for the ivresent, and even for the future. History repeats itself; and a retrospect of past progress will often assist in further advancement, more than a dogmatic inculca- tion of present knowledge, as if it were stationary and com- plete. The most enduring as well as the most comprehensive knowledge is that of principles ; and the development of principles is for the most part historical work. But this argument, to be continued profitably, should be pursued from abstract into detail, which the end of the book forbids. If I have hitherto got little credit for the work of my life, it matters little now : but seeing that it was falling into oblivion, I thought my duty was to make this effort to pre- serve it for whatever it may be worth, for the benefit of humanity. This chapter concludes secular matters past present and future : but I have a few thoughts on subjects of more enduring interest, which I reserve for the last chapter. 492 CHAPTER XLVI. EEMINISCENCES AND MEDITATIONS ON THE HIGHER LIFE. 1884. Eeligious exercises and opportunities increased by retirement. Study of Greek Testament. Evangelical convictions on Christian Truths. Aids of learned commentators. Discussion of certain passages of Scripture. Literal translation recommended. Other Scripture helps and manuals. In all one thing necessary. GOD revealed to man in and through CHKIST only Scriptural proofs John Hebrews, &c. Gospel of John throughout, especially 14th chap. Convergence of all Scripture to one point CHRIST. Old Testament Gospels Epistles and Eevelation. To the Christian, CHRIST ALL and IN ALL The True God and Life Eternal ' Guard yourselves from imitations.' Church of England Christian in Articles and Liturgy, always holding CHRIST the Mediator and Eedeemer. Christian faith avoids equally human superstition and infidelity Tares Work of the Enemy. Protestant is Christian loitncssing for Truth as it is in Jesus God's Truth as Jesus Christ before Pontius Pilate. Protesting for the Truth includes protesting against error but this a negative and secondary sense Primary importance of founding Protestantism on the positive Truth of God, not on mere negation of error. Imperfect knowledge of Scripture Truth among educated classes. Equal ignorance of the necessity of growth in Divine Grace and knowledge. Explanation of Greek words denoting ' Become holy,' and ' Full knowledge.' I PROPOSE to devote this last chapter to a few reminiscences and reflections relating to the Higher Life and the work of Grace. During a busy professional life I had little time or opportunity for religious associations or exercises ; and except in attending a few meetings of the Christian Medical Asso- ciation, which has been already noticed, there is nothing to record. It was always a refreshment to me to visit my daughter's dear friends, the Rev. W. W. Andrew and his family at Hethersett, whose devotion to the Higher Life and labour of love was always exemplary and edifying ; and our Bible readings together were a source of enjoyment and com- fort. Since my residence at Cannes there have been also profitable opportunities for Bible readings, especially at Mr. EVANGELICAL CHURCH DOCTRINES. 493 and Mrs. Cheyne Brady's meetings ; which I attended until increasing deafness incapacitated me. One of the principal objects to which I looked forward in my retirement was a course of Scripture study, more consecu- tive and complete than I had been able to pursue in the midst of professional occupations. Mention has been already made of our customary readings of the Greek Testament, but little was attempted beyond getting as literal and simple a transla- tion of the text as possible, without going into the expositions of learned commentators. We attended the ministry of that sound and judicious preacher, the Eev. W. Reeve, of Portman Chapel, for upwards of twenty years, and found much comfort and edification in his thoroughly evangelical teaching and ministrations. And the more I studied them and observed their effect on the lives and conversation of men, the more I became attached to the leading doctrines of our reformed Church as expressed in her llth and 6th articles, compre- hending justification by faith and the adequacy of Holy Scriptures, through the promised teaching of God's Holy Spirit, to make us wise unto salvation through faith which is in Jesus. This preference of spirituality and truthful simplicity of doctrine implied also aversion to all forms of ritualism and sacerdotal- ism; not only as signifying a tendency to relapse into the errors and superstitions of the dark ages tares sown by the enemy, but also as vitiating and destroying the unity and sovereignty of the most fundamental truths of Christianity. In the study of the Holy Scriptures, especially their most fully inspired and revealed portion, the New Testament, I found the writings of modern commentators of the greatest use. Dean Alford's translation and exegetical notes proved very instructive ; and one cannot but admire the candour as well as earnestness that pervades them ; but the language of the latter is often so much involved parenthetically that it is difficult to catch its meaning; and not a few errors of the authorised version escaped his notice. Bishop Lightfoot's scholarly revisions of the Flpistles to the Galatians and Philip- pians ' gave me much satisfactory help, as did also Dean 1 In Phil. 4. 7, Dr. Lightfoot proposes to translate fi vow, surpassing every device or counsel of man. I have for years entertained 494 AIDS TO SCRIPTURE STUDIES. Vaughan's profitable and devotional commentary on the Epistle to the Eomans. 1 Adolph Saphir on the Epistle to the Hebrews, Hay Aitkin's ' School of Grace,' (Tit. ii. 11-13), and some others of his works I found very edifying ; West- cott's Canon of Scripture proved satisfactory in settling the mind in questions as to the authenticity of different parts of Scripture. For an accurate knowledge of the language of the New Testament I recommend the daily reading of portions in the original Greek to those who have even a moderate knowledge of that language. For others, the revised version may be substituted, as decidedly more exact than the authorized translation, which in many instances fails to render accurately the sense of the original. I am indebted to my friend Mr. Arthur St. John Mildmay for a copy of a very elaborate work, entitled, ' The Englishman's Bible,' by Thomas Newberry, of Weston-super-Mare. In this the endeavour is made 'to put the reader in possession of some of the precisions, beauties, the presumptuous thought that I can suggest another rendering, more literal, and more full of comfort in its meaning than this or the ordinary translation. I cannot see how forepe'xco can be made to mean, I surpass. "EX>> I have or hold, never means passing, or motion, but station. So inrtpfxca means I over- hold, dominate, have position over. T& uirepe'^oj/, the participle, means any- thing holding position above, higher, Rom. 13. 1 ; Phil. 2. 3 ; 1 Pet. 2. 13. To pass or surpass would be expressed by vvfpftd\\ci>, as in Eph. 3. 19, and 2 Cor. 9. 14. Tldvra vovv may be translated every mind, more literally than all understanding. Then we have the following literal translation of the 6th and 7th verses. ' Be distracted about nothing : but in everything by prayer and supplication, with thanksgiving, let your requests be made known unto God. And the peace of God, overholding (or dominating) every mind, shall guard your hearts and your thoughts in Christ Jesus.' The usual translation of the article and participle into relative pronoun and verb which overlwldeth every mind may be substituted, but is less literal. The thought of God's peace specially superintending every mind, is surely more comforting than that of its being something incomprehensible. 1 Dr. Vaughan's commentary is the only one in which I have seen mention made of the omission of the Greek articles in certain passages, apparently with the intention of emphasizing the expression of personality. It seems to me to be more significant than even he makes it. When in Rom. 1. 17, the Gospel is declared to be (not the power of God, but) God's power unto salvation to every- one believing there is a force and directness of assurance which would be im- paired by articles and prepositions. In like manner in Rom. 8. 16, and 1 Jno. 3. 1, 2, the omission of the article the before children, enforces the strength of the union as God's children. There are many similar passages in the Epistle to the Romans. DAILY DEVOTIONAL MANUALS. 495 and hidden treasures in the Hebrew and Greek originals, and to keep them before the eye of the Biblical student.' Varia- tions in type, and a great number of marks and notes are used to distinguish and explain the full and precise meaning of particular words and texts, beyond what appears in the common translation. The work is one of prodigious labour and profound erudition, and is highly commended by several eminent scholars and divines. It seems a most valuable help to earnest students of Scripture who are unacquainted with the original languages. The smallness of the type and signs has prevented me from profiting by it so much as I could wish. In addition to the Bible and New Testament, little books with a selection of texts for daily study are most useful and convenient. Of the great numbers of such, I may specially name as excellent, ' Daily Light on the Daily Path,' (Bagster), ' Night and Morning Watches,' ' Faithful Promiser,' ' Words of Jesus,' and others by Dr. Macduff, which I have often found acceptable among patients. The ' Altar Incense ' of the same author long proved useful as an aid to family or private devotions. These in the last year have been richly supple- mented by the manual of my dear old friend the Eev. W. Niven, formerly vicar of St. Saviour's, Upper Chelsea, whose state of health has debarred him of late from public ministra- tion. But he has been blessed with fruitful work in old age, not only in a sweet pamphlet of exhortation on that special subject (' Fruit in Old Age '), addressed to aged pilgrims, but also in excellent commentaries on several of St. Paul's epistles for family reading. They seem to me models of Christian teaching simple and plain, yet full of the very essence and efficacy of Gospel truth and comfort. Two years ago I met with ' The Daily Bound,' on each page of which is, 1. A text for every day in the ecclesiastical year ; 2. A short statement of what the words mean and teach ; 3. Some thoughts and reflections intended to bring home the general lesson, so as to make it of personal practical use ; 4. A short prayer, in which what has been brought before mind and heart is laid before God ; 5. An appropriate verse of a hymn. This little book, although wearing some- 496 THE NAME ABOVE EVERY NAME. what of a high church dress in phrase and form, especially in the editions adorned with red letters, I found on closer study to be, for the most part, an excellent manual of devotion, rich in the most precious scriptural truths, and deeply spiritual and practical in their interpretation and application. The language although simple, is remarkably terse and epigrammatic, and speaks so plainly and to the point, that every sentence in each page is full of meaning. And most of the pages ring with the true sound of the Gospel in the Name which is above every name. 1 Yet, strange to say, in some pages, neither the name nor the office of Christ is mentioned, and the language might be that of a deist. I doubt not that the omission is uninten- tional ; and perhaps it may be pleaded, that the name, if not expressed, is understood. But THAT NAME is the NAME to be not only understood, but ever expressed and confessed 2 before all, as the only ' NAME given among men wherein we must be saved.' 