\AJ6 
 
 THIS WORK 
 
 TO THE 
 
 MEDICAL PROFESSION OF THE UNITED STATES 
 
 BY THKIIl OBEDIENT, HUMBLE SERVANT, 
 
 THE AUTHOR. 

 
 PREFACE TO THE FIEST EDITION. 
 
 The Author of this work has endeavoured to keejD before him the 
 difficult objects of adapting it to the student in medicine and to the 
 more advanced. For the advantage of the former, therefore, he has 
 aimed at such method as he might command, and such illustration as 
 might not seem irksome to the latter. With a view to the former, 
 also, he has endeavoured to indicate the intimate manner in which all 
 the topics embraced in the work are related to each other, and their 
 mutual dependences, by constant references from one part to others ; 
 and, what is unusual, the Author has made these connecting refer- 
 ences in a prospective as well as retrospective manner. With a view, 
 also, to the same objects, the Author had designed a more copious 
 Index ; but as the stereotype was completed as long ago as the mid- 
 dle of November, and as the state of his health, and other avocations, 
 have not permitted him to complete the Index, in its regular order, 
 beyond the 125th page, he has concluded to print it as it now stands, 
 and to extend it in a future edition. Many subjects, however, 
 throughout the work, are now incidentally carried out in the Index ; 
 but many of the most important receive only a general reference, ex- 
 cepting as they are related to others which are more amply noticed. 
 
 New York, Jan. 1, 1847. 
 
 ^ PREFACE TO THE FOURTH EDITION. 
 
 Three Editions of these Institutes, the first of which w^as pub- 
 lished in 1847, having been exhausted, the Author now submits a 
 fourth to his medical brethren, in which he has endeavoured to incor- 
 porate, in an Appendix, the most important of the recent discoveries 
 in Physiology, Pathological Anatomy, Therapeutics, Organic Chem- 
 istry, and Microscopy that are relative to the principles about which 
 this work is interested, and he has connected the Appendix intimate- 
 ly with the main body of the work by copious references to the sec- 
 tions embraced in the former, while the same system is carried out 
 reciprocally in the latter. It is also gratifying to the Author to pay 
 his humble tribute of admiration particularly to the immense labors 
 of the microscopist, who, through the great improvements of the in- 
 strument, is now enabled to analyze Avith surprising accuracy the ul- 
 timate and varying conditions of the solids and fluids. The Author 
 has also fulfilled his design, as expressed in the Preface to the first 
 edition, of extending the original Index, a second one being now 
 added, in which he has endeavoured to present an epitome of the 
 whole work. It is proper, however, to suggest that the Reader will 
 find an advantage in consulting simultaneously the original Index, as 
 it is more particularly analytical. An Essay upon the Soul and In- 
 stinct forms a part of the Appendix. 
 
 New York, Novemhei-^ 1857.
 
 PKEFACE TO THE FIFTH EDITION. 
 
 The Supplement which is added to the present edition embraces 
 observations that go to corroborate some of the Author's principal 
 views in medical philosophy ; but he is not aware of any discoveries 
 in Physiology, or of any new facts in Pathology, or of any improve- 
 ments in Therapeutics since the late edition to affect adversely any 
 of his doctrines. Indeed, as a work of principles, and as a consistent 
 whole, should any doctrine of importance be shown to be fallacious, 
 the entire fabric must be abandoned. But if, on the contrary, its 
 principles be foimded in Nature, they can not be affected by any fu- 
 ture accumulation of facts — no more than the law of gravitation was 
 rendered more absolute by the successful calculation of the periodic 
 time of Halley's comet. That achievement was simply a corrobora- 
 tion of a great discovery. It is of no importance, therefore, to the 
 essential objects of this work to mtroduce new discoveries till some 
 one or more may present themselves, that, Hke chlorine, iodine, &c., 
 in their relation to Lavoisier's theories of oxygen, shall invalidate the 
 system of medical philosophy herein embraced ; by which the Author 
 means such facts as can be undeniably shown to contradict that phi- 
 losophy. This, it is true, will appear strange to those (and of such 
 there are many) who look upon principles as "liable to exceptions" 
 — as having no stability — exposed to daily fluctuations — as consisting 
 •even of isolated facts ; such philosophers, particularly, as see no dis- 
 crepancy between the conflicting laws of organic and inorganic be- 
 ings, and who, therefore, are ever ready to engraft them mdiscrim- 
 inately upon organic philosophy, or as one or the other may have its 
 chance in the irresistible pronimciations of organic life, or in the spu- 
 rious analogies of simple matter. To muiltiply facts in this work 
 which merely contribute to the validity of its principles, or to incor- 
 porate others that may be speciously arrayed against those principles, 
 would constitute a defect for the most ordinary criticism. Never- 
 theless, some things, both of the former and latter nature, have been 
 admitted into the Appendix, although precisely parallel facts occur 
 in the body of the work. But they were said to be new, and the 
 Author yielded to this general belief, though he concedes that the 
 facts are more fully displayed in the latter than in the former cases, 
 and that he therefore contemplated an advantage from their corrob- 
 orating effect. But their exclusion would not have otherwise affected 
 the work, though it might have been regarded by some as a defect. 
 The same may be also afiirmed of the Supplement, where, for exam- 
 ple, some late observations relative to absorption by the intestinal 
 villi are stated, although they simply confirm what had been long 
 ago ascertained ; but they are more precise and complete, and place 
 the doctrine in these Institutes beyond question.. 
 
 New York, August, 1859.
 
 PREFACE TO THE SIXTH EDITION. 
 
 A CAREFUL, attention lias been bestowed upon this sixth edition, as 
 will be sufficiently manifest in the numerous references which have been 
 added to the sections wherever the subjects under consideration are allied 
 to other parts of the work and may derive illustration through this re- 
 lationship. These new references (which occupy mostly the former va- 
 cant spaces at the end of sentences) are prospective as well as retro- 
 spective, and amount to more than seventeen hundred ; and the Indexes 
 have been improved in a similar manner. The Author has also en- 
 deavored to simplify the exposition of some of the most difficult prob- 
 lems, and to thus render them of more easy comprehension by the young 
 medical student. For this purpose he could have equally desired great- 
 er amplification, and especially to protect himself against misapprehen- 
 sion or misrepresentation (from the latter of which, however, he is not so 
 unwise as to hope for escape) ; but the vastness of the field, the immensity 
 of the labyrinth which he has explored, has rendered it necessary to em- 
 ploy as much brevity xis such variety and intricacies would admit, and 
 he has considered it most expedient to carry into the Appendix and 
 Supplement the same compactness that characterizes the body of the 
 work. Of the Supplement it is said that "it is very brief, but speaks 
 a volume." 
 
 But whatever advantages in respect to detail and perspicuity may at- 
 tend a work upon the principles of medicine as founded in Nature, it -can 
 have but little chance with other systems unless the student be ambitious 
 of knowledge, and disposed to grapple at the very beginning of his career 
 with the difficulties of truth as distinguished from the fascinating sim- 
 plicity of error. The latter once impressed upon his imagination, or once 
 productive of mental indolence, fetters his aspirations and decides his 
 destiny. Hence the incalculable importance of a right beginning. 
 Whatever the apparent obstacles, they may be soon surmounted. The 
 task will have been the best possible mental discipline for the young in- 
 quirer. He will have learned the important art of thinking for himself; 
 and when once inducted into the true philosophy of medicine he can not 
 help thinking, and into the very depths of that philosophy. He will have 
 also shielded himself against the seductions of artificial systems. He will 
 quickly distinguish what is true in Nature from factitious analogies. He 
 is not, however, to be discouraged from informing himself of spurious 
 doctrines ; and with this object in view the Author of these Institutes 
 has incorporated in the work a copious exposition of the offsprings of
 
 X PREFACE TO THE SIXTH EDITION. 
 
 error. But, as he has also endeavored to indicate their fallacies, the 
 student has the double advantage of learning the inventions of art and 
 at the same time the infirmities which are so apt to commend them to 
 our natural indolence. The Author's method, therefore, if he be right 
 in his premises, is not open to the objection alleged by Burke (but on 
 the contrary defeats it), that — " When education takes in error as a part 
 of its system there is no doubt that it will operate with abundant ener- 
 gy and to an extent indefinite." ' 
 
 Much has been recently said by a few writers upon the recuperative 
 law of Nature, and presented in such a manner as to convey an impres- 
 sion that now, for the first time, the old doctrine of the vis medicatrix na- 
 turce has been distinctly announced. The Orator, for example, of the Lon- 
 don Hunterian Society for the present year remarks that — " From time 
 immemorial the professors of the healing art, with one or two exceptions, 
 seem to have known nothing of the course and termination of diseases, 
 save in connection with, and as modified by, special therapeutical agents. 
 Nearly all their reasoning upon the action of medicines has, in conse- 
 quence, been based upon comparisons of one method of treatment with 
 another. They seem never to have thought of taking as the basis of 
 their reasoning the curative resources of Nature herself, as ascertained 
 by study of the natural course of disease." 
 
 It is evident that they who have lately written in the foregoing man- 
 ner have had their attention divei'ted from Hippocrates, Celsus, Galen, 
 &c., and if they will turn to the mottoes at page 661 of this work they 
 will find that those early masters '•' took as the basis of their reasoning" 
 what is supposed to be of such very recent origin. And the Author of 
 these Institutes, unwilling to be excluded, may be permitted lo assure 
 these reformers that throughout the work he has " taken as the basis 
 of his reasoning the curative resources of Nature herself, as ascertained 
 by study of the natural course of disease." It is the absolute foundation 
 of all his Therapeutics, and the foi'egoing mottoes were employed to in- 
 dicate the fact. But these reformers have, also, nearly as large a reli- 
 ance upon Nature as the homoeopath, Avith much less regard for the 
 noble science, and appear to be of Magendie's opinion that "the nurse 
 can prescribe equally well"' (§ 744) ; and perhaps this may be what is 
 intended by claiming for the honor of the present age the discovery of 
 the 175 medicatrix natwce. In that aspect of the subject the Author of 
 these Institutes does not sympathize (excepting as it respects a few " self- 
 limited" diseases, and multitudinous cases in which there is no pi'ofound 
 derangement, results of mechanical injuries, «fcc.), although he endeavors 
 to expose the errors of excessive medication, and agrees with the abo7'- 
 tive disciples of Nature that wherever this practice obtains (as it does 
 with the mass of the profession) the whole work of cure is supposed to 
 devolve upon art; and this, he maintains, is the inevitable effect of the 
 chemical and Immoral doctrines.
 
 PREFACE TO THE SIXTH EDITIOIS". XI 
 
 Nature, in the foregoing sense, is nothing but a system of laws, 
 a proper conformity with which is as much at the foundation of 
 therapeutics as of hygiene. The physician, tlierefore, should be 
 alone employed in applying to his use the laws by which organic 
 beings are governed. A A'ital principle, or vital force (as may be 
 preferred), in connection with organic structure, forms the basis of 
 those laws. 
 
 Such i§ a glance at some of the objects of this work, and to which the 
 Author invites especially the impartial attention of the young student of 
 medicine, and with the assurance that he will meet with no timid or un- 
 fair concealment of doctrines that ai-e opposed to those of the Institutes. 
 
 There remains to be noticed what may seem to be an isolated subject, 
 but which is essentially relative to physiology — the essay upon the Soul 
 and Instinctive Principle (incorporated in the Appendix), in which the 
 Author endeavors to demonstrate the substantive existence and self-act- 
 ing nature of the Soul and Instinct upon strictly physiological principles. 
 If this have been accomplished by the Author, who believes the demon- 
 stration to be conclusive, then is there an end to materialism ; and even 
 he who doubts not the probabilities of the metaphysical inductions, or 
 relies with greater confidence upon Revelation, must realize a new sat- 
 isfaction in that tangible proof which no ingenuity can invalidate, no 
 misrepresentation pervert, and no sophistry evade. 
 
 As to the Author's reference to his essay upon " Theoretical Geology" 
 (p. 908, 927), it will be seen that the work embraces many facts that are 
 allied to organic philosophy ; but it is now his object to state that the 
 discussion proceeds upon recognized grounds in natural philosophy, chem- 
 istry, geology, &c., and without departing from the rules j)rescribed by 
 " positive science ;" and as the Author's aim is simply the development 
 of truth, he entertains the hope that the essay may be scrutinized accord- 
 ing to its supposed philosophical premises. The issue must ultimately 
 turn upon this mode of investigation, not upon the usual ground of geo- 
 logical hypotheses, which, indeed, are the veiy things in question. It 
 must be decided in tTie open field of those various sciences which consti- 
 tute the physiology of Nature ; since the near aflSnities among the facts 
 in geology constantly bring them under the collective interpretation of 
 the different departments of knowledge, and no one who has not direct- 
 ed his attention to the whole circle of the sciences is qualified to grapple 
 with the subject. 
 
 New York, September, 1860.
 
 PEEFACE TO THE EIGHTH EDITION. 
 
 A SEVENTH edition of this work was published in 1861, which, as 
 stated in a Preface, " is distinguished from the preceding editions by 
 the addition of several brief foot-notes and some other improve- 
 ments." In 1862 appeared another edition, but under the designa- 
 tion of the seventh edition, though distinguished from that by the 
 addition of twenty pages of Notes appended at the end of the Sec- 
 ond Index^ and by frequent references to them in the text, and also 
 by the addition of several brief foot-notes, and by many references 
 to sections throughout the work. Doubtless it had been better to 
 have entitled that edition the eighth. 
 
 The present edition is distinguished from the last particularly by 
 an extension of the Notes at the end of the Second Index, and by 
 numerous references to them in the text. Several of the former 
 Prefaces are reproduced as memoranda of the progressive condition 
 of the work. In the Preface to the seventh edition, which is now 
 omitted, there occurs the following explanatory statement: "The 
 fiuthor embraces this opportunity to say (what may not be obvious 
 to all) that the fractions which appear in many of the numerical des- 
 ignations of the sections, as § 303^ «, are intended for sections that 
 were made after the original completion of the manuscript, by which 
 the labor of a revision of the entire work was saved. The addition 
 of letters to a series of figures of the same denomination indicates 
 distinct sections, but that they are either closely allied, or are intend- 
 ed as substitutes for fractional parts." 
 
 New York, 1865. 
 
 PEEFACE TO THE NINTH EDITION 
 
 An Eighth Edition Revised of this Avork was published in 1867 
 and 1868, in which improvements were introduced. The present 
 or Ninth Edition has also been carefully revised, and, although the 
 text has been in no essential respect altered, some notes have been 
 added. 
 
 The Author, in concluding this brief Preface, thinks it but just 
 to himself to say that during the fifty-four years of his professional 
 life he has at no time intermitted his professional labors, either sci- 
 entific or practical, and that, therefore, he does not offer this new 
 edition of his work in ignorance of the latest contributions to med- 
 icine, or when it might be supposed that his interest in the great 
 subject Avas not as ardent as ever. 
 New York, 1870.
 
 TABLE OF CONTENTS. 
 
 PRELIMINARY REMARKS 
 
 PHYSIOLOGY 
 
 Composition 
 
 Structure 
 
 Vital Principle and its 
 
 Properties . . . . 
 
 Vital Principle .... 
 
 Irritability 
 
 Scjisibility 
 
 Mobility 
 
 Vital Affinity 
 
 Vivification 
 
 Nervous Power .... 
 General Remarks upon the 
 
 Philosophy of Life . 
 The Mind and Instinct, and 
 
 their Properties 
 Functions, Co.mmon 
 
 Motion 
 
 Absorption 
 
 Assimilation 
 
 Distributio7i 
 
 Appropriation 
 
 Excretion 
 
 Calorification 
 
 Gcjieration 
 
 Functions, Peculiar . . . 
 
 Sensation 
 
 Sympathy 
 
 Its general relations to 
 
 the nervous system . 
 
 Experiments illustrative 
 
 of 
 
 Varieties or kinds of. . 
 Laws of, applied patho- 
 logically and therapeu- 
 tically . .... 
 In its relation to special 
 tissues and organs 
 Relative to the Mental Prin- 
 ciple and Instinct . 
 
 Vital Habit 
 
 Age 
 
 Infancy 
 
 Childhood 
 
 Youth 
 
 Manhood 
 
 Old Age 
 
 Temperament, Constitu- 
 tion, Idiosyncrasy . 
 The Sanguine . 
 The Melancholic 
 The Choleric . 
 The Phlegmatic 
 The Nervous . 
 
 1-15 
 
 15^12 
 
 23-49 
 
 50-73 
 
 73-125 
 
 73-89 
 
 89-100 
 
 100-103 
 
 103, 104 
 
 105 
 
 105 
 
 106-111 
 
 111-122 
 
 122-125 
 125-280 
 126-128 
 128-134 
 134 
 207-217 
 217-227 
 227-234 
 234-279 
 279, 280 
 280-362 
 280-283 
 283-362 
 
 284-295 
 
 295-321 
 321-335 
 
 335-353 
 
 353-362 
 
 382 
 363-372 
 373-383 
 373-375 
 375, 376 
 376-380 
 380,381 
 382, 383 
 
 383-391 
 
 386, 387 
 387-389 
 
 389 
 389, 390 
 
 390 
 
 Physiology — continued. 
 
 Races of Mankind .... 391-393 
 
 Sex 393,394 
 
 Climate 394-396 
 
 Habits AND Usages . . . 396,397 
 Relations of Organic Be- 
 ings to External Ob- 
 jects 398-400 
 
 Death 401-404 
 
 Summary Conclusion in 
 Physiology, or its Uni- 
 ty OF Design .... 405-412 
 
 PATHOLOGY 413-540 
 
 Remote Causes .... 414-427 
 Pathological or Proximate 
 
 Cause 427-434 
 
 Symptoms 134-455 
 
 The Pulse , 443^48 
 
 The Tongue 448^50 
 
 Secretions and Excretions . 450-455 
 Morbid Anatomy .... 456-463 
 
 Inflammation 464-489 
 
 Description of 464-480 
 
 Remote Causes of . . . 480, 48 1 
 Pathological Cause of . . 482-489 
 Active and Passive . . . 486-489 
 
 Fever 489-499 
 
 Description of 489-497 
 
 Remote Causes of . . . 497-498 
 
 Pathological Cause of . . 498-499 
 
 Venous Congestion . . . 500-513 
 
 Humoralism 514-540 
 
 THERAPEUTICS .... 541-777 
 General Consideration of 541-563 
 
 Cathartics 563-570 
 
 Astringents 570-578 
 
 Tonics and Diffusible Stim- 
 ulants 583-590 
 
 Antispasmodics 590-593 
 
 Cinchona, and its Alka- 
 loids 593-607 
 
 Arsenic 607-612 
 
 Iodine 612-620 
 
 Ergot 620-628 
 
 Emmenagogues 628, 629 
 
 Diuretics 630-633 
 
 Expectorants 633-642 
 
 Counter-irritants . . . 642-660 
 Remedial Action, its Gen- 
 eral Philosophy . . . 661-689 
 The Seton ...... 679-681 
 
 Local Sedatives, Warm 
 
 Poultices, <^c 681-683 
 
 Genito-urinary Agents . . 683-689 
 Uterine Agents .... 683-C8i)
 
 Tlierapeulics — continued. 
 
 Bloodletting 690-777 
 
 Leeching 692-698 
 
 General BloodleUins- ■ . ■ 698-702 
 
 TABLE OF CONTENTS. 
 
 P.ige 
 
 Therapeutics — continued. 
 Bloodletting — continued. 
 
 Simple Intermittent Fe- 
 ver 736-739 
 
 Cuvving 702-703 | In the Cpld Stage of Fever 739-741 
 
 The Nervous Power in its In Apoplectic Affections . . 741-747 
 
 Relation to the Effects of I Expericjice and Opinions of 
 
 distinguished Physiciayis 
 as to Bloodletting in In- 
 flammatory, Congestive, 
 and Febrile Diseases . . 747-766 
 In the Diseases of Infancy 
 
 and Old Age .... 768-770 
 Spontaneous Hemorrhage . 770-772 
 Misapplied and Excessive . 772-776 
 General Conclusions as to . IIQ-ITI 
 
 Loss of Blood .... 703-711 
 
 General and Practical Obser- 
 vations upon .... 711-777 
 
 General Extent of Bloodlet- 
 ting 711-724 
 
 In Congestive Fevers . . 724-732 
 
 7?* the recognized Forms of 
 
 Iiiflammation .... 732-736 
 
 In Simple Continued and 
 
 CONTENTS OF APPENDIX. 
 
 Progress of Physiological and Pathological Chemistry .... 779-802 
 
 Production of AnIiMal Sugar 783-794 
 
 Progress of Physiology 801-816 
 
 Structure of Organs 801-803 
 
 Of the Spinal Cord 802-803 
 
 The Nervous Power and Organic Properties 803-806 
 
 Animal Heat in its connexion with the Nervous System 807-812 
 
 The Primordial Cell 812-814 
 
 The Boundary-line between Animals and Plants 815 
 
 Hybrid Animals 816 
 
 Absorption and Circulation in Plants 817-824 
 
 Experiments to ascertain whether the quantity of Blood circulat- 
 ing IN the Brain may be reduced artificially 824-828 
 
 Sedatives — a farther exposition of their uses and of the philosophy relative 
 
 to their effects 828-835 
 
 Alteratives — their uses and mode of action considered practically, &c. . 835-851 
 
 Jalap, p. 851-853 — Saline Cathartics, p. 853-854 — Rhubarb, Scammony, 
 Aloes, Colocynth, Senna, Colchicum, p. 855-862. 
 
 Of the action of Chloroform and analogous agents in producing 
 
 Insensibility when inhaled 862-864 
 
 Oi'' the Influence of the Mind upon the Action of Remedial Agents 865-868 
 
 Have Diseases undergone Changes of Type within the last forty 
 
 Years, or have new ones appeared 1 868-872 
 
 Physiology of the Soul and Instinct, or Demonstration of their 
 
 substantive existence and self-acting nature 873-911 
 
 Rights of Authors 912-920 
 
 SUPPLEMENT. 
 
 Correlation of Forces. — The Glycogenic Function of the Liver. — The Cause 
 of the Blood's Fluidity. — Modus Operandi of Remedies. — Absorption by the 
 Skin. — Transfusion of Remedies. — Intestinal Absorption and Lacteal Circula- 
 tion. — The Forces which circulate the Blood 921 
 
 Indexes 935 
 
 Notes 1111
 
 INSTITUTES OF MEDICINE. 
 
 PRELIMINARY REMARKS. 
 
 " Until it is proved that the forces which, in a living body, interrupt the play of the natu- 
 ral chemical affinities, maintain a proper temperature, and preside over the various actions 
 of organic and animal life, are analogous to those admitted by natural philosophy, we 
 shall act consistently with the principles of that science, by giving distinct names to 
 THESE TWO KINDS OF FORCES,* and employing ourselves in calculating the different 
 LAWS they OBEr." — Andral's Pathological Anatomy. See, also, Medical and Physio- 
 logical Commentaries, vol. i., p. 626-632. 
 
 " Our notion of life involves something more than mere reproduction, namely, the idea 
 of an ACTIVE POWER, exercised by virtue of a definite foiTn, and production and genera- 
 tion in a definite form. The production of organs, the co-operation of a system of organs, 
 and their power not only to produce their component parts from the food presented to 
 them, but to generate themselves in their original fonn and with their properties, are 
 characters belonging exclusively to organic life, and constitute a form of reproduction in- 
 dependent OF CHEMICAL POWERS. This VITAL PRINCIPLE Is Only known to us through 
 the peculiar form of its instroments ; that is, through the organs in which it resides. Its 
 LAW'S must be investigated just as we investigate those of the other powers which 
 EFFECT MOTION AND CHANGES IN MATTER." — Liebig's Organic Chemistry applied to 
 Physiology, p. 355. 
 
 "Simple views, whether of health or disease, however ingenious, can seldom be just. 
 They have their origin in the spirit of system, not in the careful study and faithful ena- 
 meration of the complicated circumstances which concur in the production of all vital phe- 
 nomena." — Thompson, on Infiamination. 
 
 1, a. SoLiDisM and vitalism will form the basis of these Institutes. 
 If consistent in all their parts, without a violation of facts, it is, frima 
 facie, a proof of their foundation in Nature. To show this consist- 
 ency, and to develop the great principles and laws of organic beings, 
 and erect a substantial fabric of Institutes which shall guide the hand 
 of art, we must ascend, progressively, along the fundamental facts in 
 physiology, pathology, and therapeutics ; till, at last, we proceed to 
 convert the great system to practical uses, in the preservation of 
 health, and a just, intelligible, and philosophical application of the 
 materia medica to morbid states of the body. 
 
 To render this work, therefore, most practical, and to simplify as 
 far as possible the highest department of knowledge, I shall adopt an 
 analytical method. I have also endeavored to arrange the various 
 topics in their most natural order, or as each successive one may ap- 
 pear to emanate from, or to depend upon, the preceding. The stu- 
 dent, therefore, to understand the last, must comprehend all the pre- 
 ceding, and so of each in succession. We have thus a connected link 
 throughout; a difficult achievement, and the more difficult as it is the 
 first effort that has been made to present the natural relations of my 
 . whole subject in their just order, to point out the affinities, and to ex- 
 hibit throughout the important laws and essential foundations of vital- 
 ism and solidism, and to maintain throughout a consistency of facts 
 and of laws that shall stamp the whole as the PJiilosopJiy of Medicine. 
 
 In making this claim for the Institutes, I am prepared, as in the 
 
 case of the Commentaries, to invite the most rigid scrutiny.* If there 
 
 be any where a collision in principles or iacts, or any contradictions 
 
 of myself, let them be pointed out. My aim is truth, and I desire 
 
 * Medical and Physiological Commentaries, New York, 1840. 
 
 A
 
 3 INSTITL'TE.S OF MEDICINE. 
 
 nothing for myself Avliich I do not yield to others. If there be minor 
 imperfections I would gladly know them. Many of the original doc- 
 trines which appear in this work are presented in various connections 
 in the ISIedical and Physiological Commentaries. The spirit of the 
 Commentaries will pen'ade the Institutes, as being, in my judgment, 
 the only stable foundation.* 
 
 1, b. In the farther prosecution of this work it will still be my 
 object to speak of such errors as have usurped the rights or blighted 
 the interests of rational medicine. It is not now the time for a simple 
 expression of facts, of experience, and of philosophical doctrines. 
 The errors which surround, them must be also exposed and refuted, or 
 the foe of truth, or the ambitious aspirant, or the lover of indolence, 
 will gain something from an indulgence which they know how to seek 
 and appi'opriate. Nor is any one more aware of the tendencies of 
 free discussion or unsparing of physiologists than he who has been 
 most successful in the propagation of error, or who would sooner stifle 
 inquiry into factitious systems. Thus, it is said by Liebig, that 
 
 " It is too frequently forgotten by physiologists that their duty 
 really is, not to refute the experiments of others, nor to show that they 
 arc erroneous, but to discover tnith, and that alone." — Lieeig's Organic 
 Chemistry applied to Physiology, Sfc. 
 
 Now this obvious sophistry betrays its motive, since it is utterly at 
 variance with the habits of him who would enjoin the fiction upon 
 others. Truth should be, indeed, the ultimate object of pursuit ; but 
 the first and most important step toward its attainment is the removal 
 of obstacles that may lie in its way (§ 820). It is allowed, indeed, 
 by one of Liebig's most zealous advocates, the editor of the London 
 Lancet, that " the removal of error claims a place next to the establish- 
 ment of truth" (Dec, 1S44); and it has grown into a proverb, that " it 
 is more difficult to subdue a prejudice than to build a pyramid." 
 
 Although, therefore, the contemplated method must be sometimes 
 arorumentative and controversial, it has the advantage of leading more 
 immediately to a knowledge of the truth upon disputed questions, 
 than any other which is not demonstrative. There can be no doubt, 
 indeed, that the "establishment of truth" in medical philosophy can 
 be effected only by a simultaneous refutation of the errors which sur- 
 round it. The mind will not surrender a favorite doctrine, however 
 false, to the force of truth alone. Even its practical disasters, as we 
 every where witness, are an inadequate demonstration. But, when 
 error and truth are presented in forcible contrast, it is the pride of 
 reason to embrace the latter. AVhat is also important, the reader 
 will have been presented, as in the Commentaries, with the great 
 rival doctrines in medicine, and in their proper relations to each 
 other (§ 3501). 
 
 2, a. The Institutes of Medicine are natural inductions of principles 
 and laws from the healthy and morbid phenomena of living beings. 
 They relate to Physioloory, Patholog}', and Therapeutics, and to noth- 
 ing else. All other systems, therefore, must be spurious. The sub- 
 stitutes have no depth, no principle, no laws, and are recommended 
 alone by their naked simplicity. "Gentlemen," says Bacon, "nature 
 is a labyrinth, in which tlie very haste with which you move will make 
 you lose your way." 
 
 2, h. The immediate objects of physiology are a critical analysis of 
 
 * Tbe autlior has seen no reason to modifj- this statement, made more than twenty 
 A-ears ago — 1870.
 
 PBELLMINAKY REMARKS. 3 
 
 the vital conditions and results of organic beings, as manifested in 
 different organs, and in tbeir relations to each other. It contemplates 
 organic nature, therefore, in its natural state ; and the laws which 
 it obeys are its highest end. Patholog^y is to the physician the oreat 
 final object of physiology. It investigates the causes which disturb the 
 physiological conditions, and inquires into the phenomena, and the 
 nature of the vital and structural changes. These, in connection, 
 form the ground-work of Therapeutics, which considers the indica- 
 tions to be fulfilled, and the means and the manner by which they 
 are to be accomplished, and nature thus aided in the process of cure. 
 The Materia Medica comes last, and is the subordinate object of all 
 the rest. It investigates the composition and physical character of the 
 material objects by which the therapeutical intentions are fulfilled, and 
 interrogates especially their relations, as vital and alterative agents, 
 to pathological conditions. Disease, being a modification of the phys- 
 iological or natural condition, produces new relations between the 
 properties of life and the natural, morbific, and remedial agents; and 
 these are ascertained by observation of their effects upon morbid 
 states alone. It is thus that remedies become beneficial when thev 
 would be morbific in health; and what is salubrious in health is ren- 
 dered morbific by diseased conditions. The principle is in beautiful 
 harmony %vith the instability of the vital properties ; and the final 
 cause of this instability is the preservation of organic being (^ 133, c, 
 153-156, 63S). 
 
 2, c. Nevertheless, each of the four great departments of medicine 
 possesses so many peculiar characters that they may be severally con- 
 sidered as constituting, to a large extent, distinct parts of one great 
 symmetrical whole (^ 83, c). Pathological conditions could never have 
 been inferred, a priori^ from any extent of physiological inquiries, 
 nor could the effects of therapeutical agents, or the natural termina- 
 tion of disease in health or in death, from any knowledge of anatomy, 
 physiology, or pathology. The whole is originally the Avork of ob- 
 servation ; and we come to learn the relations of the four great 
 branches of medicine by comparing the phenomena which are pre- 
 sented under the various conditions of health and disease, and as 
 these phenomena may be affected by artificial influences. 
 
 Anatomy, however, affords no such standard of comparison. And 
 yet it is obvious, as will more distinctly appear hereafter (§ 83-163), 
 that anatomy is the basis of medicine. It is, however, of the svstem 
 of organic life that I mainly speak. All, at least, that is superficial 
 in animal life, the voluntary- muscles, &c., abstracted from their rela- 
 tions to the organic condition, belongs to the domain of surgerv, and 
 is, therefore, of little importance to the physician. 
 
 2, d. XotAvithstanding, therefore, the foregoing qualifications, it 
 Avill be seen, in our inquiries into the great fundamental points, that 
 the science of medicine is, throughout, a perfectly connected chain ; 
 beginning with the laws which govern the modes in which the ele- 
 ments of matter are combined in org^anic beingfs, — advancingr to the 
 union of organic compounds mto cells and tissues, — to the laws which 
 respect the various processes which are conducted by these tissues, 
 and by the organs into which they are combined, — to those laws as 
 affected by the contingencies of disease, — and, lastly, to the laws 
 which regulate the changes through which the morbid statPK return tc
 
 4 INSTITUTES OF MEDICINE. 
 
 the natural conditions of life. All are connected together by intimate 
 dependencies, and are determined by the natural or by the varying 
 states of the vital properties in their operation through material parts. 
 The ground-work of the whole is, evidently, perfectly simple ; since 
 the laws by which the whole is regulated are established upon the 
 constitution of the organic properties (§ 169,^ 638). 
 
 2, e. To the eye of the philosopher, therefore. Nature, in her or- 
 ganic department, as in every other, appears in an aspect of astonish- 
 ing simplicity, when he contrasts her forces and laws with the diver 
 sity of their phenomena; nor does he confound the principles and 
 laws which distinguish the different departments of nature. To every 
 other eye the phenomena of life appear confused, and seem referable 
 to no common powers or laws. But he who has obtained the key 
 to the true philosophy of life, by a wide observation of nature, lays 
 open at once the apparent secrets of all its results, whether in health 
 or disease. Whatever he sees has its individuality, and stands in re- 
 lief from all the rest. He knows at a glance from whelice this or that 
 springs, how it is related to others, and he traces the whole directly up 
 to a few simple principles. To all but such an eye, however, the 
 phenomena of life, and more especially of life diseased, appear as 
 does a field to all but the botanist. The common observer sees nothing 
 but a confused assemblage of grasses, and probably will tell you there 
 is but one species where the botanist will as instantly discover fifty. 
 Each species has to the latter a distinct individuality, and he cannot 
 regard them in that state of confusion which is seen by the ignorant. 
 He has studied each plant, knows its specific characters, its relations 
 to others, its habits, &c. By these modes of observation he has also 
 acquired the knowledge that nature has pursued a common plan of 
 organization, and linked the whole, by close analogies, throughout the 
 vegetable kingdom. Were the botanist, therefore, to range simulta- 
 neously among the 100,000 species of plants, he would see nothing 
 but individuality, and the greatest simplicity in the principles upon 
 which the whole are constituted. And just so it is with a philosophi- 
 cal observation of the healthy and morbid phenomena of the animal 
 kingdom. 
 
 3, The organic and inorganic kingdoms have, respectively, their 
 peculiar properties and laws. Such as appertain to life, in its nat- 
 ural, as well as morbid aspects, are denoted by an incomparably 
 greater variety of phenomena than those of the external world ; and 
 as their only intelligible foundation is the phenomena evinced, we 
 attain our knowledge of either according to the extent and variety of 
 the phenomena. We know nothing more of matter itself. 
 
 Without a comprehensive knowledge of the properties and func- 
 tions of living beings, and especially of the laws by which they are 
 governed in their healthy and morbid states, the practice of medicine 
 is mere empyricism. The ignorant, alone, undei-value causes and 
 piinciples, and depend upon unconnected facts. 
 
 4, a. In medicine, therefore, we must concern ourselves with some- 
 thing besides effects. We must understand the laws under which 
 they take place, and, as far as possible, trace up the effects to the pri- 
 mary causes. This is always done in other sciences and in the arts. 
 Why, then, should it be neglected in that science whose practical ap- 
 plication relates to the highest welfare of man?
 
 PRELIMINARY REMARKS. 5 
 
 The human mind will have its theories upon all subjects ; and cho 
 whole history of medicine is a perpetual exemplification that in no 
 inquiries do theory and hypothesis abound so universally as in the 
 healing art (§ 819, 960). This arises, m part, from the intricacies of 
 the subject, but mostly so from the constitution of the mind itself. 
 The Almighty designed it for theoretical conclusions, and set us the 
 example in those stupendous theories upon which the universe, and 
 all it contains, are founded. And what else are, or should be, our 
 inquiries and our theories, than finding out and adopting those of 
 which He is the author ] What other theory in the natural world 
 can there be than such as are instituted by the Almighty Being? 
 And shall we hesitate to embrace, and to act upon such theories'? 
 And yet it is one of the pretended improvements of the day to insist 
 upon nothing but facts, and to denounce all principles in medicine ; as 
 if the Almighty had not ordained principles and laws as well as facts, 
 which are mere emanations from the former. 
 
 4, h. The ignorant pretender will tell us that all this is unimport- 
 ant ; though no one is so much directed by hypothesis, or theory, as 
 this very pretender himself (§ 884). Does not every empiric in the 
 land prescribe his drastic cathartics for the purpose of cleansing the 
 blood of its supposed impurities % Are they not exactly on a par, in 
 their doctrines, and in their practice, with the most speculative of our 
 enlightened humoralists % Nay, have the ignorant portion of that 
 sect, our Brandreths, our Morrisons, et id oinne genus, any reference 
 v^rhatever to facts or experience % Is it not all hypothesis, and, there- 
 fore, all a reckless waste of human life \ Mount up the scale, and 
 you shall find at every step of your ascent, from him who prowls about 
 the outskirts of the profession, to him who directs the all-potent drug 
 with the most consummate skill, that each and all rely mainly upon 
 their conceptions of the philosophy of disease. But you shall also 
 find, that in proportion as Nature has been taken for their guide, and 
 as medical principles are founded upon the absolute phenomena of 
 life, in their healthy and morbid aspects, there will always be the 
 greatest reference to facts and experience. 
 
 Hence, again, the importance of looking Avell to our theories, and 
 of seeing that they are established on well-grounded facts, or on the 
 analogy to which they conduct us. Could we, as we cannot, direct 
 the treatment of disease without principles, we never should ; and it 
 should therefore be the business of the practitioner to enlighten his 
 mind upon the philosophy of medicine, or his unavoidable disposition 
 to theorize may prove a scourge to mankind. Of this, indeed, the 
 records of medicine abound with examples (§ 801, h, 819, &c., 960, 
 1005, 1068).— Notes F p. 1114, Ee p. 1133, Ff p. 1135, Gg p. 1138. 
 
 It will therefore be my agreeable task to expose, in these Insti- 
 tutes, the fallacies of the prevailing physical doctrines of life and dis- 
 ease, as well as to inculcate principles which exalt our science above 
 the mere world of matter, render it consistent in all its details, and 
 present it to the profession as a department of knowledge fundament- 
 ally distinct from all other pursuits. — See Rights &c. p. 912. 
 
 Differences of opinion on questions of great moment to mankind 
 are apt to be strongly conveyed, and apparent error to be censured in 
 no measured terms. This, perhaps, is often admissible, considering 
 the obstinacy of error, and so long as it is the doctrine, and not its au-
 
 6 INSTITUTES OF MEDICINE. 
 
 tiior, which is assailed. We may revere the names of Voltaire, of 
 Hume, and of Gibbon, yield them a proud rank in the scale of intel- 
 lect, and gratefully acknowledge the rich legacies they have left be- 
 hind. But, who of us would hesitate to speak of their infidelity ac- 
 cording to its nature and tendencies 1 This is even demanded by 
 what we believe of the jarecepts of religion. And so of the principlen 
 of medicine, which hold as high a relation to the temporal interests of 
 man as do the precepts of religion to his spiritual welfare. The high- 
 est order of intellect is often devoted to the dissemination of error, 
 and perhaps more frequently in religion and medicine than in any 
 other of the great interests of mankind. This must be fully and firm- 
 ly met, not only by evidences of the truth, but by an exposure of its 
 perversions and cori'uptions. 
 
 4^, a. The physiological world has been lately divided into three 
 schools. One of these sects virtually regards organic nature as a part 
 only of inorganic, endowed with the same properties and governed by 
 the same laws. It maintains, in short, that there is no essential dif- 
 ference between a man and a stone. At the head of this school stands 
 Liebig, the distinguished and able chemist. It is a great and power- 
 ful school, but is falling, daily, beneath the weight of its vast ei'rors 
 and corruptions. It is denominated the chemical school of medicine. 
 
 4|, h. Contrasted with this is the school of vitalism, which regards 
 organic and inorganic nature as distinct in their most essential attri- 
 butes. It supposes that each department is governed by properties 
 and laws peculiar to itself. It regards the organic being as funda- 
 mentally distinct from the inorganic in its elementary constitution, in 
 the aggregation of its molecules, in the structure of its parts, in its 
 condition as a whole, and in every phenomenon which it evinces. It 
 sees design in every part of the living being — eloquent even in the 
 dry bones of a skeleton ; a design peculiar to every part, while all 
 concur together to the common ends of the more universal designs of 
 procuring the means of sustenance, of maintaining life, of perpetua- 
 ting the species, &c. On the other hand, this school discerns no cor- 
 responding design in the constitution, or in the condition of inor- 
 ganic matter. It sees nothing here but mere vis inertice, which, 
 however, is supposed by the chemical school to be capable of evolv- 
 ing from simjjle matter every variety of organization, with all its spe- 
 cific designs, even instinct and reason, while, at the same time, we 
 hear from the depth of materialism that " organic nature is the mys- 
 tery of mysteries" — the Creator being the only "mystery" about it. 
 
 Again, the vitalists, in consideration of the facts now stated, main- 
 tain, in the language of Liebig, the gi-eat head of the school of mere 
 physics, " the existence of a principle distinct from all other powers 
 of nature, namely, a vital principle ;^^ which organizes and governs 
 all living beings, and which is the fundamental cause of all their phe- 
 nomena in health and disease. I say, in the language of Liebig, "a 
 principle distinct from all other powers of nature ;" for this mere 
 chemist, in his conflicts with living nature, concedes the existence of 
 such a principle as at the foundation of all vital phenomena, yet, in 
 the same general manner, and on all specific questions where he had 
 introduced its direct and exclusive agency, he as unequivocally de- 
 clares that there is no such principle, and that every result of life and 
 disease, even thought itself, are entirely owing to chemical agenciesi
 
 PRELIMINARY REMARKS. 7 
 
 His whole system, as set forth in his " Organic Chemistry applied to 
 Physiology," and in his "Animal Chemistry" as applied to Pathol- 
 ogy and Therapeutics, is a tissue of similar contradictions, and of the 
 boldest assumptions. Yet, with deep mortification I say it, he has 
 been hailed with an enthusiasm before unknown in the annals of med- 
 icine, as the only true expounder of physiology and of medical phi- 
 losoph3^ The world, however, is fast awaking from its spell-bound 
 delusion, and the doctrines of this " reformer" will soon be mingled 
 with the same and more original chimeras which did their part in 
 "the dark ages of science" (§ 350, 1029, 1030, 1034). 
 
 41, c. Finally, the third school, or that of chemico-vitalism, en- 
 deavors to form, as it were, a bond of union between the schools of 
 pure vitalism, and of pure chemistry ; though such an alliance be as 
 unnatural as human brains in a block of granite. The chemico-phys- 
 iologist makes a compromise with philosoj^hy, and takes for his rule 
 " in medio tutissivius ihis.'" It is as regardless as the school of pure 
 chemistry of the universal consent with which physiology has been 
 hitherto restricted to the condition, functions, results, and laws of liv- 
 ing beings, and chemistry to the condition and laws of dead matter. 
 This school, therefore, mingles the doctrines of vitalism and chemis- 
 try ; allotting to the former one half of the phenomena of life, and the 
 other half to the latter. This is the school to which the young student 
 has the greatest chance of becoming the victim; for it is apparently 
 recommended by the conciliatory principle which I have stated in the 
 form of its motto, and by many of the most distinguished members 
 of our profession. 
 
 4^, d. I have said that it is a remarkable characteristic of the medi- 
 cal school of pure chemistry, that its doctrines are in perfect conflict 
 with each other, as shown in a work (Liebig's "Animal Chemistry") 
 which is assumed as the basis of the chemical philosophy of life — as 
 the great foundation on which the school itself has been erected. 
 And how could it be otherwise, seeing that this school, and this writer, 
 are constantly employed about two subjects which have no affinities ; 
 that is to say, the philosophy of life and the philosophy of chemistry? 
 I shall think it of sufficient importance to substantiate the foregoing 
 fact by many proofs in the course of this work ; and, as an example of 
 the whole, I shall adduce the contradictory views which are put forth 
 upon the most important principles which lie at the foundation of 
 organic life, and at the basis of medical science. On the very subject 
 of a vital principle itself the genius of the school is as flatly contra- 
 dictory as on the most unimportant doctrine ; for at one moment he 
 avows the existence of such a principle " distinct from all other pow- 
 ers of nature," and calls it "the vital principle," which, he says, gov- 
 erns all the processes of living beings (§ 59, 60), and at the next moment 
 he asserts that, " in the animal body we recognize, as the ultimate 
 CAUSE OF ALL FORCE, Only ONE CAUSE, the clicmical action which the 
 elements of the food and the oxygen of the air mutually exercise on 
 each other. The only known ultimate cause of vital force, either in 
 animals or in plants, is a chemical process T 
 
 He renders, as will be seen by ensuing quotations (§ 350), what he 
 assumes as an original fundamental cause of life the indispensable 
 source of another cause, which he avows to be equally original and 
 fimdamental ; and what is yet more indicative of the chaotic state of
 
 INSTITUTES OF MEDICINE. 
 
 the chemical speculations relative to living beings, this author (as I 
 have shown in the Medical and Physiological Commentaries of many 
 others) assumes, at one time, the chemical force to be the sole cause 
 of all vital processes and results, while, at another time, he regards the 
 vital principle as the only power concerned in the same phenomena. 
 It will be gratifying to curiosity, for example, to observe how Liebig 
 entangles his reader, as it respects the physiology of digestion, by 
 making that process to depend on a purely chemical action, and to 
 evolve that vital principle which he as unequivocally declares to be 
 the only power concerned in chymification (§ 350, nos. 3, 17, 51, 58). 
 
 5. Chemical and mechanical philosophy, as we have already seen, 
 are strangers to the philosophy of medicine. There is a natural con- 
 flict between the subjects of each. They have no relationship, no sym- 
 pathies, but caiTy on a pei-petual hostility. The organic being is for- 
 ever converting to its own uses the inorganic, and changing its very 
 nature into its own. The inorganic is fruitless in resistance and in 
 assault, till the former is passive. It then lays waste the fabric by 
 which it had been wrought into a great system of designs, and de- 
 gi'ades the whole to its own level. Chemistry, therefore, begins where 
 physiology ends ; and physiology begins with organic influences upon 
 the elements of matter, or where chemistry leaves off". No depart- 
 ment of medicine has any thing to hope from chemistry beyond its 
 power of analysis (§ 1029, 1030). 
 
 And yet do the labors of chemists aspire at a substitution of the 
 ever-fluctuating principles of chemical science for all that has been 
 hitherto founded upon the phenomena of life and disease. Their oft 
 repeated effort to carry a science which is mainly analytical and me- 
 chanical into that which is eminently intellectual and overflowing 
 with the most sublime institutions, and distinguished by the most pro- 
 found principles and laws of nature, and therefore seductive to an am- 
 bition which is restif under the practical manipulations of the labor- 
 atory, would raise no inquiry as to motive, or end, did not the proper 
 guardians of the science not only abandon their old and rich dom.ain 
 at the very approach of the enemy, but, with most unnatural distrust 
 of self, invite the destroyer (§ 349, d, 433, p. 719, § 960, a). 
 
 The late publication of Liebig's "Animal Chemistry" has abund- 
 antly proved the truth of what I sufficiently established in the '• Med- 
 ical and Physiological Commentaries," that the recent application of 
 chemistry to physiology and medicine is not a partial, but a complete 
 substitution of that science. In justification of all this, we are now 
 told that the means of investigation, of analysis, and of creation, have 
 received an extension of which our predecessors had no knowledge. 
 Such, however, has always been the pretext of chemistry for its inva- 
 sions upon the science of life. Take, for example, the words of 
 Fourcroy, who wrote more than sixty years ago,*and who, like Lie- 
 big and his school, attempted to substitute chemistry for physiology, 
 and to rear up a fabi-ic of medicine upon that imaginary foundation ; 
 and this, too, in the case of either of the masters, without having ever 
 read a medical book, or having ever prescribed for a disease. The 
 language of Fourcroy is exactly such as we now hear from the lips 
 of Liebig and his followers ; who cheerfully allow that nothing flow- 
 ed from the labors of Fourcroy to illuminate the dark ways of or- 
 ganic life (§ 1029, 1080). 
 
 * Now more than eighty years — 1870.
 
 PRELIMINARY REMARKS. 9 
 
 So identical are the language, and ambition, and hope or confi- 
 dence, and the visionary speculations, of the older and recent chem- 
 ists, that a space may be well assigned to this exposure of chemical 
 pretensions. We read, then, in Fourcroy, what we read in the works 
 of Liebig and his cotemporary chemists. Thus : 
 
 " The errors of the chemical physicians of the last century, and the 
 indifference many practitioners of the present time seem to have for 
 chemistry, have produced a disadvantageous opinion in the minds of 
 many persons, which time alone can remove. If the enthusiasm of 
 those physicians, who cultivated chemistry, misled, them, it does not 
 follow that any conclusion can be drawn from thence that may he ap- 
 plied to the present time. The exactness which the moderns have 
 introduced into every part of experimental philosophy ought to re- 
 move the apprehensions of such as, for want of acquaintance with the 
 subject, are apt to imagine that chemistry is still the dark, mysterious 
 science it was a century ago." " It is chemistry alone that can throw 
 any light on the composition of the fluids, and the changes they under- 
 go by the processes that are carried on during life. We cannot avoid 
 having recourse to this science, in our endeavors to discover the true 
 mechanism of the animal functions ; the properties of the fluids separ- 
 ated by the different viscera ; or the alterations such fluids undergo." 
 ♦' It will be necessary to enlarge and multiply these researches on 
 subjects of different age, size, and temperament, in various climates 
 and seasons, and to pursue them among the different classes of ani- 
 mals," &c. " We think it equally necessary to examine the solids, 
 by chemical methods, as well in the sound as in the diseased state, 
 and hy a comparison of their properties, endeavor to discover to which 
 of the fluids they owe their formation ; and this being known, we may 
 proceed to conjecture, in morbific dispositions, the solid or fluid that 
 has suffered a change. 
 
 " If it be thus established that the theory of medicine is capable of 
 receiving the most essential advantages from chemistry, it is equally 
 certain that the practice is no less in need of the same assistance ; 
 since both must of necessity accompany each other, and are promoted 
 by the same means." " Nothing can be more evident than that the 
 choice of aliments, and of air, cannot be made with any certainty, but 
 in consequence of chemical researches into the nature of foods, and the 
 properties of the atmospheric fluid" (§ 18). — Fourcroy's Medical 
 Chemistry, 1782.— Also, Appendix § 1028-1030, 1034, Lehmann. 
 
 I have said, in the Commentaries, that " a prosperous harvest" was 
 promised from Fourcroy's reformation. But, again I reiterate, where 
 is the evidence ? since which time, also, chemistiy has made greater 
 advances than any other science, has had its unmolested sway, and 
 Fourcroy's example has been followed with a corresponding diligence. 
 Can you point to a solitary instance in which organic chemistry, ex- 
 cept in a negative sense, has advanced the science of life or disease ? 
 Do not the veiy chemists of this day incidentally allow the perfectly 
 abortive nature of their science in relation to physiology and medi- 
 cine ] Consult the quotations in section 350, b, 1, &c., and 350^— 
 3503-. Or take the affirmations of the distinguished Mulder (§ 350f), 
 which go, with the rest, to establish the truth of my former assertion, 
 that " chemistry has been a perfect incubus upon medicine; and the time 
 is not distant when it will have proved, by its own shotving, its want of
 
 10 INSTITUTES OF MEDICINE. 
 
 relation to our subject, if it have not done so already.'" — Commtat., voL 
 i., p, 586, note. — See Appendix § 1028-1030. 
 
 5i, a. I agree with the chemical physiologist that "facts are slub- 
 bovn things," and, with the analogy which reposes upon them, are 
 at tV.e foundation of all philosophy ; but it does not equally follow 
 that facts are always philosophically or even honestly applied, nor 
 that he who devotes himself to the laboratory is the best qualified to 
 apply his own facts to organic natui'e. " Wc can have no very high 
 idea of experiments made by gentlemen," says Hunter, " who, for 
 want of anatomical knowledge, have not been able to pursue their 
 reasoninf even beyond the simple experiment itself" Least of all 
 can the chemist be permitted to charge upon the vitalist a neglect of 
 chemical facts ; since it is as well by these as by the phenomena of 
 life that the vitalist overthrows the artificial system (§ S50-350|). 
 Nor let it be forgotten that it is purely by an appeal to certain false 
 analogies, and by a disregard of the phenomena of living beings, that 
 the physical and chemical hypotheses of life and disease have obtained 
 their ascendency (§ 733, d). 
 
 All our theories and principles in medicine, it cannot be too often 
 reiterated, should rest upon well-ascertained facts. The great diffi- 
 culties with which truth has had to contend since the restoration of 
 the proper method of observing nature consists in the mistaken nature 
 of facts, or of false conclusions from admitted facts. What is often 
 assumed to be fact is just otherwise, and, where the premises are 
 sound, they have frequently led to spurious theories (§ 350^-3503, 
 433, &c., 493, 823, &c.). 
 
 5i, h. The phenomena of nature are the facts about which all phi- 
 losophy is concerned, and therefore form the substantial ground of all 
 intellectual acquirements. As they relate to organic beings, to their 
 laws, their properties, their functions, whether morbid or healthy, 
 they are to be found in the organic being himself, not in the work- 
 shops of the chemist or of the mechanical philosopher. But, even 
 where the mind admits this proposition, if prone to speculation, it too 
 often regards each fact by itself, and rears up hypotheses wrong in 
 themselves, and in conflict with each other. Facts should therefoi^e 
 be compared before they are reduced to theory ; or, where they may 
 conflict with acknowledged principles they should remain in an iso- 
 lated state till their true nature may be better understood, or till the 
 principles which they appear to contradict may be shown to be erro- 
 neous. Should some fact, for example, appear to indicate the depend- 
 ence of life upon chemical or any other physical forces, the evidence 
 to the contrary is so various and conclusive, that that fact must be 
 considered as deficient in some of its elements, which, if known, would 
 readily bring it under a well-established principle in physiology. 
 These absent elements are some other facts which escape our obser- 
 vation ; and thus what is truly fact, in an abstract sense, is made the 
 ground-work of important error. 
 
 5^, c. It is the peculiar misfortune of science to generalize too 
 hastily ; and it often happens that the explosion, or the introduction, 
 of one error, is the parent of many others. It is also astonishingly- 
 true that a few phenomena are abstracted from the whole, of which 
 they may bo only sequences of the others, and are made the ground 
 of conflicting doctrines, and substitutes for the theories that are insli-
 
 PRELIMINARY REMARKS. 11 
 
 tuted upon the more fundamental facts ; and thus a blind disregard 
 of consistency is permitted to prevail till a most incongruous series of 
 assumptions, as in Liebig's Animal Chemistry, is presented to us as 
 the science which Nature teaches. 
 
 Again, there is a proneness of the human mind to admit of no real- 
 ities but such as make a strong demonstration upon the senses; and 
 hence it is that the physical and chemical philosophers of life prefer 
 the facts of the laboratory to such as are supplied by organic beings. 
 The former are therefore assumed as the foundation for principles 
 and laws in physiology and medicine ; and when it is considered how 
 large a proportion of mankind have not the ability to distinguish the 
 true from the false, especially when the latter is set forth in a confi- 
 dent and dogmatic manner, it ceases to be remarkable that what is 
 comparatively simple, and comes plausibly recommended by the tangi- 
 ble and visible attributes of matter, should command their confidence 
 beyond those realities which can be appreciated only by an exercise 
 of the understanding in connection with the revelations of sense, and 
 which form the ground-work of principles of difficult penetration. 
 There are few, indeed, who ai'e capable of reasoning beyond their 
 senses and the facts themselves, and this is equally true of the chem- 
 ist, both as to the facts of the laboratory and the phenomena of living 
 beings, whenever he attempts an exposition of the properties and laws 
 of a department of nature which lies not within his sphere of investi- 
 gation. " Truth, whether in or out of fashion, is the measure of 
 knowledge and the business of the understanding. Whatever is be- 
 side that, however authorized by consent or recommended by variety, 
 is nothing but ignorance or something worse'* (§ 1034). 
 
 5i, d. It cannot but be conceded, that, as knowledge advances, and 
 the subjects of inquiry become more or less exhausted, ambition is 
 likely to depart from an observation of nature to seek gratification 
 and renown in artificial expedients. This is"" becoming a prevailing 
 propensity in medicine; and many have left, and are leaving, the bul- 
 wark of knowledge to rear up hypotheses upon distortions of nature, 
 which, for their better success, they dignify by the name of " experi- 
 mental philosophy" (§ 1085).— Note Pp p. 1142. 
 
 51, e. In medicine, at least, there is but one kind of experimental 
 observation, which consists in the simple study of the phenomena of 
 nature. Or, if art be applied to give them a fuller development, the 
 means must be such as shall elicit results conformable to the institu- 
 tions of nature. But aside from chemistry, it has been the fatality of 
 the physiological department of medicine to have been encumbered 
 with rude experiments, giving the wildest distortions to the features 
 of nature. When we consider the wonderful susceptibility of the 
 properties of life, how readily their actions and results are influenced 
 by natural agents, how a drop of hydrocyanic acid, or of the alcoholic 
 extract of nux vomica, applied to the tongue of an animal, will ex- 
 tinguish life in an instant ; or that the same may be done by thrust- 
 ing a needle into the medulla oblongata ; or how concentrated mias- 
 ma may almost as instantly induce an attack of fever ; or how a little 
 excess in eating may bring on an attack of apoplexy as immediately 
 fatal as a blow on the region of the stomach — fatal, perhaps, in either 
 case, as the aitillery of the clouds ; or how simple irritations of a 
 nerve may be followed by death from tetanus ; or how all the veg-
 
 12 INSTITUTES OF MEDICINE. 
 
 etable and animal poisons, as well as all things else which do not pos- 
 sess natural relations to the properties of life, will variously change 
 those properties and all their results, — when, I say, we consider all 
 these things, we may well imagine the difficulty of imitating nature by 
 the most cautious experiments, or of developing her laws by mutila- 
 ting the structure of organic beings, or of illustrating those modifica- 
 tions which spring up in disease, by resorting to processes which are 
 foreign to natural influences. Even the greatest experimentalist in 
 modern times, he who has performed more vivisections than any 
 other man, has placed it upon record, that it is one of the most diffi- 
 cult things in physiology to perform an experiment that shall not be 
 liable to objection. Yet no man ever ventured more hastily upon 
 conclusions from such experiments, and none has thrown gi'eater ob 
 stacles, in consequence, in the way of physiology and pathology. 
 
 ^\,f' The limits which restrain the interposition of art are very 
 narrow: and whenoraranic nature is brouijht under the influence of arti- 
 ficial causes with a proper reference to these limits, the resulting phe- 
 nomena may form a safe ground of reasoning as to the laws by which 
 organic beings are governed. Much has been accomplished, in this 
 way, as to the physiological connections of the nervous system with 
 organic actions, the part which it takes in the morbid processes, the 
 sympathetic communications which it establishes throughout the or- 
 ganization, and the interpretation which it supplies of the operation 
 of remedial agents. Nevertheless, the most important part of our 
 knowledge upon these great and intricate questions is abundantly 
 supplied by the natural phenomena of life, as manifested under the 
 varying conditions of health and disease. And that this is so, is suffi- 
 ciently evident fi-om the fact, that but Yittie practical information of the 
 foregoing nature has been added, by recent experiments, to what had 
 been known centuries ^ago. The late experiments, however, upon 
 the nervous system have confirmed what had been deduced from the 
 more natural process of observation, and have developed some useful 
 facts which it might have been impossible to have known by any 
 other method. Such, for example, is the difference of function be- 
 tween the component parts of the spinal nerves ; one part being de- 
 signed for the transmission of sensation and sympathetic influences, 
 the other for the operation of the will and the development of motion. 
 And yet, if analogy were allowed its proper weight in physiological 
 inquiries, as it must be in reality the great basis of medical science, — 
 if there had been less pertinacity as to the necessity of abstract facts 
 for every conclusion, we might have come, by a process of analogy 
 founded upon ultimate facts, to a knowledge of the constitution of 
 the compound nerves. This could have been inferred from their 
 complex functions as evinced by their phenomena, and by associating 
 them with the simple elements of cerebral nerves, where it is 
 plainly seen that some of the nerves have, individually, a specific 
 function, and whose phenomena are destitute of complexity. 
 
 5i, a. But the reign of " experimental philosophy" which so lately 
 appeared in the mutilations of animals to discover their natural func- 
 tions ; in the injection of corrosive and putrid substances into the cir- 
 culatory apparatus of animals to illustrate the pathology of human 
 disease; in the transfusion of remedial agents into the same order of 
 beings, and even into plants, to asceitiin the virtues of remedies, their
 
 PKELIMINARY REMARKS. 13 
 
 modus operandi as curative agents, and the right treatment of human 
 maladies, has given place to an " experimental philosophy" in which 
 organic life has no participation. This is the " philosophy" against 
 Avhich the observer of nature is now called upon to contend; fraught 
 with far greater evils than the spiyrious systems which it has so sud- 
 denly surprised and superseded. It is impossible to calculate the 
 mischief which must result to mankind from its unrestrained popular- 
 ity. Something may be gathered from its former effects when chem- 
 istiy was young ; and something from the progress of error under the 
 fresh spur of Liebig's Animal Chemistry (§ 350-350|, 821). We all 
 know how common the enthusiastic belief that this " Reformer" had 
 overthrown all former systems in every department of medicine ; and 
 we may take the following editorial passage from the London Lancet 
 as expressing a very common opinion of the profession as to the ap- 
 plication of chemistry at the bedside of disease : 
 
 "As organic chemistry marches on the basis of an improved system 
 of medical practice," says the veteran editor, " it will prove impera- 
 tive that a rigorous examination of the products of the animal frame, 
 the several humors and excretions of the body, should be employed in 
 the investigation of disease. The period approaches when it will be 
 incumbent on us, not perhaps invariably, but still very often, in pre- 
 scribing, — say, for typhus, or purpura, or any of the numerous vari- 
 eties of cutaneous affections, that by a chemical analysis we should first 
 ascertain the constituents and proportions of the proximate elements 
 of the urine, the saliva, the expired breath, the perspired matter, per- 
 haps the blood, the faeces of the patient, before applying our remedies; 
 and this process may have to be gone through not once only, but sev- 
 eral times in the progress of the malady." " The time is, we repeat 
 it, approaching when the foundation op practice on the laws of 
 Organic Chemistry will form the distinction between the enlight- 
 ened physician and the mere pretender" (§ 851, 863, e; 883, h).— 
 London Lancet, April 2^, 1843. (Also, § 1029, 1030.) 
 
 5i, h. In the foregoing quotation we have essentially what is now 
 extensively denominated " the progress of medical science," and the 
 nature of the doctrines to which these Institutes are opposed. These 
 Institutes will be found mainly, so far as physics are alleged to be 
 concerned, by the side of all the most illustrious physiologists from 
 Hippocrates to us, whose general views are thus summarily express- 
 ed by Bichat : 
 
 " The organic chemistry of the laboratory," says Bichat, " is the 
 dead anatomy of the fluids, not a physiological chemistry. The 
 physiology of the fluids should be composed of the innumerable 
 variations which they experience according to the different (vital) 
 states of their respective organs." " The instability of the vital pow- 
 ers is the quicksand on which have sunk the calculations of all the 
 physicians of the last hundred years. The habitual variations of the 
 living fluids, dependent on the instability of the powers of life, one 
 would think, should be no less an obstacle to the chemical physicians 
 of the present age." 
 
 " Again, had physiology been cultivated by men before physics, I 
 am persuaded that many applications of the former would have been 
 made to the latter. Rivers would have been seen to flow from ihe 
 tonic action of their banks, crystals to unite from the excitement
 
 14 INSTITUTES OP MEDICINE. 
 
 which they exercise upon their reciprocal sensibilities, and planets 
 to move because they mutually irritate each other at vast distances. 
 All this would appear unreasonable to us, who think of gravitation 
 only in consideration of these phenomena. And why should we not, 
 in fact, be as ridiculous when we come with this same gravitation, 
 with our chemical affinities and chemical compositions, and with a 
 language established upon their fundamental data, to treat of a sci- 
 ence with which they have nothing whatever to do ]" — Bichat's Gen- 
 eral Anatomy and Physiology. 
 
 6. We may now readily perceive the reason why, chemistry has 
 undergone changes within a few years, while all that relates essen- 
 tially to the properties and laws of organic beings may have been 
 long since known. The chemist operates, and makes all his discov- 
 eries, through the forces and laws of inorganic matter. These he 
 may carry into his laboratory, turn into his test glasses, or involve in 
 his crucible. He can therefore oblige nature to form the same inor- 
 ganic compounds as she forms spontaneously. He can then separate 
 the elements again, and again oblige nature to recombine them after 
 their original manner. But, can he do the same thing with organic 
 beings ? He cannot form the most simple organic compound — can- 
 not even recombine the elements when they are once separated ; — 
 although he has then the necessary elements, and in their exact pro- 
 portions. The reason is obvious. The chemist has not at his com- 
 mand in this case, as in the other, the necessary powers ; or, as the 
 chemist expresses it, " he cannot place them in the same circumstan- 
 ces as Nature does." 
 
 It is clear, therefore, that while the laboratory is the proper place 
 for the study of the inorganic kingdom, we must go to the organic 
 being itself to learn the nature of the powers and laws by which it is 
 governed. These, then, are the reasons why the laws of organic be- 
 ings have been long so much better understood than those of chemis- 
 try. Every thing is artificial in the laboratory, so far as experiments 
 are concerned ; and, if these be not the right ones, or be imperfectly 
 conducted, they will either fail to represent nature correctly, or will 
 give her a wrong interpretation. Hence the great instability of this 
 science ; and yet we are told that every new theory in chemistry is 
 applicable to physiology and medicine. 
 
 But, it is quite otherwise with organic beings. Here all the ex- 
 periments are carried on by Nature herself, and they cannot deceive. 
 The various results and phenomena are seen in the being itself, and 
 can be seen nowhere else. They must, therefore, be the true guide, 
 and the only guide, to the powers and laws by whicli organic beings 
 are governed. These phenomena, too, are astonishingly multiplied 
 in any given being, and new ones are presented as the being may 
 come under new influences. But, this variety is extended almost to 
 infinity when we consider that every distinct species of plants and 
 animals has its peculiar manifestations of life. It is also true that 
 each one of this endless variety is utterly different from any of the 
 phenomena of the inorganic world. And when we take all the phe- 
 nomena of organic beings in connection, and find a perfect harmony 
 among the whole, the nature of the proof is so various and immense 
 as to conduct us to a right knowledge of the principles and laws of 
 life in all their aspects.
 
 PHYSIOLOGY. 15 
 
 Now all this variety has been perpetually before the observation 
 of mankind, and always presented to our observation by nature her- 
 self. It therefore ceases, I say, to be remar-kable that the science of 
 life had so greatly outstripped that of chemistry ; and it will proba- 
 bly forever remain better understood ; since nature is the experi- 
 menter in one case, and man in the other. 
 
 PHYSIOLOGY. 
 
 7. The sensible world is composed of animate and inanimate be- 
 ings, which, with their difference in composition and structure, has led 
 to their division into the organic and inorganic or mineral kingdoms. 
 
 8. The relations between the two gi-eat kingdoms of nature, and 
 their conti-adistinctions, render a general reference to the inorganic 
 indispensable to our physiological and higher branches of inquiry. 
 
 9. Animals and plants, wliich make up the organic kingdom, are 
 essentially dependent on the inorganic ; but the latter kingdom is per- 
 fectly independent of the organic. 
 
 10. The beginning of organization is in plants, which are the pri- 
 mary source of nourishment to animals. 
 
 11. From the foregoing law arises the great fundamental distinc- 
 tion between plants and animals — that the former subsist on the ele- 
 ments of matter, while the latter are nourished by those elements in 
 an organic state. It appears, therefore, that vegetables are more 
 creative than animals (§ 303). 
 
 12. All organic substances are compounds of the simple elements 
 of matter. They are combined by the vital powers, while inorganic 
 compounds are produced by chemical forces. 
 
 13. As organization begins in vegetables, it is obvious that a de- 
 compounded organic substance can be restored to an organic state 
 only by that vegetable kingdom which was created for the specific 
 purpose of organizing the mineral Icingdom, for the ultimate final 
 cause of supplying food to animals. The plant reduces, the animal 
 consumes (§ 303).— Notes N R pp. 1121, 1123. 
 
 14. a. If an animal compound be decompounded, the reunion of 
 the elements into an animal substance requires the agency of both 
 vegetable and animal organization ; and, not only so, but nothing can 
 reproduce any given animal compound but the precise part of the 
 same species of animal which gave origin to the part so decompound- 
 ed (§ 12).— Note R p. 1123. 
 
 14, b. Owing to this universal law, by which the animal is rendered 
 so perfectly dependent on the vegetable kingdom, the Creator has 
 given a striking perfection to the grand design in the institution of 
 an invisible world of animalcula for the cfmsumption of that vast pro- 
 portion of organic matter which is passing through the process of 
 maceration to its elementary state. Thus airested by these econo- 
 mists of nature, it advances through an ascending series of animals, 
 till, at last, it becomes the food of man (§ 151, 1052). 
 
 The foregoing distinction is fundamental in nature ; and hore, at 
 the very threshold, we are met by a barrier which the chemist and
 
 16 INSTITUTES OF MEDICtNE. 
 
 physical philosopher cannot pass from one side, nor the pihysiologist 
 from the other (§ 1052). 
 
 14. c. I may also say, that it is no small proof of a Creator, that the 
 elements of all combinations which are generated by animals and 
 plants are derived from the inorganic kingdom, which will be allowed 
 to be less productive than the organic. And since, especially, no or- 
 ganic being can generate any elementary substance, nor the ele- 
 ments unite, of themselves, into organic compounds, it follows that 
 the whole was created by a Being of greater power. "We can go no 
 farther back than the elements of matter. Here the atheist himself 
 pauses in dismay. They proclaim a God, and reason submits to this 
 limit of its powers. 
 
 I may also propose another, and perhaps greater proof of the en-or 
 of spontaneous generation. The kingdoms of nature are governed by 
 inherent powers, and the organic possess powers peculiar to them- 
 selves ; but the existence of matter, whether organic or inorganic, is 
 also indispensable to their respective forces.- These forces, therefore, 
 did not create matter ; and since matter cannot create matter, and 
 therefore did not create itself, it follows that its associate powers did 
 not create themselves. Whence it is obvious that some greater Power 
 exists by which the powers of nature were created in union with 
 matter (1079 &, 1083, 1085).— Notes Pp p. 1142, aQ p. 1145. 
 
 These arguments, therefore, may be taken in connection with those 
 which I formerly adduced for the purpose of exposing the fallacy of 
 the doctrine implied by Carpenter, Pritchard, Fletcher, and others, 
 by assuming that the vital properties exist in the elements of matter, 
 and that, therefore, the elements are capable of arranging themselves 
 into organic beings. (See my Exainination of Reviews, p. 37, and 
 my Notice of Revieics. Also, § 1051, 1052.) 
 
 15. Exact analyses are readily made of mineral compounds, and 
 the elements may be recombined into the same or other mineral com- 
 pounds. 
 
 The precise analysis of the most simple organic compound, solid or 
 fluid, as fibrin or albumen, is very difficult, and always liable to doubt. 
 
 16. Excepting the earths, plants subsist upon the atmosphere and 
 what it contains (§ 303) ; but they immediately derive much of their 
 nourishment from decaying organic substances that are incorporated 
 with the soil. But, before such compounds can be appropriated by 
 plants, they must be resolved into their elementary state. They can 
 be taken into the organization of plants only in the condition of min- 
 eral substances ; and even then the most simple binary compound 
 must be decompounded before organization can begin. All the re- 
 combinations, as constituting parts in the vegetable economy, are es- 
 sentially unlike any substance in the mineral kingdom. 
 
 17. If animal organization resolve an organic compound into a min- 
 eral condition, such compound is useless in the animal economy (§ 13, 
 14). There is never present, therefore, in the animal organization, 
 as a part of, or as a source of supply to that organization, any mineral 
 substance (§ 360). Whatever mutations the materials of supply may 
 undergo, they must always exist in an organic state, or be permanent- 
 ly restored to the mineral kingdom. — Notes N R pp. 1121, 1123. 
 
 18,,.«. We learn from the foregoing premises (§ 17), that food does 
 not lose its organic state during the process of digestion ; and since it
 
 PHYSIOLOGY. 17 
 
 becomes more and more nearly assimilated to the living solids fi'om 
 the earliest action of the gastric juice, it is evident that chemical 
 agencies have no connection with the transformations to which it is 
 subjected in the alimentary canal (§ 350-376). 
 
 18, h. Hence, also, the fallacy of attempting, by chemical analysis, 
 to indicate the proper sustenance of man and animals. " To deter- 
 mine^'' says Liebig, " what substances are capable of affording nour- 
 ishment, it is only necessary to ascertain the composition of the food, and 
 to compare it with that of the ingredients of the bloods He then pro- 
 ceeds to a practical application of this principle by setting forth the 
 chief elements of the blood. The difficult subject, also, of identifying 
 hay with the flesh of animals, and all the vegetable substances which 
 enter the human stomach with the various tissues of the body, is so 
 far disposed of as to require no other interposition between the nutri- 
 ment and its conversion into living animal compounds than the chem- 
 ical forces. This chemical doctrine is thus set forth by Liebig : 
 
 " The most recent and exact researches have established as a univer- 
 sal fact, to which nothing yet knoion is opposed, that the nitrogenized 
 constituents of vegetable food have a composition identical xoith that of 
 the constitxients of the bloods — Liebig's Animal Chemistry. 
 
 18, c. And such, too, is a common example not only of the assump- 
 tions of this writer, but of that positive manner which has inspired 
 such universal confidence (§ 3501-3505). There are, of course, in 
 nitroo^enized vegetable food certain combinations more or less analo- 
 gous to what are called the constituents of the blood, though never 
 the same, and but comparatively few in many that are appropriate as 
 means of nourishment ; nor could it be doubtful that the elements of 
 the flesh and blood of animals subsisting on vegetables must exist in 
 their food. But the identity of elements in any given vegetable and 
 animal compounds is very different from identity of compounds, and 
 this, too, with every imaginary latitude of the isomeric and polymeric 
 problems. Nor have any two chemists agreed, as yet, in their analy- 
 sis of blood, or of any animal compound ('J 1029, 1030,). 
 
 But we have from the laboratory most ample admissions of the 
 groundless nature of the preceding statement. Thus, again, Liebig : 
 
 " As far as our researches have gone, it may be laid down as a law, 
 founded on experience, that vegetables produce, in their organism, 
 compounds of proteine; and that out of these compounds of proteine 
 the various tissues and parts of the animal body are developed by the 
 VITAL FORCE, icith the aid of the oxygen of the atmosphere and of the 
 elements of water. 
 
 " Now, although it cannot be demonstrated that proteine exists 
 ready formed in vegetable and animal products, and although the dif- 
 ference in their properties seems to indicate that their elements are 
 not arranged in the same manner, yet the hypothesis of the jne-exist- 
 ence of proteine, as a point of departure in developing and comparing 
 their properties, is exceedingly convenient. At all events, it is certain 
 that the elements of these compounds assume the same arrangement 
 wJien acted on by potash at a high temperature''* ! ! — Liebig'? Animal 
 Chemistry. 
 
 Nor is this the end of the contradiction ; for we also read in the 
 same work, that 
 
 " We cannot, ir.deed, maintain that the animal organism has no 
 
 B
 
 18 INSTITUTES OF MEDICINE. 
 
 power to form other compounds, for we know that it is capable of 
 producing an extensive series of compounds, differing in composition 
 frowj the chief constituents of the blood" (§ 409, b, and 53, b). 
 
 But, if the foregoing quotations be conclusive of the specific inqui- 
 ries before us, the following admitted facts not only establish the same 
 conclusions, but prove that chemistry is entirely incompetent to any 
 one of its pi'etensions as to a proximate analysis of the blood, or of 
 other organic compounds, and that it is strictly limited to a mere ele- 
 mentary decomposition, while they also concede the existence of a 
 vital principle as an " immaterial" governing power, wholly different 
 from any attribute of inorganic nature, and therefore render it certain 
 in another aspect, that the chemist, from want of this agent, can,, at 
 most, only effect the elanentary analysis of organic compounds. Thus, 
 then, the organic chemist : 
 
 " If the problem to be solved by organic chemistry be this, namely, 
 to explain the changes which the food undergoes in the animal body; 
 then it is the business of this science to ascertain what elements must 
 be added, what elements must be separated, in order to effect, or, in 
 general, to render possible, the conversion of a given compound into 
 a second or third ; but we cannot expect from it the synthetic proof 
 of the accuracy of the views entertained, because every thing in. the or 
 ganization goes on under the influence of the vital force, an immate- 
 rial AGENT ivhicJt the chemist cannot employ at will" — Liebig's An- 
 imal Chemistry. 
 
 18, d. If we now tuni to section'409, b, we shall there find that it 
 is in the blood alone that the reputed proximate principles of vegeta- 
 bles are assumed to exist, and that many proximate compounds ars 
 allowed by the chemist to be elaborated from the blood to which 
 there is nothing at all analogous in the vegetable kingdom, or even in 
 the blood itself 
 
 This, then, is the sum of the whole subject: 1st. The chemist hashia 
 favorite doctrine of digestion, as an important foothold for material- 
 ism, forever present, to be extended as far as the obscurities of the 
 subject will admit, and to borrow an apparent confirmation from these 
 predicated assumptions. The absolute amount of that doctrine is 
 thus expressed by Liebig: 
 
 " In the natural state of the digestive process, the food only under- 
 goes a change in its state of cohesion, becoming fluid without any 
 other change of properties." — Liebig's Animal Chemistry. 
 
 2d. Now, the food undergoing no other change " in the digestive 
 process" than that of becoming" fluid," it is the easiest matter to find 
 it all in the blood just as it was taken into the stomach, — vegetable as 
 well as animal ; while, in so finding it, a pretended confinnation is set 
 up of the " universal fact, to which nothing yet known is opposed, 
 that the nitrogenized constituents of vegetable food have a compo- 
 sition identical with that of the blood," and vice versa. Or, as Liebig 
 also has it, " vegetables produce in their organism the blood of all 
 anitnals" (§ 350, no. 76). 
 
 But, 6d. We are assured by chemists, that nothing is more diffi- 
 cult of analysis than the blood, even as it respects its elementary com- 
 position; while it is well known that the analyses of this fluid are 
 always discrepant. Hence the impracticability of instituting unex- 
 ceptionable comparisons between even the elementary composition of
 
 PHYSIOLOJ3Y. 
 
 19 
 
 " In the natural state of the 
 digestive process, the food 
 only undergoes a change in 
 its state of cohesion, becom- 
 ing fluid without any other 
 change of properties." — Lie- 
 big's Animal Chemistry. 
 
 blood and the nitrogenized constituents of plants ; while the very 
 nature of the chemical influences exerted upon a vital compound of 
 17 or 18 elements vi^ith a view to its analysis is conclusive of the arti- 
 ficial condition of all the chemical compounds which may be thus 
 fymed out of the homogeneous fluid. And so Lehmann, ^ 1029, 1030. 
 
 Again, 4th It is finally said that many substances elaborated from 
 the blood are utterly difterent from any thing discovered in plants, or 
 in the blood itself (§ 409, h). Here, the composition of the organic sub- 
 stances being simple, readily leads to an exposure of the assumptions 
 which have taken refuge under the greater difficulties, and obscu- 
 rities, and disagreements, attending the analysis of the most complex 
 substance known in nature {§ 53). 
 
 18, e. But we shall see, farther on, that the chemical school main- 
 tain, through their principal chief, those doctrines of digestion, to 
 suit other hypotheses in organic chemistry, which are fundamentally 
 opposed to each other, and which I shall now arrange in connection, 
 that the reader may see, at a glance, not only the speculative nature 
 of organic chemistry, but the feebleness of the assumption as to the 
 identity of the blood and the nitrogenized constituents of plants 
 Thus : 
 
 B. 
 
 " The VITAL FORCE CAUSES 
 
 A DECOMPOSITION of the con- 
 stituents of food, and destroys 
 the force of attraction which 
 is continually exerted be- 
 tween their molecules. It 
 alters the direction of the 
 
 CHEMICAL FORCES in SUch 
 
 wise, that the elements of 
 the constituents of the food 
 arrange themselves in an- 
 other form, and combine to 
 produce 7iew compounds. It 
 forces the new compounds 
 to assume forms altogeth- 
 er DIFFERENT from those 
 which are the result of the 
 attraction of cohesion when 
 acting freely, that is, without 
 resistance." — Liebig's Ani- 
 mal Chemistry. 
 
 It will be therefore seen by the quotations B and C, that the state- 
 ment is admitted to be a mere assumption ; while it necessarily fol- 
 lows, by adopting either of the contradictory statements, B or C, 
 that the veo^etable substances undergo a radical chana;e during: the 
 process of digestion, and, therefore, that we cannot find those sub- 
 stances in the blood, but their elements, only, in new and peculiar 
 combinations. The differences, indeed, are probably often much 
 greater than between calomel and corrosive sublimate (§ 3501). 
 
 What, also, gives to the whole of this subject its proper interpre- 
 tation is the parallel which is drawn by Liebig between the assimila- 
 tion of the most virulent poisons and the most appropriate food, as 
 set forth in Section 350, Nos. 41 and 42. The looseness of the clos- 
 ing sentence of No. 41, abstracted from all the surrounding evidence 
 of hypothesis, is abundantly conclusive of the conjectural natui'e of 
 the whole of this pretended mathematical demonstration. 
 
 There is no difliculty, however, in comprehending the source of 
 the mistake which honest chemists have made in attempting, by 
 
 C. 
 "The most decisive ex- 
 periments of physiologists 
 have shown that the process 
 of CHYMiFiCATioN is inde- 
 pendent of the vital force ; 
 that it takes place in virtue 
 of a PURELY chemical ac- 
 tion, exactly simitar to 
 those processes of decom- 
 position or ti'ansformation 
 which are known as putre- 
 faction, fermentation, or 
 decay." — Liebig's Animal 
 Chemistry.
 
 20 INSTITUTES OF MEDICINE. 
 
 chemical analysis, to indicate the proper sustenance of man and ani 
 mals. It lies in a wrong conception of the economy of vegetable 
 life, and thence reasoning from a mistaken coincidence of princi- 
 ples, which exist in the two departments of the organic kingdom in 
 a strikingly modified state, to their more analogous results {§ 1^, 
 13-17).— Notes N R pp. 1121, 1123. 
 
 Since, however, plants subsist upon mineral substances, in their 
 elementary state, the chemist may often successfully indicate those 
 inorganic or organic compounds which will yield to any given species 
 of plant (whose general elementary composition may be known) the 
 elements that go especially to its nutritive economy. But, from a fun- 
 damental distinction between plants and animals (§ 11, 13-17), it is ob- 
 vious that no such thing can be done in relation to the latter. No 
 better practical proof of this can be wanted than the perfectly indiges- 
 tible nature of many compounds which contain the requisite elements. 
 Such compounds, upon the chemical philosophy, as I have said, and 
 as admitted by Liebig, include many virulent poisons in the vege- 
 table kingdom, and many inorganic substances whose binary com- 
 pounds embrace numerous elements. We need not, indeed, go any 
 farther than the recent experiments by Dr. Beaumont upon the va- 
 rieties of food, as will be subsequently noticed (366), and Magendie's 
 analogous experiments with the food of animals,* to show that the 
 whole of this subject must be left to natural experience. 
 
 Nor does it appear to have occurred to the chemical physiologist, 
 in the foregoing inquiries, that the elementary composition of animals 
 is greatly alike, at least in all mammalia. It should follow, there- 
 fore, upon the chemical philosophy, that the practical distinctions 
 should not exist between the food of man and animals, but that a 
 common diet should be as universally adapted as atmospheric air. 
 To this conclusion it may be also added, that the same chemical phi- 
 losophy refers chymification to a purely chemical pi'ocess ; or, in the 
 language of Liebig, " it takes place in virtue of a purely chemical 
 action, exactly similar to those processes of decomposition or trans- 
 formation which are known ?i& putrefaction, fervientation^ or decay y — 
 Animal Chemistry^ p. 16. And since, therefore, chymification is 
 " independent of the vital force" {ibid.), and as chemistry identifies 
 the gastric juice of man and quadrupeds, and even the chyme, it is 
 obvious that chemistry can predicate nothing, upon this subject, of 
 any difference in the vital constitution of man and animalst (§ 409, 
 350, d). 
 
 19. In respect to their general structui'e, inorganic bodies are ho- 
 mogeneous, organic beings heterogeneous. This applies as well to 
 the elementary constituents in their modes of combination as to the 
 compound structure of the whole being. Each particle of a mineral 
 compound is as much a whole as the gi-eater mass, and has the same 
 combination of elements. Each element is as perfect as the com- 
 jiound conditions. Animals have muscles, glands, nerves, vessels, 
 &;c., with an endless variety in the elementary combinations in the 
 same individual. All these parts are necessary to make a whole, and 
 depend, mutually, upon each other for their existence. The same 
 
 * See Medical and Physiological Commentaries, vol. i., p. 697, &c. 
 t See my article on the foregoing subject in the Boston Medical and Surgical Journal 
 December 27, 1843.
 
 PHYSIOLOGY. 21 
 
 general principle is applicable to plants. Nevertheless, apparent ex- 
 ceptions occur in both animated kingdoms, as in ])arts of many plants 
 and of polypi. But, in these instances, each part possesses essential- 
 ly the whole apparatus of organic life. 
 
 20. Organic beings grow from within by interstitial deposition of 
 molecules derived from the blood or sap, according to the exact na- 
 tui'e of each part. Inorganic bodies do not grow, but increase only 
 by a superficial juxtaposition of parts, which may, also, be wholly 
 unlike the original crystal, or other nucleus, in their elements. 
 
 In the process of growth and nutrition the new material is con- 
 veyed within from without, and subjected to many specific changes, 
 till it is resolved into one homogeneous fluid. Atmospheric air is 
 also indispensable to all organic beings, Thex'e is nothing analo- 
 gous in the inorganic world ; while these, and an endless series of 
 other facts, establish the similitude of the organic life of plants and 
 animals. 
 
 21. A peculiar action of certain agents upon the whole organism 
 of plants and animals, called vital stimuli, entirely unlike the action 
 of chemical agents, is necessary to the growth and existence of or- 
 ganic beings. They are both internal and external, and give rise to 
 all the phenomena in organic life, and maintain the whole in one ex- 
 act condition ; while the action of agents upon inorgaisic, or on dead 
 organic, substances, does not elicit one of these multifarious phenom- 
 ena (§ 74, 1881). 
 
 22. Every part of an animal or vegetable is forever distinguished 
 by the same vital phenomena and physical results ; and the action of 
 vital stimuli is forever the same on each part, respectively, but, 
 like the vital phenomena and physical results, different in each ; the 
 whole being liable to invariable modifications at different stages of 
 life, and according to temperament, and according, also, to every 
 other modifying influence. 
 
 23. Unlike inorganic bodies, organic beings require the coexist- 
 ence of solids and fluids in their composition. 
 
 24. All organic beings have the power of generating motion within 
 all their parts. Mineral compounds have no such endowment. If 
 motion take place in their internal constitution, it depends upon in- 
 fluences which have no existence in living beings. Nor is this all ; 
 for motion is always generated in living beings by the operation of a 
 power implanted in their constitution, and this power is brought into 
 action by the mind, and by internal and external physical agents. 
 
 25. The solids and certain fluids of organic beings act upon each 
 other. But the fluids act only upon the organic properties of the 
 solids, while the solids transmute the most important fluid into their 
 own substance. The stimulant action of the blood upon the organic 
 properties, and the reaction of the solids upon the blood, are design- 
 ed for a common end. The concurrence of the whole fabric is ne- 
 cessary to these, as to all other, results. There is nothing analogous 
 in the mineral kingdom. 
 
 26. When external or internal agents produce motion in organic 
 beings, they do not affect the composition, in the natural state. It is 
 quite otherwise with inorganic or dead organic compounds. 
 
 27. Organic beings are perpetually subject to a vital decomposition 
 and removal of old parts, while the old are exactly replaced by new
 
 22 INSTITUTES OF MEDICINE. 
 
 ones. It is essential to mineral compounds that they remain without 
 change. Any disturbance of their molecules deranges their structure 
 or composition. 
 
 "While, therefore, inorganic compounds are forever the same, or- 
 ganic beings are subject to an unceasing loss of identity as respects 
 their present component parts. 
 
 28. The external foi-ms of plants and animals are variously and 
 greatly contradistinguished from those of inorganic bodies. The 
 condition of one, also, is uniform ; that of the other, even when crys- 
 talized, is vat'iable. 
 
 29. " The only character," says Muller, " that can be possibly 
 compared in organic and inorganic bodies, is the mode in which sym- 
 metry is realized in each ; that is to say, the character which miner- 
 als possess in their state of crystalization." Yet there is not, in this 
 respect, the slightest analogy ; since no true organic compound ever 
 approaches the condition of a crystal. Here we may trust the au- 
 thority of Liebig, who says of the "vital principle of the animal 
 ovum, as well as the seed of a plant," that, 
 
 " Entering into a state of motion or activity, it exhibits itself in the 
 production of a series of forms, which, although occasionally bounded 
 by right lines, are yet widely distinct from geometrical forms, such as 
 we observe in crystalized minerals. This force," he goes on, " is the 
 vital force, vis vitae, or vitality." 
 
 30. The foregoing considerations, each and all (§ 8-29), demon- 
 strate a radical difference between the forces and laws of organic and 
 inorganic beings, and a remarkable modification of such as are com- 
 mon to plants and animals. But, as the institutions of organic life lie 
 at the foundation of medical science, they should be still farther 
 sought in the contradistinctions between the organic and inorganic 
 kingdoms, and in those diversified phenomena which indicate a com- 
 mon but modified government of animals and plants. All organic- 
 beings possess in common the most essential conditions of life, though 
 existing in the two great departments of living nature under specific 
 modifications or varieties ; not, how^ever, very dissimilar, but inti- 
 mately connected by a gradation of analogies, as we descend along 
 the chain of either, till we arrive at their more absolute connecting 
 link in the lowest being of one and the other. Other conditions are 
 superadded to the nobler dej^artment, which, with the differences of 
 structure and the modifications of their common properties of life, and 
 their modes of subsistence, distinguish the two living kingdoms from 
 each other. 
 
 31. Physiology may be divided into, 1st. The composition of or- 
 ganic beings ; 2d. Their structure ; 3d. Their properties ; 4th. Their 
 functions ; 5th. Modifications of properties and functions which arise 
 from sex, temperament, climate, habits, age, &c. ; 6th. The relations 
 of organic beings to external objects ; 7th. Death. 
 
 These several topics will be considered with a special view to the 
 great principles which form the Institutes of Medicine.
 
 PHYSIOLOGY.- — COMPOSITION. 23 
 
 FIRST DIVISION OF PHYSIOLOGV. 
 
 COMPOSITION. 
 
 32. The principal object contemplated by this work in ascertaining 
 the facts relative to the composition of organic beings is to settle the 
 principles and laws upon which such beings are constituted, by tracing 
 them out in the fundamental conditions of organic matter. 
 
 33. Composition is subdivided into ultimate or elementary, and the 
 proximate parts; the latter being compounded of the former. 
 
 34. Of the sixty-six known elementary substances, the following 
 seventeen have been found in the composition of plants : carbon, oxy- 
 gen, hydrogen, nitrogen, potassium, calcium, ii'on, manganese, phos- 
 phorus, sulphur, silicium, magnesium, aluminum, chlorine, sodium, 
 iodine, bromine. 
 
 35. The same elements (34), with the addition of fluor, and the 
 probable exception of aluminum, occur in animals. Arsenic is also 
 often found in man.* Although animals are exposed to various 
 sources from which other elements might be derived, they reject ev- 
 ery other elementary principle ; or, rather, are incapable of their 
 assimilation. — Notes N R pp. 1121, 1123. 
 
 36. The foregoing coincidence in the common nature of the ele- 
 ments of plants and animals supplies no small proof of the peculiar 
 properties and laws of organic beings. Others, however, more stri- 
 king, lie at the foundation, and form, also, contradistinctions with the 
 inorganic world. 
 
 37. Animal and vegetable substances are mostly composed of car- 
 bon, oxygen, hydrogen, and nitrogen, four out of the sixty-six ele- 
 ments that go to the formation of inorganic compounds. The main 
 bulk of plants, indeed, such as the cellular and vascular tissues, is 
 probably composed of carbon, hydrogen, and oxygen alone, as the 
 essential elements ; though nitrogen is indispensable to many of the 
 products of vegetable organization, and Liebig says it is found in all 
 parts of a plant (§ 62, y, note). The three or four indispensable ele- 
 ments compose 90 or more parts of 100 of all the soft textures of an- 
 imals, and of all plants. These are selected, universally, by the veg- 
 etable kingdom, as if by instinct. This circumstance increases great- 
 ly the force of the conclusion in the foregoing section (§ 36). 
 
 38. The elements of mineral compounds are always united in a 
 binary manner ; those of organic in a ternary, quater-nary, &c., being 
 always intimately blended with each other. This distinction involves 
 an absolute difference in the powers and laws of the two kingdoms. 
 
 39. No two elements, therefore, can form a true organic compound. 
 The rare exceptions which have been made by the chemists are not 
 organic substances, nor can they be rendered such by the animal or- 
 ganization. They belong to the mineral kingdom, from which they 
 cannot be elevated but by the properties of vegetable life (§ 14, 16, 17). 
 
 All mineral compounds may be resolved into their elements, which 
 are as perfect minerals as when united. Indeed, the most natural con- 
 dition of a mineral is the state of a simple element. 
 
 * Whence coiri« Uio fluor aiid the arsenic, unless through plants? ($ 14-18.)
 
 24 INSTITUTES OP MEDICINE. 
 
 40. What, therefore, is so fundamental in oi-ganic beings as ex- 
 pressed in sections 38 and 39, and universally admitted, allows of no 
 introduction of powers, principles, laws, &c., which shall conflict with 
 the poweis and laws upon which the simplest organic compound is 
 constituted.* In the progress of this work it will be seen that this 
 position is every where substantiated. Unity and harmony prevail 
 throughout each department of nature, respectively ; and while the 
 powers and laws of the organic are as fully contradistinguished from 
 those of the inorganic kingdom as are their physical and all other attri- 
 butes, we shall find that the former are apparently embarrassed by a 
 great diversity of phenomena as manifested in health and disease, but 
 that, in reality, all the variety goes to the conclusion that the funda- 
 mental principles are the same throughout (§ 638, 733, d). 
 
 41. Again, we may suppose at least some 20,000,000 of distinct or- 
 ganic compounds in the various species of plants, and some 30,000,000 
 more in the animal kingdom, formed greatly out of four elements 
 (§ 37), wliile these same elements yield scarcely a dozen combina- 
 tions in the mineral kingdom. 
 
 42. The foregoing organic compounds are formed in each individ- 
 ual, respectively, out of one common homogeneous fluid, composed of 
 about seventeen elements. No chemical hypothesis can interpret 
 this universal characteristic of the organic kingdom ; while all the 
 relative facts of inorganic chemistry are totally opposed to this almost 
 endless and undeviating variety of new combinations out of a common 
 fluid, according to the species of animal or plant, and according to the 
 nature of every particular part. If chemical agencies operated, there 
 would be no uniformity in any secreted product at any two successive 
 moments (§ 741, b, 1052). 
 
 It is one of the frequent concessions of the distinguished chemico- 
 vitalist, Miiller, that 
 
 " The opinion that the component principles of the organs exist in 
 the blood in their perfect state cannot be possibly adopted. The com- 
 ponents of most tissues, in fact, present, besides many modifications 
 of fibrin, albumen, fat, and ozmd.z.omG, other perfectly peculiar matters, 
 nothing analogous to which is contained in the blood." " Even the 
 fibrin of muscle cannot be considered identical with the fibrin of the 
 liquor sanguinis." — Muller. — So, also, Lehmann, § 1029-1031. 
 
 John Hunter also laid down the following doctrine, as expressed by 
 his editor, Mr. Palmer : 
 
 " It is highly probable that the different proximate principles of 
 vegetable and animal substances hold different ranks in the scale of 
 organized substances, in the same manner that one animal ranks high- 
 er in the scale of organized beings than another." — Huntek. 
 
 And thus Liebig, as a vitalist, in opposition to himself, as a chemist : 
 
 " In that endless series of compounds, which begins with carbonic 
 acid, ammonia, and water, the sources of the nutrition of vegetables, 
 and includes the most complex constituents of the animal brain, there 
 
 is NO BLANK, NO INTERRUPTION. TlIE FIRST SUBSTANCE CAPABLE OF 
 AFFORDING NUTRIMENT TO ANIMALS IS THE LAST PRODUCT OF THE CRE- 
 ATIVE ENERGY OF VEGETABLES." — Liebig's Animal Chemistry. 
 
 * Since the foregoing sentence was written, tlie new doctrine of the " Correlation of 
 Physical and Vital Forces" has induced Chemistry to exalt a multitude of its fabrica- 
 tions out of inorganic substances to the condition of organic compounds. But this will 
 probably soon "mark a past epoch in Organic Chemistry." See Note 1>f p. 1150; 
 also LiiiLMANX, p. 779-782.
 
 rKYSIOLOGY. COMPOSITION. 25 
 
 43. Although it be generally true that it is the wonderful province 
 of organization to elect only four elements from the homogeneous fluid 
 (§ 42) in the formation of organic compounds, yet there are some com- 
 pounds which embrace a greater number, though unlike the elements 
 of inorganic compounds, in intimate union with each other (§ 38). 
 The blood, indeed, has not less than seventeen or eighteen elements 
 thus united; a circumstance in itself conclusive that other powers than 
 the chemitial must preside over the elaboration of the very limited 
 number of elements that go uniformly to the formation of all other 
 organic compounds. And, although the metallic and earthy sub- 
 stances form no part of the essential organs of life, they are yet 
 vitally united with the indispensable organic compounds in particu- 
 lar parts, and are elaborated from the blood or sap by those parts 
 only, and with an astonishingly relative proportion to the other 
 elements, as sulphur by the brain, phosphate of lime by the bones, 
 fluate of lime by the teeth, phosphate of magnesia by wheat, silex by 
 the stem of wheat, and by the skeletons of many poriferi, &c. We 
 shall not regard these substances as accidental, or as introduced by 
 a physical process, but, as contributing a subordinate part with the 
 essential organic elements toward the perfection of an unfathomable 
 system of Designs, whose moving power is only short of the Creative 
 Energy, in being substituted for that Great First Cause, with limita- 
 tions that chain it to the fulfillment of secondary ends (§ 847). 
 
 44. Organic compounds are forever the same, in health, in any given 
 part of any species of being at each stage of existence, but liable 
 to be moi"e or less modified in an exact manner at the several stages 
 (§ 153-159). 
 
 And so of disease. The same morbid state of any given part, ccete- 
 ris paribus, always produces the same modifications of the organic 
 compounds of which it may be composed, the same alterations of the 
 secreted fluids, and the same new formations. All this is distinctly 
 seen in the phases of scrofula, in small-pox, cow-pox, lues, measles, hy- 
 drophobia, &c. 
 
 It is opposed, to all facts, that any chemical influences can decom- 
 pound a fluid composed of seventeen or eighteen elements, not only in 
 the exclusive manner represented in the last section, but according, 
 also, to the exact vital constitution or vital modification of each part, 
 
 45. Nevertheless (§ 44), the general composition of animals is the 
 same, whether they subsist upon grass, or flesh, or whatever be the 
 nature and variety of the food. So of the chyme, the chyle, and the 
 blood. There is nothing in chemistry that will throw any light upon 
 these coincidences (§ 18, 409). 
 
 46. Contrary to what has been seen of the variety of organic com- 
 pounds out of four simple elements (§ 41), only a few hundred, at most, 
 of distinct inorganic compounds can be formed out of the 66 elements 
 which compose the mineral kingdom (§37). Those few compounds, 
 however, make up the great mass of the globe, while the organic are 
 only scattered over its surface. Nor is there a globe in the universe 
 that would not be as worthless as space, did it not administer to the 
 purposes of life. 
 
 47. Different combinations of carbon, oxygen, hydrogen, and nitro- 
 gen, constitute, mainly, the whole vegetable and animal materia medi-
 
 i26 INSTITUTES OF MEDICINE. 
 
 ca; while their inorganic compounds do not contribute one remedial 
 agent of any importance. 
 
 48. It is evident that the four principal elements of organic com- 
 pounds combine not only in different proportions, but so variously, in 
 respect to the proportions, among themselves, as to bevv'ilder the 
 imagination (§41). Chemistry can give us no light upon these sub- 
 jects but what is purely analytical ; while, in respect to their mineral 
 compounds, the same elements unite only in a small number of pro- 
 portions, upon which chemistry throws its light with a brilliancy that 
 may be said to penetrate the unfathomable recesses of their organic 
 compounds. This fundamental distinction is necessarily conceded ; 
 and it were well for science if chemistry did not overstep the limit. 
 But, the chemist shall always speak for himself. Thus Liebig : 
 
 " 6 eq. tartaric acid, by absorbing 6 eq. oxygen from the air, 
 form grajje sugar, with the separati(jn of 12 eq. carbonic acid. We 
 can explain, in a similar manner, the formation of all the component 
 substances of plants, which contain no nitrogen, whether they are pro- 
 duced from carbonic acid and water, with separation of oxygen, or by 
 the conversion of one substance into the other, by the assimilation of 
 oxygen and separation of carbonic acid. We do not know in lohat 
 form the froduction of these constituents takes place. In this respect 
 the representation of their formation which we have given must not he 
 received, in an ahsolute sense, it being intended only to render the na- 
 ture of the process more capahle of comprehension. But, it must not be 
 forgotten, that, if the conversion of tartaric acid into sugar, in grapes, 
 he considered a fact, it must take place vmder all circumstances in the 
 same proportions'''' ! — Liebig's Organic Chctnistrij applied to Physi- 
 ology. 
 
 The reader should never lose sight of the foregoing hypotheses 
 and admissions. They should be ever ready to chasten his credulity 
 as to the chemical interpretation of every organic compound. They 
 stamp the whole " science of organic chemistry," in its synthetical 
 aspects, as one of pretension, and' unworthy the confidence of an intel- 
 ligent mind (§ 350-350^). 
 
 And this is farther confirmed by the statements in the two next 
 following sections. 
 
 49. " The particles of matter," says Liebig, " called equivalents in 
 chemistry, are not infinitely small, for they possess a weight, and are 
 capable of arranging themselves in the most various ways, and of thus 
 forming innumerable compound atoms. The properties of these 
 compound atoms differ in organic nature, not only according to the 
 form, but, also, in many instances, according to the direction and 
 place which the simple atoms take in the compound molecules. 
 
 " When we compare the composition of organic compounds with 
 inorganic, we are quite amazed at the existence of combinations in 
 one single molecule, of which ninety or several hundred atoms or 
 equivalents are united. Thus, the compound atom of an organic acid 
 of very simple composition, acetic acid, for example, contains 12 
 equivalents of simple elements ; 1 atom of kinovic acid contains 33 ; 
 1 of sugar, 36 ; 1 of amygdalin, 90 ; 1 of stearic acid, 138 equivalents. 
 The component parts of animal bodies are infinitely more complex 
 even than these." — Liebig's Organic Chemistry, &c. 
 
 »50. " Inorganic compounds differ from oi'ganic in as great a degree
 
 PHYSIOLOGY. COMPOSITION. 27 
 
 in their other characters as in their simplicity of constitution. Thus, 
 the decomposition of a compound atom of sulphate of jaotash is aided 
 by numerous causes, such as the power of cohesion, or the capability 
 of its constituents to form solid, insoluble, or, at certain temperatures, 
 volatile compounds with the body brought into contact with it ; and, 
 nevertheless, a vast number of other substances produce in it not the 
 slightest change. Now in the decomposition of a complex organic 
 atom there is nothing similar to this." — Liebig's Organic Chemistry . 
 &c. 
 
 51, "An essential distinction between organic and inorganic com- 
 pounds is, that in organic products the combining proportions of their 
 elements do not observe, as in mineral compounds, a simple arith- 
 metical ratio." 
 
 52, An interesting corollary flows from the foregoing facts (§ 22, 
 41-50), namely, that all animal and vegetable poisons, all remedial 
 agents of an organic nature, and all the varieties of food, depend upon 
 the mode and proportions in which a few particular elements 
 unite with each other. It is evident, also, from § 41, that uo two re- 
 medial agents generated by different species of plants or animals, 
 however similar, can be exactly alike in their morbific or remedial 
 virtues. Hence the differences among cathartics, emetics, &c. As 
 composition, especially of the sap, also varies more or less at the dif- 
 ferent ages of plants and at diflerent seasons, and also from unhealthy 
 conditions, so will corresponding differences arise in their remedial 
 and morbific virtues. In all the cases, however, the characteristics of 
 organic products as vital agents are uniformly the same under any 
 given condition of the organic being; and so of each simple element, 
 and of the physiological effects of all vital agents (§ 188^, d). The 
 precise natural or morbid states of the organic properties lie at the 
 bottom of the whole philosophy, since these properties, through their 
 instruments of action, combine the elements exactly according to their 
 existing state (§ 650, 741 5, Note Fff p. 1150). 
 
 53, a. From the facts now stated (§ 38-51), it is evident that the 
 organic chemist can do no moi'e than effect an analysis of organic 
 compounds. He can only present each simple element by itself, 
 without the possibility of acquiring a knowledge of the modes and 
 pi'oportions in which they combine with each othei*. 
 
 53, b. So, also, if the aggregate compounds, such as blood, sap, 
 muscle, gastric juice, &c., be, in reality, made up of more simple 
 compounds, or " proximate principles," by the union of compound 
 atoms, chemistry can give us no information as to the conditions in 
 which they naturally exist. Those combinations which are most 
 alike are different from each other in eveiy distinct part of the or- 
 ganic being, and different in the same parts of distinct species. This 
 is so from the first development of the germ ; and what is then begun 
 is perpetuated through the life of the individual, and transmitted to all 
 succeeding generations (§ 63-81 , 1 55). The differences, as we have 
 seen, result from the different proportions in Avhich some three or 
 four principal elements are itnited together, and from the proportions 
 of different compound atoms which may enter into the entire combi- 
 nation, and from the manner in which they and their elements are 
 combined among themselves. It must be obvious, therefore, that we 
 can never reach the secret of these combinations. We should neces-
 
 28 INSTITUTES OF MEDICINE. 
 
 sarily expect, even from the shades of elementally distinctions, that 
 chemistry would confound and even identify many compounds that 
 are totally unlike in their nature. And this it actually does, in pre- 
 senting to us sugar, vinegar, starch, gum-arabic, wood, &c., as the 
 same substance ; and in identifying pus and cheese, and, again, the 
 albumen of eggs, lymph, mucus, and the pi'oduct of certain cancerous 
 affections. Nor is there generally any agreement among the chem- 
 ists in their analyses of organic compounds. It is as true now, as 
 when Bostock (a chemical physiologist) affirmed, ih^t " every subse- 
 quent attempt to discover the elements of organized substances differs 
 moi'e or less from those that preceded it" (s^ 1029, 1030). 
 
 The moment chemical agencies begin their operation, artificial 
 transformations necessarily ensue, and the nature of the organic com- 
 pound is changed in a corresponding manner. A large proportion of 
 the resulting products are perfectly new formations, particularly all 
 , tliG binary compounds (§ 38, 39). Nor can there be any doubt that the 
 reputed " proximate principles" are intimately incorporated in any 
 given compound, and have no such separate existence as chemistry 
 teaches. It lies at the very basis of chemistry, that all the elaborations 
 ax'e the artificial results of affinities which have been set in motion by 
 the agents employed, and which are employed for that very purpose. 
 This I have already endeavored to demonstrate in the Medical and 
 Physiological Commentaries (vol. i., p. 674-682), even so far as to 
 show that urea may not be formed by the kidneys, but is the result 
 of spontaneous changes after the elaboration of urine, as it is of 
 artificial influences (§ 54, a). But, attentive observation will gen- 
 erally detect the chemist in the admission of facts which are subver- 
 sive of his speculative doctrines (§ 18, 350) ; and so it is in the case 
 before us. The admission covers the whole ground as to the preten- 
 sions of organic chemistry beyond the most simple elementary anal- 
 ysis. Thus (Note Fff p. 1150), 
 
 53, c. " Were we able to produce taurine and ammonia directly 
 out of uric acid or allantoine, this might perhaps be considered as 
 an additional proof of the share which has been ascribed to these 
 compounds in the production of bile. It cannot, however, be viewed 
 as any objection to the views above developed on the subject, that 
 with the means we possess, we have not yet succeeded in effecting 
 these transformations out of the body. Such an objection loses all its 
 force, when we consider that we cannot admit, as proved, the pre-ex- 
 istence of taurine and ammonia in the bile; nay, that it is not even 
 PROBABLE that those compounds, which are only known to us as the 
 products of the decomposition of the bile, exist ready formed, as 
 ingredients of that fluid. By the action of muriatic acid on bile, we, 
 in a manner, force its elements to unite in such forms as are no 
 longer capable of change under the influence of the same re-agent." 
 — Liebig's Animal Chemistry. 
 
 By the admissions, also, in § 18, 42, and 350, it will be seen that 
 the Utopian nature of organic chemistry is equally established in all 
 its pretensions by its own founders and advocates (§ 1030). 
 
 54, a. Organic substances alone undergo fermentation and putre- 
 faction ; and this shows us, also, in the language of Tiedemann, that 
 " even when the life of organic bodies is extinct, we should consider 
 the qualities which they possess, from the time of death to the com
 
 PHYSIOLOGY. COMPOSITION. 29 
 
 plete resolution of organization, asfthe result of the vital powers 
 which have been active in them." 
 
 This obvious principle conducts us at once to the whole philoso- 
 phy of those numerous transformations of which organic compounds 
 are susceptible from chemical agencies, while they still retain their 
 elementary combinations, and appear under uniform aspects when 
 subjected to the same chemical influences, and often analogous to the 
 natural condition of the compound. " It is the power of formation," 
 says Tiedemann, " which, after the extinction of the individual life of 
 organized bodies, renders the organic matters, separated from their 
 organization, capable, provided they have not been reduced to their 
 elements by external physical or chemical actions, of assuming new 
 and more simple forms, according to the diversity of external in- 
 fluences, such as heat, light, water, &c., which determine them in 
 taking on this new form. This power appears, therefore, to be a prop- 
 erty inherent in organic matters in general, rendering them able to 
 take other more simple configurations when detached from the com- 
 binations of living bodies" (§ 1029, 1030). 
 
 Some organic compounds undergo transformations of the foi'egoing 
 nature as soon as separated from the organic being. The homo- 
 geneous blood is immediately reduced into three principal compounds, 
 which have no natural existence as such. Nor is this all; for there 
 is a fundamental change among the elements and the compound 
 atoms of the entire mass. The changes arise from the loss of the 
 vital properties, and the subsequent operation of chemical influences. 
 Such, too, is the constitution of organic compounds that there may 
 be a remarkable uniformity in the resulting products when the same 
 chemical agents operate upon any given compound ; as exemplified 
 in the various transformations to which sugar is liable, and as seen in 
 the uniform production of morphia, narcotina, quinia, cinchonia, &c. 
 
 54. I). It is obvious, however, from the premises which I have set 
 forth, that chemistry can, at most, present but a few compounds as appa- 
 rently distinct from each other in their elementary composition; for, al- 
 though there are many millions of these distinct combinations in organic 
 beings (§ 41), they commonly possess such analogies that chemistry 
 is obliged to confound all but a few which have strong characteris- 
 tics. These few, which are denominated proximate principles, are 
 supposed by the chemist to make up the entire composition of organic 
 beings. But, a greater proportion even of these few are so inscruta- 
 bly different from each other in their elementary combinations, that 
 they are classed under common denominations, not only for the fore- 
 going reason, but on account of certain resemblances in their physical 
 properties ; while it is by these last, and by their differences in re- 
 sults as vital agents, we come to know that broad distinctions may 
 exist among them. Such, for example, are the various acids, oils, 
 resins, &c. — Note Fff p. 1150. 
 
 55. All organic substances, while endowed with life, resist the de- 
 composing influences of all surrounding agents. All inorganic com- 
 pounds yield to these influences. 
 
 56. As soon as organic beings are dead, the very agents that had 
 contributed to their growth and nourishment now become the causes 
 of breaking up their elementary combinations, and with a rapidity un- 
 known in the ordinary decomposition of mineral compounds. In the
 
 30 INSTITUTES OF MEDICINE. 
 
 former case, it is allowed by Dlebig, that the " vital principle op- 
 poses to the continual action of the atmosphere, moisture, and tem- 
 perature, upon the organism, a resistance which is in a certain degree 
 invincible^ 
 
 57. In the seed and ovum the properties of life are in a state of ac- 
 tion which maintains their elementary combinations against the chem- 
 ical forces. They resist degrees of cold which operate destructively 
 upon their composition when their life is extinct. Those agents, too, 
 as heat and moisture, which speedily resolve the eg^ and seed, when 
 deprived of life, into their ultimate elements, will in the same de- 
 grees of intensity develop from the germ, when alive, a perfectly 
 organized being. In the former case the operation of the principle of 
 life is generally mistaken for " a force in a state of rest.'" Thus, Lie- 
 big : 
 
 " In the animal ovum, as well as in the seed of a plant, we recog- 
 nize A CERTAIN REMARKABLE FORCE, the SOURCE of grOWth, S>CC.,aforce 
 
 in a state of rest ^ — Liecig's Animal Chemistry, first sentence. See, 
 also, my Examination of Reviews, p. 7-28. 
 
 58. It follows, therefore, that the power which resists the decom- 
 posing forces and agents in living beings combined the elements of 
 such beings, and that death is an extinction of that power. The chem- 
 ical forces can have no connection with the combinations, since they 
 are held together by a power in direct composition to '"hemical influ- 
 ences. 
 
 What, therefore, unites the elements and maintains them against 
 the action of chemical agents, being the fundamental power, must ne- 
 cessarily preside over all the processes and results to which organic 
 beings are liable. 
 
 59. " The elements of dead organic matter," says Liebig, in his Or- 
 ganic Chemistry, " seem merely to retain passively the position and 
 condition in which they had been placed." " The atoms exist only 
 by the vis inertice of their elements." So, also, Mulder, § 350|, n, and 
 other chemical physiologists. This shows that the original union is 
 effected by other powers than the chemical, which, otherwise, woiild 
 still operate after death, and prevent decomposition. We also thus 
 learn why dead organic compounds so readily undergo fermentation 
 and putrefaction, and from the slightest influences. All of which, 
 indeed, appears to be abundantly conceded by the chemical philoso- 
 pher when he yields to the force of facts. For what can be more 
 ample than Liebig's aflSrmation, that 
 
 " The VITAL FORCE is manifested in the form of resistance, inas- 
 much as by its presence in the living tissues, their elements acquire 
 the power of withstanding the disturbance and change in their form and 
 composition, which external age^its tend to produce ; a ]}Otver,which, 
 as chemical compounds, they do not possess.^' — Liebig's Animal Chem- 
 istry. 
 
 And yet again may I press into the service of truth the organic 
 chemist, when he temporarily loses sight of the laboratory, and con- 
 tradicts those speculations which impart to his writings the zest of 
 novelty. In his Lectures for the winter of 1844, Liebig appeal's to 
 have been alarmed for the safety of his empire, and we have here an 
 unusual amount of " vitality." 
 
 The work on Anitnal Che?nistry applied to Pathology a?id Thera-
 
 PHYSIOLOGY. COMPOSITION. 31 
 
 peutics wus more of a distillation froin the laboratory than its prede- 
 cessor, Organic CJiemistnj applied to Physiology ; and, as many of 
 the most eminent physiologists in Europe, who were inclined to min- 
 gle chemistry with vitalism, were nauseated by the dose which was 
 last administered, Liebig came out in his Lectures with the following 
 placebo for the vitalists, and the chemico-vitalists. Were it not con- 
 tradicted by the lecturer, it should place him in the very front rank of 
 vitalism. The doctrines are of the most fundamental nature, and lie 
 at the basis of these Institutes, and of my " Medical and Physiological 
 Commentaries." It will be seen that they are strictly relative to my 
 present subject, and inculcate all that the most transcendental vital- 
 ist can desire as to the distinct nature oj" tJic vital j^rinciple, its full con- 
 trol over the processes of life, its extinction at death, and an absolute 
 distinction hetiveen vital and chemical j^rocesses and results, tvJiHe those 
 frocesses and results are, respectively , referred to forces of a totally dis- 
 tinct nature. Thus : ' 
 
 "After the extinction of the vital principle," says Liebig, " in or- 
 ganic atoms, they maintain their form and properties, the state into 
 which they have been brought in living organisms, only by reason of 
 their inherent inertia. It is a great and comprehensive law of matter, 
 that its particles possess no self-activity, no inherent power of origin- 
 ating motion, when at rest ; motion must be imparted by some exter- 
 nal cause ; and, in like manner, motion once imparted to a body can 
 only be ari'ested by external resistance. 
 
 " The constituents of vearetable and animal substances havinq-been 
 formed under the guidance and power of the vital j)rincij)le, it is this 
 principle which determines the direction of their molecular attraction. 
 The vital principle, therefore, must be A motive power, capable of 
 imparting motion to atoms at rest, and of opposing resistance to other 
 forces producing motion, such as the chemical force, heat, and elec- 
 tricity. We are able to reliquefy and redissolve albumen, after it had 
 been coagulated by heat, but the. vital principle alone is capable of 
 restoiing the original order and manner of the molecular arrangement 
 in the smallest particles of albumen. Coagulated albumen is again 
 converted into its original form, it is transformed into flesh and blood 
 in the animal organism. — Notes N R pp. 1121, 1123. 
 
 " In the formation of vegetable and animal substances, the vital 
 principle opposes, as a force of resistance, the action of the other 
 forces, — cohesive attraction, heat, and electricity, — forces which ren- 
 der the aggregation of atoms into combinations of the highest order 
 impossible, except in living organisms. 
 
 " Hence it is, that when those comjjlex combinations which consti 
 tute organic substances ai'e withdrawn from the influence of the vita 
 force, — when this no longer is opposed to the action of the other dis- 
 turbing forces, great alterations immediately ensue in their properties. 
 and in the an-anojement of their constituents. The sliojhtest chemical 
 action, the mere contact of atmospheric air, suffices to cause a transpo- 
 sition of their atoms, and to produce new arrangements ; in one word 
 to excite decomposition. Those remarkable phenomena take plac( 
 which are designated by the terms fermentation, putrefaction 
 and decay ; these are the processes of decomposition, and their ulti 
 mate results are to reconvert the elements of organic bodies into thai 
 Rtate in which they exist before they participate in the processes of life."
 
 32 INSTITUTES OF MEDICINE.- 
 
 The reader, however, will be more astonished to learn that he h&s 
 not discovered, amid the multitude of conflicting statements and doc 
 trines, a passage in the work on Animal Chemistry which, even more 
 than the preceding, identifies " the Reformer" with the most exclu 
 sive vitalists, and completely annuls all his chemical and physical 
 speculations as to organic life, and his radical distinctions between 
 plantsand animals (§ 350, nos. 12, 15,20). It will be also seen with 
 what pretense he has been denominated " the Reformer,^' and " tlic 
 author of a neiv and the greatest era in physiology ^ The extract in- 
 culcates the doctrines of an independent vital principle, its identity 
 in plants and animals, the action of stimuli upon that principle, its 
 susceptibility of influences from the nervous power in animals, the 
 absence of that influence in plants, and the dependence of all organic 
 processes and results, equally in plants and animals, upon that piin- 
 ciple. 
 
 Now these are exactly the doctrines which are also fundamental 
 throughout the Medical and Physiological Commentaries and these 
 Institutes. They are relative to the constitution and processes of 
 organic beings as a whole, while the foregoing quotations from Lie- 
 big's Lectures comprehend the principles by which I have interpret- 
 ed the elementary condition of organic bodies. Thus our author : 
 
 " The activity of vegetative life manifests itself in vegetables, ?tf?YA 
 the aid of external influences ; in animals, hy means of influences pro- 
 duced within the organism. Digestion, circulation, secretion, are, no 
 douht, under the influence of the nervous system; hut the force which 
 gives to the germ, the leaf and the radical fihres of the vegetable the 
 SAME WONDERFUL PROPERTIES, is the SAME as that residing in the se- 
 creting memhranes and glands of animals, and which enables every 
 animal organ to perform its own proper functions." — Liebig's Ani- 
 mal Chemistry. 
 
 60. " The diversity of the transformations and of the resulting 
 products," says an able advocate ©f Liebig's physical doctrines of 
 life, " indicate most certainly the complexity of an organic product" 
 (§ 41). " The metamorphoses which occur after organic substances 
 are rexnowedi from the influence of the vital force, constitute a separa- 
 tion, or splitting up into new and less complex compounds" (§ 54). — 
 Mr. Ancell, in London Lancet, Nov. 26, 1842. 
 
 Thus, again and again, does the chemical physiologist unavoidably 
 concede that the elements of organic beings are held together by a 
 vital principle, and, therefore, that they are originally united by that 
 principle. — Note Fff p. 1150. 
 
 Vitalism becomes established in all its aspects, even in what has 
 been denominated " transcendental vitalism," when it may be shown 
 that the elements of organic beings are, in the language of Liebig, 
 "united by a peculiar viode of attraction, resulting from the existence 
 of a pjoiocr distinct from all other j^owers of nature, namely, a Vital 
 Principle :''^ since, as I have said, the powers and laws which regu- 
 late the composition must be at the foundation of all the subsequent 
 results. Concessions of fundamental principles overthrow all oppos- 
 ing "facts," and all secondary doctrines of a conflicting nature. 
 These, therefore, may be advantageously connected with demonstra- 
 tions of the truth. There are few intelligent minds that do not right- 
 ly appreciate those grand phenomena of Nature which conduct us to
 
 PHYSIOLOGY. COMPOSITION. 33 
 
 a knowledge of her fundamental laws, or do not incidentally betray 
 their conviction of the right, however the enticements of fame may 
 beguile them into ingenious substitutions. I shall, therefore, as on 
 all former occasions, continue to bring to the aid of my conclusions 
 the powerful concessions of the most eminent men who belong to the 
 adverse schools in organic philosophy. It is manifest that such au- 
 thorities must weigh with the force of demonstration, since it is obvi- 
 ous that their admissions can flow only from convictions that have 
 been obtained in the school of Nature. Among the most illustrious 
 of the adverse school is Liebig, and standing intermediate is the pro- 
 found and erudite Miiller. And having thus refeiTed again to this 
 great philosopher, I will not lose the opportunity of obtaining from 
 him an important contribution to the doctrines of vitalism as they re- 
 late to the very composition of organic beings, and in which he insti- 
 tutes a broad contrast between the affinities which unite the elements 
 of organic and inorganic compounds. Thus : 
 
 " Chemical substances," says Miiller, " are regulated by the intrin- 
 sic properties and the elective affinity of the substances uniting to 
 form them. In organic bodies, on the contraiy, the power which in- 
 duces, and maintains, the combination of their elements, does not 
 consist in the intrinsic properties of those elements, but in something 
 else, which not only counteracts those affinities, but effects combina- 
 tions in direct opposition to them, and conformahhj to the laws of its 
 own operation." — Muller, Elements of Physiology , p. 4. 
 
 Liebig, also, variously inculcates the same great principle. Take, 
 in the first place, a demonstration the converse of Miiller's. It is tho 
 last paragraph in the work on Organic Chemistry. Thus : 
 
 " The same nutnerous causes which are opposed to the formation of 
 complex organic violecules, under ordinary circumstances, occasion 
 their decomposition and transformations when the only antagonist 
 
 POWER, THE VITAL PRINCIPLE, NO LONGER COUNTERACTS THE INFLU- 
 ENCE OF THESE CAUSES. Ncw compounds are formed in which chem- 
 ical AFFINITY HAS THE ASCENDENCY, and opposes any farther change, 
 while the conditions under which these compounds were formed re- 
 main unaltered." 
 
 Again, we are informed by this chemist, that 
 
 " The equilibrium in the chemical attractions of the constituents of 
 food is disturbed by the vital principle, as we know it may be by 
 many other causes. But'the union of the elements, so as to produce 
 NEW combinations and forms, indicates the presence of a peculiar 
 
 MODE OF attraction AND THE EXISTENCE OF A POWER DISTINCT FROM 
 ALL OTHER POWERS OF NATURE, namely, the VITAL PRINCIPLE." " If 
 
 the food possessed life, not merely the chemical forces, but this vi- 
 tality would offer resistance to the vital force of the organism it 
 nourished." " The individual organs, such as the stomach, cause all the 
 organic substances conveyed to them, which are capable of transfor- 
 mation, to assume new forms. The stomach compels the elements of 
 these substances to unite into a compound fluid for the formation of 
 blood." — Liebig's Organic Chemistry, p. 356, 357, 346, 384. 
 
 61. It is a remarkable characteristic of organic beings that they aie 
 composed chiefly of combustible substances, properly so called, and a 
 supporter of combustion ; with the principal exception of that anom- 
 aly in the inorganic kingdom, nitrogen gas {^ 37).
 
 34 INSTITUTES OF MEDICINE. 
 
 62, a. The general introduction of nitrogen gas into the constitution 
 of animal compounds, and into many of a vegetable nature, while it is 
 excluded from mineral compounds, is one of the most striking distinc- 
 tions between the two kingdoms of Nature. Upon that distinction I 
 have founded an argument, in my Essay on the " Philosophy of Vital- 
 ity," in proof of the difference in the powers and laws by which the 
 two kingdoms are governed. It appeal's also appropriate to this work 
 that the proof should be here introduced. 
 
 62, b. I have said in the foregoing Essay, that it is abundantly ev- 
 ident that living beings are endowed with 2)ropertie3 which protect 
 their elementary composition against all those decomposing agencies 
 which are perpetually separating the elements of all mineral com 
 pounds. This shows that the properties, by which the elements of 
 living beings are united, are utterly different from such as combine 
 the elements of inorganic compounds. Nevertheless, the living or- 
 ganization is undergoing a systematic change, a perpetual decomposi- 
 tion, surpassing any mutations that are in progress in the surrounding 
 world. These decompositions are, also, of a peculiar nature, govern- 
 ed by established laws, various in different parts of the same individ- 
 ual, yet forever the same in any given part (§ 44). I shall not stop 
 to ghow how the old are replaced by new materials, and how the pro- 
 cesses go Giifari passu, and in opposition to all the philosophy which 
 chemistry teaches, but only say that the decompositions must be effect- 
 ed by properties as peculiar to the living compound as are the results ; 
 and that these results conspire with the peculiar modes in which the 
 elements are combined in j)roving the existence of specific properties, 
 which are the common cause of all the harmonious phenomena of liv- 
 ing beings (§ 38-42). 
 
 62, c. When, however, the organic being dies, a new order of de- 
 composition begins, eminently of a chemical nature, and in forcible 
 contrast with that which concerns the vital process of renewal. This 
 is due to the special element, nitrogen gas, which may be called the 
 principle of dissolution. Wherever present, it gives rise to ti'ansfor- 
 mations and disunion of all the other elements after the properties of 
 life have lost their sway. The moment these cease, chemical decom- 
 position begins, — confusedly, violently; and such are the nature and 
 combinations of the elements, that their disrujDtion would go on with 
 no other contribution from surrounding agents than water alone. 
 Hence the more rapid transformations and dissolution of animal than 
 of vegetable tissues, and of sap and other substances which are gen- 
 erated by vegetable organization. 
 
 62, d. Liebig says of nitrogen gas, that "there is some peculiarity in 
 its nature, which gives its compounds the power to decompose sponta- 
 neously with so much facility. Now, nitrogen is known to be the 
 most indifferent of all the elements. It evinces no particular attrac- 
 tion to any OTieof the simple bodies, and this character it preserves in 
 all its combinations ; a character which explains the cause of its easy 
 separation from the matter with which it is united." And again, 
 " When those substances are examined which are most pifone to fer- 
 mentation and putrefaction, it is found that they are all, ivithout ex- 
 ception, bodies which contain nitrogen." — Liebig's Organic Chemistry 
 app)lied, &c., p. 241. 
 
 G2, c. In the inorganic kingdom, nitrogen is mostly confined to the
 
 PHYSIOLOGY. COMPOSITION. 35 
 
 aJmosphere, where it probably exists in a state of simple intermixture 
 with oxygen. " All bodies which have an affinity for oxygen abstract 
 it from the atmosphere with as much facility as if the nitroo-en were 
 absent altogether ;" and we have striking examples of the disposition 
 of nitrogen to separate from its compounds, " in the easy transposi- 
 tion of atoms in the fulminating silvers, in fulminating mercury, and 
 In all fulminating substances," whose ready explosion is owino- to the 
 presence of nitrogen. " All other substances," says Liebig, " con- 
 taining nitrogen acquire the same power of decomposition when the 
 elements of water are brought into play." 
 
 62,/! Now the foregoing characters belong to nitrogen only as it 
 exists in inorganic or in dead organic compounds, while the former, 
 also, are artificial, or due to accidental causes. In living beino-s, 
 where it abounds,* it adheres to its associated elements with a tena- 
 city which no agent can impair till it destroys the life of the part ; or, 
 in other words, till it destroys those vital properties by which the ele- 
 ments were truly united. It is then, however, that the forces of chem- 
 istry take possession, and the elements may explode, I had almost 
 said, with the facility of the fulminating compounds. 
 
 62, g. " There is," says Liebig, " in the nature and constitution of 
 the (inanimate) compounds of nitrogen, a kind of tension of their 
 component parts, and a strong disposition to yield to transformations, 
 which effect spontaneously the transposition of their atoms 07i the in- 
 stant that water or its elements are brought in contact with them." 
 On the contrary, " it is found that no body destitute of nitrogen pos 
 sesses, when pure, the property of decomposing spontaneously while 
 in contact with water." — Liebig. 
 
 But, although dead animal compounds readily pass into sponta 
 neous decomposition under slight degrees of moisture, yet, composed 
 as they are, in part, of the elements of water, and very largely im- 
 pregnated with aqueous substances in their living state, neither those 
 elements, this water^ nor any other agent, can disturb the exact com- 
 binations. 
 
 But, when the oi'ganic being dies, chemical agencies have their 
 play, and it is then that 
 
 " The result of the known transformations of substances containin" 
 nitrogen proves," according to Liebig, " that the water does not mere- 
 ly act as a medium in which motion is permitted to the elements in 
 the act of transposition, but that its influence depends on chemical 
 affinity. "When the decomposition of such substances is effected with 
 the assistance of water, the nitrogen is in^riably liberated in the form 
 of ammonia." — Liebig. 
 
 In respect to the inorganic world, had nitrogen been incorporated 
 in its compounds, there would have been no stability among them. 
 They would have been perpetually undergoing decomposition, until 
 finally the whole of the nitrogen would fly off by itself, and nothing 
 of the original compound would remain ; and it could never be re- 
 combined. 
 
 62, k. Besides the disposition of nitrogen to tear asunder the ele- 
 
 * Niti-ogen is well known to abound in all the tissues of animals. Of vegetables, Lie- 
 big says, that, " Estimated by its proportional weight, niti'ogen fonns only a very small 
 part of plants, but it is never entirely absent from ani/ part of them. Even when it does 
 not enter into the composition of a particular part or organ, it is always to be found in the 
 fluids vrbich pervade it." — Liebig's Organic Chemistry applied to Physiology, &c., p. 4.
 
 36 INSTITUTES OF MEDICINE. 
 
 meiits with which it may be combined, the complexity of these ele- 
 ments in organic beings contributes to the disorganizing results after 
 death, and is another principal cause of spontaneous fermentation and 
 putrefaction (§ 38, 41, 46, 48, 52, 53). 
 
 62, i. From the foregoing facts, especially from the universality 
 and fixedness of nitrogen in organic beings, I amve at the conclusion 
 that the elements of their compounds are united by forces as peculiar 
 as the facts which relate to these compgunds, and that the forces of 
 chemistry have no agency in combining the elements, or in effecting 
 changes of their combinations during life. It is also abundantly man- 
 ifest from my premises, that Liebig's declaration that " by chemical 
 agency we can produce the constituents of muscular fibre, skin, and 
 hair," is without the slightest foundation (§ 12, 13, 14). 
 
 62, k. The whole labyrinth of combinations in organic beings, and 
 their ultimate return to binary compounds, are full of the most stu- 
 pendous design. The final cause of the reduction of the organic being, 
 when its own specific purposes are ended, is that of again supplying 
 the means of growth to vegetables yet alive, that the elements may be 
 again elaborated into ternary and quaternary compounds, to carry out 
 the final purpose of the vegetable kingdom in supplying nutriment to 
 animals (§ 303).— Note C p. 1113. 
 
 63. In the Essay to which I have referred in the last section, I have 
 endeavored to deduce the principles of vitalism from the phenomena 
 ihat attend the development of the incubated egg, as had been briefly 
 set forth in my " Examination of Reviews." The considerations 
 there made are peculiarly appropriate to the present work, and to 
 the place at which I have now arrived. It was my object to considei', 
 
 1st. The constitutional nature of the ovum. 
 
 2d. To show by the philosophy of generation, and by the nature of 
 the powers which are universally admitted to be alone concerned in 
 developing the germ or ovum, and in forming the organs of the new 
 being, that the same powers are, also, alone concerned in carrying on 
 forever afterward the processes of life, and, of course, that no new 
 powers, or principles, are introduced. 
 
 3d. To consider the manner in which the germ is impregnated, or 
 its vital propeities so stimulated into action as to result in the devel- 
 opment of the germ, and in unfolding the various attributes of the 
 new being. 
 
 4th. To show that we may find in the physiology of generation, or 
 the principles through which the ovum is impregnated, the whole phi- 
 losophy of organic life, or ^e principles through which the actions of 
 life are forever carried on. 
 
 5th. To state the manner in which the natural peculiarities of each 
 parent, whether as it respects the properties of life, or the physical 
 conformation, are infused into the germ and combined in the full- 
 grown offspring. 
 
 6th. To show that hereditary diseases are transmitted in the same 
 way as those more natural peculiarities which belong to parents. 
 
 7th. To show, also, that the principles which are concerned in the 
 transmission of hereditary diseases are the same as concur in the pro- 
 duction of ordinary diseases. 
 
 8th. To deduce fi'om the philosophy of generation the vital nature 
 of hereditary diseases ; or, in other words, to show that the morbid
 
 PHYSIOLOGY. COMPOSITION. 37 
 
 impression is established upon the vital properties of the ovum, and 
 of course, upon those of the new being ; and that the hereditary vitia- 
 tion does not consist in any transmitted impurity to the blood or other 
 fluids of the offspring, as is now supposed by the humoralists. 
 
 If the foregoing propositions be true in relation to man, they will, 
 of course, be equally so of animals, and of the whole vegetable king- 
 dom (§ 169/, 1051, 1052). 
 
 64, a. If it be universally conceded, as a matter of course, that not 
 only the elementary constitution of the ovum, but its whole develop- 
 ment, depends entirely upon a vital principle or vital properties, it will 
 follow that the same principle or properties are forever afterward 
 concerned in organic processes, and alone concerned. 
 
 Let us hear, in the first place, the most eminent in the school of 
 vitalism, but who are inclined to lean upon chemistry after the full 
 development of the ovum. 
 
 64, h. It is said, for example, by Tiedemann, 
 
 " That it is the vital power, which in the fecundated germinative 
 liquid, brings the molecules of the organic combinations to the solid 
 form, and calls the first lineaments of the vegetable and animal em- 
 bryo into existence. All the parts and tissues that are formed in it, 
 according to a definite order of succession, are products of the power 
 of formation, and on this they depend in all that relates to their first 
 appearance, their development, aggregation, configuration, and ar- 
 rangement. The phenomena exhibited in the act of formation of an 
 embryo, are placed^ar above all the mechanical and chemical acts we 
 ibserve in bodies not endowed with life." — Tiedemann, ComiKirative 
 Vhysiology. 
 
 64, c. By the illustrious Miiller, it is said, 
 
 " The creative force exists already in the germ, and creates in it the 
 essential parts of the future animal. The germ is potentially the 
 loliole animal. During the development of the germ, the essential 
 parts which constitute the actual whole are produced." " The en- 
 tire vital principle of the e,^^ resides in the germinal disk alone ; 
 and since the external influences which act on the germs of the 
 most different organic beings are the same, we must regard the 
 simple germinal disk as the potential xoliole of the future animal, 
 endowed with the essential and specific force or principle of they^- 
 ture being, and capable of increasing the very small amount of this 
 specific force and matter which it already possesses, by the assimila- 
 tion of new matter." And again he says, " This force exists hcfore 
 the harmonizing parts, which are, in fact, formed by it during the 
 development of the embryo." " The vital force inherent in organic 
 beings itself generates the essential organs which constitute the whole 
 being." " The formative or organizing principle is a creative pow- 
 er, modifying matter blindly and unconsciously;" yet with such won- 
 derful precision that Miiller also says, that " this rational creative 
 FORCE is exerted in every animal strictly in accordance with what the 
 nature of each requires." "The vital principle," he says, "is in a 
 quiescent state in the fi-g^ before incubation." — Mijller, Elements of 
 Physiology. 
 
 64, d. Passing from the chemico-physiological school to that of 
 pure chemistry, we shall find the same admissions as to the exclusive 
 agency of a vital principle in the formation and development of the 

 
 SS INSTITUTES OF MEDICINE. 
 
 seed and ovum. The extraordinary contradictions, which will aston- 
 ish the reader, necessarily abound in all authors who are employed 
 in identifying two subjects that have no relation to each other. 
 
 64, c. Take Liebig, as a first example; and take, in the first place, 
 his chemical doctrine of life. 
 
 " In the animal body," he says, " we recognize, as the ultimate 
 cause of all force, only one cause, ilie chemical action which the ele- 
 ments of the food and the oxygen of the air mutually exercise on each 
 other. The only known ultimate cause of vital force, either in ani- 
 mals or in plants, is a chemical process. If this be prevented, the 
 phenomena of life do not manifest themselves. If the chemical action 
 be impeded, the vital phenomena must take new forms." 
 
 And yet only a few sections before, and in the very first sentence 
 of Liebig's work on " Animal Chemistry applied to Physiology and 
 Pathology," we read, 
 
 " In the animal ovum, as well as in the seed of a plant, we recog- 
 nize A CERTAIN REMARKABLE FORCE, the SOURCE of growtli or increase 
 in the mass, and of reproduction, or of supply of the matter consumed; 
 a force in a state of rest* By the action of external influences, by 
 impregnation, by the presence of air and moisture, the condition of 
 static equilibrium of this force is disturbed. Entering into a state 
 of motion or activity, it exhibits itsef in the j^roduction of a series of 
 forms, &c. This force is called the vital force, vis vitcs, or vitality." 
 — Liebig's uini?nal Chemistry. 
 
 Turning back to the same author's work on " Organic Chemistry 
 applied to Physiology," we meet not only with a similar contradiction 
 of his grand doctrine of the entire dependence of life upon chemical 
 processes (and as we had before seen in respect to digestion, section 
 GO), but with that which is particularly apposite to my present inquiry. 
 
 " Our notion of life," says Liebig, " involves something more than 
 mere reproduction, namely, the idea of an active power exercised, by 
 virtue of a definite form, and production and generation in a definite 
 form (§ 59). The production of organs, the co-operation of a system 
 of organs, and their power not only to pi'oduce their component parts 
 from the food presented to them, but to generate themselves in their 
 original form and with their jjroperties, are characters belonging ex- 
 clusively to organic life, and constitute a form of reproduction inde- 
 pendent OF CHEMICAL POWERS. The chcmicul forccs are subject to 
 
 the INVISIBLE CAUSE BY WHICH THIS FORM IS PRODUCED. This VITAL 
 
 PRINCIPLE is only known to us through the peculiar form of its instru- 
 ments ; that is, through the organs in which it resides. Its laws 
 must be investigated just as we investigate those of the other pow- 
 ers WHICH effect motion AND CHANGES IN MATTER." LiEBIg's Or- 
 ganic Chemistry , &c., p. 355. 
 
 64, yi Roget, of high authority, maintains that, 
 
 " However the laws which regulate the vital phenomena may ap- 
 pear, on a superficial view, to differ from those by which the physical 
 changes taking place in inorganic matter are governed, still there is 
 really no essential difference between them." " It may, in like man- 
 ner, be contended, that the affinities which hold together the elements 
 of living bodies, and which govern the elaboration of organic products, 
 ARE THE SAME vvitli those wliicli preside over inorganized compounds." 
 * See my Examination of Reviews p. 7-28.
 
 PHYSIOLOGY. COMPOSITION. 'Si) 
 
 " Hence it becomes every day more and more probatle that the forces 
 immediately concerned in the production of chemical changes in the 
 body ARE THE SAME as those which are in constant operation in the 
 inorganic world ; and that we are not warranted in the assertion that 
 the operations of vital chemistry are directed by distinct laws, and are 
 the results of new agencies." 
 
 " However natural it may he to conceive the existence of a single 
 and presiding principle of vitality, we should recollect that this, in the 
 present state of our knowledge, is only a fiction op the mind, not 
 
 WARRANTED BY THE PHENOMENA THEMSELVES." RoGEt's Outlines 
 
 of Physiology. 
 
 Let us now hear this able writer on the subject of foetal development. 
 
 "A portion of the vital power of the parent," he says, "is for this 
 purpose employed to give origin and birth to the offspring. The ut- 
 most solicitude has been shown in every part of living nature to se- 
 cure the perpetuity of the race, by the establishment of laavs, of which 
 the operation is certain in all contingent circumstances.^'' 
 
 Roget ultimately describes, in his usual felicitous manner, the de- 
 velopment of the ovum ; and here we have nothing from our author 
 /)ut the agency of the vital powers. 
 
 " The foundations of the edifice," he says, " are laid in the homo- 
 geneous jelly hy the efforts of the vital powers." " At first, all 
 the energies of vitality are directed to the raising of the fabric, and 
 to the extension of those organs, which are of greatest immediate util- 
 ity; but still having a prospective view to farther and more impor- 
 tant ends," — and so on throughout the chapter ; the whole work of 
 developing and fashioning the foetal organs being assigned, exclu- 
 sively, to " the efforts of the vital powers," and to the " energies of vi- 
 tality." — Roget's Animal and, Vegetable Physiology, Bridgeivater 
 Treatise. 
 
 64, g. Finally, let us hear, also. Dr. Carpenter, who advocates the 
 chemical doctrines of life so far as to lay down the following princi- 
 ple no less than twice within six pages, and in nearly the same words. 
 Thus : 
 
 " Reason," he says, "has been already given for the belief that the 
 affinities which hold together the elementary particles of organized 
 structures are not different from those concerned in the inorganic 
 world ; and it has been shown that the tendency to decoxMposition 
 after death bears a very close relation with the activity op the 
 
 CHANGES which TAKE PLACE IN THE PART DURING LIFE." CaRPEN- 
 
 ter's Principles of General aiid Comparative Physiology, jj. 140 ; 
 also, p. 146. 
 
 Now the authority of such a writer, and a prominent leader in the 
 purely chemical school of physiology, must be allowed to be impor- 
 tant when any unavoidable concession is made to vitalism. Let us 
 then hear him in the matter of the ovum : 
 
 "Organization, and vital properties,'' he says, " are simultaneously 
 communicated to the germ by the structures of its parent. Those 
 VITAL PROPERTIES CONFER upon it THE MEANS of itself assimilating, 
 and THEREBY ORGANIZING AND ENDOWING WITH VITALITY the materials 
 supplied by the inorganic world." — Carpenter's Principles, &c., p. 
 138. 
 
 And again, this mere chemist, in his general views of the philosojihy 
 of life, observes, that
 
 40 INSTITUTES OP MEDICINE. 
 
 " The AGENCY of VITALITY, as Dr. Prout justly remarks, does not 
 change the properties of the elements, but simply combines them 
 [the elements] in modes which we cannot imitate." — Carpenter's 
 Principles, &c., p. 146. 
 
 64, h. Dr. Prichard is strictly of Dr. Carpenter's school (see my 
 " Examination," &c., p. 37), between whom there is a point of agree- 
 ment which is worth noticing in its connection with the subject now 
 before us, and to which I have referred in a former work, in its rela- 
 tion to Dr. Carj)enter. Both of these writers see so much of peculiar 
 design in organic nature, and find it so impossible to interpret the 
 phenomena of organic beings upon the chemical and physical princi- 
 ples which they have so strenuously set forth, and in their aversion to 
 any other principles, and to the obvious rule of analogy as to second 
 causes, that, in the end, they assign the functions and phenomena of 
 life to the imviediate action of the Deity. 
 
 " The theory of a vital principle," says Dr. Prichard, " has been 
 applied in a different manner, to account for the phenomena displayed 
 at the beginning of life in animals and vegetables, and to get rid of 
 the mystery which attends the gradual evolution of organic structure 
 from ova and germs. Here the vital principle is no longer considered, 
 a chemical agent, but assumes the character of a plastic and formative 
 power," &c. 
 
 Now Dr. Prichard "cuts the knot" and "gets rid of the mystery" 
 after the following manner : 
 
 " We may," he says, " if we choose to do so, tei'm the cause which 
 governs the organization and vital existence a plastic principle ; but 
 it is a principle endowed with intelligence and design [ ! ] It is, 
 in fact, nothing more than the Energy of the Deity." " The devel- 
 opment of forms, according to their generic, specific, and individual 
 diversities, not less in the vegetable than in the animal world, can 
 only be accounted for by ascribing it to the universal energy and 
 wisdom of the Creator." — Prichard's Preview of the Doctrine of a 
 Vital Principle. See, also, Paine's Commentaries, vol. i., p. 10, 25 ; 
 and his Exainination of Reviews, p. 37, 41, 43, 44. 
 
 This is a far greater admission than the vitalist can desire ; since, 
 if the development and growth of the germ depend immediately upon 
 Almighty Power, so must all the analogous processes of the living 
 being at all stages of its existence, and science would be merged in 
 the direct manifestations of that Power. But, while this doctrine is 
 utterly exclusive of all the assumed chemical agencies at all periods 
 of life, and overlooks the analogy between the development of the 
 germ and the subsequent processes, there can be no hesitation as to 
 the disposition which should be made of it, without any reference to 
 its prevaricating nature (§ 175 d, 699 c, 740). 
 
 65. Having now before us a plain statement of our necessary prem- 
 ises as they respect the exclusive agency of the " vital principle," 
 or " organic force," or " creative power," or " vital properties," or 
 "vital powers," or "vitality" (whichever term may be preferred), in 
 carrying out the full development of the embiyo, it may be interesting 
 to know the details of that development and growth, which is thus 
 allowed, on all hands, to be conducted by powers utterly distinct from 
 the chemical and physical, and in which these have no agency. 
 
 " The development of the separate parts," says Miiller, " out of
 
 PHYSIOLOGY. COMPOSITION. 41 
 
 the simple mass, is observable in the incubated egg. All the parts 
 of the egg, except the germinal membrane, are destined for the nu- 
 trition of the germ. The simple germinal disk is the potential whole 
 of the future animal, endowed with the essential and specific force, 
 or principle of the future being, and this germ expands to form the 
 germinal membrane, which grows so as to surround the yolk; and by 
 transformation of this germ, the organs of the future animal are pro- 
 duced. The rudiments merely of the nervous and vascular systems, 
 and of the intestinal canal, are first formed ; and from these rudi- 
 ments the details of the organization are afterward more fully devel- 
 oped ; so that the Jirst trace of the central parts of the nervous sys- 
 tem must be regarded neither as brain nor as spinal marrow, but as 
 still the potential whole of the central parts of the nervous system. 
 In the same manner, the different parts of the heart are seen to be 
 developed from a uniform tube ; and the first trace of the intestinal 
 tube is more than the mere intestinal tube ; it is the j^otential whole, 
 — the representative of the entire digestive apparatus ; for, as Baer 
 first discovered, liver, salivary glands, and pancreas, are, in the far- 
 ther progress of the vegetative process, really developed from that 
 which appears to be merely the rudiment of the intestinal canal. It 
 can be no longer doubted that the germ is not the miniature of the 
 future being, with all its organs, as Bonnet and Haller believed, 
 but is merely potentiall]/ this being, with the specific vital force 
 of which it is endowed, and which it becomes actually by develop- 
 ment, and by the production of the organs essential to the active 
 state of the actual being. A high magnifying power is not necessary 
 to distinguish the first rudiments of the separate organs, which, from 
 their first appearance, are distinct and very large, but simple. So 
 that the later complicated state of a particular organ can be seen to 
 arise by transformation from its simple rudiment. These remarks 
 are now no longer mere opinions, but facts; and nothing is more dis- 
 tinct than the development of glands from the intestinal tube, and of 
 the intestinal tube itself from a portion of the germinal membrane." 
 — MiJLLER, ihid—{^ 1051, 1052). 
 
 Such, then, is the history of the development of the germ in birds, 
 and in all the higher animals ; and the whole work is ascribed by 
 physiologists of every denomination exclusively to principles un- 
 known in the inorganic world, and wholly distinct from any of a 
 chemical nature. They are called, indiscriminately, vital properties, 
 vital powers, vital principle, organic force, creative force, &c., to distin- 
 guish the principle, or properties, from every thing that has any 
 known existence in inorganic substances, or as the source of any in- 
 organic results. But, physiologists of the chemical school stop here, 
 and ascribe all organic compounds after the being is fully formed to 
 chemical agencies. It is remarkable, however, that it has not occur- 
 red to these philosophers, that precisely the same elementary combi- 
 nations, the same formation into tissues, and the same secretions, take 
 place at all stages of the rudimentary development as at all future 
 periods of life, and that the rudimentary development consists in 
 these formations of simple compounds and their union into tissues ; 
 and if the early or rudimentary growth of the being, all its secreted 
 products, all its elementary combinations, be determined by the vital 
 properties, so are the same results determined by the same propertie.a
 
 42 INSTITUTES OF MEDICINE. 
 
 or power's forever aftei-ward. To call in the agency of chemical or 
 physical forces, to accomplish precisely the same results at any future 
 stage of the organic being as are admitted to be performed in the de- 
 velopment of the "essential parts" of that being by the "vital prin- 
 ciple" or " vital properties" alone, is a violation not only of the plain- 
 est rule in philosophy, but of the clearest facts (§ 41, 42, 55-58). 
 
 66. We have thus before us a peculiar order of powers by which 
 the organic being is developed, fashioned, and forever exclusively 
 governed. It is these powers about which physiology, pathology, 
 and therapeutics, are essentially concerned. We may, therefore, 
 seek in the composition of organic beings, and in the laws of their 
 development, yor the great rudimentary j^rinciples of medicine. The 
 vital principle has also the extraordinary task of laying out, in the 
 ovum, the whole organization of the future being ; so that its subse- 
 quent labor must be comparatively simple, and it is then, least of all, 
 that it can require any help fi'om the forces of the inorganic king- 
 dom, or that it would, permit a violation of the great principle in na- 
 ture of avoiding an unnecessary multiplication of causes. 
 
 67. It may be farther shown by the incipient development of the 
 ovum, that the vital powers, or properties, are more concerned in the 
 growth, nutrition, and all the subsequent physical results, throughout 
 the whole existence of the being, than is generally supposed by even 
 the exclusive vitalists. The usual supposition is that the vessels or 
 instruments of action, which are moved by the vital powers, perform 
 the work of decomposing the blood and other parts, and recombining 
 them again in other proportions and forms, according to the particu- 
 lar organization of parts, and the modification of their vital states. 
 It has been the doctrine of most physiologists till a recent day, that 
 the ovum, in its germinating part, is a mere organic fluid, destitute 
 of vessels, and all other parts of the future apparatus. Later re- 
 searches, however, have disclosed the existence of a rudimentary 
 cell; and it is said by Miiller (1835) that "in the incubated egg the 
 s-ole material for the first formation of blood is the substance of the 
 germ or germinal membrane, which itself grows by assimilation of 
 the fluid of the egg^ or the yelk. It may be distinctly observed that 
 the blood is generated in the germinal membrane before the vessels 
 are formed ;"* from which it appears that t*he first "assimilation of 
 new matter" must take place without the agency of vessels, or of 
 any parts which are subsequently formed ; and, therefore, the same 
 powers which enabled the cell to generate vessels, nerves, <fcc., con- 
 tinue to make the same conversion out of blood ; and as all this was 
 originally done Avithout the aid of vessels, so must the same powers 
 be forever operative with their subsidiary agency only.f As the 
 ovum possesses the potential Avholo,it is equivalent to the mature 
 structure. 
 
 We see, therefore, that Miiller, reasoning upon other grounds, may not 
 have been altogether hypothetical in his inference that the " vital prin- 
 ciple exerts its influence even beyond the surface of an organ, as shown 
 by its effects on the chyle, in maintaining the fluidity of the blood," &c. 
 
 By the same rule, it may be at once shown that the only ingenious 
 chemical hypothesis ever invented to interpret organic results, — the 
 catalytic, — is purely an assumption ; since this hypothesis is predica- 
 
 * Kclliker states that " the membrane of animal cells, the largest of which are 3-elk- 
 cclls, exhibit no structure of any land." — Ulicroscojncal Anatomy, Wurzburg, 1852. 
 
 f So far as this the author had inculcated more than twenty years ago what is now 
 known as the cell-theorij — 1870.
 
 PHYSIOLOGY. COMPOSITION. 43 
 
 ted of the bioocl-vessels. But, if there be no vessels in the germ, the 
 first vessels must, of course, be produced without the supposed chem- 
 ical influence of vessels, and, by my showing, therefore, as to the 
 subsequent formation of vessels and other parts, the supposed agency 
 of the catalytic forces is a mere assumption (§ 41, 42, 1051; also, 
 Medical and Physiological Commentaries, vol. i., p. 74-7G). 
 
 On this subject, too, chemistry must abide by admissions which are 
 made in the very face of consistency ; so imperative is fact, and so 
 imbecile is hypothesis. Thus, it is said by the distinguished chemico- 
 physiologist. Dr. Prout, that 
 
 " The most determined sceptic cannot assert that there is any ne- 
 cessary relation, or, indeed, any relation whatever, between the 
 mechanical arrangements and the chemical properties to which they 
 administer. There is no reason why the chemical changes of or- 
 ganization should result from the mechanical arrangements by which 
 they are accomplished [ ! ] ; neither is there the slightest reason 
 why the mechanical arrangements, in the formation of organized be- 
 ings, should lead to the chemical changes of which they are the inst.ru- 
 ments" ! — Dr. Prout's Bridgetoater Treatise. — Such is the proof 
 which chemistry offers. 
 
 68. The question then arises as to what is the particular ofiice of 
 those vessels where the elementary combinations and decompositions 
 take place] Simply this: to convey, and eliminate through the agen- 
 cies of the vital properties, those parts from the blood out of which 
 the vital properties effect the new elementary combinations, whether 
 solid or fluid, — to aid in arranging the new molecules, and to carry 
 forward those fluid products which may be destined for other ends. 
 
 69. But, have not the nerves an indispensable agency in effecting 
 the elementary combinations and decompositions % Certainly not, 
 as I shall endeavor to show. But the sympathetic nerve exerts an 
 influence upon all organic functions, and impresses a special condition 
 upon all organic compounds, and this physiological law is extensively 
 involved in patholoay and therapeutics ('§ 22G, 232, 233, 399, 446 a, 
 461, 461i 488-L, 489, 512, 639, 746 c). 
 
 70. But, all the vessels, and all the solid parts of the organism, have 
 their various specific offices. Here, in every part, reside the vital 
 properties, which had been fully developed in the ovum, and here 
 are they modified according to the exact nature of the organization 
 and the peculiar final causes of " the properties of the vital principle" 
 in each part. Hence they manifest peculiarities in parts that are 
 apparently alike. The modifications vai-y, for instance, in the serous 
 membranes, and more remarkably in the mucous, as known by the 
 influence of foreign agents, their phenomena, their products, &c. 
 The vital properties differ in different parts of one and the same con- 
 tinuous tissue, as in the mucous tissue of the nose, lungs, stomach, 
 &c. Hence one of the important objects of studying the structure of 
 organs, and the nature of their tissues ; for, as the vital properties are 
 naturally modified in different parts, so will their alterations in the 
 same disease be different in different tissues of one organ, and, for 
 the same reason, even of different parts of one continuous tissue. 
 
 These natural modifications of the vital properties in different parts 
 have, at least, three great final causes. The first is what I have al- 
 ready stated, namely, to separate from the blood, through the agency 
 of the capillary vessels, that exact part which is to be decompounded
 
 44 INSTITUTES OF MEDICINE. 
 
 at any given point ; the second is, by these modifications, to enable 
 " the properties of the vital principle" to decompound and recombine 
 the elements according to the exact nature of the combinations which 
 belong to the part ; and the third, to qualify the properties, through 
 the medium of the capillary vessels, to shape and unite the new mole- 
 cules to the old. It is easy to apply this principle, under its different 
 aspects, to all other vessels, as the veins, the secretory and excretory 
 vessels of the glands, and the absorbents. 
 
 71. Now, at the first start of the development of the germ, " the 
 properties of the vital principle" (as they are well designated by Miil- 
 ler) are but very imperfectly, if at all, aided by any of the foregoing 
 physical means, though they come into operation at the moment they 
 are successively produced. " The properties of the vital principle," 
 therefore, must exist in that potential cell in a modification, and with 
 a formative energy which they do not possess in any of the new de- 
 velopments ; and herein it will have been seen that the very chemist 
 has come to this conclusion (§ 64 y, 190 b). 
 
 72. The process of generation presents a varied and most impres- 
 sive illustration of the peculiarities of the vital properties, and of the 
 manner in which they are liable to be imj^ressed and permanently 
 modified in their nature. It results in the production of organic be- 
 ings similar to' those which exercise the generative faculty. This fac- 
 ulty is therefore manifested with as many specific modifications as 
 there are different species of organic beings. If we allow to the globe 
 one million of distinct species of animals, the specific modifications of 
 the germinal product will be as numerous, and these are more or less 
 influenced by the semen of the male. The seminal or productive 
 principle of the male exerts its special influences upon the living prop- 
 erties of the germ, and according to the special constitution of the 
 ovum directs their operation in such a maimer that none but beings 
 of the same kind with the parents, where both are of the same species, 
 are produced. That the various modifications which distinguish each 
 species are determined by both parents is fully demonstrated in hybrid 
 animals, and is sufficiently obvious in the transmission of the peculiai'- 
 ities of the male or female, where the individuals are of the same spe- 
 cies. And, notwithstanding our supposed million of distinct species 
 of animals, and the specific variations in all the parts of each species 
 (§ 41), this almost endless variety is made up by successive deposi- 
 tions of elementary compounds out of mainly four simple substances 
 (§ 37, 42, 46), three of which are gaseous, united in modes unknown 
 to chemistry (38-40, 48), and which chemistry cannot detect, and for- 
 ever uniting in different modes and proportions according to the ex- 
 act nature of every part (§ 43, 44). The act of generation establishes 
 the essential modifications which are to be continued, without varia- 
 tion, throughout the life of the new being ; and this new individual, be- 
 coming in its turn the agent of procreation, pei-petuates all the specif- 
 ic modifications which appertain to itself and to its ancestors. The 
 intermino-linf of species, which results in hybrid animals, proceeds 
 upon the same plan. It must therefore necessarily be, that the vital 
 properties of the ovum are so impressed by the exciting influences of 
 the semen that those peculiar elementary combinations and aggrega- 
 tions are started which ultimately make up the hybrid. " These vital 
 properties," says Dr. Caipenter, " confer upon it the means of itsel/
 
 PHYSIOLOGY. COMPOSITION 45 
 
 assimilating, and thereby organizing, and endowing with vitality, the 
 materials of the inorganic world ;" leaving it, also, clear to all minds 
 that the action of the semen must be exerted directly upon the vital 
 properties of the ovum (§ 189, 1051). 
 
 That this important question as to the direct action of the semen % 
 upon the vital properties of the ovum, and its capability of establish- 
 ing certain modifications of these properties, and that the humoral in- 
 terpretation of transmitted peculiarities is an unfounded assumption, 
 may be definitively settled, I will also add, 
 
 " The well-kno\vn fact, that when the Earl of Morton's Arabian mare 
 was covered by the quagga, not only did the mule so begotten partake 
 of the character of the sire, but when the mare was subsequently sub- 
 mitted to an Arabian stallion, by whom she had three foals at differ- 
 ent times, the first two continued to exhibit some of the distinctive 
 peculiarities of the quagga conjoined with the characters of the Ara- 
 bian breed." — Montgomery, ow the Signs and Symptoms oj^ Pregnan- 
 cy, p. 17. This should overthrow the whole fabric of humoralism.* 
 
 The author of the foregoing statement supposes that the semen 
 " may influence several ova, and so continue to manifest its effect in 
 the offspring of subsequent conceptions when impregnation has been 
 effected" by males of another species. The reader will also not fail 
 to remark that the history of this case is in direct conflict with the late 
 attempts to revive the old^doctrine of referring the germ to the male 
 parent (§ 67, 1051, 1052, 1078). 
 
 73, a. The semen, then, is a vital stimulus, and so far on a par with 
 the ordinary stimuli of life. These may be natural, like air, food, 
 heat, &c. ; or they may be morbific, like malaria, poisons, &c. ; or cu- 
 rative, like medicines. In all the cases, their action is upon the vital 
 properties ; and it is in consequence of these influences that the ovum 
 is developed, that life is maintained, health preserved or impaired, or 
 disease removed. The ova of oviparous animals show the analogy in 
 respect to stimuli, and the principles involved, more impressively than 
 those of viviparous ; since by an admirable design, in respect to the 
 former, the impression of the semen has a limited operation, when the 
 vital properties of the ovum return to their quiescent state, but may 
 be again roused into action by the simple stimulus of heat. (See Med. 
 and PJiys. Gomm.y vol. i., p. 21, &c.) 
 
 73, h. The action of the semen upon the properties of the vital prin- 
 ciple of the germ is a type of all the influences that are produced upon 
 the same vital properties during the life of the animal, and from which 
 all its organic actions, and all their results, arise. And so of the ger 
 mination and growth of plants ; which, by-the-way, evinces the com- 
 mon nature of the principle of life, and of organic actions, in the two 
 departments of the animated kingdom (§ 18Sj, d). It is the whole es- 
 sential philosophy of physiology. It is the alterations produced in 
 the vital properties which constitutes the philosophy of disease, and 
 in which, indeed, all disease virtually consists. It is the art of finding 
 out the remote causes, and the nature of the alterations they produce, 
 and of adapting to the altered condition of the properties of life such 
 agents as shall establish new impressions upon them, and thus enable 
 them to return to their natural state, which forms the basis of thera- 
 peutics in its connection with pathology. 
 
 74. a. Here I shall digress for a moment, to consider certain anal- 
 
 * The same is stated of Sir G. Ousley's mare and a zebra, and of a mare and an ass, 
 and the subsequent foals bj' stallions.
 
 46 INSTITUTES OF MEDICINE. 
 
 ogies ill the development of special organs, tlirough the influence of 
 specific stimuli, with that general evolution of the organic fabric 
 which is started by the action of the seminal principle upon the germ. 
 These analogies are to be found in the organs of animal life. The 
 senses, for example, sometimes manifestly require for their full de- 
 velopment the prolonged operation of the stimuli which are natural 
 to each. This is habitually observed in the young of some animals, 
 and is seen conspicuously in the subteiTanean fish of Kentucky. In v 
 this last instance organic life is perfectly developed ; but, owing to the 
 exclusion of the natural stimulus of the eye from the very outset of 
 life, that organ I'emains in its rudimentary state. 
 
 A fortiori, therefore, the reputedly first inhabitants of this globe, such 
 as the trilobite, attest the existence of the same light at their crea- 
 tion as is enjoyed at the present day; geologists to the contrary not- 
 withstanding (^ 1079, h). 
 
 Superficial observers of nature, either through inattention to the 
 moral consequences, or through infidelity, are apt to believe that phys- 
 ical agents are the real creative forces of ors^anic beingrs, from ob- 
 serving that particular parts are clearly dependent for their develop- 
 ment upon the action of certain specific stimuli. But, in all these cases, 
 the rudiment is there, and has been perpetuated ever since the original 
 species came from the Hand of Creative Power. That Power is en- 
 titled to all the praise, as the Author of tl|e rudiment, of its endow- 
 ment with peculiarly modified properties of life, of the existence of 
 the physical agents, and of the mutual adaptation of these modified 
 properties of the rudiment and the virtues of the physical causes, so 
 that the operation of the latter upon the former shall result, for exam- 
 ple, in vision, and, under certain circumstances, as when the ovum is 
 developed and matured out of the body, the physical agent, in the ex- 
 ample supposed, shall be necessary to the development of the rudi- 
 mentary organ of sight (§ 350|, /i-350|, Z). The principle is much 
 the same as that which applies to the necessity of exten;al heat and 
 light to the development and growth of plants. The specific stimu- 
 lus of light by which the vital properties and actions of the leaf are 
 enabled to decompound carbonic acid, and to assimilate the carbon, is 
 manifestly a parallel example with my supposed influence of light in 
 developing an animal organ in which the nervous system is extensive- 
 ly incorporated for the final cause of the whole organ ; although it be 
 certainly true that, in the case of the eye as of the leaf, the essential 
 influences of light are exerted upon the organic properties of either 
 part, and that the nervous system, in the former case, is only a medi- 
 um of transmitted influences to the organic properties (§ 188, 188j, 
 189, 202, 203, 222, 223, 226, 227, 514 k, 1072 a, note). 
 
 It would be an interesting inquiry to ascertain whether, by a total 
 exclusion of light from the ovum of fish, after fecundation, the pecu- 
 liarity of the Kentucky wonder may not be established in the first 
 generation ; and whether, also, an exclusion of light for a series of 
 years would not be followed by a failure of the balance of absorption 
 and nutrition in the eyes, and consequently a wasting of diose organs. 
 The general law of absorption operates universally, without the aid 
 of any specific stimulus ; while it is clearly otherwise in respect to 
 nutrition, and especially in regard to certain organs. The voluntary 
 muscles become emaciated from want of the stimulus of exercise, &c
 
 THYSIOLOGY. COMPOSITIOX. 47 
 
 We see, therefore, how it happens that fishes with and without eyes 
 may exist together in subterranean caverns as extensive as that of 
 Kentucky; the latter inhabiting the dark regions, while the former 
 exist in springs near the crevices of the cave (§ 136, 137, 548 a, 649 (Z. 
 733 i). 
 