3 And here is the point on which (as it seems to me) centres the whole truth of Christianity, GOD revealed to man, in and through CHEIST, only. This conclusion, in my humble opinion, is fully warranted by the teaching of the following and other portions of Holy Scripture. John, chap. 1. vv. 1-4 and 9-14 ; Mat. 1. 23 ; Isaiah 9. 6, 7 ; Heb. 1. 1-3 (Literal translation), ' God, having of old in many parts, and in many modes spoken unto the fathers in the prophets, at the last of these days spake in (his) Son (sv VIM), whom He appointed heir of all things, by whom also He made the worlds ; who being effulgence of His glory, and very im- press of His substance, 4 and upholding all things by the word of His power, having made purification of sins, sat on right hand of the majesty on high, that is, in full possession of the power and authority of God. f All power is given unto me in heaven and on earth,' Mat. 28. 18. 1 Phil. 2. 9, 10, 11. Revised Version. 2 Matt. 10. 32. 3 Acts 4. 12. 1 x a P aKT ^IP T 'J S viroffTaffftas avrov seems more than image or likeness of His person or substance. The sense of cutting or engraving is conveyed in the first noun, and in conjunction with the second (which surely is substance), conveys a meaning of participation or identity, rather than of mere likeness or imita- tion, such as the word image would express. CONCURRENCE OF ALL SCRIPTURE. 497 And to the end of the chapter is declared in prophecy the pre-eminence of God the Son, as King, Creator, and Everlast- ing God. Further on He is announced as ' High Priest for ever after the order of Melchizedek,' and a compassionate High Priest, having partaken of our nature ; yet Jesus Christ, the same, yesterday, to-day, and for ever.' 13. 8. ' Through Jesus Christ, to whom glory for ever and ever.' 18. 21. To these absolute declarations of the Deity of Our Lord and Saviour Jesus Christ may be added that of Col. 2. 9. 'In Him dwelleth all the fulness of the Godhead bodily,' and many others, in letter and in spirit, both in the Old and in the New Testament. And concerning this second Person in the Blessed Trinity, * Very God of very God,' what does the Holy Spirit speak of Him and of His office ? In the mouth of John Baptist : ' No one hath seen God at any time : the only begotten Son, being in the bosom of the Father, that One (Eiceivos) hath declared Him.' And of His sacrificial character, ' Behold the Lamb of God which taketh away the sin of the world ! ' John the Evangelist, the beloved disciple, names Him as 'O Aoyos, The Word, the Speech, the Voice of God ; and as the personifica- tion also of all the Divine attributes : Life, Light, Truth, Wisdom, Love, Holiness : through Him alone can man become partaker of these attributes of Divine Nature. 1 And if we follow the same evangelist, whom His Divine Master loved and instructed most deeply in His truths and in the mysteries of His love, we find Him in the third chapter opening the mind of the Jew to the necessity of a new birth for the spiritual reception of the new life from above. In the fourth chapter, after reproving the sinning woman of Samaria, He proclaims the spirituality and freedom of God's true worship through Him, the fountain of ' living waters springing up into eternal life.' And without dwelling on the rich revelations of Himself in the intermediate chapters, as the Spiritual Bread of Life from heaven the Light of the world the Door of the sheep the Sanctified of the Father the Eesurrection and the Life the Glorified of the Father, we come to the 14th and two following chapters in which the identity and co-equality of 1 John, throughout first epistle. 2 Pet. 1. 4. K K 49$ CHRIST ALL AND IN ALL. God the Father with God the Son are emphatically affirmed ; and not less absolutely and exclusively the Son of God as Son of man is declared to be the Mediator, Intercessor, and Advocate between God and man. But the revelations were gradual and progressive, and not completed until after the Resurrection and the sending the Holy Spirit, the Spirit of Truth who should guide into all truth (v. 17). 'I have yet many things to say unto you, but ye cannot bear them now. Howbeit, when he, the Spirit of Truth is come, he shall guide you into all truth ' . . . ' He shall glorify me ; for he shall take of mine, and declare unto you. All things whatsoever the Father hath, are mine ' (26. 13, 14). But some revelations are announced at once, absolutely, and for ever, as funda- mental doctrines, especially these two : I AM THE WAY, AND THE TRUTH, AND THE LIFE : NO ONE COMETH UNTO THE FATHER, BUT BY ME (14. 6) ; and BELIEVE ME THAT I AM IN THE FATHER AND THE FATHER IN ME ' (14. 11.) In these two declarations, fortified and enforced by numerous others, it is affirmed that Jesus Christ is the only Mediator between God and man, and as His Beloved Son in whom He is well pleased, He shares with God the Father all the glorious attributes of Divine Being, in which, in chap. 17, he intercedes with God the Father for the participation of His Church. This being so, we can understand the convergence of all Scripture to this one point CHRIST revealed in the Old Testament dimly, yet intelligibly in the Gospels clearly and personally in the Acts, Epistles, and Revelation with em- phatic distinctness and fulness. He is the ' One thing needful,' declared by Himself to be ' The good part,' ' The treasure found in a field,' ' The pearl of great price,' the end and object of the parables of the 'kingdom of heaven,' the theme of all the Epistles. Christ is ' God's power unto salva- tion ' of Romans 1. 16 ; ' The end of the law for righteousness to everyone that believeth ' (10. 3) ; ' God's power and God's wisdom,' of 1 Cor. 1. 24; Paul's 'glory' in Gal. 6. 14; the object of his prayer in Eph. 4. 14-21 ; the object of his struggle in Phil. 3. 13, 14 ; ! of his thanksgiving and un- 1 The force and meaning of this beautiful verse beginning in the Greek, S.v 8? , has been injured in the authorized version by the interpolation of the &EWARE OF IDOLS IMITATIONS. 499 bounded adoration in Col. 1. 18-19. In fellowship with God the Father in possession and distribution of Eternal Life and all Divine attributes in John's First Epistle, and in announcements in anticipation of His Second Coming in Almighty Power and Great Glory in the Apocalypse. To the true Christian then Christ is ' all and in all.' And this not in doctrine or idea only; but in reality. In the parable of the Vine He tells His disciples, ' Apart from me ye can do nothing.' It is only by the indwelling of His spirit that we can partake of His life and love, and in His strength bring forth fruit to His Glory. And should not the Christian, Christ's man, be very zealous in his Master's service, and jealous of His honour ? Not only will he remember the warn- ing in Matt. 6 : ' Not everyone that saith unto me Lord, Lord, &c.,' but also the closing words of St. John's first Epistle, which, after emphatically declaring Jesus Christ the Son of God to be the True God and Life Eternal, concludes, addressing his children with a term of endearment, 'Tsxvia, (f>v\d^ars sav-Tovs aTro rwv el&o!>\(av.' 'Little children, guard yourselves from the likenesses, or imitations.' There are many idols, or resemblances, and all the more dangerous, because they have an outward likeness or resemblance : and our only safeguard is that ' the Son of God is come, and hath given us understand- ing that we may know Him that is true, and we are in Him that is true in His SON JESUS CHRIST ' (1 Jno. 5. 20). The Established Church of England proves its Christian character, not only in the Scriptural doctrines set forth in its Articles, but also by the evangelical character of its Liturgy, and by the express mention of the mediation and intercession of words 'I do,' which are not in the original, and the error has not been corrected in the Revised Version. Aietaw is a verb active, and immediately governs tv : thus the literal translation is ' but forgetting things behind, and reaching forwards to things before, I pursue one thing toward the goal unto the prize of the upward calling of God in Christ Jesus.' Another example of the confusing effect of interpolating words, not in the original, may be found in Eph. 2. 1. And you lw.Ui lie quickened (did lie quicken, Revised Version), destroys the literal kense which couples ' And you ' (heathen) of the first verse with ' us ' (Jews) ' together with Christ,' of the fifth verse. Both heathen and Jews dead in trespasses both ' made alive together with Christ, and made to sit together in the heavenlies in Him.' It has been to me a confirmation of the truth of Holy Scripture, that it comes out purer and clearer when rid of human additions. K K 2 5 co TARES IN THE CHURCH. Our Lord and Saviour Jesus Christ in every one of the prayers and thanksgivings. It is to be feared, however, that the monotony of the phraseology, and the usually irreverent mode of reading the service have much obscured the depth and vital importance of the meaning. Although I prefer a liturgical service to extemporaneous prayer, in common with many others, I should be glad to see some changes introduced with the view to render it more spiritual and evangelical ; but this is too wide a subject to be entered on here. But I cannot help expressing the wish that the attention of the English clergy were more directed to improve the matter and manner in their ministrations as servants l of Christ, and not wasted in the trivial matters of ritual and ornament, emblems of an obsolete priesthood, belonging to an age of shadows and carnal ordinances, long superseded by the possession of a spiritual reality, Col. 3. 