 74. b. Such, then, is my philosophy of this subject, and such the full 
 extent of the gi'ound upon which infidelity would plant its stand ai'd. 
 Nor will I dismiss this subject without referring, now and hereafter, 
 to the calm indifference with which this infidelity is regai'ded even by 
 the religious world, by adducing not a few of the present popular 
 treatises on theoretical geology (^ 350|, g-k, 1085). 
 
 75. Let us now see if the beginning of individual existence does 
 not supply a key to the whole jihilosophy of disease, as it does to that 
 of physiology. We have seen that all the actions, and all the results 
 of life, are merely effects which arise from the operation of the vital 
 properties through their organic instruments (§ 65-67, 133, &c., 188, 
 &c.). • These properties must be constantly excited into action by 
 foreign agents, as by food, blood, &c., or the properties will become 
 extinct, and, of course, the effects will cease (§ ISSj, h). Now, the 
 actions in disease are nothing more than the altered actions of health, 
 and the same rule applies to all the morbid products. It follows,' 
 therefore, that the properties of life, ujjon which these altered condi- 
 tions depend, are modified or altered in a corresponding manner. 
 As a consequence of this, it also results that the vital properties have 
 been varied from their natural state by agents or causes capable of 
 producing the change. These agents make their impressions in the 
 same way as the natural stimuli of life, only the moi'bific agents at 
 the same time affect the nature of the vital properties, and bring them 
 into a new condition. This new condition constitutes disease. 
 
 76. The type of all this may be found in the impregnated ovum. 
 The properties which animate the germ before conception are deter- 
 mined entirely by the vital constitution of the female parent. But we 
 have seen that the new being may partake of the physical characters 
 of the male as well as of the female, and it happens not unfrequently 
 that the characteristics of the male are predominant. Hence it fol- 
 lows that the semen so far establishes changes in the original consti- 
 tution of the vital properties of the germ. 
 
 Since, therefore, all the foetal developments, all their physical pe- 
 culiarities, depend upon the precise modifications and actions of the 
 vital properties (§ 70), and since these properties in the unimpregnated 
 ovum are determined entirely by the female parent, their nature after 
 impregnation must be more or less affected, and assimilated to the 
 peculiar nature of the male parent in all the cases where the offspring 
 manifest any of the male characteristics. This is entirely analogous, 
 in principle, to the modifications which are produced in the properties 
 of life by morbific causes; but with this difference in contingencies: 
 in the case of the impregnated ovurn the modifications are perma- 
 nently established, and can never be altered, so far as the vital prop- 
 erties, in either parent, upon which the modifications depend, are fun- 
 damental in their nature. In the case of the morbific agent, or the 
 cause of disease, the vital properties are diverted from the healthv 
 state, and from such modified conditions they commonly possess the 
 ability of escape, and of returning again to their natural standard (§
 
 4S INSTITUTES OF MEDICINE. 
 
 S53, 858, 898). In the case of the impregnated ovam a modifying 
 agent operates, whose properties are intended to confer on the new 
 being a stable condition, however they may modify the exact consti- 
 tution of the impregnated germ. This vital stimulus, the semen, 
 therefore, in virtue of its specific properties, bestows upon the corre- 
 sponding vital properties of the ovum the peculiarities which belong 
 to itself; and these being natural, vital, and determinate, the trans- 
 mitted peculiarities should be equally so. Or, where the male parent 
 enjoys a perfectly natural constitution, the innate predispositions to 
 disease depend upon special peculiarities in the vital state of the ovum, 
 which may be as permanently established, through the modified con- 
 stitution of the female parent, as any of the natm-al characteristics. 
 In the case of disease, however, the morbific agents have none of the 
 properties of life which are natural to the fecundating semen, and the 
 modifications, therefore, which they may determine may be different, 
 even if we suppose them to act, as in the case of the germ, upon the 
 whole constitution. Whatever modifications, therefore, may arise 
 from their action, they must consist of deviations from the standard 
 of health. But, it does not necessarily follow that certain artificial 
 modifications may not be as permanent as the natural ones ; and it is 
 from observation alone, that we learn that they are so, or neai'ly so ; 
 as in the case of artificial "temperaments," the effects of domestica- 
 tion upon animals, the changes which are wrought in the vegetable 
 kingdom by cultivation and by change of climate (§ 535, &c.). 
 
 77. In the case, however, of the ■ formation of temperaments by 
 change of climate, and the more remarkable alterations produced in 
 animals by domestication, and in plants by cultivation, &c., the results 
 are brought about by the new and habitual influences to which the 
 properties of life are exposed ; and, in all these cases, a radical, and 
 often permanent modification is established, approximating closely 
 the modifications which are bestowed upon the germ by the fecunda- 
 ting semen. Now, it is also true, that what is denominated predispo- 
 sition to disease is entirely analogous, in principle, to the permanent 
 temperaments of which I have just spoken. Both are results of phys- 
 ical agents, modifying the properties of life ; and this chain of analo- 
 gies conducts us to those predispositions to disease which are im- 
 pressed upon the germ by the fecundating semen, and by which I 
 show that the philosophy of the operation of morfibic causes is vari- 
 ously, and even exactly exhibited in the impregnation of the germ (§ 
 63, 75, 535, 539, 559). 
 
 78. Take the scrofulous subject as supplying an example of hered- 
 itaiy predisposition to disease. If it exist in the female, her ova will 
 partake of this peculiar modification of the vital properties, and it is 
 in this way that her progeny inherits the scrofulous diathesis (§ 144- 
 147). In this case, as in all transmitted predispositions to disease, 
 the peculiarities induced in the parent have arisen, originally, from 
 the operation of deleterious agents — imbuing the ovum with the mod- 
 ifications belonging to the female, or imparting to the semen the whole 
 concentrated force of what may have been the slow work of numerous 
 causes upon the male parent. 
 
 Here, then, we see illustrated in the very ovum, even before im- 
 pregnation, the whole pi-inciple which concerns artificial tempera- 
 raentG, and those influences of morbific agents which establish predis-
 
 PHYSIOLOGY. — COMPOSITION. 49 
 
 positions to disease in the full-grown subject. It frequently hap- 
 pens, also, that this natural diathesis is so great, that it results in 
 actual disease before the birth of the offspring, as manifested by- 
 tuberculous affections of the lungs, syphilis, and small-pox in new- 
 ly-born infants. 
 
 79. But, to make the philosophy of this'subject more obvious, let us 
 consider the germ when it derives its scrofulous diathesis from the male 
 parent. Before impregnation its vital condition is perfectly natural. 
 The semen of the male parent establishes upon it the modification 
 which constitutes the predisposition to scrofula, just as malaria deter- 
 mine those modifications which result in fever, &c. And here we 
 may readily detect a perfect analogy between the alterative influences 
 of the semen and of remedial agents, and come to understand how it 
 is that the latter produce their effects (§ 904, d). We have only to 
 observe those instances where some of the offspring inherit the scrof- 
 ulous diathesis of the female parent, while others are as entirely ex- 
 empt as the male parent ; the natural condition of the semen having 
 altered the vital constitution of the ovum in the latter case, and im- 
 pressed a disposition to a development of the new being in its perfect 
 state. 
 
 80. The subject may be pursued under a variety of aspects, and 
 with various illustrations, whether physiologically or pathologically- 
 Other exemplifications will occur under the subjects of vital habit 
 and the temperaments. The same principle is concerned throughout, 
 whether in respect to the physiological conditions impressed upon the 
 ovum by the seminal fluid, or as those conditions are modified in he- 
 reditary scrofula, gout, &c., or whether it concern the temperaments 
 and other permanent changes that are induced by climate, domestica- 
 tion, &c., or as malaria may establish their peculiar modifications of 
 the properties of life. Nor can such conclusions be unexpected to 
 those who duly consider the simplicity of nature in her elementary 
 principles and laws (§ 561). 
 
 81. Could the doctrine entertained by Walker, Elliotson, and oth- 
 ers, that the imagination of the parents influences the physical organ- 
 ization of the offspring, be shown, the philosophy which I have set 
 forth, though not rendered more clear, would be yet fortified. But, 
 this is at best but speculation. I could, however, turn to the myste- 
 rious production of the soul. This remarkable principle is doubtless 
 developed at the very outset of foetal life, as evinced by its often com- 
 bining the intellectual peculiarities of both parents, or, again, of man- 
 ifesting chiefly those of the male. But here we have no other fact to 
 guide us, and all beyond has been involved in an impenetrable mys- 
 tery by the great Creator. Here it is a pride and a help of philoso- 
 phy to rest on faith alone (§ 433). 
 
 82. For an examination of vital phenomena, and relative facts, in 
 proof of the existence of properties peculiar to organic beings, and of 
 the abstraction of such beings from the laws of the inorganic world, 
 see Essay on the " Vital Powers," in Medical and Phyiiological Com- 
 mentaries, vol. i. 
 
 D
 
 50 INSTITUTES OF MEDICINE. 
 
 SECOND DIVISION OF PHYSIOLOGY. 
 
 STRUCTURE. 
 
 83, a. There are certain details in respect to the structure of or- 
 gans which must be stated, now and hereafter, to enable us to com- 
 prehend the laws which govern the healthy and morbid states of man 
 
 Perhaps few things can impress us more forcibly with the impor- 
 tance of a correct analysis not only of the physical organization of all 
 parts of the body, but more especially of the vital characteristics of 
 each part, than the continued propagation from high sources of doc- 
 trines like the following ; while they equally prove my position as to 
 the appropriate sources of knowledge (§ 51-51, &c.), and the tenden- 
 cies of the microscope.* 
 
 83, h. The eiTors in doctrine to which I have referred are I'cvealed 
 sufficiently in the following extract from an article by the distinguish- 
 ed Mr. Paget, contained in the 27th volume of the Transactions of the 
 Royal Medical and Chirurgical Society, London, 1844. The article 
 is entitled "An Account of the Examination of a Cyst containing 
 Seminal Fluid;" in the course of which Mr. Paget observes, 
 
 " If, with the aid of these observations, we endeavor to find an ex- 
 planation of the occurrence of spermatozoa in the fluid of cysts con- 
 nected with the testicle, we may suppose either that the fluid part of 
 the semen has permeated from the seminal tubes into the cysts, and 
 been farther organized in them ; or, that the cyst itself secretes a fluid 
 in which the organic structures of the semen may be developed." 
 " The most probable explanation of these cases, therefore, seems to 
 be, that certain cysts, seated near the organ which naturally secretes 
 the materials for semen, may possess a power of secreting a similar 
 fluid"! (s^ 251). 
 
 I cannot doubt that before I shall have parted with the reader in 
 what I shall have said of the peculiarities of structure, and the more 
 remarkable modifications of vital properties and functions, there will 
 be a disposition to concede the importance of the subject, and that 
 this importance is rendered more manifest by the prevalence of opin- 
 ions analogous to those in the foregoing extract. 
 
 83, c. As I have already intimated, however (§ 2, c), anatomical 
 science can lead, originally, to no conceptions of the properties and 
 functiuns of life, and therefore to none of their modifications in dis 
 ease. The most that we can infer, abstractedly, from a knowledge of 
 structure, are certain general results that are denoted by the constitu- 
 tion of organs, or assemblages of organs, upon the known principles 
 
 * See Medical and Physiological Co^nimentarics, vol. i., p. 699-712. Also, my Exam- 
 ination of Rericwti, p. 6, 89, 90. 
 
 t The Me'dicoChirurgical Heview for January, 1845, quotes this paragraph, and ob- 
 serves of it, that " Mr. Paget's explanation of the %'icai-ious appearance of the spermatozoa, 
 which has of late so much puzzled the members of the society, has the merit of being in- 
 genioHx and original." — I cannot acquiesce in this decision. The docti'ine is old, though 
 recently, for the first time, enforced by the deceptive report of the microscope. It is thus 
 noticed in the Medical and Physiological Commentaries : " True, we know that the an- 
 cient belief is even maintained at this day, by Sir A. Cooper, and others, that the testis 
 is of no special use, but that the semen is the product of those simple resei-v'oirs, the vesi- 
 culas seminalcs. But, whtit does this show?" &c. See, also, my comments on this sub- 
 ject, in vol. i., p. 588, and on the supposed vicarious secretion of miUi, urine, cf-c.. p. 601- (it)3.
 
 PHYSIOLOGY. STRUCTURE. 51- 
 
 of Design. The construction of the eye, for example, evinces some 
 great final cause relative to light ; that of the urinary apparatus, that 
 a fluid is produced by the kidneys, and conveyed to a receptacle 
 where it accumulates, and is finally evacuated through the urethra ; 
 and so of many other parts. We thus infer, also, the uses of each 
 part, individually, from their relations to each other as a system of 
 Design. In other cases the function of a part may be inferred from 
 the known uses of other parts to which it is related ; as the valves of 
 the vehis, for example, were supposed by Harvey to be designed for 
 giving the blood a direction toward the right cavities of the heart; 
 and this induction from anatomical Design conducted him to a full 
 exposition of the circulation. But, in respect to the great processes 
 of life, no conclusions can be originally drawn but through their phe- 
 nomena, nor does structure denote even the principle of vision (§ 251). 
 Having, however, acquired a knowledge of structure in a particular 
 species of animal, as man, for example, and learned the uses of each 
 particular part by a study of its phenomena, so perfect is the system 
 of Design throughout organic nature, and so harmonious are the anal- 
 02:ies of function among- ortjans that bear certain resemblances of 
 structure, or of relations to each other, in all species of animals, al- 
 though the differences in respect to structure, particulai'ly, may be 
 very great (§ 107, 409, e), yet illustrated by greater analogies of relation, 
 we may generally infer, by this analogical process (§ 5i), the absolute 
 uses of every part in any species of animal that may be, for the first 
 time, subjected to the knife of the anatomist. And this process of in- 
 duction may be carried to a great extent from an established standard 
 of comparison in the animal to the vegetable kingdom. But the prin- 
 ciple is equally comprehensive in respect to plants, when, as with an- 
 imals, a complex being is marked out, as a standard, in all its struc- 
 tures and functions. 
 
 The same is also true, though in a far more limited extent, of the 
 modifications of structure, and the corresponding modifications of func- 
 tion, at the different eras of life (§ 153-162). And when we come to 
 the variations of function in morbid states, though unattended by any 
 appreciable alteration of structure, and consider how various must be 
 the treatment according to the nature of the affected tissue, we are 
 deeply impressed Avith the indispensable importance, to the physician, 
 of an accurate knowledge of all that is relative to the sensible organ- 
 ization of the material part of organic life (§ 2, c). Though the struc- 
 ture, itself, reflect no light upon pathology, excepting through its mor- 
 bid alterations, an obsen^ation of its morbid phenomena leads us to a 
 knowledge of the parts diseased, and this knowledge is important to 
 a just interpretation of the phenomena, and to a right method of treat- 
 ment (§ 131). 
 
 832-. We have now seen that the composition of organic beings is 
 formed by properties peculiar to organic structure, and that what is 
 thus at the foundation presides over all, and is the cause of all that is 
 •superinduced upon that composition. The structure of organic be- 
 ings, which is comprehended under our second division of physiology, 
 is therefore dependent on the same creative cause. 
 
 84. The greatest physical characteristic of organized structure id 
 supposed to be its arrangement into cells. Here all analogy with in- 
 organic substances disappears entirely. The chemico-physiologists
 
 52 INSTITUTES OF MEDICINE. 
 
 imagine that the contradistinction between organic and inorganic be- 
 ings commences at this step in the ascending series of organic results 
 (§ 42). But we have seen suiiiciently that all that relates to the com- 
 position of plants and animals is equally significant of a radical dis- 
 tinction between the simplest organic compound and those of an inor- 
 ganic nature ; .the same powers being equally concerned in the forma, 
 tion of organic compounds as in their aiTangement ilnto tissues. 
 
 85. The general structure of organic beings is made up of tissues. 
 A knowledge of the vital characteristics of the different compound tis- 
 sues, of the same tissue in separate parts, of the different parts of one 
 and the same continuous tissue as it may pass through different com- 
 pound organs, of the whole as they may be combined into complex 
 organs, of their vital relations to each other, and of all parts to each 
 other, is indispensable to a knowledge of the laws in physiology, pa- 
 thology, and therapeutics. 
 
 86. Bichat analyzed the tissues more ably than others, and arranged 
 them as follows : 
 
 1. Cellular. 
 
 ,^ T-T i cerebro-spinal. 
 
 2. JXervous { r • 
 
 { ganghonic. 
 
 3. Muscular [ involuntary. 
 
 ( voluntary. 
 C arterial. 
 
 4. Vascular . . . ' . < venous. 
 
 ( lymphatic. 
 
 5. Osseous. 
 
 I fibrous. 
 
 6. Fibrous < fibro-cartilaginous. 
 
 ( dermoid. 
 
 7. Erectile. 
 
 8. Mucous. 
 
 9. Serous. 
 
 10. Synovial. 
 
 11. Glandular. 
 
 12. Epidermous, or corneous. 
 
 87. Until the era of Bichat, the tissues were limited to three, as 
 designated by Haller; namely, the cellular, muscular, and nervous. 
 The cellular was supposed to form a large proportion of other tissues. 
 
 88. There was a great error, physiological and pathological, in the 
 foregoing limitation (§ 87), since it took no note of the modifications 
 of the vital properties, and of the particular functions of the tissues as 
 arranged by Bichat.* 
 
 89. The several tissues are distinguished by differences of internal 
 structure, as well as by modifications of their properties and func- 
 tions. They are called simple organs, when considered in their func- 
 tional character; and when two or more go to the formation of more 
 complex parts, they are called compound organs. Certain compound 
 organs, which concur together in some general function, are called 
 an apparatus ; as the urinary, the digestive, the ciixulatory, &c. As 
 the whole exist in the universal body, they are called an organism. 
 Each tissue, collectively, is also a system ; as the mucous, serous, 
 muscular, &c 
 
 * For practical purposes Biohafs analysis has not been improved, nor probably can be — 18T0.
 
 PHYSIOLOGY. STRUCTURE. .^.S 
 
 91. The simple tissues rarely occur in a separate state, but are 
 more or less connected together into complex organs. 
 
 92. The simple textures are, themselves, compound organs, so far 
 as their organization is made up of various tissues. The union of 
 tissues, therefore, in the simple textures, is quite different and far 
 more intricate than when the simple textures form what is called, 
 specifically, a compound organ. 
 
 93. The structure of the general body, and of its different parts, is 
 radiated. The ray??, or branches, of certain parts, as the vessels and 
 nerves, are called ramifications. The rays increase in number and 
 diminish in size, as they go off from the centres of radiation. 
 
 94. The trunks of vessels and nerves, and their ramifications, unite, 
 respectively, in various ways with, each other. This is anastomosis, 
 and subserves very important uses. It promotes circulation in the 
 vessels, and through the nerves it contributes especially to bind all 
 the organs together in one harmonious action and common depend- 
 ence. Through the last, also, the play of reflex nervous actions is pro- 
 moted when the nervous power is developed in the central parts of the 
 cerebro-spinal and ganglionic systems by morbific or remedial agents. 
 
 95. The animal organism is symmetrical as a whole, and in its va- 
 rious parts. This symmetry is conducive to uniform results, is im- 
 portant to the great processes of life, is always the same in the natu- 
 ral conformation, is indicative of great Design, and of peculiar proper- 
 ties and laws. 
 
 96. Bichat, " following the path marked out by nature herself," di- 
 vided the animal organism into two great systems or classes ; the dis- 
 tinction having been already indicated by Aristotle. 
 
 97. The first class relates to the individual being ; the second to 
 the species. 
 
 98. The first class is divided by Bichat into the organs and func- 
 tions o^ animal life, and the organs and functions o? organic life. 
 
 99. " The two classes have nothing in common, but the general 
 connection that unites all the phenomena of living bodies ; but a va- 
 riety of distinctive attributes characterize them, which cannot be sep- 
 arated from them." — Bichat. 
 
 100. The organs of animal life are those whose functions connect 
 us sensibly with external objects, are peculiar to animals, and distin- 
 guish them from vegetables. 
 
 101. The organs of organic life consist of such as perform functions 
 that are common to animals and plants. " The only condition of en- 
 joying this life is organization." It forms an indisputable boundary 
 between orojanic and inorganic bodies. 
 
 102. Animals have two states of existence, sleeping and wakmg \ 
 but the former applies only to the division which embraces the func- 
 tions of animal life. The animal powers are subject to fatigue, and 
 require repose ; the organic are not, and are in perpetual operation. 
 
 103. The foetus has only the organic functions in operation ; but all 
 its animal faculties and the soul exist in a passive state.* The latter 
 are brought only gradually into exercise. 
 
 104. The great, immediate, office of the organs of organic life is to 
 maintain a constant vital composition and vital decomposition of or- 
 ganic matter ; or nutrition and vi^aste. 
 
 * See Medical and Physiological Commentaries, vol. i., p. 13.
 
 54 INSTITUTES OF ftlEDICINE. 
 
 105. The organs of digestion, absorption, circulation, resjiiration, 
 and secretion, compose organic life. Secretion comprehends nutrition, 
 exhalation, calorification, and excretion ; which four are often ranked 
 as distinct functions. 
 
 106. " Animal life is composed of the organs of sense which receive 
 impressions, of the brain which perceives them, reflects, and wills, of 
 the voluntaiy muscles, and larynx, that execute this volition, and of 
 the ners'es which are the organs of transmission." — Bichat. 
 
 107. The organs of organic life are quite analogous in the lowest 
 animals and plants ; but each has peculiar characteristics. In ani 
 mals a little higher in the scale, the common functions are performed 
 by organs of greater complexity, and this complexity increases in the 
 ratio of the development of animal life. Nevertheless, in most ani- 
 mals above the rudimentary there are the same subsidiary functions, 
 whatever the difference in organization. There is in most, for exam- 
 ple, the secretion of gastric juice, saliva, bile, &c., which subserve the 
 common function of assimilation. 
 
 108. No organ of animal life, in a philosophical sense, is necessary 
 to the individual. But, no part of the animal can exist without all 
 parts of the organic system, or an equivalent; which is also true of the 
 organic viscera. If the heart, for example, be wanting in the foetus, 
 the blood-vessels, as an equivalent, carry on the circulation. 
 
 109. a. The indispensable organs, of which no one can he. abstracted 
 without destroying the whole, are generally single in animals (§ 128). 
 The same is true of plants, if we regard those organs which perform 
 a common function in the light of a single organ. If the leaves fall 
 spontaneously and abruptly in cold climates, no injury results to the 
 plant, because it is passing into a torpid state. 
 
 109. h. Nevertheless, neither the action of the heart by which the 
 blood is circulated, nor that of the lungs by which the blood is oxy- 
 genized, nor that of the brain by which the harmony of organs is main- 
 tained, nor that of the kidneys and skin by which redundancies are 
 excreted, nor that of the liver by which bile is generated, nor that of 
 any other compound organ, constitutes the real functions of life. They 
 are only secondary or suboi'dinate to others in which the absolute pro- 
 cesses of life consist ; and these are carried on by those extreme vessels 
 which perform the immediate work of nutrition and vital decomposi- 
 tion. This is exemplified in the development of the ovum (§ 63-72), 
 and throughout the vegetable kingdom. Indeed, life may be continu- 
 ed after removal of the brain merely by inflating the lungs ; and could 
 we substitute a machine for the heart, and the process of transfusion, 
 both the heart and the lungs could be dispensed with for awhile. 
 
 These facts are important in showing the nature of the organic 
 properties ; how it is, and thi'ough what influences, the compound or- 
 gans contribute, and are, each one, indispensable, to thelife of animals ; 
 and that it is to the fundamental organization that we must look for 
 all the absolute processes of life, and for the essential conditions of 
 disease (s^ 1041). 
 
 110. The parts by which life is carried on in the organic viscera are 
 blended in the organs of animal life, and in those of the species. 
 
 111. The cerebro-spinal system is assigned both to animal and or- 
 ganic life. The sympathetic, like the cerebro-spinal, goes to the or- 
 ganic life of animals, and therefore pen'ades the organization in ani 
 mal as in organic life (§ 110).
 
 PHYSIOLOGY. STRUCTURE. OO 
 
 The cerebro-spinal nerves and the sympathetic interchange con- 
 tributions, in all parts, by which important influences of the former 
 are established in the organs of organic life (§ 452, &c., 500, 512, 
 514J-530, 889, 891^,^, k, 893, a, c-e, 902-905, 940-952). 
 
 112. Nevertheless, the cerebro-spinal system is especially designed 
 for the uses of animal life ; but an important final cause is answered 
 in making it subservient to the common interests of the whole being 
 (§ 455). 
 
 113. The sympathetic system is added especially to the oi'ganic 
 life of animals on account of the complexity of the organs, and to 
 unite them in harmonious action, through circles of sympathy, and 
 thus render them, each in its place, conducive to a common end. 
 The cerebro-spinal system contributes to this result (§ 111, 112) ; and 
 each system, unitedly, or independently, exerts special influences on 
 the specific actions of organs, though these actions are carried on es- 
 sentially through properties inherent in the several tissues (§ 226-233, 
 485). The nervous influence thus also bestows upon animal com- 
 pounds peculiarities that do not obtain in plants (^ 461, 489, 493 cc). 
 
 114. The most important common end (§ 113), as it respects the in- 
 dividual, relates to the functions of animal life. The organic system, 
 then, in animals, though physiologically the most important, must be 
 held subordinate to the uses of aiiimal life. In plants, organic life is 
 the whole being. 
 
 115. The foregoing union of organic life with all other parts (§ 110- 
 114) establishes mutual relations between all parts of the organism, 
 and brings the animal and sexual systems under the laws which ap- 
 pertain to the organic system (§ 455). 
 
 116. The same intimacy of parts confounds, in a degree, the dis- 
 tinction in the two lives (§ 115). 
 
 117. An important consequence of the foregoing vital union of or- 
 ganic with animal life (§ 110-114) is a general coincidence in the 
 pathological as well as physiological condition of the whole. The dis- 
 eases of each react mutually on each system of organs, each requires 
 common methods qf treatment, and remedial, as well as morbific, 
 agents operate upon the universal body through any given organ 
 (§ 455, 524, no. 1, 647), by exciting reflex nervous influences. 
 
 Nevertheless, diseases of the animal organs more readily derange 
 the organic viscera than the latter the former ; but, remedial agents 
 operate far more powerfully in the opposite relation. The sympa- 
 thies in the two lives, therefore, are not exactly reciprocal. 
 
 The foregoing apparent want of harmony in the physiological, 
 pathological, and therapeutical relations of the two systems of life is 
 reconciled by the consideration that nature has ordained, fc^r the pro- 
 tection of the organs of animal life, that their wants shall be emphat- 
 ically made known to those of the life on which they depend, and, on 
 the other hand, their dependence on organic life has placed them un- 
 der the special therapeutical control of that life ; wliile the organic 
 viscera being Independent of the organs of animal life, therapeutical 
 influences are but feebly propagated from the latter to the former. 
 Such are the final causes in the great plan of Unity of Design. 
 
 118. The second class of organs and functions, which relate to the 
 species, ai-e divided into three orders : 1st, such as belong to the male ; 
 2d, to the female ; 3d, the functions relative to Impregnation. 
 
 119. The several organs, and reproduction, belong both to plants
 
 56 INSTITUTES OF MED. CINE. 
 
 and animals. They are not necessaiy to the individual, though the 
 whole oi'ganic system is necessary to their existence. 
 
 120- Although the organs of generation be not necessary to the in- 
 dividual, they exert many natural vital influences upon the animal 
 functions. Their full development has also certain influences in or- 
 ganic life, which illustrate some important laws as to the vital prop- 
 erties. Their diseases may also give rise to great derangements of 
 the organic functions. They fail earlier than the animal functions 
 (§117, .578). . _ _ 
 
 121. In the great sense of ultimate Design, all organic processes 
 have for their final cause the development of the generative organs, 
 and the production of germs ; that similar beings may be maintained 
 in one unvarying round of development and growth. Many beings 
 die as soon as this end is attained, and return to the mineral kingdom 
 to be again reorganized by plants, and again, and again, refitted for 
 the nutriment of animals, and carry out, in both organic kingdoms, 
 the final cause of their regeneration from the mineral. 
 
 122. It is necessary that the ovum of mammiferous animals should 
 lemain connected with the parent till the organs of organic life are 
 developed. The law of dismemberment (§ 108, 109) does not apply 
 to the ovum of oviparous animals, nor to the seed. They are en- 
 dowed with the whole essential organization, and maturity of the vital 
 principle, for independent life. The former gets its nutriment from 
 the parent, till the organs are brought forth. The latter are supplied 
 with nutriment from within themselves. In this case, also, the spe- 
 cies are destined for gi'eat multiplication and distribution ; in the 
 other, their numbers and sphere are more circumscribed. 
 
 Nevertheless, the germ of all animals contains within itself the prin- 
 ciple of carrying out the full development of a being similar to the 
 parent, in all its complicated parts, which, however, have no rudi- 
 mentary existence in the ovum. The progress, too, of foetal devel- 
 opment is always the same in each species, and every part is brought 
 forward in the order of its importance in the organic life of the foetus, 
 and of its future uses. It is the same in the vegetable kingdom. 
 
 123. The history of the seed and egg probably supplies one of the 
 most remarkable illustrations of Design that can be found in nature ; 
 especially that of the seed. They are the only instances where the 
 entire properties of life cease their ordinary operation without be- 
 coming extinct ; and were it not for this interval of repose, the spe- 
 cies would probably disappear ; since, even if the properties of life 
 carried out the development of the seed into the plant, the chances of 
 preservation, and especially of multiplication, would be vastly dimin- 
 ished (§ 633, 1051, 1052). 
 
 124. Besides the foregoing general division of the organs and func- 
 tions of living beings, another arrangement of the organs is founded 
 upon the relation of special functions. Each component part, each 
 group of organs, and the whole collectively, are replete with various 
 and wonderful Design ; each, and all, having peculiar ends, all con- 
 spiring to common ends, and in one harmonious Unity of Design 
 maintaining the life of each other. 
 
 125 The followins: is
 
 PHYSIOLOGY. STRUCTURE. 
 
 51 
 
 1. Nervous System. 
 
 2. Vascular System. < 
 
 Direct circulatory or- 
 gans. 
 
 > Destined for waste. 
 
 ) Conveying the means 
 ) of repair. 
 
 The Arrangement of Organs according to tlieir relative Functions. 
 C Brain and cerebral nerves. 
 < Spinal cord and its nerves. 
 ^ Sympathetic ganglia and sympathetic nerve 
 C Heart and its 
 
 Pericardium. 
 
 Arteries. 
 
 Veins. 
 
 Lymphatics. 
 
 Lymphatic glands 
 
 Lacteals. 
 
 i Lacteal glands. 
 Mouth, stomach, intestine 
 Salivary srlands and pancreas. 
 JO 
 Spleen. 
 
 ! Larynx and vocal system. 
 Trachea. 
 Lungs. 
 Diaphragm. 
 Muscles of thorax and abdomen. 
 System of voluntary muscles. 
 
 C Derma, or main portion. 
 J Papillary tissue. 
 [ Rete mucosum. 
 [^ Epidermis, 
 r Kidneys. 
 J Ureters. 
 S Bladder. 
 ) Urethra. 
 ( Organ of hearing. 
 3 " sight. 
 
 ( " smell. 
 
 Bones. 
 Cartilage. 
 Ligaments. 
 Synovial capsules. 
 Testes. ") 
 
 Ductus defei'ens. 
 Seminal vesicles. 
 Prostate gland. 
 Penis. 
 
 Muscles of perinaeum 
 Ovaries. 
 
 Fallopian tubes. 
 Uterus. 
 Vagina. 
 Hymen. 
 Clitoris. 
 Nymphce. 
 
 Labia. I 
 
 Constrictor vaginae, j 
 ^. Mammae, — accessory parts. ^ 
 
 Respiratory Sys- 
 tem. 
 
 6. Cutaneous Sys 
 tem. 
 
 7. Urinary System. 
 
 8. Special Sensitive 
 System. 
 
 9. Osseous System. 
 
 ■) 
 
 10 Genital System. < 
 
 > Formative. 
 \ Copul 
 
 ative. 
 
 Formative. 
 
 •Copulative. 
 
 > Male. 
 
 Female.
 
 as INSTITUTES OF MEDICINE. 
 
 126. The organic and animal functions are also naturally subdivi« 
 tied into, 
 
 1st. Those which operate from without inward, as in digestion ; and, 
 2d. Those which operate from within outward, as in circulation, se- 
 cretion, &c. 
 
 127, There are generally two sets of organs for the animal func- 
 tions, having a harmony of action in their natural and healthy states. 
 
 128. When the organs of organic life are in pairs, as the kidneys, 
 concerted action is not necessary; and here one organ may supply 
 the place of both (§ 109). 
 
 129, a. The whole assemblage of organic viscera act together in 
 concert ; but the animal organs, as a general system, act more or less 
 independently of each other. 
 
 129, b. The mutual relations which subsist between the various or- 
 gans and their several functions are of two principal kinds; namely, 
 the vital, and the mechanical. 
 
 129, c. The first class of relations may be distributed into tlnee dif- 
 ferent orders. The first order consists of the relations between the 
 organs of sense. The second order embraces those between the brain 
 and voluntary muscles. The third order comprises the relations 
 which are especially maintained by sympathy. It is the last subdi- 
 vision, mostly, which is relative to our present subject. It concerns, 
 therefore, the organization by which organic life is carried on in ani- 
 mals, and depends upon the nervous power in its function of sympa- 
 thy, and upon a principle independent of the nervous power, called 
 continuous sympathy, and which is probably also an important princi- 
 ple in plants (§ 111-113, 222, 233, 495-500, 6381, 81 8i).— Note U. 
 
 129, d. The vital relations of a general nature evince the highest 
 order of Design. They refer to the mutual co-operation of distinct 
 systems of organs in the production of particular results, and of these 
 various systems in the maintenance of universal life ; while the sev- 
 ei'al individual organs possess distinct and specific offices that are 
 more or less dependent upon the principle of sympathy (§ 222-233, 
 455), that is, reflex action of the nervous system. 
 
 129, e. The sympathetic relations are most strongly pronounced 
 among organs which concur together in the performance of special 
 functions, as the circulatory, the digestive, the urinary, the sexual 
 systems, &:c. [^ 124). Other special relations subsist between the 
 brairi and the organs of animal life through the medium, in pait, of 
 the mental functions. Such is seen between the brain and voluntary 
 muscles in the production of voluntary motion (§ 500, d). .Thus, 
 also, the senses aid each other ; the sight being most independent. 
 In this way, too, a concurrence is established between the teeth, mus- 
 cles, eyes, nose, &c., in procuring food and supplying the stomach , 
 each individual part having been also constituted with a reference to 
 the nature of the food, and the mode of obtaining it (§ 323). 
 
 129, Jl Plants are devoid of all that intimate association of parts 
 which is owing to reflex nervous influence in animals, as well as 
 to peculiarities of structure and special modifications of the common 
 properties of life. But, a general relation of functions obtains to a 
 certain extent in plants through the ]a\v of continuous sympathy, which, 
 as I have endeavored to show, depends upon the organic jn-opertiea 
 and which 1 would designate as continuous influence (§ 498).
 
 PHYSIOLOGY. STRUCTUKi:. 59 
 
 1^9,^. The sympathetic relations in organic life are of the very 
 highest moment in medicine. Disease is propagated, is maintained, 
 and removed, very greatly, through these natural relations. 
 
 129, li. The sympathetic relations are variously modified by dis- 
 ease, and are often more strongly pronounced than in health, though 
 more or less diverted from their natural condition. Remedies also 
 operate with greater effect through these modified relations, as well 
 as through the greater susceptibility of the organic properties (§137, d). 
 For the same reason, natural stimuli, as food, often prove morbific 
 in diseased conditions (§ 152, h). The sympathies which grow out 
 of morbific agents depend upon the natural principle, of wliicli they 
 are only modifications. And so of those which spring from remedial 
 agents ; these agents giving rise to greater influences in consequence 
 of the morbid state of sympathy and of the organic properties, as 
 well as in consequence of their own intrinsic virtues (§ 718, 901). 
 
 129, i. It appears, thei-efore, to be a most important law, that mor- 
 bid states call into operation reflex nervous actions among organs, 
 which, in their natural state, manifest but feeble, and perhaps no di- 
 rect relations whatever; and that, in consequence of morbid changes, 
 remedial agents will operate sympathetically through the stomach, 
 &c., upon remote parts, when they would have no such effect in the 
 healthy state of the organs. This principle is demonstrated in every 
 case of disease, and constitutes our first position against the humoral 
 pathology, and the doctrine of the operation of remedial agents by 
 absorption (§ 819, &c.). New vital relations being developed by 
 disease, our remedies continue to operate through those acquired re- 
 lations so long as they exist; while, also, the remedies themselves 
 may institute analogous sympathetic relations, and thus simultane- 
 ously induce reflex nervous actions of a salubrious nature in organs 
 not morbidly affected (§ 74, 117, 137, 143, 155, 156, 387, 422, 514 7i, 
 524 A, 525, 528, 733 &, 905, 980). 
 
 129. k. The mechanical relations are equally common to plants and 
 animals. They are maintained by the motion of matter from one or- 
 gan, or part, to another ; as the transmission of blood from the heart 
 through the blood-vessels, sap from the roots to the leaves of plants, 
 food through the intestinal canal, urine from the kidneys to the blad- 
 der, and from the bladder through the urethra, &c. But, the move- 
 ment of the matter is effected by the vital properties operating through 
 the various organs. 
 
 130. Every part is a perfect labyrinth, anatomically considered. 
 It is a labyrinth, also, of perfect designs ; while the harmonious con- 
 currence of these designs in the aggregate organs and tissues is too 
 profoundly complex for any exact analysis. The deep intimacy of 
 parts in each tissue coiTOsponds with the union of the wliole, with 
 the dominion of common laws, and with that concerted action of all 
 parts, which, in a popular sense, makes up the life of the organic 
 being. 
 
 131. It has already been stated, that a knowledge of the minuteness 
 of structure which is supplied by the microscope is practically use- 
 less, while the deceptions of that instrument have led to many im- 
 portant errors in physiology and pathology (§ 83). It cannot be de- 
 pended upon, especially, in exploring soft structures. If it lead to 
 unimportant facts, it is equally liable to betray us into error and fal-
 
 60 INSTITUTES OF MEDICINE. 
 
 lacious hypotheses. The whole history of that instrument, so far aft 
 physiolofry is concerned, has gone to confirm the foregoing conclu- 
 sions, which were originally advanced in another work, and has con- 
 clusively sustained the opinion of one of the most profound observers 
 of the present age. Thus : 
 
 "Authors," says Bichat, "have been much occupied with the in- 
 timate structure of glands. Let us neglect all these idle questions, 
 in which neither inspection nor experiment can guide us. Let us 
 begin the study of anatomy where the organs can be subjected to the 
 senses." " No methodical mind will attend to the minute nature of 
 the muscular fibre, upon which so much has been written. The ex- 
 act progress of the sciences in this age is not accommodated to those 
 hypotheses, which made general anatomy and physiology a frivolous 
 romance in the last." 
 
 Microscopical information, so far as correct, goes to the amount of 
 human knowledge, and to the perfection of science, though it may 
 not contribute to useful ends. But experience shows us that we 
 may not depend, as it respects the microscope, upon the vision of oth- 
 ers, especially where a high magnifying power is required. Each 
 must observe for himself; and, as allowed by Ehrenberg, long prac- 
 tice, alone, can assure him of any general accuracy. The laborious 
 student may attend to this accomplishment. But, vita hrevis, ars 
 longa ; and he will be likely to live the subject of deluded sense 
 rather than of enlightened understanding. 
 
 " Enough is left besides to search and know. 
 But knowledge is as food, and needs no less 
 Her temperance over appetite, to know 
 In measure what the mind may well contain ; 
 Oppresses else with surfeit, and soon turns 
 Wisdom to folly, as nourishment to wind." — Milton. 
 
 The following is another example in illustration of Milton'g prin- 
 ciple, and another instance* of the revolutionary spirit of the micro- 
 scopic observers. I quote from Wagner's " Elements of Physiology 
 for the Use of Students.^' 
 
 " The study," he says, " of the varieties of form presented by 
 the seminal animalcules ought not to be held as any trifling matter, or 
 as tending to accumulate superfluous details. Most important phys- 
 iological CONCLUSIONS may be based on the information thus ac- 
 quired" (§ 83, b). 
 
 It is one of the few correct physiological conclusions to be found 
 in the writings of Liebig, that 
 
 " The most exact anatomical knowledge of the structure of tissues 
 cannot teach us their uses ; and from the microscopical examination 
 of the most minute reticulations of the vessels, we can learn no more 
 as to their functions than we have learned concerning vision from 
 counting the surfaces on the eye of a fly." — Liebig's Animal Chem- 
 istry.— {k 83 c, 251, 699 c and d). 
 
 When we consider, therefore, the constant deceptions of the micro- 
 scope, especially in all explorations of soft substances, and the abso- 
 lute uselessness of any knowledge it may convey as to the recesses 
 of organization, it may be reasonably expected that the time is not 
 
 • See ai-ticle on the Microscope, in Medical and Physiclogical Commeniaries, vol. i . p 
 699-712; and my Examination of Reviews, p. 6, 89; also, this work, § 515.
 
 PHYSIOLOGY. STRUCTURE. 61 
 
 distant when all this lumber will be excluded from practical woi'ka 
 on physiology, and turned, at least, into a channel by itself.* 
 
 132. Each simple texture, when united into compound oi'gans, has 
 as much its own specific function as the aggregate compound. It is 
 even more important, in a pathological sense, to regard the individ- 
 ual textures than the compound organ which they may form. 
 
 133, a. A consideration of the tissues in respect to their special 
 character and functions, as well as their obvious anatomical differen- 
 ces, being of the vqry highest importance to the physiologist and phy- 
 sician, they can be studied advantageously only in these several as- 
 pects. Much must, therefore, be now anticipated as to what will be 
 subsequently stated more circumstantially in regard to the properties 
 and functions of life. The student must be prepared with that anal- 
 ysis before he can approach the tissues with any hope of enlightened 
 knowledge. A simple statement of their apparent anatomical charac- 
 teristics and relations, and of their products, would present a barren 
 field. Nor is it alone their vital attributes which should most entja^e 
 the attention of the medical philosopher, but he should be equally 
 and simultaneously employed in learning how these conditions are 
 modified in disease. Such, therefore, is my projected plan in relation 
 to the tissues (§ 83, c). 
 
 133, h. Every distinct tissue, and often the same tissue as it occurs 
 in different places and connections, and even the different parts of one 
 and the same continuous tissue, possess, respectively, special modifi- 
 cations of the vital properties and functions. Upon these modifica- 
 tions depend the vai-iety of the natural vital phenomena, as, also, very 
 greatly, those which are morbid. 
 
 133, c. But there would be no disease were there not another im- 
 poitant condition in the constitution of the vital properties ; and this 
 is their mutability. Its final cause is the well-being of organic nature ; 
 since, as organization changes in the progress of the plant or of ani- 
 mals to a state of maturity, so must there be an antecedent change in 
 the properties which conduct the development of organs, &c. The 
 same principle is displayed in gestation, lactation, &c. It is this, in 
 connection with the susceptibility of the properties of life to the action 
 of blood and other vital agents, which renders them liable to morbid 
 changes when other causes operate. Such, therefore, is a necessary 
 consequence of the final cause of the adaptation of the properties of 
 life to the influence of salutary agents, and to the varying exigencies 
 of organic nature. 
 
 Nor would there be any recovery fi-om disease, but for the same 
 mutability of the organic properties, and their liability to other chan- 
 ges when yet other causes operate (§ 177, &c., 901). 
 
 134. Owing to the peculiarities in the vital constitution of the dif- 
 ferent tissues, a common disease, as inflammation, is characterized by 
 many peculiarities of symptoms, &c., in the several tissues, respect- 
 ively. Differences also arise in their constitutional influences, and 
 they may require corresponding variations of treatment (§718). This 
 is even true of different paits of a continuous tissue, as the alimentary 
 and pulmonary mucous membrane ; where inflammation of this mem- 
 brane in the nose, larynx, trachea, lungs, fauces, stomach, and intes- 
 tines, is distinguished by ahnost as striking peculiarities in the vital 
 signs, and in their constitutional influences, as are the physiological 
 
 * jSTot one disclosure has been j'et made bj- the microscope that can affect a doctrine 
 in these Institutes — 1870.
 
 62 INSTITUTES OF MEDICINE. 
 
 functions of the different compound organs which it traverses (§ 140 
 752-754, 7S0, 783). 
 
 135, a. The special modifications of the vital properties in differ- 
 ent parts of one and the same continuous tissue is often strikingly de- 
 noted by the character of the natural product of the several portions, 
 respectively ; as in the tissue last mentioned. Nothing, for example, 
 can be more unique than the gastric juice, a product of all complex 
 animals, while it can be generated by nothing but the mucous tissue 
 of the stomach. Again, in the lungs we meet wiUi this tissue per- 
 formino- the office of excretion ; being the only example in which an 
 organ eliminates truly effete matter from venous blood. And here an 
 important analogy occurs to show that the elaboration of carbon is a 
 vital process (§ 316, 419, 827 h). In the uterus the same membrane 
 appears as an organ of excretion in relation to the arteria] blood, but 
 for the uses of the uterus alone ; nor is there any thing else in nature 
 that is capable of generating a similar product. But, in all the cases, 
 the analogy which is indicated by the coincidence of anatomical struc- 
 ture is farther confirmed by the universal production of mucus by this 
 remarkable tissue. The anatomical differences are microscopical. 
 
 135, h. All the foregoing is delicately exemplified by the great 
 variety of formations which are generated by the granulations that 
 spring from ulcers ; since, although in all the cases the granulations 
 appear to be identical in character, we know from their production of 
 parts analogous to such as had been removed by the ulcerative pro- 
 cess, that, in every instance, the granulations must have been endow- 
 ed, respectively, with specific modifications of the organic properties 
 and shades of diflerence in organic structure (^ 733 c). 
 
 136. In consequence, also, ofthe foregoing peculiarities of vital con- 
 stitution, every tissue, and often continuous parts of a tissue (as in the 
 last example), are determined in their results by special vital influ- 
 ences, as well as by any peculiarities of organization. This is denoted 
 by the phenomena where structures are most alike. Owing, also, to 
 the general coincidence in the vital constitution of all parts there are 
 certain general stimuli adapted to the whole, especially the stimulus 
 of heat. The blood has been regarded as a universal stimulus ; but, 
 it is only so in relation to the sanguineous system. This fact, it may 
 be now remarked, evinces, what is shown by diseases, a near identity 
 in the vital constitution of all that part of the arterial system which 
 conveys red blood ; while, on the other hand, the difference between 
 arterial and venous blood shows a difference in the organic proper- 
 ties ofthe aiterial and venous systems. This has its deep foundation 
 in the whole physiological condition of man and animals, and I may 
 also add, in the whole vegetable tribe (§ 847, c). While every sur- 
 face has some secreted product adapted to its own special modifi- 
 cation of initability, many of these products may be offensive to 
 other parts. Again, the special irritability of one part may be exactly 
 suited to some product of another part, and this may or may not be a 
 natural vital stimulus, and perfectly inoffensive, to the second part, 
 while it may excoriate all other parts. Bile, for instance, is the nat- 
 ural stimulus of the intestine, but will injure other parts. Venous 
 blood is harmless in the veins, and excites them, more or less, to a 
 contractile action ; but is rapidly fatal within the arteries (§ 849). 
 Urine is the natural stimulus of the bladder, but will excoriate most 
 other parts (§ 74, 188^ d, Mb\, 500 m, 514/, 6471, 650, 847 e).
 
 PHYSIOLOGY. STRUCTURE. 63 
 
 137, a. In this relative sense the animal is filled with poisons;, 
 each one of which, however, in its proper place, is not only inoffen- 
 sive, but indispensable. Here is the principle. 
 
 137, b. It is, also, upon the foregoing organic constitution of differ- 
 ent parts, and which gives rise to a mutual relation of the different 
 vital agents and products of organs and of the various parts of the or- 
 ganism, that the difference in the effects of remedial as well as mor- 
 bific agents upon different parts is essentially founded. Wine in- 
 flames the mucous tissue of the bladder, &c., but may be good for 
 the stomach. Tobacco smoke is inoffensive when inspired in the or- 
 dinary mode ; but it is a violent poison when introduced within the 
 ahmentary canal. Other agents affect the stomach, or intestines, or 
 livei', or uterus, or bladder, &c., each organ more than the others, and 
 more than other parts (§ 233f , 872 c, 838.) 
 
 137, c. From not duly regarding these important facts, or fi'om an 
 ignorance, or a disregard of physiology, many agents which have a 
 specific relation to the vital constitution of some tissue in a particular 
 part of the body, as the mucous, for example, are supposed to have 
 the same relation to the tissue in all other parts. Hence the oil of 
 turpentine, copaiva, naphtha, &c., have been abortively or injui'iously 
 employed in pulmonary catarrh, phthisis even, diarrhoea, dysentery, 
 &c., mostly for the reason that they exert a specific efi'ect u^Jon the 
 mucous tissue of the urinary organs. 
 
 This great law of adaptation is so universal as to extend through- 
 out the whole domain of medicine, reaching as fully into pathology 
 and therapeutics as it is conspicuous in physijology. If the blood be 
 rendered morbid by morbid states of the solids it never becomes 
 morbific, since there is a progressive adaptation of the vital changes 
 in the solids to such as the solids induce in the blood. And so of va- 
 rious morbid secretions in relation to the parts by which they may be 
 produced. These results, in which the vital properties of the solids 
 are always concerned as the primary cause, ai-e founded in an all- 
 pervading law of the animal economy, and by which, and which alone, 
 nature is enabled to throw off disease (§ 524 d, 944 c, 847 a-h). 
 
 137, d. Again, it is one of the most im^iortant laws in medicine, 
 that the susceptibility of tissues and organs to the action of remedial 
 agents is more or less affected by disease. Many agents which oper- 
 ate powerfully in certain morbid states, and in certain doses, both lo- 
 cally and sympathetically, may be perfectly inert in the natural states 
 of the same organs. And so of the natural agents of life. The great- 
 ness of the effects, also, will depend very much upon the nature and 
 intensity of disease. The same principle applies to the impressions 
 which are made by many remedial agents upon existing states of dis- 
 ease, or upon organs in their state of integrity ; by which the diseased 
 or healthy parts are increased in their susceptibility to the subsequent 
 action of the same or other remedies, or to morbific causes (§ 143, c). 
 
 137, e. It is, therefore, one harmonious system of laws throughout. 
 Were it, indeed, otherwise, remedial agents could have no existence,, 
 and disease, of course, could receive no help from art. These, also^ 
 are the beginning of a long series of facts which show us that the' 
 effects of all agents, whether morbific or remedial, may be traced to 
 the peculiar impression which they exert upon parts with which they 
 come in contact; and by which, also, we overthrow the whole systtnr.
 
 64 INSTITUTES OF MEDICINE. 
 
 of chemical physiology, the humoral pathology, and the doctrines of 
 debiUty, and of cure by the absorption of remedies (§ 847, e). 
 
 138. The natural modifications of the vital properties and functions, 
 or the special vital constitution, of any particular tissue, or parts of a 
 continuous tissue, and, therefore, their special modifications in any 
 given disease, conform to the general nature of the complex organ of 
 which the tissue may form a component part. 
 
 Certain tissues of a compound organ are far more liable to disease 
 than its other tissues. Thus, the mucous tissue of the stomach is 
 quite liable, the serous rarely, and the muscular more rarely (§ 764, a) 
 
 139. Disease of any particular tissue, or parts of a tissue, is apt to 
 be most severe, in its local and general character, according to tho 
 importance of the functions of the conipou7id organ of which it may 
 form a component part. This, however, is less true of the constitu- 
 tional influence, than of the local intensity of disease. 
 
 140. The sympathetic influences of disease are also greatly detei- 
 mined by the nature of the affection, especially the constitutional ef- 
 fects. Inflammation of the serous, venous, and ligamentous, tissues, 
 disturb the constitution far more than the same degrees of inflamma- 
 tion affecting the mucous, arterial, and muscular, tissues. But much, 
 also, as already said, will depend upon the nature of the compound 
 organ with which the tissue, or part of a continuous tissue, may be 
 associated ; though sometimes, where the compound organ is compar- 
 atively unimportant, inflammation of one of its tissues may give rise 
 to great constitutional disturbances. Such, for example, is true of 
 some inflammatory affeptions of the mucous tissue of the throat; and 
 few diseases are more intractable than laryngitis. Much, also, will often 
 depend upon the special modification of disease; as in acute articular 
 rheumatism (§ 525-530). 
 
 141. a. Tissues of the same organization are most allied in their 
 vital properties, and hence are most liable to sympathize with each 
 other in their diseases. 
 
 141, h. When a tissue of an organ becomes diseased the proper- 
 ties and functions of the others are more or less disturbed ; though 
 the primary disease is not apt to be propagated to them from the tis- 
 sue first affected. It continues rather in the tissue first invaded. In- 
 flammation, for example, beginning in the mucous tissue of the stom- 
 ach, will extend along that tissue, so far at least as its connection 
 relates to the stomach, without being often propagated to the other 
 tissues of the compound organ. This principle has a broad founda- 
 tion, and is owing to the general coincidence in the vital constitution 
 of all parts of the same tissue, and to the differences between the vital 
 states of that and the associated tissues. Exceptions, however, occur 
 more frequently in some parts than in others ; as in the lungs, where 
 pleuro-pneumonia is not unfrequent. Nevertheless, in these cases, 
 the simultaneous affection of two distinct tissues of a compound or- 
 gan may be rather owing to a general predisposition effected by some 
 remote cause than to morbific influences exerted by one tissue upon 
 the other. In other cases, especially of specific inflammation, the dis- 
 ease is propagated directly from one tissue to another, as in scrofula, 
 heumatism, &c. ; but in most other instances by reffex nervous action. 
 142. For reasons stated in § 133-136, morbific agents may readily 
 excite disease in one part of a continuous tissue when they would have
 
 PHYSIOLOGY. STRUCTURE. 65 
 
 110 effect on another part of it ; or may operate more profoundly on 
 one part than on another. And this holds true of the action of rerae. 
 dial agents. The same is also true of the sympathetic influences 
 which may be exerted by disease ; and a like principle applies to cer- 
 tain sympathies that fall upon special parts which are immediately 
 continuous with each other, but Avhich are determined, also, by cer- 
 tain special vital relations of the diiFerent parts. Thus, the vital rela 
 tions of the tongue to the alimentary canal being far greater than to 
 the lungs, and as the canal readily sympathizes with other chylopoi- 
 etic viscera, the tongue is far more sensitive to abdominal than to pul- 
 monary derangements (§ 129 c, i, 689 ^, 694f). 
 
 143, a. A'gain, there may be varying susceptibilities of the differ- 
 ent parts of a continuous tissue (arising from numerous causes not 
 positively morbific), when the same morbific, or remedial, cause will 
 affect one part or the other more in conformity with the acquired sus- 
 ceptibilities, than with the natural modifications, of the vital proper- 
 ties in the several parts, respectively. This is also more applicable 
 to the tissue as it occurs in compound organs not anatomically con- 
 nected, and to tissues which differ in their organization (§ 783). 
 
 143, h. Hence it follows, that, if all the organs be rendered preter- 
 naturally susceptible, a general explosion of disease may follow the 
 operation of some cause, which, in sounder health, would be harm- 
 less. Under these circumstances, however, disease is most apt to 
 spring up more or less sympathetically, and successively, in one part 
 after another, till all parts may ultimately be brought into some, though 
 variable, forms of disease (§ 514 h, 660, 666, 905). But, in these 
 cases, it generally happens that some of the morbid states abate, or 
 subside, as new ones come forward, the new ones, perhaps, subduing 
 sympathetically the older in the series (§ 804, 905). The system, 
 therefore, is rarely universally invaded by disease, except in idiopathic 
 fever (§ 148, 783). Reflected nervous action applies in all the cases. 
 
 Nevertheless, it probably does not often, if ever happen, except in 
 fever, that the primary is the efficient predisposing cause of universal 
 disease, but that disease of one organ proves the predisposing of dis- 
 ease in another ; and as one organ after another becomes affected in 
 this manner, they co-operate together in rendering other parts suscep- 
 tible of disease (§ 644, &c., 715-719). 
 
 143, c. In proportion, therefore, as the susceptibility of the system 
 at large is increased by morbid changes, or predisposed by morbific 
 influences, so, in a general sense, will the alterative action of reme- 
 dial agents be felt in a corresponding manner (§ 137 d, 152 b, 715). 
 By the law of adaptation as set forth in the Medical and Physiological 
 Commentaries (vol. i., p. 649, 653-655, &c.), and in various parts of 
 the present work, the sympathetic influence of any local disease 
 which is felt by distant organs modifies the vital states of those parts 
 in. a manner that institutes harmonious relations to the part more pro 
 foundly affected ; and thus remedial agents will extend their salutary 
 alterative action to such distant parts, and render them the source of 
 salutary effects upon the essential seats of disease (§ 73,80, 117, 1292, 
 133-137, 140, 155, 156, 169/, 387, 399, 422, 514 Ji, 524 d, 525, 528, 
 638, 649 (Z, 811, 848, "902/, 905). "When the whole system is inva- 
 ded by disease, as in idiopathic fever, the alterative action of rem- 
 edies is felt over the universal body (§ 148, 152 i, 222-232, 500, 
 
 E
 
 66 INSTITUTES OF MEDICINE. 
 
 904 d). It is owing, also, to the same law of adaptation, the same 
 universal, however partial modifications of the vital states which local 
 diseases often induce, that parts remote from the direct seat of dis- 
 ease are protected against all morbific effects from any changes which 
 the blood may undergo as a consequence of morbid action (§ 845, &c.). 
 Independently, however, of any increased susceptibility of organs, the 
 action of numerous agents upon the stomach may determine influences 
 upon distant parts whose natural state is unimpaired, and these influ- 
 ences may become the source of other impressions upon other parts. 
 Circles of reflex nervous action may be thus engendered universally, by 
 which all parts shall concur in the effects of the gastric irritation which 
 the remedies may institute. In this manner a cathartic or an emetic 
 may bring the whole organism to bear with favorable influences upon 
 some slight inflammation of the throat which had exerted no mod- 
 ifying effects upon other parts (§ 514 h, 692 a, 902 g). 
 
 143. d. Again, there are some remedial agents possessing general 
 vital relations to the whole body, especially the several preparations 
 of mercury, and others whose specific relations are more limited, like 
 cantharides, which will affect profoundly the entire organization, or 
 certain individual parts, and alter the condition of their vital states, in 
 the most healthy conditions. These agents, therefore, approach most 
 nearly the truly morbific ones, while they possess the grand charac- 
 teristic of the Materia Medica of instituting morbid changes which are 
 of transient existence (§ 1059, 854 d). 
 
 144. Many acquired conditions may be transmitted fi-om parents to 
 child, which may thus form a constitutional predisposition to disease ; 
 being a permanent and more or less universal modification of the vital 
 properties (though of some parts more than others), which does not 
 properly belong to them ; as in scrofula. Here, the absolute remote 
 cause has operated upon the ancestor (§ 75-80, 661). 
 
 145. Subjects thus constituted (§ 144) are liable to morbific influ- 
 ences which the more natural do not feel ; and such causes as would 
 produce in the natural subject common inflammation of the nose, 
 trachea, &c., will excite scrofulous inflammation in the lungs of the 
 acquired constitution (§ 650, 659). 
 
 146. Hereditary predisposition to disease manifests itself in certain 
 tissues and organs more than in others, according to the nature of the 
 transmitted constitution (^ 143, a). 
 
 147. Sympathetic diseases may spring up in unusual constitutions, 
 when they would not in the more natural. Thus, in certain heredi- 
 tary conditions indigestion gives rise to scrofulous, rheumatic, and 
 gouty inflammation of parts distant from the chylopoietic viscera. 
 The same principle is also in operation when the vital constitution of 
 parts is modified by habits, climate, age, the development of the gen- 
 erative organs, &c. (§ 542), all depending upon reflex nervous action. 
 
 148. Certain causes appear to be capable of affecting, directly and 
 indirectly, all the tissues of the body, as in idiopathic fever; though, 
 in these cases the primary morbific effect is on particular parts, from 
 which it is disseminated by morbific reflex nervous action (§ 649, 
 665, 666, 760). In these cases, however, it appears not to be a posi- 
 tive state of disease in the part upon which the morbific agents may 
 exert their primary effects, as on the mucous surfaces, which brings 
 the iost of the system into a predisposition to disease; but a predis-
 
 PHYSIOLOGY. STRUCTURE. 67 
 
 position being established in those primary parts, the impression is of 
 such a nature as to be propagated sympathetically over the universal 
 body; just as when many remedial agents acting upon the mucous 
 surface of the stomach exert powerful influences upon remote organs, 
 but without inducing disease in the gastric mucous membrane. It is, 
 therefore, in idiopathic fever, as well as in numerous local affections, 
 that the parts on which the morbific agents exert their direct effects 
 may not manifest any signs of disease till the explosion of fever takes 
 place ; or as when pneumonia, or catarrh, is induced by the action of 
 cold upon the skin ; while it often happens that the parts thus origin 
 ally, but imperceptibly impressed, become sympathetically the seats 
 of alDsolute disease by the reacting influence of the diseases which had 
 been sympathetically produced through these parts. Very complex 
 circles of reflex nervous action may thus arise. These general af 
 fections may be also broken up by the action of a single remedy, as 
 by an emetic, or mercury, &c. (557, 559, 712, 715-719). 
 
 149. It is a great and important law, resulting from the physiolog- 
 ical considerations now made (§ 133-148), that morbific causes, ex- 
 ternal or internal, determine disease upon the tissues of one com- 
 pound organ or another according to the particular virtues of the 
 morbific causes, and in accordance, also, with the natural modifica- 
 tions of the vital properties in every part, and the susceptibilities 
 which they may acquire from other causes (§ 642 Z>, 722 d, 725, 
 794, 795, SOS). Hence it follows that many of the natural stimuli of 
 ^afe may become morbific. 
 
 150, a. It is a great fundamental law, that a genei-al coincidence 
 exists between the natural susceptibilities of the properties of life to 
 their ordinary stimuli (§ 136), and to those of a morbific, and of a re- 
 medial, nature, according to the natural modifications of the vital 
 properties, whether in a general sense (§ 148), or in their relation to 
 particular parts (§ 136) ; the influences produced conforming, of 
 course, to the natural modifications of the properties of life and the 
 special virtues of the several agents, though modified by the tran- 
 sient or permanent influences which spring from other sources, espe- 
 cially from disease (584, 644-674, 772 c, 826, &c., 847 e, 904). _ 
 
 Such is the inevitable result of the constitution of the properties of 
 life (§ 177). It is, as it were, the great focal point from which all di- 
 verges that is embraced in medicine ; the bond which unites every 
 branch of the science. 
 
 150, h. All that is here said, and in § 149, is equally applicable to 
 the nervous power, in all its modifications, as an agent in the produc- 
 tion and cure of disease, as to agents of a physical nature (§ 222- 
 233J, &c.). 
 
 151. It is through the foregoing law (§ 150) that the natural stim- 
 uli of life maintain all parts in their precise conditions ; through 
 which, also, morbific agents alter those conditions in certain uniform 
 ways, and through which remedial agents establish certain other 
 changes which enable the properties and actions of every part to re- 
 turn spontaneously to their natural states. The law involves an im- 
 mense range of facts in physiology, pathology, and therapeutics, and 
 groups many other fundamental principles. It should be the point of 
 departure in all our medical researches and reasonings ; for it is, as it 
 were, the polar star which will guide us safely upon our difl^icult aijd 
 dap^erous vovase (\ 794, 795, &c.).
 
 68 INSTITUTES OF MEDICINE. 
 
 J 52, a. It follows, therefore, from § 150, 151, that the operation of 
 all things upon the living organism, whether food, heat, cold, blood 
 poisons, the nei-vous power, or remedies for disease, is upon one com- 
 mon principle, which is relative to the natural constitution of the or- 
 ganic properties. Food stimulates the stomach, and throws a genial 
 sympathetic influence over the whole organism, warming the cold 
 surface as soon as it enters its appropriate receptacle ; blood main- 
 tains, in the same way, the actions of all parts ; poisons and morbific 
 agents, put into the stomach, affect the vital properties of that organ 
 injuriously, when, unlike the case of food, pernicious reflex nervous ac- 
 tions are determined upon other parts, or the same food in excess • 
 may do the same. We then introduce into the same organ another 
 class of morbific agents that are less profound in their operation, and 
 which prove remedial in certain doses, and therefore establish, through 
 the same piinciple, a salutary change in the same properties which 
 other poisons had affected injuriously (§ 638, 642 h, 854). 
 
 152. h. It is also worthy of repetition, that such is the analogy be- 
 tween morbific and remedial impressions, that the organs which sus- 
 tain the former are thus rendered susceptible of the latter, when they 
 might be otherwise insensible to the same remedial agents, in their 
 appropriate remedial doses. Such is the harmony of the laws of na- 
 ture ; such their great final causes (§ 524, no. 3, d). For the same 
 reason, also, many of the natural agents of life, such as the ordinary 
 kinds of food, may be intensely morbific in most of the diseases of 
 man (§ 849). Or, again, the agents which heal in their remedial dosea 
 may establish severe forms of disease when administered in health. 
 
 153. Through the law of development, the tissues undergo natural 
 modifications in their structure and vital endowments at many periods 
 of life. In infancy, the organs are imperfectly developed, though the 
 projDorties and functions of organic life, unlike those of animal life, 
 are strongly pronounced in many of the viscera. A relation obtains, 
 however, in organic life, between the properties and functions and 
 the relative size of organs (§ 159). 
 
 In childhood, there is another well-marked change. In adoles- 
 cence, another ; when the organs become mature. . In old age, an- 
 other; when life is naturally on the decline. 
 
 154. The foregoing stages of development (§ 153) are not sudden, 
 but gradually progi'essive. 
 
 15o. The changes of organization (§ 153, 154) are preceded by 
 corresponding changes in the vital properties, upon which the former 
 depend (§ 445, y). This principle, too, like all others which relate to 
 organic life, whether in health or disease, is universally ti'ue under 
 any given combination of circumstances. It is true of the develop)- 
 ment of all tissues and all organs, and all other products, from the be- 
 ginning of conception to the end of life. Hence, also, the variety in 
 the remedial or morbific virtues of many plants, at different stages of 
 their growth. As structure varies, the vital properties have under- 
 gone modifications, in conformity with that order of Design which was 
 instituted, that where one specific end is accomplished, and others are 
 to be fulfilled, the powers by which these final causes are to be ac- 
 complished shall have their necessary adaptations. And while, also, 
 the vital properties, under all their natural modifications, are so con- 
 stituted as to receive certain exact impressions from the natural stim-
 
 PHYSIOLOGY. STRUCTURE. ' 69 
 
 uli of life, that vital actions may be determined according to the pur- 
 poses ordained, so also will morbific and remedial agents be varied in 
 their influences (§ 129 i, 387, 980). 
 
 156, a. The foregoing variations (§ 153-155), therefore, give rise 
 to new dispositions to disease in many parts, and are productive of 
 modifications of former diseases, or the latter disappear. This, as 
 we have seen, is a necessary consequence of the physiological chan- 
 ges, since the same properties which carry on nutrition and growth 
 carry on all diseases. The relations of vital and morbific agents move 
 on, j)a7-i -passu, with the natural changes in the properties of life ; and 
 remedial agents undergo corresponding modifications of action. 
 
 156. h. The great law of adaptation is forever present to the eye 
 of the naturalist; and when the same subjects are contemplated in a 
 moral sense, the same evidences of Design meet him at every glance 
 of the mind. Take an example of a compound nature, a universal 
 physiologico-moral phenomenon in which our present topic is involv- 
 ed. Thus, no sooner was man created than he was doomed to obtain 
 his subsistence by the sweat of his brow. Roots, grains, fruits, «&c., 
 were, therefore, as far as the wants of animals would allow, created 
 mostly in an unedible condition, but rendered susceptible of the re- 
 quisite improvement by cultivation ; and to carry out the great pur- 
 pose, the nature of soils, air, water, &c., were made subservient (§ 
 74, 80, 117, 137, 143, 155, 169/; 266, 384, 385, 387, 399, 409/, 422 
 514 I, 524 d, 525, 526 d, 528, 638, 733 h, 847 g). 
 
 157. Organs are sofl:est and most fluid at the beginning of their de- 
 velopment, and increase, progi'essively, in density through life. The 
 animal ovum is scarcely more than an organic fluid (^ 67). 
 
 158. Vascular action is promoted by the greater fluidity of or- 
 gans, and vice versa (§ 142). Inflammation is in part, therefore, 
 more intense and rapid in infancy and childhood than at later peri- 
 ods, which, with other causes, gives rise to the necessity of great 
 promptitude of remedies. Other causes attending the vital condi- 
 tions of old age render equally important a decisive treatment of the 
 severe diseases that may befall that age (§ 574, &c., 1009, &c.). 
 
 159. The proportional size of organs varies at different stages of 
 life. The cerebro-spinal system, for example, is largest in child- 
 nood. Hence a greater development of the organic properties in those 
 parts, and a greater consequent liability of the brain to inflammatory 
 and congestive affections, and to hydrocephalus. The large propor- 
 tional size of the nervous and arterial systems affects the physiolog- 
 ical and pathological condition of all other parts ; giving activity to 
 nutrition, and susceptibility and intensity to disease. « 
 
 The glandular tissue of the liver has the largest proportional size 
 in infancy ; but not so the venous system of the liver. Hence, again, 
 ♦^he glandular function of that organ is especially liable to derange- 
 ment in infancy, and its venous tissue to congestion at more advanced 
 
 It is also important to understand, that the veins, in a general 
 sense, " have a real inferiority as it respects the arteries, during the 
 first periods of life." — Bichat. There are some exceptions, espe- 
 cially in the brain. 
 
 160. What has now been said of the m.odifications of the vital con- 
 Btitution of different tissues and organs may be illustrated by the rel
 
 70 INSTITUTES OF MEDICINE. 
 
 ative liability of different tissues, and parts of common tissues, to 
 some given disease, by the relative danger of that disease as it may 
 affect the different parts, and by the eff'ects of some remedial agent 
 ujjon the various parts, respectively. The remedy may be loss of 
 blood, and the supposed disease inflammation. The statement may 
 be conveniently made in a tabular form, while, also, it may be con- 
 verted to practical uses (^ 711). 
 
 161. The tables are intended in a general sense, and suppose the 
 constitution to be naturally sound. If hereditary predispositions to 
 disease exist, as in scrofula, or if the constitution be affected by in- 
 temperance, or by pre\'ious diseases, &c,, the order of liabilities to 
 inflammation, &c., as marked in the first table, will be more or less 
 affected. In the scrofulous constitution, for example, instead of the 
 mucous, the lymphatic tissue may be most liable. 
 
 162. The tables will be more or less modified by age. Thus, the 
 veins of the pia mater are more liable to congestion in infancy and 
 childhood than any other part of the venous texture. This liability 
 afterward decreases, and returns at the age of fifty and upward, re- 
 sulting in cerebral hemon'hage (§ 805). 
 
 PHYSIOLOGICAL AND PRACTICAL SUGGESTIONS. 
 
 Tissues most liable to disease, especially to inflammation, in the 
 order of arrangement : 
 
 1. Mucous. 
 
 2. Venous {venous congestion). 
 
 3. Cellular. 
 
 4. Serous. 
 
 5. Ligamentous and dennoid [Jibrous). 
 
 6. Glandular. 
 
 7. Lymphatic. 
 
 8. Nervous. 
 
 9. Synovial. 
 
 10. Periosteum {Jibrous). 
 
 11. Osseous. 
 
 12. Tendons, cartilage, dura mater, and peiicardium (Jibrous). 
 
 13. Muscular. 
 
 14. Arterial. 
 
 1. Mucous texture 
 
 TABLE II. 
 
 '' of the nose. 
 
 " lungs, fauces. 
 " eyes. 
 
 ( Ilium, 
 *' small intestine, < Jejunum, 
 
 Duodenum. 
 
 stomach, 
 large intestine, 
 uterus and vagina, 
 bladder.
 
 PHYSIOLOGY.— STRUCTURE. 
 
 71* 
 
 2. Venous texture (forai- 
 ing, mostly, venous 
 congestion) 
 
 3. Cellular texture 
 
 4. Serous texture . 
 
 5. Glandular texture , 
 
 6. Lymphatic texture . 
 
 7. Fibrous texture . . • . < 
 
 8. Nervous texture . . 
 
 9. Synovial texture . . 
 1 0, Osseous texture . . , 
 
 of pia mater, in infancy and childhood. 
 *' liver. 
 
 " small intestine. 
 *' pia mater of adults. 
 " rectum implies). 
 " uterus [phlebitis). 
 " lungs {congestive asthma). 
 " lower extremities [varix). 
 " spermatic cord {circocele). 
 sub-cutaneous, 
 of the lungs. 
 
 " pia mater. 
 
 " voluntary muscles, 
 of the lungs. 
 
 " parietes of thorax. 
 
 " parietes of abdomen. 
 
 " liver. 
 
 " small intestine. 
 
 " large intestine. 
 
 " heart and pei'icardium. 
 
 " cerebral ventricles. 
 
 " kidneys. 
 
 " stomach, 
 lymphatic glands, 
 mammae [puerperal). 
 salivary glands, 
 liver, 
 testis. 
 
 lacteal glands, 
 kidney. 
 
 thyroid gland [goitre). 
 thymus gland, 
 pancreas, 
 of the lower extremities. 
 
 " upper extremities. 
 
 " uterus (see Comm., vol. ii., p. 470) 
 others rarely, 
 ligaments, 
 dermoid, 
 periosteum, 
 cartilage, 
 tendons, 
 pericardium, 
 dura mater, 
 brain. • 
 
 nerves. 
 
 ganglia of sympathetic, 
 spinal cord, 
 of the knee-joints. 
 
 " ankle. 
 
 " joints of upper extremities, 
 spongy bone, 
 solid bone.
 
 72 INSTITUTES OP MEDICINE. 
 
 ^ of the brain. 
 
 , - . ^ . , , ^ ] arch of aorta. 
 
 11. Arterial texture . . . .< ,, 
 
 } " extremities. 
 
 (^rare in other parts. 
 
 TABLE in. 
 
 Relative danger of high inflammation affecting the tissues of dif 
 ferent organs, according to the order of arrangement : 
 
 1. All textures of the brain. 
 
 2. All textures of the heart and pericardium. 
 
 3. Venous and lymphatic textures of the womb, iliac and other 
 
 veins. 
 
 4. Peritoneum of abdomen [piterjyeral women). 
 
 5. Serous membrane of small intestine. 
 
 6. Veins of the liver (^venous congestion i?i congestive Jevers). 
 
 7. Parenchyma of lungs. 
 
 8. Glandular texture of liver. 
 
 9. Mucous texture of small intestines. 
 
 10. Mucous texture of stomach. 
 
 11. Serous texture of large intestine. 
 
 12. Textures of kidney. 
 
 13. Mucous texture of large intestine. 
 
 14. Serous texture of lungs and thorax. 
 
 15. Serous texture of liver. 
 
 16. Serous texture of abdominal paiietes [common inflammation). 
 
 17. Veins of lungs (lore, or sub-active, forming congestive asthma. 
 
 See Comm., vol. ii., p. 494). 
 
 18. Textures of bladder. 
 
 19. Mucous texture of uterus. 
 
 20. Ligaments. 
 
 21. Bone and cartilage. 
 
 22. Lymphatics of extremities. 
 
 TABLE IV. 
 
 Tissues which require the greatest extent of general blood-letting, 
 when affected with high inflammation, — according to the organs in 
 which they are associated, and in the order of arrangehient. The 
 remedy is supposed to be applied eai'ly. 
 
 1. All textures of the brain. 
 
 2. All textures of the heart and pericardium. 
 
 3. Serous texture of small intestine. 
 
 4. Peritoneum of abdomen (in puerperal women). Note H p. 1117. 
 
 5. Parenchyma of lungs. 
 
 6. Serous texture of storfiach. 
 
 7. Serous texture of large intestine. 
 
 8. Veins and lymphatics of uterus. [Early.) 
 
 9. Serous and glandular texture of liver. 
 
 10. Venous texture of liver. [Sub-acute, congestion in congestive 
 
 fever. Often more largely.) 
 
 11. Mucous texture of small intestine. 
 
 12. Uterus. 
 
 13. Textures of kidney.
 
 PHYSIOLOGY. VITATi TROPERTIES. 73 
 
 14. Mucous texture of stomach. 
 
 15. Mucous texture of large intestine, 
 
 16. Serous texture of lungs and chest. 
 
 17. Serous texture of abdominal parietes. ( Common injlamviation.) 
 
 18. Ligaments. [Often more largely.) 
 
 19. Bladder. 
 
 20. Mucous texture of bronchiae. 
 
 21. Mamma, testis, parotid gland. 
 
 22. Absorbents of extremities. 
 
 163. In the treatment of disease, therefore, we should consider the 
 precise pathology of each affected tissue, the natural vital peculiari- 
 ties of the affected tissue in the compound organ, its general character 
 as well |s that of the compound organ in the animal economy, the in- 
 fluences which its morbid state exerts upon the other tissues in a 
 compound organ, its own morbific influences and the combined influ- 
 ences of the compound organ upon other parts, and how the remote 
 sympathizing parts may react, or shed an influence on yet other parts. 
 And then follows not only the general plan of treatment, but all that 
 nice discrimination of cathartics, emetics, alteratives, and other gi'oups 
 of agents possessing, in their individualities, respectively, analogous 
 virtues, their combinations, altei'nations, precise dose, frequency of 
 repetition, &c. (§ 675, 685, 686). The same variety of considerations 
 are to be made when the condition of diseased parts may undergo 
 changes, favorable or unfavorable, from the operation of remedial 
 agents. 
 
 We are mostly assisted in the foregoing inquiries by comparisons 
 of the morbid with the natural vital phenomena and physical products 
 of each part, and the whole collectively. We also acquire much of 
 our knowledge of the natural constitution of individual parts by ob- 
 serving the deviation of their phenomena when acted upon by mor- 
 bific or remedial agents. The phenomena are then more strongly 
 pronounced than in health, or new ones are developed. Indeed, it is 
 sometimes through morbid conditions only that we acquire a knowl- 
 edge of some of the important physiological conditions ; as, for ex- 
 ample, the existence of common sensibility in all parts. Hence a 
 corollary, that none but an observer of disease can expound the nat- 
 ijral conditions and laws of life (§ 685, 686, 848). 
 
 THIRD DIVISION OF PHYSIOLOGY. 
 
 PROPERTIES OR POWERS OF LIFE. 
 
 164. A VITAL, or peculiar governing principle or power, in organic 
 beings, has been recognized by all the most distinguished medical 
 philosophers at all ages of the science. It is the fundamental cause 
 of growth, nutrition, and of all other phenomena of organic beings. 
 It is, in all but the vulgar acceptation, synonymous with the term life ; 
 and Ife, therefore, is a cause, and not an effect, as has been assumed 
 by many distinguished physiologists, and as taught by chemistry.
 
 7'4 INSTITUTES OP MEDICINE. 
 
 165, a. " Until it is proved," says Andral (the rastorer of the hu 
 moral pathology), " that the forces which, in a living body, interrupt the 
 play oi" the natural chemical affinities, maintain a proper temperature, 
 and pieside over the various actions of organic and animal life, are 
 analogous to those admitted by natural philosophy, we shall act con- 
 sistently with the principles of that science, by giving distinct names 
 to those two kinds of forces, and employing ourselves in calculating 
 the different laws they obey." — Andral's Pathological Anatomy. 
 
 And, to the same effect, the distinguished organic chemist, Liebig, 
 the chief of the school of pure chemistry (§ 4|) : 
 
 " There is nothing to prevent us from considering the vital force 
 as a PECULIAR property, which is possessed by certain material bodies, 
 and becomes sensible when their elementary particles are combined 
 in a certain arrangement or form. This supposition takes ^rom the 
 vital phenomena nothing of their wonderful peculiarity. It may, 
 therefore, be considered as a resting point from which an investi- 
 gation into these phenomena, and the laws which regulate them, may 
 be commenced ; exactly as we consider the properties and laws of 
 LIGHT to be dependent on a certain luminiferous matter or ether, 
 which has no farther connection with the laws ascertained by investi- 
 gation." — Liebig's Animal Chemistry. 
 
 So, also, Carpenter, Roget, and other eminent chiefs of the physical 
 school (§ 64). 
 
 And thus, the eminent Miiller, who leads in the school of chemico- 
 vital physiology : 
 
 " The only character that can be possibly compared in organic and 
 inorganic bodies, is the mode in which symmetry is realized in each." 
 " Whether the vital principle is to be regarded as imponderable mat- 
 ter, or as a force or energy, is just as uncertain as the same question 
 in reference to several phenomena in physics. Physiology, in this 
 case, is not behind the other natural sciences ; for the properties of this 
 principle in the functions of the nerves are nearly as well kno^yn as 
 those of light, caloric, and electricity, in physics." — Muller's Physi- 
 ology. 
 
 Finally, we have the pure vitalist, teaching the same doctrine ; 
 though, with greater consistency. Thus : 
 
 " Physiology," says Bichat, " would have made much greater prog- 
 ress, if all those who studied it had set aside the notions which are 
 Dorrowed from the accessory sciences, as they are termed. But, these 
 sciences are not accessory ; they are wholly strangers to physiology, 
 and should be banished from it wholly." " To say that physiology 
 is made up of the physics of animals, is to give a very absurd idea of 
 it. As well might we say that astronomy is the physiology of the 
 stars." — Bichat's General Anatomy, Sfc. 
 
 Tiedemann, too, was right in saying that, 
 
 " All the qualities of organic bodies should be looked upon as the 
 effects of the vital powers. Even those phenomena seen in them, 
 which they exhibit in common with inorganic bodies, undergo modifi- 
 cations of their specific action, and should be considered subordinate 
 to the vital powers." — Tiedemann's Physiology, Sfc. 
 
 There is not, indeed, in the whole range of medical literature, one 
 author, however devoted to the physical and chemical views of life, 
 who does not evince the necessity of admitting a governing vital prin-
 
 PHYSIOLOGY. VITAL PROPERTIES. 75 
 
 ciple as a distinct entity, distinct from all other things in naUire. I say, 
 there cannot be produced one author of any consideration, who does 
 not summon to the aid of his discussion a vital principle whenever he 
 touches upon the abstract phenomena of life. And this I have abun 
 dantly shown by an extensive range of quotations in my various pub- 
 lications {Except ^ 1034). 
 
 165, b. We are constantly asked, how we know the existence of 
 the vital properties or powers ] Again, I say, precisely by the same 
 means as the advocates of the chemical and physical philosophy 
 of life defend their knowledge of the forces which govern the inor- 
 ganic world. The question is important, as implying that physiolo- 
 gists either do not ai'rive at their knowledge of causes through their 
 effects, or, that there is nothing different in the phenomena of organic 
 and inorganic beings. What would the metaphysician say, were we 
 to ask him for any other demonstration of mind than its manifesta- 
 tions ; or the mechanical or chemical philosopher, should we demand 
 any other evidence of gravitation, magnetism, chemical affinity, &c., 
 than the effects which they supply 1 And do we not distinguish one 
 from the other, and regard them as wholly distinct forces, by the dif- 
 ference in their effects ? The proof is clear and tangible, in all the 
 cases. Where the results of power differ so materially from each 
 other, it is as good a ground of ai'gument, that the phenomena depend 
 upon specific powers in one case as in the other ; and, if it be " a 
 cloak of ignorance" in either case to assume the existence of powers, 
 it must surely appertain to him who attempts an explanation of the 
 phenomena by assuming forces with which such phenomena have no 
 known connection (§ 175, hh^ 1085). 
 
 166, Many of the eminent ancient physicians considered the vital 
 principle an intelligent agent; and even Hunter has been supposed, 
 though erroneously, to have been of that opinion. Some distinguish- 
 ed physiologists, of the present day, are inclined to regard the soul as 
 that agent. Others confound it with the Deity ;* while yet others, 
 confounding the Deity with Nature, fall into a labyrinth of absurdi- 
 ties.t Others suppose the vital functions alone to constitute life.| 
 The ancient physicians generally distinguished the vital principle from 
 the soul, and regarded both as immaterial (§ 175 d, 350^ k). 
 
 167, a. The vital principle was early known underthe names o£ An- 
 ima and Calidum Innatum. It was gi'eatly lost sight of in the " dark 
 ages," but reappeared among the earliest restorers of learning, when 
 it took the name of Anima Vegetans, as significant of its organizing 
 power in plants and animals. The eccentric philosopher, Paracelsus, 
 substituted the name of Sidereal Spirit, to suit his dogmas of plane- 
 tary and demoniac influence. Then came Van Helmont with his in- 
 novation of a Spiritus Archceus, an immaterial principle, which he lo- 
 cated in the upper orifice of the stomach. It presided over the body 
 in a general sense, and had under its command several subordinate 
 spirits (one for each organ), to execute the orders of the great spirit. 
 But, like Paracelsus, he expounded much of his physiological results 
 upon chemical principles, and had no definite conceptions of the office 
 of his Archaaus. Stahl followed Van Helmont with his Rational Soul, 
 
 * See my article on the " Vital Powers," in Medical and Physiological Commentaries 
 vol. i. ; and my " Essays on the Philosophy of Vitality." 
 
 t See my " Examination of Reviews, ' p. 43. t Comm., ut supra
 
 76 INSTITUTES OF MEDICINE. 
 
 and Lord Bacon had entered the field in defense of a vital principle, 
 Then came Haller, with his great philosophical and practical distinc- 
 tion of the Vis Insita and Vis Nervca. Here we enter into the midst 
 of the profound theories of irritability and sensibility, which had been 
 suggested by Galen (§ 476, b). Grlisson, too, had forced his way into 
 the laws of irritability ; and Baglivi had already dealt his fatal blows 
 upon the humoral pathology. We may, therefore, date the progress- 
 ive and substantial foundation of vitalism and solidism from Baglivi 
 to Haller ; a period of about one hundred years. 
 
 167, b. Whytt modified the Stahlian doctrine; and the visionary 
 Des Cartes led the way in rejecting altogether, for awhile, the vital 
 powers, in which he was aided by the hypothesis of a nervous fluid, 
 which appeared about his time. The doctrine then followed, as a 
 consequence, that matter acquires vitality in virtue of a peculiar or- 
 ganization, and this became an easy step to the atheistical doctrine of 
 spontaneous generation. Then came up the view as set forth by 
 Monro, Sir Humphrey Davy, and others, analogous to the Cartesian, 
 that a living principle pervades the universe, and governs all things. 
 Some of this school suppose the universal principle to be subordinate 
 to the Deity; but a greater number, like Carpenter, Prichard, and 
 especially many of our present geologists, as Lyell, &c., regard it as 
 the Deity Himself, whereby the latter, either directly or by implica- 
 tion, confound nature with God. The doctrine becomes, here, either 
 atheistical or of a direct atheistical tendency ; and we have, as a re- 
 newed consequence, the assumption of spontaneous generation.* 
 
 167, c. Those gi'eat luminaries. Hunter and Bichat, came forward 
 in good time to rescue the philosophy of medicine from the degrada- 
 tion with which it was threatened by chemistry and physics, and have 
 left an impregnable shield to all future ages. 
 
 167, d. Tiedemann, too, soon after appeared with his " Physiology 
 of Man," in which the doctrines of life are ably expounded, and which 
 must be ranked as one of the productions of an original mind. Tiede- 
 mann could not believe that there was any sincerity in the absolute 
 rejection of a peculiar governing principle of living beings. " How- 
 ever different," he says, " may be the names chosen by physiologists 
 and physicians to designate this power, however various the ideas 
 they attach to it, yet all must agree on the essential point, that of re- 
 garding it as intended to maintain living bodies, vegetable and animal, 
 and all their parts, during a certain space of time, in a state of integ- 
 rity, in the composition, organization, and vital properties that are 
 peculiar to them, and to render those bodies capable, at a certain pe- 
 riod of their existence, of producing beings of the same species as 
 themselves, which beings are confined to the same determinate mode 
 of formation and development, and exhibit similar phenomena." 
 " We are bound, therefore, to consider the principle which presides 
 over those different acts, as a power inherent in all parts of living be- 
 ings, and we cannot assume that, either in vegetables or animals, it is 
 limited to any one part or parts. All the parts of a plant, the roots, 
 stem, branches, leaves, flowers, wood, and bark, are nourished. Nu- 
 trition takes place in all the tissues and organs of animals. The con- 
 
 * See Medical and Physiological Commentaries, vol. i., p. 25, and vol. ii., p. 124-.140. 
 Also, "Examination of Reviews," p. 43 ; "Notice of Reviews," p. 4; "Essays en Vital' 
 itj'," &c., p. 17.
 
 PH"J3I0L0GY. VITAL PROPERTIES. 7") 
 
 tinual tendency of this power to preserve the individual and all its 
 parts, forms the prominent character of individual life, and is present- 
 ed to us as the most important internal condition of life. This power 
 not only converts the alimentary matters, drawn from without, into nu- 
 tritive fluids, endowed with special properties and assimilated by it, 
 but it also introduces them into the solid organic form, determines and 
 regulates the composition, the organization, and the vitality of parts. 
 Every living body is exposed to externaV influences, which urge it to 
 manifestations of activity. Every one, however, under certain exter- 
 nal circumstances, retains its form, its composition, and activity. Cer- 
 tain external impressions, however, of a mechanical or chemical na- 
 ture, and divers organic matters, vegetable and animal poisons, are 
 able to ANNIHILATE tliis power* and thus to cause the death of the 
 living bodies on which they opel'ate." 
 
 167, e. Next came the illustrious Miiller to aid in arresting the al- 
 most universal onslaugh, in Europe, that seemed to threaten the ex 
 tinction of every sage in medicine from Hippocrates to the exit of 
 Bichat. Under the magic wand of Andral the venerable doctrine of 
 humoralism reared its portentous form ; while Louis substituted mor- 
 bid anatomy for the science of pathology, and Liebig, and his school 
 with fire and acids, overrun the whole domain of medicine. 
 
 Although Miiller employs the language of Stahl, in relation to a 
 vital principle, I think it rather designed as a forcible mode of ex- 
 pression, than as imputative of intelligence. Thus, '■'•this rational cre- 
 ative force^'' he says, " is exerted in every animal strictly in accordance 
 with what the nature of each part requires.'" The fact is truly stated ; 
 but it reposes on great laws of organization, not upon intelligence 
 That such is Miiller's view appears from another expression, that, 
 " the formative or organizing principle is a creative power, modifying 
 viatter blindly and ujiconsciously." The radical fault of this philoso- 
 pher consists, like that of Van Helmont, Stahl, Hoffmann, and Para- 
 celsus, in referring many vital results of organic beings equally to a 
 "vital creative principle" and to chemical forces. — See Muller's 
 Physiology. 
 
 10)1, f So remarkably different, however, are all the results of life 
 from those of dead matter, that some of the shrewdest physiologists, 
 of our own day, can scarcely avoid the chimerical theory of Van Hel- 
 mont. Thus, even Marshall Hall : 
 
 " The principle of action in the cerebral system," he says, " is the 
 ipvxq, or the immortal soul. Upon the cei'ebrum the soul sits en- 
 throned, receiving the embassadors, as it were, from without, along 
 the sentient nerves; deliberating and willing, and sending forth its 
 emissaries and plenipotentiaries, which convey its sovereign viandates, 
 along the voluntary nerves, to muscles subdued to volition,"! — (Hall 
 
 * See " Examination of Reviews," p. 26-28 ; also, this work, § 189 h, 350^ h. 
 
 t I have somewhere seen it suggested that the doctrines of vitalism may be applied in 
 support of animal magnetism. But, while vitalism is fundamentally opposed, even to 
 speculative theoiy, and rests alone on the absolute phenomena of organic beings, it is not 
 less true that, with rare exceptions, the medical advocates of animal magnetism are, as 
 in ancient times, among the physical theorists of life (^ 844). Dr. Elliotson is of that de- 
 nomination. (See Med. and, Phys. Comm., vol. ii., p. 137, 138.) And, although I have, in 
 the foregoing work (vol. i., p. 632), expressed my opinion of the countenance which has been 
 given to this imposture by distinguished members of the medical profession, I will add 
 my entire concurrence in the following sentiments by Hannah More. In a letter to Hor- 
 ace Walpole, dated 1788, she remarks, " I give you leave to be as severe as you please 
 on tbe demoniacal inummery which has been acting in this country ; it was, as usual with
 
 78 INSTITUTES OF MEDICtNE. 
 
 on the Nervous System.) Here I suppose the " emissaries and pleni- 
 potentiaries" to be nothing more than the nervous power, a property 
 
 prodigies, the operation of fraud upon folly. In vain do we boast of the enlightened eigh- 
 teenth ceutuiy, and conceitedly talk as if human reason had not a manacle left about her, 
 but that philosophy had broken down all the strong-holds of prejudice, ignorance, and su- 
 perstition ; and yet, at this very time, Mesmer has got a hundred thousand pounds by 
 animal magnetism in Paris. Mamaduc is getting as much in London. There is a fortune 
 teller in Westminster who is making little less. The divining rod is still considered as 
 oracular in many places. Devils are cast out by seven ministers. Poor human reason, 
 when wilt thou come to years of discretion !" (9 844.) 
 
 I may also add the foUowiug'exti'act from the New York Journal of Medicine for March, 
 1845: 
 
 "New York, Feb. 14, 1845. 
 "Mr. Editor, 
 
 " Dear Sir — In a letter of the 11th inst, addressed to myself, you desire me to state 
 what I witnessed of the firmness of a young gentleman, upon whom the operation of ex- 
 section of the inferior maxillary bone was performed by Prof Mott, 'and the reflections 
 to which it gave rise, as bearing on the subject of alleged surgical operations without 
 pain in the mesmeric state.' 
 
 "The case to which you refer is briefly reported in the January number of the New 
 York Journal of Medicine, by some person, who, like myself, was present at the opera- 
 tion. The subject is there stated to have been ' a fine intelligent young man, whose he- 
 roic deportment greatly facilitated the operation.' 
 
 " Perhaps it is enough that I should have quoted the expressive language of one, who 
 appears to have looked on with the same admiration as myself; though these examples of 
 ' heroic deportment' are common enough in the walks of surgery, especially among females ; 
 and that, too, without mesmeric imposture. The same eminent surgeon, who operated in 
 the case which is the subject of these remarks, wiU tell you that he has extirpated many 
 breasts, rendered highly sensitive by carcinomatous disease, without observing any evi- 
 dence of pain. But there was something in the case of Mr. Baker, which certainly better 
 deserved the encomium of ' heroic,' than any thing I had ever before seen, or heai'd of, or 
 even imagined as within the compass of human fortitude. 
 
 " This case, therefore, is interesting at this moment, as evincing a perfect capability of 
 enduring the most intense, and sudden, and prolonged pain, without emotion, and as form- 
 ing a test by which ' the subject of alleged surgical operations without pain in the mes- 
 meric state,' will receive the explanation which you seek. 
 
 "The case is also physiologically interesting, and interprets the composure of those or- 
 ganic movements, under similar conditions, which has been set forth in behalf of animal 
 magnetism. 
 
 "To appreciate properly the 'heroic deportment' of young Baker, you must imagine 
 yourself to have been a spectator ; foUow the able surgeon in all the capital steps, and in 
 all the minor details of the operation, and watch attentively the ' deportment' of the sub- 
 ject. He was laid at a convenient elevation upon a table, his feet crossed upon each 
 other, and his hands lapped. I mention this position, because he did not move his feet, 
 nor displace his hands during the operation. 
 
 " Now observe the operator ; first, making a long and deep incision among the muscles 
 of the neck, and then tearing his way down to the carotid artery, and throwing and tying 
 the ligature. It was, in itself, one of the most capital operations in surgery; but, owing 
 to the dexterity with which it was performed, and with an operation stiU before us far 
 more difficult, and tedious, and dangerous, this grand step toward the exsection of the jaw 
 lost much of its usual interest to the spectator. But it was not the less painful to the 
 sufferer ; who, however, sustained it without betraying the slightest evidence of pain. 
 
 " Next came the circular incision, reaching all the way from the joint of the maxillary 
 bone, down along its lower edge, up to the middle of the chin, 'riiis was done by one 
 rapid, immense sweep of the knife; but there remained the same imperturbable compo- 
 sure of the patient. Not a sigh, not a groan escaped, no muscle moved — the very eye did 
 not wink. And then followed, as you may well suppose, a prolonged, tedious, painful dis- 
 section, in which it became necessary to exasperate the suffering by securing many bleed- 
 ing vessels ; till, finally, the operator was ready for his saw. But nothing had yet hap- 
 pened to elicit a single manifestation that the patient was not in a profound slumber, ex- 
 cepting that his eyes were open, and that he occasionally swallowed. 
 
 " But, before sawing the bone at the middle of the chin, it was necessary to remove one 
 of the incisor teeth, and this was so firmly rooted that a straight forceps slipped in the 
 hand of a capable assistant. Another puU, however, brought with it the tooth ; but in 
 neither attempt was there any more indication of suffering than in drawing a nail from a 
 board. 
 
 " Then came the process of sawing, and this was calculated to greatly amioy the patient 
 from a shght accident which happened to the saw, and which prolonged this part of the 
 operation. Still, however, the same ' heroic deportment' distinguished the patient for- 
 bearance of the sufferer, the same unexampled complacency continued to mark every lin- 
 eament of his face, his very eye displaying nothing but gentleness, softness, and calm 
 resignation.
 
 PHYSIOLOGY. VITAL PROPERTIES. 7P 
 
 of the vital principle of animals, and whose modus operandi in devel- 
 oping voluntary motion I have endeavored to expound in sections 233, 
 245, 500, d, and references there. 
 
 167, g. For the proof of the existence of a vital principle, and of 
 the government of organic beings by laws peculiar to themselves, as 
 derived exclusively by myself from their composition, see that divis- 
 ion of this work, and my Essays on the Philosophy of Vitality ; and 
 for the proof which I have offered as founded on the phenomena of 
 life, see Essay on the Vital Powers, in Medical and Physiological 
 Commentaries, vol. i., p. 1-119. — Also, Rights of Authors, p. 912. 
 
 IGS. It is practically useless to investigate the nature of the vital 
 principle. That nature, however, may be as well inferred through 
 the medium of its phenomena, as the nature of the most tangible ob- 
 jects. The opinion of Miiller commends itself to every right-thinking 
 mind. 
 
 "Whether the vital principle," he says, "is to be regarded as im- 
 ponderahle matter, or as a force or energy, is just as uncertain as the 
 same question is in reference to several important phenomena in 
 physics. Physiology, in this case, is not behind the other natural sci- 
 ences ; for the properties of the vital principle are as well known in 
 the functions of the nerves, as those of light, caloric, and electricity 
 in physics." " But, without, in the remotest degree, wishing to com- 
 pare the vital and mental principles with the imponderable agents, 
 we must express our conviction that there is nothing in the facts of 
 natural science which argues against the possibility of the existence 
 of an immaterial principle independent of matter, though its powers be 
 manifested in organic bodies — in matter." — Mijller's Physiology. 
 
 " The bone being' separated at the chin, the dissection was resumed among the impor- 
 tant parts, and though conducted with all possible skill and rapidity, it was necessarily 
 tedious, as well as hopelessly painful, and, therefore, still calculated to try the firmness of 
 the stoutest heart. A great extent of all kinds of tissues was divided, and, of course, no 
 small proportion of nerves. Bleeding vessels continued to be secured, the difficult divis- 
 ion of the articulating ligaments perfonned witii as much facility as its difficulties would 
 admit ; and after the removal of the jaw, remaining portions of diseased muscle, &.C., were 
 cut away, and which tended not a little to embarrass that ' heroic deportment' which had 
 marked every stage of this great and triumphant operation. From its beginning to its 
 ending, which occupied one hour and a half after the first incision till the final extirpation 
 of all the diseased mass, the suiferer did not manifest the slightest evidence of pain, or of 
 impatience, or of fatigue, either by language, gesture, expression of countenance, winking, 
 groaning, sighing, or any other imaginable method by which the mesmerite might be dis- 
 posed to evade the overwhelming rebuke which the recital of this case cannot fail to in- 
 flict on his love of the marvelous, or his love of mischief, or his yet more culpable designs 
 on human credulity. 
 
 " I have said that there was something physiologically interesting in the foregoing case 
 Deyond its simple merit of an 'heroic deportment,' and that it goes to the very depths of 
 mesmeric assurance and duplicity. It was this : 
 
 " On feeling the pulse of the patient twice during the operation (the last time after the 
 lapse of an hour), I found it calm, undisturbed, and with about the same frequency it had 
 before the operation was begun. This proves to us what I have before expressed, that it 
 is not pain, but the consequent mental emotions which aifect the organs of circulation, 
 whether the heart or blood-vessels. 
 
 "Thus ended an operation, unequaled in ti^ie annals of surgery; alike triumphant to 
 the surgeon, to American Genius, to the admirable subject, to the cause of truth, of moral- 
 ity, and of sound religion. 
 
 " If you desire it, you may publish the foregoing statement, to which I should add some 
 comments had I not already contributed my part, in a medical work, toward the sup- 
 pression of one of the greatest nuisances that has yet infected the moral and reflecting 
 part of the community. I have, however, some developments in reserve, which will prob- 
 ably see the light when the parties interested may be beyond the reacli of greater re- 
 proof or mortification. 
 
 " I remain, very truly, ycur friend and obedient servant, 
 
 " Martyn Paisk."
 
 80 INSTITUTES OF MEDICINE. 
 
 In the language of Liebig, " In regard to the nature and essence of 
 the vital force, we can hardly deceive ourselves, when we reflect^ that 2t 
 behaves, in all its manifostations, exactly like other natural forces ; 
 that it is devoid of consciousness^ or of volition, and is subject to the ac- 
 tion of a blister" (§ 165, a). 
 
 169, a. We know, however, but little of the nature of the princi- 
 ple of life, and as little of the most obvious material substances ; 
 but, while this proposition is sufficiently plain, it is extensively ar- 
 gued that the vital principle, or organic force, has no existence, be- 
 cause it is not obvious to the senses. Thus neglecting its infinite 
 phenomena (our only knowledge of the most sensible existences), the 
 age has run into a materialism that takes in its way the soul itself. 
 
 Our great interest lies in the phenomena of nature. Through 
 these phenomena their causes may be sought ; their nature but veiy 
 impei-fectly. We can only describe matter by its manifestations; 
 and so of the soul, and the principle of life. Of the nature of the 
 soul, however, we have, as it respects its spirituality and some other 
 important attributes, a special Revelation, 
 
 169, b. If organized beings possessed a principle of life that could, 
 like light, be seen, they would then be allowed to be governed by this 
 agent, and we should be relieved of the encumbrance of the phys- 
 ical and chemical hypotheses. But, though no such principle ad- 
 dress itself to the sight like electricity or light, its existence is far 
 more variously attested by other phenomena, and more so than all 
 the other powers of nature ; and these phenomena being Avholly dif- 
 ferent fi'om such as appear in the inorganic world, it is frima facie 
 evident that powers or properties which are predicated of them 
 carry on the processes of health and disease ; while the scrutiny of 
 ages has never produced a fact in opposition. 
 
 169, c. Indeed, with so much light upon our subject, so much of 
 fact to substantiate our conclusions, it would seem highly probable 
 that all the facts which may be raised in opposition have no j-elative 
 bearing, and that they are brought forward in the spirit of hypoth- 
 esis. 
 
 169, d. The more comprehensive a law may be, the more readily 
 is it known and determined, and the less likely is it that apparently 
 conflicting facts will arise. Whenever such are produced, it is ow- 
 ing to a pi'oper want of investigation. The facts are examined su- 
 perficially ; and the speculative or the credulous mind seizes upon 
 some prominent characteristic, and pushes its opposition to nature 
 under the spur of novelty, or the delight of discovery, or the goad of 
 ambition. (See Correlation of Forces, p. 921, § 1085.) 
 
 Since, also, we seek, alone, for the existence and the nature of 
 causes by means of their jjhenomena, he is no philosopher who refu- 
 ses an inquiry into causes from want of other means of information. 
 The objection has never been raised in any science excepting medi- 
 cine ; but here we are told by many that we have no means of 
 reaching even the existence of the properties of life as contradistin- 
 guished from those of inorganic matter. It is this blindness, in part, 
 which refuses to apply to the science of life the universal fact, that the 
 phenomena are the only index to the forces which govern the inor- 
 ganic world, that has embarrassed the progress of medicine, and en- 
 cumbered it with a spurious philosophy.
 
 PHySIOLOGY. VITAL PROPERTIES. 81 
 
 1G9, e. Conscious, then, that I have taken my stand upon ground 
 which true philosophy will recognize as her own, I shall go on with 
 an investigation of the properties of life, as the source of all vital 
 phenomena, of all morbid conditions, and which constitute life itself, 
 and lie at the foundation of medicine. I shall enter far more exten 
 sively into an analysis of those properties than any other writer, shall 
 set forth original views as to the character and office of the nervous 
 power, and as to the mode in which this power participates in the 
 operation of remedial and morbific agents, and endeavor to show, 
 also, that, in proportion as philosophy may depart from the deduc- 
 tions which are founded on the phenomena of living beings, so must 
 all such philosophy be fundamentally false, and become the unavoid- 
 able cause of practical errors ofthe highest moment (Rights &c., p. 912). 
 
 169, /. Nor is it a small part of the proof that vitalism is founded 
 in nature, that it is consistent throughout'; seeking no multiplication 
 of causes, but serving as an impregnable and universal foundation for 
 every fact and every rational principle in physiology, pathology, and 
 therapeutics ; and, therefore, uniting all the principles relative to 
 life, health, disease, and the art of medicine, into one consentane' 
 ous, harmonious whole. What a contrast with the mechanical and 
 chemical speculations, or those commingled with vitalism ! What a 
 boundless source of stupendous philosophy for the votaries of one ; 
 what unmitigated confusion, and corruption of knowledge, and mis- 
 application of mind, for the disciples of the other ! How truly, and 
 with what sublimity on the one hand, and imbecility on the other, is 
 here exemplified the great distinction between man and his Creator, 
 that the former devises in parts that may have no congruity, while 
 the latter perfects the whole and aZ^ together (§ 63, &c., 74, 80, 117, 
 137, 143, 155, 156, 266, 323-326, 387, 399, 514 li, 524 d, 526 d, 
 638) ! 
 
 170, a. The vital principle is a whole, in respect to its substantial 
 nature, and is common to vegetables and animals. Organic matter, 
 or an organized substratum, is necessary to its existence ; and, since 
 the perpetuity of organic matter depends upon the vital principle, it 
 is manifest that both were brought into being without the agency of 
 each other. The vital properties cannot be generated by matter, 
 since upon them the existence of organization depends, nor is there 
 a single phenomenon that indicates their presence in inorganic sub- 
 stances ; nor can they be produced by the forces of physics, since 
 they are perfectly incapable of restoring the sti'ucture, or even its 
 elementary composition, after the organized matter is decomposed, 
 or, of reanimating the machine before decomposition has begun ; while, 
 on the other hand, these are the forces which lay waste the structure, 
 and only so, after the signs of the vital properties shall have totally 
 disappeared (§ 1079 h, 1085).— Notes Pp p. 1143, ftci p- 1145._ 
 
 This unavoidable deduction goes far in confirming the Mosaic ac- 
 count of the different steps observed by the Almighty in the creation 
 of living beings ; that the sensible structure was first produced, and 
 the spiritual and vital existences superadded.* The rudiments of 
 that organization have been perpetuated in connection with the prop- 
 erties of life since they came from the hands of the Creator, and are 
 the present source of all animated beings. Any doctrine adverse to 
 
 " See Medical and Physiological Commentaries, vol. i., p 86-92. 
 
 F
 
 82 INSTITUTES OF MEDICINE. 
 
 this is not only atheistical, but is opposed to all the suggestions of 
 reason* ( ^ 74, 350| k). Nor is this all. The varieties in the differ- 
 ent tissues of each animal, and of every plant, all the modifications 
 of the vital properties in each species of animals and plants, in each 
 tissue, and in every part, as already set forth (§ 133, &c.), and to be 
 yet expounded, all the various functions that correspond to the mod- 
 ified structure and vital properties, all the secretions, even to the od- 
 or of flowers, &c., are exactly the same now as at the day they were 
 called into being. This shows us that the properties and laws by 
 which organic beings are governed, though infinitely varied, are as 
 precise as the principle and laws of gravitation, as the conditions of 
 the solar beam and the laws which they obey. — Note Pp p. 1142. 
 
 170, h. Again, the moment inorganic matter is brought into a state 
 to receive the vital principle, however low in degree or energy, it 
 must be exalted to an organic condition. If chyle, blood, semen, 
 the gastric juice, &c., possess life, so, also, must they possess an or- 
 ganic state. This, indeed, is obvious from what we have seen of thn 
 manner in which their elements are united. 
 
 170. c. The living principle appears, therefore, to be neither the 
 result of organic compounds, as supj^osed by Hunter and others, 
 nor, as stated by Proiit, Millengen, and others, the primary cause of 
 organic conditions. Both have coexisted since they were the prod- 
 uct of Creative Power, both are necessary to the vivification of dead 
 matter, and the co-ojDeration of both to the farther development of 
 each, 
 
 171. The vital principle appears entire in parts when separated 
 from their connections, if such parts be constituted with the requisite 
 structure for independent nutrition (§ 304). Hence the development 
 of the egg, the germination of seeds and flower-buds, the growth of 
 shoots, and the multijjlication of polypi from portions of the animal. 
 
 Midler, and others, suppose the vital principle to be divisible in 
 such cases ; but this construction regards the principle too much in 
 the light of ordinary matter, and too little in that of a specific sub- 
 stance endowed with a variety of properties. These properties, so 
 far as necessary to organic life, are implanted in every part, and each 
 part may be regarded as a whole as it respects its own organic con- 
 dition. In simple beings, therefore, where no great complexity of 
 organs is necessary to the great final cause, nutrition, many jDarts of 
 such beings may be capable of carrying on the process independent- 
 ly of the rest (§ 299, 302, 304, 322). It is probable, therefore, that 
 the vital principle, in the foregoing cases, is no more "divided" than 
 the soul or instinct as implanted in the ovum, — Medical and Physio- 
 logical Commentaries, vol. i., p. 85, 87. 
 
 172. The principle of life, or life itself, may be summarily defined 
 as a cause, consisting of certain specific properties, appertaining to 
 organic matter, capable of being acted upon by external and internal 
 physical agents, by the nervous power, and by mentalcauses, and of thus 
 being brought into a state of action itself, and in no other way. Its 
 action is exerted upon the organism, and upon certain external sub- 
 stances, as upon food. In the former case its action gives rise to mo- 
 tion, upon which all the functions depend ; in the latter its operation 
 
 * See Med. and Phyaio. Comm., vol. ii., p. 123-140. Also, "Examination ofKevieirs, 
 p. 43; and "Notice, nf Reviews," p. 2, (na., in "Med. and Physiolog. Comm.," vol iii. 
 -Also, i, 1079 b, 1085.
 
 PHYSIOLOCy. VITAL PROPERTIES. 83 
 
 is through the medium of the gastric juice in animals, but is more 
 obscure in vegetables. The principle is creative so far as it combines 
 the elements of matter in peculiar modes, and arranges the compound 
 molecules into tissues and organs, and in modes identical with those 
 which came originally from the Creative Energy of God, Who thus 
 far imparted to the principle of life a formative endowment. The 
 principle is capable of protecting the matter which it endows against 
 the decomposing influences of all the physical agents by which it is nat- 
 urally surrounded, while the extinction of the principle exposes the or- 
 ganic substance to an intestine chemical dissolution, and to the decom- 
 posing action of surrounding agents, which proceeds with a rapidity 
 without parallel in the natural state of the inorganic world. The 
 principle is also susceptible of certain limited changes from the in- 
 fluence of causes, mental and physical, which constitute the essence 
 of disease ; while other causes are capable of modifying the morbid 
 changes in such wise that the principle of life takes on a restorative 
 energy, through which it recovers its normal condition. The prop- 
 erties of the vital principle are variously and naturally modified in 
 different j^arts, and undergo natural modifications at certain stages of 
 life, giving rise to changes of organization, &c. (§ 62, 64, 133, &c.). 
 These natural modifications will be farther explained in all the detail 
 which is demanded by one of the most important topics in physiolo- 
 gy ; and I now proceed to the various specifications relative to the 
 principle of life. 
 
 173. It is the special province of the vital principle in plants to 
 combine the elements of matter into organic compounds ; while in an> 
 imals it can only appropriate compounds of an organic nature. This 
 is a fundamental distinction between the two departments of the or- 
 ganic kingdom ; from which it appears that plants are indispensable 
 to the existence of animals (^ 1052). 
 
 174. The vital principle is subject to extinction, and this consti- 
 tutes death. When speaking of the composition of organic beings 1 
 adverted to the manner in which they resist the decomposing eftects 
 of chemical agents, and how the seed and egg are capable of being 
 converted into complex living beings, or the whole animal and vege- 
 table kingdom of being resolved into their ultimate elements, by the 
 action of heat, air, and moisture. The same structure remains in 
 either case when life is suddenly destroyed, and the exact difference 
 which arises in the two cases, from the influence of the same causes, 
 can be owing only to the presence of peculiar powers in one case 
 which have disappeai-ed in the other. The cessation of the phenom- 
 ena of life is the consequence of death ; and, there is nothing to die 
 (certainly not the forces of chemistry) but the principle of life upon 
 which the phenomena depended, and which held the elements of 
 structure in vital union (§ 584, 633). 
 
 175. a. As set forth in the Medical and Physiological Commentaries, 
 " I believe the vital principle, vital power, organic force, organic power, 
 are one substance, whether material or immaterial ; and they refer, 
 with me, to a universal cause of animal and vegetable life, or, rather, 
 as constituting life itself I believe, also, that this principle has vari- 
 ous attributes, common or generic, and partial or specific ; or perhaps 
 I should call the former distinct pi'operties. Thus, of the generic, we 
 have irritability, mobility, sensibility, &c., and the modifications of
 
 84 INSTITUTES OF MEDICINE. 
 
 each of these in the same or different tissues form the specific or pai- 
 tial variations. These properties are also constantly varied in dis- 
 ease, and these variations I call changes in kind. The partial modifi 
 cations in their natural state I designate as variations 'in kind" (§ 133 
 163, 171). 
 
 l75, h. The vital principle has certain analogies with the mind or 
 soul, and with the instinct of animals (§ 241). Each is inherent in or- 
 ganic matter, and the Generations of each are through the medium of 
 that matter. Each, respectively, is one substance, and each possesses 
 certain distinct attributes or properties. Each is not only capable of 
 acting by means of organized structure, but of being acted upon, and 
 modified in its nature, and only so in conjunction with that structure 
 (§ 189, 191, 234/ 241, 5(56-568). 
 
 Even in the inorganic world we meet with a substance which is 
 not without its light in the way of analogy. This substance is light 
 itself. It is apparently one homogeneous, imponderable, substance, 
 yet said to consist of distinct component parts, each of which is endowed 
 with specific attributes. These component parts would thus be distinct 
 entities, which I do not recognize in relation to the properties of the vi- 
 tal principle, or of the soul. But the distinction is not important to 
 my present purpose, and I should also add that it is indifferent wheth- 
 er we here regard the corpuscular or the more probable wave theory 
 of light (§ 234 e), as the individuality operates in either case. 
 
 175, hh. It has been well said by Professor Draper, that 
 
 " Just in the same way that I am willing to admit the existence of 
 forty different simple metals, so, upon similar evidence, I am free to 
 admit the existence of fifty different imponderable agents, if need be. 
 Is there any thing which should lead us to suppose that the imponder- 
 ables are constituted by Nature on a plan that is elaborately simple, 
 and the ponderables on one that is elaborately complex % That the 
 former are all modifications of one primordial ether, and the latter in- 
 trinsically different bodies, more than a quarter of a hundred of which 
 iiave been discovered during the present century 1" (^ 1085). 
 
 " We are thus forced to admit that rays of light, rays of heat, ti- 
 thonic rays, phosphoric rays, and probably many other radiant forms, 
 have an independent existence, and that they can be separated, by 
 proper processes, from each other." — Draper's Treatise on the For- 
 ces wliich produce the Organization of Plants, p. 70, 71. 
 
 Organic life, however, needs only a single principle, or " imponder- 
 able," till it be showTi that its supposed properties are individual ex- 
 istences (§ 165, h). 
 
 175, c. I have presented in the Commentaries, in the Essays "■on 
 the Vital Powers,''' and '• Spontaneous Generation," and my " Notice 
 of Reviews, ''' certain facts which go to the conclusion that the mind 
 or soul is a distinct immaterial substance, and that the instinctive 
 principle of animals is equally a distinct substance from the brain. I 
 will now add a few words, physiologically, in respect to the main ar- 
 gument of the materialists, drawn from analogy, that the mind, like 
 the gastric juice, the urine, &:c., is only a product of the functions of 
 the brain (^ 1076, c). 
 
 The analogy is fictitious. Both the mind and instinct are entirely 
 wanting in every known attribute of the product of other organs, and 
 are sui gc7icris in all their characteristics. This is sufficiently obvi-
 
 PHYSIOLOGY. VITAL PROPERTIES. . 85 
 
 ous. But there are other considerations which establish the distinc- 
 tion more fully, though they appear not to have engaged the attention 
 of physiologists. What, for example, is the efficient cause of the pro- 
 duction of bile, urine, &c. 1 Certainly the blood, in connection with 
 organic structure and organic actions, and while these actions go on, 
 bile, urine, &c., are uninteiTuptedly secreted ; or, if aiTOSted, it is from 
 the failure of the organic processes. But, it is just otherwise in re- 
 spect to the mind and the instinctive principle. These are completely 
 suspended in all their manifestations during sleep, and often so with 
 great instantaneousness. And yet there is every reason to believe 
 that the organic functions of the brain continue to move on as per- 
 fectly as those of the liver, the kidneys, &c. ; especially when it is con- 
 sidered that sleep may happen in almost the twinkling of an eye. 
 Indeed, were any change to befall the brain, it should be more or less 
 manifested by some consequent modification of all the organic actions ; 
 particularly as those of animal life undergo complete suspension. 
 
 Again, other peculiarities which contradistinguish the mind and 
 instinct from every organic product are the quick transitions from 
 sleeping to waking, and the occurrence of the change without any 
 change in the organic functions of the brain. Take in connection the 
 act of sleeping and the act of waking, — the instant suspension and 
 the instant reproduction of the intellectual operations, and in all their 
 isolated aspects, and the most obtuse understanding must concede not 
 only the entire want of analogy with any other phenomena of nature, 
 but that there must be a unique cause for such perfectly unique effects. 
 
 But, again, suppose some change in the organic condition of the 
 brain as the cause of sleep ; what is it, I say, that so instantly rein- 
 states its functions when we pass from the sleeping to the waking 
 state 1 What rouses the organ to its wonted secretion of mind 1 Are 
 there any analogies supplied by the liver, the kidneys, &c. (§ 241)1 
 What is it, I say, that brings the great nervous centre into operation 
 in all the acts of volition, in all the acts of intellection 1 This ques- 
 tion must be answered consistently, or in some conformity with the 
 argument drawn from analogy. If that can be done, then it must be 
 conceded that the analogy is forcible, and that the argument in favor of 
 materialism is logically taken. So, on the other hand, should the ar- 
 gument fail in this indispensable requisite, materialism must stand 
 convicted of sophistry, insincerity, and a leaning to infidelity (§ 14, c). 
 
 The premises are perfectly simple. They are also sound so far as 
 it respects all organic actions and results. The blood, as with all 
 other organs, is the natural stimulus of the brain, and here as there 
 all the organic phenomena are distinctly pronounced. They proceed, 
 in all parts, with uniformity, and without interruption. Nothing can 
 suspend them or modify them in the brain, or elsewhere, during their 
 natural condition. So far the analogy is complete. Now, as it can- 
 not be the blood, according to the analogy, which rouses the brain to 
 action in willing, reflecting, &c., I ask the materialist the nature of the 
 stimulus which operates upon the brain in eliciting the phenomena 
 of mind ] And again, I say, if he can sustain his answer by analogy, 
 such is the consistency of Nature in organic philosophy, such the har- 
 mony of Design, that it might be difficult to oppose Revelation itself 
 to what is so fundamental in Nature. {Continued at p. 882, ^ 1076). 
 
 175, d. It is assumed by many late physiologists, as Drs. Carpew
 
 86 INSTITUTES OF MEDICINE. 
 
 ter, Prichard, &c., after admitting and denying the existence of vital 
 properties, and contending for their existence in the elements of 
 matter, and the organizing agency of the forces of chemistry, that, 
 nevertheless, all the results of organic beings ai-e owing to the im- 
 mediate acts of the Almighty (§ 64, li). This, therefore, as with the 
 author of the "Vestiges of Creation," is only a circuitous method 
 of confounding nature with God (§ 350f 7^.-350^ I). Let us, how- 
 ever, suppose that there is a Supreme Being in their opinion, who is 
 the Author of nature, and that He is the Power who presides in or- 
 ganic beings, and regulates all their processes, and we shall see that 
 the doctrine abounds with absurdities. Its advocates generally carry 
 this sophistry so far as to affirm that the particles of matter are con- 
 stantly maintained in union by Almighty Power, that chemical affini- 
 ties are nothing but manifestations of that Power, that gravitation is 
 only a constant emanation of the Deity, that digestion, circulation, 
 secretion, excretion, &c., are only immediate acts of God. It is 
 plain, therefore, that they can allow no other God than nature. 
 
 But, let us now look physiologically at this pantheism. Organic 
 beings are made up of matter, which, it will be conceded, is distinct 
 from God, if we allow Jiis existence as distinct from matter. It is 
 therefore perfectly consistent to suppose that this matter is endowed 
 with distinct forces for its own government (§ 14, c). If we regard, 
 next, the results of vital stimuli, we have a palpable proof that they 
 elicit actions and physical results through principles which possess the 
 power of acting, or we must take up the absurdity of supposing that 
 they act on God himself The same may be affirmed of the poisons, 
 medicinal agents, &c. But this will not hold either in religion or 
 philosophy. Nevertheless, it is evident that some active agent is op- 
 erated upon. If stimulants are applied to the nose, the heart may be 
 thrown, on the instant, into increased action. Of course, it cannot be 
 entertained that God is the agent acted upon in such a case, any more 
 than when prussic acid destroys life with the same instantaneousness ; 
 and, therefore, He cannot be assumed as the cause of the healthy and 
 natural functions (64 h, 241 d, 350f g--350f o, 376i, 733 d). 
 
 In my " Exam, of Reviews^'' (in Comm., vol. iii.) I have shown 
 that the doctrine of " the jnopertks of life, in tJie elements of viatter" is 
 thoroughly material as it respects the soul (§ 14 c, 189 Z>, 350| I, m). 
 176. Besides an organized substratum and a principle of life, there 
 is something still beyond not less important to all the great purposes 
 of life. This consists of the actions and various results of life. If 
 all animated beings existed in the state of the seed and ovum, the 
 whole universe would be nearly without any other apparent anima- 
 tion than what is elicited by the forces of physics and chemistry. 
 The movements of the heavenly bodies would be the principal de- 
 monstrative source of power. 
 
 Although, therefore, the actions and phenomena of organic beings, 
 like the motions of the heavenly orbs, are merely the effects of a pe- 
 culiar power which we call life, they are, nevertheless, the only at- 
 tendants of life that interest our senses beyond the physical struc- 
 ture. Hence, it is not remarkable, considering how liable the senses 
 are to take the lead of the understanding, that even the soundest 
 minds have supposed that life consists of its results alone, and have 
 overlooked the great efficient cause or power upon which the results
 
 PHYSIOLOGY. VITAL PROPERTIES. 61 
 
 depend (§ 234^, 247). Had they considered for a moment, however, 
 the analogy which subsists between the motions of organic beings 
 and those of the heavenly orbs, and that the latter depend upon a 
 power which is called gravitation, and without which all the orbs 
 would suffer the stillness of death, the conclusion would have been 
 unavoidable that celestial motion is merely an effect, and, therefore, 
 that all organic motions and their results depend upon moving pow- 
 ers. They should have seen, too, that when a drop of prussic acid, 
 or of the spirituous extract of nux vomica, is apjslied to the tongue, 
 all the phenomena of life are instantly extinguished, that nothing can 
 reproduce them although the organized structure remains unimpair- 
 ed, and that the whole being is immediately resolved into its ultimate 
 elements (§ 1042). 
 
 177. The properties of life are the fundamental cause of all healthy 
 and morbid phenomena. They are liable to be more or less diverted 
 from their natural state by a variety of causes, and these new condi- 
 tions constitute the most essential part of disease. This instability 
 of the properties of life is at the foundation of all disease, and even 
 of therapeutics (§ 642, b). Other causes, acting upon these morbid 
 conditions, alter them in yet other ways, and contribute to their res- 
 toration to the natural standard. This is the aim of all our remedies ; 
 and the recuperative tendency of the properties of life [t7ie vis viedi- 
 catrix naturce), when they are driven by morbific causos from their 
 healthy state, enables them to recover spontaneously from the artifi- 
 cial conditions which are substituted by remedial agents for the more 
 intensely morbid (§ 172, 851 a, 853, 854, 893, 900, 901, 905, 1059). 
 
 178. Notwithstanding the natural instability of the properties of 
 life, they have a definite character in every part of the body, accord- 
 ing to the nature of each part, at every hour of existence (§ 153-156). 
 
 179. The exact nature of disease depends mostly upon the forego- 
 ing definite conditions (§ 178), and upon the particular virtues of the 
 morlji^c agents. The salutary changes produced by remedial agents 
 invo^^ the same principles. But, these definite changes, and the ac- 
 tion of morbific and remedial agents, are liable to contingent influen- 
 ces fi'om habits, &c. ; as set forth under the fifth division of Physiol- 
 ogy. Our calculation of results is thus embarrassed according to the 
 nature and extent of the contingent influences (§ 756, V). 
 
 180. The vital properties are without renovation, or mutation in 
 h-ealth, except as they are liable to certain natural modifications at 
 different periods of life, or during gestation, or from the slow opera- 
 tion of external agents, as in the artificial temperaments. They must 
 remain without renewal, to be forever ready for the work of nutri- 
 tion, &c. (§ 237, 570-630). 
 
 181. The permanency of the vital properties enables us to under- 
 stand the nature of predisposition to disease, artificial temperaments, 
 and hereditary diseases, which many refer to the ever-changing blood 
 (§ 238, 666). 
 
 182. a. According as the vital properties may be modified, either 
 in the foregoing manner (§ 181), or as in disease (§ 177), so will be 
 the condition of the elementary combinations, and other physical 
 products. 
 
 182, h. Nevertheless, the properties of life never undergo any rad- 
 ical change till they shall have passed the limit of their recuperative
 
 88 INSTITUTES OF MEDICINE. 
 
 power (§ 177), and are therefore approaching a state of extinction. 
 Hence, essentially, in connection with the nature of the remote causes, 
 the analogies among diseases (§ 670, 756). 
 
 183. In their highest development, the properties of the vital prin- 
 ciple are six ; namely, irritability, mobility, vital affinity, vivijicaiion, 
 sensibility, and the nervous power (§ 175). They are called vital prop- 
 erties, vital powers, and vital forces ; but are clearly attributes of a 
 common principle, just as judgment, perception, the will, &c., are 
 properties of the soul. They will be examined according to their 
 nearest relations to each other in the most perfect beings, and their 
 practical application. 
 
 184, a. The first four properties (§ 183) are common to plants and 
 animals, and reside in all the tissues. Tlaey may be properly called 
 organic properties, as they carry on the organic processes (§ 476-492, 
 516 a). The last two are peculiar to animals. This multiplication 
 of vital properties in the animal kingdom harmonizes with the intro- 
 duction of tissues and organs which have no existence in plants (§ 201, 
 222,232, 450, &c., 500). 
 
 184, b. The nervous power has been considered a principle by 
 itself, and often regarded by eminent physiologists as the galvanic 
 fluid, generated by the brain, or other organs, and conducted by the 
 nerves {Med. and Phys. Com?7i., vol. i., p. 65-68, 107-119). Its phe- 
 nomena, however, declare it to be entirely distinct in its nature from 
 all things else ; while its analogies to the other properties of life show 
 it to be an element of the vital principle (§ 227-232). If it be difli- 
 cult for the limited comprehension of man to surmise how this prop- 
 erty should prove an agent to others with which it is associated, the 
 difficulty is no greater than the admitted fact that the will may con- 
 trol other properties of the mind, and the passions. Nevertheless, it 
 is unimportant in a practical sense, and in the institution of principles, 
 whether the nervous power be considered a property of the vital 
 principle, or a principle by itself (§ 175 bb, 186, 226, 1072 b). 
 
 185. Although the organic properties which are common to plants 
 and animals ai'e essentially the same, they possess greater modifica- 
 tions throughout than will have been seen to appertain to the same 
 properties in the different parts of animals. But all the variations in 
 the two organic kingdoms are intimately connected by close analo- 
 gies ; just as they are in the different animal tissues (§ 133, &c.). 
 Much of the difference in the general vital constitution of the two 
 kingdoms is owing to the presence in one, and the absence in the oth- 
 er, of the nervous system, and those corresponding properties which 
 play so important a part in the animal tribes (§ 733,^"). In both de- 
 partments of organic nature, however, there is, essentially, the same 
 principle of life, its great organic elements, and the same great func- 
 tions over which they preside. Here, too, in the vegetable kingdom, 
 in the modifications of structure and of the organic properties and 
 functions, and of the laws which they obey, we witness the greatest 
 simplification of life. The vegetable tribes, being also exempt from 
 most of those secondary influences which so constantly embarrass our 
 inquiries in more complex organization, especially from the compli- 
 cations that arise from nen'ous influence, are better subjects for the 
 experimental researches which concern the philosophy of life ; and 
 tlie facts, therefore, which they supply may be canied up, for the
 
 PHYSIOLOGY. VITAL PROFERTIES. 89 
 
 bame general pm'pose, as sound analogies, to more complex beings 
 (§ 191 a, 409, 733, 853, 1052). 
 
 186. The mental property, perception, is necessary to the exercise 
 of specific and common sensibility, and the will to that of mobility as 
 modified in the function of voluntary motion (§ 194, &c., 226, 241 
 243, 500 e). Here we have not only other analogies between the in- 
 tellectual and vital principles, but each is brought into direct action 
 with the other (§ 175, 184 h). 
 
 187. The vital properties co-operate together in their functions, 
 more or less, as they exist in any given being, 
 
 187^. The conditions now mentioned as to the principle of life, as 
 well as all those to be hereafter stated, and the phenomena of which 
 they are predicated, form other groups of facts, which, individually 
 and collectively, contradistinguish the principle of life from all the 
 forces of inorganic nature (^ 1041). 
 
 IRRITABILITY. 
 
 188. a. Irritability belongs to all tissues, and is the property upon 
 which all vital agents, external and internal, physical and mental, nat- 
 ural, morbific, and remedial, produce impressions in organic life ; ex- 
 cept as sensibility is concerned in reflex nervous actions (§ 201-203, 
 220), and as the nerves, from being incorporated in other tissues, take a 
 subordinate part in organic functions, independently of reflex action 
 (§4G1, 492). All actions or motions, in animal as well as organic 
 life, ax-e brought about by impressions on irritability (§ 205, 233, 257, 
 486, 500 d). This may be either by the direct action of the agent, or 
 by the indirect action of the nervous power (§ 222, &c.). 
 
 When vital agents affect the organic functions in a direct manner, 
 it is by direct action upon the irritability of the parts which perform 
 the functions. This is true, in part, of the natural excitants of organs ; 
 as blood acts directly upon the irritability of the heart and blood-ves- 
 sels, bile upon that of the intestines, food upon that of the stomach, 
 &c. In these cases, however, influences are also transmitted through 
 sympathetic sensibility to the nervous centres, and thence reflected 
 upon the muscular tissue of the organs (§ 201, 514/). So, also, re- 
 medial agents operate upon the irritability of parts to which they are 
 applied, and thus aflfect their functions in a direct manner. But their 
 influences are commonly more extensive, and then they call into ope- 
 ration the nervous power by their action upon sensibility (§ 201), thus 
 giving rise to reflex nervous actions (§ 222, &c., 475i, 500). 
 
 When mental emotions affect the organic functions it is by determ- 
 ining the nervous power upon the irritability of the parts (§ 226, 227). 
 And, although sensibility receives the primary impressions in the func- 
 tion of sympathy, the resulting influences upon organic actions are 
 brought about by a determination of the nervous power upon the irri- 
 tability of the affected organs (§ 201, 226, 227, 4751 6471, 1041). 
 
 188, h. When vital agents act upon specific sensibility the results of 
 their impressions are merely their propagation to the nervous centres, 
 and a consequent action upon those parts (§ 194-204, 222-234). 
 
 188, c. I shall endeavor to show that the doctrine is entirely unfound- 
 ed which supposes that vital agents produce their effects in organic 
 life by direct impressions upon the nervous system, excepting so far 
 as explained above (§ 188 a). This demonstration, indeed, was made in
 
 90 .NSTITUTES OF MEDICINE. 
 
 the Commentaries, but mainly by other processes than will be present- 
 ed in the Institutes. The fact alone, however, should be adequate, 
 that jjlants have no nervous system, yet carry on all the essential or- 
 ganic processes that exist in animals ; while they are alike liable to 
 corresponding results from the operation of morbific and remedial 
 agents. 
 
 ISSj, a. Every thing which is capable of affecting irritability, and 
 sensibility, is a vital agent. These agents are either natural to the 
 body, as blood, heat, bile, &c., or external, as food, air, heat, light, 
 electricity, &c. Irritability is perpetually alive to the stimulus of 
 blood in all parts of the sanguiferous system, as it is to that of the 
 sap wherever it circulates (§ 136). This shows the exquisite suscep- 
 tibility of the property. 
 
 1881, h. Many vital agents, those just mentioned, are indispensable 
 to the maintenance of organic processes, either in animals or plants. 
 Hence, from maintaining the organic powers in constant action, they 
 are called vital stimuli. Those of a morbific or remedial nature are 
 known by these epithets, though, in a philosophical sense, they are 
 vital agents. They are distinguished by very different characteristics 
 from the natural agents of life ; even all those which are stimulant to 
 the organic processes ; for they not only excite the properties of life, 
 but are capable, also, of affecting their intrinsic nature. But, there 
 are others, whose effect, in certain degrees of intensity, is directly the 
 reverse of the foregoing, as hydrocyanic acid, tobacco, &c. ; and these, 
 when thus operating, are vital depressants (§ 441 d, 650, 743). 
 
 188|, c. Some of the vital stimuli which are natural to the body, 
 as blood, and bile, and also food, subserve other purposes than that 
 alone of rousing the action of organs. They are also acted upon and 
 appropriated to the uses of the system. This is more extensively 
 true of animals than of plants. In the latter case there are certain 
 external stimuli which are indispensable to vegetation, and whose 
 only operation is that of excitants, but which are comparatively un- 
 important to animals. These agents are particularly light and heat, 
 and pei'haps electricity. The heat which is most important to animals 
 is generated by the living organism. 
 
 188^, d. An important error has prevailed among chemists, from 
 their necessary want of physiological knowledge, in regarding the 
 imponderable agents as the causes of life, and not as mere stimuli to 
 those real causes which are implanted in the organization itself, and 
 by which, of course, all the actions and results are determined. This 
 vitiation of philosophy has beset, especially, the functions of animals 
 as it regards their assumed dependence on electricity, and the func- 
 tions of plants in their obvious dependence upon light. The fallacy 
 of the former hypothesis is shown extensively in the Medical and 
 Physiological Commentaries {Essay on the Vital Powers and its Ap- 
 pendix). Of the latter I will now say, that in all the relations of light 
 to plants we have the most distinct analogies with other vital stimuli 
 to guide us to the same certain conclusion, that, like other stimuli, it 
 does but rouse the properties of life to certain special modes of ac- 
 tion, by which they decompose carbonic acid gas, carry on the work 
 of appropriation, &c. {Parallel Columns, nos. 64, 65, 66, 68, 74).* 
 
 But, thanks to my colleague, Professor Draper, whose name in 
 early life glows upon the sunbeam, organic science is supplied with 
 * See Correlation of Forces, p. 921, ^ 1085.
 
 PHYSIOLOGY. V:TAL rROPEETIES, 91 
 
 an adornment which vies in delicacy, yet sublimity, witn the capa- 
 bilities of the nervous power (§ 222, &c., 234 e). 
 
 The professor has obligingly furnished me with the following state- 
 ment of the pi'ogress, and nature, of the discoveries in relation to the 
 solar beam. Thus : 
 
 " Until the time of Sir Isaac Newton, it was universally supposed 
 that light was a simple elementary body, and therefore incapable of 
 decomposition. 
 
 " The great optical discovery of Newton consisted in proving that 
 the white light of the sun, or of day, is in reality made up of many 
 colored varieties. He fixed the number at seven : red, orange, yel- 
 low, green, blue, indigo, violet. He indisputably established that 
 that which we commonly call ligJit is made up of, and therefore con 
 tains, the seven prismatic rays. They differ not only by impressing 
 the organ of vision with different sensations, but also in intrinsic brill- 
 iancy or illuminating power. It is to be remarked that of these the 
 yellow is the brightest. 
 
 " It was the opinion of Newton, and his followers, that when light 
 falls upon bodies and disappears, it is converted into heat ; or, in oth- 
 er words, that heat is extinguished light. Sir W. Herschel, the as- 
 tronomer, proved the separate and distinct nature of these j^rinciples. 
 The proof chiefly depends on the fact that the brightest ray is not the 
 hottest, and that in the sunbeams there exist rays in abundance which 
 are wholly invisible, but which can rapidly raise a thermometer. 
 That which we cannot see we should scarcely call light. Moreover, 
 a vessel of hot water in the darkest place is invisible ; yet common 
 observation shows it is emitting calorific emanations. The independ- 
 ence of light and heat may therefore be considered as established. 
 
 " Some of the alchemists discovered that certain of the white salts 
 of silver (the chloride) turned black under the influence of the sun- 
 shine. Toward the close of the last century it was shown that the 
 rays which produced this effect were invisible, and therefore could 
 not be regarded as rays of light. At a later period I showed that they 
 could not disturb a thermometer, or communicate to our organs the 
 impression of warmth, and therefore must be distinct from heat. 
 From the circumstance that they are always accompanied by light, I 
 gave them the provisional name of Tithonic rays, from the fable of 
 Tithonus and Aurora. 
 
 " The same species of modification which light exhibits (as colors) 
 has been traced by Melloni for the rays of heat, and by me for the 
 Tithonic rays. But, as both these classes of rays are" invisible, their 
 coloration must be necessarily so too, and is known to us only by in- 
 direct facts. We speak of it, therefore, as ideal or imaginary. There 
 are seven colors for heat and the chemical rays, as there are seven for 
 
 " It is worth remarking how complex the constitution of light is 
 now understood to be, when contrasted with the opinion held by the 
 predecessors of Newton (§ 183, &c.). 
 
 " I have established, as respects some of these rays, that they dis- 
 charge extraordinary functions. It is the yelloio ray of light which 
 has control of the evolution of plants. Under its influence their leaves 
 effect the decomposition of carbonic acid gas in the atmosphere, set- 
 ting free its oxygen and fixing its carbon. This wonderful phenom-
 
 92 INSTITUTES OF MEDICINE. 
 
 enon is unquestionably the first step in the production of organized 
 matter, such as starch, woody fibre, &c., from inorganic gases. Tho 
 carbon is first fixed under the form of chlorophyll in the leaf. Chloro- 
 phyll occurs under remarkable circumstances as the coloring matter of 
 bile. 
 
 " Extended investigations have shov^^n that each particular ray of 
 these principles exerts specifi: jDOvv^ers. The compounds in which 
 silver enters are afl'ected by those of a violet color; chlorine is most 
 acted on by the indigo; and carbon by the yellow. It is for this rea- 
 son, as I have shown, that to the animal eye the yellow ray is bright- 
 est. If nature could have formed a retina of which silver was the 
 basis, the indigo would have been the most brilliant ray. All our 
 conceptions of beauty in colors depend, therefore, on the physical pe- 
 culiarities of the carbon atom. And it is a beautiful and interesting 
 fact, that the ray which evokes from atmospheric air the multitude of 
 forms composing the vegetable world has charge of the process of 
 vision in all animals (p. 797, 798, ^ 1034). 
 
 " Dr. Gardner discovered that the movements of plants are chiefly 
 directed by the indigo rays of light. They grow in the direction in 
 which it falls upon them ; and the blue color of the sky is one of the 
 causes of the upright growth of stems. 
 
 " Besides the three classes of rays which I have mentioned, there is 
 a fourth, of which much less is known ; the phosphorogenic rays. 
 These take their name from the fact that when they fall on certain 
 bodies, such as the diamond, Canton's phosphorus, &;c., they cause 
 them to glow with a pale or splendid light. The extraordinaiy pecu- 
 liarity they possess is, that glass is opaque to them. 
 
 " The advance of chemical optics has sufficiently proved that each 
 of the constituent rays of the sunbeam, or of light derived from arti- 
 ficial sources, has capabilities of its own. Thus, each of the seven 
 rays of light impresses our minds with special sensations. The yel- 
 low, moreover, controls the growth of plants, the indigo their move- 
 ments. Of the Tithonic rays, the blue is the one concerned in Da- 
 guerreotype portrait taking, and the red can bleach paper blacked 
 with oxide of silver. The same peculiarities will undoubtedly be 
 discovered as respects the rays of heat." 
 
 Professor Draper's analysis of the sunbeam, by subjecting plants to 
 the various elements of the solar spectrum, demonstrates, what was 
 still conjectural, the individuality of its component parts, and estab- 
 lishes their rank as distinct physical and vital agents. Analogy justi- 
 fied this demonstration ; and had the professor proceeded upon the 
 basis of analogy, and applied the spectrum to the philosophy of life, 
 it would have been one of the most splendid achievements of the hu- 
 man mind. But, like Philip and Muller, in respect to the nervous 
 power, he lost the opportunity ; but in losing it, he reared another 
 beacon upon the quicksands of chemistry (§ 476, 493, 514^ b). 
 
 The chemical properties of the solar spectrum having been an- 
 nounced by other philosophers, it only remained to infer that, like all 
 other things, the integral parts of the spectrum which had manifested 
 peculiar agencies in the physical world would probably, if each were 
 specifically distinct, exhibit greater diversities in organic life (§ 52, 
 136, 175 lb). This would appear to settle the individuality of the numerous 
 rays. The results of sensation, the test of the thermometer, and even
 
 PHYSIOLOGY. VITAL PROPERTIES. 93 
 
 of chemistry, with their united force, established only probabilities. 
 Nature may have supplied the unerring, the " indisputable'' requisite, 
 in the Vital Principle. And, although discovery is probably only be- 
 gun, the principles of individuality, and of organic relations, are as 
 well determined by the properties of one ray as by those of a dozen. 
 That others than such as are known belong to the class of vital agents, 
 there can be little doubt. The physical capabilities of other rays sup- 
 ply a sti'ong analogy for this conclusion. Ikit the doctrine of individ- 
 uality is unimportant to our purpose, since, if the homogeneous nature 
 of light and the elegant wave theory become established, each prismat- 
 ic ray will be as much distinguished by peculiar properties as if every 
 ray were an entity (§ 175 bh, 234 e). 
 
 It will be now observed that every tangible substance yields an 
 overwhelming analogy in corroboration of the doctrine which I ad- 
 vance as to the vital relations of the solar spectrum ; while the coin- 
 cidence in the specific influences of its component parts upon organic 
 life with every other distinct agent, equally in its own turn, surrounds 
 the spectrum with a vital philosophy. 
 
 Nor is this alone the importance to organic philosophy of the rich 
 discovery. The individual parts of the spectrum not only affect sen- 
 sibility and irritability in modes peculiar to each, but, in beautiful 
 harmony with all tangible substances, each part, respectively, affect? 
 certain oi-gans only, according to their special modifications of irrita 
 bility or sensibility, and according to its own peculiar virtues (§ 133 b, 
 136, 137 b, 150 a, 188 a, 190, 194, 199, 203). Here, also, it will be 
 seen, is another analogical proof of the vital nature of the influences 
 of light upon organic beings (§ 74 a, 303 e). 
 
 Much, also, may be found in Professor Draper's own conclusions 
 to show the vital nature of the agency of light. Take, for example, 
 the statement that the '■^indigo ray controls the movements of plants," 
 and that "the blue color of the sky is one of the causes of the upright 
 growth of plants." Now what intelligible explanation can chemistry 
 offer of those phenomena in their undoubted relation to light 1 The 
 unavoidable answer supplies an indisputable analogy for the vital in- 
 fluences of the yellow ray, &c. As to the decomposition of carbonic 
 acid gas, it is the only phenomenon in organic life, and I may add 
 animal, which Liebig abstracted, unequivocally, from chemical agen- 
 cies (§ 350, nos. 66, 68). 
 
 If we now carry the foregoing analogies along in comparing the 
 effects of heat and electricity with those of light upon vegetable or- 
 ganization, we shall readily see that a common philosophy attends 
 the operation of the whole, and that light, in its relation to vegetable 
 life, is nothing but a vital stimulus, adapted to the peculiarly modified 
 vital properties of the leaf, as blood is to the sanguiferous system, 
 sap to the circulatory system of plants, bile to the intestine, semen to 
 the ovum, pollen to the germen, &c. (§ 133, &c.). Consider, too, the 
 analogy which is supplied, in the foregoing aspect, by the action of 
 light upon the retina (§ 234, e), and how it contributes to the produc- 
 tion of various hues of the skin, and how, on the other hand, the skin 
 becomes blanched, like the plant, by the exclusion of light. And the 
 analogy may be extended to the motions produced in the iris by the 
 action of light upon the " carbon atom" of the retina (§ 514, k). 
 Nay, more, the action of light, as I have shown, by its absence, at
 
 94 INSTITUTES OF MEDICINE. 
 
 least, reaches far beyond the peculiarly modified sensibility of the 
 retina (§ 199) ; since, by its long privation, the entire organ of vision 
 ceases to be developed (§ 74). Again, by what chemical philosophy 
 shall we interpret not only the painful effect of light upon an inflamed 
 eye, but its aggravation of the disease 1 And here, by-the-way, its 
 simultaneous action upon the sensibility of animal life and the irri- 
 tability of organic life concur together in the demonstration. 
 
 And now to continue the analogies with electricity and galvanism. 
 Either will promote the growth of plants which no degree or modifi- 
 Ccltion of light can exert. So will they, also, promote nutrition in 
 muscles that are wasted in paralysis ; and if the pneumogastric nerve 
 be divided, the transmission of galvanism through the inferior portion 
 will rouse the stomach to the production of the true gastric juice and 
 partially restore digestion. And here I may stop to say, that the co- 
 incidence in the effects of galvanism upon vegetable and animal organ- 
 ization is one of the many facts which establish the general identity 
 of the properties of life in both departments of the animated king- 
 dom, while it proves that galvanism and the nervous power are per- 
 fectly distinct, though each be a vital agent (§ 73 b, 74, 185, 226). 
 Again, also, galvanism is a remedial agent, affecting morbid functions 
 after the manner of other remedies, which, with its analogy to light in 
 promoting the growth of plants, shows farther that the latter is, in the 
 same sense, only a peculiar stimulus to organic functions (§ 74, 303). 
 
 What is said by Professor Draper in the foregoing abstract on the 
 subject of the yellow ray in its connection with sensation deserves a 
 critical inquiry, not only for the sake of the facts, but as contributing 
 light upon organic philosophy. The chemical doctrine of vision is 
 so clearly fallacious, that any specific relations which may be shown 
 between particular rays of light and the sensibility of the retina, may 
 advance our knowledge, analogically, of the connection of the rays 
 with organic functions, through irritability. But I see not how it is 
 shown that the yellow ray " has charge of the process of vision in all 
 animals," since " each of the seven rays of light impresses our minds 
 with special sensations" (p. 797-798, I 1034). 
 
 Moreover, if the yellow ray give rise to sensation by its action on 
 the carbon atom, or by any chemical influence, then, also, do each of 
 the remaining six, and each one in modes peculiar to itself, and in all 
 the cases upon distinct bases. Nay, more, when the retina feels the 
 united rays, each of the seven must simultaneously exert their specific 
 chemical actions. Besides, how are those invisible rays employed 
 which operate chemically upon inorganic compounds ? 'What means 
 the important distinction between the visible and invisible rajs that 
 the former act upon organic beings, the latter upon inorganic ? 
 
 From the close analogies between the relation of physical agents to 
 sensibility in animal life and irritability in organic life, if their action 
 in the former case be not chemical, but vital, so is it equally in the lat- 
 ter, and vice versa. It is either vital throughout, or chemical altogether. 
 
 But, organic philosophy, through its analogies, should be able to 
 explain what chemistry cannot as to the resulting sensation when the 
 united rays of the sunbeam fall upon the retina. One example will 
 do it. Thus, every distinct agent of positive virtues produces distinct 
 impressions in organic life. But, by uniting two or more together, 
 either mechanically or chemically, a new agent is created, which op-
 
 PHYSIOLOGY. VITAL PROPERTIES. 96 
 
 erates either in an individual sense, or if by several virtues, as an en- 
 tire vi^hole. So, in i-espect to vision, the united virtues of the numer- 
 ous rays of the sunbeam acting upon the sensibility of the retina give 
 rise to sensation attended by a white light (§ 136, 188, 193, 199, 650, 
 872 a, 1054). In organic life they equally act separately or unitedly. 
 
 The intelligent reader may now test the foregoing philosophy by 
 what is perpetually observed within himself, and bring to its illustration 
 the exact analogies which I have indicated as being supplied by the 
 different passions of the mind ; how anger stimulates the whole vascu- 
 lar system, — how fear depresses it, — how shame acts upon the capilla- 
 ries of the face alone, — how joy acts upon the heart and kindles the 
 eyes in its own peculiar way, or its antagonist, grief, seeks the lachry- 
 mal gland, or expectation of food the parotids, — how fear, again, 
 rouses the kidneys, or bathes the skin with perspiration, — how love 
 poises its aim at the genital organs (§ 227, 234 g^ 509, 512, &c.). If, 
 therefore, light do not affect organic actions, and influence organic 
 results as supposed of the foregoing mental causes, and as imputed, also, 
 to all vital agents, but, on the contrary, its operations upon plants, and 
 therefore upon animals, be of a chemical nature, then, by the clear- 
 est analogy, all other agents of life, the mind and its passions, every 
 act of intellection, every voluntary movement, belong equally to the 
 same category (§ 175 c, 349 e, 1072). 
 
 189, a. where physical views of life obtain, their advocates sup- 
 pose that vital agents operate directly upon the structure. This is 
 one of the first steps in materialism. Many of the chemical school 
 imagine, as Liebig expresses it, that " every motion, every manifesta- 
 tion of force, is the result of a transformation of the structure, or of 
 the substance of parts ;" that " every thought, every mental affection, 
 is the result of a change in the composition of the substance of the 
 brain." And so of every pulsation of the heart (§ 350). Others, 
 again, who belong to the school of vitalism, to accommodate their lan- 
 guage to the physical conceptions of the day, speak of the action of 
 vital agents " upon the structure through the medium of the vital: 
 properties." This difference among vitalists is only verbal; since,; 
 by admission, the structure can only be affected " through the medi- 
 um of its vital properties," upon which, therefore, the impression 
 must be made. Hence, distinguished vitalists. Professor Caldwell, 
 for example, who defend the semi-physical mode of expression, often 
 fall into the simple realities of their philosophy. Thus the professor, 
 m his " Outlines of a Course of Lecttcres,^' observes that " irritability 
 and sensibility can be acted on by stimulants alone." " Purgative 
 medicines act chiefly on our irritability," &c. (p. 185, 187). And so 
 it ever happens with inquirers after truth. They cannot adhere even 
 to ambiguities of language ; and others who see the truth, but build 
 upon hypotheses, are often betrayed into fatal contradictions (§ 64, 
 236, 345-350, 350f n, 699 c, 740, 819 b). 
 
 189, b. But, what is more remarkable, the most absolute physical phi- 
 losophers of life, they who deride the existence of the " vital proper- 
 ties," and speak of their " destruction" as an absurdity, not only fall into 
 the language of the vitalists, but unavoidably contradict their wholo 
 system of materialism, whenever they approach the realities of life. 
 This is true even of Dr. Carpenter, who, in his review of my Com- 
 mentaries, attempted their overthrow by satirizing the supposed exist-
 
 96 INSTITUTES OF MEDICINE. 
 
 ence of " vital properties," and particularly the supposition that prop 
 erties could be "destroyed.'" Thus, then, Dr, Carpenter, at a subse- 
 quent time, and in a work of great professional popularity. The cap- 
 itals and italics are mine : 
 
 " It is a fact of some importance, in relation to the disputed question 
 of the connection of muscular irritability with the nervous system, 
 that when, by the application of narcotic substances to the nerves, 
 their vital properties are destroyed, the irritability of the muscle 
 may remain for some time longer; and the latter must, therefore, be 
 independent of the former. Hence we should conclude that contrac- 
 tility [mobility, of these Institutes, § 205] must be a property really 
 inlierent in muscular tissue, which may be called into action by va- 
 rious stimuli APPLIED to itself, and which may be weakened by vari- 
 ous depressing agents applied to itself ; and that the nerves have 
 the power of conveying the stimuli which call the property into 
 action, but have little or no other influence on it." — Carpenter's 
 Human Physiology, Sectio?i 376. — See, also, this work, § 175 d, 167 d, 
 291, 350| b ; and Examination ofRevieivs, p. 8-12, 26-43. 
 
 It is important to the great objects of medicine, that I should now 
 say, that the foregoing is only an example of numerous palpable con- 
 tradictions of the physical views which form the fundamental philoso- 
 phy of life in the foregoing work, and, I may add, of most others which 
 tire devoted to the propagation of medical materialism. It will be 
 »een that enough is admitted in the preceding quotation to substantiate 
 every doctrine advanced in these Institutes. There are the vital prop- 
 erties, in all their individuality, called into action by stimuli, and " act- 
 ing" of themselves even beyond the doctrine of vitalists, or, again, 
 " weakened by various depressing agents," and liable to be " de- 
 stroyed;" though I do not allow, as affirmed in the quotation, that 
 "con/rac^z'toy" is the property acted upon (s^ 206). Finally, we have ad- 
 mitted, " that the nerves have the power of conveying the stimuli which 
 call the proioerty [contractility, or mobility^ into action ;''' and which is 
 all that is necessary to the whole doctrine which I have propounded 
 as to the nervous power (§ 222-233f , 500, &c., 512, &c., 893-905). 
 
 189, c. The impressions which are made on the vital properties be 
 come the causation of the changes which may ensue in the actions, or 
 structure, of the solids, where the impression is made. No vital agents 
 elicit actions, or a single phenomenon of life, when applied to an in- 
 organic compound, not even from an organic being just dead from in- 
 stant destruction by hydrocyanic acid, or by a pin thrust into the me- 
 dulla oblongata. On the contrary, indeed, all the agents which had 
 before contributed to the maintenance of life, now caiTy out the work 
 of destruction, and more speedily resolye the organic fabric into its 
 ultimate elements than any inorganic compound {k 62). It follows, 
 therefore, that agents do not elicit the actions of life by operating upon 
 the organized structure ; but upon those properties which hydrocy- 
 anic acid, &c., may extinguish in an instant of time ; nor do they op- 
 erate upon the functions, since those are merely effects (§ 176). And 
 is it not a greater paradox that hydrocyanic acid, or aconite, &c., 
 should destroy life in a second of time by its action upon the mere 
 structure than upon that living principle which imparts to the organic 
 kingdom all its peculiar characteristics'? Or, as the blood, or joy, or 
 fcnger, rouses the heart, or as fear brings on perspiration, micturition,
 
 PHYSIOLOGY. VITAL PROPERTIBS. 9T 
 
 <fec., or as the want of air throws into action the respiratory muscles, 
 or as odors, light, &c., produce their sensations 1 
 
 By facts of the foregoing nature, and by all those considerations 
 which have been made in relation to the differences in the vital con- 
 stitution of the different tissues, and of different parts of one and the 
 same continuous tissue (as of the alimentary and pulmonary mucous 
 membrane, § 133, &c.), it becomes perfectly obvious that the projDer- 
 ties of life are something j^er^e, something besides organization itself, 
 or organic functions, and upon which the agents of life exert their im- 
 mediate impressions (^ 1029, 1030, 1034, 1041). 
 
 There can, therefore, be no appreciation of the laws of organic be^ 
 ings, of the modus opei'andi of natural, morbific, or remedial agents, 
 of healthy or morbid processes, of voluntary or involuntary muscular 
 motion, of the results of the operation of the nervous power and sen- 
 sibility, or even of perception, without a critical reference to the prop- 
 erties of life as the efficient causes, and as receiving the impressions 
 which may be exerted by external and internal agents (§ 872). 
 
 190, a. Irritability, and other vital properties, are naturally modi- 
 fied, in kind and degree, in the different tissues, in tissues of the same 
 order, and in different parts of one and the same continuous tissue 
 (§ 133, &c., 199, 203, 227-232, 525-529). 
 
 These natural modifications are shown in all parts by the peculiar 
 action of the natural stimuli of life ; as blood upon the heart and 
 blood-vessels, food on the stomach, bile on the intestines, urine on the 
 bladder, the will, through the nervous power, upon the voluntary 
 muscles (§ 215, 227, 486), and by the differences that arise from their 
 action on parts to which they are not peculiar. And so of the diversi- 
 fied effects of external agents on different parts. 
 
 190, b. There are remarkable modifications of irritability in the ova 
 of oviparous and viviparous animals, and in seeds. Semen is the only 
 natural stimulus of the former, in their absolute state of ova ; while 
 in the ova of viviparous animals, the actions, after being roused by 
 the stimulus of semen, must go on to a full development of the organ- 
 ic being, and in undisturbed connection with the parent ; but, in th« 
 oviparous, when the ovum has acquired a certain development, the 
 actions cease spontaneously, the properties of life no longer obeying 
 the vital stimuli as in the other case. These properties then become 
 dormant (and in the seed, also), and nature, having fulfilled her final 
 cause, the ovum is expelled from the body, and the seed cast off, that 
 they may be subjected to new agents. Semen will not now act upon 
 the egg, but heat and atmospheric air become necessary to I'estore 
 the actions, and carry out the process originally instituted by the spe- 
 cific stimulus of semen. 
 
 There are certain oviparous animals that present other peculiarities^ 
 and other changing modifications, of irritability in respect to their ova. 
 At certain seasons their ova undergo a partial development from the 
 influence of season, and from the stimuli supplied by the female pa- 
 rent. These influences, however, finally cease to operate, and the 
 ovum is expelled to undergo the action of semen in the external 
 world. This action again modifies irritability, and adapts it to other 
 vital stimuli. 
 
 Again, it may be affirmed of many oviparous animals, e.g. birds, thai 
 a partial development of the ovum takes place, though imperfectly, 
 
 G
 
 98 INSTITUTES OF MEDICINE. 
 
 tlirougli Stimuli supplied by the female parent, and the ovum is ulti- 
 mately expelled as when incipient development is brought about by 
 the stimulus of semen, but that these ova are insusceptible of renewed 
 actions, either from the stimulus of semen, or other vital agents (§ 
 71-73, 1051). 
 
 191, a. The variations in kind and degree of in-itability (§ 190) 
 adapt each part to be acted upon by peculiar natural agents, while 
 the same agents may have a pernicious effect on other parts, in the 
 great plan of organic life (§ 133, &c.). The same principle governs 
 the operation of morbific, and, more or less, of remedial agents, and 
 is one of the main causes of disease, and of the determination of dis- 
 ease upon one part in preference to another (§ 149-151). The prin- 
 ciple is, therefore, very comprehensive, and refers as well to the kind, 
 enei'gy, and degree of the operating causes or agents, as to the kind 
 and degree of irritability (§ 150). And so, also, of sensibility (§ 194). 
 
 The principle is not only seen in all parts of the organic being, but 
 eveiy distinct species of animal and plant has, in a collective sense, 
 its own special modification of irritability, through v/hich its organic 
 habits as to food, composition, nutrition, &c., are specifically regula- 
 ted. It is this which renders what is poisonous to one animal or 
 plant salubrious or inoffensive to another. And this lets us into a 
 knowledge of the reason why certain atmospheric influences induce 
 the "milk-sickness" in the hine of the Western States, and probably 
 in no other animal. It reveals to us how it is that the stately plata- 
 nus occidentalis and the common ])each tree have been dying out over 
 extensive regions of country, and why the potato-crop is cut off, year 
 after year, in vast regions of Europe and America, while every otner 
 tree and herb escape the epidemics (§ 150). These very facts de- 
 monstrate, also, the principle as to the natural modifications of the 
 properties of life, and establish, alone, the fundamental identity of the 
 vital properties in the two departments of the organic kingdom (§ 185). 
 
 191, h. Again, more remarkable modifications of irritability, or 
 changes in kind, are artificially effected by morbific and remedial in- 
 fluences, external and internal, physical and moral ; and these, far 
 more than a mere increase and depression of this property, constitute 
 an essential part of disease. These affections of irritability give rise 
 to new series of influences, from every variety of agent, and often 
 very different from such as are exerted under circumstances of health 
 (§ 542). Hence it is that ordinary food, &c., becomes morbific in 
 diseased conditions, remedial agents operative, either for good or for 
 evil, when otherwise they might fail of any effect (§ 226), and, upon 
 this mutability, and varying susceptibility of the property now under 
 consideration, is greatly founded the art of medicine. It is, especial- 
 ly, these varying conditions of irritability which demand so much 
 critical reference to the exact nature of remedial agents, their doses, 
 &c. (§ 857, 871, 878), and to the mutability of the property is partic- 
 ularly due the salubrious influences which are exerted (§ 901). 
 
 191, c. And here we have striking analogies in the manner in 
 which the properties of the mind are modified in their character and 
 again restored to their integrity when the organic properties of the 
 brain become affected in the foregoing manner (§ 175). 
 
 191, d. Remote analogies probably exist even in the inorganic 
 kingdom ; though we have apparently nothing there in this respect
 
 PHYSIOLOGY. VITAL rROPERTIES. 99 
 
 which transcends other affinities between the two great kingdoms of 
 nature. We do not find that dead matter is endowed with proper- 
 ties as specifically distinct from the matter itself as the living being and 
 the properties by which it is governed. And, so far as this analogy 
 extends to dead matter, its properties do not appear to be liable to 
 any mutations in kind, but only in degree ; and here it would seem 
 that the analogy should end, since we do not find that instability in 
 the mineral world which, in the organic, grows out of the mutability 
 of the properties of life. 
 
 What I have thus said of the analogies between the properties of 
 living and dead matter is sustained by the late researches of chemists. 
 Thus, on the allotropism of simple bodies, it is said by Prof. Draper, 
 that, " to a certain extent, the views of M. Berzelius coincide with 
 those which have offered themselves to me from the study of the prop- 
 erties of chloi'ine. They are not, however, altogether the same. M 
 Berzelius infers that elementary bodies can assume, under varying cir- 
 cumstances, different qualities. The idea which it is attempted to 
 communicate in this memoir is simply this, — that a given substance, 
 such as chlorine, can pass from a state of high activity, in which it 
 possesses all its well-known properties, to a state of complete inac- 
 tivity, in which even its most energetic affinities disappear. And that, 
 hetween these extremes there are innumerahle intermediate jwints. Be- 
 tween the two views there is, therefore, this essential difference : From 
 the former, it does not appear what the nature of the neioly -assumed, 
 froperties may he ; from the latter, they must obviously be of the same 
 character, and differ only in intensity or degree, diminishing from stage 
 to stage until complete inactivity results." — Draper, on Allotropism 
 of Chlorine as Connected with the Theory of Substittitions. 1845. 
 
 192. Ii'ritability stands as a sentinel at all the openings and pores 
 of the body, and between the capillary and extreme vessels of the ar- 
 terial system ; admitting and excluding according to its natural mod- 
 ifications in different parts. Thus, all but chyme is excluded from 
 the duodenum by the pyloric orifice of the stomach, and all but atmo- 
 spheric air by the glottis. The globules of blood are vastly smaller 
 than the visible capillaries which carry only white blood, from which 
 they are excluded by the peculiar irritability of these vessels.* When 
 admitted, as in inflammation, it arises from a morbid alteration of irri- 
 tability. And so when the lacteals absorb deleterious agents, or the 
 pylorus allows the escape of undigested food. There is no analogy 
 between a set of inert tubes and the living ducts. And yet are we 
 presented with tubular instruments of glass, &c., to demonstrate the 
 laws which govern the circulation of the blood and of sap, and sponges 
 and lamp-wick to exemplify the process of absorption as carried on 
 by the lymphatics and lacteals (§ 289, 291). 
 
 193. Bichat confounded irritability with sensibility, by calling the 
 former organic sensibility, and the latter animal sensibility. He made, 
 also, a greater mistake in supposing that irritability and sensibility are 
 only different degrees of one property. This fact deiives its impor- 
 tance from the high authoritij^of the French philosopher, and the er- 
 rors into which he has thus led a multitude of others. 
 
 The coincident functions between plants and animals, and organic 
 actions being carried on in parts of animals after the greatest possibla 
 destruction of the nervous communications, evince the clearest distinc- 
 * A few are said to be admitted, but are visible only through the microscope.
 
 100 INSTITUTES OF MEDICINE. 
 
 tion between irritability and sensibility, however close their analogies 
 in respect to the operation of physical agents. Nor can the nervous 
 influence act as a stimulus in such cases, though the nerves may form 
 a channel for other stimuli (§ 461, 476i c, 489, 490). 
 