17. The Confession of faith which I have endeavoured, how- ever weakly and imperfectly, to express above, is designed to avoid equally the blinding and debasing errors of human superstition on the one hand, and the vain and dreary doctrines of unchristian infidelity on the other. These are all opposed to the Truth of Christ's Gospel ; and in so far as they have penetrated the visible church they must be looked on as tares sown by the enemy, of which we are exhorted to beware, and to avoid until the end when the Lord Jesus shall come to destroy them all in judgment. (Matt. 13. 30 ; 2 Thes. 2. 8). I accept and rejoice in the title of Protestant ; but less in its common negative sense of protesting against error, than in its positive and Scriptural meaning, (the first knowledge of 1 It is remarkable how Paul in several epistles, and James, Peter and Jude, all glory in calling themselves slaves (SoCAoi) of Christ. There are five or six other words for servant in Greek, but they choose one implying, ' whose I am,' as well as, ' whom I serve.' They ' are not their own, but are bought with a price,' and rejoice in His service which is perfect freedom, because they find His yoke pleasant (xpi)efore Dalton, Prof. Thomson, &c. Prof. Graham ap- pointed with Author to investigate the subject. 98. Author read paper in Phy- sical Section 'On Physical Explana- tion ot* Production and" Propagation of Sound.' Lecture of Sir C. Bell on Nervous System. Reports of Commit- tees on motion and sounds of the heart, 110 note. Meeting at Bristol. Report of Committee on Heart-sounds, and paper on Ear-trumpets, in Physical Sec- tion, 117. Meetings contrast genially with those of Royal Society, 117. Second Report of London Committee (Drs. Williams and Todd) of the British Association on the Sounds of the Heart, chiefly on Murmurs. Abstract of ex- periments and conclusions, 1 22-5. Read at meeting at Liverpool in 1837. De- monstrations there highly successful ; Dr. Roget's public report quite the contrary, 126. Meeting at Glasgow, Author s report on contractility of air- tubes, 153. Meeting at Plymouth, 1841, 187. Attempt to discontinue Medical INDEX. 507 BBI Section counteracted. Meeting at Man- chester, 191. Author put on Council, 192. Biology to be title of Medical Section, 142. Letter from Sir R. Mur- rhison on Phvsiological Section, 192. Meeting at Belfast, 439 ' British Medical Journal,' 297, 428, 468, 469 Brodie, Sir B., experiments on Animal Heat corrected by Author, 25, 27, 105 ; (Letter on Experiments), 108-9, 112, 138, 278 Bronchitis, by Author, in ' Cvclo. of Pract. Med.,' 76 Brougham, Lord. 137 Broussais, Dr., Val de Grace, antagonist of Laennec, 41, 89 Brown, F. J., 189 Brown-SeVjuard, Dr., 160, 271 note on Spinal Irritation, 90 Browne, Mr. R. T., 179 Bruit de Soufflet, mottche, diable, &c., 122 it seq. Brunei, Isambard Mark, 112 Brute speech, 7, 8 Bryden, Dr., 308 Buccleuch, Duchess of, 397 Buckell, Francis, 189 Buckle, Mr., author of ' History of Civili- sation ' on ' Principles,' 209 Bucknill, Dr. J. C., F.R.S., 147 Budd, Dr. George, 2*25 Dr. \V., 394 Buenos Ayres, 313 Bunion-Sanderson, Dr., 159, 161, 205 Burfoot, Mrs., nurse, Lord St. Maur's case, 363 note Burger, Dr. C., Description of Micro- organisms of Whooping Cough, 51 note Burrows, Dr. Mann, 28 Sir George, Pres. R.C.P.. 225, 377, 379, 405 Burton, Kirkham, 189 Bury, John, 189 - Rev. Charles, 187, 258 Byam, W. J., our family medical atten- dant, 92 C CABS, hansom, objection to, 133 Cadge, W., account of Mr. Listen's death, 227-9 Cairns, Earl and Countess, 439 Camacha, mountain residence in Madeira. 59 Cammack, Richard, 189 Cannes, first visit to, 464 ; retirement to, villas, &c., 464-8 ; all delightful except drainage, which is still grossly defective, 468-71 ; institutions, &c., 471 ; comet seen from, 472-4 ; transit of Venus from, 475 Canney, Dr. George, 189 CHR Canterbury, Archbishop of (Tait), 384 Cape of Good Hope, 313 Carbonic acid bath at Franzensbad, 397 Cardiac murmurs, distinction between basic and apex, first made bv the Author, 128-9 Cardiganshire and Carmarthenshire, horse- back tour through, 75 Carlile, Mr., of Dublin, on sounds of the heart, 98, 103 Carlsbad, 397 Carriages, 133. See Two-Wheeled Carswell, SirR., 17, 142^5 Cartellieri, Dr., of Franzensbad, 396 Catarrh, article by Author in Cycl. Pract. Med., 77 Cecil, Lord Thomas and Lady Sophia, 439 Mr., Bournemouth, on Comet, 473-4 Ceeley, Robert, of Aylesbury, 323 Celsus, De Medicina,' 11 Cesspool abominations at Cannes, 469 Chaffey, Dr. Robert, of Martock, 17, 26 Challis, Rev. Prof., 312, 471 Chalmers, Dr., astronomical discourses, 4 ; his natural eloquence, 14 Chambers, Dr. W. F., Physician fo St. George's Hospital, 75 ; on his resigna- tion Author becomes candidate in opposition to Dr. Hope, 130 ; but with- draws. Dr. Chambers's letter on the occasion, 132 note, 138, 278 Chamonix, first visit to, 70 Champs-Elysees, Paris, 32 Chandler, Rev. Dr., 242 Charles X., King of France, 1825, appear- ance in processions, &c., 31 Charter of Royal College of Phvsicians, 162-3 of Royal Society, legal opinions on, 452-3 Chawner, Henry, 213 Chemistry, experiments in, 4 ; Prof. Thomson's system, 4 ; Dr. Hope's lec- tures on, 11 ; Author's investigations in, 20-5, 91-9, &c. necessary to medicine, 196 Cherbourg, Lord Lvons escorting the Queen to, 325 Chest, Diseanes of, Author's work on, first edition, 64 ; second edition, 101 ; third edition, 111 ; fourth edition, 148 ; trans- lated into German and Swedish. De- mand for further works not supplied, 267-8 Cheyne Brady, Mr. and Mrs., Bible read- ings, 493 Watson, on bacilli, 393 Childe, Rev. C. F., 313 Children, Mr., Secretary Royal Society, 97 Chinese expedition, sanitary success of, 307 Christ, the Way, the Truth, and the Life, 28; the only Mediator; God manifest in the flesh ; our All in All ; to whom all Scriptures point and converge, 496-9 5 o8 INDEX. Christian knowledge and sanctification gradual and progressive, 502 Christian Medical Association, 242, 492 Christian service, 500 note Christison, Prof. Sir Robert, medical juris- prudence, 5, 17 Chuckerbutty, Soorjo-Coomar, 224 Churchill, Mr. John, publisher of Author's works, 101 Church of England, essentially Christian, 499, 500 ClanWilliam, Earl of, 263 ; Admiral, 322 Clarendon, Earl of, 439 Clark, Sir James, from Rome, 28 ; work on Climate, 54 ; Censor of London prac- tice, 55 ; friendly offices, 56, 138 ; re- fuses fellowship of College of Physicians, 154 Clarke, Sir Chas. Mansfield, 325 Classical studies, 2, 10 Clayton, Wm., 211 Clendinning, Dr. George, reports of London Committee on Heart, &c., 110 note, 116, 138, 210, 225 Clerical support of Brompton Hospital, 181-3 Clifton, James, 211 Climate of the South of France, by C. T. Williams, M.D., 350, 464 Clinical assistants and clerks, 189, 212, 243 investigations, instruments of, 415 lectures, Edinburgh, 12 ; Universitj' College, 142, 148, &c. ; publication of, 148, 213 medicine, special professorship of Uni- versity College, London, 142-3 ; im- portance of, 198-9 observation essential to medicine, 197-9 Society of London, founded by Dr. Headlam Greenhow, 414 ; ample scope for it, and its success, 414-6 ; officers and transactions, 414-6 Clinique MeViicale of Andral, Fils, 41 Clover, Dr. J. T., 213, 240 Clutterbuck, Dr., 28 Clymer, Dr. Meredith, Editor of Ameri- can reprints of Author's works, 149 Cockburn, Lord Chief Justice, 336-46 Cocks and hens, language, fighting, &c. of, 7, 8 Cohnheim, Prof., 161, 442 Col de Balme, view from, 70 Coleridge, Mr., Q.C., for plaintiff in Hunter v. 'Pall Mall Gazette,' 336 (and see Sir John, Solicitor-General) ; Author's counsel in action for libel, Williams v. Duke and Duchess of Somerset, 391, 372-8 College de France, Laennec's lectures on Medicine, 43 College, University. See University, King's. See King's ORE Combustion, low, experiments by Author, begun in 1823, and, encouraged by Faraday, carried on so as to establish the fact as a general law, affecting al- . most all combustible bodies, 92-95 ; proofs of combustion, 93 ; varied phe- nomena with sulphur, arsenic, and potassium, which is luminous at com- mon temperatures like phosphorus. Phosphorus ignites itself when placed on a non-conducting material. Relation of low combustion to ordinary ignition. Nature of its products, 95, "96 ; spon- taneous combustion explained, 97 ; Author's lecture on the subject at Royal Institution. Paper read to Royal Society excited much interest at meet- ing of British Association at Edinburgh, and Prof. Graham appointed with Dr. Williams to investigate the subject further, 98-9 Comet of 1882, shadow beyond tail, 472-4 ; observations and paintings of, 473-4 Concluding sentences of later lectures, 239 note Confession of Christian faith, 496-500 Congestion of blood, 156 et seq. Connemara, 443 Conquest, Dr., 273 Consumption, hopeless, 61 on the use of cod liver oil in, 247- 253 ; its success and mode of adminis- tration, &c., 248 ; letter from Prof. Louis on, 251 ; Dr. Hughes Bennett on, 251 note ; cod liver oil in other diseases, 253 See Pulmonary Consumption. Cooper, Samuel, Prof, of Surgery U.C.L., 144, 153 ; Dictionary of Surgery, 161 note ; resignation of his chair, 238 Copland, Dr., 138 ; dictionary, 156 Coppleston, Right Rev. Dr., Bishop of Llandaff, 188 Cormack, Sir John Rose, M.D., 411 Corpuscles, white, leucocytes, sarcophytes, 160 et seq. Corsica visible from Cannes, 465 Coryza and Catarrh, by Author, in Cycl. Pract. Med., with recent additions on treatment, and speedy modes of cure, 76 ; by dry method, 77-9 ; by opiates, 80-1 ; by inhalations, 81-2 Counterirrilation, Author's article in Cycl. of Pract. Med., with recent addi- tions and recommendations, 83-5 ; counterirritation both rational and efficacious, 83 ; pustulating counterirri- tants, 85 Country journeys, and country practi- tioners, 321-26 ; rate of remuneration, 321 ; duty of resting mind in long journeys, 325 ; over demands of, 326 Crawford, Dr., on Animal Heat, 20 Cremer, H., Esq., 179 INDEX. 509 CKB Crepitation of Pneumonia explained, 66 Creswick & Co., pasteboard ear-trumpet makers, 12 Great Portland Street, Lon- don, 434-6 Crimean War, 281. 305-10 Croagh Patrick, 443 Croft, Dr., 213 Croix de Garde, Cannes, 465 Crookes, Mr., F.R.S., repulsion of volcanic dust, 484 Cross, Mr. Andrew, at Bristol meeting of British Association, 117 Cross, Robert, 211 Cruveilhier's Pathological Plates, 145 Crystal Palace. Hyde Park, 259; sym- phonic bed from, 259 note ; inaugura- tion, 260 Cullen, Prof. W., ' Nosology,' 11 Cunningham, Dr., 308 Cupping, for inflammatory earache, 409 Curative medicine, success of, 302 Curling, Mr. Thos. Blizard, F.R.S., 416 Curral, Grand, Madeira, 62 Cuvier, Baron, member of the Institute, 36 ; his opinion of the Royal Society of London, 453 1 Cyclopaedia of Practical Medicine,' edited by Drs. Forbes, Tweedie, and Conolly, 76 ; Author's articles, 86-90 D DAILY ROUND, The, 495 Dalrymple, Donald, M.P., 157, 324 Davi'es, John, 157 John W., 189 Sir David, physician to William IV., 68 ; death of his wife, my cousin, 73 W., 189 Davis, Dr. D., Prof, of Obstetrics, U.C.L., 144 Davison, Dr. T., at Kinnerton Street Lectures, 115 Daw, Dr. John, on Animal Heat, 21 Sir H., on Flame, 95 Deafness, mother's, 9 ; Author's becoming inconvenient, 408 ; successfully pre- vented in early life, remedies, 408-9 De Blainville, Professor of Comparative Anatomy at Sorbonne, 36, 43-4 Degeneration of Textures, 203 De Leon, Dr. Hananel, 410 Democritus and Lucretius, 401 De Morgan, Augustus, Professor of Mathe- matics U.C.L., 144 Denison, Right Hon., Speaker of House of Commons, 319 Descartes, 441 Deserta Islands, Madeira, sketched, 38 Determination of Blood, 157 et serf. Diagnosis, error in, 63 ; of disease, 203 Dickens, Charles, on behalf of Brompton Hospital, 183 Dickson, Dr. Robert, 179 T5AR ' Dictionary of Medicine,' by Dr. James Copland, 138, 156 by Dr. Quain, makes no reference to Author's works, 290 ; letters on the subject, 488-9 ; Author invited to contribute, 487-90 ; a work of the present writer's, 491 Diligence, old French, 30 Disease, causes of, 140 Dissecting difficulties, 11 Doidge, John, 213 Dolby, Mr., aural surgeon, 313 Dole, summit of Jura, view of Pennine Alps from, 70 ; Dole, France, Mont Blanc visible from, 71 Drawing, early instructions in, 9, 17 ; les- sons in improved by science, 33 ; natural philosophy applied to, recommended to President of Royal Academy, 34 Dreams causing nightmare, and the con- verse, 87 Dresden, 400 Druitt, Dr. Robert, 161 note Dublin, visit to first meeting of British Association at, discussion on Heart Sounds, Irish hospitality, 113 Duncan, Profs. Andrew, junior and senior, 12, 18, 19, 408 Duncombe, T. S., M.P., 318 Dupin, Baron, member of the Institute, 36 Dupuytreu at Hotel Dieu, 38 Dust, ice, in high atmosphere, 486 volcanic, 484-7 Dyke Poore, Miss, exhibition of Seaweed "from Jersey at meeting of British Asso- ciation at Belfast, 440 Dyspnoea, Author's article in Cycl. Pract. Med., with recent additions, super- venosity, &c., 85, 86 E EARLK, Edw. Emra, 242 Earl-Marshal, the, invitation from, to funeral of Duke of Wellington, 263 Earl St. Maur, case of, 351-82 ; history and first examination, 351-2 ; second visit and examination, 353-5 ; third visit, 355-9 ; fourth visit and fatal attack, 361-2 ; instant tracheotomy ne- cessary as only chance, 363-4 ; momen- tary relief soon ending in death, 365 ; reflections on nature of the disease : comparison with Listen's case, 366-9 ; post-mortem inspection refused, 371-2 ; false and libellous account of the case occasioning an action at law, which ended in verdict with costs for plaintiff, and complete retractation and apology from defendants, the Duke and Duchess of tiomerset, 372-5 ; opinion of leading physicians and surgeons of London, 377 ; reasons for publishing an Au- thentic Narrative of the Case,' 376-7 Ear-trumpet, on the acoustic principles and construction of (Medical and Chi- rurg. Soc.), 432 ; materials, 433 ; con- versation tubes, 433 ; ear-trumpets for distance, 434, 456 ; audiphone, 436 ; further suggestions to instrument- makers, 437 Edinburgh, and University, 1, 2 ; profes- sors and lecturers, 11, 12, 17-19 life and studentship in, 10-26 New Academy, 2, 6 Edwards, Dr. VV. F., Paris, 36 Elements of Disease, Primary and Proxi- mate, 202 Ellerton, J., 224 Elliot, Sir George, M.P., 384 Elliotson, Dr., resignation, U.C. Coll., 138, 140, 188 Elliott, J. H., 211 Ellis, Robert,, 211 W., on Respiration, 21, 23 Eremacausis slow combustive change. 97 note Erichsen, John Eric, F.R.S., 327, 377, 380 Esquirol, physician to Hosp. Salpetriere ; 50 Esterel Mountains, 465 Etiology, causes of disease, 194, 202, 204 Evans, Dr., of Birmingham. 324 - Howell, 189 Exeter, Dowager Marchioness f, 439 Experimental investigation, beneficial results of, 153 physiology, lungs and air-tubes, 151 F FAIRBAXK, Dr., 351-2 Fall from horseback, and fracture of cla- vicle, 116 Falmouth, in voyage to Madeira with patient, 56 Familv arrangements, 241, 311-14 events, 9, 72, 118, 212, 215, 241, 383-7 Faraday, Prof. Michael, Royal Institu- tion, " introduced to, 7(5; interested in ' Low Combustion, 93 ; aiding at ex- periments, 97, 112 Fnrre, Dr. Frederick, Treasurer of Royal College of Physicians, 4 12 Father, Rev. D. Williams, Hcytesbury, Wilts, 1 et seq. ; illness and death ; tri- bute, &c., 118 Fearnside, Henry, 211 Fees, physicians', equitably considered, 213, 268 for hospital practice, 146 Fellowship of the Royal College of Phy- sicians, 153-5 et gen. " yal S in number, 447-62 Fellows of the Royal Society, limitation Ferguson, Dr. Robert, 262-3, 328 Fergusson, Sir VV., 377, 380 GER Fertilisation of soil at Cannes and in Switzerland, 470 Field, Mr. John, letter respecting experi- ments, 105 Filliter, William, 224 Finnncial balance, 150 Finch, R. Swan, 211 Fishing, 7 Fiske, Rev. Mr., Hamilton Terrace, 242 FitzRoy, Hon. Henry, M.P., 318 Flammarion, M., ' L Astronomic,' 476 Florence, 384 Fog-signals, in Professor Tyndall's obser- vations on discussion "with Author whether diversions are due to reflection or refraction of sound, 446-7 note Forbes, Rev. Dr. Edward, 467 Sir John, translator of Laennec. friend of Sir J. Clark, 55, 68; with Drs. Tweedie and Conolly, editor of ' Cvcl. Pract. Med.,' 76, 181, 222 Forclaz, view of Rhone valley from, 71 Fossil-hunting, 7 Foster, Mr. Cooper, 416 Foulis, Rev. Sir Henry, Brompton Hos- pital, 182 Fowler, Dr. Richard, of Salisbury, 27, 53, 54 Fox, Dr. and Mrs. Francis Ker, Brisling- ton, 117 Franco-German war, 384 Franzensbad mud-baths and carbonic acid baths, 396-7 French army, mortality in, 305 language, study, 32' Friends, in Paris, 34-5 ; in Wiltshire, 53 ; serious and affectionate, 73 Fuller, Dr. H. W., 280 ; obituary, 423-4 H. P., of Piccadilly, father of the above, 278 ; his zeal for St. George's Hospital, 279 lumchal, Madeira, 58, 60 G GABB, John, 211 Galatians and Philippians, Bishop Light- foot on Epistles to, 493 Gallon, Captain Douglas, F.R.S., 469 Galway, Viscountess, 439 Gamecock, language and battle with, &c., 8 ; submission or dominion, 8, 9 Gamgee, Joseph, 242 Ganr, F. J., 224 Gardiner, Mr., 179 Garrod, Dr. Alfred Baring, F.R.S., 189, 424 Gaseous pervasion o f membranes, 22-4 Gay-Lussac, Professor of Sorbonne, 36, 43 ; portrait, 44 General pathology, its practical utility, 1 93 et srq., 200 et seq. German language, attempt to lenrn in tra- velling, 325 INDEX. OER Gorman translation of author's first work, 111 Gladstone. Sir Thomas and Lady, 439 Gniiinden, Lake, shooting the rapids from, 398 GOD revealed to man in and through CHRIST only, 490 ; declared in Epistle to Hebrews i et seq., Col. 2, 9, John Baptist and John Evangelist, Gospel, and First Epistle, and in other Gospels and Epistles, 490-99 Goldsmid, Sir Isaac Lyon, 190 Good, Mr. W. H., letter about experiments on the heart, 106 Graduation at Edinburgh, 26 Graham, Prof. Robert, botany, 19 Prof. Thomas, chemistry, 98, 99, 143 Gramshaw, James, 189 Grant, Prof. K. E., comparative anatomy, 242 ; his letter on Dr. WVs resignation, _' H ; flattering acknowledgment as Dean of the Faculty on Dr. W.'s retife- ment, 245 Gruuviile, Karl and late Countess, 439 Graves and Stokes, Drs., Dublin, 113 Greek studies, 2 ; Testament, 257, 494 Green, Mr., Prof. Royal College of Sur- geons, 27 Park, view from Halfmoon Street, 73 Grcenhow, Dr. Headlam, founder of the Clinical Society, 414 Greenwood, Fred, 213 Gregory, Dr. George, 28, 153 Dr. James Crawford, 35, -15 Prof., 'Conspectus,' 11, 35 Griffith, Dr. G., 313 Grundy, William L., 189 Guersent, Dr., Physician to Hopital des Enfans Malades, 50 Gull, Sir William, 32(5, 377, 379, 383, 415 Gulliver, George, F.R.S., 210, 211 (itilstonian Lectures at College of Phy- sicians, Author's, 158 et seq. Guy, W. A.,M.D., F.R.S., 179, 183; remi- niscence of, 210 H II.KMORKIIAGE, 202 Hakes, James, 211 Half-Moon Street, Piccadilly, first resi- dence in London, 73, 140 Halford, Sir Henry, first book dedicated to; his Nuyse Canoric, &c., 68,112, 155 Hall, Dr. Marshall Hall, 138, 197, 441 Mr. and Mrs. S. C., 183 Hallcr, Baron, 19, 101, 152 Hallion, Geo. A., 211 Iluinhro, family, of three generations, :i-27 Hamilton, Otho,Esq., 179 Professor James (Midwifery), 12. 18 Hammerton, Thomas, partner of H. P. Fuller, Piccadilly. 