 2. SENSIBILITY. 
 
 194. Sensibility, which is peculiar to the vital principle of animals, 
 resides exclusively in the nervous system. That which gives rise to 
 true sensation is mainly limited to the cerebro- spinal system (§ 184, 
 523). 
 
 195. Through sensibility we learn the existence and nature of ex- 
 ternal objects. These objects make their impressions upon this prop- 
 erty as we have seen of other agents in respect to irritability (§ 188, 
 &c.). 
 
 Another important function is also performed by sensibility, which 
 consists in the transmission of impressions to the cerebro-spinal axis, 
 as a part of the great function of sympathy, or reflex nervous action. 
 
 All the modifications of sensibility are designed for the transmission 
 of impressions from the circumference to the nervous centres (§ 450, 
 451). Tbe sympathetic nerve contributes centres in organic life. 
 
 196. The nerves are the organs of sensibility, and the brain and 
 spinal cord the recipients of impressions transmitted by this property 
 through the medium of the nerves. Perception is also necessary to 
 the recognized modifications of sensation ; and, therefore, the perfect 
 exercise of the power, in its function of true sensation, requires a 
 healthy state of the foregoing elements (§ 523, no. 3). 
 
 197. Sensibility is said to be of two kinds, common and specific. I 
 shall distinguish it into a third kind, which may be calle^l sympathetic 
 sensibility (^ 1037, h). 
 
 198. Common sensibility is the source of pain, and resides in all 
 the nerves. It is generally dormant in the organs of organic life, but 
 may be gi-eatly roused by disease. The best examples of this latent 
 state occur in the ligaments and bones. Its development by disease 
 is a clear illustration of the light which is reflected upon natural phys- 
 iological conditions by their moAid changes (§ 137, d). 
 
 199. Specific sensibility is peculiar to the senses, where it mani- 
 fests very striking peculiarities. Light, alone, will affect the specific 
 sensibility of the retina, the intrinsic virtues, only, of various substan 
 ces give rise to tasting and smelling, certain mechanical impressions 
 to hearing, &c. This proves a difference, or modification, of specific 
 sensibility in the several organs of sense, by which, as in the case of 
 irritability (§ 190, 191), it is adapted, in various parts, to the action of 
 special stimuli, according to the predetermined uses of each part. 
 
 199|. The impressions transmitted by common and specific sensi- 
 bility are received by the brain alone, or its equivalent. The spinal 
 cord is only a medium of communication. These, also, are the kinds 
 of sensibility which require for their operation the exercise of per- 
 ception (§ 451, 523, nos. 1,2); and it is these upon which true sen- 
 sation depends. Whenever brought into operation, the mind takes 
 cognizance of the transmitted impressid'Jis (p. 864, note). 
 
 200. The foregoing (§ 197-199) are coincident with what we have 
 eeen of differences in irritability (§ 133, &c., 190, 191), though more 
 strongly pronounced, and are clear examples of what is meant by
 
 PHYSIOLOGY. VITAL PROPERTIES. 101 
 
 natural modifications of the vital properties ; and illustrate those mod- 
 ifications which constitute the essence of disease (§ 133, &c., 191). 
 
 The three principal kinds of sensibility, and the several modifica- 
 tions of the specific kind, as shown by the special causes which, re- 
 spectively, give rise to seeing, tasting, smelling, &c., also illustrate 
 the principle which governs the special relations of different agents, 
 natural, morbific, and remedial, to irritability as modified in difterent 
 parts ; and this, also, reciprocally illustrates the characteristics of sen- 
 sibility. A harmony of laws prevails universally (§ 133-138). Like 
 irritability, sensibility is also liable to artificial modifications from the 
 action of external and internal causes ; and, as will be seen, the ner- 
 vous power is susceptible of even more remarkable influences (^ 226- 
 232, 725). 
 
 201, a. The last section leads me to consider the third kind of sen- 
 sibility, or what I have denominated sympathetic sensibility (§ 197). 
 Its oflftce will explain the qualifying term sympathetic, which appears 
 to be necessary to avoid the confusion which prevails in the applica- 
 tion of the general term to the distinct offices of exciting acts of in- 
 tellection and of influencing organic motions, and of producing invol- 
 untary motion in animal life. There was a radical objection to Bi- 
 chat's designation of irritability as organic sensibility (§ 193) ; but in 
 the present term there seems to be a peculiar advantage (§ 451, d). 
 
 " Impressions," says Miiller, " conveyed by the sensitive nerves to 
 the central organs are either reflected by them upon the origin of the 
 motor nerves, without giving rise to true sensations, or are conducted 
 to the sensorium, the seat of consciousness." 
 
 When light produces vision, or odors give rise to agreeable sensa- 
 tions, it is due to specific sensibility. The mind perceives, and the 
 effect goes no farther; there is no extension of the impressions be- 
 yond the sensitive nerves. Again, the light or mechanical irritants 
 are productive of pain, and the effect is limited in the same manner. 
 But here there is no specific sensation. It is the same in all the or- 
 gans of sense. This, therefore, is due to common sensibility. At 
 another time, however, the light induces a paroxysm of sneezing, or 
 the odor syncope or disease. Here is a perfectly new train of re- 
 sults, the principal of which are in parts distant from the direct seat 
 of the impressions. The primary influeuces have been propagated 
 upon various organs by the nervous centres through the system of 
 motor nerves. These influences, therefore, have called into action 
 another modification of sensibility, and that is the sympathetic (§ 450, 
 &c., 464, 514 h-m, 902).— Note Dp. 1114. 
 
 201, b. This variety of the common property, like specific sensi- 
 bility, belongs to certain parts only of the nervous system, and is the 
 medium through which impressions upon all parts are transmitted to 
 the cerebro-spinal axis, in the function of sympathy. Perception, and 
 true sensation, therefore, which is rarely an attendant phenomenon, 
 are not necessary to the office of this modification of sensibility, nor 
 is a continuity of the nerves with the brain. Reflected motion may 
 be as readily excited through the spinal cord as through the brain; 
 " and we are in possession," says Miillei-, " of no facts which prove 
 that the spinal cord, when, separated from the brain and medulla ob- 
 longata, can be the seat of true sensation. The reflected motions ex- 
 cited by the irritation of the surface in decapitated frogs are no proof 
 of this." The ganglia of the sympathetic nerve are, also, centres.
 
 102 INSTITUTES OF MEDICINE. 
 
 201, c. Sympathetic sensibility appertains to what are denominated 
 the sensitive nerves, and the sensitive fibres of comj^ound nerves, 
 which are also, in part, the instruments of common sensibility. But, 
 a remarkable anatomical distinction, and which goes far to sustain 
 the variety of sensibility which is here indicated, is found in the sen- 
 sitive fibres of the sympathetic and pneumogastric nerves ; which 
 possess, in the most exalted degree, the power of transmitting organic 
 impressions to the nervous centres, but which are nearly destitute of 
 common sensibility. Indeed, it is through this system of sensitive 
 fibres that the whole organic department maintains the specific rela- 
 tions of its several parts (§ 129, 523, nos. 1, 2, 3, 6, 1037, h). 
 
 201, d. The impressions transmitted through sympathetic sensibility 
 may be received either by the brain, spinal cord, or certain parts of 
 the ganglionic system (§ 520) ; and either connectedly or independ- 
 ently of each other. When thus received by the nervous centres, 
 they give rise to a development and transmission of the nei-vous pow- 
 er through what are called the motor nerves, and terminate in those 
 influences which complete the function of sympathy, by giving rise to 
 sensible or insensible motions, or modifying such as had existed. 
 
 202, a. The manner in which sympathies are brought about through 
 the medium, in part, of sensibility, and the failure of impressions upon 
 common and specific sensibility to generate sympathy, or to excite the 
 influence of the motor nerves, and the absence of sensation in the 
 former case, and the admissible absence of the brain, as well as other 
 peculiarities, prove, abundantly, the existence of this third kind of 
 sensibility. Besides, also, the prominent demonstrations to the fore- 
 going effect which occur in disease, this modification of sensibility is 
 in universal operation in healthy states of the body; as manifested in 
 resjjiration, and in the concerted action with which the various organs 
 carry on their respective functions. Through this modification al) 
 parts transmit to the cerebro-spinal axis special influences that are 
 relative to their existing conditions, and these influences are propa- 
 gated through motor nerves, and maintain a harmony of movements. 
 
 These reflex nervous actions are, therefore, universal and perjoetual. 
 
 The special function of this kind of sensibility, and its co-operation 
 with the nervous power in the function of sympathy, will be faither 
 considered along with that function, and the function of motion, and 
 again under the laws of sympathy, and the modus operandi of reme- 
 dial agents (^ 1037, V). 
 
 202, h. It may be now said, however, that when sympathetic sen- 
 sibility contributes to motion, whether in organic or animal life, or 
 whether sensible or insensible, it is through impressions received and 
 transmitted by this property to the cerebro-spinal axis, or to the 
 centres of the sympathetic when a medium of reflex action, and a 
 consequent development of the nervous power, which power then op- 
 erates, through motor nerves, upon the organic irritability of parts 
 which are brought into motion. 
 
 203. Like specific sensibility (§ 199), and the organic property, ir- 
 ritability (§ 190-192), sympathetic sensibility is variously modified in 
 different parts, by which it is adapted to the reception of impressions 
 from agents of particular virtues, and for their transmission to the 
 nervous centres, and for the ultimate generation of true sympathy; 
 while the same agents fail of these effects in other parts (§ 133, &c.).
 
 PHYSIOLOGY. VITAL PROPERTIES. 103 
 
 204. Another manifest contradistinction between sympathetic, and 
 common and specific sensibility, is seen in the general failure of im- 
 pressions made on sympathetic sensibility to act upon the mind, and 
 therefore in the ordinary- absence of all sensation. If sensation be an 
 attendant phenomenon, it then arises from impressions simultaneously 
 made upon common sensibility (§ 445, 464-467, 473, no, 5, 474, no. 4, 
 523, 1037, b). 
 
 3. MOBILITY. 
 
 205, a. Mobility is the property by which all motions are carried 
 on in animals and plants. It is peculiar to the solids, though some 
 late physiologists have ascribed it to the globules of blood, while oth- 
 ers have mistaken the globules for entozoa (§ 233, 253, &c.). 
 
 205. b. Sensible and insensible contractility, as employed by Bichat, 
 and muscular power, are bad substitutes for the name mobility. They 
 lead to erroneous conclusions ; since the heart, blood-vessels, and other 
 muscular organs dilate or elongate, as well- as contract, through the 
 same vital property; and motion occurs in various tissues. — [Med. 
 and Physiolog. Conim., vol. i., p. 150, 379-391.) 
 
 The terms sensible and insensible contractility limit the law of mo- 
 tion to simple contraction, while there must be often a con-espond- 
 ing active dilatation, or the part would always remain in a state of 
 tonic spasm. Elasticity will never explain the dilatation of the heart, 
 of the veins, &c. — [Med. and Physiolog. Conmi., vol. ii., p. 147-156, 
 175, 176, 399-402, Mhere this is fully examined). 
 
 206. The philosophical Macbride remarks that, " as irritability ne- 
 cessarily implies mobility of the animal fibres, this does not require 
 to be considered a distinct property." If, then, the existence of mo- 
 bility be thus implied, it is a distinct property; and when the phenom- 
 ena of irritability and mobility are duly considered, it will be seen 
 that they should be regarded in a separate sense. Imtability is cer- 
 tainly necessary to the exercise of mobility ; but the former may be 
 greatly exalted without a corresponding increase of motion. The 
 distinctions are numerous and of great practical importance (^ 500, d). 
 
 207. The existence of mobility in plants is abundantly shown by 
 the motion of their fluids, which no mechanical principle can inter- 
 pret, by their secretions, and by other results analogous to those which 
 depend, in part, on this property in animals. It is also manifested by 
 the sensible movements of the leaves, blossoms, stamina, &c. ; and 
 from these we may reason analogically, and infer insensible motions 
 of the sap-vessels, the secretory apparatus, &c., as is also done in an- 
 imals (^ 1054). 
 
 Mobility, therefore, gives rise to sensible and insensible motions. 
 They are generally sensible in animal life, and of either kind in or- 
 ganic (§ 476-492, 516, no. 2 ; also, Medical and Physiological Com- 
 mentaries, vol. ii., p. 150, 379-391). 
 
 208. Mobility is brought into operation through impressions made 
 on irritability, whether by vital stimuli in organic life, or by the ner- 
 vous power in either organic or animal life (§ 188). The philosophy 
 of this will be considered along with the attributes of the nervous 
 power, the function of sympathy, and the laws of sympathy. 
 
 209. If sensation apparently give rise to motion, it may be occa- 
 sioned by the action of external or internal causes upon sensibility;
 
 104 INSTITUTES OF MEDICINE. 
 
 but this impression is imparted to in-itability and then to mobility, 
 before motion can follow (§ 195) ; or, from the intimate associations 
 and analogies between irritability and sensibility, the two properties 
 may be simultaneously affected by the same agents. Where, how- 
 ever, sensation is accompanied by motion as an apparent effect of im- 
 pressions upon common sensibility, it probably arises in all cases from 
 a simultaneous impression upon sympathetic sensibility (§ 198, 201, 
 202). This exact analysis is indispensable to our subject. 
 
 210. Irritability may be increased through an exalted state of sym- 
 pathetic sensibility, and organic motions may be thus increased 
 through sensibility ; which is nearly the same as the foregoing law 
 (§209). 
 
 211. It is doubtful whether parts may be irritated without exciting 
 mobility (§ 202) ; but it is otherwise with common and specific sensi- 
 bility, as in seeing, tasting, &c., and in pain. 
 
 212. Mobility, like irritability and sensibility, may be in a'passive 
 or dormant state, as in the ovum and seed, or as sensibility exists in 
 the organic life of animals. All are roused by appropriate agents, 
 and could not be roused were they not already present. Certain an- 
 imals, such as the wheel, and the sloth animalcula, may have all appa- 
 rent traces of life extinguished, maybe completely exsiccated, and be 
 speedily revived by heat and moisture.* 
 
 The first impression of semen, or of heat, &c., upon the ovum, or 
 seed, is made on irritability, through which, as the next stejD in the 
 process, mobility is roused into action. Then follow the new ele- 
 mentary combinations. 
 
 We thus learn, in part, that life is a cause, not an effect. — [Med. 
 and Physiolog. Comm., vol. i., p. 9, et seq.) 
 
 213. Sensible mobility is especially manifested in the compound 
 organs, taken as a whole (§ 205). Insensible mobility occurs in the 
 small vessels (§ 207). But, the palpable evidences of a special law 
 of motion in the small vessels are apt to be sacrificed to the negative 
 fact that the motion itself is not of a visible nature. As well might 
 we deny the existence of microscopical animals. 
 
 214. The insensible motions in organic life are the most important 
 that occur, especially such as take place in the extreme capillary ves- 
 sels ; since these are the instruments of all the most essential actions 
 and phenomena of life, and of disease. 
 
 215. Voluntary motion is brought into exercise by the will and 
 nervous power, as will be set forth under my consideration of the lat- 
 ter property and the function of motion (§ 222-233|, 500 d). The 
 essential difference, therefore, between the motions in animal and or- 
 ganic life lies in the nature of the stimuli ; voluntary motion requiring 
 the exercise of the will, while the organs of oi'ganic life rarely obey 
 the stimulus of the nervous power when excited by the will (^^ 500 e). 
 It is probable, also, that mobility has a peculiar modification in the 
 muscular tissue of animal life. 
 
 Notwithstanding mobility, in animal life, is always subject to the 
 nervous power, motion is here, as in organic life, independent of the 
 nervous system, excepting as supplying a stimulus (H83, 486). 
 
 * Sec Spallanzani's Experiments in Opusculi di Fisca Animale, Opere, t»vi, p. 
 *83-55e.
 
 PHYSIOLOGY. VITAL PROPERTIES. 105 
 
 4. VITAL AFFINITY. 
 
 216. It has been seen that the elements of organic compounds arc 
 very differently combined from those of inorganic (§ 32, &c.). Hence 
 has arisen the term vital affinity, as denoting a property peculiar to 
 plants and animals, by which all their elements are united and main- 
 tained in combination. When death takes place, chemical affinities 
 operate, and resolve the organic into inorganic compounds, or into 
 their simple elements (§ 174). 
 
 217. Vital affinity exists in modified states in the two departments 
 of organic nature ; since, in plants, it unites the simple elements into 
 organic compounds, while in animals, it can operate only upon com- 
 pounds of this complexity. Vegetable organization is, therefore, 
 more of a creative nature than animal (§ 13). 
 
 5. VIVIFICATION. 
 
 218. By vivijication, in conjunction with vital affinity, life is bestow- 
 ed upon dead matter. The elements of matter are, essentially, com- 
 bined into organic compounds by vital affinity ; but there is a pro- 
 gressive vitalization of the organic compounds till they become united 
 with the solids. This shows that vital affinity must have an associate 
 power of vivification. 
 
 219. Vivification belongs, particularly, to the assimilating organs, 
 though its energy must be great in the gastric juice. It has natural 
 modifications in all parts, and presents distinctions between plants 
 and animals. 
 
 220. a. Vital affinity and vivification, like the other properties of life, 
 are susceptible of morbid changes. This gives rise to changes in the 
 general vital character, and in the composition, of the solids and fluids. 
 
 These changes in composition are inferred upon principle, as well 
 as from observation (§ 666, Z»). No chemical analysis can detect them, 
 unless it be an alkalescence or an acidity of the secreted fluids, or 
 changes in the urine ; and even these imperfect results are often sur- 
 rounded by objections (§ 5^ b, 53, 1029, 1030). 
 
 220, b. Changes in some of the secretions, as in the milk, may be 
 brought about by temporary influences, and independently of disease, 
 as by emotions of the mind, the action of cathartics, &c. These also 
 affect the condition of organs and their products in the various states 
 of disease; and upon this depends the art of medicine (§ 852, &c.). 
 
 220, c, The alterations which take place in the solids and fluids are 
 always the same in any given condition of the affected properties of 
 life. They are, therefore, constantly liable to variations during the 
 progress of disease, and are various in different diseases, and accord- 
 ing, also, to the nature of remedial influences, and of those other causes 
 by which they are affected independently of disease (§ 672). 
 
 221. The changes which arise in the solids and fluids from morbid 
 conditions never approximate the condition of dead matter {^ 674). 
 
 22 li. Changes in organic compounds may be the result of the di- 
 rect action of physical agents, but are generally owing to alterative in- 
 fluences of direct or reflex nervous action leading to disease, and some- 
 thing to the natural law that the nerves impress a special condition 
 upon animal compounds, both solid and fluid (§ 69, 226, 399, 405, 
 446 a, 455, 456 a, 461, 485, 4881 489, 512, 740, 952).
 
 106 
 
 INSTITUTES JF MEDICINE. 
 
 6. THE NERVOUS POWER ITS DIRECT AND REFLEX ACTION. 
 
 222, a. The analysis which I shall make of sympathy establishes so 
 clearly its functional character, that I shall remove it from among 
 the properties peculiar to animals, where it has been hitherto placed. 
 In defining this function, generally regarded as a property, 1 shall 
 introduce the nervous power, upon which, in connection with sensi- 
 bility, the function depends (§ 201). This is reflex nervous action. 
 
 222. b. The philosophy of the operation of the nervous power in 
 producing motion, under all its various aspects, as manifested in its 
 natural regulation of organic functions (^ 202), or by its ether reflex 
 actions as induced by morbific and remedial agents, or by the influ- 
 ences of disease, in the motions which are generated in the organs of 
 organic life by the passions and analogous aftections of the mind, in 
 the movements of the voluntary muscles, in the production of sudden 
 death from all causes, as well as the solution of other relative prob- 
 lems, and the physiological interpretation of the recognized laws of 
 sympathy and their general introduction into pathology and thera- 
 peutics, were originally attempted by myself in the Medical and 
 Physiological Commentaries, and subsequently, and more extensively, 
 in my Essay on the Modus Operandi of Remedial Agents.* Should 
 the exposition there and now set forth prove to be well founded, it 
 must necessarily result, sooner or later, in the overthrow of all the 
 mechanical and chemical hypotheses in physiology, consign to its 
 well-merited oblivion the humoral pathology, and place upon its true 
 foundation the operation of remedial agents. — See Eights, &c., p. 912. 
 
 223. The nervous power appertains to the vital principle, resides 
 exclusively in the nervous systems, and is, therefore, peculiar to ani- 
 mals (§ 184, h). It gives rise, however, to results in organic as well as 
 animal life. These results, also, are far more numerous and impor- 
 tant in the organic than the animal mechanism, while sensibility is es- 
 pecially designed for the latter. Unlike sensibility, also, in its func- 
 tion of sensation, perception is not necessary to the operations of the 
 nervous power, nor does the latter, like sensibility in its office of pro- 
 ducing sensation, require a continuity of the nerves with the brain for 
 reflex or direct action, especially in organic life (§ 209, 507). 
 
 The nervous power is constantly, though, for the most part, in in- 
 sensible operation throughout the organic mechanism, modifying tho 
 actions and animalizing the products of all parts. For this special 
 reason 1 have endeavored to show that the nervous power is super- 
 added to the vital principle of animals, and that the complexity of or- 
 gans and functions which it is designed to subserve, and the absence 
 of its phenomena in plants, afford a substantial proof that the proper- 
 ty belongs to animals alone (^ 1041.) 
 
 224. The nervous power is exerted, especially, through what are 
 denominated the motor nerves and the motor fibres of compound 
 nerves, or " nerves of motion ;" these nerves, however, being mainly 
 dependent for the nervous power upon the brain and spinal cord 
 (§ 201). 
 
 Nevertheless, there is reason to suppose that the nervous power is 
 
 implanted in the motor nerves, as well as in the brain and spinal cord. 
 
 The phenomena of contiguous sympathy, as when inflammation of 
 
 the liver, the lungs, &c., is relieved by blisters, over the region of the 
 
 * Mkd. and Phys. Com.\i., 1840.— Ess.u', cJc., 1842.
 
 PHYSIOLOGY. VITAL PROPERTIES. 107 
 
 affected organs, cannot be traced through the cerebro-spinal system, 
 excepting in its connection with the ganglionic, which supplies, in such 
 cases, the immediate centres of reflex nervous action (§ 893). There 
 exists a great fundamental distinction between the cerebro-spinal and 
 ganglionic systems, the former of which is allotted especially to animal 
 life, the latter to organic (§ 113); and, although the cerebro-spinal be 
 associated in function with the ganglionic, purely cerebro-spinal nerves 
 exert no influences upon the organic functions, not even the pneumo- 
 gastric till independent life begins, while the ganglionic supplies the 
 stimulus to organic muscles, combines the organic viscera, and determ- 
 ines exciting and modifying effects upon all their actions, by which the 
 secretions are variously increased or diminished, and the organic prod- 
 ucts imbued with peculiarities that distinguish them from the or- 
 ganic compounds of plants ; and what is of vast practical importance, 
 it is owing to those physiological differences that morbific and reme- 
 dial agents operate, essentially, through the sympathetic system (§ 113, 
 409 h, 422, 461-46U, 475i, 500 g, 524 a, no. 7, 89U g, Ic, 893i). 
 
 225. Like irritability, sensibility, and the other properties of life, the 
 nervous power is capable of being acted upon by external and internal 
 causes, both mental and physical, of being increased, or diminished, or 
 altered in kind, according to the nature of the causes (§ 200, 203, 258). 
 
 226. The nervous power possesses the remarkable characteristic of 
 being a vital agent to the property irritability (§ 184 I). It is also li- 
 able to artificial modifications from the operation of physical and mental 
 causes upon the nervous system ; and its influences upon irritability will 
 correspond with the nature of its modifications ; being thus rendered a 
 vital stimulus, or a vital depressant, or a vital alterative (§ 150). When, 
 therefore, this power operates in any unusual manner, organic and an- 
 imal motions, whether sensible or insensible, will be variously modified, 
 or produced, by calling mobility into exercise, according to the nature 
 of the influences exerted upon the power, and products will vary ac- 
 cordingly. This grows ovit of the natural ofl[ice of the nervous system 
 of exciting and modifying organic actions and their results (§ 461). 
 
 227. The nervous power is brought into unusual operation very va- 
 riously, according to the seat and nature of the exciting cause (§ 951). 
 
 1st. Its operation is excited in a direct manner by irritants, «&c., ap- 
 plied to the brain, to the spinal cord, and to the motor nerves. It is 
 also excited directly by cerebral or spinal disease, by the passions, men- 
 tal emotions, imagination, intense reflection, and by the yvi\\. This I 
 call direct nervous action (§ 222 a). In all the cases, the nervous pow- 
 er will be rendered stimulant, or depressant, or alterative to the or- 
 ganic properties and functions , and variously energetic according to 
 the nature of the operating cause, and the intensity and suddenness 
 with which it may operate (§ 480, 743, 951). In blushing, the pow- 
 er is rendered stimulant; by fear, depressant; by grief, anger, hope, 
 &c., alterative (§ 844). These effects are also commonly very sud- 
 den, especially the physiological. Even such as are morbific are oft- 
 en almost instantaneous ; and this rapidity of change ceases to be re- 
 mai'kable when we regard their near coincidence with the natural re- 
 sults, and that the same principle is involved in voluntary motion. 
 
 A close analogy subsists between all the foregoing direct causes 
 and all the physical agents of life, whether natural, morbific, or reme- 
 dial, as the latter may develop the nervous power through sensitive 
 nerves. These analogies Avill have been variously illustrated. They
 
 108 INSTITUTES OP MEDICINE. 
 
 evince tlie simplicity of fundamental principles and the relationship 
 and perfect harmony which prevail among the whole, even those 
 which are especially relative to mind and instinct as superadded to 
 the simple condition of the vegetable kingdom (§ 323-325, 818^). 
 
 2d. The reflex action of the nervous power is excited through the 
 medium of sympathetic sensibility (§ 201-203). This complex process 
 results in the true function of sympathy. Impressions are made by 
 physical and mental causes, by disease, &c., upon the foregoing varie- 
 ty of sensibility, which I call sympathetic from the office of the sensi- 
 tive conductors in this function of reflex nervous action. The impres- 
 sions are then communicated to the cerebro-spinal axis, or to other 
 central parts of the nervous system, and there bring into operation, 
 and variously modify, the nervous power (§ 224). The power, thus 
 developed, thus influenced, or so modified in kind that it partakes of 
 the nature of the transmitted impressions, which are more or less co- 
 incident with the virtues of the remote causes, is then exerted, through 
 the motor system of nerves, upon the organic properties of distant 
 parts, or of the nervous system itself (§ 208, 209, 462-469), by which 
 those properties, and their resulting functions and products, are vari- 
 ously affected according to the foregoing circumstances. From this 
 fact it also results, that the modified conditions which are brought 
 about by the nervous power, when the preternatural operation of this 
 power depends upon extei'nal causes, whether morbific or remedial, 
 are more or less analogous to those changes in the organic conditions 
 which are wrought in parts by the direct operation of the same causes 
 (§ 188, 657 b, 503-505, 8911 k 893 e, 902, 904 a, 951 c, 990^). 
 
 228, a. It thence follows, that there is imparted to the nervous 
 power, by the foregoing means (§ 227), more or less of the charac- 
 teristic virtues of the remote causes, but under the influence of its own 
 nature, by which the nervous power is substituted for those causes, 
 and thus reaches, with its acquired attributes, and their various effects, 
 every pait of the organization, and, often, with great instantaneous- 
 ness. It appears, therefore, that this constitution of the nervous pow- 
 er is wonderfully suited to the various exigencies of life ; while, as 
 will be seen in section 232, it grows out of its physiological nature as 
 a regulator of organic actions (§ 1057, 1075, 481 d). 
 
 228, h. It is also an important law that the nervous power is vari- 
 ously influenced in its morbific and remedial action by slight vari- 
 ations in the intensity of the operating causes, whether mental or phys- 
 ical ; though a determination is simultaneously given to its action by 
 the numerous other conditions already mentioned, and which may 
 happen to be present. Thus, an impression from cold, as a blast of 
 air, or a drop of cold water, upon the skin in syncope, will rouse the 
 respiratory organs. Another impression from the same, and under 
 other circumstances, will excite catarrh, or pneumonia, or articular 
 rheumatism. One degree of impression upon the stomach by tartar- 
 ized antimony will determine the nervous power upon the respiratory 
 muscles (as will cantharides upon the bladder, or mercury upon the 
 salivary glands), and vomiting is the consequence ; while it simul- 
 taneously reflects the same power upon the skin, and other organs, 
 and of which perspiration, &c., is a consequence. In smaller doses, 
 the respiratory movements are not affected, but only the condition of 
 the skin, &c., and in lesser degrees. But, these examples embrace
 
 PHYSIOLOGY. VITAL PROPERTIES. 109 
 
 only certain pails of the influences in each case ; while in others they 
 are far more complex, one sympathetic result becoming the cause of 
 others, till, through a single impression upon the skin, vai'ious circles 
 of morbific or remedial reflex nervous actions may be instituted. 
 
 229. When disease operates in the foregoing manner in exciting 
 the nervous power, and determining it with alterative effects upon re- 
 mote parts, or upon the nervous system itself, it often imparts to it a 
 modification by which a similar condition of disease is generated in 
 the parts vipon which the power is thus determined. Hence the con- 
 secutive inflammations which are often springing up, sympathetically, 
 in various parts. But, this depends, more or less, upon the nature of 
 the organs secondarily affected, upon their precise condition as divert- 
 ed more or less from their healthy states by other causes, upon tem- 
 perament, age, sex, &c. When, thei'efore, the nervous power is de- 
 veloped by disease, other conditions varying more or less from the 
 primary affection are observed among the common effects. For the 
 same reasons, also, when morbific and remedial agents operate through 
 the medium of the nervous power, the results may be very various. 
 
 230. If the nervous power be brought into preternatural operation 
 in a direct manner (§ 227), as when impressions are made upon the 
 brain, or spinal cord, or the trunks of nei-ves, or by cerebral disease, 
 or when the mind or passions develop its operation, it is also liable to 
 modifications, and corresponding effects, as when the impressions are 
 communicated through the medium of the sensitive conductors. Thus 
 alcohol, applied to the brain or spinal cord, increases the action of the 
 heart and capillary blood-vessels, and so do anger, joy, hope, love, 
 imagination. But, a watery infusion of opium or of tobacco, applied 
 in like manner, depressesthose actions, and so do fear, grief, and anx- 
 iety. We see, also, various other organic functions affected in a cor- 
 responding manner (§ 480-485, 489-492, 943, 945). In these cases, 
 the nervous power is often determined, with more or less effect, di- 
 rectly upon the organic properties of the brain, and may extinguish 
 them instantly. A sudden explosion of anger may, in this manner, 
 induce apoplexy, while in other cases the destructive influence of the 
 nervous power is expended mainly upon the heart. Inflammation of 
 the brain determines the nervous power directly upon the cerebral 
 vessels which carry on the morbid process, and thus increases its force 
 and obstinacy. So with many morbific and remedial agents of a 
 physical nature, which, when applied to the stomach, excite the ner- 
 vous power indirectly, or through the medium of the sensitive fibres 
 of the pneumogastric and sympathetic nerves, but in which cases the 
 nervous power is reflected upon the organic properties of the brain, 
 or of the spinal cord, or of the individual nerves, as well as upon 
 those of other parts. Such is the case with all the narcotics, strych- 
 nine and analogous substances, prussic acid, aconite, &c., which bear 
 specific relations to' the nervous system ; either exciting or removing 
 morbid states of the brain or nerves (§ 487 g, 526 d). 
 
 231. It is not alone the general functions of tissues and of com- 
 pound organs which are affected by the nervous power in the fore- 
 going manner (§ 227-230), but equally, also, those of the intimate or- 
 ganization of all parts, upon which nutrition, vital decomposition, &c., 
 depend. It always acts upon minute structure {^ 395, 1040). 
 
 232. The modifications of the nervous power now described (§
 
 110 INSTITUTES OF MEDICINE. 
 
 5J27-230) are analogous to those which we have seen to be exerted 
 upon irritability and sensibility (§ 191, 200), and they spring from 
 that physiological constitution of the nervous power which is design- 
 ed for great natural purposes in the animal economy. This power is 
 manifestly associated with the vital principle of animals (§ 184, h) as 
 a regulator of their multifarious parts, by which the whole are main- 
 tained in harmonious action, or by which the varying changes and 
 failures of some shall institute vital changes in other parts that shall 
 contribute to the restoration of the former, or exempt the general or- 
 ganism from the evils which would otherwise arise (§ 455). Volun- 
 tary motion (§ 215, 486), respiration, a permanent contraction of the 
 sphincters, are also other final causes of the institution of the nei-vous 
 power. Tlie power is in perpetual operation in every part of the 
 animal organization, though more obviously pronounced in some of 
 its results than in others, as in the function of respiration, the perma- 
 nent contraction of the sphincters, the motions of the iris, &c. It is, 
 however, not less constantly operative, though with less intensity, in 
 all organic processes, bestowing important conditions upon all pro- 
 ducts of an organic nature, solid or fluid, and forever stretches its 
 universal sway, as a harmonizing power, over the whole organic 
 mechanism. This power, therefore, is rendered exquisitely suscepti- 
 ble to the most astonishing variety of physical, vital, and mentalcauses ; 
 and, that it may feel and transmit the influences of the vital changes 
 that may befall one part or another to other parts, for the maintenance 
 of the gi'eat balance of functions, and to fulfill the ofiice of restoration 
 as well as of conservation, there is imparted to it, as to the other prop- 
 eities of life, a partial mutability in its nature, confoiTnable to the va- 
 rious impressions exerted upon it, and by which it is rendered vari- 
 ously and usefully alterative to morbid conditions; and since, also, 
 such alterative effects as are demanded by morbid states could not be 
 exerted by a natural vital agent in its unmodified condition. Thus 
 we have, in the obvious constitution of the nervous power, as manifest 
 in its common functions, a principle of interpretation for all the vari- 
 ety of changes that are not less obviously exerted upon it by morbific 
 and remedial agents than are plain its reflex and direct actions. 
 
 233. The nervous power does not generate motion either in animal 
 or organic life (§ 476-492, 516, nos. 2, 7). It only influences the or- 
 ganic property mobility, upon which all motion depends, through the 
 medium of irritability (§ 188, 205, 208, 209, 226). Even voluntary 
 motion is entirely independent of the nervous system, excepting as 
 the nervous power is a stimulus to in'itability. In the production of 
 this complex function several elements are concerned : 1st. The will, 
 operating as a stimulus upon the brain, develops the nervous power; 
 2d. This power is then transmitted to the voluntary muscles, where it 
 acts as a stimulus upon irritability (§ 226) ; 3d. Mobility is thus called 
 into exercise, the immediate result of which is voluntary motion (§ 
 205, 206, 208, 209, 245, 256, 476 c, 486, 487, 492, no. 7, 500 d). 
 However complex, and destitute of analogies in the world of mere 
 physics, this phenomenon may be, I have no doubt that the solution 
 which I have offered will bj received by every philosophical mind 
 which may attentively consider the nervous power in its connections 
 with the motor nerves, and the experiments of Wilson Philip (§ 464, 
 &c., 476, &c., 1041).
 
 PHYSIOLOGY. VITAL PROPERTIES. Ill 
 
 Since, also, the nervous power has no existence in plants, their ac- 
 tions are alone influenced by the physical agents of life ; and, havin<» 
 no sympathetic relation of parts, the diseases of one part are felt by 
 other parts only through the common laws of nutrition, wliile, also, 
 remedial agents are curative by their local action alone. 
 
 2331^. The nervous power, in a manner analogous to its determ^ia- 
 tion upon the sphincter of the bladder after the evacuation of the 
 urine, may be propagated upon distant parts, with morbific or curative 
 effects, long after the removal of the agent by which it was originally 
 ■excited. This is owing to the continued change, or impression, wrought 
 upon the part to which the agent was applied (§ 514 g, 516, no. 6). 
 
 233 J. One of the most remarkable laws of the nervous power is 
 that of its determination through particular nerves upon certain parts, 
 according to the nature of the exciting cause, whether mental or phys- 
 ical, whether natural, morbific, or remedial, and equally so in animal 
 and organic life ; passing over, in the fulfillment of this law, various 
 intermediate nerves of more direct anatomical connection. This is 
 remarkably exemplified in many musical performances and feats of 
 agility. This special determination of the nervous power is most in 
 conformity with the special influences that may bring it into operation, 
 in healthy conditions of the body ; but in diseased states, or where or- 
 gans are but partially diverted from their natural state, a direction is 
 more or less given to the determination of the power by these acquired 
 susceptibilities (§ 500 j, k, 871). This peculiar attribute of the ner- 
 vous power distinguishes it from the direct action of remedial and 
 morbific agents, which, if taken into the circulation in efficient quan- 
 tities, would often derange the universal body. But the same physi- 
 ological constitution of the nervous power which renders it obedient 
 to the will in its transmissions to particular muscles, or to the passions 
 in its effects on special organs in organic life, renders the power, when 
 modified by remedial or morbific agents, and according to its pre- 
 cise modification and susceptibility of parts, equally determinate and 
 circumscribed in its operation (§ 150-152, 838, 814). There is noth- 
 ing in Nature more wonderful and paradoxical than this attribute of 
 the nervous power ; and while the facts which it supplies in connec- 
 tion with the operation of the will and the passions bear with the 
 strongest analogical force upon the philosophy which respects the in- 
 fluences of morbific and remedial agents upon all paits distant from the 
 seat of their application, that analogy is corroborated by the limitation 
 of the morbific or remedial effects to certain parts of the organism. 
 
 2334. It appears, therefore, that the nervous influence, rtjlex or di- 
 rect, is generally the immediate remote cause of all changes beyond the 
 seat of the direct action of other causes (§ 644-647^, 889 A). 
 
 GENERAL REMARKS UPON THE PHILOSOPHY OF LIFE. 
 
 234, a. Notwithstanding all the laws of sympathy, that are neces- 
 sary to the full interpretation of the remote effects of morbific and re- 
 medial agents, are as well established as any laws in physics, they 
 have not been applied to these important objects ; but, on the contra- 
 ry, those philosophers who have contributed most to their critical ex- 
 position overlook their pathological and therapeutical bearings, and 
 cling to the doctrines of humoralism, and of the operation of remedial 
 agents by absorption ; nor have they applied, in the least, the nervous
 
 112 INSTITUTES OF MEDICINE. 
 
 powei ill a philosophical manner to an exploration of the natural phe- 
 nomena of sympathy. The oscillations of Newton, the contractions 
 of Darwin, the vibrations of Hartley, the secretions of Galen, the gal- 
 vanism of Galvani, the destructive forces of the chemist, and the caloric 
 and the magnetism of wilder imaginations, continue to be adopted, 
 an^ show as well by their great incongruity as by their failure, that 
 the hypotheses are founded on imaginary data, and that each has 
 neglected the phenomena of life (§ 189 h, 785, 1085). 
 
 234, h. I say nothing of those who still refuse their assent to the 
 well-ascertained laws of sympathy, as manifested in the natural states 
 of the body. These they have yet to study and to learn ; but it may 
 be well objected that their ignorance shall prove an obstacle to the 
 progress of knowledge (^ 905f). 
 
 He, indeed, must have been a vei-y imperfect spectator of human 
 events, who anticipates the acquiescence of ignorance or prejudice, or 
 the ready concuiTence of inferior minds, in the intricate problems 
 which relate to the laws of the vital functions. The demonstrations 
 of Philip have become obsolete in all but their abstract nature; and 
 the discoveries of Prochasca, Sir Charles Bell, Miiller, Hall, Valentin, 
 and others, in the functions of the nerves, are either unknown, or un- 
 appreciated, by all but the erudite student or such as aim at erudition ; 
 and the very anatomical medium of reflex actions, through which the 
 operations of the nervous power and the phenomena of sympathy ap- 
 peal, as it were, to the senses as well as to the understanding, is apt to 
 be regai'ded as an accidental or as a superfluous appendage of the 
 body, or thrown in to embaiTass inquiry by multiplying the complex 
 ities of organic beings (^ 1039). — Rights of Authors, p. 912. 
 
 Coming to the ditferent kinds of irritability and sensibility, or as 
 these are modified by morbific and remedial agents, or by other phys- 
 ical causes, as well as the analogous modifications of the nervous 
 power, and its remarkable attributes as a vital agent, its direct action 
 as such when developed by causes acting directly upon the nervous 
 system, or when brought into opei'ation indirectly through the medi- 
 um of sympathetic sensibility (§ 227), and other analogous facts which 
 are equally substantiated by an endless variety of phenomena, they 
 are pronounced by a no small number of the profession, even by wri- 
 ters who appear in the character of expounders of medical philosophy, 
 as metaphysical speculations, or as imaginary hypotheses. Even life 
 itself is regarded as a subtlety of the schools, or as a phantom of less 
 reputable claims. " For my part," says Magendie, " I declare boldly 
 that I look upon these ideas about vitality, and the rest of it, as noth- 
 ing more than a cloak for ignorance and laziness"* (§ 1034). 
 
 234, c. If, then, you object to the existence of a principle of life, 
 why not to the existence of mind, to the imponderables, or to tangible 
 matter itself (§ 168, 169, 175 hb) ] Do you deny its several well- 
 attested properties ? Then why not deny the properties of the mind % 
 Have you not, for the aid of the senses, a tangible analogy in the solar 
 beam (§ 188^ d, 234 e)1 Do you cast aside all the phenomena of 
 irritability and sensibility, and maintain that the action of internal and 
 external causes, the mind and its passions, is exerted upon the struc- 
 ture alone, because you cannot see the properties (§ 169, 189) ] Can 
 
 * See Medical and Physiological Commentaries, vol. i., p. 397, 511, 512, 514, 515, as to 
 Magendie
 
 PHYSIOLOGY. VITAL PROPERTIES. 113 
 
 you see the Maker of the eye, or did the eye make itself (§ 74) ? Do 
 the muscles move without a moving power 1 Are you not amazed at 
 what you cannot deny, that the mutual co-operation of the mind and 
 the 'brain, which results in willing, is limited in its action upon the 
 body to exactly those parts where its operation can be alone useful 
 to the animal, namely, the voluntary muscles ; nay, more, that the will 
 elects of these muscles such only as are precisely necessary to its 
 present purpose, and bestows every imaginable degree of force with- 
 in the limit of its power, and variously, also, on the several muscles 
 which it may throw into simultaneous action (§ 233f , 349 e, 500 i) % 
 Is there nothing as improbable in all this as in the propositions of the 
 vitalist ] Consider how, on the other hand, those other acts of the 
 mind, called the passions, so near akin to the will, judgment, reflec- 
 tion, are clearly ordained to operate in organic life for the moral and 
 physical good of the being ; or, if they be also the causes of pain and 
 disease, the analogy of Nature shines out even here in placing them 
 on a par with the morbific agents of the external world. If this be 
 so, or a single fact conceded, how will you disregard the multitudi- 
 nous phenomena of irritability and sensibility, or their various natu- 
 ral and artificial modifications (§ 64, y) % Will you consider an ar- 
 gumentum ad Tiominem 7 Do you, then, deny that you possess judg- 
 ment, reflection, and the ability to discover truth ] If you object not 
 to this, you must concede the philosophy of these Institutes as to the 
 foregoing properties of life, and by the same demonstration upon 
 which that philosophy rests you must admit the imputed attributes of 
 the nervous power, which are far more clearly and variously attested 
 than judgment, reflection, or the ability to discover truth. Look at 
 the experiments by Wilson Phihp, Hall, Miiller, Bell (§ 464, &c., 476, 
 &c.). Look at the nervous system, and there you shall absolutely see. 
 Or, do you require other aid for your sc?ises, look, again, at the analo- 
 gies which are supplied by the solar beam, by electricity, by galvan- 
 ism, by magnetism. Consider how they astonish you in their over- 
 powering influences upon all things but the living being. And yet 
 you can not see how these destructive effects are exerted. You give up 
 your senses when the needle traverses the compass, and stand in mute 
 astonishment, gazing at the north for some sign that shall help the un- 
 derstanding as to the nature of the mysterious agent. But you see 
 and Jeel nothing. Nor is this all ; for the dismay of sense becomes 
 inexpressible, when imagination surveys the interval of thousands of 
 miles, through which the unseen force exerts its mystic sway. And 
 so of gravitation. But the effects are strongly pronounced upon the 
 sense of vision, and their frequent repetition begets an acknowledg- 
 ment that there is something besides the tangible and visible qualities 
 of matter which, operating through vast distances, maintains the nee- 
 dle in one everlasting direction, and the heavenly orbs in their unde- 
 viating rounds. And here, in the perpetual operation of magnetism, 
 there is something to aid your conception of an equally unintermit- 
 ting exercise of the nervous power {^ 1034). 
 
 234, d. Do you object to what I have propounded as to the artifi- 
 cial and temporary modifications of the nervous power (§ 227-232) ? 
 Can you state an objection, farther than that which has been just con- 
 sidered 1 Do not the infinite phenomena of sympathy mutually con- 
 spire together, without a contradictory fact, in proving the occurrence 
 
 H
 
 114 INSTITUTES OF MEDICINE. 
 
 of sucli modifications ; and is there a single effect of morbific and 
 remedial agents, operating through the nervous systems, which cannot 
 be clearly, perfectly, explained by the doctrines which I have pro- 
 pounded in relation to the nervous power 1 Can a like afl[irmation be 
 made of any other thing 1 But, you cannot see the modifications of 
 the nei-vous power. Neither can you see the modifications of the 
 electric fluid, as manifested under the conditions of electricity and 
 galvanism ; but, the effects of the latter make a strong impression 
 upon sense, which grows into the belief that physical causes do, in re- 
 ality, alter the conditions of electricity and turn it to galvanism, and 
 those effects have actually engendered the expression of "modification 
 of electricity." Here, then, is something for the senses, to aid them 
 in their sui-vey of the less tangible, but not less precise, and infinitely 
 diversified, phenomena, that mark the artificial modifications of imta- 
 bility, sensibility, and the nervous power. And, should you require 
 a like assistance as to the natural modifications of irritability and sen- 
 sibility, or even the existence of the different properties which apper- 
 tain to the vital principle, you have only to regard the solar beam, 
 and the solar prism, and try experiments with each prismatic color 
 (§ 188i, d). 
 
 234, e. Do you marvel at the rapidity with which the nervous 
 power moves in its operations 1 Consider, then, the incomprehensi- 
 ble velocity of light, — 200,000 miles in a second of time ; or the more 
 rapid apparent motion of the electric fluid. Or, take the more prob- 
 able doctrine of the undulations of light, and this will be yet more con^ 
 formable to what is probably true of the nervous power. Of the un- 
 dulations, then, we have not less than 458,000,000,000,000, for the red 
 ray; 535,000,000,000,000, for the yellow ray ; 727,000,000,000,000, 
 for the violet ray, in a second of time. — Note Eee p. 1150. 
 
 I say, when we think of the physical effects of electricity, galvan- 
 ism, magnetism, and of light, and more especially when we attempt to 
 think of the inconceivable rapidity with which the undulations of light 
 are propagated, we shall have no difficulty with what I have attrib- 
 uted to the nervous power in resolving the phenomena of sympathy, 
 voluntary motion, &c. ^ and when, also, we reffect that those very un- 
 dulations, according to their variety, produce on the retina all the im- 
 pressions that are requisite for every phenomenon of vision, and that 
 every impression, which is thus produced, must be transmitted to the 
 brain, before the sense of vision can be excited (§ 188^ d, 500 k). 
 
 If, also, the retina be thus sensitive to the undulations of a substance 
 which is so imponderable that it is doubted by many whether the sub- 
 stratum of light be actually material, we shall have no difficulty, I say, 
 by the aid of this plain analogy, in making the same philocophical use 
 of the vastly more numerous and unique facts that are supplied by an- 
 imal life, or in apprehending that the virtues of more substantial 
 agents, whether morbific or remedial, may, in like manner, exert pow- 
 erful impressions upon the properties of every part, both nervous and 
 organic, and that such influences may, equally with the impressions 
 of light, be transmitted to the brain and spinal cord, and establish im- 
 pressions upon the parts in conformity with the virtues of each agent 
 (§ 503). 
 
 The undulations of light are excited by the various objects from 
 which they proceed. And so of the nervous power. It is not w tran'
 
 PHYSIOLOGY. VITAL PROPERTIES. 115 
 
 iitu, a movable substance, but, like the principle of ligbt, is every- 
 where diffused through its appropriate medium,'and, like that princi- 
 ple, is brought into operation by exciting causes. Is it difficult, how- 
 ever, to imagine how the nervous power can move with the velocity 
 of light in parts so dense as the nerves ? It is less difficult than the 
 comprehension of the admitted fact that light traverses the diamond 
 as rapidly as it does ethereal space (§ 175 b, 1SS| d). Do you still 
 marvel as to 7iow the nervous power should induce or subvert diseases 1 
 Were you not equally in the dark as to the modus operandi of the so- 
 lar beam in its various agencies upon inorganic compounds, till a few 
 obscure phenomena led to the hypothesis of undulations % But, what 
 have you gained by the undulations % Can you tell us how these in- 
 conceivably small motions operate, without a resort to absolute as- 
 sumptions ] Are you any more convinced than before, that the phe- 
 nomena of light are realities, or have you been aided a whit, by these 
 discoveries, as to your former knowledge of the laws of light ] You 
 tell us that not only the well-known colors of the solar spectrum 
 possess, individually, specific properties, but that " each of these com- 
 prises rays differing in constitution, and differing in refrangibility, 
 and that, doubtless, to each one specific effects are due."* You show 
 the physiologist a few positive results, and he believes the analysis, 
 and the existence of the several rays ; though he may greatly dis- 
 credit your philosophy of the effects as manifested in a department of 
 nature which you study only under influences supplied by the labora- 
 tory (§ 188^, d). But, you tell him, also, that the solar ray embraces 
 " other principles which are invisible," and you call upon him to ad- 
 rait the existence of these, notwithstanding he cannot see them (§ 
 175, bb). The physiologist, however, readily admits their existence 
 upon the strength of the few facts which imply the operation of an in- 
 visible agent ; and he does so because he is a physiologist. But, ta- 
 king your own rule of judgment as to a vital principle and its several 
 properties, you were doubtful whether he might demand more tangi- 
 ble proof; and, accordingly, you prepare him for an admission of 
 your premises by a mode of -reasoning which you reject, contemptu- 
 ously, when the physiologist sets forth his endless series of facts which 
 prove, each one, the existence of properties peculiar to living beings. 
 You prejudge the case, as it were, by impugning his understanding, 
 unless the induction be conceded. You tell him, that, "just in the 
 same way that I am willing to admit the existence of forty simple 
 metals, so, upon similar evidence, I am free to admit the existence of 
 fifty different imponderable agents, if need be" (§ 175 bh). The phys- 
 iologist requires you to admit but one, and, with this one he explains, 
 with perfect consistency, all the processes of living beings, all the 
 phenomena in physiology, in pathology, and therapeutics, while no one 
 of them can be interpi'eted without the agency of such a principle. 
 
 234, y] But again, I say, what have we gained in a practical sense, 
 or as to the modus operandi, or the laws of light and heat, or of the 
 constituents of the solar ray, by the discovery of the undulations, or 
 by any supposed decision of the question as to distinct rays or modi- 
 fications of a common ray, or even by the prismatic colors % Nothing 
 whatever ; no more than has been gained, in a useful sense, by mi- 
 croscopic explorations in physiology, but with the greater advantage 
 
 * Draper's Treatise on The Forces which produce the Organization of Plants, p. 103.
 
 116 INSTITUTES OF MEDICINE. 
 
 of more precision, and more accomplishment to science, and without 
 the pernicious hypotjjeses of the latter. And can the same affirma- 
 tion be made of our knowledge of the properties of the vital princi- 
 ples, and of their natural modifications in different parts, and those 
 which are induced by morbific and remedial agents 1 On the contrary, 
 we see this knowledge every where converted to the most important 
 uses of organic beings, not only in a direct practical sense, but in un- 
 folding the great laws by which they are governed. This knowledge, 
 indeed, is the great foundation of physiology and of the healing art. 
 
 Do you object to the relation which sympathetic sensibility bears 
 to the nervous power (§ 201), and the relation of the nervous power 
 to irritability (§ 226), in the phenomena of motion? Have you any 
 better data for your conceptions of the relation of the magnetic pole 
 to the needle ; and to explain that relation, do you not admit a pecu- 
 liar imponderable, invisible agent, which acts upon the properties of 
 the needle ? Do you understand any better, or have you any better 
 facts resj^ecting, the relation of physical agents to the mind, in the phe- 
 nomena of sensation] You obtain your ideas of matter through the 
 operation of physical agents upon the intellectual part ; and how will 
 you explain the access of those physical means to the spiritual sub- 
 stance unless you also admit the physiological property, sensibility 1 
 What intelligible connection is there between the properties of mind 
 and the motions of the brain 1 What intelligible connection between 
 the stimulus of the blood and the motions of the heart, or those mo- 
 tions which attend the generation of bile and all other organic products, 
 unless you admit a principle of life 1 The forces of life are concerned 
 about sensation in a peculiar manner, and there would be a violent 
 interruption of the law of analogy were there not something interme- 
 diate between mind and matter, a bond of union, as it were, through 
 which impressions upon the senses should reach the spiritual existence. 
 We may fancy it to be electricity, or the chemical forces ; but, this 
 no more aids our comprehension, through the known phenomena sup- 
 plied by these causes, as to the communications from matter to the 
 immaterial, thinking existence, than if we regard the nerves, ^er se, 
 as the only medium. We therefore tui'n our reason to the special 
 phenomena, and find a property in universal operation throughout the 
 body, as the medium through which certain kinds of impressions from 
 physical agents are transmitted to the mind. But, we find, also, an- 
 other analogous series of phenomena which force us to the conclusion 
 that these depend, also, upon a certain modification of the same prop- 
 erty as that through which impressions are made upon the mind by 
 external objects. We see, also, that these transmitted impressions 
 give rise to another endless series of peculiar results, which have their 
 point of departure in the nervous centres; and we see, too, that each 
 one corresponds with, and confirms the others, in the several series 
 respectively. We learn, besides, that those of the last series are anal- 
 ogous to the direct effects of vital agents, healthy, morbific, and re- 
 medial, upon the organs which are the immediate seat of their opera- 
 tion. Hence, we conclude, inevitably, that there exists what is de- 
 nominated the nervous power, with all the capabilities which I have as- 
 cribed to it, and that it is brought into operation through the same 
 channel of sympathy as the mind when sensible objects exert their 
 effects. The mind, and the nervous power, are, therefore, so far on a
 
 PHYSIOLOGY. VITAL PROPERTIES. 117 
 
 par. Each is an agent, each gives rise to sensible and insensible mo- 
 tions, and modifies variously the ordinary results when themselves 
 are affected in an unusual manner, and each is brought into opera- 
 tion by analogous causes. The mind, through the properties of life, 
 forms a special bond of union between itself and certain paits of the 
 organization ; the nei'vous power, another special bond between the 
 same properties of the vital principle and other parts of the organi- 
 zation, and by which, and by the peq^etual operation of that power, 
 the whole organic mechanism of animals moves on in a well-balanced, 
 concerted action. Thus are the proj)erties of the mind, the proper- 
 ties of the vital piinciple, and the sensible mechanism, all mutually 
 related to each other, and bound together by laws as precise as those 
 more simple ones which rule in the inorganic world. 
 
 234, g. We need not, therefore, inquire into the intrinsic nature of 
 the nervous power, or of the organic properties. It would be as ab- 
 surd as to interrogate the nature of gravitation, or of any other prop- 
 erty of mere matter, or even matter itself; though we may well say 
 what the nervous and organic powers are not, and thus save much 
 speculation and its resulting practice. It is enough that we know 
 their existence and the laws they obey. This is all that can be philo- 
 sophically or practically useful. With these we are about as well 
 acquainted as we are with the laws of gravitation, or of light. An 
 ignorance of the nature of the principles or causes affects in no respect 
 our study of their laws, of their modes of operating, or of the influ- 
 ences to which they may be liable. Their laws, like the laws of gal- 
 vanism, or of optics, must remain the same, whatever theory may be 
 adopted as to the nature of the causes. 
 
 Inquiries, therefore, so obviously beyond our reach as the absolute 
 nature of the vital principle, or any of its properties, should never 
 raise our curiosity, much less receive our attention. Their pursuit 
 vitiates the judgment, diverts the mind from practical and useful in- 
 quiries, and renders it prone to speculation. 
 
 But again, I say, we know enough of the whole of this subject for 
 the purposes of philosophy, and for the good of mankind, by the phe- 
 nomena alone ; and since the phenomena of organic beings are far 
 more diversified than those which relate to inorganic matter, so also 
 should we be as contented with the former as with the latter, and ap- 
 ply them in the same philosophical and practical manner. We also 
 know enough of physics to marvel at nothing in organic beings which 
 may be utterly different from the constitution, the phenomena, and 
 the laws of inorganic matter ; and, if it seem mysterious that such an 
 agent as the nervous power should exist, with the characteristics 
 which I have assigned, it will become less wonderful when we reflect 
 upon the phenomena of the immaterial mind in its connection with 
 organization, as in muscular motion, blushing, palpitation, syncope, 
 apoplexy, &c., or even upon the velocity of light, the inconceivable 
 rapidity of its undulations, its laws, its effects, &c. 
 
 All that we can know of the nature of any substance, material or 
 immaterial, is by the phenomena it manifests. Where these are the 
 same, or closely allied, as in electricity and galvanism, we may be 
 sure that the essential causes are the same. But, where gi'eat and 
 striking differences exist, and more especially where there are no 
 analogies in the phenomena, as between the nervous power, or the
 
 118 INSTITUTES OF MEDICINE. 
 
 organic properties, and all inorganic agents, substances, or causes, we 
 may be equally certain that the agents, substances, causes, or powers, 
 are as different from each other, in their essence, as in tljeir phe- 
 nomena (^ 1085). 
 
 It follows, therefore, that the nervous power, and the organic prop- 
 erties, are, respectively, sui generis ; having no analogies in the inor- 
 ganic world. 
 
 The phenomena v/hich different agents, powers, or causes, manifest, 
 are so vmlike each other, that different modes of investigation must be 
 pursued to arrive at a knowledge of each ; and the phenomena will 
 be just as conclusive of the nature of one substance or power as of 
 another. A stone, for instance, affects the sight, and touch ; it ap- 
 pears of a certain size, shape, color, &c., or it is hard or soft ; if an- 
 alyzed, it is found to be composed of several distinct substances, each 
 of which manifest other phenomena; and this is all we know of the 
 natui'e of a stone. And so of magnetism, galvanism, light, heat, and 
 whatever else appertains to the inorganic world. We examine their 
 manifestations, and compai'e them together, and distinguish different 
 things from each other by the manifestations or phenomena of each. 
 But, there are grouj^s of phenomena which have certain general re- 
 semblances, and these we aiTange into genera or families, as the sev- 
 eral earths, metals, gases, &c. ; but the specific distinctions always 
 remain, so that by the phenomena peculiar to each species we can 
 always distinguish one from another. Just so it is in respect to the 
 physical and chemical powers. The means of knowledge are of the 
 same nature in all the cases, and the proof is as good in one case aa 
 in another. 
 
 Coming to plants and animals, a general survey of their phenomena 
 shows us that they have no other analogies, of any importance, with 
 the inorganic world, than in the elements of which they are composed. 
 These are derived from the inorganic kingdom ; and here the simili- 
 tude ends. If we investigate the phenomena analytically, they come 
 upon us in a profusion wholly surpassing those of inorganic beings, 
 and without the most remote resemblance. Here, therefore, we ap- 
 ply the same rule as to inorganic beings, and we learn by the same 
 process of observation as much of the nature and powers of one class 
 of beings as of the other, and the proof is as good in one case as 
 in the other, though more conclusive in respect to organic beings, in- 
 asmuch as their phenomena are more various. By the same rule, also, 
 we attain all the knowledge we possess of the soul, and, beyond that 
 of Revelation, all that is relative to a Supreme Being ; and we distin- 
 guish each from all the others, or bring them into relationship, in the 
 same way. — See Correlation of Forces, § 1085. 
 
 The same mode of reasoning is, of course, applicable to what I 
 have said of the modifications of the nervous power (§ 227-229), and 
 of the organic properties (§ 133-156, lSS-215). 
 
 234, 7i. We are, however, so much the creatures of sense, that the 
 majority will probably still go on explaining every thing appertaining 
 to life by some tangible or visible cause, or by some laws with which 
 we fancy ourselves to be better acquainted. I have already cited sev- 
 eral examples ; and if we take up any writer, indifferently, it is more 
 than an equal chance that the authorities will be increased. Thus, 
 here is Sir Gilbert Blane's excellent work on " Medical Los;icy
 
 PHYSIOLOGY. VITAL PROPERTIES. 119 
 
 " The changes," he says, " accomplished by the actions of life may be 
 conceived to be effected through the agency of some imponderable 
 fluid ; such as electricity, light, or magnetism. We may conceive, 
 for instance, that each gland may be furnished with a sort of voltaic 
 apparatus for effecting its specific change." The same doctrine has 
 been adopted by a host of medical philosophers of our own times. 
 But, did any of tlae foregoing agents ever produce, out of the organic 
 being, a single one of the phenomena of life 1 Did they ever o-ive 
 rise to one of those phenomena in a dead subject, although the organ- 
 ized sti'ucture remain unimpaired ; as in cases of instant death from 
 hydrocyanic acid, nux vomica, or from a needle thrust into the medul- 
 la oblongata "? Is not the whole hypothesis contradicted by all that is 
 known of the effects of those agents 1 It is the merest assumption to 
 sustain an unintelligible and absurd hypothesis to affirm that struc- 
 tural derangement is necessary to death. If galvanism, the chemical 
 forces, &c.,be the immediate cause of the deposition which constitutes 
 the interstitial growth, what bestows vitality (or life, if it be preferred) 
 on the new-formed matter "? Or, if this vitality be imparted by spe- 
 cific powers of the formative instruments, why should not those pow- 
 ers be adequate to the entire work (§ 64) 1 Why so great a violation 
 of the most common rule in philosophy as to introduce other forces, 
 whose great office is to pull down, and whose results are confusion 1 
 
 234, i. The whole art of medicine consists in producing certain im- 
 pressions upon properties or powers that are wholly unlike those 
 which rule in the inorganic world. It will not answer to talk of mod- 
 ifying the operation of galvanism, magnetism, gravitation, light, chem- 
 ical affinity, &c., by an emetic or cathartic. It must, however, come 
 to this, if you will have it that those forces preside over organized 
 beings, or even if they be allowed to have a subordinate agency (§ 
 175, d, 360, 409 k, 446 a, 488^ 493 cc, 500 n7i, 893 a, 893^). 
 
 235. Finally, the phenomena of life are as easily comprehended as 
 those of inorganic matter, and denote as clearly, and even more so, 
 the nature of the causes. Who will demonstrate the nature of those 
 physical properties by which foreign agents produce their impression 
 on the properties of life 1 And yet so accurate is our discrimination 
 among them, as prompted by the vital signs which they produce, that 
 it is one of the most important objects of the physician to select from 
 the multitude of cathartics, emetics, &c., a certain species whose 
 properties shall correspond with the modified signs of the properties 
 of life ; and, it is no unusual phenomenon, that, of the whole range 
 before him, he decides with accuracy that there is only one medicine 
 which is well suited to the case. And his conceptions of the specific 
 properties of the agent, and of those of the organization, even in the 
 modified state of the latter, are so comprehensive that he may foretell 
 their united result. He knows as much of the properties of life as of 
 the remedial agent. He knows them far better ; and that he admits 
 their existence and specific nature is manifest from his deliberate ac- 
 tion. Whoever prescribes for disease upon any other ground is a 
 mere charlatan. 
 
 Who, again, will define the nature of cohesion, gravitation, chem- 
 ical affinities, &c. ] Like the properties of life and of spirit, and their 
 relations to matter, their existence is only inferred from certain uni- 
 form phenomena, and from such, alone, we deduce their relations to
 
 120 INSTITUTES OF MEDICINE. 
 
 objects of more sensible demonstration ; and this is all we know of 
 the sensible objects themselves. We reach the connection between 
 common matter and its properties, between the vital properties, and 
 organized structure, between the intellectual and moral faculties and 
 the nervous system, the concurrence between them in the production 
 of certain effects, and the differences in the nature of the several prop- 
 erties, by a common process of observation. There are mysteries at- 
 tending the same conditions of the whole which must be left to the 
 sole comprehension of the Author Who intended the whole to sub- 
 serve the purposes in which we are alone interested ; Who has wise- 
 ly secured to Himself the nature and control of primary causes; and 
 Who has thereby restricted our inquiries to the only useful end of 
 knowledge, the existence of the causes, and their A^arious phenomena 
 and laws. These may be so employed as to answer the wants, the 
 conveniences, and the various exigencies of intelligent beings. Those 
 are the springs of action which it might be unsafe for man to under- 
 stand. 
 
 236. From what I have hitherto said on the subject of life it must 
 evidently be regarded, in a philosoj)hical sense, as a cause, not as an 
 effect. The functions and other phenomena are the effects. This con- 
 struction, which I have also set forth in my Essay on the " Vital Pow- 
 ers" in other demonstrative aspects, is indispensable to any sound 
 principles in medicine. All effects have their causes ; and this simple 
 principle obliges us to look for a cause of the phenomena of life. It 
 is with the conditions of that cause, ascertained through the medium 
 of its effects, that all physiology and medicine are concerned. 
 
 237. The powers by which living beings are governed, cffi'c?7"*^;ar- 
 tbus, are always as precise in their operation, and bring about results 
 as precise, as gravitation itself. But the properties of life are con- 
 stantly liable to variations, and, therefore, there will be correspond- 
 ing variations in their phenomena. Gravitation, and other physical 
 forces, on the other hand, are immutable, and there are, therefore, no 
 variations in the results of their operation. But it is also equally true 
 that any given condition of the properties of life, connected with any 
 given influences, is equivalent to the unvarying state of the physical 
 forces. That particular condition, in conjunction with the supposed 
 influences, always determines the same results, whether in health or 
 disease. Every power in nature, when operating under given circum- 
 stances, always terminates in uniform effects. The uncertainties, 
 therefore, to which the science of medicine is liable, or any other which 
 has natui-e for its foundation, are owing to our inability to understand 
 all the facts. If any remedial agent produce an efl'ect at one time 
 which it does not at another it is because the properties of life have 
 been differently affected in the different cases ; and there may have 
 been, also, a concurrence of many other different influences. Never- 
 theless, in each case, the medicine operates according to established 
 laws, and the modifications depend upon the difference of circumstan- 
 ces. Each combination of circumstances, however, ahvays gives a 
 uniform determination to the laws which govern the effects. Where 
 the conditions are the same, the remedy in a certain dose will always 
 produce the same results. 
 
 Although gravitation is immutable in its nature, we yet see some- 
 thing analogous to the foregoing influences upon the properties of
 
 PHYSIOLOGY. VITAL PROPERTIES. 121 
 
 life in the manner in wliich the revolution of the heavenly bodies 
 may be affected by their interference, in relation to each other, with 
 the power as exercised by the sun ; as seen in the erratic movement 
 of comets. In either case the incidental influences may be calculated, 
 and the results foretold, — conforming, in one case, to the laws of grav- 
 itation, and in the other to those of the vital force. The sameness of 
 the physiological conditions enables us to calculate not only what will 
 happen to-day, but through all future time. But, the vital conditions 
 are subject to precise modifications at the several great eras or stages 
 of life ; but, being marked by uniformity, the results are forever the 
 same, at each era respectively. The fundamental changes enable 
 us, also, to foresee how the modified properties of life will be differ- 
 ently affected by vital stimuli, the new sympathies that will spring up, 
 the different relations of sensibility to the faculties of the mind, the 
 difference in the acquisition of knowledge, &c., at the several eras. 
 From these natural and uniform modifications of the vital states, we 
 may turn to those of a fluctuating and accidental nature, which grow 
 out of the influence of climate, habits, employments, &c., and which 
 may be not only as lasting as the individual, but may be transmitted 
 to his posterity. As at the different eras of life, we here find, also, 
 variable influences from the natural, the morbific, and the remedial 
 agents, variable sympathies, &c., among organs, according to the arti- 
 ficially-modified condition of the properties of life. These conditions, 
 however, are rarely exactly the same in any two individuals ; but, 
 they are strictly analogous in principle to the natural ones which dis- 
 tinguish the several stages of life, and, so far as they may be known 
 in any given case, we may calculate, with great approximation to the 
 truth, what will be the special characteristic phenomena that will 
 mark the organic, the animal, and the intellectual existence of that in- 
 dividual (§ 153-156, 535, &c., 574, &c.). 
 
 Thus we have a series of analogies, in respect to the mutability of 
 the properties of life, and corresponding results, which bring us upon 
 the confines of disease ; which consists, also, in certain modifications of 
 the vital properties, but more profound, more various, and more tran- 
 sient (§ 176-182). Here lie the difficulties of medicine ; difficulties 
 attending our knowledge of the modifying causes, the influences they 
 produce, the complications of sympathy, and other contingent circum- 
 stances. All these conditions must be known in any given case, to 
 foresee, with certainty, any immediate or more remote result either 
 of disease or of the action of any medicine, or of any natural vital 
 agent. But, the properties of life being never very greatly varied 
 from their natural character, we may come, by a careful observation 
 of their varying phenomena, to a knowledge of their conditions, and 
 to foresee the results, or such as may spring from the operation of 
 medicine, from the different kinds of food, &c., with sufficient accura- 
 cy for all useful purposes. With this knowledge, we get at the most 
 important laws of disease, general and specific, and build up princi- 
 ples which are more valuable in practice than ages of disconnected 
 experience (§ 149, 150). 
 
 238. I have said, that although instability is a prominent character- 
 istic of the properties of life, and lies at the foundation of disease and 
 therapeutics, these properties never undergo any radical change till 
 they shall have lost their recuperative tendency. They are the only
 
 122 INSTITUTES OF MEDICINE. 
 
 attributes of organic beings that do not undergo absolute change and 
 renewal. These properties must be forever present, without essential 
 change of their nature, to carry on the work of decay and renewal, 
 which are in perpetual progress in all the solids and fluids over which 
 the properties preside. 
 
 Hence an important law, that all hereditary predispositions to dis 
 ease, and all impressions from morbific agents, which do not produce 
 their manifest effects till the blood shall have undergone a renewal 
 (as in hydrophobia, fevers, &c.), must be primarily exerted upon the 
 properties of life, and that all the subsequent changes in the fluids 
 and solids must be due to that original modification of the vital prop- 
 erties. To perpetuate the primary influences something of a perma- 
 nent nature must receive the impression. Analogy, alone, would as- 
 sure us that this must be also equally true of the effects of all mor- 
 bific and remedial agents (^ 666). 
 
 239. There is nothing more important to be known and appreci- 
 ated than the endowment of the properties of life with a tendency to 
 return from diseased to their natural states. This is the vis medica- 
 trix naturcB, and is the immediate foundation of therapeutics. This, 
 and this alone, has given rise to the art of medicine ; since, by no ar- 
 tificial means can the diseased properties and functions of life be con- 
 verted into their healthy state. It is also remarkable that the most 
 efficient remedial agents institute their favorable effects by establish- 
 ing new pathological conditions ; which farther shows that it is nature 
 alone which cures, and through the foregoing principle. That prin- 
 ciple consists in the controlling influence of physiological laws, and, 
 without it, organic nature would become extinct (^ 853). 
 
 240. Connected with the foregoing law is another not less funda- 
 mental, and which shows the fallacy of reasoning from the effects of 
 remedial agents upon healthy to morbid conditions. It is, that the 
 susceptibility of all parts to the action of remedies, physical or mental, 
 is very different in disease from what it is in health, and the nature 
 and the results of the influences are greatly different in the two con- 
 ditions. Take many of the most powerful agents, arsenic, tartarized 
 antimony, iodine, &c., and when administered in certain small and 
 repeated alterative doses they bring about the cure of the most ob- 
 stinate and formidable conditions of disease ; while the same doses 
 may not manifest any action upon the system, or on any part of it, un- 
 der circumstances of health. This manifestly depends upon an in- 
 creased susceptibility of the organic properties, in their diseased con- 
 ditions, to the action of foreign agents, and upon an increased dispo- 
 sition to undergo changes. And here we have opened a grand dis- 
 play of infinite Design, Wisdom, and Goodness, to mitigate the pen- 
 alties of disease, and to pi-eserve the human race. This law, which 
 unfolds a principle latent in health, and by which morbid organic 
 properties acquire susceptibilities to salutary influences from agents 
 which in health would either produce no effects, or lead to untoward 
 results, and its ally, the great recuperative principle (§ 239), impose 
 the highest obligation on physicians to become medical philosophers. 
 
 7. THE MIND AND ITS PROPERTIES. 
 
 241. a. Reason and instinct belong to man; instinct alone to ani- 
 mals. INIind is commonly regarded as synonymous with reason, and
 
 PHYSIOLOGY. MENTAL PROPERTIES. 123 
 
 instinct a principle by itself. The latter is undoubtedly true of ani- 
 mals ; but I would consider instinct, in relation to man, as a property 
 of the soul ; while in animals it is shorn of the great distinguishing 
 attribute of man, the rational, immortal faculty. Independently of 
 the specific facts which go to this conclusion, it has the strong ground 
 of analogy in the more complex condition of the principle of life as it 
 exists in animals than in plants (§ 184, 185). 
 
 241, h. To simplify the discussion of this intricate subject, the word 
 mind, with the foregoing explanation, and mental properties, so far as 
 perception, the will, and the understanding, are concerned, may be 
 applied indiscriminately to man and animals. Judgment and reflec- 
 tion are the great characteristics of reason ; but, contrary to the usual 
 representation, the understanding belongs as well to the instinct of 
 animals as to the human mind. Many, again, may be disposed to 
 consider the understanding a function, rather than a property ; but 
 this construction would suppose the operation of judgment and reflec- 
 tion, which do not belong to animals. The term is also employed in 
 other acceptations than the present. 
 
 241, c. The abstract manner in which metaphysicians have consid- 
 ered all the operations of the mind, while no one of them is performed 
 without the co-operation of the brain, or a principal nervous centime, 
 and originally elicited through the corporeal senses, proves to us that 
 physiologists are best qualified to analyze the phenomena of the soul 
 and of instinct, and to indicate their relations to the body, and the 
 laws which they observe. There is also a mysterious afl^nity between 
 the soul of man and the instinct of animals, of which metaphysicians 
 take but little or no cognizance. This alliance is shown by the cor- 
 responding manifestations of perception, of understanding, and of the 
 will in animals; by the amazing precision with which their habits are 
 regulated ; by the evidence of common passions ; by the coincidence 
 in the external senses of man and animals, through which they alike 
 acquire a knowledge of external things ; by the parallel in the ana- 
 tomical structure of the brain of man and of animals which stand high 
 in the scale ; and by other analogies, which denote an affinity between 
 the soul and instinct So great and various, indeed, are the evidences 
 of the foregoing nature, that the special attributes of instinct are as- 
 sociated with the human mind ; thus forming a connecting link, through 
 the moral faculties, between rational and irrational beings. 
 
 Nevertheless, the phenomena of the human mind are infinitely su- 
 perior to those of instinct, while the operations of instinct in animals 
 greatly surpass any of its manifestations in man. Many special pecu- 
 liarities concur, also, in demonstrating an absolute distinction between 
 the rational mind and instinct. The latter, for instance, always moves, 
 in each individual species of animal, in a particulai", unvarying path, 
 but differently in each species of animal.* It never diverges to im- 
 prove its original endowments, or to add a gain which it did not pos- 
 sess in its infant condition. It is then nearly as perfect in its opera- 
 tions as at mature age ; nor does one generation of animals gain upon 
 its predecessors. How different with reason, and with the instinct 
 of man ! He passes thi'ough early infancy without a trace of the for- 
 mer, and with only that helpless development of the latter which ena- 
 
 * Here I may say that analogy proves that there is hut one species of mankind, since the 
 manifestations of reason and instinct are the same in all.
 
 124 INSTITUTES OF MEDICINE. 
 
 bles him, with the foreign aid of reason, to imbibe the sustenance re- 
 quired by organic Hfe. Unlike the instinct of animals, however, the 
 corresponding manifestations become greatly multiplied as age ad- 
 vances ; but it remains always far more circumscribed and imperfect, 
 and often plunging itself, and leading reason, into violations of their 
 natural functions. And what a contrast between the limitations of in- 
 stinct and the progress and grasp of the human mind ; the latter for- 
 ever ranging through all the labyrinths of nature, investigating their 
 phenomena, developing their powers, their subsidiary causes, and their 
 laws, turning in upon itself and multiplying its knowledge, and en- 
 larging its powers by its own independent efforts, laying up the gains 
 of the past as a fruitful source of present good and of farther acquisi- 
 tions, distinguishing good from evil, from which results the sense of 
 moral responsibility, investigating its own attributes, and attempting 
 even its own nature, and tracing up its existence to a Higher Power, 
 as the Author of the Universe which was made for the contemplation 
 and the enjoyment of mind (§ 175 c), 
 
 241. d. It is not an object, however, of the Institutes to investigate 
 the philosophy of mind beyond those physiological considerations 
 which are relative to the properties and functions of life, however 
 it may have been important to their interests to contradistinguish the 
 Maker from His works (§ 14 c, 175, 350J h-l). Perception and the 
 tvill are the only mental properties which concur, more or less, in the 
 phenomena of animal life. 
 
 242. Perception is always necessary to true sensation, and therefore 
 to the exercise of all the senses. The mind, or instinct, must per- 
 ceive an impression made upon sense, and consciousness must operate 
 before the impression can be realized. The phenomena of sympa- 
 thy in their connection with sensibility, in the ordinary processes of 
 life, are not relative to sensation, but depend on a special modification 
 of sensibility and on the neiTous power. 
 
 243. The toill, another property of the 'mind, upon which volition 
 depends,*exemplifie3 yet farther the complexity of the principles 
 which obtain in the animal kingdom ; and its phenomena admonish 
 us to pause over that materialism which sees nothing but the demon- 
 strations of physical and chemical power in the equally unique mani- 
 festations of irritability, sensibility, mobility, the nervous power, — the 
 entire organic force (§ 215). 
 
 The will presides in animal life. It governs the movements not 
 only of the voluntary muscles, but even the operations of the other 
 mental faculties. In producing muscular motion, the operations of 
 judgment and perception are often associated, and even bring the will 
 into action. All muscular movements with which the mind, or in- 
 stinct, is not connected, depend upon other causes than the will. Vol- 
 untary motion is, therefore, as dependent on the will as true sensation 
 is upon perception (^ 1072, b). 
 
 The will has very little operation in organic life (§ 500, e) ; though 
 the passions operate with power upon the heart, the abdominal viscera, 
 &c. This peculiarity is founded in consummate Design ; since great- 
 er latitude to the will would be incompatible with animal existence ; 
 while, on the other hand, other elements of the mind are allowed, for 
 useful pm-poses, to stretch their influences to the deep recesses of life. 
 
 244. The will, a property of the mind, like the nervous power a 
 
 * Hy some the will is considered as a result of the concurrent action of the mental 
 faculties. But this is unimportant. See my work on the Sour, and Instinct, 1870.
 
 PHYSIOLOGY. FUNCTIONS. 125 
 
 property of the vital principle, is, therefore, a vital stimulus to the 
 brain, w^hose chief office is the production of voluntary motion, by 
 bringing into action the nei-vous power. 
 
 245. When the will gives rise to voluntary motion the philosophy 
 is the same as when motion is developed in the organs of organic life 
 by the nervous power (§ 205-215). The latter may take place 
 through impressions transmitted to the nervous centres (§ 227, 500), 
 or by impressions exerted in a direct manner upon these centres (§ 
 227, 230, 477). The will operates in the direct manner, develops 
 the nervous power, and transmits it to the irritability of the voluntaiy 
 muscles, by which mobility is brought into operation (§ 233). When 
 the passions affect the movements in organic life it is exactly in the 
 same way as with the will in animal life (§ 500 h, 1040, 1072 b). 
 
 246. Thus it appears that the unity in the great plan of the ner- 
 vous power, in its relations to both organic and animal life, to mind as 
 well as to matter, and the perfect concurrence of all the facts, and the 
 obvious nature of the whole, which declare a harmony of principles 
 and laws throughout all the immense variety relative to the nervous 
 power, continue to unfold a grandeur of the subject which invites an 
 unprejudiced attention to the expositions I have made of this brilliant 
 institution of Nature (§ 1069-1082). 
 
 FOURTH DIVISION OF PHYSIOLOGY. 
 
 FUNCTIONS. 
 
 247. Our fourth grand division of Physiology comprehends the 
 functions of organic beings. They are carried on by the properties 
 of life in their connection with organized structure (§ 170, 175, 177), 
 and of which the functions are the great final causes, or effects (§ 176). 
 They ai'e, indeed, the only useful ends of life ; since, otherwise, all 
 organic beings would exist in the condition of the seed and e^g (§ 
 235, 236). The terminating series of the capillary vessels are the im- 
 mediate instniments of all the essential processes in organic life, and 
 therefore, also, of all diseases (§ 109, 410, 411, 668, 679). 
 
 248. The functions are common BTid peculiar. 
 
 249. The common functions belong to all organic beings. They 
 consist of, 1st. Motio7i ; 2d. Absorption ; 3d. Assimilation; 4th. Dis- 
 tribution ; 5th. Appropriation, or nutrition and secretion ; 6th. Excre- 
 tion ; 7th. Calorification; 8th. Generation. The first seven are in- 
 dispensable to animals and plants. The eighth appertains only to 
 the species, and has no essential part in the organic economy (§ 97, 
 118-123, 153-156, 237, 578). 
 
 250. The peculiar functions belong to animals only. They are, 
 
 I. Functions of relation ; comprehending, 1st. Sensation ; 2d. Sym- 
 pathy, or reflex nervous action. 
 
 II. Voluntary motion, and functions by which the mind and instinct 
 act on external objects. 
 
 III. Other mental and instinctive functions.
 
 126 INSTITUTES OF MEDICINE. 
 
 I. COMMON, OR ORGANIC FUNCTIONS. 
 
 251. Organs which perform similar functions are very variable in 
 structure in different orders of animals. The liver, for example, " is 
 represented in one case by simple caeca, or blind sacs ; in another by 
 tufts of cseca ; in a third by bunches of cells ; in a fourth by a spongy 
 mass ; in a fifth by branched ducts ending in feather-like terminal 
 twigs ;" and so on, up to the complication of the most perfect animals. 
 Nevertheless, they all secrete a very analogous fluid. And so of oth- 
 er organs and functions. 
 
 A due regard for the preceding facts must unavoidably reconcile 
 every mind to what I have said as to microscopical explorations, of the 
 minuteness of structure (§ 131, 304, 306, 409, e). 
 
 252. Though structure be very various, there is a great analogy 
 in the vital functions and their immediate products, — even between 
 plants and animals. This is remarkably true of every individual part 
 in the different races of animals, whatever its simplicity or complexi- 
 ty (§ 251). Hence, it becomes more and more manifest that the 
 properties of life have a greater agency in the formation of organic 
 products than the structure itself (§ 67-69). 
 