279 note HIP Honnay, Alex., of Glasgow, 16 Hardiiige, Dr., 356-61 Hare, Dr. Chas. J., 147 Harrison, Dr. Edwin, 35, 45 Rev. W., 182 Hart, Mr. Ernest, 411 Harveian Society, founded by Dr. W Stroud ; Author elected President, 120 Harvey, Dr., at Kinnerton Street Lec- tures, 115 Wm. Geo., 213 Havre, Honfleur, &c., 29 Hawkins, Caesar H., 222, 278, 363 Dr. Francis, Registrar of the Royal College of Physicians, 225 Mr., Q.C., counsel for defendants in action for libel, Williams v. Duke and Duchess of Somerset, 351, 371-5 Health, trials of, 151, 211, 239-40, 247, 266, 268-9, 314 Hearing, Author's capacity for ; a ear more for mimicry than for music, 409 Heart, auscultation of, in first work, 67 ; on motions and sounds, 101-11 ; Dr. Hope's experiments, 102 ; Author's experiments, 104-8 ; Sir B. Brodie's letter on, 108 ; other letters on, 105, 106 ; ' Brief Account of Facts,' &c., 106 ; Dublin Committee on sounds of, 113 diseases of, 67, 101-11; valvular murmurs of, 128-9, 318 ; obstructive and regurgitant murmurs, 421 Heaton, John Deakin, gold medallist, 146 Hebrew connection of University College, 190 Hebrews, Epistle to, literal translation of i. 1-3, 496 Heineken, Dr., Funchal, 60 Uemson, Henry, statement respecting Author's experiments on the heart, 10S Henry, Dr. Alex., 213, 411 Dr., of Manchester, and son, Dr. W. H. Henry, 117 Hensman, Rev. John and Mrs., of Clif- ton, and daughter, 74 Herbert, Right Hon. Sidney (Lord), 53, 280-1, 306-10 Herschel, Major, on Comet, 472-4 Sir Win., on the Sun, 480 Hewett, Sir Prescott, 416 Hewitt, W. M. G., 242 Hey, Mr., of Leeds, 324 Heytesbury, Lord, and family, 53 Wilts, native place and early home, 1 ; return to, 26 Higher life, reminiscences and meditations on the, 492 Highlands, excursion to, 13 ; pedestrian tour in, 26 Hills, Mr. T. H., 274 Hippocrates, his aphorism enlarged would IK- a better motto for the College of Physicians, and other institutions of art, 413 512 INDEX. HOD Hodgkin, Dr. Thomas, 45, 145, 273 Holiday Tours Wales, 284 ; Cader Idris and Snow- don, 285 Scotland, Argyllshire Highlands, Isle of Sky e, and Aberdeen Highlands, 285 ; Isles of Bute and Arran, 286 Ireland, Wicklow Mountains, Lakes of Killarney, and Glengariffe, 285-6 Rhine, Homburg, 286 Swiss Tours Effects of mountain- climbing, 287 ; directions for foot equip- ment, indiarubber shoes, 288. Tours with sons Bernese Oberland, Grimsel, and Rhone Glacier; Zermatt, Monte Kosa from Val Anzasca, Monte Moro to Saas, 289. Tours with daughters Glarus and Klonthal, Engelberg and Triibsee Alp, Keichenbach and Grimsel, Seelisberg, Thusis, and Via Mala. In the Engadin, Morteratsch, Val Roseg. Piz Languard, and the Maloya and Bernina Passes, Bormio, Santa Caterina and the Stelvio, 290 ; Breuil, St. Theodul, Becca di Nona, 290. Metrical description of tour in the Oberland, and over the Simplon to Domo d'Ossola, 291-6 ; view of Val d'Aosta after a storm, 296 Tour in Pyrenees ending in fever at Luchon, 291 Refreshing and invigorating effects of mountain tours, 287, 296 Winter tour in Italy, 386. See Italy Tour in Eastern Germany and Austria, 396-400 Holland, Dr. Charles, 16 ; manager of Royal Institution, 76, 153 Sir Henry, F.R.S., obituary, 422-3 Holies Street, Cavendish Square, second residence in London, 140 Hollond, Rev. Edm,, 179 Holmes', Mr., ' System of Surgery,' 161 note ; Lord St. Maur's case, 364-71 Holt, Thomas, 189 Holy Scriptures, study of the, 493 et seq. ; commentaries and manuals, 493-6; adequacy of, 493 Homoeopathy, denounced as a fallacy, in theory and practice, 254. Its funda- mental dogmas (Similia simUihux, and infinitesimal medication) contrary to facts. Its practice fallacious and in- conclusive, 255. Fatal results of its de- lusions. Refusal to consult with a homeopath, as abetting dangerous error, 256. Modern homceopatlis, not holding Hahnemann's doctrines, guilty of deception, in using his terms, and obtaining money under false pretences, 256 Home, Professor (Medicine), 12 Hooke, Dr., first experimentalist of Royal Society, 451 Hooker, Sir Joseph, P.R.S., 440-3, 458- HUL 60 ; Author's reply, on the illiberal and unwarranted innovations in the Roval Society, 461-2 Hope, Dr. James, 16 ; experiments and work on the Heart, 102 ; criticisms on them and others, 102-104 ; his back- wardness in research, 102 ; his assistance to Author, 105 ; his misstatement and appropriation of experiments, 106-8; ' Replies to Statements in Mem. of Dr. Hope,' 106, &c. : his last experiments, 110 note ; his diagnosis of valvular murmurs failing, he adopts Author's, without acknowledgment, 129 ; his mis- understanding and hostility ; opposition to his election in consequence of his unpopularity ; withdrawn on finding the medical officers would vote for him ; attempts at reconciliation frustrated ; College of Physicians refuse to arbi- trate ; further irritation from tone and temper of Dr. Hope's third edition, which led to rejoinders, regretted by Author, although correct in fact, 131, 132, 155 Professor Charles T. (Chemistry), 12, 19 Hoppus, Rev. Dr., Prof, of Logic, U.C.L., 144 Hop wood, Robert, 211 Horseback journey with wife to Tun- bridge Wells, South Coast, &c., 117 Horse exercise for ladies, 114. 314 Hospital, St. George's, 27 ; became Gover- nor, 75 ; candidate for office of Phy- sician, but withdraws, 130 ; letter from Dr. Chambers, 132, 279 ; old building, 279 ; dinner for rebuilding, Duke of Wellington presiding, lines on, 279 note ; Anti-Lancet camp, 318 for Consumption and Diseases of the Chest, 178; founded by Philip Rose: his consultations with the Author and others, 179 et seq. ; Author ap- pointed Consulting Physician, 181 ; history of Hospital, 180-3 ; enlarge- ment and present condition, by Dr. C. T. Williams, Physician to the Hospital, 183-6 University College, Author appointed first Physician to, and Professor of Clinical Medicine, 139 ; work and lectures, 142 ; improvements in, 144 ; hospital fees relinquished by Professors, 146 ; relations with officers, and mis- understandings, 212, 243, &c. Hospital practice, Edinburgh, 121 ; fees for in London, 146 Hospitals, London, 27 ; Parisian, 27 Hounsell, H., 242 House Physicians, relations with, 212 Howth, Countess, 439 Hudson, Dr., Dublin, 113, 415 Hulke, Dr., at Duke of Wellington's funeral, 263 INDEX, HUM HumboMt, Alex, vou, Member of the Institute, 36 Humphreys, John R., 213 Hungarians, &c., 397 Hungerford Almshouse, Heytesbury birthplace, 1 Hunter, John, 17, 159, 197, 278 Hunter v. The ' Pall Mall Gazette,' trial for libel, 333 ; Dr. Hunter's pamphlet ; its extortions and deceptions denounced and exposed, 334-6 ; account of trial, 336 ; Author's evidence and cross-exami- nation, 337-44 ; verdict, 344 ; com- ments on counsel and judge, 344-46 ; reflections on the trial, 347-8 Hutchinson, Dr. John, spirometer, vital capacity explained to Mr. Coleridge, 345 Jonathan, F.R.S., founder and secre- tary of New Sydenham Society, 275 Huxley, Professor, 441 Hyeres, 313, 464 Hydrogen, peroxyde of, its formation promoted by turpentine (?), 86 Hygienics, hygiene, 147, 203 JHyperasmia, too much blood, lectures on, 158 et seq., 202 Hypophosphites, their increasing the affinity of the blood for oxygen, 86 ILCHESTER, Earl of, 439 1 Improvemeuts in two-wheeled carriages for ease and safety, 133 Incubus. See Nightmare India rubber and gutta percha, applica- tions to medicine, 192 Indocility of patients, 392 Infant school of Cannes, 471 Inflammation, 157 et seq., 203 Inhalation, commonly employed in throat and chest diseases, 339-40 Insanity, generally declined attendance on cases of, 116 Institute of France, 36 ; portraits of mem- bers, 37 ; a government institution, totallv different from Royal Society, 449-50 Institutes of Medicine, Edinburgh, 11 ; included in author's course, 156 Ireland, much bog and no fisheries in, 442 Irish races, ancient Irish, Sir \V. Wilde on, 443 Irritability, disease of, 202 Irritation, article by Author in Cycl. Pract. Med.,' analysed and defined as a pathological principle, 89, 90 Italy, tours in, 289-96 ; winter tour in, 383 ; severe weather at Florence and Pisa, snowed up at Pistoja, deep snow at Parma, and intense cold over the Brenner to Munich, 386 Italian, lessons in, 38 Ivy Rock, country residence, near Chep- stow, 114, 155, 187-8,284 .LAC JAMES, Dr. J. B., 17, 26 Jeffery, Edward, M.D., 147 Jeffreys, Gwyn, F.R.S., 350 Jenkins, Harriett Williams, author married to, 72 James, Esq., Chepstow, father of the above, 72 ; his death, 237 Jenner, Dr. Edward, statue removed from Trafalgar Square, 304 Sir William, F.R.S., 377, 415 Jeune, Rt. Rev., Bishop of Peterborough, a reader of ' Principles,' 209 Johnson, Dr. George, 275 Dr. James, at Westminster Medical Society, 121 ; pleased with imitation of cardiac murmurs, 126 Henry Charles, letter on experiments on heart, 106 Jones, George Thomas, 242 Joyce's scientific dialogues, 3 Jura, travelling over, and view from summit. 70-1 Justification by faith, 493 K KA^SLAKE, Mr., Q.C., counsel for defen- dant in Hunter v. ' Pall Mall Gazette,' 336 tt seq. ; Author's counsel in action for libel, Williams v. Duke and Duchess of Somerset, 351 Katrine, Loch, 26 Kay-Shuttleworth, Sir James and family, 328 Kelly, William, 189 Kemp, Robert, 211 Kennedy, Dr. Evory, Dublin Rotunda and Castle Belgard, 113 Ker, Mr. Bellenden, 464 Key, C. Aston, second President of the Pathological Society, 222 T. H., Prof, of Latin, U.C.L., 144 Kilmaine, Lord and Lady, 439 King's College, London, Hospital fees, 146 King William IV. and Queen Adelaide, Sir D. Davies their physician, 73 Kinnerton Street Anatomical School, ex- periments at, 105 ; Author's lectures there, 114, 119 Koch on Bacilli, 'Berliner Medicinische Wochenschrift,' April 1882, 393 Konigsee, Bavarian Alps, 399 Kufstein, New Year's Day spent in a starving journey to and from, 386 LABOUCHERE, John, Esq., 179 La Charite", Hospital, 40 ; clinique of Laennec, Lerminier, Andral, Choinel, and Louis, 40, 43 L L INDEX. LAE Laennec, Prof. R. T. H., his clinique, &c., 40, 45 ; portrait, 46 ; his teaching and discoveries, 47 et seq. ; views on aus- cultation, &c., 49, 64-8, &c. Lambert, Aylmer Bourke, President of Linnean Society, 54, 278 Lamotte, Alex. J., 189 Lancashire manufacturer's 'doing busi- ness,' 323 Lancet, The, 215, 227, 236, 317, 337, 348, 441 Land's End, too many calls to, 326 Langham, John, 242 Lankester, Dr., 213 La Place, Marquis de, author of 'Me- canique Celeste,' with portrait, 36-7 Larry, Baron (surgeon of Napoleon), at Hopital Val de Grace, 38 ; cupping, 39 Latham. Dr. P. M., 131, 164, 222 Latin, studies, 2, 10, 11 ; notes of lectures in, 43 ; spoken by Laennec, 40 Lavoisier on Combustion. 20 Lawrence, Sir W., 27 Lea, Mr. H., publisher, Philadelphia, 208 Leared, Dr., on the Sounds of the Heart, 467 Lectures on medicine at University Col- lege, 139-40 ; introductory, 141-2, 192 ; illustrations, 145 ; last course, 242 ; badly reported in ' Medical Times,' and disavowed, 243 Lectures, teaching by, 12 ; attendance on, 12; Author's, on physiology and diseases of the chest, in Kinnerton Street, 114 ; published in 'Medical Gazette,' and generally commended, but not published separately. 127 Leenane, 444 LeightoD, Dr. F., 35, 145 Sir Frederick. P.R.A., Author's recom- mendations of Professor of natural phil- osophy for Royal Academy to, 34 Leutchenberg, H.I.H., Duke de, 439 Lerins Islands, 466 Liberty of conscience, 137 ' Library of Medicine,' edited by Dr. Tweedie, Author's contribution in vol. iii., 77, 149 Licentiates of College of Physicians. 