 1, MOTION. 
 
 253. Motion is the immediate result of the action of mobility or 
 contractility, and was necessarily explained in describing that prop- 
 erty (§ 205-215). It is the function by which all things acquire their 
 movement in organic beings. 
 
 254. Motion may be remotely mechanical, as the movement of the 
 blood, ingesta, &c. ; but the power and the actions of parts which gen- 
 erate the mechanical movements are purely vital. 
 
 255. Motion belongs, of course, to every tissue in which its mani- 
 festations occur ; and it is therefore an error, however common, to 
 limit this function to the muscular tissue. 
 
 256. The great offices of motion in organic life are to supply the 
 system with useful materials, and to remove such as are useless. 
 
 257. In animal life this function appears under the aspect of loco- 
 motion or some analogous result, and I have associated the considera- 
 tion of this modification of the function with that which is common to 
 the organic life of animals and plants, on account of their common na- 
 ture. 
 
 258. Voluntary motion proceeds from the action of the will upon 
 the great nervous centre, by which the nervous power is developed 
 and transmitted to the irritability of the voluntary muscles (§ 188, 208, 
 233, 476 c). Here the excitation of the nervous power is direct, as 
 in the experiments by Wilson Philip (§ 486, 487). If the motion be 
 involuntary, as in the ordinary movements of respiration, the develop- 
 ment of the nervous power is indirect, according to the usual process 
 when organic actions are influenced by the nervous power (§ 222, &c., 
 500). When other involuntary motions affect the muscles of animal 
 life, as convulsions, &c., the development of the nervous power may 
 be direct, as in diseases, and concussions, of the brain, or indirect, as 
 in teething, and intestinal irritation. The philosophy, however, re- 
 specting the production of motion in all these cases, is exactly the 
 same. Whether the movements be voluntary or involuntary, the
 
 PHYSIOLOGY. FUNCTIONS. 127 
 
 movements depend upon the action of the nervous influence upon mo- 
 bility through the property irritability. The mind does not, as has 
 been supposed, leave the brain to enter the muscles in voluntary mo- 
 tion. The difficulties of explanation are not only multiplied by this 
 supposition, but it is shown to be erroneous by the analogous move- 
 ments which may be excited through the spinal cord, or through the 
 nerves, after the soul and instinctive principle are separated from the 
 body by the removal of the head. This philosophy is also coincident 
 with that which I have propounded as to influences of the nervous 
 power in organic life. Each illustrates and sustains the oth^r (§ 500). 
 
 259. It is now important to repeat, that the nervous power never 
 generates motion, per se (§ 222-232). The function always depends 
 immediately upon the organic property mobility/, which is brought into 
 action through impressions made upon irritability (§ 188). The ner- 
 vous power is only a stimulus to irritability. But, it is much more im- 
 portant to motion in animal than organic life ; since it is the only nat- 
 ural stimulus of the voluntary muscles, while blood, and other agents, 
 operate upon the tissues with which they are in contact in organic life, 
 and thus excite reflex nervous actions, and render them tributary as an 
 exciting cause of muscular motion and in increasing or diminishing 
 and otherwise affecting the secreted products (§ 22-i, 226, 475-^, 893-i). 
 
 260. Very important laws grow out of the foregoing distinction be- 
 tween the relation of the nervous power to the function of motion in 
 animal and organic life, and its essential independence of that power 
 in either life (§ 475^ 476, 498, 500 m, 893^, 1042). 
 
 261. That motion does not depend upon the nerves is showix by 
 the sensible and insensible motions of plants ; by that of their leaves, 
 stems, stamens, by their absorption, nutrition, secretion, &c. (§ 455, c). 
 The analogies in results prove this independence of the nerves, and 
 the near identity of the function in plants and animals. Indeed, the 
 chemists will have it that all the essential compounds of the animal 
 are formed by vegetable organization (§ IS, 409). Such analogies are 
 always sound, being based on great fundamental laws. But there may 
 be great variety of mechanism. Where nerves exist, and in connection 
 with centres capable of generating a stimulus, they are so far ti'ibutary 
 to muscular and other motions, and voluntary motion is wholly depend- 
 ent upon that stimulus, as also natural involuntary muscular motion. 
 
 262. " The heart of a frog continues to beat with its ordinary rhythm 
 even when the entire base of the organ, when the ventricles, as far as 
 their juncture with the auricles, are cut away" (p. 346, ^516 d, no. 8). 
 
 In the same way, "the peristaltic movements of the intestinal canal 
 continue not only when the intestine is removed from the trunk to- 
 gether with the mesentery and ganglionic plexus, but also when the 
 intestine itself is isolated from the plexus by being separated from the 
 mesentery at the line of its insertion." — Muller's Physiology. 
 
 263. Dr. M. Hall tied a ligature around the root of the heart and 
 lungs, and then separated them from the body. " The action of the 
 heart was still such as to carry on, in a slight degree, and for a short 
 period, the circulation of the blood through the pulmonary artery, and 
 a few of the capillary vessels." He adds his belief, " that the actual 
 circulation of the blood has not been before seen proceeding entirely 
 and independently of the sympathetic system." — Hall. 
 
 264. Now, in the last two of the foregoing cases there may have
 
 128 INSTITUTES OF MEDICINE. 
 
 been local nervous centres, ganglia, perhaps, or some other part of the 
 sympathetic nerve to supply the requisite stimulus through reflex ac- 
 tions ; the air and the injuries operating as remote exciting causes of 
 the nervous influence (§ 475i). But in the case of the mutilated heart 
 the nature of the injury precludes the supposition that there could have 
 been any radiating focus of reflex actions, which is probably equally 
 true of the case in § 498 e; so that in those instances the air and the 
 mechanical irritation Avere alone the exciting causes. Note A p. 1111. 
 
 265. Motion, therefore, whether voluntary or involuntary, is carried 
 on througji properties inherent in the various tissues, and the nervous 
 influence is only a remote exciting cause, and in that respect on com- 
 mon ground with other vital agents, while also, as will be seen, it is an 
 indispensable regulator of the organic mechanism of animals, and trib- 
 utary to the perfection of their oi'ganic compounds (§ 222-233|, 500). 
 
 266. The nervous power, in developing motion in either organic or 
 animal life, as a stimulus to the organic properties, does not follow 
 the nerves according to their regular order of distribution from the 
 nervous centres. On the contrary, its entire want of uniformity in 
 that respect — operating simultaneously, at one time, through a nerve 
 or nerves pi'oceeding from the cranium and some inferior part of the 
 spinal canal, while it passes over all intermediate nerves — or, at an- 
 other time, electing, without any regularity in respect to order of ar- 
 rangement, two or more of those intermediate spinal nerves — thia 
 entire want of respect to anatomical order is so familiar to all that it 
 has not appeared as one of the most difficult and sublime problems of 
 nature. This very extraordinary attribute of the nervous power is 
 rendered the more remarkable by our knowledge of the fact that ita 
 operation is determined through particular nerves either by an act of 
 the Avill, or, in oi'ganic life, by particular passions, by their intensity 
 of operation, and by the special nature and intensity of physical agents 
 which may transmit their influences to the nervous centres through 
 some other part ; and, in the cases relative to organic life, according, 
 also, to the existing susceptibility of the various parts of the organism 
 (§ 137 cl, 143, 148-152, 233f, 500, 892i v, 893, 905, 1059). 
 
 267. All the foregoing are established facts, of perpetual occurrence ; 
 and they should be taken in connection with the doctrines which I have 
 advanced as to artificial modifications of the nervous power, and the 
 modus operandi of morbific and remedial agents (§ 224-233|, 497-500, 
 503, 506, 889 a, 89 U /.-, 892 aa, 893-905). 
 
 2. ABSORPTION. 
 
 268. Absorption is performed, in animals, by the lacteals and lym- 
 phatics ; those vessels being very similar in their constitution and 
 function. There are corresponding means for the office of absorption 
 in the roots and leaves of plants. 
 
 269. Magendie, and others who have copied from him, have fallen 
 into the error of attributing the office of absorption to the veins. He 
 was led into the mistake by an ignorance of the fact that the lymphat- 
 ics terminate variously in small veins.* Fallacies of that nature 
 should be apparent upc n principle alone — at least to such as recog- 
 nize a unity of design, and a simplicity in the great institutions of 
 nature. Every system of vessels, so far as known, has but one func- 
 
 * Sec Medical and Physiological Commentaficf, vol. ii., p. 170, note, 380, 394-39G.
 
 PHYSIOLOGT. FUNCTIONS. 129 
 
 tion, however that may be modified in diiFerent partr, as seen in the 
 lymphatics and lacteals, in the terminal series of the capillary arter- 
 ips in all parts, &c. The distinction depends either upon structure 
 connected with the modifications of common vital properties, and 
 their relative adaptations to the physical properties of different fluids, 
 or, structure may be apparently less concerned than the organic prop- 
 erties ; which is one of the most universal and important principles 
 in physiology (§ 133-150). 
 
 270. The lacteals perform the office of absorbing, and introducing 
 into the organization of animals, foreign nutritive matter. 
 
 271. The lymphatics, in greater part, are destined for the vital de- 
 composition of the body, and for the removal of waste parts, which 
 are conveyed by the lymphatics into the torrent of blood to be ulti- 
 mately cast out of the system, or again to undergo, in part, the process 
 of sanguification. May absorb from surfaces, but not nutritijje matter. 
 
 272. By these vessels, also, the solids are removed in the ulcerative 
 process of inflammation, and mortified parts are detached from the 
 sound,* and foreign substances which are introduced into the body are 
 taken up and removed. 
 
 273. Hence it is obvious that the lacteals and lymphatics are antag- 
 onizing systems, and that beings so endowed are the constant subjects 
 of waste as well as of nutrition ; the balance being maintained through 
 the inlet supplied by the lacteals, and the outlet provided by the lym- 
 phatics (§ 180-182, 286). Notwithstanding, therefore, the coincidence 
 in the general function of these two systems of vessels, the office of one 
 is creative, that of the other destructive. 
 
 During the period of growth nutrition overbalances waste ; but, 
 when growth ceases, nutrition and vital decomposition must be in 
 equillbrio. 
 
 274. No substances but such as exist in a fluid or very attenuated 
 state are taken up by the lacteals and absorbents. 
 
 275. The intestinal villi have been shown by Cruikshank, Bleuland, 
 and others to possess open orifices,! though this is denied by the mi- 
 croscopists; and I have shown that the modifying influence of the 
 ganglionic nerves upon all the organic functions and products contra- 
 dicts the hypotheses of catalysis and endosmose and exosmose (§ 1089). 
 
 276. Different substances are absorbed with various degrees of ra- 
 pidity, both in animals and plants. This depends on their peculiar 
 virtues, and on the manner, therefore, in which they affect irritability ; 
 thus showing the vital nature of the process (§ 149, 188, &c., 207). 
 The same conclusion is also inferable from experiments, as well upon 
 plants as animals. 
 
 277. a. Again, the lacteals, in virtue of their special modifications 
 of irritability, exclude every thing but chyle. Bile is not taken up 
 either by the lacteals or lymphatics; cathartics pass off; emetics are 
 rejected. The principle is every where; is shown in the larynx, 
 pylorus, &c., in the sparseness of the red globules in the lymph 
 vessels, though their diameters be many times larger than the globules 
 of blood (§ 399). The principle lies in the virtues of the agents and 
 the special modification of irritability which belongs to each part (§ 
 135). It is designed for the conservation of every part, and of the 
 
 * See Med. and Phvsiolog. Coinm., vol. ii., p. 168, 169, 171-173. 
 t Ibid., vol. i., p. 683-690, 699-712. 
 I
 
 130 INSTITUTES OF MEDICINE. 
 
 whole. Had not the lacteals and lymphatics been endowed in this 
 wonderful manner, or were absorption a mere physical process, or ca- 
 pillary attraction, or endosmose, all foreign substances would have free 
 access to the internal parts of the organization, and organic beings 
 would have had no continued existence. They would have perished 
 as soon as created. Hence, are the vital properties so modified in all 
 these millions of inlets into the labyrinth of organization that they 
 shall be not only vigilant sentinels, but recognize, at once, every one 
 of the thousand offenders that may endeavor to steal its way into the 
 sanctum sanctorum (§ 192). 
 
 277. h. Some of the most important laws in medicine are founded on 
 the special modifications of irritability in different parts (§ 149, 150); 
 and as it respects the lacteals and lymphatics, the principle not only 
 contradicts the assumption of the operation of medicines by absorption, 
 but confirjps, in a beautiful manner, the laws of sympathy. 
 
 278. It is only when the lacteals and lymphatics become morbidly 
 affected, or their irritability essentially modified by the morbific action 
 of agents offensive to the organization, that those agents are at all ad- 
 mitted, and then only very sparingly. The principle is the same as 
 when undigested food escapes the pyloric orifice in indigestion, or 
 the red globules of blood gain admittance to the serous vessels in in- 
 flammation (§ 14, 74, 117, 137, 143, 155, 156, 169 f, 266, 303^ a, 306, 
 310, 313, 325, 387, 399, 409/, 422, 514 li, 524 d, 525, 526 d, 528 c, 
 638, 649 d, 764 h, 811, 847 c, 848, 902/, 905). 
 
 279. If, therefore, foreign agents affectthe absorbent vessels in the 
 foregoing manner, so also do they affect the condition of the other tissues 
 of the part. This is the beginning of disease, which may now go on 
 accumulating without any farther agency of the exciting cause ; or, 
 if the offending cause gain admission into the circulation, it may con- 
 tinue, per se, to exasperate disease. But, even in this case of the con- 
 tinued operation of morbific or remedial agents after their absorption, 
 I have shown that solidism and vitalism can alone explain their effects 
 (§ 819, &c.). 
 
 280. I have also shown that when morbific or remedial agents are 
 taken into the circulation the quantity is so small, their dilution by 
 the blood and other fluids so great, and their elimination by the kid- 
 neys so rapid (at least in a general sense), that little or nothing is 
 likely to be contributed in this way to the morbific or remedial effects. 
 
 The rapidity with which agents that are not morbific, but useless 
 to the system, are elaborated .by the kidneys, is a proof, upon the prin- 
 ciple of Design, that a provision exists for the exclusion of deleterious 
 agents from the circulation. But, since they may, under special cir- 
 cumstances, pass the gi'eat sentinel (§ 278), the kidneys are provided 
 as other guards to the general organism, to expel the offenders at once. 
 Just so with the lungs. If offensive objects pass the larynx, all the 
 muscles of respiration, through a beautiful system of Design, imme- 
 diately set at work to get rid of the intruder. The intelligent reader 
 will readily carry this principle to more recondite processes, as the 
 institution of abscesses, and the curious steps that attend their progress 
 from deep-seated parts toward the surface (^ 733). 
 
 281. It may be also added, that I know of no critical attempt having 
 been made to invalidate the facts and the reasoning set forth in my 
 Essay on the Humoral Pathrdogy, which has for its object the ex-
 
 PHYSIOLOGY. FUNCTIONS. 131 
 
 posure of that pathology and the defense of solidism and vitalism ; 
 and, although that work has been now six years before the public, I 
 know not that I have omitted the investigation of one essential fact or 
 experiment that has been alleged or instituted in behalf of humoralism. 
 If such omission has occurred, let it be shown.* 
 
 282. Many distinguished men have been led into the error of sup 
 posing that noxious substances are taken readily into the circulation 
 because the skin is deeply tinged with yellow, in jaundice ; or because 
 the bones become red when madder is eaten ; or the urine is colored 
 by rhubarb, or manifests the odor of tuipentine, of garlic, &c. But, 
 let it be considered, that the inoffensive coloring matter of the bile is 
 alone absorbed, as is also that of madder and rhubarb, &c. ; while the 
 thousandth part of a grain of spirits of turpentine, or of garlic, is enough 
 to impart all the odor to the urine that has been ever observed to at- 
 tend that product. 
 
 283. If remedial and morbific agents be absorbed, it devolves upon 
 the mechanical philosophers to show the fact, which they have failed 
 of doing in regard to many of the most important (§ 826 c) ; but should 
 their assumptions become realities, I shall have demonstrated by a mul- 
 titude of analogies where absorption is out of the question, and in va- 
 rious other ways, that the modus ojjerajidi of the whole rests upon the 
 philosophy of the natural physiological laws (§ 1088-1089). 
 
 284. Although a very limited operation of morbific and remedial 
 agents, through their absorption into the circulation, be not incompat- 
 ible with solidism and vitalism (§ 277, 278, 283, 827/), the usual in- 
 terpretation of their effects, according to the doctrines of humoralism, 
 would compel us to abandon the application of physiology to medicine, 
 whether pathologically considered, or in respect to the operation of 
 curative agents. The laws of disease would be totally unlike the 
 laws of health; or, rather, disease would be without laws, and there 
 would, therefore, be no general principles in medicine. Practice would 
 be a blind empyricism. Diseases would be just as various and un- 
 certain as every chemical change in the blood, and these changes, 
 upon the ground of humoralism, would have no resemblances to each 
 other. 
 
 285. The properties of life lie at the foundation of physiology. 
 It is a knowledge of their character, and of the laws which they obey, 
 that enables us to conform our habits, at all ages, in the best way for 
 the maintenance of health. But, what is disease 1 It is a deviation 
 from the state of health ; and, therefore, if there be any consistency 
 in nature, disease should consist primarily and essentially in modifi- 
 cations of those vital properties, which, in a different state, constitute 
 the important conditions of health. In this way, therefore, medicine 
 takes the rank of an intelligible and important science. Physiology 
 is the ground-work throughout. Pathology becomes nothing more 
 than physiology modified. And, coming to therapeutics, it is still 
 physiology applied to the cure of diseases ; or, in other words, the 
 
 (application of such agents to the morbid properties of life as shall aid 
 their i-estoration to their natural physiological state. The whole is 
 thus bound together. No new elements come into operation ; but, 
 throughout the whole series of changes, the same powers are in action 
 and carry on all the processes. Nor are there any new laws intro- 
 
 'duced. The powers and actions being fundamentally the same, 
 
 *In Medical and Physiological Comm. vol. i. 1840. — Now 25 years, and no attempt made. 
 —1865.
 
 132 INSTITUTES OF MEDICINE. 
 
 80 are the laws, of health and disease, as are those, also, by which 
 diseased are converted to healthy conditions. But, the powers or 
 properties of life being modified in disease, and again modified in 
 other ways by the action of remedial agents, so are the laws, mider 
 which all these results happen, varied in a corresponding manner. 
 The laws are only the conditions under which effects take place ; and, 
 as those effects have always a direct reference to the state of the vital 
 properties, they must be fundamentally of the same nature under all 
 the various conditions of life, since, also, the vital properties never 
 lose their fundatnental character (^ 1, 639). 
 
 286. When, therefore, I may speak of the laws of health and the laws 
 of disease, I must not be understood as meaning something entirely 
 different in the two cases. And yet, their modifications are always 
 precise, and the results of each are always determined in one uniform 
 manner. This is necessarily so, because the changes in the vital 
 properties are always precise, and according to the nature of the in- 
 fluences by which the changes are effected (§ 149, 150). 
 
 287. In this sense, therefore (§ 286), the laws may be assumed to 
 be, in each individual modification, of a specific nature. 
 
 288. Laws may be said to be general and specific; which, how- 
 ever, is only another mode of considering the foregoing principle (§ 
 285). Thus, it is a general law that the absorbents, whether in health 
 or disease, do not take up foreign substances of a deleterious nature ; 
 but, it is a specific law, that when the irritability of the lacteals or 
 lymphatics is modified in a certain way, they will admit a small pro- 
 portion of the noxious agent by which the alteration is produced (§ 
 277, 278). 
 
 289. Those mechanical physiologists who have not, or will not have, 
 just conceptions of the properties and actions of life, refer the process 
 of absorption to capillaiy attraction, or that mechanical principle which 
 determines the ascent of oil in the wick of a lamp (§ 277). The 
 chemists belong to this class of reasoners ; even such of them as allow 
 the existence of a vital principle. Thus, for example, Liebig has it, 
 that, 
 
 " A cotton wick inclosed in a lamp, which contains a liquid satura 
 ted with carbonic acid, acts exactly in the same manner as a living 
 plant in the night. Water and carbonic acid are sucked up by capil- 
 lary attraction, and both evaporate from the exterior part of the wick." 
 Again, " All substances in solution in a soil are absorbed by the 
 roots of plants exactly as a sponge imbibes a liquid, and all it con- 
 tains, without selection." — Liebig's Organic Chemistry ap-plied to 
 Physiology and Agriculture. 
 
 Now all this might be very good philosophy for a common agricultu- 
 rist; but it evinces an unaccountable disregard of facts, and of the plain- 
 est suggestions of nature. And yet it is a common docti-ine now-a- 
 days ; a part of the " new experimental philosophy." In the first place, 
 however, it is not true that the roots of plants imbibe their nourish- 
 ment " without selection." When plants are cultivated in glass ves- 
 sels containing distilled water, their roots will even decompose the 
 glass, and select its silica, or alkali, or take them both, and assimilate 
 them to themselves, and in the absence of any known chemical affini- 
 ties or influences. Absorption is nearly as exact in plants as in ani- 
 mals ; and so is appropriation. Like animals, their absorbent system
 
 PHYSIOLOGY. FUNCTIONS. 133 
 
 is naturally repulsive of every thing that is offensive and not suitable to 
 their economy. If poisons, when artificially applied, get admission, 
 it is by inflicting a violence on the radicles of plants (§ 278). And 
 what is thus prompted by reason, by analogy, by common expei'ience, 
 is fully confirmed by the chemists themselves, in those analyses of all 
 parts of a plant, even the sap, which are designed as standards of the 
 composition which shall serve for any particular part of any given 
 species of plant, as well through all future time as at the hour when 
 the analyses were made (^ 1052, 1053, 1054). 
 
 290. The simile of the " lamp-wick," and of the " sponge" (§ 289), 
 show us how far astray our friends are from the path of truth. It is 
 not alone the complex mechanism of the root which the absorbed ma- 
 terials traverse, but a labyrinth of highly organized and living tubes, 
 passing through the whole trunk of the plant, till the materials finally 
 reach the leaves. In those respiratory organs, the pabulum vitce is 
 farther subjected to the action of another complicated, unique, and 
 living system of vessels. And what is the "wick of a lamp?" A 
 mere bundle of dead, disorganized fibres, broken upon the card, and 
 spun upon the wheel (§ 3501- n, o, 826 c). 
 
 291. But, the foregoing degrading docti'ine of life (§ 289) is not pe- 
 culiar to the chemists. Some reputedly profound physiologists apply 
 it not only to plants, but to animals, and, like Liebig, identify the 
 same vital and physical processes. One example, in a distinguished 
 quarter, will suffice. Thus, Dr. Carpenter : 
 
 " It will be hereafter shown that the absorption of nutritious fluid 
 is probably due to the physical power of endosmose. A continued 
 absorption may be produced by a physical contrivance wliich imitates 
 the effects of vital action ; [ ! ] as in the wick of a lamp, which draws up 
 oil to supply the combustion above, but will cease to do so when the de- 
 mand no longer exists'^ ! (§ 64 g, 175 A). — Carpenter's Comparative 
 Physiology. 
 
 The work, a standard one, from which the foregoing is quoted, 
 abounds with analogous doctrines. They are, of course, fatal to 
 physiology and to all medical science. 
 
 292. Immediately after the quotation from Liebig, in the preceding 
 section, that author proceeds to reprobate physiologists for their ex- 
 clusion of chemistry from organic life, and charitably regards it as a 
 prejudice arising from our ignorance of the science (§ 350, c). This, 
 however, is quite an untenable position ; for, wherever medicine is 
 cultivated chemistry is justly made a fundamental part of education. 
 It is, indeed, the knowledge which the soundest physiologists possess 
 of chemical science that enables them to institute the necessary con- 
 trasts, and which convinces them that chemistry, in its proper ac- 
 ceptation, has no connection with the processes of living beings. 
 This, indeed, I have abundantly shown to be the real opinion of the 
 chemists themselves (§ 350, &c.). Bold in assumption, inapt in illus- 
 tration, and, at last, like Liebig, contradicting the whole by an ac- 
 knowledgment that " vitality, in its peculiar operations, makes use of 
 a special apparatus for each function of an organ," and that "m the 
 living organism we are acquainted with only one. cause op motion ; 
 artd this is the same cause tvhich determines the growth of living tis- 
 sues, and gives them the power of resistance to external agencies. It la 
 VHE vital force." — LiEBiG (§ 350, nos. 26, 27, 28, 71-77, &c.).
 
 134 INSTITUTES OF MEDICINE. 
 
 293. Looking at other facts attending the process of absorption in 
 plants, we shall find them all concurring with what I have already 
 stated as to the dependence of this function upon vital actions ; and, 
 if vital here, we need not look for other proof of a similar law in an- 
 imals. Thus, Van Marum demonstrated that absorbed fluids could 
 rise onlj'' eight inches by capillary attraction. Hales, Walker, Mirbel, 
 Chevreuil, and others, have shown that the sap moves with such ve- 
 locity and force in plants, that it must be propelled by vital contrac- 
 tions and dilatations of the vessels. "We have examples of this sur- 
 prising rapidity of the circulation in grape-vines. Don aiid Bai'bieii 
 affirm that they saw the movements of the vessels. 
 
 Again, the motion of sap is increased by light, heat, and other stim- 
 uli, which have no effect on capillary attraction. And this is the opin- 
 ion even of Liebig, who says that " the functions of plants certainly 
 proceed with greater intensity and rapidity in sunshine, than in the 
 diffused light of day ; but it merely accelerates in a greater degree 
 THE action already EXISTING;" "an action," he says, "which de- 
 pends on the vital force alone^ 
 
 It was shown by La Place, that, if the sap rose by capillary attrac- 
 tion, it should not, as it does, flow from the openings made in the ves- 
 sels. But, again, the sap will not flow from the openings, if the plants 
 be poisoned with pmssic acid. The effect is the same as upon the 
 circulation of the blood; and it would be equally absurd, in either 
 case, to suppose that the poison acts upon any physical force. As- 
 tringents, and various other substances, apjalied to the openings, avert 
 the flow of sap, which can only be done through the foregoing prin- 
 ciples (§ 278-284, 1054). 
 
 294. Here is another fact, and which appears to be conclusive of 
 the vital nature of absorption, and of the discrimination observed by 
 the radicles of plants (§ 289, 291). It is, that the sap of the root is 
 unlike any thing which it absorbs from the earth. All the substances 
 are decompounded at the moment of entering the roots, just as the 
 carbonic acid is by the leaves. Their elements are then also united 
 according to the modes Avhich prevail in organic compounds (§ 38, 42). 
 
 295. Equally unfounded as the doctrine of capillary attraction are 
 the supposed processes of endosmose and exosmose. They are gen- 
 erally predicated of experiments upon dead matter, and are then car- 
 ried, by way of analogy, to the living organism, and in defiance of all 
 the contradictory phenomena of life.* Having entered extensively 
 into a refutation of the hypothesis of endosmose and exosmose in 
 the Medical and Physiological Commentaries, I shall not now resume 
 the subject (^ 1052, 1053, 1054). 
 
 3. ASSIMILATION. 
 
 296. By the function of assimilation substances taken into the 
 body are converted into the homogeneous blood, and identified in com- 
 position and vital properties with all parts of the body. It is there- 
 fore especially concerned in the process of growth, and in supplying 
 the waste which is constantly in progress. It is the function, there- 
 fore, by which the properties of life are communicated to dead matter. 
 
 297. All dead matter, before its reception into the body, is subject 
 to the forces of chemistry. The operation of these forces is arrest- 
 ed in tho alimentary canal of animals, and in the absorbing vessels of 
 plants. 
 
 * Violence is inflicterl in the experiments upon living tissues.
 
 PHYSIOLOGy. FUNCTIONS. 135 
 
 298. The nutriment of vegetables consists always of inorganic sub 
 stances, or is reduced to the condition of inorganic matter before its 
 appropriation. The food ot animals is always organic. The former 
 exists in an elementary or in a state of binary combination, the latter 
 of ternary, quaternary, &c. It is the work of vegetable assimilation 
 to overthrow the chemical combinations, and to unite the elements 
 in those very different modes which constitute organic compounds. 
 This is the most remarkable and comprehensive System of Design of 
 which we have any knowledge (^ 1052). — Notes NR pp. 1121, 1123. 
 
 299. Assimilation, therefore, devolves especially upon the proper- 
 ties vivification and vital affinity (§ 216, 218) ; though it be certainly 
 true that all the organic powers and functions are necessary to each 
 other, and concur together in producing every result. But, in every 
 result thei'e are some more interested than others. 
 
 300. Animals, being incapable of organizing inorganic substances, 
 are dependent upon the vegetable kingdom as their ultimate source 
 of supply (§ 13, 14). Such, indeed, is the final cause of vegetable 
 life. But the food of animals must be dead before it can begin to un- 
 dergo the action of the vital properties in another being. The gas- 
 tric juice, for instance, has no effect upon any living substance. 
 
 301. No organic compound ever undergoes chemical decomposi- 
 tion, or any approximation toward such decomposition, to fit it for the 
 purposes of animal life. On the contrary, every such tendency places 
 the appropriate nutriment of animals, more or less, beyond their as- 
 similating endowments. It is the province of animal life, and of all 
 its provisions for assimilation, not to carry back toward their inorganic 
 condition the peculiar compounds generated by the vegetable king- 
 dom for the foreordained uses of the animal, but to carry them for- 
 ward to yet higher degrees of life and organization. This is one of 
 the most fundamental laws of nature, and is conclusive against all the 
 chemical speculations with which physiology has been so unhappily 
 visited (§ 356 b-376)* The argument belongs to me (§ 1084). 
 
 302. a. The assimilating organs in vegetables are more simple than 
 in animals, and the complexity increases in animals according to their 
 rank in the scale of life. It would appear, therefore, that organiza- 
 tion bears a ratio more or less proportionate to the endowment of or- 
 ganic compounds with the properties of life (§ 301, 409). 
 
 302, b. The process of converting inorganic into organic compounds 
 begins in two orders of vessels, one of which are the radical absorb- 
 ents of plants, the other analogous vessels in the leaves. 
 
 The matter absorbed by the roots ascends through the stem to the 
 leaves, where, by the operation of a series of vessels, variously mod- 
 ified in different species, it is converted, along with that absorbed by 
 the leaves, into a juice, which, like the blood, is thus fitted for the 
 purposes of nutrition. This juice then descends through other ves- 
 sels, to be appropriated to all parts, and to form the source of all the 
 various products of vegetable organization. 
 
 303, a. We come, therefore, to a conclusion as remarkable as it is 
 comprehensive, that the atmosphere is not only essential to plants and 
 animals in its usual acceptation, but that it supplies the gi'eat means 
 of nutriment to both organic kingdoms : directly to the vegetable, and 
 indirectly to the animal department (§ 298-300). Mineral compounds 
 appertaining to the earth must yield the less important elements, and 
 
 * Chemists are beginning to adopt this conclusion, as iJppears in Note at p. 196. — 1860.
 
 136 INSTITUTES OF MEDICINE. 
 
 even some proportion of oxygen through the decomposition of rocks 
 and metals and the appropriate combinations that may ensue ; but 
 we must look especially to the atmosphere and what it contains for 
 the four great elements which compose organic beings. The oxygen 
 and the nitrogen of the air, the oxygen and the hydrogen of the vapor 
 which the air contains, and the carbon of the carbonic acid, are as 
 much at this day the gi'eat source of nutriment to plants, as before the 
 " mist" went up from the seas, or animals yielded ammonia. Oxygen 
 and nitrogen, therefore, as it respects atmospheric air, are appropri- 
 ated by plants in their elementary condition. Upon organic com- 
 pounds thus formed is animal existence, in the main, dependent. 
 Ammonia certainly contributes to the nourishment of plants. But 
 this is an incidental means, at least if there be any truth in Moses. 
 And that his Record is true, is plain enough upon the principle of 
 Design ; since it is impossible that Providence should have created 
 the animal kingdom, which yields the ammonia, before he brought 
 forth that kingdom upon which animals depend for their existence. 
 
 303, h. As it respects absorption, the leaves and the roots of plants 
 appear to have a common office, though the former are designed es- 
 pecially for assimilation. The carbonic acid, and the oxygen and the 
 nitrogen of the air, are precipitated along with the vapor, and thus 
 reach the organs which are principally devoted to absorption. In no 
 other way can we primarily reach the materials of all organic beings. 
 Before their absorption can have begun, the most essential elements 
 must have been embraced originally in the atmosphere, and in the 
 simple conditions which I have stated. Nor is it a difficult process to 
 follow out that circuit of causes and effects in which revolves the 
 economy of nature in making the waste of organic beings during their 
 own existence a subsidiary supply of nourishment to themselves, or to 
 others of their own day, or to generations in the womb of time ; or, 
 when consigned " to the dust," how their elements, from one genera- 
 tion to another, form an endless round of materials for reproduction 
 and growth, either in the form of gases and vapor diffused in the air 
 or as imbo'dled with the earth. 
 
 303, c. Although it be the special object of the radical fibres to 
 carry on the function of absorption, this office is more or less perform- 
 ed by the leaves of plants, but in various degrees, according to the 
 nature of the species. In arid climates, the leaves have this function 
 strongly pronounced ; and many plants, like the semper vir ens, will 
 grow as well when suspended by a string, as when connected by theic 
 roots with the soil. 
 
 303, d. The leaves of plants absorb carbonic acid mostly during the 
 day, decompound it through a vital process, and otherwise prepare it as 
 an important source of nourishment. Light is necessary to this func- 
 tion of the leaves, and without it the plant languishes and dies. As 
 an attendant result oxygen gas is evolved into the atmosphere. The 
 process is, therefore, suspended during the absence of light, and some 
 proportion of carbonic acid is regenerated and escapes along with the 
 vapor which is exhaled by the leaves. It has been also supposed that 
 more or less oxygen is absorbed at night; but this opinion appears 
 not to be sustained by later and better observations. It is most proba- 
 ble, indeed, that the temporary absence of light occasions scarcely more 
 than a suspension of the assimilating process. Light acts as a vital
 
 PHYSIOLOGY. FUNCTIONS. 137 
 
 Stimulus to the leaves, by which their organic properties are lendereil 
 capable of overthrowing that most refractory compound, carbonic acid 
 (§ 188| d, 350, nos. 64, 66, 68-76,) 
 
 303, e. The leaves of plants being the great organs of assimilation, 
 and light the vital stimulus by which the function is maintained (§ 
 188J, d), it appears from what has been now said that light holds the 
 first rank among the requisites of life. It was therefore brought into 
 existence before the creation of the vefjetable kingdom : and being 
 thus indispensable to all living beings, we see the fallacy of a common 
 tenet in theoretical geology, that the most thrifty period of vegetation 
 was through a great cycle of total darkness, and an atmosphere of 
 carbonic acid (§ 74, 1079 b): 
 
 303 J, a. One of the most interesting facts in vegetable physiology 
 is the immediate necessity of plants to animal life during their very 
 growth; their final cause, in this respect, being the abstraction of car- 
 bonic acid from the atmosphere, and the renewal of its oxygen. Ani- 
 mals, too, as we have seen, incidentally contribute carbon to the vege- 
 table kingdom, in the form of carbonic acid, and nitrogen in the form 
 of ammonia. There is this remarkable subserviency of the organic 
 kingdoms to each other, though there be not a reciprocal dependence. 
 Vegetables, indeed, preceded animals, and are, therefore, essentially 
 independent, while animals derive all they possess from vegetable 
 creation (§ 303, a). Plants are the producers, animals the consumers. 
 The former directly, and the latter indirectly, live upon the air and 
 what it contains. The plant dies and becomes food for the animal ; 
 but it seems scarcely less important in its living state to the exigen- 
 cies of animal life. And so the animal, living and dead, yields back 
 its all to the atmosphere ; and thus are the inorganic, and the two de- 
 partments of the organic, kingdoms united (§ 1052, 1053). 
 
 303i, b. But, we have seen, as I originally indicated in the Essay 
 on the Philosophy of Vitality, that the supply of ammonia to the atmo- 
 sphere is only a contingent result of the creation of animals, and there 
 fore not indispensable to vegetation (§ 156 b, 303 a). Liebig, how- 
 ever, reverses the order of Creation, and afllirms that 
 
 " We have not the slightest reason for believing that the nitrogen 
 of the atmosphere takes part in the process of assimilation of plants 
 and animals." " These facts are not sufficient to establish the opinion 
 that it is ammonia which affords all vegetables, without exception, the 
 nitrogen which enters into the composition of their constituent sub- 
 stances. Considerations of another kind, however, give to this opin- 
 ion a degree of certainty which completely excludes all other views of 
 the matter.^' — Liebig's Organic Chemistry, Sec, p. 70, 71. 
 
 303i, c. The same mistake has arisen with the chemists as to the 
 recipi'ocal dependence of animals and plants, in regard to the excre- 
 tion of carbon by one and oxygen by the other. However true it may 
 be that animals are dependent on plants for oxygen gas, it is certainly 
 an assumption that the vegetable kingdom is alike dependent on the 
 animal for its carbonaceous element. If the primary creation of plants 
 be admitted, that is sufficient; and to those who reject the Mosaic 
 Record, and the concurring testimony of geologists, I may repeat 
 the admitted faCt that vegetables are the ultimate source of supply 
 to all animals. The former, therefore, are essentially independent, 
 the latter dependent; while this universal fact corroborates, also,
 
 138 INSTITUTES OF MEDICINE. 
 
 the original account of the primary creation of the vegetable kingdom 
 (§ 303}). 
 
 As to the relations of the living plant to organic life, it is computed 
 by Saussure, and allowed by others, that the atmosphere contains about 
 -_i__th part of its w^eight of carbonic acid. The atmosphere must 
 be also losing, through the processes of respiration, combustion, &c., 
 a proportion of its oxygen. It is estimated, also, that the present num- 
 ber of human beings w^ould, alone, double the existing quantity of car- 
 bonic acid in the air in 1000 years ; and, in 303,000 years would ex- 
 haust its oxygen. It is also found that atmospheric air of the present 
 day does not contain less oxygen than that which is found in jars 
 buried for ISOO years in the ruins of Pompeii. 
 
 From all this it is inferable that there is a universal cause in oper- 
 ation, by which the carbonic acid of the air is consumed, and oxygen 
 supplied; and, from the various well-known, and indispensable uses 
 Df the vegetable kingdom to the animal, which declare its creation for 
 the benefit of the latter, and, therefore, its antecedent or simultaneous 
 creation, we should naturally be prompted, by analogy, to look to this 
 subordinate provision as the universal source through which the great 
 purposes of respiration are maintained unimpaired. Chemistry has 
 here elegantly illustrated this great element in the final causes of the 
 vegetable kingdom, and the contingent aid which it derives from the 
 animal ; while it enlarges our view of the vast conceptions of Unity of 
 Design. 
 
 303^. It is also worth our while to observe of these important laws, 
 as we go along, how they are perverted by the ignorant in physiolo- 
 gy, and how incapable the chemist is constantly proving himself of 
 " pursuing his reasoning," as said of him by Hunter, " even beyond 
 the simple experiment itself." 
 
 Vegetables, as we have seen, are composed mainly of carbon, oxy- 
 gen, hydrogen, and nitrogen (§ 37, 303). The carbonic acid of the 
 air (as well as of the soil) is absorbed by plants, and appropriated 
 to their nourishment and growth. This gaseous substance, therefore, 
 is decomposed by vegetable organization, the carbon vivified and ap- 
 propriated, and a part of the oxygen thrown off to replenish the at- 
 mosphere. It is incorrectly said, however, by Liebig, that " the at- 
 mosphere must receive by this process a volume of oxygen for every 
 volume of carbonic acid which has been decomposed." It may be 
 meant, however, that an equivalent or atom of oxygen for every equiv- 
 alent of carbon is given off to the atmosphere ; but even this construc- 
 tion is invalidated by the multiplicity of sources from which plants arc 
 supplied with that important element. But enough is known to ren- 
 der it certain that a large proportion of the oxygen of carbonic acid is 
 retained by plants and combined under a new form along with the car- 
 bon and other elements. Liebig's hypothesis of capillary attraction 
 led him, not improbably, to overlook the fact that the water which 
 is absorbed by plants is actually decompounded, and its elements com- 
 bined with others according to the laws which determine organic com- 
 pounds. It is water, indeed, which yields, far more than ammonia, 
 the hydrogen which abounds in plants (§ 303, Z»). Water, therefore, 
 being composed of oxygen and hydrogen, furaishes a source of the 
 supply of that oxygen which goes to the increase of vegetables ; and, 
 for aught that can be said to the contrary, it may form a part of what 
 is evolved into the air.
 
 PHYSIOLOGY. FUNCTIONS. 139 
 
 "We have seen, also, that plants derive a part of their oxygen from 
 mineral compounds appertaining to the earth, and probably by means 
 of the roots from the atmospheric air which is held in solution by water, 
 when the gas may be thus appropriated, notwithstanding its elementary 
 condition in the latter case. Although, doubtless, more or less carbonic 
 acid is reproduced in the leaves and escapes at night along with the va- 
 por exhaled, the probabilities arc against the supposition that a propor- 
 tion is also then generated and emitted by plants in a manner analogous 
 to the respiration of animals, and having for its object, in part, the 
 separation of carbon from some of the vegetable constituents. 
 
 303f. But let us come to philosophy : — 
 
 " At night," says Liebig, " a true chemical process coxMMENCEs, 
 in consequence of the action of the oxygen of the air upon the sub- 
 stances composing the leaves, blossoms, and fruit. This process is not 
 at all connected with the life of the vegetable organism, because it 
 goes on in the dead plant exactly as in a living one" ! 
 
 Here, in the first place, is an important fallacy in the premises from 
 which the induction is made ; since the processes have not the least 
 analogy in the living and dead plant. In the former, the oxygen is 
 taken into the organization, and goes to form organic compounds. In 
 the dead plant, it is an agent of chemical decomposition, by which the 
 organic compounds are destroyed, and the structure broken up. 
 
 Now we shall always find that authors who reason in the foregoing 
 manner perpetually contradict themselves. In the case before us, a 
 contradiction necessarily arises from the fundamental differences be- 
 tween the processes of organic and inorganic beings, and the laws by 
 which they are governed. A little farther on from the quotation I 
 have just made, Liebig affirms that " tlie laws of life cannot he investi- 
 gated in an organized being which is diseased or dying" Here, then, is 
 a contradictory opinion, which inculcates as great an error in physi- 
 ology as that of identifying the effects of oxygen on " living beings" 
 and on such as are actually dead. Here is an absolute denial of any 
 analogies between the laws which govern living " diseased beings" 
 and the "laws of life." But, this declaration of the chemist, devoid 
 of truth as it is, is universally applicable where he would be least 
 disposed to see it operate. Such an application, too, is an irresistible 
 sequitur ; since, if" the laws of life cannot he investigated i?i an organ- 
 ized being which is diseased or dying," it certainly follows that the 
 laws which relate to dead, or inorganic beings, and the forces upon 
 which those laws depend, can have no agency in living beings. 
 
 Such, however, is the material which is now-a-days denominated 
 " experimental philosophy," and " the progress of medical science." 
 And, if the reader will now turn to the parallel columns (§ 350), he 
 will see yet other contradictions directly relative to the foregoing 
 quotation (^ 1052, 1053). 
 
 But, it may, perhaps, be well enough, before dismissing this sub- 
 ject, to say, that, although " the laws of life cannot be investigated in 
 an organized being which is dying," the laws which govern diseased 
 actions and their results are only slightly modified " laws of life," and 
 often reflect great light upon their strictly healthy condition. We 
 are, or should be, constantly reasoning in this manner in all cases of 
 disease ; and it is only by comparisons of the modifications, which 
 constitute disease, with the natural conditions of life, that we can have
 
 140 INSTITUTES OF MEDICINE. 
 
 any just knowledge of diseases. In proportion, however, as the indi- 
 vidual approximates a state of death all this reasoning fails ; and, 
 when actually dead, no such comparisons can be instituted. Here, 
 then, it is that the foregoing admission of the chemist applies with all 
 the force of truth (§ 639 a). 
 
 304. The greater complexity of the organs of assimilation in ani- 
 mal life gives rise to a variety of subordinate functions in animals not 
 found in plants ; such, for example, as digestion by the gastric juice, 
 saliva, bile, &c. ; then a farther advancement of the process in the 
 lacteals, in the blood-vessels, in the lungs, &c. Some of these subor- 
 dinate functions, however, have their analogies in plants ; such as the 
 action of the sap-vessels upon the circulating fluid, the imbibition and 
 exhalation of gaseous substances by the leaves, &c. But, in all the 
 cases, the extreme vessels which perform the office of nutrition are the 
 main instruments of organic life. All the functions which are carried 
 on by compound structures are subsidiary only to that of the nutritive 
 vessels (§ 171). 
 
 305. The organs of assimilation in animals are more or less com- 
 plex according to the nature of the food. Probably every animal 
 has a stomach, or some analogous organ, aiid a mouth, and anus, 
 which would form, as supposed by Aristotle, a fundamental distinc- 
 tion between plants and animals (§ 11). The analogies which are 
 supplied by the higher orders of animals would prompt this conclu- 
 sion in respect to the most inferior, or some equivalent arrangement. 
 
 306. In vertebrated animals the stomach is generally an expand- 
 ed portion only of the intestinal canal. In fishes the intestine is 
 commonly short ; but this is often compensated by folds in the mu- 
 cous membrane. In birds there is a complexity of the alimentary 
 organs which does not exist in fishes, amphibia, or reptiles. In mam- 
 malia the digestive organization is still different ; and here it is more 
 remarkably various according to the nature of the food, and as the 
 necessity of supplies may be felt at short or at longer intervals. The 
 more, also, the phenomena of animal life are multiplied the greatei 
 is the development of the digestive system (§ 107, 251, 353). Its 
 complex nature has an intimate relation to the qualities of the food, 
 and these relations have an affinity with that- principle of instinct 
 which directs animals in the selection of food. The more dense and 
 tough the food, and the more removed from the nature of the body 
 which it is destined to nourish, the more complex are the organs of 
 digestion. And so, on the contrary, the softer the food, and the more 
 it is like the animal in its composition, the more simple are the assim- 
 ilating organs. Animals, therefore, which live on hay have these or- 
 gans much more complex than such as are nourished by animal food ; 
 especially that part of the organization which is destined to make the 
 first and "freatest chanofe. 
 
 007. The principal agent in the assimilating process, in animals, is 
 the gastric juice ; a vital organic fluid, which is secreted by the inter- 
 nal coat of the stomach (§ 135 a, 316, 419, 827 b). This secretion is 
 especially promoted by the stimulus of food, which is dissolved and 
 altered in its elementary constitution by the vital influences of the 
 juice. This is the first and greatest step in the process of assimilation. 
 It is here that dead matter receives its first impressions from the prop- 
 erties vivification and vital affinity (§ 216, 218). The chemists tell us
 
 PHYSIOLOGY. FUNCTIONS. 141 
 
 that the process is a chemical one ; and that, notwithstanding the va- 
 rious, and unique, and astonishing devices of nature for the elaboration 
 of the gastric juice, theywould persuade physiologists into the belief 
 that many different processes of the laboratory vv^ill generate a gastric 
 juice with all the unique properties that appertain to the fluid as elab- 
 orated from the blood by the various modifications of organization 
 which were instituted by Almighty Power for these specific objects. 
 And having been thus regardless of the most sublime and profound 
 institutions of that Power, they proceed to assume that the product of 
 these artificial compounds, in their action upon food, is the homoge- 
 neous chyme of living nature, and which is apparently the same in all 
 animals, whatever the kind or the variety of food. But the chemist 
 is met at the very threshold by the fact, that there is nothing in or- 
 ganic nature itself that can elaborate that fluid from the blood but that 
 particular part of the great system of mucous membranes which forms 
 a component part of the stomach (§ 135, a). — Notes N R. 
 
 308. The foregoing relates to complex animals ; but analogy, as well 
 as observation, renders it evident that the inferior races possess an or- 
 ganization which is equivalent to the stomach (§ 251). 
 
 309. In most animals that consume food of a solid nature, there are 
 preparatory organs which assist mechanically, by dividing the food. 
 The construction of these organs of mastication, both as to their osse- 
 ous and muscular parts, has a strict reference to the kind of food upon 
 which the animal is destined to subsist. Animals of prey are furnish- 
 ed with organs for the destruction of life and organization ; since no 
 substance which possesses life can undergo digestion, and all solids 
 must be divided to admit of a free access of the gastric juice and saliva. 
 
 310. The organs of mastication are more various than any other 
 parts ; yet so uniform in each species, so allied among numerous spe- 
 cies, that naturalists have taken these characters not only as signifi- 
 ,cant of the species, but as the foundation of a systematic distribution 
 of the species into genera, and of genera into orders. 
 
 311. Where the usual organs of mastication are deficient in ani- 
 mals, the species is often supplied with means in the stomach itself 
 for reducing the aliment to a soft substance, so that it may be pene- 
 trated by the gastric juice. The stomach of the armadillo, which sub- 
 sists on insects, and of the granivorous birds, is endowed with a pow- 
 erful muscle for crushing, or grinding the food. The stomachs of 
 other animals are armed with bony or horny parts, as in many insects. 
 
 312. The food is moved about in the stomach by the muscular ac- 
 tion of the organ ; but so peculiar and exquisite is the modification 
 of irritability of the pyloric orifice, the food is not permitted to pass 
 this outlet till it is converted into chyme (§ 278). Much of the aque- 
 ous portion, however, is early and rapidly absoi'bed by the stomach. 
 
 313. When, however, as we have seen, the irritability of the pylo- 
 rus is artificially modified, as in disease, it will often allow undigested 
 food to paSs, more or less readily, into the duodenum (§ 278). But it 
 is more remarkable that it will suffer many hard, indigestible sub- 
 stances to escape, while it detains such as are most congenial to its 
 nature. The passage of indigestible substances is effected gradually 
 by repeatedly presenting thernselves at the pylorus, and thus so habit- 
 uating the irritability of that orifice to their own irritant effects, but 
 not to those of digestible food, that they are allowed to pass, while
 
 142 INSTITUTES OF MEDICINE. 
 
 the latter is detained ; the stomach thus electing what is most conge- 
 nial to its nature and to the wants of life (§ 188, &c., 539 a, 543, 551). 
 
 314. The saliva, bile, and pancreatic juice are auxiliary to the gas- 
 tric juice, though how far is considered problematical. The liver is 
 found, under a great variety of forms, in all animals whose structure 
 can be made the subject of ocular demonstration, and it is knov\Ti to 
 generate bile in all instances. The pancreas and salivary glands oc- 
 cur in all the mammifera, birds, and reptiles, and in many fishes, mol- 
 lusca, and insects. 
 
 From the general occurrence, therefore, of the foregoing organs, it 
 cannot be doubted, independently of the more direct facts, that the 
 fluids which they secrete have an important vital agency in the pro- 
 cess of assimilation. 
 
 315. Animals which nve on vegetables have larger salivary glands 
 than such as feed on animal substances ; and, since vegetables require 
 greater assimilating means than animal food, it is a just inference 
 from final causes that the saliva answers a far more important object 
 than, as is commonly imputed to it, of moistening the food and facili- 
 tating its passage to the stomach. On the other hand, however, it has 
 been with still less reason imagined by others that it contributes more 
 than the gastric juice to the conversion of food into chyme. But 
 here, as on all speculative questions, some distinguished chemists re- 
 fer the agency of the saliva in the process of digestion to the atmo- 
 spheric air it conveys to the stomach, while others of equal renown 
 attribute this high office to its o^vn specific virtues. 
 
 316. The bile and pancreatic juice mingle with the chyme in the 
 upper part of the duodenum, where it is probable that the latter fluid 
 contributes an assimilating influence analogous to that of the saliva ; 
 while the disappearance of some of the components of the bile, and 
 other relative facts, show a direct connection of this fluid with the 
 px'ocess of assimilation. The bile also separates the excrementitious 
 from the nutritious part of the chyme ; the former portion occupying 
 the centre of the canal, and the latter the parietes (417, h). 
 
 Connected with these important uses of the bile is its well-known 
 function of maintaining peristaltic action. Such, therefore, being its 
 great final causes, we may safely reject the hypothesis of the mechan- 
 ical theorists, that the liver, like the lungs, is designed to depurate 
 the blood. The injury consequent on the failure of the liver, by ex- 
 periment or otherwise, to perform its function, no more proves its 
 supposed depurating office than a like contingency befalling the stom- 
 ach would place that organ in the same category. — See ^ 1031-1033. 
 
 317. The intestinal tube, like the roots of plants, is supplied with 
 absorbing vessels, which are called lacteals in animals of complex or- 
 ganization. The nutritive part of the chyme is taken up by these 
 vessels, where it undergoes a farther assimilation, and receives the 
 name o? chyle. 
 
 Nothino- is absorbed by the lacteals which is offensive to their 
 exquisitely modified irritability, excepting under the circumstances 
 already set forth (§ 278). 
 
 318. In the higher animals the chyle is transmitted by the lacteals 
 to the thoracic duct, and by this vessel to the left subclavian vein, 
 where it mingles with the general mass of blood. Thence it passes 
 to the riffht cavities of the heart to be sent to the lungs, where it re-
 
 PHYSIOLOGY. FUNCTIONS. 143 
 
 ceives another important impress of vivification, parts, for the first 
 time, with a portion of its carbonaceous matter, and undergoes a de- 
 velopment of its coloring principle. From the lungs, it passes with 
 the old blood, with which it is now fully incorporated, to the left cav- 
 ities of the heart, to be transmitted to all parts of the body to under- 
 go the last act of assimilation. 
 
 319. Assimilation advances progressively from the first conversion 
 of food into chyme till the nutritive matter becomes vitally united 
 with the solid parts. At each step of the process, in the stomach, in 
 the duodenum, through the lacteals, in the lungs, and at its final des- 
 tination, the degree and kind of assimilation is forever the same, at 
 each of its stages, in every species of organic beings ; thus denoting 
 specific powers and laws by which all this unvarying exactness is 
 maintained (§ 42). 
 
 Assimilation is more simple in animals low in the scale of organi 
 zation ; but close analogies prevail throughout. 
 
 320. The chyle is found to exhibit globules under the microscope, 
 of which some are reddish. It is said, also, that they have been seen in 
 the chyme ; but Miiller thinks that impossible, as the lacteals, accord- 
 ing to him, have no open orifices, and, therefore, the globules could 
 not be admitted through the " invisible pores" of the closed lacteals. 
 These vessels, however, have open terminations by the villi of the in- 
 testines (§ 275, 1089). 
 
 These questions as to the existence and shape of the globules of 
 blood, chyle, milk, &c., are of very little practical importance and are 
 apt to lead to much waste of time, and encumber medicine with specu- 
 lation and false doctrine ; while the instrument, through the aid of 
 which the imagination is thus sent upon its airy flight, is also the im. 
 bodyment of a thousand falsehoods in the path of truth (§ 131, 251). 
 
 321. Since, however, no one doubts that the nutritive part of the 
 chyme undergoes a very positive change in the lacteals (§ 320), and a 
 higher degi-ee of assimilation, the proof is the same here, as in absorp- 
 tion by plants, that the fluid is not taken up and carried forward by 
 capillary attraction (§ 289-291). 
 
 322. Looking back upon the variety of parts which are concerned 
 in the work of assimilation ; their exact adaptation to each other ; 
 their peculiarities in different species of animals according to the na- 
 ture of their food — varying, indeed, more or less in every species, yet 
 always alike in all individuals of the same species ; the prevalence 
 of four specific digestive fluids, and each of these analogous in all an- 
 imals, notwithstanding the variety in the structure of the secreting or- 
 gans, yet only generated, respectively, by one special part, their pro- 
 duction in unusual quantities, especially of the gastric juice, to meet 
 the exigencies of digestion ; the apparently exact similarity in the 
 composition of the chyme of all animals, whatever the nature and the 
 variety of the food ; it appears to be one of the highest absurdities to 
 suppose that all this complexity of paits, all this magnificence and 
 variety in Design, should be merely intended to subserve a chemical 
 reduction of food in the stomach, especially, too, as all that is known 
 of chemistry is in conflict with every part of this stupendous whole. 
 And when we pursue the other steps through which the great end of 
 liigestion is attained, and steadily regard each individual part forever 
 giving rise to certain unvarying results, each part in its anatomical
 
 144 INSTITUTES OF MEDICINE. 
 
 and. vital relations to all the rest, the necessity of every part to every 
 step in the process of assimilation, the necessity of the whole lo every 
 seci'eted solid and fluid, the derivation of the whole unique and for- 
 ever exact variety (millions upon millions, § 41-46) from four ele- 
 ments mainly, out of a homogeneous fluid which embraces yet fourteen 
 other elements, the necessary co-operation of many of the secreted 
 fluids toward their own formation individually, and toward every for- 
 mation in the complex animal — when, I say, we duly consider this 
 labyrinth of complexities, moving on in one unvarying round of har- 
 monious action and results, moved by a power within which has no 
 known analogy in the world where chemical results obtain, we may 
 reconcile unbelief in all this Design with a yet higher order of infi- 
 delity, but certainly not with the ordinary promptings of reason, oi 
 with the plainest rules of evidence (§ 638). 
 
 But, let us analyze, in another section, the great plan of nature foi 
 the maintenance of organic life in animals. 
 
 323. Let us analyze, after the manner of Cuvier, the constitution 
 of animals in respect to the subserviency of the various parts of the 
 fabric to the single function of digestion, and according to the nature 
 of each species of animal ; and when we shall have reflected upon 
 the principles which determine the coincidences, and see that no one 
 of them can be explained by any of the forces and laws of the inor- 
 ganic world, let us cast from us, as unworthy a thoughtful mind, the 
 supposition that the final act, or that of digestion, is a chemical pro- 
 cess ; and let us also apply the same induction to every other process 
 of living beings. 
 
 " Every organized being," says Cuvier, " forms a whole, a unique, 
 and pei-fect system, the parts of which mutually correspond, and con 
 cur in the same definite action by a reciprocal reaction. None of 
 those parts can change without the whole changing; and, consequent- 
 ly, each of them, separately considered, points out and marks all the 
 others. Thus, if the intestines of an animal are so organized as only 
 to digest flesh, and that fresh, it follows that the jaws of the animal 
 must be constructed to devour prey, its claws to seize and tear it, its 
 teeth to eat and divide it, the whole structure of the organs of motion 
 such as to pursue and catch it, its perceptive organs to discern it at a 
 distance. Nature must have even placed in its brain the necessary 
 instinct to know how to conceal itself and lay snares for its victims. 
 That the jaw may be enabled to seize, it must have a certain-shaped 
 prominence for the articulation, a certain relation between the posi- 
 tion of the resisting power and that of the strength employed with the 
 fulcrum ; a certain volume in the temporal muscle, requiring an equiv- 
 alent extent in the hollow which receives it, and a certain convexity 
 of the zygomatic arch under which it passes. This zygomatic arch 
 must also possess a certain strength to give strength to the; masseter 
 muscle. That an animal may catry off" its prey, a certain strength is 
 requisite in the muscles which raise the head ; whence results a de- 
 terminate formation in the vertebrae and muscles attached, and in the 
 occiput where the muscles are inserted. That the teeth may cut the 
 flesh, they must be sharp, and they must be so more or less according 
 as they will have more or less exclusively flesh to cut. Their roots 
 should be more or less solid, as they have more and larger bones to 
 nreak. All these circumstances will, in like manner, influence the de-
 
 PHYSIOLOGY. FUNCTIONS. 145 
 
 velopment of all those parts whicli serve to move the jaw. That the 
 claws may seize the prey, they must have a certain mobility in the 
 talons, a certain strength in the nails ; whence will result determinate 
 formations in all the claws, and the necessary distribution of muscles 
 and tendons. It will be necessary that the forearm have a certain 
 facility in turning, whence, again, will result certain determinate for- 
 mations of the bones which compose it. But, the bone of the fore- 
 arm, articulating in the shoulder-joint, cannot change its sti-ucture 
 without this also changes." 
 
 Again, observe what may be infen-ed from some other given part, 
 as from the shape of the bones : " The formation of the teeth bespeaks 
 that of the jaw ; that of the scapula that of the claws ; just as the equa- 
 tion of a curve involves all its properties. So the claw, the scapula, 
 the articulation of the jaw, the thigh-bone, and all the other bones 
 separately considered, require the certain tooth, or the tooth requires 
 them, reciprocally ; and, taking any one of them, isolated from the skel- 
 eton of an unknown animal, he who possesses a knowledge of the laws 
 of organic economy, could expound every other part of the animal. 
 Take the hoof, for example. We see, very plainly, that hoofed ani- 
 mals must all be herbivorous, since they have no means of seizing 
 upon prey. We see, also, that having no other use for their fore- 
 feet than to support their bodies, they have no occasion for a power- 
 fully-framed shoulder ; whence we infer, what is the case, the absence 
 of the clavicle and acromion, and the straightnessof the scapula. Not 
 having any occasion to turn their fore-legs, their radius will be solidly 
 united to the ulna, or, at least, articulated by a hinge-joint, and not 
 by ball and socket, with the humerus. Their herbivorous diet will 
 require teeth with a broad surface to crush seeds and herbs. This 
 breadth must be irregular, and for this reason the enamel parts must 
 alternate with the osseous parts. This sort of surface compelling hor- 
 izontal motion for grinding the food to pieces, the articulation of the 
 jaw cannot form a hinge so close as in carnivorous animals. It must 
 be flattened, and correspond with the facing of the temporal bones. 
 The temporal cavity, which will only contain a very small muscle, will 
 be small and shallow," &c. (§ 169,y"). 
 
 324. An intestine, claw, tooth, hoof, or other bone, therefore, of an 
 unknown animal being given, we may construct a skeleton that shall 
 be nearly true to nature in all its parts. We may then proceed to 
 cover it with muscles ; and, lastly, we can tell from that tusk, or claw, 
 or hoof, or other bone, what was the structure of the digestive appa- 
 ratus, and to what kind of food the gastric juice was specifically adapt- 
 ed, and what were the peculiar instinct and habits of the animal, — so 
 special is the adaptation of all other parts of the organization, both in 
 animal and organic life, and all the habits and instincts of animals, to 
 the peculiarities of the digestive organs in every species (§ IS). 
 
 325. Now the whole of the foregoing mutual concurrence of all 
 parts of the body, the adaptation of each part to the others in structure 
 and use, being directly designed to subserve the purposes of diges- 
 tion, and since it cannot be seriously entertained that any physical or 
 chemical force is concerned in such a labyrinth of harmonious struc- 
 ture and actions, and so distinguished throughout by a multitude of 
 the most consummate Designs, and all conspiring to one common end, 
 it is manifestly absurd to imagine that digestion, thejinal came of the 
 
 K
 
 146 INSTITUTES OF MEDICINE. 
 
 whole , is carried on by agencies which have no connection with the va- 
 rious subordinate means (§ 14, 74, 80, 117, 129 i, 133-137, 143, 155, 
 156, 169/ 266, 3031 a, 306, 318, 336, 387, 399, 422, 514 h, 524 d, 
 525, 526 d, 528 c, 638, 649 d, 733 b, 764 b, 811, 847 c, 848, 902/ 905). 
 
 326. What we have noAv seen of fundamental Design in the con- 
 struction and subservience of all parts to the function of assimilation, 
 and of the exact concurrence of the whole toward the incipient step, 
 may well prepare the mind to realize the same Design throughout the 
 whole system of organic processes, the same exact foundation in an- 
 atomical structure, and in vital properties, the same precise and ever- 
 lasting laws (§ 169,/). Do we look again, therefore, at the stupen- 
 dous fabric upon which, and its special vital endowments, the laws of 
 sympathy depend 1 Astonishment abates, and unbelief yields as well 
 to the force of analogy as to direct demonstration. 
 
 327. The philosophy of assimilation applied pathologically, and in 
 conformity with the doctrines of solidism, is the following : The func- 
 tion of assimilation, being performed by the organic properties through 
 their media of action, there will be a corresponding change in the 
 elementary combination of the new compounds which are added to 
 the parts affected, and the same morbid condition of the vital proper- 
 ties will be imparted to the new compounds. 
 
 328. If the stomach be diseased, then the nature of the gastric juice 
 will be altered according to the manner in which the properties of the 
 stomach may be affected. If, also, we allow, in this case, that the 
 chyme will have a corresponding variation, and that this will in itself 
 affect the whole character of the circulating mass of blood, so that the 
 new elementary combinations, those of the solids and secreted fluids, 
 will be more or less modified in all parts, we shall in no respect com- 
 promit the consistency of nature, or the fundamental principles of 
 physiology (§ 44, 52, 78, 153-155, 218-220). However such admis- 
 sion may look like humoralism, it has no affinity with it. The whole 
 process resolves itself into a primary disease of the solids ; and the 
 modified condition of the blood, which I am now supposing, does not 
 derange the vital properties and actions of the system (§ 156 b, 845, 
 &c.). But when chylification is affected by diseased states of the 
 stomach, reflex nervous actions are then so exerted by that organ upon 
 other parts, that their vital states do actually sustain a change, and 
 often a far greater one, from that sympathetic cause. This more gen- 
 eral modified condition of the solids contributes still farther to modify 
 the new combinations, and to give rise to what are called vitiated se- 
 cretions. The most striking examples are seen, of course, when di- 
 gestion fails altogether, and the solids become universally affected by 
 disease, as in fever (§ 143 c, 148, 657 b, 776, &c.). 
 
 329. If the heart and vascular system at large feel, mainly, the in- 
 fluence of gastiic or some other local disease, the blood is always more 
 or less affected in its composition, and assimilation is otherwise va- 
 riously modified in all other parts, not only in consequence of the 
 change in the blood, but of the affection of all the organs and fluids 
 which are concerned in assimilation. Nothing affects the composition 
 of the blood so rapidly as disturbances of the vital conditions of the 
 heart and blood-vessels ; or, perhaps, I should rather say of the ex- 
 treme capillary blood-vessels. Nothing can prove more distinctly the 
 truth of solidism and the fallacies of humoralism; especially those
 
 PHYSIOLOGY. FUNCTIONS. 147 
 
 more instantaneous changes which are effected in the entire circula- 
 ting mass of blood by abstracting only an ounce of it from the arm (§ 
 845, &c., 952). 
 
 330. Now, suppose, instead of treating disease upon some broad 
 principles, we were to undertake the specific object of theliumoralists 
 in any of the foregoing cases (§ 327-329) ; that is to say, the resto- 
 ration of the blood in its composition and nature. The humoral pa- 
 thologist would attempt its direct medication, in the vain hope that his 
 drugs can pi'oduce, by their direct action upon the fluid, that natural 
 combination of its elements, and that natural state of its vital properties, 
 for doing which Nature has provided the whole system of the great 
 vital organs, and many living secretions (§ 845, &c.). Since, there- 
 fore, the humoralist has not a physiological principle for his govern- 
 ment, he has departed wholly from nature. The duty of cure thus 
 devolves upon the solidist, who proceeds to restore assimilation by re- 
 establishing the natural condition of the various tissues and organs 
 whose functions had become dei'anged and had been the cause of the 
 altered condition of the blood ; and this is effected according to the 
 manner set forth in my chapter on the modus operandi of remedial 
 agents. There, too, you shall find, as well as in my disquisitions 
 upon the philosophy of solidism, that the living solids are the only 
 agents which can possibly effect any salutary changes in the pabulum 
 vitce, and, therefore, that when the former are diseased along with the 
 latter, they must take the initiating step both in the morbid and healthy 
 processes. Just in proportion, therefore, as the solidist improves the 
 condition of the diseased organs, assimilation will approximate its 
 natural state, and the blood be regenerated according to established 
 physiological laws. — Note R p. 1123. 
 
 331. The condition, therefore, of the blood and of the products 
 elaborated from it, in all cases of disease, should be regarded only as 
 moi-e or less significant of the morbid changes which may affect the 
 solid parts. 
 
 332. Having now gone over the general philosophy relative to as- 
 similation, I shall proceed to consider its principal element, or what 
 is denominated 
 
 THE PHYSIOLOGY OF DIGESTION. 
 
 In my investigation of this subject I shall enter rather extensively 
 upon the ground of Organic Chemistry, in all its applications to the 
 science of medicine ; since it is here, especially, as said in the Com- 
 mentaries, that chemistry has reared its batteries, and from whence it 
 sends forth its artillery into the. various dominions of organic life. A 
 contrast will be instituted under the general designations of Physiol- 
 ogy and Organic Chemistry, in their relation to healthy and morbid 
 processes. 
 
 333. The doctrines of life, as hitherto expounded, should be appli- 
 cable to all the problems in organic beings which may seem to a su- 
 perficial observer to fall under the laws of chemistry, or of physics. 
 Such problems are especially presented by digestion, respiration, and 
 the production of organic heat ; and these are the main intrenchments 
 af chemistry. If the philosophy, therefore, which I have thus far pro- 
 pounded lie at the foundation of the foregoing results, it is probable 
 that chemistry must be abortive in facts, and wild in conclusions ; and
 
 i48 INSTITUTES OF MEDICINE. 
 
 the more so as it advances to tlie greater obscurities in physiology^ 
 pathology, and therapeutics. Such are the realities ; and their expo- 
 sure is the overthrow and the perpetual doom of organic chemistry. 
 
 334. Human physiology has been greatly vitiated, in recent times, 
 by experiments upon animals, and conducted under the most unnat- 
 ural circumstances. They have been extensively made, in a physio- 
 logical aspect, without any view to the differences in organization 
 and vital constitution between animals and man, and often with a ref- 
 erence to more functions than belong to any organic being. When 
 prompted by pathological and therapeutical considerations the ex- 
 periments have been liable not only to the foregoing objections, but 
 to the greater one of assuming that there is no difference in the sus- 
 ceptibility of organs to the action of natural, morbific, and remedial 
 agents in the varying states of health and disease (§ 149, 150, 240). 
 These experimental fallacies, and the vast errors to which they have 
 led and are still leading, I have considered extensively in my Essay 
 on the Humoral Pathology. — See p. 839, § 1058 b, note. 
 
 In a physiological sense, the greatest evil attending the foregoing 
 experiments consists in neglecting the fact that the constitution of man 
 is different from that of animals when applying the results of such 
 otherwise unnatural experiments to explain the vital laws which gov- 
 ern the functions of the human species. 
 
 The disparity increases between the natural laws and results of the 
 human and those of vegetable organization, and others, again, of 
 chemical affinities, just in the ratio of the difference between the va- 
 rieties of organization and vital constitution, and the attributes of the 
 inorganic kingdom. 
 
 335. What, then, shall be said of those experiments which are con- 
 ducted in the laboratory of the chemist to determine the physiology 
 of the highest function of life, but in which organization takes no part, 
 and the whole process is carried on by artificial " mixtures'" and 
 chemical reagents 1 This is now the almost universal philosophy, and 
 therefore demands an investigation which shall lead either to its con- 
 firmation or to its overthrow (Rights of Authors, p. 912). 
 
 336. It is in the stomach that vitality is exemplified in its most im- 
 pressive and astonishing aspects, and where unequivocal demonstra- 
 tions abound that fluids, as well as solids, are endowed with the prin- 
 ciple of vital operations, " a principle distinct from all other powers 
 of nature" (§ 64, 339). It is here, especially, that nature has illus- 
 trated her distinction between the animate and inanimate world, and 
 established her chain of connection. It is here, in the incipient change 
 of dead into living matter, that we witness a full display of those 
 powers which operate in the most elaborate organization, and an equal 
 exclusion of the forces which appertain to dead matter. It is here 
 the line of separation begins abruptly ; but where analogies are pre- 
 sented in the conversion of dead into living matter, through new 
 modes of combining the same elements ; and admiration increases, 
 as we mount along the entire function of assimilation, and find, at 
 each step of the ascending series, that the whole agency is committed 
 to forces that have no existence in the inorganic world ; that the whole 
 is the harmonious result of a principle which may form an interme- 
 diate link between spirit and matter ; and that there is no power with- 
 in our control by which we can determine the nature of the changes.
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 149 
 
 Casting a glance at the vegetable world, we find the connection coti- 
 tinued, by other analogous links, with elementary matter itself; but 
 hero, as in the higher department of nature, the line of separation is 
 equally defined, however low in the scale of analogy may be the prop- 
 erties of life which have their beginning in vegetable organization. 
 
 It is here, then, at the threshold of life, as in the propagation of the 
 species, that we especially witness a substitution for Creative Power ; 
 and, as all that appertains exclusively to the organic world was per- 
 fectly distinct in its Creation from the inorganic, so are the substituted 
 processes_ of generation, and of the conversion of dead into living mat- 
 ter, equally distinct from the causes and results of inorganic processes 
 (§ 32, &c., 63, &c.). 
 
 For conducting that connected series of changes which make up 
 the process of assimilation in animals, a complex apparatus has been 
 provided, whose beginning in the vegetable kingdom, and whose pro- 
 gressive development in the higher kingdom, have been contrived 
 upon consummate principles of Design, that the elements of matter 
 shall be gradually brought into those perfectly new conditions, both 
 as to composition and properties, which contradistinguish the organic 
 from the inorganic kingdom, and thus as in all things else in the nat- 
 ural world, that abrupt transmutation of inorganic into organic matter 
 which distinguished the Creative Act shall be avoided, and remain a 
 characteristic of Creative Power (§ 14, 172, 325). 
 
 337. In the early part of this work, I set forth some general facts 
 which evince an incongruity of doctrines that clearly divides the physi- 
 ological world into three schools ; one of them (pure chemistry) mak- 
 ing no distinction between the properties and laws of organic and in- 
 organic beings ; a second (pure vitalism) contradistinguishing the two 
 kingdoms in those fundamental conditions; and the third (chemico- 
 vitalism) blending the doctrines of chemistry and vitalism (§ 4^, 820 c). 
 Each of these denominations has interpreted the philosophy of di- 
 gestion accordinty to the g-eneral doctrines of life which are peculiar 
 to each. 
 
 338. Beginning with pure chemistry, we find the great leader set- 
 ting forth the process of digestion in the following language in his 
 late work on Animal Chemistry applied to Pathology and Therapeutics, 
 
 " Chymifxcation," he says, " is independent of the vital force. 
 It takes place in virtue of a purely chemical action, — exactly sim- 
 ilar to those processes of decomposition and transformation which are 
 tnown as putrefaction, fermentation, or decay" (§ 365). 
 
 It will be also seen from the foregoing quotation, that the chemist 
 s regardless of his own rules of philosophy, and of the fundamental 
 principles of chemistry ; since he identifies the organizing act, or that 
 which combines the elements of matter into complex organic com- 
 pounds, with the chemical process that resolves these compounds into 
 their ultimate elements. We are told, indeed, that this is " experi- 
 mental philosophy," and that, therefore, we must submit to it (§ 350). 
 
 339. a. I shall now set forth the exact doctrine of the vitalists rela- 
 tive to the physiology of digestion, in the language of the same dis- 
 tinguished " reformer" whom I have quoted in the preceding section. 
 It is true, the doctrines are as fundamentally opposed as contradiction 
 can possibly make them. But, as will have been abundantly seen, 
 the mo;t remarkable characteristic of the writings of this distinguishei?
 
 150 IXSTITUTES OF MEDICINE. 
 
 man are their palpable contradictions. Nor can there be any proof 
 so conclusive of the radical distinction between the philosophy of life 
 and the philosophy of cliemistry, about which " the reformer" was 
 simultaneously concerned. 
 
 But, I will go back for a conflicting doctrine to the treatise "on 
 Organic Chemistry applied, to Physiology " published a year or two 
 antecedently to his work " on Animal Chemistry ;^^ by which we shall 
 learn the extent of the confusion which pei'vades his writings, and the 
 tardiness with which it is discerned by his medical disciples. In that 
 work he says, 
 
 " The equilibrium in the chemical attractions of the constituents of 
 food is disturbed by the vital principle. The union of its ele- 
 ments, so as to produce new combinations and forms, indicates the 
 presence of a peculiar mode of attraction, and the existence of k 
 power distinct from all other powers of nature, namely, the 
 VITAL principle." " If the food possessed life, not merely the chem- 
 ical forces, but this vitality would offer resistance to the vital force 
 of the organism it nourished." — Liebig. 
 
 Such, then, is exactly the doctrine of the vitalist and solidist, mis- 
 taken by the chemist for his own, when he happened to be reasoning 
 according to the promptings of organic nature. The same views are 
 presented in the work on Ayiimal Chemistry (§ 350). 
 
 339, h. And here, perhaps, it may be worth our while to say that 
 the resuscitated chemical doctrine (§ 338) is apparently too wide a de- 
 parture from fact even for that part of the British medical profession 
 who have received most of the sayings of Liebig as oracular revela- 
 tions ; for we read in the late edition of the " Pharmacologia,'" now 
 devoted to the authorized philosophy (§ 349 (^,.676 h), that, 
 
 " According to the experiments of Spallanzani, and still more re- 
 cently of Dr. Beaumont, if, after putrefaction has actually advanced, a 
 substance in such a condition be introduced into the living stomach, 
 the process is immediately checked, and no signs of putrefaction are 
 presented by the digested food, although were the same substances 
 left at the temperature of 99° F., they would soon evince evidence of 
 its progress. It is therefore clear that the vital powers of the di- 
 gestive organs must, in such cases, reverse or suspend the ordinary 
 chemical affinities" (§ 676, b). — P aris'sP har7?iacologia, p. 148. Lon- 
 don, 1843. And such, in reality, is one of Liebig's conflicting state- 
 ments. 
 
 And why should not the " vital powers reverse or suspend the ordi- 
 nary chemical affinities" in all other cases of food, whei-e it is far more 
 obvious that such resistance does happen ; and why may we not con- 
 clude that the law in relation to digestion has a wide foundation in liv- 
 ing beings 1 Why does not the blood putrefy ] Why not any other 
 animal or vegetable fluid ] Why not any living animal or vegetable 
 solid ] 
 
 340. Let us now hear the student of organic nature upon the phys- 
 iology of digestion. What says John Hunter, of whom it is said by 
 one, that "he stands alone in our profession;" that, "in his immense 
 ■career, every thing bore reference to one great idea, — the discovery 
 and elucidation of ?iature' slaws ;" "who," says another, " was neither 
 anatomist, physiologist, surgeon, nor naturalist, alone, but the most 
 rema-.kable combination of all these which the world has yet seen;"
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 151 
 
 for, " where," says another, " in the calendar of time, shall we look 
 for an equal in the compass, the variety, and the depth of his researches 
 into the mysteries of animal life, or for consequences such as those 
 that have resulted from his labors to universal pathology ;" while an- 
 other apostrophizes, " how humble do any of the men of the present 
 day appear when placed by the side of Hunter!" "The genius of 
 Hunter," says another, "long ago explained the objections to othei 
 theories of digestion. These have been turned into ridicule to smooth 
 the way for hypotheses that have no better foundation." 
 
 Well may we ask, what says John Hunter on the physiology of di 
 gestion 1 
 
 "Digestion," he says, "is an assimilating process. It is a species 
 of generation'; but the curious circumstance is its converting both veg- 
 etable and animal matter into the same kind of substance or com- 
 pound, which no chemical process can effect. Those who took it up 
 dietnicalh/, being ignorant of the principles of the animal ecoyiojny, have 
 erroneously referred the operations of the animal machine to the laws 
 of chemistry." 
 
 341. The illustrious George Fordyce, after a thorough experiment 
 h1 investigation of the subject, comes to the conclusion that, 
 
 " The changes which take place in the substances capable of giving 
 nourishment, and, therefore, of being converted into the essential parts 
 of the chyle, are totally different from those changes which take 
 place any where but in the stomach, duodenum, and jejunum, when 
 alive. Therefore, no experiment made any where, excepting in these 
 INTESTINES OF THE LIVING ANIMAL, can in the Smallest degree influence 
 the doctrine of digestion." "Food placed in all the chemical circum- 
 stances that can be conceived similar to those in which it is placed in 
 the living animal, will never be converted into chyme, but will under- 
 go other changes totally different," He finally adds, as the result of 
 his own experiments out of the stomach, that, " tvhether we employ the 
 gastric juice, or bile, or saliva, in no case has chyle, or any thing like 
 IT, ever been produced." The reason is, that the gastric juice, like 
 the blood, loses its vitality as soon as abstracted from the stomach. 
 Hunter arrived at exactly the same conclusion from his obsei'vations 
 (§ 364).^ _ _ _ ...... 
 
 342. It is the opinion of Tiedemann, another distinguished inquirer 
 into the nature of digestion (§ 340, 341), that, 
 
 " All the phenomena of digestion and assimilation, and which are 
 only observed in living bodies, appear to rest, as to their foundation. 
 on the VITAL property which organized liquids -possess of producing, 
 under certain circumstances, in other organic matters, similar changes 
 that cause these bodies to acquire the properties themselves are en- 
 dowed withal." Again : 
 
 " It cannot be mistaken that digestion is an operation exclusively 
 the property of living bodies, and is in no ivay to be compared with the 
 changes of composition which general physical forces and the play of 
 chemical are capable of producing in inorganic matters. It must be 
 considered as a vital act, as an effect of life." 
 
 As to assimilation by vegetables, Tiedemann holds the same doc- 
 trine as Hunter, Fordyce, and all other physiologists whose opinions 
 have survived the day on which they were promulgated. Thus : 
 
 "On the subject of the material changes which vegetable parts un-
 
 152 INSTITUTES OF MEDICINE. 
 
 tlergo in nutrition, chemistry has hitherto given us no satisfactory in- 
 foiTnation, simply because, being effects of life, such changes arc beyond 
 the domain of chemical science. All that we are authorized to admit 
 is, that the changes of composition that occur during the nutrition of 
 veo-etables are the consequence of vital manifestations of activity, and 
 not the effects of chemical affinities, such as are observed in inorganic 
 bodies." 
 
 "All the attempts," he goes on, "of the iatro-mechanicians and ia- 
 tro-chemists to reach this point (assimilation) have failed ; and it is 
 vfeW ascertained that such ideas are both unsatisfactory and erroneous. 
 We are therefore under the necessity of regarding them as effects, 
 sui generis, as vital manifestations, founded on a pow^er peculiar to, 
 and inherent in, organic bodies." — Tiedemann's Physiology. 
 
 343. Turning to the gieatest of French physiologists, we hear from 
 him the same general protest against the corruption of medicine by 
 ingrafting upon it the physical sciences (§ 5^, b). 
 
 344. In considering farther the physiology of digestion, I shall in- 
 troduce, in the first place, a series of general conclusions which have 
 been derived from chemistry, both as to digestion and other organic 
 processes, and when in this respect and otherwise prepared, I shall 
 state the remaining grounds upon which I rely more specifically for 
 establishing the vital doctrine. 
 
 345. Let us hear, then, the distinguished chemist, Dr. Prout, as the 
 representative of those who mingle chemistry with vitalism. 
 
 " First," says Dr. Prout, " the stomach has the power of dissolving 
 alimentary substances, or, at least, of bringing them to a semi-fluid 
 state. This operation seems to be altogether chemical. 
 
 " 2d. The stomach has, within certain limits, the power of changing 
 into one another the simple alimentary principles," and " this part of 
 the operation of the stomach appears, like the reducing process, to be 
 chemical ; but not so easy of accomplishment. It may be termed the 
 converting operation of the stomach. 
 
 " 3d. The stomach must have, within certain limits, the power of 
 organizing and vitalizing the different alimentaiy substances." " It 
 is impossible to imagine that this organizing agency of the stomach can 
 be chemical. Its agency is vital, and its nature completely unknown." 
 
 346. Such, then, is the doctrine of digestion as entertained by the 
 chemico-vitalist (§ 345). But, from what we shall have seen of the 
 absolute contradictions which abound in the writings of those who at- 
 tempt the application of pure chemistry to the functions and results of 
 organic life, we may expect that the chemico-vitalist will be equally 
 inconsistent when he applies himself, at one time, to the phenomena 
 of living beings, and, at another, reasons from the results of the labor- 
 atory to those phenomena. Accordingly, we find within a few pages 
 of the foregoing doctrine of the chemico-physiologist, that he broadly 
 affirms that 
 
 " There is no relation whatever between the mechanical ar- 
 rangements and the chemical properties to which they administer." 
 " There is no reason why the chemical changes of organization should 
 result from the mechanical arrangements by which they are accom- 
 plished ; neither is there the slightest reason, why the mechanical 
 arrangements in the formation of organized beings should lead to the 
 chemical changes of which they are the instruments" !
 
 PHYSIOLOGY. ORGANIC CHEMISTRY — FUNCTIONS. 153 
 
 Here, then,' in a single sentence, are not only the strangest contra- 
 dictions, but a full admission that there is not the " slightest reason" 
 for the application of chemistry to any piocess, function, or result of 
 living beings. 
 
 347. Nor is that all. For the chemico-vitalist, the same eminent 
 chemist whom I have just quoted, goes on to say, that " vs^ith the liv- 
 ings the animative properties of organic bodies, chemistry has not the 
 smallest alliance, and probably will never, in any degree, elucidate 
 those properties. The phenomena of life are not even remotely anal- 
 ogous to any thing we know in chemistry as exhibited among inorganic 
 agents." And, as if to complete the overthrow of the chemical part 
 of the philosophy of digestion, the same reasoner observes that, " the 
 means by which the peculiarities of composition and structure are 
 produced, which is so remarkable in all organic substances, like the 
 results themselves, are quite peculiar, and bear little or no resem- 
 blance to any artificial process of chemistry f that "those who have 
 attempted, to apply chemistry to physiology and pathology have split 
 on a fatal rock by hastily assuming that what they found, by experi- 
 ment to be wanting, or otherwise changed, in the animal economy, 
 was the cause of particular diseases, and that such diseases were to 
 be cured by supplying, and adjusting artificially, the principle in error. 
 But the scientific physician will soon discover that Nature will not al- 
 low him to officiate as her journeyman, even in the most trifling de- 
 gree." — Dr. Prout's Bridgewater Treatise. 
 
 348. And, to the same effect may be quoted Dr. Carpentei', one of 
 the foremost, as we have seen, in the school of pure chemistry (§ 64,^). 
 
 " The agency of vitality," says this reasoner, in his Comparative 
 Physiology, where he generally ridicules the term and all that is rela- 
 tive to it, " the agency of vitality, as Dr. Prout justly remarks, does 
 not change the properties of the elements, but simply combines the 
 elements in modes which we cannot imitate"! 
 
 So, also. Dr. Roget, alike distinguished, in the school of chemico- 
 vitalism (§ 64, f) : " Vital chemistry" he says, " is too subtle a 
 vowEKfor human science to detect, or for human art to imitate." 
 
 And. thus the eminent Wagner, not less arrayed on the side of 
 chemistry : 
 
 " The existence of one or more powers, commonly called vital 
 powers, is not, however, denied. The final cause of the secretion 
 of the gastric juice lies in the nature of the animal organism, and 
 is unknown to us." — Wagner's Physiology, London, 1842, p. 346. 
 And yet this distinguished observer is one of the manufacturers of gas- 
 tric juice. 
 
 349. a. Thus might I go on with one after another, till I should 
 have exhausted the whole that have attempted to confound the science 
 of life with the science of chemistry, and prove by their own state- 
 ments that there is not the slightest intelligible connection between 
 them. Indeed, I have already, in the Medical and Physiological 
 Commentaries, pointed out this universal admission {^ 626 h). 
 
 The ground of chemistry being thus virtually abandoned to the vi- 
 talist, it would seem superfluous to pursue an adversary who is al- 
 ways upon the retreat. But, as he flies, he is forever shooting from 
 behind, and his Parthian weapons fall thickly and heavily upon the 
 vast multitude. He must therefore be subdued into a practical acqui-
 
 151 INSTITUTES OF MEDICINE. 
 
 esceiice \vith those consistent piunciples of nature which exact his con 
 sent, but not his comphance. 
 
 349, b. Perhaps no author has supplied so many examples of con- 
 tradictions in great fundamental principles, and in so small a compass, 
 as he who has so lately taken captive the physiological world. In the 
 Preface to the Essays " On the Philosophy of Vitality and the Modus 
 Operandi of Remedial Agents" I had occasion to say of the article on 
 " Poisons, Contagions, and Miasma," in Liebig's " Organic Chemistry 
 applied to Agriculture and Physiology,''^ that " it is certainly the most 
 stupendous exhibition of perverted facts, of combinations of conflict- 
 ing doctrines, and of the rudest system of pathology and therapeutics, 
 that can be found in the records of dreamy speculation." 
 
 It was objected by the editor of the London Lancet, that I did not 
 prove my allegations (§ 5^, a). Nor was it in any respect the object 
 of that work to do so. I was satisfied with calling attention to the 
 facts, and with what I had already published in the Medical and Phys- 
 iological Commentaries. Since that day, the work on " Ani7nal Chem- 
 istry'^ has appeared ; and it is now my purpose to sustain the allega- 
 tions of the " Preface," and this more especially from the objections 
 alleged by Liebig against physiologists (§ 350, mottoes, a, h, c, and d). 
 
 I say, therefore, that we meet on the same page a purely chemical 
 and a purely vital philosophy of digestion ; and equally so of other 
 important organic processes. That each is laid down without quali- 
 fication, and with the dictum of a master, who is conscious that the 
 preponderance he gives to the purely chemical philosophy of life will 
 establish his Empire in that philosophy with an age more prone than 
 ever to the doctrines of materialism. 
 
 349, c. Let us, therefore, not be deceived; for, however this very 
 extraordinary and successful pretender in medicine may beguile us 
 with words, and seem to persuade rather than to rule, let us remem- 
 ber that, at most, he does but invalidate his own edicts by counter- 
 mands, and that in the end he tells us that these apparently adverse 
 decrees are, in their absolute import, one and the same ; that they 
 are consistent laws delivered from the laboratory, though apparently 
 in conflict on account of the opposing forces, the attraction and repul- 
 sion, which preside in the chemistry of nature ; that, however, in re- 
 ality, there is no difference whatever in the seemingly two great prin- 
 ciples which lie at the foundation, which are one and identical, since 
 " the mysterious vital principle can he replaced hy the chemical forces f^ 
 and since, also, " the vital force unites in its manifestations all the pe- 
 culiarities of the chemical forces, and of the no less wonderful cause 
 which toe regard as the ultimate origin of electrical phenomena.'' And 
 again, " in the processes of 7iutrition and reproduction, the ultimate cause 
 of the different conditions of the vital force are chemical forces'" (§ 64, e). 
 — Liebig's Organic Chemistry ; and Animal Chemistry. 
 
 349, d. It is painful to speak thus of one so highly endowed, so 
 devoted in mind, so accomplished in chemistry ; but science and hu- 
 manity demand the sacrifice. But, again, I wish to be understood, 
 that neither here, nor in any other case, is it the individual of whom 
 I speak, but of his doctrines alone (§ 1 Zi, 4 h). Nor yet would the 
 doctrines of an individual become the subject of extended remark, 
 did they not represent the existing state of the three high branches 
 of medicine. The gigantic physical school had too much of the Pro-
 
 PH\SIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 155 
 
 teaxi character, too little unity of purpose, and demanded greater sta;- 
 bility. The learned men of a great Nation, The British Associa- 
 tionfor the Advancement of Science, united in the object, and be- 
 stowed the honor of achieving the enterprise upon a foreign Chemist. 
 The note of proscription has been sounded in high quarters, in due 
 conform'ity (§ 51 a, 350^ ]ck), and medical philosophy has nothing to 
 hope even from a spirit of toleration. The subject, therefore, must 
 be brought to the test of observation and reason, and he who arraigns 
 the authorized doctrines will cheerfully abide an unsuccessful issue 
 (§ 1 b, 676 b, 709, note). I shall therefore dwell upon the conclusions 
 of those who have engendered the corruptions, and shall array them 
 in all the force demanded by the magnitude of my subject, that we 
 may the better realize the shallowness of that pretended philosophy 
 which has so lately swept, like a hurricane, over the intellectual world, 
 that we may see, in the system of contradictions, the equal fallacy of 
 that school who endeavor, with great sincerity, to mingle the conflict- 
 ing principles, and that we may the better cultivate and enjoy the 
 simple and consistent philosophy which nature teaches. Nor will 1 
 yet leave this general reference to that stupendous system of assump- 
 tion and contradiction which was so lately hailed by physiologists as 
 the harbinger of a total revolution in medical science, ay, in the very 
 practice of medicine, without showing you the depth of the material- 
 ism in whicli it was founded. I say nothing now of the avowed 
 infidelity to which it has led. Examples of that disregard of instinct- 
 ive faith I have already placed in their proper connection with my 
 subject.* But, I will merely present, in relief, from Liebig's revolu- 
 tionary work, a doctrine of the chemical school, from which, if I mis- 
 take not the ambition of intellectual and immortal beings, the very 
 impulse of nature will turn the most indifferent with a loathing aver- 
 sion. We shall see from it, also, how entirely degraded to the rank 
 of the merest matter is every thing relating to organic life ; even man 
 himself. Thus, then, " the Reformer," in behalf of the school of 
 chemistry : 
 
 349, e. " Physiology has sufficiently decisive grounds for the opin- 
 ion that every ^notion, every manifestation of force, is the result of a 
 transformation of the structure or of its substance ; that every concep- 
 tion, every mental affection, is followed by changes in the chemical 
 nature of the secreted fluids ; that every thought, every sensation, is 
 accompanied by a change in the composition of the substance of 
 the brain." " Every manifestation of force is the result of a trans- 
 formation of the structure or of its substance^ — See p. 158, no. b\. 
 
 And now may it not be reasonably asked, what is the cause of those 
 ciiemical changes in the cerebral substance which give rise to " every 
 conception, every mental affection, every thought, and every sensa- 
 tion" (§ 175 c, 500 n, 1054, 1076 a) those ''manifestations of force" ? 
 
 Many organic chemists, however, are disposed to admit a spiritual 
 part, and they should therefore recollect that the existence of a prin- 
 ciple of life is not less substantiated by facts than the existence of the 
 soul, which they are so ready to concede when inviting our attention 
 to the physical doctrines of life. 
 
 350. I have just said that I would present such an aiTay of contra- 
 
 * See Medical and Physiological Commentaries, vol. ii., p. 122-140. Also, the Essay 
 on the Vital Poioers, in vol. i. Also Tacitus' Dialogue Concerning Oratory,
 
 156 INSTITUTES OF MEDICINE. 
 
 dictoiy opinions on the physiology of digestion, and the general phi- 
 losophy of life and disease, from the two brief National Essays by 
 Liebig (§ 349, b), as should induce physiologists to retrace their steps, 
 and thus make some atonement to the science which was surrendered 
 with an acclamation that had been worthy the original institution of 
 medicine. 
 
 In the first place, however, with a view to the cause which I advo- 
 cate, and in justice, also, to able and independent philosophers, I shall 
 quote the foUowdng remarks from a letter addressed to myself by a 
 distinguished writer, of Manchester (England) : 
 
 "Manchester, May 5, 184G. 
 
 " Dear Sir, 
 '■'■ I made your famplilet (a Lecture on Digestion) tlie sxihject of a 
 Paper xoMcli I read before the Manchester Literary and Philo- 
 sophical Society, and which provoked a discussion two nights. The 
 result was almost unanimously infovor of your views in reference to the 
 Philosophy of Digestion. lam, &c., 
 
 " Charles Clay, M.D," 
 
 I shall now exhibit, in parallel columns, the new philosophy which 
 forms the present science of medicine, preceded by some appropriate 
 mottoes. 
 
 a. " Animal and vegetable physiologists institute experiments without being ac- 
 quainted with the circumstances necessary to the continuance of life — with the qualities 
 and proper nourishment of the animal or plant on which they operate — or with the nature 
 and chemical constitution of its organs. These experiments are considered by them as 
 convincing proofs, while they are fitted only to awaken pity" (no. 50). 
 
 b. " All discoveries in physics and in chemistry, all explanations of chemists [ ! ] 
 must remain without fruit and useless, because even to the great leaders in physi- 
 ology, carbonic acid, ammonia, acids, and bases, are sounds without meaning, words 
 without sense, terms of an unknown language, which awaken no thoughts, and no asso- 
 ciations. They treat these sciences like the vulgar, who despise a foreign literature ia 
 exact proportion to their ignorance of it." — Liebig's Organic Chemistry applied to Phys- 
 iology, &.C. [See no. 2.]— ((J 1034). 
 
 c. " None of them (the most distinguished physiologists) had a clear conception of the 
 process of development and nutrition, or of the true cause of death. They professed to 
 explain the most obscure psychological phenomena, and yet they were unable to say what 
 fever is, and in what way quinine acts in curing it" (no. 2, 42). The oft-reiterated conclu- 
 sion folbws, that it is reserved for chemistry to resolve these problems. 
 
 d. " Thus medicine, after the fashion of the Aristotelian philosophy, has formed certain 
 conceptions in regard to nutrition and sanguification. Articles of diet have been di- 
 vided into nutritious and non-nutritious ; but these theories [ ! ] being founded on 
 observations destitute of the conditions most essential to the drawing of just conclusions, 
 could not be received as expressions of the truth. How clear are now to us the relations 
 of the different articles of food to the objects which they sei-ve in the body, since organic 
 chemistry has applied to the investigation her quantative method of research" ! (§ 18, 409.) 
 
 e. "The limited acquaintance of physiologists with the methods of research employed in 
 chemistiy will continue to be the chief impediment to the progress of physiology, as 
 well as a reproach which that science cannot escape." — Liebig's Animal Chemistry. 
 
 f. " Wliat has the soul, what have consciousness and intellect to do with the develop- 
 ment of the human foetus, or the foetus in a fowl's egg ? Not more, surely, than with the 
 development of the seeds of a plant. Let us first endeavor to refer to their ultimate causes 
 those phenomena of life which are not psychological ; and let vs beware of drawing con- 
 clusions before we have a ground-ivoi-k. We know exactly the mechanism of the eye ; but 
 neither anatomy nor chemistry will ever explain how the rays of light act on conscious- 
 ness, so as to produce vision. Natural science has fixed limits which cannot be passed, 
 and it must always be borne in mind that, with aU oiu- discoveries, we shall never know 
 what Ught, electricity, and magnetism are in their essence, because, even of those things 
 which are material, the human intellect has only conceptions. We can ascertain, how- 
 ever, the laws which regulate their motion and rest, because these are manifested in phe 
 nomena. In like manner, the laws of vitality, and of all that disturbs, pro 
 MOTES, OR alters VITALITY, may certainly be discovered, although we shall never learn 
 what life is" {^ 1G8). — Liebig's Animal Cliemistry.
 
 , PHYSIOLOGY. — ORGANIC CHEMISTRY — FUNCTIONS. 157 
 
 g. "For years past a tribunal has been established at Giessen, before which Liebig 
 is at the same time accuser, witness, public prosecutor, advocate, and judge." — Mcl- 
 dek's Reply to Liehig. Translation, London, 1846. 
 
 h. " Chemists and natural philosophers, accustomed to study the phenomena over which 
 the phj'sical forces preside, have carried their spirit of calculation into the theories of the 
 vital laws." — Bichat's General Anatomy, vol. ii., p. 54. 
 
 i. " Let a man be given up to the contemplation of one sort of knowledge, and that wiU 
 become every thing-. The mind will take such a tincture from a familiarity with that ob- 
 ject, that eveiy thing else, how remote soever, will be brought under the same view. A 
 metaphysician will bring ploughing and gardening immediately to abstract notions ; the 
 history of natm-e will signify nothing to him. A chemist, on the contrary, shall reduce 
 divinity to the maxims of his laboratory, explain morality by sal, sulphur, and mercury 
 and allegorize the Scripture itself, and the sacred mysteries thereof, into the philosopher's 
 stone." — Locke, on the Human Understanding. 
 
 k. "Mr. Locke, I think, mentions an eminent musician, who believed that God created 
 the world in six days, and rested on the seventh, because there are but seven notes in 
 music. I myself knew one of that profession who thought there were only three parts in 
 harmony, to wit, base, tenor, and treble, because there are but three persons in the Trin- 
 ity." — H,EiD, 0)1 the Powers of the Human Mind, vol. ii.. Essay 6, c. viii. 
 
 I. " When education takes in error as a part of its system, there is no doubt that it will 
 operate with abundant energy, and to an extent indefinite" (^ 433). — Burke. 
 
 CHEMICAL DOCTRINES. VITAL DOCTRINES. 
 
 1. " My OBJECT has been, in the 47. "A rational physiology 
 present work, to direct attention to cannot be founded on mere re- 
 the points of intersection of cJiem- actions, and the living body cannot 
 istry with physiology., and to point be viewed as a chemical labor- 
 out those parts in which the sci- atory." 
 
 ences become, as it were, mixed " The study of the uses of 
 
 up together. It contains a collec- the functions of different organs, 
 
 lion of problems, such as chemis- and of their mutual connection 
 
 try at present requires to be re- in the animal body, was formerly 
 
 solved, and a number of conclu- the chief object in physiological 
 
 sions drawn according to the rules researches ; but lately this study 
 
 of that science. These questions has fallen into the back-ground." 
 
 and problems will be resolved; — Liebig's Animal Chemistry. — 
 
 and Ave cannot doubt that we shall (See motto c.) 
 have in that case a new physiol- 48. " With all its discover- 
 
 OGY AND A RATIONAL PATHOLOGY." lES, Modem Chemistry has per- 
 
 — Liebig's Animal Chemistry. formed but slender services to 
 
 2. " In earlier times, the attempt physiology and pathology." — Lie- 
 has been made, and often with big, ibid. 
 
 GREAT success, to apply to the ob- 49. " Physiology still endeavors 
 
 jects of the medical art the views to apply chemical experiments to 
 
 derived from an acquaintance the removal of diseased conditions; 
 
 with chemical observations. In- but, with all these countless ex 
 
 deed, the great physicians, who periments, we are not one step 
 
 lived toward the end of the 17th nearer to the causes and essence of 
 
 century, were the founders of diseased — Liebig, ihid. 
 
 CHEMISTRY, AND IN THOSE DAYS 50. " Mechanical philosophers 
 
 THE ONLY PHILOSOPHERS AC- and CHEMISTS justly ascribe to 
 
 QUAiNTED WITH IT." — Liebig's THEIR methods of research the 
 
 Animal Chemistry . (See mottoes greater part of the success which 
 
 i, e.) has attended their labors." — Lie- 
 big's Animal Chemistry (a). 
 
 3. "\xi\hQ animal hody we, r&c- 51. "In the animal ovum, as 
 ognize as the ultimate cause of all well as in the seed of a plant,
 
 158 INSTITUTES OP MEDICINE. 
 
 CHEMICAL DOCTRINES. VITAL DOCTRINES, 
 
 force only one cause, the chemical we recognize a certain remark- 
 action which the elements of the ABLE force, the SOURCE OP 
 food and the oxygen of the air growth, or increase in the mass, 
 mutually exercise on each other, and of reproduction, or of supply 
 The only known ultimate cause of of the matter consumed ; a force 
 vital force, either in animals or in in a state of rest. By the ac- 
 plants, is a chemical process. If tion of external influences, by im- 
 THis be prevented, the phenom- pregnation, by the presence of air 
 ENA OF life do NOT MANIFEST and moisture, the condition of 
 themselves. If the chemical ac- static equilibrium of this force 
 tion be impeded, the vital phenom- is disturbed. Entering into a 
 ena must take new for 7ns.'" " All state of motion or activity, it 
 VITAL activity ARISES from the exJiihits itself in the production 
 mutual action of the oxygen of the of a series of forms, which, al- 
 atmosphere and the elements of the though occasionally bounded by 
 food," — Liebig's Animal Chemis- right lines, are yet widely distinct 
 try, from geometrical forms, such as 
 
 4. " The LIFE of animals exhib- we observe in crystalized miner- 
 its itself in the continual absorp- als. This force is called the vi 
 tion of the oxygen of the air, and tal force, vis vitce, or vitality." 
 its combination with certain parts "The increase of mass is effect- 
 of the animal body." — Liebig's ed in living parts by the vital 
 Animal Chemistry. force." — Liebig's Animal Chem- 
 
 5. " Physiology has sufficiently istry. (See my Essays on Vitali- 
 decisive grounds for the opinion, ty, &c., p. 13-18.) 
 
 that every motion, every mani- 51|, " The oxygen of the at- 
 
 FESTATioN OF FORCE, IS THE RE- mosphere is the proper, active, ex- 
 
 SULT OF A TRANSFORMATION OF tcrnal causc of the WASTE of mat- 
 
 THE STRUCTURE OR OF ITS SUB- tcr in the animal body. It acts 
 
 STANCE ; that every conception, ev- like a force which tends to disturb 
 
 ery mental affection, is followed by and destroy the manifestations of 
 
 changes in the chemical nature the vital force at every moment, 
 
 of the secreted fluids; that every But its effect as a chemical agent 
 
 thought, every sensation, is accom- (in producing waste), the disturb- 
 
 panied by a change in the composi- ance proceeding from it, is held 
 
 i/(??« of the substance of the brain"! in equilibrium by the vital 
 
 — Liebig's Animal Chemistry (no. force." — Liebig's Animal Chem- 
 
 41,18-J). istry. 
 
 5i, That our Author's intent 52. " The vital force is manifest- 
 
 cannot be doubtful appears from ed in the form of resistakce, in- 
 
 his unequivocal statement that — asmuch as by its presence in the 
 
 " The higher phenomena of men- living tissues their elements acquire 
 
 tai existence cannot, in the pres- the poicer of ivithstanding the dis- 
 
 ent state of science, be referred to turhance and change in their form 
 
 their proximate, and still less to and composition which external 
 
 their ultimate causes. \()f course, agencies tend to produce : a pow- 
 
 therefore, not to a Soul'] . We only er which, as CHEJncAL COM- 
 
 know of them that they exist." pounds, they do not possess." 
 
 Again — "The efforts of philoso- — Ja^jsig's, Animal Chemistry. 
 phers, constantly made to pene- 53. " The vital principle must 
 
 trate the relations of the soul to be a motive poaver, capable of
 
 PHYSIOLOGY. 
 
 -ORGANIC CHEMISTRY- FUNCTIONS. 
 
 159 
 
 CHEMICAL DOCTRINES. 
 
 animal life, have all along retard- 
 ed the progress of physiology. In 
 this attempt men have left the 
 province of philosophical research 
 for that of fancy" (p. 182-183, 
 § 350| gg, p. 924-925, § 1085).— 
 Liebig's Animal Chemistry. 
 
 6. " In the processes of nutri- 
 tion and REPRODUCTION, we per- 
 ceive the passage of matter from 
 the state of motion to that of rest 
 (static equilibrium). Under the in- 
 fluence of the nervous system, this 
 matter enters again into a state of 
 motion. The ultimate causes of 
 these different conditions of the vi- 
 tal force are chemical forces." 
 
 7. " The cause of the state of 
 motion is to be found in a series 
 of changes which the food under- 
 goes in the organism, and these 
 are the results of processes of 
 DECOMPOSITION, to which either 
 the food itself, or the structures 
 formed from it, or parts of organs, 
 are subjected" (^ 1054). 
 
 8. " The change of matter, the 
 manifestation of mechanical force, 
 and the absorption of oxygen, are, 
 in the animal body, so closely con- 
 nected with each other, that we 
 may consider the amount of mo- 
 tion and the quantity of living 
 
 TISSUE TRANSFORMED, AS PROPOR- 
 TIONAL TO THE QUANTITY OF OX- 
 YGEN inspired and consumed in a 
 given time by the animal." — Lie- 
 big's Animal Chemistry (no. 3, 4). 
 
 9. " If we employ these well- 
 known facts as means to assist us 
 in investigating the ultimate cause 
 of the mechanical effects in the an- 
 imal organism, observation teaches 
 us that the motion of the blood 
 
 AND of the other ANIMAL FLU- 
 
 VITAL DOCTRINES. 
 BIPARTING 5I0TI0X TO ATOMS AT 
 
 REST, and of opposing resistance 
 TO OTHER forces producing mo- 
 tion, such as THE CHEMICAL FORCE, 
 
 heat and electricity." — Liebig's 
 Lectures for 1844. 
 
 "Every thing in the organism 
 goes on under the influence of 
 
 the VITAL FORCE, AN IMMATERIAL 
 
 agent, which the chemist cannot 
 employ at will." — Liebig's Ani- 
 mal Chemistry. 
 
 54. " There is nothing to pre- 
 vent us from considering the vital 
 FORCE as a PECULIAR property, 
 which is possessed by certain ma- 
 terial bodies, and becomes sensi- 
 ble when their elementary parti- 
 cles are combined in a certain ar- 
 rangement or form. This suppo- 
 sition takes from the vital j^henom- 
 ena nothing of their wonderful pe- 
 culiarity. It may, therefore, be 
 considered as a resting point 
 from which an investigation into 
 these phenomena, and the laws 
 which regulate them, may be com 
 menced ; exactly as we considei 
 the properties and laws of light 
 to be dependent oh a certain lu- 
 miniferous matter or ether, which 
 has no farther connection with the 
 laws ascertained by investigation." 
 — Liebig's Animal Chemistry. 
 
 55. " Every thing in the ani- 
 mal organism, to which the name 
 of motion can be applied, pro- 
 ceeds from the nervous appara- 
 tus." " In animals we recognize 
 in the nervous apparatus a source 
 
 OF POWER capable OF RENEWING 
 
 ITSELF at every moment of theii 
 existence." — Liebig's Animal 
 Chemistry. 
 
 5^. " We may communicate 
 motion to a body at rest by means 
 of a numher of forces, very differ- 
 ent in their manifestations. Thus, 
 a time-piece may be set in motion 
 by a falling weight {^gravitation'), 
 or by a bent spring {elasticity\
 
 160 INSTITUTES OF MEDICINE. 
 
 CHEMICAL DOCTRINES. VITAL DOCTRINES, 
 
 IDS ])roceeds fi'om distinct organs, Every kind of motion may be pro- 
 
 which, as in the case of the heart duced by the electric or magnetic 
 
 and intestines, do not generate force, as well as by chemical at 
 
 THE MOVING POWER IN THEM- tractioTfi / whilc wc cannot say, as 
 
 SELVES, BUT RECEIVE IT FROM oTH- long as we Only consider the man- 
 
 ER QUARTERS." — Liebig's Animal ifestation of these forces in the phe- 
 
 Chemistry (no. 3, 4), nomenon or result produced, which 
 
 10. " Now, since the phenome- of these various causes of change 
 na of RioTioN in the animal body of place has set the objects in mo- 
 
 ARE dependent ON THE CHANGE tion. In THE ANIMAL ORGANISM 
 
 OF MATTER, the increase of the we are acquainted with only one 
 change of matter in any part is fol- cause of motion, and this is the. 
 lowed by an increase of all the same cause which determines the 
 motions. Consequently,if, in con- growth of living tissues and gives 
 sequence of a diseased trans- \X\qxq. the j)ower of resistance Xo Qy.- 
 FORMATiON OF LIVING TISSUES, a tcrnal agencies. It is the vital 
 greater amount offeree be gener- force." — Liebig, ihid. 
 ated than is required for the pro- 57. " In order to attain a clear 
 duction of the normal motions, it conception of these manifestations 
 is seen in the acceleration of of the vital force, so different 
 ALL OR some of THE INVOLUNTARY in form, we must bear in mind, 
 motions, as well as in a higher that every known force is recog- 
 TEMPERATURE OF THE DISEASED nizcd by two conditious of activi- 
 PART." — Liebig's Animal Chem- ty," &c. — Liebig's Animal Chem- 
 istry. \Such, with § 350|-, i, and istry. 
 no. 11, M the chemical substitute for 
 the medical aphorism, " uhi irrita- 
 tio ihi ajjluxus.^' It will be also 
 scenfrovi the foregoing nos. 7, 8, 9, 
 that Liebig considers the circula- 
 tion of the blood due to the agen- 
 cies of oxygen, and not at all to the 
 action of the heart. \ 
 
 11. " The power to effectTRANS- 58. •' Our notion of life involves 
 FORMATIONS docs not belong to the something more than mere repro 
 vital principle. Each transforma- duction, namely, the idea of an ao 
 tion is owing to a distui'bance in tive power exercised by virtue of 
 the attraction of the elements of a a definite form, and production 
 compound, and is, consequently, a and generation in a definite form. 
 PURELY CHEMICAL PROCESS." — The productiou of organs, and 
 Liebig's Organic Chemistry ap- their power not only to produce 
 flied to Physiology, &c. their component parts from the 
 
 12. "The combinations of the food presented to them, but to gen- 
 chemist' relate to the change of erate themselves in their orig- 
 maiter, forward and backward, to inalform and loith all their prop- 
 the conversion OF FOOD into the crtics, are characters belonging 
 VARIOUS TISSUES and secretions, exclusively to organic life, and 
 and to their metamorphosis into constitute a form of reproduction 
 lifeless compounds ; his investiga- independent op chemical pow- 
 TioNs ought to tell us what has ers. The chemical forces are sub-
 
 VHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 
 
 161 
 
 CHEMICAL DOCTRINES. 
 
 VITAL DOCTRINES. 
 
 TAKEN PLACE AND WHAT CAN TAKE ject TO THE INVISIBLE CAUSE BY 
 PLACE IN THE BODY." LiEBIG's WHICH THIS FORM IS PRODUCED. 
 
 Animal Gliemistry. Of the existence of this cause 
 
 13. " How beautifully and admi- itself we are made aware only 
 rably SIMPLE, with the aid of these hy the phenomena which it pro 
 discoveries {chemical), appears the duces. Its laws must be inves- 
 process of nutrition in animals, tigated_;M*i as we investigate those 
 the formation of their organs," of the other powers which effect 
 &c. motion and changes in matter." — 
 
 14. "Inthehandsofthephysiolo- Liebig's Organic Chemistry ap- 
 gist, ORGANIC CHEMISTRY must be- plied to Physiology, &c. 
 
 come an intellectual instrument, by 59. "It is not the true chemist 
 means of which he will be enabled who has endeavored to apply to 
 to trace the CAUSES of phenomena the animal organism his notions 
 invisible to the bodily sight." — derived from purely chemical pro- 
 Liebig's Animal Chemistry. cesses. He has not had the re- 
 
 14i. " Since, in different indi- motest intention of undertaking 
 viduals, according to the amount the explanation of any really vital 
 of force consumed in producing phenomenon upon chemical prin- 
 voluntary mechanical effects, une- ciples. The only part which 
 qual quantities of living tissues are chemistry now, or for the future, 
 wasted, there must occur in every can take in the explanation of the 
 individual, unless the phenomena vital processes, is limited to a more 
 of motion are to cease entirely, a precise designation of the phenom- 
 condition in which all voluntary ena, and to the task of control- 
 motions are completely checked ; ling the correctness of inferen- 
 in which, therefore, these occasion ces, and insuring the accuracy of 
 no waste. This condition is caUed all observations by number and 
 sleep." — Ibid. weight. Although the chemist is 
 
 able to analyze organic bodies, and 
 tell us their ultimate elements, he 
 does not claim the power of syn- 
 thesis, or of producing them again 
 by the union of these elements" ! ! ! 
 — Liebig's Lectures for 1844 (§ 
 350|-350|).— See no. 39. 
 
 15. " The self-regulating steam- 60. " In what form or in what 
 engines furnish no unapt image manner the vital force pro- 
 ofwhat occurs in the a^imaZJofZy." duces mechanical effects in 
 " The body, in regard to the pro- the animal body is altogether 
 duction of heat and force, acts unknown, and is as little to 
 just like one of these machines." — be ascertained by experiment 
 Liebig's Animal Chemistry. as the connection op chemical 
 
 16. " The vital force unites in action with thf phenomena of 
 its manifestations all the peculi- motion, which we can produce 
 ARiTiES OF CHEMICAL FORCES, and with the galvanic battery. We 
 of the not less wonderful cause know not how a certain invisible 
 which we regard as the ultimate something, heat, gives to certain 
 origin of electrical phenomena." bodies the power of exerting an 
 — Liebig's Animal Chemistry. enormous pressure on surround- 
 
 17. "The mysterious vital ing objects. "We know not even 
 
 L
 
 162 
 
 INSTITUTES DF MEDICINE. 
 
 CHEMICAL DOCTRINES. 
 
 rRiNCiPLE can be replaced by the 
 CHEMICAL FORCES." — LiEBio's Or- 
 ganic Chemistry applied to Phys- 
 iology, &c, 
 
 17-|. "The animal body is a 
 heated mass, Avhich bears the 
 
 SAME RELATION TO SURROUNDING 
 OBJECTS AS ANY OTHER HEATED 
 
 MASS. It receives heat when the 
 surrounding objects are hotter, it 
 loses heat when they are colder 
 than itself." — Liebig's Animal 
 Chemistry. (See § 3o0f, 440 c, 
 1044 a, b, 1046-1050.) 
 
 17f . " The high temperature of 
 the animal body is uniforonly and 
 under all circumstances the result 
 of the combination of a combusti- 
 ble substance with oxygen." 
 
 " The CARBON of the food, which 
 is converted into carbonic acid 
 within the body, must give out ex- 
 actly as much heat as if it had been 
 directly burned in the air, or in 
 oxygen gas. The only difference 
 is, that the amount of heat pro- 
 duced is diffused over unequal 
 times." 
 
 " By the combination of oxygen 
 with the constituents of the met- 
 amorphosed tissues, the tempera- 
 ture necessary to the manifes- 
 tations OP vitality is produced 
 in the carnivora." — Liebig's A7ii- 
 mal Chemistry (§ 440, nos. 17 and 
 18). 
 
 18. " The nerves which accom- 
 plish the voluntaiy and involunta- 
 ry MOTIONS in the body (no. 7-9) 
 are, according to the preceding 
 exposition, not the producers, 
 but ONLY the conductors of the 
 vital force (§ 59). They permit 
 
 VITAL DOCTRINES. 
 
 HOW this something itself is pro* 
 duced when we burn wood oi 
 coals. 
 
 " So it is with the vital force 
 and with the phenomena exhibit- 
 ed by living bodies. The cause 
 of these phenomena is not chem- 
 ical force ; it is not electricity, 
 nor magnetism. It is a peculiar 
 FORCE, because it exhibits mani- 
 festations which are formed by NO 
 
 OTHER KNOWN FORCE."' 
 
 61. "In regard to the nature 
 AND essence of the vital force, we 
 can hardly deceive ourselves, when 
 we reflect, that it behaves, in all 
 its manifestations, exactly like 
 other natural forces ; that it is 
 devoid of consciousness or of vo- 
 lition, and is subject to the action of 
 a blister." — Liebig's Animal 
 Chemistry. 
 
 ^\\. " Certain other constitu- 
 ents of the blood may give rise to 
 the formation of carbonic acid in 
 THE lungs. But, all this has no 
 connection with that vital pro- 
 cess BY WHICH THE HEAT neCCSSa- 
 
 ry for the support of life is gen- 
 erated in every part of the body." 
 — Liebig's Animal Chemistry. 
 
 Glf. Nevertheless — "In the animal 
 organism two processes of oxydation are 
 going on ; one in the kings [the union 
 of oxygen with an ' organic compound of 
 iron'], the other in the capillaries [the 
 union of the absorbed oxygen with car- 
 bon, &c.]. By means of the fokjiee, in 
 spite of the degree of cooling, and of the 
 increased evaporation which takes place 
 there, the constant temperature of the 
 LtrxGS is kept up, while the heat of the 
 KEST OF THE BODY Is Supplied by the 
 latter" ! — Liebig's Animal Chemistry. 
 
 62. " In the present state of our 
 knowledge, no one, probably, will 
 
 IMAGINE that ELECTRICITY is tO be 
 
 considered as the cause of the 
 phenomena of motion in the 
 body." " Every thing in the ani- 
 mal oro-anism to which the name
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 
 
 163 
 
 CHEMICAL DOCTRINES. 
 
 the current to traverse them, and 
 present, as conductors, of elec- 
 tricity, ALL THE phenomena 
 WHICH THEY EXHIBIT AS CONDUCT- 
 ORS OF THE VITAL FORCe" ! LlE- 
 
 big's Animal Chemistry. [Com- 
 pare with no. 55.] 
 
 18j. " If CHEMICAL ACTION be 
 
 excluded as a condition of nervous 
 agency, it means notiiing else than 
 to derive the presence of motion, 
 
 the MANIFESTATION OF FORCE, FROM 
 
 NOTHING. But no force, no pow- 
 er, CAN COME FROM NOTHING"! — 
 Liebig's Animal Chemistry (no. 5). 
 
 19. " By means of the nerves, 
 ALL PARTS of the body receive the 
 moving force which is indispen- 
 sable to their functions, to change 
 of place, to the production of me- 
 chanical effects. Where nerves are 
 not found, motion does not occur. 
 [In plants, for example 1] The 
 excess of force genei"ated in one 
 place is conducted to other parts 
 by the nerves. The force which 
 one organ cannot produce in itself 
 is conveyed to it from other quar- 
 ters, [ ! ] and the vital force which 
 is wanting to it, in order to furnish 
 resistance to external causes of 
 disturbance, it receives in the form 
 of excess from another organ, an 
 excess which that organ cannot 
 consume in itself"! — Liebig's An- 
 imal Chemistry (§ 422, 423, 733 e). 
 
 20. " The phenomena of motion 
 IN VEGETABLES, the circulation of 
 the sap, for example, observed in 
 many of the characeas, and the 
 closing of flowers and leaves, de- 
 pend on PHYSICAL and mechanical 
 causes. Heat and light are the 
 
 remote causes of MOTION in VEG- 
 ETABLES ; but in animals we rec- 
 ognize in the nervous apparatus A 
 SOURCE OF POWER, Capable of re- 
 newing itself at every moment of 
 their existence," — Liebig's Ani- 
 mal Chemistry. 
 
 21. " While the assimilation 
 
 VITAL doctrines. 
 
 of MOTION can be applied proceeds 
 from the nervous apparatus. In 
 animals we recognize in the ner- 
 vous apparatus a source of pow- 
 er, CAPABLE OF RENEWING ITSELF 
 
 at every moment of their exist- 
 ence." — Liebig's Animal Chem- 
 istry (no. 55). 
 
 62i. "But all this (formation 
 of carbonic acid) has no connection 
 with that VITAL process by which 
 the heat necessary for the support 
 of life is generated in every part 
 of the body." — Liebig's Animal 
 Chemistry. 
 
 63. " Pathology informs us that 
 the true vegetable life is in no way 
 dependent on this apparatus 
 (the cerebro-spinal) ; that the pro- 
 cess of nutrition proceeds in those 
 parts of the body where theNERVES 
 of sensation and voluntary motion 
 are paralyzed, exactly in the same 
 way as in other parts where these 
 nerves are in the normal condi- 
 tion ; and, on the other hand, that 
 the most energetic volition is inca- 
 pable of exerting any influence on 
 the contractions of the heart, on 
 the motion of the intestines, or on 
 the processes of secretion." — Lie- 
 big's Ani?nal Chemistry. 
 
 64. " Although plants require 
 light, and, indeed, sun light, it is 
 not necessary that the direct rays 
 of the sun reach them. Their 
 FUNCTIONS certainly proceed with 
 greater intensity and rapidity in 
 sunshine, than in the diffused light 
 of day; but it merely accelerates 
 in a greater degree the action 
 already existing." — Liebig's 
 Organic Cheinistry applied tf 
 Physiology, &c. 
 
 0,5. " The vital principle is 
 only known to us through the pe- 
 culiar form of its instruments ,
 
 164 INSTITUTES OF MEDICINE. 
 
 CHEMICAL DOCTRINES. VITAL DOCTRINES. 
 
 of food in VEGETABLES, and the that is, through the organs in 
 
 WHOLE PROCESS OF THEIR FORMA- WHICH IT RESIDES. Hcnce, what- 
 
 TioN, are dependent on certain ever kind of energy a substance 
 
 EXTERNAL INFLUENCES wMc7i fTo- may possess, if it is amorphous 
 
 duce motion, the development of the and destitute of organs from 
 
 ANIMAL organism is, to a certain which the impulse, motion, or 
 
 extent, independent of those exter- change, proceeds, it does not 
 
 nal influences, just because the live. Its energy depends, in 
 
 animal body can produce within this case, on a chemical action, 
 
 itself that source of motion Light, heat, electricity, or other 
 
 which is indispensable to the influences [justly considered here 
 
 VITAL process." — Liebig's Ani- by Lieblg as vital stimuli and not 
 
 vial Chemistry. forces^ may increase, diminish, or 
 
 22. " Neither the emission of arrest this action ; but they are 
 carbonic acid nor the absorption not its efficient cause." " The 
 of oxygen (by plants) has any con- vital principle opposes to the 
 nection with the process of assim- continual action of the atmosphere, 
 ilation ; nor have they the slight- moisture, and temperature, upon 
 est relation to each other. The the organism, a resistance which 
 one is purely a mechanical, the is, in a certain degree, invincible. 
 other a purely chemical process. It is by the constant neutralization 
 A COTTON WICK, inclosed in a and renewal of these extei'nal in- 
 lamp, w^hich contains a liquid sat- fluences that life and motion are. 
 urated with carbonic acid, acts ex- maintained." — Liebig's Organic 
 actly in the same manner as a liv- Chemistry applied to Physiology, 
 ing plant in the night." — Liebig's &c. (§ 188J, d). 
 
 Organic Chemistry applied to 66. " An abnormal productioi' 
 
 Physiology, Sec. of certain component parts of plants 
 
 23. " At night, a true chemical presupposes a power and capabil- 
 process commences, in conse- ity of assimilation, to which the 
 quence of the action of the oxygen most powerful chemical action 
 of the air upon the substances cannot be compared. The best 
 composing the leaves, blossoms, idea of it may be formed, by con- 
 and fruit. This process is not at sidering that it sui-passes in power 
 all connected with the life of the the stronge st galvanic battery, with 
 vegetable organism, because it which v,-e are not able to separate 
 goes on in the dead plant exact- the oxygen from carbonic acid, as 
 LV as in a living one" ! is done by the leaves of plants,''^ 
 
 Nevertheless, " and without the direct solar rays." 
 
 231. " What value can be at- 67. " All that we can do is to 
 tached to experiments, in which supply those substances which are 
 all those matters which a plant adapted for assimilation by the 
 REQUIRES in the process of assim- power already present in the or- 
 ilation, besides its mere nutri- gans of the plant." — Liebig's Or- 
 ment, have been excluded with ganic Chemistry applied to Phys- 
 the greatest care % Can the iology, &c. 
 
 laws of life be investigated in 68. " The living part of a plant 
 an organized being which is dls- acquires the whole force and di- 
 eased or dying ?" — Liebig's Or- rectlon of its vital energy from 
 ganic Chemistry applied, &c. — Or, the absence of all conductors of 
 can those laws be investigated in force. By this 7neans the leaf it
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 
 
 165 
 
 CHEMICAL DOCTRINES. 
 
 " a cotton wick, inclosed in a 
 lamp ]" 
 
 And so of animals. 
 
 24. " The peiTneability to gases 
 is a mechanical property, common 
 to ALL ANIMAL tissues ; and is 
 found in the same degree in the 
 LIVING as in the dead tissue" ! — 
 Liebig's Animal Chemistry (§ 
 350J, n, and Medical and, Phys- 
 iological Commentaries, vol. i., p. 
 565, 569, notes, 683-690). 
 
 24^. " The surface of the body 
 is the membrane from which evap- 
 oration goes constantly forward. 
 In consequence of this evapo- 
 eation all the fluids of the 
 
 BODY, IN obedience TO ATMOS- 
 PHERIC PRESSURE, EXPERIENCE MO- 
 TION in the direction toward the 
 evaporating surface. This is ob- 
 viously the CHIEF CAUSE of the 
 passage of the nutritious fluids 
 through the walls of the blood-ves- 
 sels [strained of], and the cause 
 
 OF THEIR DISTRIBUTION THROUGH 
 
 THE BODY. We know NOAV what 
 important function the skin fulfills 
 through evaporation" ! — Liebig's 
 Researches on the Chemist)^ of Food, 
 «fec., American Journal of Science 
 and Arts, May, 1848, p. 415. — 
 See contradiction in nos. 5, 6, 7, 8, 
 9, 10, 69-75. Also § 350i n. 
 
 25. "Analogy, that fertile source 
 of error, has unfortunately led to 
 the very unapt comparison of the 
 VITAL functions of plants with 
 those of animals." — Liebig's Or- 
 ganic Chemistry applied to Physi- 
 ology, &c. 
 
 26. " All substances in solu- 
 tion IN a soil ARE ABSORBED BY 
 THE ROOTS OF PLANTS, EXACTLY AS 
 A SPONGE IMBIBES A LIQUID, AND 
 ALL THAT IT CONTAINS, WITHOUT 
 SELECTION," and " THEIR ASSIMI- 
 LATION is a PURELY CHEMICAL PRO- 
 CESS."— IbID. (no. 22, § 289-291). 
 
 Nevertheless, 
 
 VITAL DOCTRINES. 
 
 enabled to overcome the strongest 
 chemical attractions, to decompose 
 CARBONIC acid, and to assimilate 
 the ELEMENTS of its nourishment." 
 — Liebig's Animal Chemistry. 
 
 69. " In vegetable physiology, 
 a leaf is regarded in every case 
 merely as a leaf, notwithstanding 
 that leaves generating oil of tur- 
 pentine or oil of lemons, must pos- 
 sess a different nature from those 
 in which oxalic acid is formed. 
 Vitality, in its peculiar operations, 
 MAKES use of a SPECIAL apparatus 
 for each function of an organ. Veg- 
 etable physiologists, in the study 
 of their science, have not directed 
 their attention to that part of it 
 (the laws of vitality) which is most 
 ivorthy of investigation." — Liebig's 
 Organic Chemistry applied to Phys- 
 iology, &c. 
 
 70. "In the living plant, the in- 
 tensity of the VITAL force far ex- 
 ceeds that of the chejhcal action 
 of oxygen. "We know, Avith the 
 UTMOST certainty, that, by the in- 
 fluence of the VITAL FORCE, OXY- 
 GEN is separated from elements to 
 which it has the strongest affinity ; 
 and that it is given out in the gas- 
 eous form, without exerting the 
 slightest action on the juices of the 
 plant." — Liebig's Animal Chem- 
 istry. 
 
 71. " The ANIMAL ORGANISM I; 
 A higher KIND OF VEGETABLE." 
 
 " Assimilation, or the process 
 of FORMATION and GROWTH, goes 
 on in the same way in animals 
 and in vegetables. In both the 
 SAME cause determines the in- 
 crease of mass. This constitutes 
 the TRUE vegetative life." — Lie 
 big's Animal Chemistry. 
 
 72. " The CONSTITUENTS of veg 
 
 etable and animal substances are 
 formed under the guidance and 
 power of the vital principle, 
 which determines the direction of 
 their molecular attraction " " In
 
 166 INSTITUTES OF MEDICINE. 
 
 CHEMICAL DOCTRINES. VITAL DOCTRINES. 
 
 26^. " When roots find their the formation of vegetable and an- 
 MORE appropriate BASE in suffi- imal substances, the vital prin- 
 cient quantity, they will take up ciple opposes, as a force of re- 
 less OF ANOTHER." — And, again sistance, the action of the other 
 {in opposition to the simile of the forces," &c. — Liebig's Lectures 
 " sponge,'" and " la?np-wick") : for 1844. — See p. 31, >^ 59. 
 " It is thought very remarkable, 73. " The force which gives to 
 that those plants of the grass the germ, the leaf, and the radi- 
 tribe, the seeds of which furnish cal fibres of the vegetable the 
 food for man, follow Mm like the same wonderful properties (di- 
 domestic animals. But sali?ie plants gestion, circulation, and secretion), 
 seek the sea-shore ov sali?ie springs, is the same as that residing in 
 and the Chcenopodium the dung- the secreting membranes and 
 hill from similar causes. Saline glands of animals, and which en- 
 plants require common salt, and ables every animal organ to per- 
 plants which grow on dung-hills, form its own proper functions." — 
 only, need ammonia and nitrates, Liebig's Animal Chemistry. 
 and they are attracted whither 74. "In the animal organism the 
 these can be found, just as the vital force exhibits itself as 
 dung-fly is to animal excrements." in the plant, in the form of 
 " The roots of plants are con- growth, and as the means of re- 
 stantly engaged in collecting from sistance to external agencies." 
 the rain those alkalies which form- — Ibid. 
 
 ed part of the sea-water, and also 75. " If we assume that all the 
 
 those of the water of springs which phenomena exhibited by the oi"- 
 
 penetrates the soil." ganism of plants and animals are 
 
 27. "Each new radical fihril to be ascribed to A peculiar cause, 
 which a plant acquires may be re- different in its manifestations from 
 garded as constituting, at the same all other causes which produce 
 time, A mouth, a lung, and a motion or change of condition ; 
 stomach. The roots perform the if, therefore, we regard the vital 
 functions of the leaves from the force as an independent force 
 first moment of their formation ; (no. 3), then, in the phenomena 
 they EXTRACT from the soil their of organic life, as in all other phe- 
 proper nutriment, namely, the CAR- nomena ascribed to the action of 
 BONic ACID generated by the hu- forces, we have the statics, that is, 
 mus." — Liebig's Organic Chem- the state of equilibrium determ- 
 istry applied to Physiology. ined by a resistance, and the dy- 
 
 28. [" Nature speaks to us in a namics of the vital force" ! — 
 peculiar language, in the language Ibid. 
 
 of phenomena. She answers, at all 76. " Vegetables produce in 
 
 times, the questions which are put to their organism the blood op all 
 
 her; and such questions are exper- animals." — Liebig, ?'&?(?. 
 
 iments. An experiment is the eX' To occupy space, nos. 26^ and 
 
 pression of a thought. We are near- 27 are contrasted with nos. 25 and 
 
 er the truth, when the phenom- 26 in the same column. And so 
 
 enon, elicited by the experiment, with 5^, 23^. But here is more in 
 
 corresponds to the thought ; the more appropriate place, upon 
 
 while the opposite result shows this fundamental point. Thus : 
 
 that tlte questiomvas f\IjSTS.i.y ST A- 77. "When it is considered, 
 
 ted, and that the conception teas that sea-water contains less thar
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 
 
 167 
 
 CHEMICAL DOCTRINES. 
 
 ERRONEOUS." — Liebig's Organic 
 
 Chemistry, &c. (^ 1052, 1054). 
 
 [I pause in my quotations for the pur- 
 pose of indicating the important bearing of 
 the '■'■chemistry of plaints" upon the chem- 
 ical philosophy of digestion in animals as 
 carried on b}' the gastric juice. Now, if 
 in the latter case the agencies be of a chem- 
 ical nature, there should be some analogy 
 between the supposed chemical transform- 
 ation of organic compounds by the gastric 
 juice and the transformation of inorganic 
 substances into organic compounds as ef- 
 fected by plants, especially considering 
 that "vegetables produce in their organ- 
 ism the blood of all animals" (no. 76). 
 Chemistrj' is prodigal of experiments, and 
 of supposititious agents from pepsin to 
 chlorine, in resolving digestion by ani- 
 mals, but vouchsafes scarcel}- a word in 
 behalf of tliat ^'creative function" by which 
 " the blood of all animals" is generated by 
 plants out of the elements of matter. Will 
 Chemistry explain (§ 301, 360) ? ] 
 
 29. " The most decisive exper- 
 iments of physiologists have shown 
 that the process of chymification 
 is independent of the vital force ; 
 that it takes place in virtue of a 
 
 PURELY CHEMICAL action, EXACTLY 
 
 SIMILAR to those processes of de- 
 composition or transformation 
 which are known as putrefac- 
 tion, fermentation, or decay." 
 — Liebig's Animal Chemistry. 
 
 " Those remarkable phenom- 
 ena, fermentation, putrefac- 
 tion, and DECAY, are the pro- 
 cesses of Decomposition, and 
 their ultimate results are to re- 
 convert the elements of organic 
 bodies into that state in which they 
 exist before they participate in the 
 processes of life." — Liebig's Lec- 
 tures for 1844. 
 
 30. " The second part of the 
 work will treat of the chemical 
 processes which effect the com- 
 plete DESTRUCTION of plants and 
 animals after death, such as the 
 peculiar modes of decomposition 
 usually described d,s fir mentation, 
 -putrefoction. and decay y — Lie- 
 
 vital doctrines. 
 
 To 00 00 o' ^^ ^^^ own weight of io- 
 dine, and that all combinations of 
 iodine with the metallic bases of 
 alkalies are highly soluble in wa- 
 ter, so7nc 2>rovisio7i Tnust necessarily 
 be supposed to exist in the organ- 
 ization of sea-weed and the dif- 
 ferent kinds offeree by which they 
 are enabled, during their life, 
 TO EXTRACT IODINE in the form of 
 a soluble salt from sea-water, and 
 
 to ASSIMILATE IT IN SUCH A MAN- 
 NER that it is not again restored to 
 the surrounding mediuhi. These 
 plants are collectors of iodine, 
 JUST as land plants are of al 
 KALiES ; and they yield us this el- 
 ement IN quantities such as we 
 could not otherwise obtain from 
 the water without the evaporation 
 of WHOLE SEAS." — Liebig's Or- 
 ganic Chemistry applied to Physi- 
 ology, &c. — (^ 1054). 
 
 78, " The equilibrium ixi the 
 chemical attractions of the constit- 
 uents of food is disturbed by the 
 VITAL PRINCIPLE ;" and " the un- 
 ion of its ELEMENTS, SO as to pro- 
 duce neiv combinations ^.ndi forms 
 indicates a peculiar mode of at- 
 traction, and the existence of A 
 
 POWER DISTINCT FROM ALL OTHER 
 
 POWERS OF NATURE, namely, the 
 VITAL PRINCIPLE." — Liebig's Or- 
 ganic Chemistry applied to Physi- 
 ology, &c. 
 
 79. " The VITAL force causes a 
 DECOMPOSITION oi the constituents 
 of food, and destroys the force of 
 attraction which is continually ex- 
 erted between their molecules. It 
 altei's the direction of the chemi- 
 cal FORCES in such wise, that the 
 ELEMENTS of the Constituents of 
 the food arrange themselves in an- 
 other form, and combine to pro- 
 duce new compounds. It forces 
 the new compounds to assume forms 
 altogether different from those 
 which are the result of the attrac- 
 tion of cohesion when acting free*
 
 168 INSTITUTES OF MEDICINE. 
 
 CHEMICAL DOCTRINES. VITAL DOCTRINES. 
 
 big's Organic Chemistry aj^plicd ly, that is, without resistance.''—- 
 
 to Tliysiology, &c. Liebig's Animal Chemistry. 
 
 31. " In the SAME WAY as Mus- 80. "It is well known that 
 CULAR fibre, when separated from in many graminivorous animals, 
 the body, communicates the state where the digestive organs have 
 of decomposition existing in its been overloaded with fresh juicy 
 elements to the peroxide of hydro- vegetables, these substances un- 
 gen, so a certain product, arising dergo in the stomach the same 
 by means of the vital process, and decomposition as they would at 
 hy consequence of the transposition the same temperature out of the 
 of the elements of parts of the stom- body. They pass into ferment a- 
 ach and of the other digestive or- tion and putrefaction, whereby 
 gans [ ! ] while its own metamor- so great a quantity of carbonic 
 pilosis is accomplished in the stom- acid gas and of inflammable gas 
 ach, ACTS ON the food. The in- is generated, that these organs 
 soluble matters are digested" ! — are enormously distended, and 
 Liebig's Animal Chemistry. sometimes even to bursting." — 
 
 32. " Is it truly vitality, which Liebig's Animal Chemistry. 
 generates sugar in the germ for 81. " The vital force appears 
 the nutrition of young plants, or as a moving force or cause of mo- 
 which gives to the stomach the tion, when it overcomes the chem- 
 power to dissolve and to prepare ical forces, cohesion and affini- 
 for assimilation all the matter in- ty, which act between the con- 
 troduced into it ? A decoction stituents of food, and when it 
 OF MALT possesses as little power changes the position or place in 
 to reproduce itself, as the stomach which their elements occur. The 
 of a DEAD CALF. Both are, un- vital force is manifested as A 
 questionably, destitute of life. But, cause of motion in overcoming 
 when starch is introduced into a the chemical attraction of the 
 decoction of malt, it changes, first constituents of food, and is, far- 
 into a gummy matter, and lastly ther, the cause which compels 
 into sugar. Hard-boiled albumen, them to combine in a new arrange- 
 and muscular fibre, can be dis- ment, and to assume new forms.' 
 solved in a decoction of a calf's — Liebig's Animal Chemistry. 
 stomach, to which a few drops of 82. " It will be shown in the 
 muriatic acid have been added, second part of this woi'k, that all 
 precisely as in the stomach it- plants and vegetable structures 
 *eZ/l" — Liebig's Organic Chemis- undergo two processes of decom- 
 try., &c. (no. 11). position after death. One of 
 
 33. " All substances which can these is named fermentation, the 
 an-est the phenomena oi fermen- other decay or putrefaction." — 
 tation and putrefaction in liquids, Liebig's Organic Chemistry ap- 
 also arrest digestion when taken j'^^^^^ to Physiology, &c., (§ 349, 
 into the stomach" ! — Liebig's An- c, e). 
 
 imal Chemistry . 
 
 34. " In the natural state of the 83. " The individual organs 
 digestive process, the food only such as the stomach., cause all the 
 undergoes % change in its state of organic substances conveyed tc 
 cohesion, becoming fluid without them, which are capable of trans- 
 any other change of properties." — formation, to assume new forms. 
 Liebig's Animal Chemistry. The stomach compels the ele-
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS 
 
 169 
 
 CHEMICAL DOCTRINES. 
 
 35. Although "the process of 
 
 CHYMIFICATION IS INDEPENDENT of 
 
 the vital force, and takes place in 
 virtue of a purely chemical action, 
 EXACTLY similar to those processes 
 of decomposition which are known 
 
 as PUTREFACTION, FERMENTATION, 
 
 or DECAY ;" nevertheless, " Inor- 
 ganic compounds differ from or- 
 ganic in as great a degree as in 
 their simplicity of constitution " — 
 Liebig's Animal Chemistry, and 
 Organic Chemistry. 
 
 36. " The power of elements to 
 unite together, and to form pecu- 
 liar compounds which are genera- 
 ted in animals and vegetables, is 
 chemical affinity." — Liebig's 
 Organic Chemistry applied to 
 Vhysiology^ &c. 
 
 37. " We should not permit our- 
 selves to be withheld, by the idea 
 of a VITAL principle, from consid- 
 ering in a chemical point of view, 
 the process of transformation of 
 the food, and its assimilation by 
 the VARIOUS organs. This is the 
 more necessary, as the views hith- 
 erto held have produced no re- 
 sults, and are quite incapable of 
 useful application." — Liebig's Or- 
 ganic Chemistry applied, &c. 
 
 38. " We know that an organ- 
 ized body cannot generate sub- 
 stances, but only change the mode 
 of their combinations, and that its 
 sustenance and reproduction 
 depend upon the chemical trans- 
 formation of the matters which are 
 employed as its nutriment, and 
 which contain its own constituent 
 
 VITAL DOCTRINES. 
 
 MENTS of these substances to unite 
 into a COMPOUND j?^^e<i for the for- 
 mation of the blood." — Liebig's 
 Organic Chemistry, &c. 
 
 84. " The FIRST substance ca- 
 pable of affording nutriment to an- 
 imals is the LAST product of the 
 CREATIVE ENERGY of Vegetables." 
 — Liebig's Animal Chemistry. 
 
 85. " The special characters of 
 food, that is, of substances fitted for 
 assimilation, are absence op ac- 
 tive chemical PROPERTIES, and 
 the capability of yielding to trans- 
 formations." — Liebig's Organic 
 Chemistry applied to Physiology 
 &c. 
 
 86. " Ml experience proves that 
 there is in the organism only one 
 source of physical power ; and 
 this source is the conversion of liv- 
 ing parts into lifeless, amorphous 
 COMPOUNDS." — Liebig's Animal 
 Chemistry. 
 
 86j. " It is only with the com- 
 mencement oi chemical action that 
 the separation of a part of an or- 
 gan in the form of lifeless com- 
 pounds begins." — Liebig's Ani- 
 mal Chemistry, 
 
 87. " When a chemical com 
 pound of simple constitution is in- 
 troduced into the stomach, its 
 
 CHEMICAL ACTION is, of COUrSC, OP- 
 VoSED BY THE VITAL PRINCIPLE 
 
 The results produced depend upon 
 the strength of their respective ac- 
 tions. Either an equilibrium of 
 BOTH POWERS is attained, a change 
 being effected without the destruc- 
 tion of the vital principle ; in which 
 case a medicinal effect is occa- 
 sioned. Or, the acting body yields 
 
 TO THE SUPERIOR FORCE OF VITAL- 
 ITY, that is, IT IS DIGESTED. Or 
 
 lastly, the chemical action ob- 
 tains the ascendency and ^TS as 
 A POISON." — Liebig's Organic 
 Chemistry applied to Physiology 
 &c. 
 
 87|. " The VITAL POWER in veg
 
 f70 INSTITUTES OF MEDICINE. 
 
 CHEMICAL DOCTRINES. VITAL DOCTRINES. 
 
 elements. Whatever we regard etables accomplishes the trans 
 as the cause of these transforma- formation of mineral substances 
 dons, the act of transformation is into an organism endowed with 
 a purely CHEMICAL PROCESS. It life." — Liebig's Animal Chcni- 
 will be shown, when considering istry. 
 
 the processes oi fermentation and S7|. " The cause of waste of 
 vutref action, that any disturbance matter is the chemical action of 
 of the mutual attraction subsist- oxygen. This waste of matter oc- 
 ing between the elements of a curs in consequence of the absorp- 
 body gives rise to a transforma- tion of oxygen into the substances 
 tion." — Liebig's Organic Chem- of living parts. This absorption 
 rstry, &c. of oxygen occurs only when the 
 
 resistance which the vital force oj 
 living parts opposes to the chem- 
 ical action of the oxygen is weak- 
 er than that chemical action." — 
 Liebig's Animal Chemistry (nos. 3, 
 4, 7, 8, 11, 86i). 
 
 39. " By CHEMICAL AGENCY we 88. " The constituents of veg- 
 can produce the constituents of etable and animal substances 
 muscular fibre, skin, and hair" ! having been formed under the 
 " We are able to form, in our la- guidance and power of the vital 
 boratories, formic acid and urea, principle, it is this principle which 
 &c., all products, it is said, of the determines the direction of their 
 VITAL principle. We see, there- molecular attraction." " The vi- 
 fore, that this mysterious vital tal principle alone is capable of 
 PRINCIPLE can be REPLACED BY restoring the original order and 
 the CHEMICAL FORCEs" ! ! — LiE- manner of the molecular arrange- 
 big's Organic Chemistry (no. 16, ment in the smallest particles of 
 51, 59, ^ 53). albumen." — Liebig's Lectures for 
 
 1844 (§ 48-50). 
 
 " We cannot expect from oi- 
 
 ganic chemistry the synthetic 
 
 proof of the accuracy of the views 
 
 * entertained, because every thing 
 
 in the organism goes on under 
 
 THE INFLUENCE of the VITAL FORCE, 
 AN IMMATERIAL AGENT [!] which the 
 
 chemist cannot employ at will." 
 — Liebig's Animal Chemistry. 
 
 40. " The INFLUENCE of poisons 89. "From the theory of dis- 
 and of remedial agents on the liv- ease developed in the preceding 
 ing animal body evidently shows pages, it follows, obviously, that a 
 that the chemical decompositions diseased condition once establish- 
 and combinations in the body, ed, in any part of the body, can- 
 which manifest themselves in not be made to disappear by the 
 THE phenomena OF VITALITY, may chemical action of a remedy." — 
 be increased in intensity by chem- Liebig's Animal Chemistry. 
 
 iCAL FORCES of an analogous char- 90. " The vital force is sub- 
 acter, and retarded or put an end ject to the action of a blister." 
 TO by THOSE of opposite character: — Ihid.
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 
 
 17J 
 
 CUEMICAL DOCTRINES. 
 
 and that we are enabled to exer- 
 cise an influence on every part of 
 an organ by means of substances 
 possessing a well-defined chem- 
 ical ACTION." — Liebig's Animal 
 Chemistry (mottoes a-e). 
 
 41. " It is singular that we find 
 medicinal agencies all depend- 
 ent on certain matters, which 
 differ in composition [moral emo- 
 tions, heat, cold, change of air, ex- 
 ercise .?] ; and if, by the introduc- 
 tion of a substance, certain abnor- 
 mal conditions are rendered nor- 
 mal, it will he impossible to reject 
 the opinion, that this "phenomenon 
 depends on a change in the com- 
 position of the constituents of the 
 diseased organism [no. 5], a change 
 in which the elements of the 
 
 REMEDY take A SHARE SIMILAR TO 
 THAT which THE VEGETABLE ELE- 
 MENTS OF FOOD have taken in the 
 formation oi fat, of m,emhranes, of 
 the saliva, of the seminal fluid, &c. 
 [!] Their carbon, hydrogen, or ni- 
 trogen, or whatever else belongs 
 to their composition, are derived 
 from the vegetable organism ; and, 
 after all, the action and effects of 
 quinine, morphia, and the vegeta- 
 ble poisons in general, are no 
 hypotheses''' ! — Liebig's Animal 
 Chemistry (§ 18, and motto d). 
 
 42. " With respect to the ACTION 
 of quinine, or the alkaloids of opi- 
 um, &c., physiologists and pathol- 
 ogists entertain no doubt that it is 
 exeited chiefly on the brain and 
 nerves. If we reflect that this ac- 
 tion is exerted by substances which 
 are material, tangible, and ponder- 
 able ; that they disappear in the 
 organism ; that a double dose acts 
 more powerfully than a single one ; 
 that, after a time, a fresh dose 
 must be given if we wish to pro- 
 duce the action a second time ; all 
 these coiisiderations, viewed chevi' 
 ically, [!] permit only one form 
 of explanation ; the supposition, 
 
 VITAL doctrines. 
 
 91. " The VITAL FORCE in a liv- 
 ing animal tissue appears as a 
 CAUSE of growth in the mass, and 
 of RESISTANCE to those external 
 agencies which tend to alter the 
 form, structui'e, and composition 
 of the substance of the tissue in 
 which the vital energy resides."" — 
 Liebig's Animal Chemistry . 
 
 92. "The slightest action of a 
 chemical agent upon the blood ex- 
 ercises an INJURIOUS influence. 
 Even the momentary contact with 
 the air in the lungs, although ef- 
 fected through the medium of cells 
 and membmnes, alters the color 
 and other qualities of the blood." 
 — Liebig's Organic Chemistry ap- 
 plied to Physiology, &c. 
 
 93. " Every substance may be 
 considered as nutriment, which 
 loses its former propefties when 
 acted on by the vital principle, 
 and does not exercise a chemical 
 action upon the living organ. An- 
 other CLASS of bodies change the 
 direction, the strength, and inten- 
 sity of the resisting vital principle 
 and THUS exert a modifying influ- 
 ence upon the functions of its or- 
 gans. These are medicaments. 
 A THIRD class of compounds are 
 called POISONS, when they possess 
 the property of uniting with or- 
 gans or with their component 
 parts, and when their power of ef- 
 fecting this is stronger than the re- 
 sistance offered hy the vital princi- 
 ple.^' — Liebig's Organic Chemis- 
 try, &c. 
 
 93^. " Death is the condition 
 in which all resistance on the part 
 of the vital force entirely ceases. 
 So long as this condition is not 
 established the living tissues con- 
 tinue to offer resistance." — Lie- 
 big's Animal Chemisti-y.
 
 172 
 
 INSTITUTES OF MEDICINE. 
 
 CHEMICAI. DOCTRINES. 
 
 VITAL DOCTRINES. 
 
 namely, that these compounds, by [The n£xt folloicing (94) is con- 
 means of their elements, take a firmed by other observations, shoioing 
 share in the formation of neiv or that Alcohol, Opium, and Tobacco 
 the TRANSFORMATION OF EXISTING are not absorbed, but act through the 
 BRAIN AND NERVOUS MATTER" ! ! — nci-voiis System, p. 301-310, § 481- 
 Liebig's Animal Chemistry. 484. Alcohol is digested.] 
 
 43. " Owing to its volatility and 94. " According to all the ohser- 
 tlie ease with which its vapor per- vations hitherto made, neither the 
 meates animal tissues, alcohol expired air, nor the perspiration, 
 CAN SPREAD THROUGHOUT THE nor the urine, contains any trace 
 BODY IN ALL DIRECTIONS" ! — LiE- OF ALCOHOL, after indulgence in 
 big's Aniinal Chemistry (§ 350^, spirituous liquors." — Liebig's An- 
 n). — Notes JST R pp. 1121, 1123. imal Chemistry* 
 
 44. " It is impossible to mistake 95. " The vivifying agency of 
 the modus operandi of putrefied the blood must ever continue to 
 sausages, or mu,scle, mane, cheese, be the most important condition 
 cerebral substance, and other mat- in the restoration of a disturbed 
 ters, in a state of putrefaction.''' equilibrium, and the blood must, 
 " It is obvious that they communi- therefore, be considered and con- 
 CATE THEIR OWN STATE OF PUTRE- stantly kept in view, as the ulti- 
 
 FACTION TO THE SOUND BLOOD, mate and MOST POWERFUL CAUSE 
 
 from which they were produced, of lasting vital resistance, as 
 
 exactly in the same manner as glu- well in the diseasrd as in the un- 
 
 ten in a state of decay or putrefac- affected parts of the body." — 
 
 tion causes a similar transforma- Liebig's AniTual Chemistry, 
 
 tion in a solution of sugar''' ! Nevertheless, 
 
 45. " The mode op action of " No other component part of 
 a morbid virus exhibits such a the organism can be compared to 
 strong similarity to the action the blood, in respect of the fee- 
 OF yeast upon liquids containing ble resistance which it offers to 
 sugar and gluten, that the two exterior influences." "Thechem- 
 processes have been long since ical force and the vital principle 
 compared to one another, although hold each other in such perfect 
 merely for the purpose of illusira- equilibrium, that every disturb- 
 tion. [They have often been rep- ance, however trifling, or from 
 resented as identical.]^ But, when whatever cause it may proceed, 
 the phenomena attending the ac- effects a change in the blood." 
 tion of each respectively are con- — Liebig's Organic Chemistry ap- 
 sidered more closely, it will in re- plied, &c. 
 
 ality be seen that their influence But, again, nevertheless,. 
 
 depends upon the same cause." " It is obvious, moreover, that 
 
 " Ordinary yeast, and the viriis of in all diseases where the forma- 
 
 human small-pox, effect a violent tion of contagious matter and of 
 
 tumultuous transformation, the for- exanthemata is accompanied by fe- 
 
 mer in vegetable juices, the latter ver,Two diseased conditions .smMZ- 
 
 in the blood" ! "The action of the tancously exist, and two process- 
 
 virus of cow-pox is analogous to es are simultaneously completed ; 
 
 that of low yeast [ .' ] It commu- and that the blood, as it were, by 
 
 nicates its own state of decomposi- reaction, that is, fever, becomes 
 
 tion to A matter in the blood, and A means of cure." — Liebig's An' 
 
 from a second matter is itself re- imal Chemistry. 
 
 * This is contradicted hy French chemists, who deny, also, that alcohol is " burned " 
 but assert that it exists in the body in a free state. — 18G1.
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 
 
 173 
 
 VITAL DOCTRINES. 
 
 96. "It is only by a just appli- 
 cation of its principle that any 
 theory can produce really bene- 
 ficial results." — Liebig's Animal 
 Chemistry. 
 
 97. " We can have no very high 
 idea of experiments made by gen- 
 tlemen [chemists, vsrith reference to 
 digestion) who, for w^ant of ana- 
 tomical knowledge, have not been 
 able to pursue their reasoning 
 even beyond the simple experi- 
 ment itself" — John Hunter's 
 Observations on Digestion. 
 
 98. " Whenever the chemist for- 
 sakes his laboratory for the bedside, 
 he forfeits all his claims to our re- 
 spect, and his title to our confidence. 
 It is amusing to see the ridiculous 
 errors into which the chemist falls 
 when he turns physician." — Paris' 
 Pharmacologia. London, 6th ed., 
 1825. 
 
 CHEMICAL DOCTRINES. 
 
 generated" ! " The susceptibility 
 of infection by the virus of human 
 small-pox MUST cease after vacci- 
 nation, FOR THE SUBSTANCE tO the 
 
 presence of which this suscepti- 
 bility is owing HAS been removed 
 from the body by a peculiar pro- 
 cess of decomposition artificially 
 excited" ! " Cold meat is always 
 in a state of decomposition. It is 
 possible that this state may be 
 communicated to the system of 
 a feeble individual, and may be 
 one of the sources of consump- 
 tion" ! ! (§ 821) — Liebig's Organ- 
 ic Chemistry applied to Physiology, 
 &c. 
 
 " From the unequal degree of the 
 conducting power in the nerves, we 
 must deduce those conditions which 
 are termed paralysis, syncope, and 
 spasm" ! — Liebig's Animal Chem- 
 istry. 
 
 46. " In all chronic diseases, 
 death is produced by the same 
 
 CAUSE, namely, the CHEMICAL 
 action of the ATMOSPHERE." 
 
 " The TRUE CAUSE of death IS 
 THE RESPIRATORY PROCESS, [ ! ] that 
 
 is, the chemical action of the at- 
 mosphere." — Liebig's Animal 
 Chemistry (§ 674-67G). 
 
 * ^ The quotations from " Liebig's Organic Chemistry applied to Physiology" are do- 
 rived from Mr. Playfair's edition, London, 1840 ; those from " Liebig's Animal Chemis- 
 try" are taken from Professor Gregory's edition, reprinted New York, 1842. The italics 
 and capitals are mine. 
 
 350i. To carry out the full object of the foregoing section, I shall 
 devote another to a farther exhibition of the pathological and thera- 
 peutical doctrines which have been deduced by the author of the " new 
 era in medicine" from his chemical and physiological elements, as 
 their resulting compounds. This more extended display of theoret- 
 ical and practical doctrines, as they came to us from the laboratory, 
 will reflect a broad light upon the chemical hypotheses of digestion, 
 nutrition, &c., as set forth in the preceding section, and show us, also, 
 the extent of the probabilities which relate to the analysis of food 
 and of the conclusions which are predicated of that analysis (§ 18, 409, 
 676 b), and, in brief, enable us to comprehend the nature and amount 
 of the service which organic chemistry has rendered to the science of 
 medicine (§ 5, 5^ a, 376-t, 1029, 1030, 1034). 
 
 This otherwise isolated subject will be farther interesting, as I shall 
 embrace in the quotations the whole science of medicine as founded
 
 174 INSTITUTES OF MEDICINE. 
 
 on chemistry and physics, and thus place in contrast the systems of the 
 two rival schools, and enable the reader to adjust their relative mer- 
 its. To do this work of consigning chemistry to its legitimate pur- 
 suits the more effectually, I shall also expose, in an appropriate place, 
 the chemical doctrine of animal heat in the language of him who is 
 supposed to have settled the philosophy of that subject (§ 433-450, 
 676, 1043-1050). 
 
 And before proceeding to a farther exposition of the vital and 
 chemical dcrctrines of digestion, I shall, in consideration of the gen- 
 eral surrender of this subject to the laboratory of the chemist, exhibit 
 the corroborating testimony of the distinguished Mulder that physiol- 
 ogy and medicine have nothing to hope from obsei-vations conducted 
 out of the living body (§ 350, nos. 48,49, also Lehmann, ^1029, 1030). 
 
 By the method now contemplated obstacles may be removed, and 
 the reader better disposed to consider maturely the grounds upon 
 which I have placed the vital docti-ine of digestion, and come the more 
 willingly to the conclusion that none are so imperfectly qualified to 
 interpret the properties and laws of organic beings as they who can 
 reason alone from the slender and deceptive analogies supplied by in- 
 organic nature, and artificial expedients. 
 
 It is certainly remarkable that this systematic exposure should be 
 necessary at the middle of the nineteenth century, when arts and all 
 other sciences, though more so the arts, are making a steady, some- 
 times an astonishing progress. 
 
 I may be mistaken in the importance which I have attributed to the 
 innovations which have been made by organic chemistry upon medi- 
 cal philosophy. I know that I am but feebly sustained by others in 
 my conclusions ; though now and then a blaze of mind assures me 
 that deep volcanic action is in smothered progress (§ 376|). 
 
 350|, a. We have, then, from the authorized works of Liebig (§ 
 349, d), in the first place, the following inductions, in the order of 
 their occurrence, of 
 
 Tatliological Principles, or *' Theory of Disease'^ (350, no. 59). 
 
 " Every substance or matter, every chemical or mechanical agency, 
 which changes or disturbs the restoration of the equilibrium between 
 the manifestations of the causes of waste and supply, in such a way 
 as to add its action to the causes of waste, is called a cause of dis- 
 ease. Disease occurs when the sum of the vital force, which tends 
 to neuti'alize all causes of disturbance, in other words, when the re- 
 sistance offered by the vital force, is weaker than the acting cause of 
 disturbance ;" — with the reservation, nevertheless, that '■'the cause of 
 disturbance, or chemical force and the vital force, are one and identical." 
 
 350^, b. " Death is the condition in which all resistance on the part 
 of the vital force entirely ceases. So long as this condition is not es- 
 tablished, the living tissues continue to offer resistance." 
 
 350^, c. " To the obsers'-er, the action of a cause of disease exhibits 
 itself in the disturbance of the proportion between waste and supply 
 which is proper to each period of life. In medicine, every abnormal 
 condition of supply or of waste, in all parts, or in a single part of the 
 body, is called disease." 
 
 35O2, d. " It is evident that one and the same cause of disease will 
 produce in the organism very different effects, according to the period
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 175 
 
 of life. A cause of disease which strengthens the causes of supply, 
 either directly or indirectly, by weakening the action of the causes of 
 waste, destroys, in the child and in the adult, the relative normal state 
 of health ; while in old age it merely brings the waste and supply into 
 equilibrium. 
 
 35O2, e. " A child, lightly clothed, can bear cooling by a low exter- 
 nal temperature without injury to health. [ ! ] The force available for 
 mechanical purposes and the temperature of its body increase with the 
 change of matter which follows the cooling ; while a high tempera- 
 ture, which impedes the change Of matter, is followed by disease." 
 
 3501, y! " A deficiency of resistance, in a living part, to the causes 
 of waste, is, obviously, a deficiency of resistance to the action of the 
 oxygen of the atmosphere. 
 
 350i, g. " When, from any cause whatever, this resistance dimin- 
 ishes in a living part, the change of matter increases in an equal de- 
 gree. 
 
 350i, h. " Now, since the phenomena of motion in the animal 
 body are dependent on the change of matter, the increase of the 
 change of matter in any part is followed by an increase of all motions. 
 According to the conducting power of the nerves, the available force 
 is carried away by the nerves of involuntary motion alone, or by all 
 the nerves together. [ ! ] 
 
 3504^, ^. "Consequently, if, in consequence of a diseased transforma- 
 tion of living tissues, a greater amount of force be generated than is 
 required for the production of the normal motions, it is seen in an ac- 
 celeration of all or some of the involuntary motions, as well as in a 
 higher temperature of the diseased part. This condition is called 
 Jever. 
 
 350^, j. "When a great excess of force is produced by change of 
 matter, the force, since it can only be consumed by motion, extends 
 itself to the apparatus of voluntary motion. This state is called a 
 febrile paroxysm. 
 
 350^, Ti. " In consequence of the acceleration of the circulation in 
 the state of fever, a greater amount of arterial blood, and, consequent- 
 ly, of oxygen, is conveyed to the diseased part, as well as to all other 
 parts ; and, if the active force in the healthy parts continue uniform, 
 the whole action of the excess of oxygen must be exerted on the dis- 
 eased part alone (§ 350, no. 10). 
 
 350i, I. "According as a single organ, or a system of organs, is af- 
 fected, the change of matter extends to one part alone, or to the whole 
 affected system. 
 
 350i, m. " Should there be formed, in the diseased parts, in conse- 
 quence of the change of matter, from the elements of the blood or of 
 the tissue, new products, which the neighboring parts cannot employ 
 for their own vital functions ; should the surrounding parts, moreover, 
 be unable to convey these products to other parts, where they may un- 
 dergo transformation, then these new products will suffer, at the place 
 where they have been formed, a process of decomposition analogous to 
 fermentation or putrefaction^' ! 
 
 350|-, n. " If we consider the fatal accidents which so frequently 
 occur in wine countries from the drinking of what is called feather 
 white wine, we can no longer doubt that gases of everv ^stm^wheth. 
 er soluble or insoluble in water, possess the property of permeating am-
 
 176 INSTITUTES OF MEDICINE. 
 
 mal tissues, as water penetrates unsized paper [ ! ] (§ 350, no. 24). This 
 poisonous wine is wine still in a state of fermentation, which is in- 
 creased by tlie heat of the stomach. The carbonic acid which is dis- 
 engaged penetrates through the parietes of the stomach, [!!J through 
 the diaphragm, [ ! ! ! ] and through all the intervening membranes, [ ! ! ! ! J 
 into the air-cells of the lungs, [!!!!!] out of which it displaces the at- 
 mospherical air. [!!!!!!] The patient dies with all the symptoms of 
 asphyxia caused by an irrespirable gas, [ ! ] and the surest proof of the 
 presence of carbonic acid in the lungs is the fact, that the inhalation 
 of ammonia, which combines with it, is recognized as the best antidote 
 against this kind of poisoning" ! — (^ 1055). 
 
 " No doubt a part of these gases may enter the venous circula- 
 tion through the absorbent and lymphatic vessels, and thus reach the 
 lungs, where they are exhaled; [!] but the presence of membranes 
 offers not the slightest obstacle to their passing directly into the 
 cavity of the chest" ! (§ 349 d, 447 h, 827 h). 
 
 3501, o. " It is known that in cases of wounds oftlie lungs a pecu 
 liar condition is produced, in which, by the act of inspiration, not only 
 oxygen but atmospherical air, with its whole amount of nitrogen, pen- 
 etrates into the cells of the lungs. This air is canied by the circula- 
 tion [ ! ] to every part of the body, [ ! ! ] so that every part is inflated or 
 puffed up with the air, as with water in dropsy. [ ! ] This state ceases, 
 without pain, as soon as the entrance of the air through the wound is 
 stopped." 
 