28 ; petitioning Parliament, 153-4 ; title changed to Members, 177 Liddell & Gordon, Messrs., 312 Liebig, Baron Justus von, present at Author's second introductory lecture, 192; obituary, 418 Life, momentous period of, 73 the Higher, reminiscences and reflec- tions on, 492 ; religious exercises and opportunities increased by retirement, 492-3 Lightfoot, Bishop, on Galatians and Phi- lippians, 495 Limbery, Thomas, 213 Lind, Mile. Jenny, on behalf of Brompton Hospital, 188 MAN Lingen, Dr. C., of Hereford, his account of Dr. Roget's address, 126 Lister, Bryan, 213 Listen, Robert, Prof. Clin. Surg. U.C.L., 144, 181, 222, 225; his death and case 225, 237 ; Mr. Cadge's report, 227-9 ; Author's letter thereon, 229 ; Dr. Wat- son's first letter, 231-4 ; Dr. C. J. B. Williams's reply, 234-5 ; Dr. Watson's second letter, 236 ; conclusion, 237, 368 ; changes in University College after the death of Liston, 238 Littleton, N. H., 213 Lizars, John, practical anatomy and plates, 11 Locock, Sir Charles, 190-1, 269, 316 Logic in Edinburgh, 15 Lombard, Dr. H. C., of Geneva, 16, 35 Londesborough, Lord, 319 London, 10, 27 ; London doctors' mistakes, 56, 60 ; establishment in, 75 ; con- clusion of London life, 463 Londonderry, Marchioness of, 324 ' London Journal of Medicine,' by Dr. J. R. Cormack, on Cod Liver Oil, 247 London, University of, 137, 143 Lough Corrib, 443-5 Lowe, Septimus, 213 Lubbock, Sir John, 442 Lucas, Drs. Prestwood and Henry, Brecon, 17, 35, 190 Lumleian Lectures at College of Phy- sicians, Author's, 481-2 ; Dr. Burdon Sanderson's, 159 ; Author's successes and failures in medicine, 298 et seq. Lungs and air-tubes, experiments on the contractility and sensibility of, 151 Lushington, Right Hon. Dr.,"319 Luxembourg, 384 Lyons, AdmiralJLord, and Lady, 324-5 Lytton, Right Hon. Lord, a contrast to "J. Stuart Mill, M.P., 331 M MAcDuKK, Rev. Dr., 495 MacLeod, Dr., Physician to St. George's Hospital, 75, 138 Madden, Dr., of Torquay, 324, 394 Madeira, voyage to, with patient, 57- 63 ; description of, 58-60 ; wax-work by nuns, 62 ; wine, 63 ; Mr. Wakley's death there, 319 Maison de Saute", rescue of patient from, 116 Majendie, Professor, experimental physi- ology, 35 Maldon, Professor of Greek, U.C.L., 144 Malmsey, Madeira, 63 Manchester and vicinity, patients in, 323 Mann, Dr. Robert James, 147 ; assisting in ' Principles,' 209, 266 Manning, Fred., 189 MAN Mantua, 384 Marcet, Dr. W., on Climate, 464 (Mrs.) conversations on Chemistry, &c., 3 Marienbad, 207, 300 Marjoribanks, Edward, and family, 327 Markwick, A., 211 Marriage engagement, 72 ; visit to Aber- ystwith after, 75 Marshall, Fred., 211 John, F.R.S., 147 Marsh, Sir Henry, at meeting of British Association, Dublin, 113 Martin, Dr. Adam, of Rochester, 324 Dr. J. A., of Ventnor, 187, 324 Sir Ranald, 306 ; obituary, 427-429 Mathematics in Edinburgh, 15 Maton, Dr., 27, 54, 97, 112 Matthew, Thos. Patrick, Gold Medallist of first year, 146 Maule, Mr., aural surgeon, 409 Maurice, Mr., of Marlborough, 322 of Reading, 323 Mayo, Dr. Thomas, President of the Royal College of Physicians, 281-2 Maynard, Viscount and Lady, 439 Mayor of Cannes, his attempts to improve sanitation, 468 McDowell, Dr., Dublin, 113 McGrigor, Sir James, Director-General, 190, 304 McLennan, Dr. John, 410 McXeile, Rev. Hugh, impressive reader of the Liturgy and perfect pulpit orator, at Liverpool, 125 McNeil, Right Hon. Sir John, 306 McSorley, Rev. Hugh, in study of Greek, 257 ; Protestantism, 501 Meadows, W. H., 211 Mechanism, disorders of, 203 ' Medical Gazette, London,' 120, 127, 129, 148, 158-60, 165, 170, i99 Medical reform, Author's letters on, 165- 176 Medicine, founded on anatomy, physi- ology, physics, chemistry, the study of materia medico, and morbid anatomy, 195 ,-t seq. the Scientific Foundations and Noble Objects of, first introductory lecture, University College, 141 ; systematic lectures on, 188 ' Medico-Chirurgical Review,' edited by Dr. James Johnson, 121 Transactions,' 432 Mediterranean, views, heath. &c., 466-7 Mentone, 464 Messina, Prince de, 439 Metallic tinkling explained, 67 Metaphysics in Edinburgh, l.'i Microscopic researches, 157 et seq. Mildmay, Arthur St. John, 494 Miles, Fred, 189 Mill, John Stuart, M.P., 331 Miller, Rev. Dr., Vicarof Greenwich, 382 NBA Mimicry of poultry, 7 Minto, Earl of, engagement as travelling physician to, 69, 71 Mistral wind at Cannes, 465 Molyneux, Rev. Capel, 182, 190 Monro (Prof.), Tertius, Edin., Lectures on Anatomy, 1 1 Monson, Lord, 439 Mont Blanc, from St. Cergues, 70 ; from Dole, France, 71 Montgomery, Rev. R.. 182 Moore, Thos., the poet, his songs ; con- tempt for realistic painting, 54 W. Withers, 211 Morbid anatomy, 197 Growths, 203 Morehead, Dr. Charles, 15, 35 More, Mrs. Hannah, instructed Author's mother in reading, with Garrick for example, 9 Moreton, Geo., 211 Morgan, Rev. S. Christopher, D.D., Vicar of Swansea (son-in-law), 311 Morris, James, 224 Samuel, 242 Mother, Author's, Mrs. Catharine Williams, her deafness, delicate health, &c. ; death, 9 Carey's chicken, 62 Motion, kind causing sound, vibratory, 65 note Moule's earth-closet system, 470 Mowatt, F , Esq., 179 Mud baths, 396 Miiller, J., physiology ; on contractility of air-tubes, 152 Munich, 384, 386 Murchison, Dr. Chas., 315 Sir Roderick, 192 Murmurs, first explained, 68 ; piiority of Author's diagnosis of, 128-9 ; Dr. Hope's adopting it subsequently, 129 Mushrooming, 7 Music, 14, 28 Mustard leaves of Rigollot, right way to use them, 84 N NAIRNE, Dr., 225 ' Name above every name,' the, 496 Naples and Mount Vesuvius, :K> Nasse, Professor, of Bonn, recommending Author's works, 111 Natal, 313 Nature, the bonk of, no less than the book of Revelation, God's word and work, 125 Natural history and science, preferred to classics, 2, 6 - philosophy, works and experiments. 3 ; professor of recommended for Royal Academy, -I Neale, Richard, 242 Z, L 2 5 i6 INDEX. NET Netherlands, H.K.H. Princess Frederick of the, 439 Newbeny, Mr. Thomas, ' Englishman's Bible,' 494 New Forest, Hants, journey to, 322 Geo. W., 224 Sydenham Society, 275 ; Author first President, 275 ; objects and suc- cess, 276; Presidents' portraits, c., 277 Testament, Archbishop Whatety's correction of Authorised Version, 188 ; Greek reading of, 257, 494 ; studies of, 493, 496-503 Nice, 464 Nightingale, Miss Florence, 281, 306-310 Nightmare, Author's article in ' Cycl. Pract. Med.,' with recent additions ; pathology and nature discussed, 87, 88 Niven, Rev. W., Chaplain to St. George's Hospital, proposes arbitration to pro- mote reconciliation between Dr. Hope and Author, who had already made several attempts, 131, 179 ; ' Fruit in Old Age,' and other works, 495 Noise, to annihilate or utilise, a problem for the future, 399 Norfolk, The Duke of, Arundel Castle, 324 Nosology, 203 Nussey, John, 280 Nutrition, diseases of, 203 OBESITY, Author's article in ' Cycl. Pract. Med.,' anticipating modern ideas, 90 Odling, Prof., M.D., F.K.S., in Hunter trial, 344, 348 Ogle, Dr. John, 362 Oldfield, Miss Laura, 329, 382 Ovarian drops}-, mother's and sister's death from, 9 ; modern success in treat- ment, 72 Overend, Dr., of Sheffield, 324 Overwork, warnings of, 151, 314. 315 ; early deaths from, 425 Owen, Prof. Richard, G.C.B., 384 Oxford and Cambridge, privileges to their graduates, 164 Oxygen absorbed by blood, 22-5 ; views of Dumas and Liebig anticipated by Author, 25 PADUA, 384 Paget, Sir James, 205, 377, 379, 415 Painting, 17, 28, 33 ; application of science to, 33, 34 ; pursued by Author as recreation, in water colours and oils ; landscapes and portrait of father, 92 ; landscape and flower, 314 PHY Paley, Temple C., 213 ' Pail Mall Gazette,' action for libel against, 333 et seq. ; spirited defence, and benefit thereby conferred on the public and on medicine, law, and journalism, 344, 346 Parentage and early life, 1 Paris, Dr. John Ayrton, President of the Royal College of Physicians, 225 Paris, journey to and entrance, 29-31 ; life in (1825-6) ; buildings, streets, &c. ; fairness and foulness; transfor- mation, 30-51 ; hasty visit to, to rescue patient from a Maison de Sante, 116 ; siege of, 411, 384 Parkes, Edmund, first year's pupil at U.C.L., 146-7, 151 Park, Thos., 224 Parliament, proposal to Author to be put in nomination for a seat in, declined, 316 ; want of medical members of, 36 ; Mr. Wakley's success in, 318 Paternal tuition, 1 Pathological Society of London, forma- tion, 216; Author elected President, address at first meeting, 217-22 ; its success, 222 ; earliest supporters ; motto Nee silet mors, 223 ' Pathology and Diagnosis of Diseases of the Chest,' 110 ; fourth edit., 148 general, 156 et seq. ; proper nature of disease, 202, 204 Patients, concealment of truth from, 60 Paxton's, Sir Joseph, triumph in Crystal Palace, 260 ' Peace of God which passeth all under- standing, the,' new rendering of, 493 note Peacock, Dr. T., 13 ; early supporter of Pathological Society, 223 Pembroke, Countess of, 53, 280 Pennock and Moore, Drs., experiments on the heart, 110 note Percussion, on the acoustic principle of, 'Med. Gaz.,' Jan. 1837; abstract, 120, 121 Pharmaceutical Society and Journal, 273 Pharmacopeia, British, 273 Pharmacy, British, 272 Philippians, Epistle to, proposed transla- tion of verse 7, chap. iv. Phillips, Sir J., 306 Phillpott, Rt. Rev., Bishop of Exeter, 188 ' Philosophical Transactions,' 3 Phthinoplasms, 391 Physical signs. Author's ' Rational Expo- sition ' of, 50 Physicians and physikists, 113 note fees equitably considered. See Fees opposed to Royal College, 28 Royal College of, London, enrolled licentiate, 75 ; censors' board re- ferred to for arbitration in vain, 131 ; Author elected Fellow of, 153 ; hesita- INDEX. 517 PHY tion in accepting it, 153 ; complaints against the College, 154 ; association of licentiates and recusants, 155 ; Author intimates intention of attempting re- form, 155 ; Author's Gulstonian Lec- tures at, 158 et *eq. ; reform in, 162- 177 ; original charter, 163 ; Author's motion for reform, 163 ; Author's warn- ing to, 164 ; censorship of, '224 ; cen- sor's office of admonition, 225; senior censorship and Harveian oration re- fused ; presidency not sought for, 315; attempted changes in, 410 ; continued restrictions and exclusions, 402 ; num- bers of M.D.'s not belonging to the College, 403 ; reasons why, 404 ; Sir G. Burrows more liberal ; outline of constitution and history of the College, 405-7 ; charge of levelling downwards rebutted ; although unsuccessful in re- moving restrictions, yet elections to fellowship increased, 407 Physiology, lectures, &c., 18, 27 ; chemi- cal, 20-25 ; experimental, 35 Pictorial thermometer of Mr. Campbell of Islay, 481 Pickess, George, 211 Piorry, Prof., author of 'Percussion Mediate,' 48 Pitman, Sir Alfred Henry, M.D., Regis- trar of the Royal College of Physicians. 412 Pleura, perforation of, 61 Plymouth, landed at, 62 Pneumonia, Author's article in ' Cycl. Pract. Med.,' postponed for Vol. IT. " Pneumotiiorux, 59 ; not always fatal, 61 Pollock, Mr. George, 384 Polytechnic, sons at, 259 Porto Santo, Madeira, 58 Portraits of Members of the Institute, 37 ; Professors at the Sorbonne, 44 ; Professor G. Andral, 42 ; Professor R. T. H. Laennec, 46 Pouillet, C. J. M., Professor of Physique at the Sorbonne, 43 ; portrait, 44 Poultry language and intercourse, 7-9 Powell, Dr. Lewis, London, 17 and Lealand, microscope, 157 Practice in dispensaries, c., 91 private, reports of, 147, 150,211, 213, 224, 241, 246-7 ; full engagement in, 265 Prague, 40 Prance, Chas. R., 211 Preece, Mr., on electricity of volcanic dust, 484 President, Author elected President of Harveian and Westminster Medical Societies, 120 ; of Pathological Society, 216 ; of the New Svdenham Society, 275 ; of the Royal Medical and Chirur- gical Society, 416 Preservation of health, 203 .Preston, Wm. John, 189 Prevention of disease, 203, 303 QUA Preventive Medicine, successes of, 303-309 Priestley, Dr. Joseph, 3 Primary elements of disease, 202 Prince Consort, H.R.H., the. See Albert, Prince Leopold, afterwards King of the Belgians, Sir J. Clark first introduced to him in apartments of Mrs. Williams in Rome, 56, 142 Principles of Medicine, 140 ; work on, 156 et se<]., 200 ; first edition, 1843 ; second, 1848; third, 1856; recommended by other lecturers ; favourable opinions in this and other countries ; contents and plan of, 202 et seq. ; principles of treatment, 204; letters and critiques on, 208 ; translation into Spanish, Ame- rican reprints, &c., 209 ; unprofessional readers, 209 ; great assistance from Geo. Gulliver, F.R.S., 210 ; profits, 213 ; assistance from Dr. R. J. Mann, in third edition, 266 Pringle, Sir John, 304 Pritchard, Dr. J. C., author of 'Natural History of Man,' 113 Professional responsibilities, 53 Professors in Edinburgh, 12, 17-19 ; Paris, 40-48; U.C.L., 144 Prognosis, 203 Progressive growth in divine grace and knowledge, 502 revelation of Christ in Old and Xew Testaments, 496-8 Prophylaxis and hygienics, 201, 203 Protestantism, positive and negative, 500, 501 Protestant schools at Cannes, 471 Prout, Dr., 197, 420-1 Proximate elements of disease, 202 Publication of first work, 68 Public speaking, difficulties, 15, 16 services of medical men, 429-30 Pulmonary consumption, a chief object of Author's attention, 348 ; large experi- ence in, 349 ; publishes a work on it in conjunction with his son, Dr. C. Theodore Williams, 350 ; contents and authorship of the chapters, 388-9 ; opinions of the press, 389-90 ; extracts, and comparison with recent researches, 391-3 ; possibility of low organisms (such as modern bacilli) being con- cerned, admitted, 394 ; summary view of treatment, 394-5 ; book now out of print ; second edition in preparation, 389 ; duration of life in pulmonary consumption increased from two to eight years and upwards, 395 Q QUAIX, Dr. R., his name announced for work on the Chest, in conjunction with Author, 87, 90, 213, 223, 240, 267, 377 ; INDEX. QTTA his Dictionarj* of Medicine, 487 ; Au- thor's letter on receipt of a. copy, 487, 488 ; Dr. Quain's reply, 489-90 Quain, Richard, F.R.S., Prof, of Anatomy, U.C.L., 144 Queen, Her Most Gracious Majesty the, patron of the Hospital for Consumption, Brompton, 180 ; opening the first World's Fair, 260 ; at the Duke of Wellington's funeral, 203 ; Author appointed physician extraordinary to, 440 E RAILWAY journeys, wear and tear from, 215 ; as affecting rate of fees, 214 Rankine, Mr., of Hastings, 181 Ransom, Robert, 189 Rapids, shooting the, on Traun river. 398 ' Rational Exposition of Physical Signs,' &c., Author's first work, 64 Recreations in art and science, 90, 99 Redfern, Professor, Belfast, 441-2 Reeve, Rev. W., Portman Chapel, 495 Reflex function, diseased, 202 Reformed Church of England, 493 ileisseissen, on Air-Tubes, 152 Religion, revealed, a reality, above natu- ral knowledge, 137 Religious convictions, 28, 137, 492-503 Remuneration of physicians considered, 213-14, 321 Residence, changes of, 140, 193, 241, 246 ; review of changes, 2467 Respiration, Priestley, Lavoisier, Ellis, Lagrange, Hassenfratz, Author, &c., 21-25 Respirator-inhaler of Dr. Roberts, &c., 81,82 Restaurants in Paris, 32 Rest necessary in professional life, 268 Retirement to Cannes, 464 Reventlow, Count, Danish Ambassador, 327 Revised Version of New Testament, 258, 499 Reynolds, J. Russell, 224, 426-7 Rheumatic fever, treatment of, 383, 424 Rhone Valley from Forclaz, 7 1 Richmond, the Duke of, President of Hospital for Consumption, 180 Riley, Dr. H., of Bristol, 35 Ripon, Marquis and Marchioness of, 439 Ritualism and Sacerdotalism, 493 Roads, French, in 1825, 29 Roberts, Dr., 28 Dr. W., of Manchester, 81, 82 Robinson, Wm., 242 Robison, of Armagh, Rev. Prof., Physi- kists v. Physicians, 113 Roe, Dr. Hamilton, 181 Rogers, James, 189 Dr., St. Petersburg, 383 Roget, Dr. Peter Mark, failure of his ad- EUT dress on 'The Language of the Heart," 126 Rokitansky, Prof., of Vienna, 400 Rome, sunset from the Palace of the Caesars, 384 Roots, Dr. II. S., 164 Roscoe, Dr. Richard, 115, 136 Rose, Sir Philip, Founder and Hon. Secre- tary of Hospital for Consumption, 178- 186 ; tribute to, 186 Rouanet, M., on the Sounds of the Heart, 103 Rouen to Paris in 1825, 29 Roux, surgeon at La Chaiite, contrast with Boyer, 38 Rowe, John, 213 Roval Agricultural College, Cirencester, 313 Astronomical Society, 471 Commission of 1857 (Sidnev Her- bert's). 306-8 Institution, admitted member of, 76 ; laboratory lectures by Michael Fara- day, 92 ; lecture there by Author on Low Combustion, 97 Medical and Chirurgical Society of Lon- don, 216 ; address of condolence to the Queen on the Death of the Prince Con- sort, 283 ; Author elected President, 416 ; history and previous connection with, 416 ; conversazione and exhibi- tion by amateur artists in the medical profession, 417 ; on stethoscopes and ear-trumpets, 432 ; extracts from pre- sidential addresses at two anniversaries, 1874-5. Obituaries of Baron Liebig, Dr. Bence- Jones, Sir H. Holland, Dr. H. W. Fuller, Dr. Anstie, Sir J. R. Martin. Allusions to other matters of interest to the Society, 418-31 Medical Society of Edinburgh, library, public speaking at meetings, friends among members, 15-17 Society, paper on Low Combustion communicated to, 97 ; elected Fellow, 112 ; evening meetings, discussions, 446 ; anomalous and unwarranted restric- tions in election of Fellows, 446 et seq. ; Author's protest by address and letter, 447-55 ; original constitution unlimited, 449 ; its dwindling since 1847, 449 ; straitened by its restrictions, 450, which are illegal, 452-3 ; title of So- ciety and objects, 454 ; list of candi- dates, elections, and total numbers since 1841 , 454 ; committee on statutes report- ing in favour of limitation, 450 ; com- ments thereon, 45(5-8 ; Sir J. Hooker's remarks in President's address, 458- 60 ; Author's reply, 461-2 Ruisseaux at Cannes, poisoned by cess- pools, 469-70 Russell, Lord, 324 Rutland Duke of 324 INDEX. 519 SAA s SAARBKUCK, 384 Sabbath, observance of, 35 Sabine, Sir Edward, P.R.S., 191 Salzkammergut, in Austrian Tyrol, 398 Sandown, Viscount, 439 Sandwith, Dr., of Hull, 115 ; Dr. Hum- phry, of Kars, 115 Sanitary measures in India, report, 310 successes in British Army, 306-308 Saphir, Kev. Adolph, 494 Schools avoided, 2 ; school-teaching, games, and tricks ; public, 3, 6 Schreiber's, Dr., sanatorium at Aussee, in Styria, 398 Schwann and Schleiden, 441 Scott, Dr. John, East India Board, 190 General, Author's letter on his acoustic construction of Alliert Hall, 437 Sir Walter, and John Lockhart, 1 Scripture studies in Greek Testament, 257, 493-9 Scriven, John B., 242 Scudamore, Sir Chas., 48, 180 Scutari, 305 Seal, Goper Chunder, 218 Sea, phosphorescence of, traced to gela- tinous bodies, 58 Seaweed, by Miss Dyke Poore, at British Association at Belfast, 440 Secretion, diseased, 202 Sedgwick, Kev. Prof., 125 W., 213 Seegen, Prof., Carlsbad, 397 Self-sacrifice and self-preservation, 330 Self-supporting dispensary promoted by Author, 91 Semeiology, 203 Sensibility, diseased, 202 Sewell, Dr. Chas. Brodie, 147 Shaftesbury, Earl of, his house taken, I'lil Sharpey, Dr. 99 ; Professor, 136 ; 187-8 Siagne river canal, supplying water to Cannes, 468 Sibson, Dr. Francis, 145, 377, 380 Sieveking, Dr. Edward, 147 Simpson, Prof. Sir James Y., 270-1 ; anes- thetic discoveries, &c. Singing, 14, 314 Sisters, Author's, illness and death of two, Skoda, Professor, of Vienna, 400 Sleep, disordered, 87, 88 Sleeplessness, 315 Smith, Dr. Andrew, Director-General, 30(5 Dr. Pye, 443 Henry Duncan, 242 James, Esq., Jordan Hill, 187 Mr. T. H., John St.. ;iti:J Sir Culling Eardley, 273 Societe Protectrtce des Animaux, Cannes, diploma to Author for cart for heavy loads, 135 Solfatara, jets of steam from, 385 ; echo- ing ground near, 385-6 Somerset, Duchess of, writes for appoint- ment to see her son Earl St. Maur, 351. After the visit calls to hear opinion, which called for further consultation,353. After a second visit from Dr. Williams, hears his opinion of gravity of case, and necessity of greatest care, 354-5. Early next moraine summons Dr. Williams, who finds patient has had a dangerous fit, and arranges for another visit in the afternoon, in which he brings a medical man and nurse to be in constant charge. Another physi- cian had been called in in Dr. W.'s absence, 356-7, who had taken another view of the case. Sudden attack of suffocation, during the visit, threaten- ing instant death, to avert which Dr. W. told the Duchess that the onh- chance lay in opening the windpipe, and that a surgeon, Mr. Holmes, was there to do this. Relief was only tem- porary : the attack was fatal. The Duchess, shocked at the result, turned in anger against Dr. W. and would listen to no explanations, refusing a jwst-mortem examination, which would make the case evident, 370-1. The Duchess a few weeks after circulated among her friends a printed account of the case, full of gross inaccuracies and fal.Te accusations, for which Dr. Wil- liams brought an action for libel, which ended in the Duke and Duchess of Somerset appearing in court and mak- ing a complete retractation of, and ai>ology for, the charges and imputa- tions therein contained, .'572-5. The trial being thus stopped and no evi- dence brought into court, Dr. W. found it necessary to publish an ' Authentic Narrative,' of which extracts arc given, .'!.") 1-7 5. To these are appended the unanimous opinion of several leading London physicians and surgeons, and a letter of thanks from Dr. Williams for the sympathy and support of the medical profession, 375-8 Duke of, associated with the Duchess in the action for libel, S5I ; letter to, urging the duty of permitting an exam- ination after the death of Earl St. Maur, 371 Somerville, Dr. Jas., 28, 153 Sounding-board, explanation of its func- tions, 437 note Sound, laws of, not well understood, 65 ; observations on, 65 notr, 66 ; true de- finition of, 65 note ; objection to Dr. Young's definition, ibid. ; nature and properties of, 66 reflection and refraction of, 446, 447 note INDEX. sou Southend, 139 Special pathology and therapeutics, 200 trains, adventures with, 326 Spectroscope and the rain-band, 487 Spencer, Earl, 439 Squire, Mr. Peter, 272 Stafford, Augustus, M.P., 306 Stamford and Warrington, Earl of, 439 Stanley, Lord, 308 Startin, James, highly successful in dis- eases of the skin, 269-70 Statham, S. F., 213 St. Cergues, Jura, view of Alps from, 70 Stethoscope, Laennec's, 48 ; acoustic prin- ciples of, 40, 49 note; incredulity of London physicians respecting, 56 St. George's Hospital. See. Hospital Germain des Pre's, Hue, residence in Paris, 32 Hilaire, Geoffrey, Professor at the Sorbonne, 36, 43-5 Stilts, walking on, 7 Stoate, James, 242 Stokes, Henry James, 189, 445 . Dr. Wm., Dublin, 113 Stone, Thomas Arthur, 325 Storks, Maj.-Gen. Sir H., 306 Stradbroke, Earl of, 439 Stramonium diminishes contraction of air-tubes, 153 Strange, Lieut.-CoL, F.R.S., 447-8, 451 Strangford, Viscount, 439 Streeter, Mr., of Harpur St., at Kinnerton St. Lectures, 115 Strieker, Professor, of Vienna, 400 Stroud, Dr. William, inventor of flexible stethoscope, 122 Students, numbers entering class of medicine, U.C.L., with amount of fees, 145, 190, 211, 213, 224, 242 Studies at home, 2-6 ; in Edinburgh, 10- 19; in London, 26-7 ; in Paris, 32-61 Successes and failures in medicine, in Author's Lumleian Lectures, 198 ; sketches of failures and causes classi- fied, 299-301 ; elements of success esti- mated by analysis of objects of medicine, preliminary and final, 302 ; the final successes divided into complete cure or prevention, succes A, and partial, B. Minor successes, 302 ; prevention equally with cure the noblest aim of medicine, 303 ; signal example in vaccination, 804; preventive successes in British Army, 305-10 Suffolk, Earl of, 439 Sumner, Archbishop, 439 Sunglares, morning and evening, 482-7 ; phenomena and causes, 483 ; increase of light, and some colours subjective, 484 ; Meldrum's volcanic dust hypo- thesis expanded by Lockyer, 484 ; im- proved by Preece and Crookes. Perhaps increased by ice-dust, 466-7 Sunset from the Palace of the Ciesars, 385 THY Sunset, with transit of Venus, painted in water colours, 475 Sunspots, disappearance of, coincident with sudden cold, March 1883, 477-8 ; an- other in December, 479 ; on nature of sunspots, and their influence on solar heat, 480 ; probability of their increas- ing heat, 480 ; facts on the point, Mr. J. F. Campbell's observations, 481-2 Sun, the, by Prof. Young, 4, 5 notes, 480 Surgeons, College of, London, 27 Sutherland, Dr., 306-8 Sutro, Dr., 396 Swain, John Moore, 242 Swedish translation of Author's work, 111 Switzerland, first visit to, with Earl Minto and family, 69-71 Syme, Prof." James, Edinburgh, 100, 238 Symonds, Dr. J. A., of Clifton, 81, 205, "324 Sympathetic nervous function, diseased, 202 Syrian Aid Medical Mission, 273 T TALMA'S acting at Theatre Fran9ais, 38 Tapson, Dr. Alfred, 189 Tares in the Church, 500 Tartar emetic ointment, most effective remedy for earache, 408 Tatum, George, Salisbury, 322 Thomas, of St. Geo. Hospl., 35 ; letter about experiments, 105, 114, 322 Taylor, Dr. John, Prof, of Clinical Med. U.C.L., 143 Theophilus, 224 Teale, Mr., of Leeds, 324 Tegernsee, 399 Telescopes, 4, 5, 471-2, 475, 484 Teneriffe, 313 Testament, New, Study of, in Greek, 257 Tetley, Dr., of Torquay, 324 Theatre Fran^ais, Talma, Mad. Duches- nois, Mile. Mars, 38 Theatricals in Edinburgh, Kean, Young, Macready, C. Kemble, &c., 14 ; in London, 28 ; in Paris, 38 Thenard, Professor, at the Sorbonne, 36, 43 ; portrait, 44 Therapeutics, 156 Tlierinogranhv, by Mr. J. F. Campbell, 481 Thompson, Dr. Symes, 416 Dr. Theophilus, 181 Thomson, Dr. John, Minto House, Edin- burgh, 10-15 Prof. A. T., 28, 143 Prof. Dr. John, Edin., 17, 145 Prof. T., System of Chemistry, 4, 26 ; called on in Glasgow, 26 ; at British Assifciation, Edinburgh, 98 Thynne, Lady Ulrica, 371 INDEX 521 TIM Times commissioner, 306 Tims, Godwin, 189 Tobacco fume and perfume, 331 Todd, Dr. R. B., Report of London Com. on Heart, 110, 116 Toninty, primary physiological element, 159 ; diseased, 202 Toogood, Jonathan, of Torquay, 324 Toynbee, Joseph, 157, 313 Transforniation of textures, 203 Trap-door spiders' nests, 471 Traunsee and Traunfal, 398 Travelling physician, Author appointed, to Madeira, 56; to Earl Minto, for Switzerland, 69 Travers, Benjamin, on Constitutional Irritation, 89, 179, 181 Trinity Chapel, Conduit Street, Rev. H. H. Beamish, 242 Trotter, Dr., of Sunderland, 324 Tulloch, Maj.-Gen., 304 Turner, Professor, his correction of Laen- nec's view of heart-sounds, 101 Tweed, John J., 147 Two-wheeled carriages, diversion on, 131 ; principles of construction, to ensure safety, ease to horse and riders, direct- ness and speed in draught (1) Draw direct from axle ; (2) Instead of fix- ing springs on axle, hang them from it by attachment allowing some play, and throw weight on horse in going up hill, and under him in going down hill ; (3) With large wheels and high axle, carriage should be as near axle as possible, 131-5 Tyndall, Professor, 439-41, 446-7 UMPHELBY, Mrs., 313 Underhung, Author's two-wheeled car- riage, 134 Undulations of sound and light, 65 Unfit occupations, 330 University College, professorship of medi- cine in, 136 et seq. passim ; position and prospects, 136-7 ; Author appointed, 139 ; preparation for duties, 140 ; open- ing lecture well received, 141 ; routine and sacrifices required, 142 ; disagree- ments in surgical department ; class of medicine flourishing, 238 ; no aid from college authorities, 243 ; only a vote of thanks on taking leave, 245 of London, 137. See London Upper Brook Street, last London residence, 246 ; full practice in, 265 Urquhart, Dr. Alex., 17, 45 Uwins, Dr. David, 28 VAN OVEN, Dr. B., 190 Varna, 305 WES Vaughan, Dean, on Epistle to Romans, 494 Vauquelin, L. N., member of the Institute, 36 ; portrait, 37 Velten, Dr. Herman, translator of Author's work into German, 111 Venus, transit of, 1882, and painting of, 475, 476 Verona, 384 Vevey, Trois Couronnea, with Earl Minto, 69 Vibrations, vibratory motion, of sound, light, and heat, 65 note Vienna, 399 Villas in Cannes, L'Olivette, and Ceres, 465 ; V. du Rocher, 466 Virchow, Professor, 159 note ; his tribute to Hospital, Brompton, 186 Voluntary motion, diseased, 202 Vose, Dr., of Liverpool, 324 Voyage to Madeira with patient, 57-63 w WAGNER, Rev. Pastor, Stutgardt, 258 Wakley, Thomas, M.P. and Coroner, 317 ; as journalist advocating radical reform success and opposition Popularit)-, especially in Parliament. His courtesy towards Author, 318. Illness and death in Madeira, 319. His character as a great medical reformer, 320 Wallace, Sir Richard, founder of British Hospital, Paris, 411 Waller, Dr. Augustus, 161, 181,442 Walshe, Dr. W. H., Prof, of Path. Anat., U.C.L., 143 Warburton, Thos. J., 224 Ward, Nathaniel, Secretary of the Patho- logical Society, 217 War Minister, 306 War Office, 304-9 Watson, Sir Thomas, on the dry cure of a cold, 79 note ; reform in College of Physicians, 164, 222 ; letters on death of Robert Liston, 231-37 ; satisfactory conclusion, 237, 377, 379, 415 Watzmann, the, 399 Webb, G. F., 189 Sir John, Med. Director Ordnance, 190 Weld, History of the Royal Society, 447, 452-5 Wellington, F.M. the Duke of, at opening of the World's Fair,' 260 ; his death, and Author's visit to Walmer, 261 ; account of fatal attack, 262 ; anecdote, 262 ; invitation to funeral, 263 ; description, 263-4 Wells, Sir Spencer, 72 Wernier and Wedemever, 152 West, Chas. A., 242 E. L., 213 Richard Elliot, 213 Westcott, Rev. Canon, 494 M M 522 INDEX. WES Westminster Abbey, view of, from resi- dence in Half-Moon Street, 73 Medical Society, elected President of, 120 ; discussions at, 121 Westport, 443 Wharncliffe, Lady, 329 Whately, Archishop of Dublin, 188 Wheatstone, Sir C., on Sound, 65 note Whitehouse, Wildman, 147 Whitely, Dr. George, 273 Whooping-cough, occurring a second time, 50 ; improved treatment of, founded on microbic nature of disease, confirmed by Dr. Burger, 51 Wilde, Sir William, 443, 445 Wilkes, W. D., 213 Willan & Bateman's Diseases of Skin, 18, 51 Williams, Arthur David (son), 212, 312 David Theodore (brother), 6 Dr. Charles Theodore (son), 81, 183, 258, 288, 312, 349 ; marriage, 350, 389 tubercle bacillus in phthisis, 393 note, 390 et seq. Ernest Jenkins (son), 312 Fanny Catharine (daughter), 241, 313 Harriett Amelia (daughter), 241, 313 Harriett Williams (wife), 72, 75, 113, 117. 134, 139, 212 Harry Samuel (sou), 258, 312, 471 James Thomas (eldest son), 119, 258, 311 Mrs., of Tidenham (aunt), 56 ; her death, 71 Philip H. Williams, 89 Rev. David (father), 1, 2 passim ; habits, death, 118, 272, note Rev. John (uncle), Ystradmeirig, 1 ZOO Williams, Sophia Janet (daughter), 212 ; marriage (Morgan), 311 Thomas (brother), 5 Ven. Archdeacon (cousin), rector of New Academy, Edinburgh, 42, 73 W. H., 189 Wm. Rosser (brother), 5 Williamson, Dr. W. C., F.R.S., 147, 192 Willocks, Arthur S., 224 Wilson, W. J., of Manchester, 323 Wiltshiremen, 27 Winans, Mr. W. J., ' Drummond Castle,' 383 Wise, Dr. Thomas, 35 Wollaston, Dr., on Muscular Sound, 1 03 Wolverton, Lord and Lady, 430 Wood, John Elliott, 213 Woolfield, Mr. and Mrs., Cannes, 467 World's Fair, 259 ; inauguration, 260 Worship, places of, &c., 242, 493 Wright, George A., 211 Wurtzburg, entered at midnight in intense cold ; a candle bed-warmer, 387 Wyld, George, 224 YELLOWLY, Dr., 416 Yeoman, John, 213 Young, Dr. C. A., ' The Sun,' 5 note, 480 Dr. Robert, Camberwell, 17, 34 Dr. T., Lectures on Sound, 65 note Ystradmeirig School, 1 ZOOLOGICAL SOCIETY, children at, 259 LONDON : I'UINTED BY gPOTTISWOODE ASI> CO., NKW-STKBKT SQL'ABB AM) I'AULlAMEST STI1KET SMITH, ELDER, & CO.'S NEW BOOKS. HER MAJESTY'S JOURNAL. Fourth Edition, -with Portraits and Woodcut Illustrations, 8vo. price 10s. 6d. MORE LEAVES FROM THE JOURNAL OF A LIFE IN THE HIGHLANDS, FROM 1862 TO 1882. Now ready, fcp. 8vo. cloth limp, 2s. 6