 3501, p, •' The frightful effects of prussic acid, which, when in 
 spired, puis a stop to all the phenomena of motion in a few seconds, 
 are explaini^d in a natural manner by the well-known action of this 
 compound on those of iron, when alkalies are present" ! ! (^ 494 dd, 
 827 d, 904 h). — Liebig's Animal Chemistry. 
 
 350 1^, q. The foregoing doctrines, with the humoral philosophy as 
 quoted in § 350, nos. 40-45, make up the whole science of pathology 
 as delivered to us from the laboratory ; and such, too, are the doc- 
 trines which are hailed as the foundation of " a new and the greatest 
 era of medicine." There can be no doubt, however, that deliberate 
 investigation will satisfy every mind that they are unintelligible, im- 
 practicable, absurd ; and, consequently, that the whole pretended sys- 
 tem of physiology from which they are deduced, is equally unworthy 
 the dignity of reason. 
 
 350|, a. T shall now employ the same authorized chemist (§ 349, d) 
 to give the last blow to his baseless fabric, and to scatter its fragments 
 beyond the reach of idolatry itself This will be done by setting 
 forth, in the language of the author, his deductions from the physio- 
 logical and pathological doctrines of the laboratory, as to 
 
 The Chemical Treatment of Disease (§ 350, no. 59). 
 
 " The accelerated change of matter, and the elevated temperature 
 in diseased parts, show that the resistance offered by the vital force to 
 the action of oxygen is feebler than in the healthy state. But this re- 
 sistance only ceases entirely when death takes place (nos. 1, 46). 
 By the artificial diminution of resistance in another part (as by blis- 
 ters, sinapisms, or setons), the resistance in the diseased organ is not, 
 indeed, directly strengthened ; but the chemical action, the cause of 
 the charge of matter, is diminished in the diseased part, being direct-
 
 PHYSIOLOGY. — ORGANIC CHEMISTRY FUNCTIONS. 177 
 
 ed to another part, where the physician has succeeded in producing a 
 still more feeble resistance to the change of matter, to the action op 
 
 OXYGEN. 
 
 350|, h. "A complete cure of the original disease occurs, when ex- 
 ternal action and resistance, in the diseased part, are brought into equi- 
 librium. Health, and the restoration of the diseased tissue to its orig- 
 inal condition, follow, when we are able so far to weaken the disturb- 
 ing action of oxygen, by any means, that it becomes inferior to the re- 
 sistance offered by the vital force, which, although enfeebled, has never 
 ceased to act ; for this proportion between these causes of change is 
 the uniform and necessary condition of increase of mass in the living 
 organism." 
 
 350|, c. " In cases of a different kind, where artificial external dis- 
 turbance produces no effect, the physician adopts other indirect 
 methods to exalt the resistance offered by the vital force. He dimin- 
 ishes, by blood-letting, the number of the carriers of oxygen (the glob- 
 ules), and, by this means, the conditions of change of matter ; he ex- 
 cludes from the food all such matters as are capable of conversion into 
 blood, &c. 
 
 350^, d. " If he succeed, by these means, in diminishing the action 
 of oxygen in the blood on the diseased part, so far that the vital force 
 of the latter, its resistance, in the smallest degree, overcomes the chem- 
 ical action ; and if he accomplish this without arresting the functions 
 of other oi'gans, then restoration to health is certain. [ ! ] 
 
 350|, e. " Practical medicine, in many diseases, makes use of cold 
 in a highly rational manner, as a means of exalting and accelerating, 
 in an unwonted degree, the changes of matter. This occurs espe- 
 cially in certain morbid conditions, in the substance of the centre of the 
 apparatus of motion ; when a glowing heat and a rapid current of 
 blood toward the head point out an abnormal metamorphosis of the 
 BRAIN [ ! ] (350, motto i, nos. 3, 5). When this condition continues 
 beyond a certain time, experience teaches that all motions in the 
 body cease. [ ! ] If the change of matter be chiefly confined to the 
 brain, then the change of matter, the generation of force, diminishes 
 in all other parts. [ ! ] The metamorphosis which decides the issue of 
 the disease is limited to a short period. We must not forget that the 
 ice melts and absorbs heat from the diseased part; that if the ice be 
 removed before the completion of the metamorphosis, the temperature 
 again rises ; that far more heat is removed from the head than if we 
 were to surround the head xoith a bad conductor of heat. There has 
 obviously been liberated, in an equal time, a far larger amount of 
 heat than in the state of health. [That is to say, such is the pathol- 
 ogy of cerebral inflammation, such the remedy, and such its modus 
 operandi.] 
 
 350|,yi " The self-regulating steam-engines, in which, to produce 
 a uniform motion, the human intellect has shown the most admirable 
 acuteness and sagacity, furnish no unapt image of what occurs in the 
 animal body. 
 
 " Every one knows, that in the tube which conveys the steam to the 
 cylinder where the piston-rod is to be raised, a stop-cock of peculiar 
 construction is placed, through which all the steam must pass. By an 
 arrangement connected with the regulating wheel, this stop-cock opens 
 when the wheel moves slower, and closes more or less completely 
 
 M
 
 178 INSTITUTES OF MEDICINE. 
 
 when the wheel moves faster than is required for a uniform motion 
 When it opens, more steam is admitted (more force), and the motion 
 of the machine is accelerated. When it shuts, the steam is more or 
 less cut off, the force acting on the piston-rod diminishes, the tension 
 of the steam increases, and this tension is accumulated for subsequent 
 use. The tension of the vapor, or the force, so to speak, is pro- 
 duced BY CHANGE OF MATTER, hij the comhustion of coals in the firC' 
 place. The force increases (the amount of steam generated and its 
 tension increase) with the temperature in the fire-place, which de- 
 pends on the supply of coals and of air (§ 433, &c.). There are in 
 these engines other arrangements, all intended for regulation. When 
 the tension of steam in the boiler rises beyond a certain point, the 
 passages for admission of air close themselves ; the combustion is re- 
 tarded, the supply of force (steam) is diminished. When the engine 
 goes slower, more steam is admitted to the cylinder, its tension di- 
 minishes, the air-passages are opened, and the cause of disengage- 
 ment of heat, or production of force, increases. Another arrange- 
 ment supplies the fire-place incessantly with coals in proportion as 
 they are wanted. 
 
 " If we now lower the temperature at any part of the boiler, the 
 tension within is diminished. This is immediately seen in the regu- 
 lators of force, which act precisely as if we had removed from the 
 boiler a certain quantity of steam, or force. The regulator and the 
 air-passages open, and the machine supplies itself with more coals. 
 
 " The hody, in regard to the production of heat and force, acts just 
 like one of these machines. With the lowering of the external tem- 
 perature, the respirations become deeper and more frequent ; oxygen 
 is supplied in greater quantity and of greater density, the change of 
 matter is increased, and more food must be supplied, if the tempera- 
 ture of the body is to remain unchanged," — X^ikbig^ s Animal Chemistry. 
 
 Here ends the science of therapeutics, as founded upon the prece- 
 ding doctrines in physiology and pathology ; and as the whole system 
 is comprehended within the limits of the last three pages, the reader 
 will readily contrast its brevity with the labors of the past, and will 
 not fail to discover in this time-saving, thought-saving attainment of 
 medicine, as well as in the impenetrability of the system itself, and 
 the unequaled confidence with which it is set forth, the main causes 
 of its success. 
 
 I shall now proceed, as proposed in § 350i, to demonstrate by the 
 farther showing of chemistry itself, that physiology and medicine 
 have little to hope from the laboratory of the chemist. 
 
 350j, a. Of the school of pure chemistry, and of an authority ap- 
 proaching to Liebig, is the distinguished Professor Mulder; less in- 
 consistent than Liebig, but compelled to admjt the existence of pecu- 
 liar forces in living beings, yet positively denying them. He advo- 
 cates, after the manner of Prichard, Carpenter, Fletcher, &c., the 
 existence of all the properties of living beings in the elements of mat- 
 ter, which conducts him, like others, to the belief in Equivocal Gen- 
 eration ; adopts the Catalytic theory of Berzelius, in which he differs 
 fundamentally from Liebig (§ 409,_;) ; reasons, after the usual manner 
 of the physical philosophers of life, from the results of inorganic pro- 
 cesses, and overlooks entirely, except by admission of their existence, 
 all the unique phenomena of living beings, and, perhaps, more thah
 
 PIlYStOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 179 
 
 any author of merit, is guided in his conclusions as to the processes 
 and results of organic beings by the fallacious analogies which are 
 studiously sought in the inorganic world. The whole system of vital 
 philosophy, as taught by this distinguished Professor of Chemistry, 
 may be so briefly set forth in extracts from his work on " The Chem- 
 istry of Vegetable and Animal Physiology," and they convey so forci- 
 bly the conjectural nature and worthlessness of chemical physiology, 
 that the selection will contribute its important part toward the final 
 expulsion of chemistry from the rich and fascinating domain of or- 
 ganic nature. The quotations will be made in the order of their oc- 
 currence in the work ; and we learn from the first the author's opinion 
 ol force, which corresponds with my own as employed in the Covi- 
 mentaries, and as defended in my Examination of Reviews. Thus : 
 
 350|, b. " It is a matter of indifference whether we conceive that 
 the forces slumber in two substances, and are brought into operation 
 by contact ; or that these forces were present in the two bodies in an 
 active state, previoiis to the contact, but produced the phenomena of 
 combination only during the contact. The mode of considering this 
 point is almost a matter of indifference ; but we must always bear in 
 mind that it is ^, power, b. force which is exexted by the one, and which 
 acts upon the other." — Mulder. 
 
 350^, c. The next quotation is preliminary to the total denial of the 
 Principle of Life, and of all the properties in living beings excepting 
 such as are active or " slumbering" in the elements of matter. Here, 
 too, appears the fallacy of analogies derived from the laboratory of 
 the chemist. Thus : 
 
 " Adhering to what we observe and know with certainty, we calcu- 
 late that every elementary body is endowed with a great many specific 
 properties, which, to a large extent, are dependent on the same prin- 
 ciple that causes their combination, and thus on the proportion and 
 character of the chemical tendency. If we adopt this idea, we have 
 the advantage of seeing somewhat of vitality iiv dead matter. [ ! ] 
 It is an idea derived from the endless series of phenomena which 
 are observed in the laboratory, in daily occurrences, and in nature 
 at large" (§ 115, d). — Mulder. — (§ 1034, Lehmann). 
 
 3503, d. After the usual disquisition upon the " catalytic action" of 
 platinum and other inorganic substances, we come next to the same 
 application o? catalysis, in connection with the ordinary laws of chem- 
 ical affinity, to the interpretation of organic processes and results, as 
 I have examined in the " Commentaries'^ (vol. i., p. 55-78). It com- 
 prehends Miilder's whole theory of life, and is a good specimen of the 
 author's analogical i-easoning. Thus : 
 
 " Platinum possesses chemical tendency in a high degree ; but it is 
 of such a kind, that it does not react upon the platinum. Hence it 
 may be inferred, that we have good reason for distinguishing by a pe- 
 culiar name such actions as proceed from certain substances without 
 reacting upon themselves; and we have to acknowledge that to the 
 introduction, by Berzelius, of the peculiar term catalysis, we are in- 
 debted for a more correct idea of the nature of ordinary chemical 
 action. 
 
 " What is called the nascent state of substances is that condition of 
 the elements in which they exhibit both analytic and catalytic phenom- 
 ena; in which, being free and unconstrained, not rendered powerless
 
 180 INSTITUTES OF MEDICINE. 
 
 either by being agglomerated into masses, or by combination into c 5m 
 pounds, they show themselves in their proper cliemical condition] 
 that is, an active one, in which they can operate upon others, excite 
 a slumbering energy, and cause combinations and decompositions, in 
 which they themselves may either participate or not. This nascent 
 state is the real chemical state of bodies. In that state both the ele- 
 ments and compounds exhibit themselves in their true character. In 
 the organic kingdom the greater number of substances are actually in 
 that condition ; and to this nascent state we ought to ascribe the nu- 
 merous peculiar phenomena apparent in organic substances" (§ 409). — 
 Mulder. — (^ 1034, Lehmann). 
 
 350f , e. The next quotation sets forth the whole practical applica- 
 tion of the foregoing doctrines, and is a fine example of the chemical 
 reduction of organic nature to the condition of dead matter, and one 
 of the best summary exhibitions of chemistry in all its pretended re- 
 lations to living beings. It begins with the caption 
 
 " Disturhance of Chemical Equilibrium." 
 
 " It is a property of the chemical forces, when active in any substance, 
 to excite analogous forces in others. We notice this especially iis 
 organic nature, and it is nowhere more strikingly illustrated than 
 in the nutrition of animals. Blood, a homogeneous fluid, circulates 
 through very different parts of the body (§ 42). In the muscles it 
 sustains muscles, in the liver it supplies the component parts of the 
 liver, and from it the gall is there secreted ; in the kidneys it maintains 
 their various parts, and secretes the urine, &c. None of these secre- 
 tions appear in the hlood with their peculiar qualities ; of some of them 
 not even a trace is found. But the four organic elements of the whole 
 are to be found in protein and its combinations, in the coloring mat- 
 ter of the blood, &c. The elements of protein might, no doubt, be 
 transposed in the liver, &c., by means of catalysis, and so the compo- 
 nent parts of the liver and gall be produced from it. It would only 
 be necessary, then, that the constituent parts of the liver should be 
 put into contact with the component parts of the blood, and the forces 
 of affinity resident in the substance of the liver would not require to 
 influence those in the protein, or to produce any chemical alteration 
 in its component parts. 
 
 " Other causes, however, ought undoubtedly to be considered. 
 For instance, a change of its component parts takes place in the liver 
 itself, and, from the first, chemical forces actively operate therein. 
 For the continual change of its component parts is a chief character- 
 istic of every living organic substance. These forces may disturb the 
 chemical equilibrium of other substances, and cause the formation of 
 new products. If the constituents of the blood — the combinations of 
 protein, the coloring matter, &c. — enter the liver when it is in a state 
 of action, and are there put in contact with the gall during its secre- 
 tion, and with the substance of the liver itself, which is in a state of 
 continual alteration, then the result will be, that this change of their 
 component parts having taken place, the action will be transferred to 
 the elements of the blood, and will maintain the secretion. If, on the 
 other hand, the constituents of the blood are in a state of continual 
 change, then the circle of action in which they are involved will ex- 
 tend 'to the mass of the liver j and so with every organ (§ 18).
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 181 
 
 " We have, however, no more knowledge of the manner in which 
 this secretion originally commences — whether it proceeds from the 
 blood or from the secreting organ, [ ! ] or whether each of these con- 
 tributes its part — than with the manner in which the first germ of the 
 whole organ, the liver, is produced, or in which the germ of the ani- 
 mal is converted into an animal. But the continuance of the action — 
 the duration of secretion — entirely corresponds with some other phe- 
 nomena, which we may observe separately, and which therefore throw 
 light upon these animal actions. This is the case especially withyer- 
 mcntation, from which Liebig has drawn many illustrations, for the 
 purpose of clearly exhibiting his ideas ; and with the same view we 
 shall also avail ourselves of this process. 
 
 " Yeast changes sugar into carbonic acid and alcohol, and is at the 
 same time changed itself The latter change causes the former, and 
 is only transferred to the sugar. If we substitute hloodfor yeast, and 
 the liver for sugar, we may form an idea, more or less distinct, of the 
 secretion of the gall. [ ! ] The component parts of the blood are con- 
 tinually undergoing change. This constant change of the component 
 parts in organic bodies is a chief cause of the continuation of their ex- 
 istence. The liver without intermission assumes new parts and loses 
 others. This process we call nutrition. At the same time that the 
 parts of the blood in the substance of the liver ai'e thus undergoing 
 change, chemical forces are excited ; these forces are ti'ansferred to 
 the elements of the blood, and so are enabled to produce from them 
 the gall. This takes place the more easily, as the blood itself is also 
 in a state of continual alteration, and thus readily yields to the impulse 
 which, in some way or other, is communicated to it. As the impulse 
 varies, so does the effect. Hence that great diversity in the secre- 
 tion of very dissimilar substances, which are in a state of alteration, 
 from the same fluid — that is, the blood, which is itself at the same 
 time in a state of decomposition." — Mijlder. 
 
 350|,y^ In our next quotation we have an assumption founded on 
 a begging of the very question at issue ; that is to say, whether there 
 be or not a radical difference in the original constitution of organic 
 and inorsfanic nature. The author having: assumed that there is no 
 difference, proceeds, by the force of surmised analogies drawn from 
 the probable constitution of inorganic matter, to repeat the assump- 
 tion already stated that there are no other properties in living beings 
 than such as exist in the elements of matter. Thus : 
 
 " The idea o? communication of forces is unsound; it is only what is 
 substantial that we can communicate. Forces may be excited, they 
 cannot be communicated. Hence it results that every transformation 
 in plants is effected by the molecular forces of carbon, hydrogen, ox- 
 ygen, and nitrogen, — the elements of carbonic acid, water, and am- 
 monia, — the forces being excited in these elements by the plants them- 
 selves." " Any one who imagines that there is any thing else in ac- 
 tion than a molecular force, than a chemical force, sees more than ex- 
 ists. Thej^rce* excited in the elements vary with the influence which 
 certain agents — temperature, moisture, light, &c. — exert. By the aid 
 of crucibles and retorts, therefore, compounds can be formed which 
 differ from those produced by the organs of plants ; while, from car- 
 bonic acid and water, plants can produce cellulose and oxygen, a result 
 which CANNOT YET be imitated by art." " To expres-s our idea in a
 
 182 INSTITUTES OF MEDICINE. 
 
 few words : — The elements of the organic kingdom, carbon, hydiii 
 gen, oxygen, and nitrogen, are susceptible of endless modifications 
 For that reason they can form, with minute changes, a great diversity 
 of products (^ 41) ; and by the operation of the same friviary forces, 
 they stand toward each other in entirely different relations from those 
 assumed by all the other elements ; so that they can produce a vecu- 
 liar scries of bodies, which are called organic substances" /* " Organic 
 substances, whether called germs or food, possess properties of a pe- 
 culiar KIND, EXISTING IN THE FOUR ELEMENTS of wliich they are all 
 constituted" ! — Mulder. 
 
 350f , g. The difficulty, therefore, with the chemists appears to lie 
 in their habits of reasoning exclusively from what they obsei-ve of in- 
 organic compounds and their elements, and an indisposition to admit 
 that the Almighty superadded to organic beings a principle of life, 
 while they allow the special creation of mind in animals. Nor does 
 their philosophy permit them to imagine that the former may be as 
 capable of governing all the processes of organic, as the latter is of 
 animal life, and that the principle of life may be supposed, with as 
 much reason as the principle of intelligence, to be imparted by the 
 exact organization pei-petuated from the Almighty Hand to new ac 
 cessions to that organization ; v/hile the phenomena of life are far 
 more multifarious and conclusive of the existence of a special princi- 
 ple than such as oblige the chemist to yield his assent to a mental 
 principle distinct from the matter with which it is associated. Why, 
 then, does not the chemist equally maintain the existence of mind, as 
 of the properties of life, in the elements of matter, and that its devel- 
 opment is alike owing to a difference of circumstances ? Does he 
 fear that this stretch of materialism, this act of philosophical consist- 
 ency, or his neglect to abjure the obvious inference, may impair our 
 confidence in the apparently though not really less objectionable 
 scheme of reducing oi'ganic life to the virtual condition of the simple 
 elements of matter, and thus fail of inculcating the most dangerous 
 atheism by attributing creative power to those elements (§ 14, c)? 
 
 350|-, gg. But let us hear the chemist upon this interesting point. 
 And Liebig, first ; who, also, shall show that no injustice is done by 
 the preceding remarks. Thus : 
 
 "The higher phenomena of " Physiology has sufficiently rfe- 
 mental existence cannot, in the cisive grounds for the opinion that 
 present state of science, be referred every thought, every sensation, is 
 to their proximate, and still less to accompanied by a change in the 
 their ultimate causes. We only composition of the sicbstatice of the 
 knoio of them that they exist, brain; that every motion, every 
 We ascribe them to an immaterial manifestation of force, is the ee- 
 agency, and that, in so far as its sult of a transformation of the 
 manifestations are connected with structure or of its substance." — lb. 
 matter, an agency entirely distinct "Thought, sensation," &c., are 
 from the vital force, with which " 7nanifcstations of force," and are, 
 it has nothing in common." — Lie- therefore, " the result of," &c. 
 big's Animal Chemistry. See Parallels, p. 158, no. 51.) 
 
 And now the other able and distinguished chief: 
 
 * Seo my " Notice of Reviews " ut cit., and my ^^Examination cfHeviezcs" p. 43, 44, 
 in "Commentaries," vol. iii.
 
 PHYSIOLOGY ORGANIC CHEMISTRY FUNCTIONS. 183 
 
 '' I will not venture to raise the veil, by which the action op the 
 NERVES, or the higher functions op the MIND, have hitherto been 
 shrouded from observation. As man has an immaterial and immor- 
 tal part, which is identical with his real being, and of which alone lie 
 will consist, when the material frame by which he is bound to the 
 earth, shall be dissolved ; and, as the inferior animals possess, in com- 
 mon with man, certain powers of perception, associated with certain 
 appropriate organs, whose functions have no connection with con- 
 sciousness ; so do animals and plants perform in common a great many 
 operations which are distinct from both of those now mentioned, or 
 which, at least, have their origin in distinct causes. 
 
 " It is only the latter class of which I speak, and to which I apjDly 
 the general term of organic life. To that subject I shall restrict my 
 remarks." — Mulder, ut cit. 
 
 Now, I say, 1st. Why not "raise the veil from the action of the 
 nerves'^ in a professed, work on physiology, and a work, too, which 
 would revolutionize the science % Have you no phenomena to guide 
 you in " raising the veil V Do you fear their contact with the phe- 
 nomena of the laboratory \ Is it right to make this declaration, and 
 then to refer a vast series of phenomena exclusively to " organic life," 
 which could have had no existence without the " action of the nerves" 
 (see § 350, no. 181) ? I deny, too, 2d, that " the higher functions of 
 the mind have hitherto been shrouded from observation ;" and I am 
 supported by all who truly believe in the independent existence of 
 mind,, in the affirmation that its " functions" are characterized by an 
 infinitely greater variety of unique phenomena than are the processes 
 of inorganic nature. There is no " veil to be raised" in this or the 
 other case. It is, indeed, by the i-ecognition of these phenomena that 
 our author feels obliged to admit the existence of " an immaterial 
 part," however inconsistent the simultaneous declaration that " the 
 functions of the mind have hitherto been shrouded from observation." 
 And, I am alike sustained, also, and by every dictate of philosophy, 
 in the conclusion that, if the phenomena of mind are decisive of the 
 existence of " an immaterial part," so are the far more varied, and 
 numerous, and. equally unique phenomena of organic processes, con- 
 clusive of the existence of some not less peculiar force, power, or 
 " immaterial" or material " part," upon which they depend. In any 
 event, however, the physiologist has a right to insist that the chemist 
 shall not reject all considerations relative to the " action of the nerves,^' 
 when he invades organic nature with retorts, crucibles, acids, &c. 
 
 " Analogy is," undoubtedly, as Bacon says, " the basis of all the 
 sciences." Nature, throughout, is bound together by analogies. The 
 principle reaches from the Creator to the mind of man, to his " im- 
 material and immortal part." And. so it does from the force and 
 the properties of life to those of dead matter. Here is the delusion 
 of the chemist. But, there is even a wider difference between the 
 formative principle of life and destructive chemical affinity, than there 
 is between the Creative Spirit of God and the created, dependent 
 spirit of man (^ 1076). 
 
 350f, h. The grand characteristic of organic life is the principle of 
 life., capable of imparting that principle to matter which is destitute 
 of it, and which it retains only while in its proper connection with the 
 being by which it was so endowed. The doctrine which refers the
 
 184 INSTITUTES OF MEDICINE. 
 
 properties of life to the elements of matter is atheistical in its applica- 
 tion (§ 14 c, 74, 175) ; and the recognition, simultaneously, of a " Cre- 
 ative Power," is but another conventional word for nature, or design- 
 ed to protect the doctrine against the fatal imputation of irreligion (§ 
 64, 7i). That imputation, however, is indelibly stamped by nature 
 herself. The mode of defense is well shown in the late highly laud- 
 ed and popular work on the " Vestiges of the Natural History 
 OF Creation," in which the author considers La Place's infidelity as 
 to the modus operandi of matter in forming the Universe, and the doc- 
 trine of spontaneous generation in its most ample extent. The au- 
 thor's defense of Mr. Crosse's creation of animals out of silex is a good 
 example of the specious reasoning by which so many are cheated into 
 projects which contemplate the worst results to philosophy and relig- 
 ion.* Thus : 
 
 350|, i. " The supposition of impiety arises from an entire miscon- 
 ception of what is implied by an aboriginal creation of insects. The 
 experimentalist could never be considered as the author of the exist- 
 ence of these creatures except by the most unreasoning ignorance. 
 The utmost that can be claimed for, or imputed to him, is, that he ar- 
 ranged the natural conditions under which the true creative energy, 
 that of the Divine Author of all things, was pleased to work in this 
 instance. On the hypothesis here brought forward, the Acarus Cros- 
 sii [ ! ] was a type of being ordained from the beginning, and destin- 
 ed to be realized under certain physical conditions. When a human 
 HAND brought these conditions into the proper arrangement, it did an 
 act akin to hundreds of familiar ones which we execute every day, 
 and which are followed by natural results, but it did nothing more." 
 The defense of La Place's system proceeds upon the same specious 
 assumption (p. 910-911, § 1083, p. 921-928, ^ 1085). 
 
 Now the foregoing doctrine transcends not only the usual geologi- 
 cal hypothesis of a successive creation of animals, but that, also, of 
 spontaneous generation ; both of which are, of course, anti-Mosaic, 
 and regardless of the established order of creation (§ 303 a, 303i). 
 But here we have an exemplification of a strictly atheistical expedi- 
 ent, in the attempt to assign the existence even of organic beings to 
 the merest chance, under the pretext of ascribing to that chance the 
 intrinsic attributes of a Creative Power, and the imposing title of 
 " the Divine Author of all things" ! It is the same with each and all 
 who allow a God, a Creator, &c., yet reject entirely His Revelation 
 as to creation, supported as it is by the most consummate and endless 
 systems of Deai'^n. It is the old expedient of the wolf in the disguise 
 of the sheep (§ 14 c, 64 A, 74, 733 d). 
 
 350|, k. Nevertheless, the foregoing work is powerfully sustained 
 by able articles in the British and Foreign Medical Review for 
 January, 1845, consisting of twenty-six pages of eulogistic remarks; 
 and in the Medico-Chirurgical Review for the same month, often 
 pages not less congratulatory. The work was published late in 1844, 
 and, although not at all relevant to medicine, it was taken up with 
 avidity by the two leading medical journals of Europe, and an effort 
 
 * See Medical and Physiological Commentaries, vol. i., p. 707 ; vol. ii., p. 96. In vol. i.. 
 Grass is a typographical error for Crosse. It is also possible that the " created animals,' 
 instead of being " ciystalized spiculse," were real animals evolved by the action of galvan 
 sim from ova contained in the water (see § 74, 188^ d).
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 185 
 
 made to prepossess the medical profession before the work itself 
 should fall under their observation ; observing in this respect the sys- 
 tem which was almost universally pursued by the periodical press 
 even in anticipation of Liebig's work on Animal Cliemistrrj. 
 
 In my Essay on Spontaneous Generation, embraced in the Medical 
 arid Physiological Commentaries, I have had occasion to refer to the 
 charge of infidelity which is often laid against the Medical Profession. 
 I have there, too, defended that Profession against so great an injus- 
 tice, and have held responsible the proper Sources that have given 
 rise to this imputation. I have also shown that that imputation is 
 greatly due to the cultivation of the chemical and physical hypotheses 
 of life, to which the foregoing Reviews have been laboriously devoted. 
 In conclusion of the whole matter I have said that, 
 
 " The steps are gradual from the incipient errors in natural philos- 
 ophy to a disbelief in the Mosaic Record of Creation. When we 
 have ultimately reached the brink of the precipice, there is but one 
 dreadful plunge, and we are then in the vortex of atheism. We may 
 begin, as I have said, by a simple denial of the living powers of or- 
 ganized beings, when it will become, at last, an easy argument upon 
 this, and analogous premises, that the Almighty had but very little, if 
 any agency, in the most sublime part of existences." 
 
 " Let philosophy interrogate nature to its fullest satiety, under the 
 direction of its Heaven-born principles ; but let it be consistent, and 
 maintain its dignity. And should it sometimes, as it must in its wide 
 range of nature, come in contact with miracle, that is its limit, con- 
 tented that it begins at the confines of Creation ; yet still may it 
 stretch into the regions of Eternity, past and to come ; but now it is 
 employed in its nobler work of sacrificing its relations to second 
 causes, and in establishing relations with the First Cause of All." 
 — Medical and Physiological Commentaries, vol. ii., p. 140. 
 
 3503, hJc. It is now my purpose to quote the foregoing Reviews m 
 connection with the " Vestiges of Creation," partly for the object just 
 assigned, and in part to supply other examples in justification of what 
 I have said in behalf of the Profession, and of the tendency of the 
 chemical and physical hypotheses of life and disease to lay the foun- 
 dation of a grosser materialism, and of infidelity in Religion (§ 175). 
 It seems peculiarly appropriate that Reviewers, who wield an exten- 
 sive and powerful sway, and whose occupation it is to defame what- 
 ever molests that dominion, should be used for the contemplated pur- 
 pose, and this, more especially, as both Reviewers offer defiance to the 
 " Saints," and the "timid religionists." The Reviews are conducted 
 with great diligence and research. Their influence is coextensive 
 with medicine. That influence must be sapped by a display of its 
 tendencies. There can be no difficulty with a defense of the right. 
 The inculpated are able, their means ample, their coadjutors numer- 
 ous and powerful, the public generous, and, as I said on a like occa- 
 sion in the Commentaries, " I am single-handed, and have nothing but 
 facts for my weapons" (vol. i., p. 391). — Note W p. 1127. 
 
 Infidelity is certainly a term which should be well sustained in its 
 application ; better, at least, than when applied to myself by the first 
 of the following journals (see Examination of Reviews, p. 84-88). 
 As it respects the Reviewers, the imputation appears to be invited 
 and expected, as an obvious consequence of the doctrines advanced;
 
 186 INSTITUTES OF MEDICINE. 
 
 and, although I do not belong to the denomination of " Saints," or of 
 the " timid religionists," it is not less my duty as a man, and as an ex- 
 pounder of the Institutes of Nature, to bring those institutions to op- 
 erate vipon infidelity. There can be no place more appropriate for 
 looking " through Nature up to Nature's God," than in the general 
 survey of organic beings. If ordained in their organization and their 
 laws by a higher Power, that organization and those laws may well 
 be urged in proof of their Origin. Then, too, shall the minister of 
 health realize the importance of the Institutes of Medicine, and the 
 spirit of the HipjDocratic maxim, that " a philosophical physician is like 
 a god." 
 
 I shall quote a passage of general import from each of the forego- 
 ing Reviewers, that no doubt may linger upon the mind of any reader 
 as to the justice of the criticism which I have now exercised in behalf of 
 religion, of morality, of the dignity of medicine. The empliasis is mine. 
 
 And first the elder brother ; beginning thus : 
 
 " This is a remarkable volume, small in compass, but embracing a 
 wide range of inquiry from worlds beyond the visible starry firma- 
 ment, to the minutest structures of man and animals. No name is pre- 
 fixed, — perhaps in order to avoid the snarls of the naiTOw-minded. 
 and bigoted saints of the present day," &c. 
 
 The middle thus : 
 
 " For how many millions and millions of years this production and 
 reproduction of animals went on before man made his appearance 
 on the scene, no human being will ever know. [ ! ] In all probability, 
 countless ages must have elapsed, before this master-piece of creation 
 appeared. Our author's speculations on the liow, the why, the when, 
 and the icherefore this great event occuiTed, will not give satisfaction 
 to the present race of mankind. [ ! ] His hypothesis is three or four 
 centuries in advance of the times, and will be stigmatized by the 
 modern saints as do^vnright atheism," &c. 
 
 And the end, thus : 
 
 " We have dedicated a space to this remarkable work that may in- 
 duce many of our readers to peruse the original. The author is de- 
 cidedly a man of great information and reflection. He will have a 
 host of saints in array against him, and many will join in the cry, 
 from hypocrisy and self-interest. As we said before, his doctrines 
 have come out a century before their time." — Medico-Chirurgical 
 Review, p. 147, 153, 157. London, Jan., 1846. 
 
 Next, Di", Forbes, in the BritisJi and Foreign Medical Review. 
 
 " This is a very heautifil and a very interesting book. Its theme is 
 one of the grandest that can occupy human thought, — no less than 
 the Creation of the Universe." "We are also influenced by the 
 abstract desire to place before our readers matter for their contem- 
 plation, which cannot fail at once to elevate, to gratify, and to enrich 
 the mind. It has always been one of the boasts of our noble profes- 
 sion that it touches and blends with eveiy science ; and we should be 
 sorry that our humble efforts should at any time be wanting to stimu- 
 late its professors to exertions that might still justify the boast"! 
 
 Of La Place's nebular hypothesis, he says : 
 
 " So far from admitting the atheistical tendency which timid relig- 
 ionists have attributed to the nebular hypothesis, we consider it the 
 grandest contribution which Science lias yet made to Religion,^* &c.
 
 PHYSIOLOGY,— ^ORGANIC CHEMISTRY FUNCTIONS. 187 
 
 The reader, therefore, will have no difficulty in undei'standing the 
 ■'conventional" nature of certain phrases in the following remarks by 
 Dr. Forbes. (See Ji.) 
 
 " That the Creator formed man out of the dust of the earth, we have 
 scriptural authority for believing, and we must confess our oivn predi- 
 lection for the idea, [ ! ] that, at a period however remotely antece- 
 dent, the Creator endowed certain forms of inorganic matter with the 
 
 PROPERTIES REQUISITE TO ENABLE THEM TO COMBINE, AT THE FITTING 
 
 SEASON, INTO THE HUMAN ORGANISM, [ ! !] ovor that which would lead 
 us to regard the great-grand-father of our common progenitor as a 
 chimpanzee or an orang-outang." — British and Foreign Medical 
 Review, p. 155, 158, 180. London, January, 1846. (See I.) 
 
 The author of the Vestiges of the Natural History of Creation is 
 thus quoted by Dr. Forbes : 
 
 " We have seen powerful evidence that the construction of this 
 globe and its associates, and, inferentially, that of all the other globes 
 of space, was the result, not of any immediate or personal exertion 
 of the Deity, but of natural laws which are expressions of His will. 
 What is to hinder our supposing that the organic creation is also a 
 result of NATURAL LAWS whicli are, in like manner, an expression of 
 His will ■?" — Natural History of Creation. 
 
 Upon the foregoing extract, which is a part of a more extended 
 one of the same nature. Dr. Forbes remarks, that, 
 
 " The complete accordance of these views with those some time 
 ago propounded by ourselves (vol. v., p. 342), must be evident, we 
 think, to our readers. To the objection which some timid religion- 
 ists may urge against them, that they are inconsistent with the INIo- 
 saic record, we simjily reply with our author, that we do not think it 
 right to adduce that record either in support of, or in objection to, 
 any scientific hypothesis, based upon the phenomena of nature," &c.! 
 — British and Foreign Medical Review, p. 167. — Note Pp p. 1142. 
 Dr. Forbes assumes, of course, that all the misapprehensions and 
 perversions of " the phenomena of nature" are paramount to any thing 
 declared in the Mosaic Record (§ b\, 74, 733 d, 1079 h, 1085). 
 
 The most superficial reader cannot fail of discerning in the fore- 
 going principles, as in many other analogous instances, the motives 
 which have induced those foremost medical Reviews to lend their 
 powerful aid in propagating the materialism of Carpenter, the absurd- 
 ities of Liebig, the humoralism of Andral, and the putrid anatomy of 
 Louis, and of their respective schools ; and why, on the other hand, 
 they have been equally regardless of truth in their vocation as critics 
 on the labors, the researches, and the statements of others. — NoteW 
 350|, I. I have ah'eady shown in this and other works how conve- 
 nient a matter it is for "the properties of life in the elements of mat- 
 ter" to bring: these elements into an orsranic state. And since I am 
 now on the subject of the first and gi'eatest step in the process oi vivi- 
 fication, it may be useful, as it is appropriate, to show how the advo- 
 cates of " the properties of life in the elements of matter," and the 
 propagators of spontaneous generation, and eminent geologists who 
 promulgate a successive creation of animals according to their scale 
 in organic nature and in conformity with the development of new 
 physical agencies, ay, and certain eminent vitalists whose otherwise 
 Bound philosophy should have enlightened them sip to the Great First
 
 188 INSTITUTES OF MEDICINE. 
 
 Cause — in view of all these things, I say, it may be conducive ta 
 sound physiology to show how the foregoing schemers of " creation" 
 airive, in part, at least, at the conversion of oi'ganic matter into the 
 complex fabric, after that matter shall have been duly compounded 
 by " the properties of life which reside in the elements." For this 
 purpose I will take the statement of the distinguished vitalist Tiede- 
 mann. Thus, 
 
 " The most probable hypothesis is, that the substance of organic bod- 
 ies existed primitively in water, as matter of a particular kind, and 
 that it was there endowed with the plastic faculty; that is to say, with 
 the power of acquiring, by degrees, different simple forms of living 
 bodies, with the concurrence of the general influences of light, heat, 
 and perhaps also of electricity, &c., and of then passing from the sim- 
 ple forms to other more complicated ; varying in proportion to the 
 modification occurring in the external influences, until the point when 
 each species acquired duration by the production and manifestation 
 of activity of the genital organs" ! — Tiedemann's Physiology of Man. 
 
 That is the doctrine, candidly avowed by those to whom genius and 
 the conviction of a right discernment of the ways of nature impart a 
 fearless independence, however it may be disguised by others under 
 the " conventional term" o? creation. But, Tiedemann is a philosoph- 
 ical vitalist, and did not confound the principle of life with the forces of 
 inorganic matter, nor, like Carpenter, Fletcher, Prichard, Roberton, 
 Forbes, &c., place the properties of that principle in the elements of 
 matter. He started with matter in more or less of an organic state, 
 and leaves it problematical how its elements became united into that 
 peculiar vital compound. He did not even imply that the elements 
 being so endowed could organize themselves, for he adds to the fore- 
 going statement, that, 
 
 " Although we cannot here answer the question, whence came the 
 water and the organic matter which it contained, yet this hypotliesis 
 is the one which accords best with the facts with which geology has 
 lately been enriched.'^ And again, " If it be asked, whence oiganic 
 matters proceed, how they are produced, together with the power of 
 formation inherent in them, we are necessitated candidly to confess 
 our ignorance on the subject, inasmuch as the^r*;; origin of organic 
 matters and living bodies is altogether beyond the range of experi- 
 ment." — Tiedemann's Physiology of Man, p. 14, 193. 
 
 It will be thus seen that even Tiedemann's doctrine enjoys " a loop- 
 hole" which cannot be allowed to those who place " the properties of 
 life in the elements of matter," or who endeavor, or propose, to ere 
 ate organic compounds in the laboratory of the chemist ; since, in re- 
 spect to the latter, were the production of organic compotinds within 
 *' the range of experiment," the accidental nature of the origin of 
 such compounds, and, therefore, the incipient being of man, would 
 be established by the laboratory. And now I ask, does not the or- 
 ganic chemist attempt or profess to create organic compounds ? So 
 says Liebig, § 350, no. 39, and so say most other distinguished, chem- 
 ists. Liebig and his disciples create the compounds ; Crosse and his 
 followers create the animal. Others do but make the attempt ; and 
 this is a very numerous class who thus enter into competition with the 
 Original Author of organic compounds. What, therefore, is the 
 difference in principle between him who pretends to have succeeded
 
 PHYSLOLOGi. ORGANIC CHEMISTRY FUNCTIONS 189 
 
 m this work of creation, and the other who has attempted the work, 
 but without success 1 
 
 From the physiologist who advocates the existence of " the proper- 
 ties of life in the elements of matter," we hear that, 
 
 " There is no reasonable ground for doubt that if the elements 
 could be brought together in their requisite states and proportions iy 
 the liand of man, the result (artificial organic compound) would be the 
 same as the natural compound." Again, " that the germs (of parasitic 
 plants and animals in the interior of others) have been conveyed^ow 
 without into the situations where they are developed, must be held as 
 a very forced, supposition^'' ! — Carpenter's Principles of General and 
 Comparative Physiology, p. 146, 395 ; also, this work, ^ 14 c, 175 c, 
 d, 189 h. — See doctrine of "Developmenf'p. 922, andNoTEPpp.1142. 
 
 350|, m. Mulder has the manliness to carry out the obvious ten- 
 dency of his doctrines, which may be expressed in a brief quotation. 
 Thus, 
 
 "Upon the principles which have been stated, no room is left for 
 the dispute as to equivocal generation and epigenesis." Nevertheless, 
 it is allowed by Mulder that cellular structure " cannot yet be imitated 
 by art." But, waving this conceded difficulty, if the physiological ar- 
 guments which I have advanced in section 14 c, as to a real Creator, 
 can be invalidated, I shall concede that a ground has been obtained 
 for the doctrine of spontaneous generation (^ 1051, p. 922, ^ 1085). 
 
 350^, n. As I shall soon dismiss this author, it may be useful, in 
 consideration of his exalted woi'th as a chemist, and his authority 
 among physiologists, to show that even one who endeavors to hold a 
 consistent philosophy on the subject of chemical physiology, yet sees 
 in organic beings so much to contradict his chemical doctrines, that he 
 evinces the usual inconsistency of those who have endeavored to con- 
 found the science of life with that of chemistry (§ 4^, d). For this 
 pm-pose I shall select two passages only, and place them in parallel 
 columns, after the manner adopted in relation to Liebig in section 
 350. I shall elect, also, for the negative side, a passage which will 
 show, what cannot be too often repeated, that the chemists are absolute- 
 ly regardless of their own fundamental doctrine, of " ascending from 
 phenomena to their causes," by rejecting all the unique phenomena 
 of life as indicative of any peculiar force or laws. The afirmative 
 ?ide, however, is all that the vitalist desires (§ 189). 
 
 Denial of the Vital Principle and Recognition of the Vital Principle 
 Vital Properties. and Vital Properties. 
 
 *' Wherever forces are found in " The question is, whether, du- 
 
 organic nature, there are substan- ring decomposition, the organic 
 
 ces which are all supplied with forces grow weaker of them- 
 
 molecular CHEMICAL forces. Even selves, permitting the elements to 
 
 those singular structures, the obey their primary tendency, — or 
 
 nerves, consist of the same ele- whether causes must exist by 
 
 ments as the ordinary substances which these organic forces are 
 
 of the organic kingdom. It is made weaker 1 Neither is im- 
 
 thus undeniable, that the molecu- probable. Every thing which 
 
 LAR forces act a chief part in the ceases to be subject to the vital 
 
 organism, so far as a change of principle, becomes incapable of 
 
 substances takes place therein ; being stimulated by tlie vital
 
 190 
 
 INSTITUTES OP MEDICINE. 
 
 and that no general, no vital 
 FORCE, should be assumed as the 
 source of those molecular forces. 
 Such a vital force is irreconcilable 
 with the true principles of science, 
 which require that nothing should 
 be assumed as existing, but that 
 every thing should be sought for 
 in nature ; which teach us to as- 
 cend only from an unprejudiced 
 consideration of the phenomena to 
 their causes, and to assign those 
 causes only as we deduce them 
 from the observed phenomena." 
 — Mulder's Chemistry of Vege- 
 table and Animal Physiology, p. 
 68. 1845. 
 
 forces ; — it is placed in other 
 circumstances ; and as the prod- 
 ucts OP the vital functions 
 are different from the prod- 
 ucts OP inorganic nature, in 
 consequence of the very differ- 
 ence of the circumstances in 
 which the elements are placed, so 
 the products of substances, de- 
 prived of vital influence, must 
 also greatly vary with circum- 
 stances. Hence it may happen, 
 that THE forces present in organ- 
 ic substances, when deprived of 
 the VITAL influence, may disap- 
 pear of themselves. The impres- 
 sion they had at first received is 
 changed, modified, obliterated 
 and therefore the effects can no 
 longer be the same. A substance 
 persists in the state into which it 
 yvQ.s first put, according to the law 
 of INERTIA ; but the maxim, suh- 
 lata causa tollitur effectus, is of 
 EQUAL VALUE." — Mulder's Chem- 
 istry of Vegetahle and Animal Phys- 
 iology, p. 54 (§ 59). 
 
 I shall conclude with an extract from Mulder, in which it will bt 
 seen that he has adopted the method set forth by myself in my Essay 
 on the Philosophy of Vitality'^ (1842), of investigating the subject in 
 the development of the germ. It may be useful to place in contrast 
 the purely chemical and the purely vital interpretations of that devel- 
 opment (§ 65). I may also premise that it should be observed that 
 the chemist keeps out of view all the remarkable circumstances at- 
 tending the development of the egg which I have set forth as irrecon- 
 cilable with chemical phenomena, and limits himself to statements 
 founded on a supposed analogy with the simple results of chemical 
 affinity as observed in inorganic nature. Thus : 
 
 " If we review the phenomena of life, caused by change of materi 
 als, we must go back to the original formation of organs — to the 
 growth of an individual from a germ." After illustrating the devel- 
 ment of the germ by " an example from the inorganic kingdom" (the 
 formation of prisms from a solution of the sulphate of soda!), this 
 distinguished chemist proceeds to say, that 
 
 " Undoubtedly the differences which exist between the particles of. 
 the same organic substances are not chemical, in the ordinary gross 
 signification, but are of the nature of those which are connected with 
 polymorphism. The chemist gives us but a rude result — the compo- 
 sition in a hundred parts, fi-equently not affording us any insight into 
 either the real characters of substances, or into their real differences. 
 Whenever such dissimilar particles come together, a compound must 
 be produced, possessing peculiar forces, which, though dependent upon
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 191 
 
 the molecular forces of the elements, are yet not determined by these 
 alone. The new arrangement causes a modification of those primary 
 forces. Whenever it takes place, they appear modified, and therefore 
 indicate their presence by producing new effects. In sulphate of soda, 
 the whole collected forces of its constituent molecules — those of sul- 
 phur, sodium, and oxygen — are still existent; and upon these alone 
 depend its qualities, composition, and crystaline form. Sulphate of 
 soda cannot possess other qualities — cannot become other in property 
 — than what results from its elements, and exclusively originates in 
 these. 
 
 " Thus, then, we suppose that the molecules of the substances in 
 the embryo are arranged, in the first place, simply, and afterward more 
 complexly. Not a trace of any organ is as yet perceptible, however ; 
 nor of any force, therefore, by which these organs will be governed. 
 By the new arrangement of the particles, the molecular forces are 
 modified anew, and this process is continuous. Although the primary 
 forces, once united with the materials, remain the source of every ac- 
 tion, of every manifestation of phenomena, of every chemical and or- 
 ganic, that is, physical, combination ; they must, nevertheless, produce 
 different effects, as the combinations become more complex. Each 
 existing particle is the germ of a subsequent one, which is more com- 
 plex; and, while the temperature necessary for hatching keeps the 
 primary forces always excited, there is originated in the new arrange- 
 ment of the particles, and also in the forces proceeding from the 
 groups recently formed, a modification of these primary forces, which 
 is constantly on the increase. 
 
 " The whole material of the embryo in the egg is gradually brought 
 in this manner within the circle of action. Then the circle is still 
 more extended, and in its action are comprehended the elements of 
 the yolk, and also of the albumen. These are erroneously called the 
 food of the newly-formed chicken, or its rudiments. In these ele- 
 ments there are forces also conjoined with the materials — chemical 
 forces, analogous to those which exist in the embryo, and contributing 
 to the production of the whole. These forces differ from those found 
 in the embryo, not in nature, .but only in direction, or in the mode of 
 manifestation." — Mulder, ut cit, p. 71-73. 
 
 351. Having in the preceding sections, as well as at other times, 
 summoned, in behalf of truth, and of the noblest institutions of na- 
 ture, an adverse party, and having shown, not only by the nature of 
 the pursuits which engage the whole practical attention of the leaders 
 of that party, but by an open cross-examination of the acknowledged 
 chiefs, that the entire field of physiology and medicine remains, as 
 ever, in sole possession of those who are employed in its cultivation, 
 and that, by no possible accident, fraud, or conspiracy, can it be trans- 
 formed or transferred into the laboratory of the chemist, I shall pro- 
 ceed to a more critical examination of the philosophy of digestion, 
 both in its vital, and its supposed chemical attributes. 
 
 352. All other processes of living beings, whether animal or vege- 
 table, and especially the whole work of assimilation after the entrance 
 of the food within the lacteals, being exclusively vital, it follows, as a 
 great analogy of nature, that the first step in the process of assimila- 
 tion is equally due to vital influences (§ 323-326). 
 
 353. Since every species of complex animals has some peculiarity of
 
 192 INSTITUTES OF MEDICINE. 
 
 organization, not only of the alimentary canal, but of the liver, sali- 
 vary glands, pancreas, teath, jaw, skeleton, muscles, and also of in- 
 stinct, corresponding with a certain modification of the vital endow- 
 ments of the gastric juice in each species of animal, which shall be 
 exactly, and forever, and undeviatingly suited to the digestion of those 
 kinds of food which were ordained by the Creator for the sustenance 
 of each when He thus wonderfully instituted this almost endless sys- 
 tem of exact Designs ; each individual part having its specific final 
 cause, each final cause modified in every species and with correspond- 
 ing peculiarities of organization, and all concurring to one great final 
 cause of subserving those exigencies of life which are fulfilled by the 
 gastric juice, and whose modifications in diflferent species of animals 
 harmonize with the special attributes of all the concuixing causes, and 
 so suited by Infinite Wisdom to the nature of the food of every ani- 
 mal, that its incipient change shall be one of assimilation to the nature 
 of the being, yet nearly coincident in all animals from the general co- 
 incidence in all organic compounds ; I say, in all this labyrinth of De- 
 signs, so exactly modified in every species, yet correspondent in all, 
 and each and all, in their individuality, their variety, their modifica- 
 tions, and their unity of purpose, having a specific reference to the 
 alimentary inaterial of each species of animal, we see in perpetual 
 progress what is equivalent to a never-ending voice from Heaven, 
 proclaiming that the organic stomach has no parallel in its capabilities 
 and results in the inorganic world, or in the laboratory of the chemist. 
 But this is not all ; nor will I fail to convert the stupendous whole, as 
 I advance with the details of assimilation, to the fundamental philoso- 
 phy of organic life. 
 
 354. The constituent elements of the food having been subjected to 
 special transformations, and imbued with the first gradations of life, by 
 the vital action of the salivary and gastric juice, and perhaps, also, by 
 contact with the stomach, is thus converted, in all animals, into appa- 
 rently one and the same homogeneous product. It is then submitted 
 to the farther organizing effects of the bile and pancreatic juice, pass- 
 ed through the wonderfully vivifying lacteals, carried forward and 
 subjected to the whole animating influence of the pulmonary system, 
 perfected in its exalted endowments by the whole labyrinth of the 
 circulatory organs, and, lastly, though not least, the various com- 
 pounds are determined, each and all, from that one homogeneous 
 fluid, and in one everlastingly exact manner, and according to the 
 nature of each part, by other complex living systems, and thus per- 
 petuated forever in all their exact varieties, — but /iow, no imagina- 
 tion can form the most remote conception, but through the instrumen- 
 tality of those specific properties of life which were the only power 
 concerned from the beginning to the ending of the astonishing series 
 of unvarying changes (§ 42) ; and, however it be that each ultimate 
 product is destined for the immediate uses of the individual, it is un- 
 deniable that the great final cause of every step in the assimilating pro- 
 cess, till it results in the formation of blood, is the reproduction of gastric 
 juice for the maintenance of an unceasing supply to the exigencies of 
 organic life, and the perpetuation of the species (§ 41, 323-326). 
 
 355. The gastric juice being designed to prepare the material for 
 • the formation of blood has its powers so constituted as to be merely 
 
 an agent. The blood, being the pahuhim vitce fully prepared for the
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 193 
 
 regeneration of the gastric juice, as well as of other organic compounds 
 (§ 354), is mostly a substance acted upon by the living solids, or by 
 the ovum-cell, just as the food had been by the gastric juice, w^hile it 
 serves, also, as a stimulus to the vascular parts, and is highly endovr- 
 ed w^ith the properties of life to facilitate its conversion into living 
 solids or fluids, and to make its presence in the blood-vessels compat- 
 ible with their life. — Note R p. 1123. 
 
 356, a. While we are thus employed in describing the various de- 
 tails of assimilation, attention is unavoidably aiTested by the magnifi- 
 cence of its unique philosophy, and by the ultimate aim of every de- 
 tail of all the immense variety (§ 353-355), even excretion itself (§ 
 412, &;c.), at the production of gastric juice ! And as we penetrate 
 the more latent, but yet more impressive physiological laws to which 
 that juice is obedient, we rise in admiration of the pi'eliminary means 
 of their fulfillment; and now again addressing myself to the chemist, 
 I ask him as a philosopher, as one who would protect the consistency of 
 his own science, what can be more emphaticallysignificantof the abstrac- 
 tion of difjestion from chemical ao^encies than the fact that the nervous 
 power so modifies the vital constitution of the gastric juice that it faihi 
 of its usual function when a division is made of the pneumogastric 
 nerve ? Imagination can suiTnise no connection between the nervous 
 power and the processes of chemistry. And yet do the writings of 
 Liebig, and of other organic chemists, abound with assumptions that 
 the supposed afiinities of chemistry, as operative in animals, are sub- 
 ject to the nervous power ! though it is conceded that the nearly co- 
 incident processes and results in plants sustain no such nervous influ- 
 ences (§ 500, nn). " Tlie anivial organism,^' says Liebig, truly, " is a 
 higher kind of vegetable.'" To suppose that such powers operate in 
 harmony together, and that the mind or its passions are capable of in- 
 fluencing, extensively, the operation of chemical forces, in constantly 
 modifying the various secreted products, both as to quality and quan- 
 tity, is a positive violation of the most obvious and universal rules in 
 natural philosophy (§ 455 a, 461, 478 h, 4881, 493 ^c, 893 a, c, 8931). 
 
 356, b. It is evident that a great difficulty exists with many, who 
 admit a principle of life in relation to the solids, in imagining a fluid 
 to be equally endowed, and alike capable through that principle of 
 acting upon organic matter. But we must take the facts as we find 
 them, nor allow inorganic nature the slightest interference. If analo- 
 gies must be had, let us seek them in the organic being, and we shall 
 be certain of success. In the instance before us we have the admit- 
 ted vitality of the blood ; but, unlike the gastric juice, it produces no 
 changes in matter. We have, however, the simple ovum, " tohose vital 
 properties,'" in the language of Dr. Carpenter, " confer upon it the 
 ■means of itself assimilating, and thereby organizing and endowing ivitJi 
 vitality the materials supplied by the inorganic world" (§ 64, g'). Here, 
 then, the analogy is remarkably forcible, and the more so, as the fact 
 is conceded by the strictly chemical school of digestion. So, of the 
 Bemen, in another aspect of the active condition of the principle of life 
 in an organic fluid ; this substance, through that principle, being ca- 
 pable of modifying the organic constitution of the ovum in such wise, 
 that the offspring shall inherit the intellectual, vital, and physical pe- 
 culiarities of the male parent, with six fingers instead of five (§ 72, 73). 
 
 357. One of the most important arguments in favor of vital diges-
 
 194 INSTITUTES OF MEDICINE. 
 
 tion consists in the remarkable endowments of the stomach, as mani- 
 fested by its vital signs, and by the sympathies which prevail between 
 this organ and all other parts. The final cause of this peculiar con- 
 stitution of the stomach, this lavish supply of the properties of life, this 
 subservience of other organs to its dominion, must be sought in its 
 adaptation to the generation of a fluid that may bestow the first and 
 most difficult act of vitalization upon dead matter (§ 356, a). There 
 would also have been something harsh and abrupt in nature to have 
 admitted into the recesses of her living organization mere dead mat- 
 ter. It is opposed to all analogy, and is, therefore, opposed to all 
 reason. But, that a fluid should perform this astonishing office, this 
 first and great step in the ascending series, it must possess in a high 
 degree the principle of life. Mysterious as it may be represented, we 
 must all of us come at last to the admission of the existence of a vital 
 principle ; yet far less mysterious, and far less difficult of comprehen- 
 sion than the human soul. It is fair, then, to conclude that an organ 
 destined for such a high function should possess that principle, in 
 common with all other parts, as the means on which its function de- 
 pends ; and the best evidences in favor of this analogical inference are 
 to be seen in its diversified manifestations of life. 
 
 358. We have seen, also, that it is conceded by philosophers who 
 defend, in cxtenso, the chemical hypothesis of life, that there may be 
 something appertaining to the stomach totally distinct from the chem- 
 ical powers, and which is capable of imbuing the chyme with vitality 
 and an organic condition ; and it is, therefore, quite a philosophical 
 conclusion that this vital something has an important agency in pre- 
 paring the material for the admitted exercise upon it of the vivifying 
 or organizing power. Nor can there be any valid objection to the 
 supposition that this vitalizing power, which so far transcends the 
 chemical forces in the organizing effect it is allowed to exert, may be 
 fully adequate to any transmutations the food may undergo ; and this 
 inference is the more corroborated by the consideration that matter 
 already in an organic state must be better fitted for the process of 
 vivification than it can possibly be after its elements are broken up 
 and recombined by forces with which those of life are in absolute op- 
 position. Besides, the vitality of the gastric juice, or the vital influ- 
 ence of the stomach itself, being fully admitted, and even capable of 
 organizing the food anew, should sufficiently protect the alimentary 
 matter against any chemical agencies which have been supposed to 
 operate. That this counteracting power, indeed, prevails to the full 
 extent which I have alleged, appears to be rendered certain by the 
 ordinary absence of any of those chemical changes which take place 
 where numerous substances are mixed together out of the stomach — 
 substances which often possess strong chemical affinities for each 
 other, and v/hose operation within the stomach would be promoted by 
 its high temperature. On the contrary, whatever the variety, it is 
 uniformly resolved into one and the same homogeneous substance, ut- 
 terly unlike the results of chemical reactions of one kind of food upon 
 other kinds ; and what is also as conclusive as it is astonishing, the 
 chyle is apparently the same substance in all animals. Chemistry 
 must here be consistent with itself, and not renounce, for the sake of 
 hypothesis, those precise laws by which, in its legitimate pursuit, it 
 lays open, with astonishing exactness, what had appeared the arcan?
 
 I'HYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 195 
 
 of nature. Here, too, upon the chemico-physiological hypothesis, is 
 presented an instance in which it is necessarily assumed that the 
 properties of life and the forces of chemistry act together in concert 
 in converting dead into living matter — one destroying, and at the 
 same moment the other vitalizing ! while the assumption is contra- 
 dicted by all that is known of the relation of these forces to each 
 other (§ 301, 338, 360, 436). 
 
 Nor may we lose sight of the demand of philosophy not to multiply 
 causes where one is perfectly adequate ; and especially where it is 
 admitted that all the others are of themselves wholly inadequate. 
 
 359. The last remark may be also equally applied to a common as- 
 sumption which is set forth in the following apparently plausible man- 
 ner : " The vitalists," says one of their opponents, "are loath to admit 
 the operation of chemical agents at all, and would seem to consider it 
 derogatory to suppose that any changes, save the subtle ones effected 
 by the powers of life, are worked upon the aliment." " The vital 
 principle,^' he says, " whatever it may be, incessantly makes use of 
 chemical and mechanical agents for its purposes ; and it is no more 
 degrading to it to employ an acid liquid, and a triturating process, in 
 order to digest the aliment, than it was to have recourse to bony lev- 
 ers, cartilaginous pulleys, and tendonous ropes." 
 
 Here, in the first place, will be observed an entire begging of the 
 question as to digestion by an acid, since that has never been shown, 
 and is the main point at issue. It is a perfectly unfounded and ex- 
 torted inference from the factitious analogy supposed to be seen in 
 the admitted mechanical movement of the food in the stomach, bony 
 levers, cartilaginous pulleys, &c. But the pi'etended analogy, I say, 
 is utterly inapplicable, were it admissible to reason from better prem- 
 ises of this nature to the existence of important facts which have no 
 other foundation. The bony levers, muscles, tendons, heart, and large 
 blood-vessels, are mere instruments acted upon by the vital princij)le, 
 and have no part in the vital results, except as they are the passive 
 instruments of the properties of life. The same distinction exists be- 
 tween the process of digestion, and the mechanical movement of the 
 food in the stomach, or the " trituration" of the food, as it is errone- 
 ously called by the writer just quoted ; since food is not triturated by 
 the stomach excepting where that organ is designed to supply the 
 place of teeth. There exists, I say, a total want of analogy between 
 that mechanical movement of the food and the assumed action of an 
 acid ; since, in the latter case, a radical change is supposed to be 
 wrought in the alimentary mass, while np such change is wrought by 
 the mere movement, or even by the trituration or grinding of food in 
 the stomach. The contractions of the stomach, which are purely of a 
 vital nature, facilitate the process of digestion; but they do no more 
 than to expose the food freely to the action of the gastric juice, by 
 which, alone, the conversion into chyme is performed. The contrac- 
 tions, or " trituration," ar6 exactly on a par, as auxiliaries to diges- 
 tion, with the teeth, or with the knife, which divide the food. The 
 acid alone applies to the supposed chemical process of chymification. 
 This is the only agent, involving the only force distinct from the vital 
 principle that is supposed to operate, and to take part with the prop- 
 erties of life in the functions which belong to these properties. Nor 
 •3 this all. Those chemical forces, or an equivalent agent, are sup-
 
 19G INSTITUTES OF MEDICINE. 
 
 posed to a}, pertain to the gastric juice (a product of the most highly 
 endowed oigan in the animal system) ; and through that product, and 
 by that product, to operate independently of the vital properties, or, 
 under their control. But, here it may be again affirmed that through- 
 out nature there is not an analogical fact to warrant the conclusion ; 
 and with equal truth it may be said that there is nothing to aid our 
 conception of the co-operation of the chemical and vital forces, while 
 all that is known of their relations to each other proclaims their ab- 
 solute independence. — Med. Chirurg. Rev. Lend. vol. 29, p. 107. 
 
 360. But, again, it is the admitted final cause of the gastric juice to 
 bestow life upon dead matter, while it is incontrovertible that inorgan- 
 ic matter is insusceptible of any such influence from gastric action. 
 Every fact proclaims that nature has provided the vegetable kingdom 
 for the purpose, especially, of determining organic combinations out 
 of inorganic substances for the sustenance of animal life. In the lan- 
 guage of Liebig, " The first substance capable of affording nutriment 
 to animals is the last product of the creative energy" — ay, " the 
 CREATIVE ENERGY," he says, " of vegetables." — (Animal Chemistry.) 
 It is manifest, therefore, that it would be an absurdity on the part of 
 nature to have ordained that chemical agencies should operate even 
 at the very threshold of life, at the very fountain for which she had 
 provided elaborate means to subvert the combinations of chemistry, 
 and to bring them into those entirely new arrangements that approx- 
 imate the changes they are destined to undergo in the animal stom- 
 ach. And far less probable is it, that this fundamental principle 
 should be lost as we ascend from vegetable to animal organization ; 
 since every chemical result within the stomach would tend to reduce 
 the aliment to the state of that inorganic matter whose complete re- 
 duction into organic compounds was effected by the vegetable king- 
 dom for the uses of the animal. Such chemical results, therefore, 
 would counteract the great final cause of nature, in either organic 
 kingdom; and, in the animal, would render the means of sustenance 
 more and more indigestible, and progressively liable to the condition 
 of inorganic matter (§ 33S).* This is fully allowed by the chief of the 
 school of pure chemistry, as shown in the foregoing parallel quota- 
 tions. Take another summary statement, than which nothing can be 
 more contradictory of the chemical rationale. "While no part of an 
 organized being," says Liebig, " can serve as food to vegetables, un- 
 til, by the process of putrefaction and decay, it has assumed the form 
 of inorganic matter, the animal organism requires, for its support and 
 development, highly-organized atoms. The food of all animals, in all 
 circumstances, consists of parts of organisms." — {Ani7)ial Chemistry.) 
 Chemical philosophy should consider that nutriment of an animal na- 
 ture requires but little more than the solvent process, and the bestow- 
 ment of vital properties ; while, in accordance with its crude hypothe- 
 ses, animal compounds must be, more than vegetable, subject to dis- 
 organizing agencies, and thus more completely removed from their 
 original and near approximation to those of the living animal ('^ 18 a). 
 oGl. But again I say, if the vital principle be "capable of making 
 use of chemical agents," no reason can be assigned why it may not 
 be equal to the whole work of digestion, and of every other process 
 
 * This argument is adopted b}' a writer (a distinguished chemist!) in the Amer. 
 Jourti. of Science and Arts, May, 1859, wlio verbally agrees with me that — " The forces 
 of life and inorganic nature act in opposite directions, the former vpivard, the latter 
 do2i-mvard."—SiQe § 301, and p. 911, § 1083. Also, p. 236, ^ 436.— (1860).
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS, 19'' 
 
 of living beings. The simple construction may be comprehended, 
 wbile the other is utterly unintelligible. The former alone is agree- 
 able to the rules of philosophy, and abolishes the inextricable confu- 
 sion which attends the chemical hypothesis. What, indeed, can be 
 meant, by the vital properties making use of chemical forces 1 Can 
 there be a more glaring absurdity % more absolute nonsense 1 How 
 are those chemical forces brought into use, how held in subjection, 
 how forever maintained in one exact operation in each particular or- 
 ganic process, of which there are multitudes, distinct from each other, 
 going on in the same individual ] How do they elaborate from one 
 common, homogeneous fluid, either the blood, or the sap, all the va- 
 rious, unique, unchanging, secreted products of the whole organic be- 
 ing 1 Products, forever the same in every part, yet differing from 
 each other according to the nature of the parti Did you ever hear 
 or dream of any thing analogous to this in that inorganic world where 
 chemistry holds its empire ] When do those chemical forces begin 
 to operate, in the living body, what part do they perform, and what is 
 the allotment of the properties of life 1 Is there any known concert 
 of action between the two species of forces "? On the contrary, is it 
 not every where demonstrated that the properties of life are in direcl 
 opposition to the forces of chemistry 1 
 
 Whatever be the construction, by uniting the two forces (as is done 
 by the only chemical school that is entitled to a respectful notice), we 
 convert what is a simple problem, like all other processes of nature, 
 into the greatest paradox that has been yet devised by the ingenuity 
 of man. It is in vain to say that some one or two of the products of 
 organization, such as carbonic acid, and urea, are such as result from 
 chemical affinities, since these are excrementitious ; while chemistry 
 assures us that all organic compounds are utterly different in their el- 
 ementary combinations from any compound of a chemical nature. 
 
 Thus might I go on to argue this subject upon general principles 
 alone ; while at every step of the argument we should see the whole 
 chemical hypothesis of life taking its proper rank as a dream of the 
 imagination, or as a project of ambitious minds. 
 
 362. Digestion having been assumed to be more or less, or alto 
 gether, a chemical affair, it rationally followed that it might be imita- 
 ted by art. Accordingly, when this ambitious science had succeeded 
 in turning the whole inorganic world into the laboratory, it set itself 
 at the manufacture of organic compounds, and even at the entire ani- 
 mal. It did not, like Alexander, sit down and weep because it had 
 no more worlds to conquer; but, like Shakspeare, having "exhaust- 
 ed worlds, it then imagined new." Even eminent physiologists, who 
 should look with jealousy upon any invasions upon the laws of nature, 
 especially upon such as it is their peculiar province to illustrate, be- 
 gan the manufacture of gastric juice by fire and acids, and metallic 
 salts. We are thus presented by these philosophers with artificial 
 compounds, of a most incongruous nature, and we are told that each 
 one is the gasti-ic juice ; that each is capable of the same precise 
 results as that universal product of animals, apparently the same in 
 all, and elaborated from the blood by an organ of the highest vital 
 endowments, and to which there is nothing analogous in all the other 
 products of living beings, each product being, also, equally unique, 
 and all derived from one common source (§ 135 a, 314, 419, 827 Z*).
 
 198 INSTITUTES OF MEDICINE. 
 
 363. A diversity of opinions exists as to the real nature i^f the 
 chemical agent supposed to be employed by nature in the process of 
 digestion. Free muriatic acid having been found, or supposed to ex- 
 ist, in the stomach, it has been concluded by many that this must be 
 the gi-eat agent; while Dr. Prout, and others, affirm that "free mu- 
 riatic acid more or less retards the process of reduction." Dr. R. 
 Thompson, however, states that, by digesting muscular fibre in dilute 
 muriatic acid, he produced a substance "exactly resembling chyme." 
 This experiment was pretty widely repeated, and many were equally 
 successful with " dilute muriatic acid" as was Dr. Thompson. Oth- 
 ers, on the contrary, declared their failure, and others, like Dr. Prout, 
 maintained that this acid retarded digestion. Eberle had already ad- 
 vanced the hypothesis that mucous membranes, no matter whether of 
 the stomach or the bladder, dissolved either in muriatic or acetic acid, 
 Avould form the true gastric juice, and perform its wonderful opera- 
 tions. There is now a general bias in favor of one of these com- 
 pounds, though other preparations are supposed by many to form very 
 good gastric juice. Again, it is said that the "digestive mixture," as 
 it has been well denominated by the manufacturers, " retains its sol- 
 vent properties for months," while the gastric juice loses its solvent 
 power soon after its abstraction from the stomach (§ 341). And what 
 equally establishes a total difference between the " mixture" and the 
 gastric juice is the no small circumstance that the chemist may torture 
 and extinguish the artificial "digestive principle" in a variety of ways, 
 and then transmute it back in all its vigor. Thus, according to Schwann 
 and Miiller, the artificial "digestive principle" maybe neutralized by 
 an alkali, and afterward " precipitated from its neutral solution by 
 acetate of lead, and obtained again in an active state from that precip- 
 itate by means of hydro-sulphuric acid." This precipitate, we are 
 told, when thus treated, and thus compounded of principles radically 
 different from the original mixture, is essentially the same as the 
 gastric juice, and that the results of such artificial preparations must 
 be taken as the test of the physiology of natural digestion ; that, aban- 
 doning nature, we must look to the resources of the laboratory" for 
 any satisfactory account of her vital processes. Nor do I at all exag- 
 gerate ; for it is distinctly avowed that we knew nothing of digestion 
 till the invention of the artificial mixtures. Thus, it is said of Schwann 
 by one so able and distinguished as Miiller, that he (Schwann) "hav- 
 ing discovered that the infusion of dry mucous membrane with dilute 
 acid, even after it is filtered, still retains its digestive power, the di- 
 gestive principle, therefore, is clearly in solution, and the theory of di- 
 gestion hy contact falls to the ground." Here, a most important phys- 
 iological induction is wholly founded upon a process which has not 
 the most remote connection with organized matter. 
 
 364. I have said that the experimenters took the hint of manufac- 
 turing gastric juice from the occasional discovery of an acid in the 
 stomach. But, this is undoubtedly a rare phenomenon in a healthy 
 stomach, and where the food has been at all appropriate in quality 
 and quantity. The chemical hypothesis, as I have said, was long ago 
 in vogue, and was put at rest by demonstrative proof. Distinguished 
 observers, Hunter, Haller, Willis, Spallanzani, Fordyce, and more 
 recently Dumas, Schultz, and others, insist that the reputed acid is 
 the result of a true chemical decomposition of vegetable matter
 
 PHYSIOLOGY. ORGA.M C CHEMISTRY FUNCTIONS. 19ft 
 
 Spallanzani, whose experiments were almost endless, Scopoli, Chev- 
 reuil, and others, rarely succeeded in finding it at all, and in some an- 
 imals never. Spallanzani, indeed, affirms that the gastric juice is 
 neither acid nor alkaline in its natural state. 
 
 As far back as Haller's day, when this subject was agitated, it is 
 said by this illustrious and accurate observer, that, " although there 
 may be some rare signs of an acid in the stomach, it does not, there- 
 fore, become "us to suppose that food is animalized by a chemical 
 process ; much less to compare this process with the action of an 
 acid." And, anticipating the modern experiments with the " diges- 
 tive mixture," he declares of analogous proceedings at his own era, 
 " frustra etiam quisquam, imitatus liquores acres chemicos, liquoi'em 
 corrodentem invenerit, qui carnem in pultem resolvat." And there 
 can be no doubt that Hunter's prophecy holds good to this day, that, 
 
 " If ever any matter is formed in any of the juices secreted in any 
 part of a vegetable or animal body similar to what arises from fer- 
 mentation, we may depend on it, it arose from that process ; but we 
 may also depend on it, that there is a defect of the living principle in 
 these cases." 
 
 These are not the mere speculations of genius, but the facts and 
 the conclusions of genius after a long, and wide, and experimental 
 survey of nature. And are these observations, nay, our own experi- 
 ence, our own senses, to be set aside to accommodate an hypothesis 
 of "life which identifies dead, even inorganic, with living beings 1 
 
 364^. But perhaps even a greater violence, than the foregoing 
 manufacture of gastric juice, has been recently done to physiology, 
 in the alleged conversion, by chemical manipulations, of the secreted 
 products of organs, totally unlike, into each other. It should be con- 
 ceded, however, that this has been generally, sanctioned by the jour- 
 nals of the day. Thus, in the London Lancet for July, 1845, is a 
 quotation from the report of MM. Villefranche and Barreswill to the 
 French Academy on the " Che??iical Phenomena of Digestion," from 
 which the conclusion is deduced that 
 
 " Thus, it appears easy to transform the gastric juice, the pancreatic 
 fluid, and the saliva, into each other, and to make an artificial 
 
 GASTRIC JUICE FROM THE PANCREATIC FLUID, and vicC VCrSO" ! 
 
 It appears, also, from these late experiments, that the digestive 
 principle depends on an organic matter, that " the said matter may be 
 destroyed by an elevated temperature," and that " its digestive pow- 
 ers vary, according as it is associated with a fluid having an acid or 
 an alkaline reaction." 
 
 It would seem, therefore, not improbable that a new hypothesis 
 will soon be in vogue, and that the acid principle will be abandoned 
 to satisfy the claims of new aspirants. 
 
 365. The assumed identity of the artificial products with the chyme 
 of the human and other stomachs has never been shown in the slight- 
 est degree ; and that it is the merest assumption is not only proved 
 by what I have already set forth, but is fully admitted by those who 
 advocate the chemical doctrine. The conclusion rests upon the mere 
 appearance which the artificial substance offers to the eye. Thus, it 
 is lately said by Dr. Davy, that 
 
 " It is impossible to witness the change which takes place in mus- 
 cular fibre, in consequence of putrefaction giving rise to a fluid very
 
 200 
 
 INSTITUTES OP MEDICINE. 
 
 like cliyme in appearance, without asking, may not putrefaction bo 
 concerned in digestion itself, according to the earliest theoretical no- 
 tions on the subject," and as now maintained by Liebig, and his fol- 
 lowers (§ 350) ] Farther on, however, in the same work, he says, 
 " twenty different semi-fluids might be mentioned, to which, as far as 
 ihe eye can judge, this puti-id matter bears as close a resemblance as 
 to chyme'' (§ 341). 
 
 366. " Dr. Beaumont [of St. Martin celebrity] has instituted several 
 experiments with a view to determine the power of acids in dissolv- 
 ing articles of food ; and the results which he obtained, although they 
 varied somewhat according to the substances employed in the exper- 
 iments, have nevertheless led him to the conclusion that no other fluid 
 produces the same effect on food which the gastric juice does, and that 
 IT is the only solvent of aliment''' (§ 341, 373). — Muller's Physiology, 
 p. 589. London, 1839. 
 
 So far Dr. Beaumont's accuracy may be readily admitted. But, as 
 his observations upon the natural process of digestion, as carried on 
 in St. Martin's stomach, have become incoi-porated in most of the 
 subsequent works on physiology, and even in systematic works on 
 diet, where they generally serve as a foundation for some of the most 
 important conclusions in the science of life, and have been seized 
 upon with avidity by the supporters of the physical and chemical 
 doctrines, and without any reference to their credibility, or to the un- 
 natural condition of that celebrated stomach, it may be well to show, 
 by their conflict with universal expei'ience, that those observations 
 are not only worthless, but pregnant with the greatest practical er- 
 rors. For this purpose, it is only necessary to present a brief abstract 
 from the tabular view supplied by the author of the average time oc- 
 cupied by different alimentary substances in undergoing digestion. 
 Thus : 
 
 ARTICLES OF DIET. 
 
 Pigs' feet, soused 
 
 Tripe, do 
 
 Salmon trout, fresh . 
 Apples, sweet .... 
 Cabbage, with vinegar 
 Hash, meat and vegetables 
 
 Goose 
 
 Cake, sponge .... 
 
 Pig 
 
 Pork, fat and lean, recently salted 
 
 Pork steak 
 
 Sausage, fresh .... 
 Dumpling, apple 
 Green com and beans 
 Bread, wheat, fresh . 
 
 Do. Indian com 
 Eggs, fresh .... 
 
 Oysters, fresh .... 
 Beef, fresh, lean, rare 
 Mutton, fresh .... 
 Fowls, domestic 
 Potatoes, Irish .... 
 
 Mean Time of Chymijia.ition. 
 
 Preparation. 
 
 h.n,. 
 
 boiled. 
 
 1 00 
 
 do. 
 
 1 00 
 
 do. 
 
 1 30 
 
 raw. 
 
 1 30 
 
 raw. 
 
 2 00 
 
 warmed. 
 
 2 30 
 
 roasted. 
 
 2 30 
 
 baked. 
 
 2 30 
 
 roasted. 
 
 2 30 
 
 raw or stewed. 
 
 3 00 
 
 broiled. 
 
 3 15 
 
 do. 
 
 3 20 
 
 boiled. 
 
 3 00 
 
 do. 
 
 3 45 
 
 baked. 
 
 3 30 
 
 do. 
 
 3 15 
 
 boiled. 
 
 3 30 
 
 stewed 
 
 3 30 
 
 roaste'' 
 
 3 00 
 
 do. 
 
 3 15 
 
 do. and boiled. 
 
 4 00 
 
 boiled. 
 
 3 30 
 
 Here, then, we have pigs' feet nearly four times as easy of diges 
 lion as baked bread, or roasted mutton, or beef, or domestic fowls, 
 or eggs, or oysters ; raw cabbage nearly twice as easy of digestion ; 
 I'oasted pig and goose a third or more eas?ier, &:c. And these aro
 
 rtlYSlOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 201 
 
 common examples of what is known, in medicine, as " the experi- 
 mental philosophy of the nineteenth century," and " the march of med- 
 ical science" over all former and more rational experience {§ IS). 
 
 367. The experiments with pepsin, or the artificial mixtures, have 
 been limited to substances already animalized, in their simple condi- 
 tions, and in minute proportions. Hay, nuts, onions, and even arrow- 
 root, would be appalling to pepsin ; and the quantities of the gor- 
 mand, or the variety of the epicure, would soon show the nature, of 
 this branch of " experimental philosophy." 
 
 368. A chemical dilemma pi-esents itself The supposed chemical 
 agent in digestion should be the same in all animals, to explain, in the 
 least, the identity of the resulting products, — and so it is admitted by 
 the advocates of one " mixture," or of another, respectively. But 
 this, on the other hand, is clearly contradicted by the variety of the 
 " mixtures," and by the vast variety of alimentary substances, con- 
 sumed by different species of animals ; while, indeed, if the least re- 
 gard were paid to the laws of chemical affinity, it should be obvious 
 that there would be no small variety of chemical influences in the 
 stomach of omnivorous man. 
 
 369. Nevertheless, if the " digestive mixture" be made from the mu- 
 cous tissue of the stomach of a strictly graminivorous animal, or even 
 from its bladder, it will " digest" meat and other substances which 
 form the peculiar food of carnivorous animals, but will refuse to di- 
 gest most of the substances common to the animal fi'om whose stomach 
 the " digestive mixture" is pi'epared. This, therefore, is contrary to 
 nature. 
 
 370. Digestion is well performed and often promoted when alkalies 
 are taken into the stomach in sufficient quantities to hold the reputed 
 amount of acid in a neutral state. 
 
 371. On the contrary, digestion is always impaired by the introduc- 
 tion of acids into the stomach while the process is going on. 
 
 372. Did the supposed acid exist in the gastric juice, it would ren 
 der the medicinal doses of the nitrate of silver, or the acetate of lead, 
 perfectly inert. This principle is also of obvious application to many 
 other substances. " Indeed, it would be a perpetual " incompatible" 
 with many remedial agents. 
 
 373. If digestion depend on the supposed chemical agencies, the 
 stomach should always undergo more or less of that change after 
 death ; especially violent death. It is the rarest phenomenon, however, 
 in man or animals, to witness the slightest change in that organ that 
 can be referable to the gastric juice (§ 366). 
 
 374. It is fundamental in nature that an organ which is designed 
 for the production of an organic fluid does not also generate an inor- 
 ganic substance, especially a simple element like chlorine, for the pur- 
 pose of bestowing organization and life. 
 
 375. Again, since it is the raucous tissue of the stomach alone 
 which, in all animals, secretes a juice capable of producing chyme; 
 and as no other part of any organized being can generate a substance 
 of similar power, how arrogant, therefore, the supposition that art can 
 manufacture a fluid of the same virtues (§ 323-325) ! 
 
 376. As new aspirants enter the field, novelties, of course, will 
 spring up. They serve, however, to show us the importance of re- 
 garding with suspicion whatever ^nav conflict with the long-estab)ish-
 
 202 INSTITUTES OF MEDICINE. 
 
 ed conclusions which have been drawn from an observation of the 
 most common phenomena of living beings. This leads me to advert 
 to the experimental researches of Dr. Schultz, the eminent Berlin 
 professor, which, whatever be their foundation, effectually destroy our 
 confidence in all those " digestive mixtures" which have figured, of 
 late years, so conspicuously in nearly all the systematic works or; 
 physiology. 
 
 In the first place, Professor Schultz infers that neither the stomach 
 nor the gastric juice have much agency in digestion, but that this 
 great office is mostly performed by the saliva. This distinguished 
 observer also finds that, 
 
 1st. " The secretions of the stomach are always alkaline excepting 
 during the process of digestion." 
 
 2d. " No food undergoes digestion without saliva." 
 
 3d. " The chyme is not produced by chemical action, but is an or- 
 ganic compound formed by a vital transformation of the food." 
 
 4th. " There is no such product as the supposed acid gastric juice; 
 only a sour chyme" (§ 364, Hunter). 
 
 5th. " The acid found in the stomach is the result of a chemical de- 
 composition of the food" (§ 364). — Schultz, de Aliment. Concoctione 
 Also, the Rejuvenescence of Man, &c, 1842. 
 
 Again, still more recently, M. Blondlot, under the guidance of " ex- 
 perimental philosophy,"* afl&rms that the saliva is of the nature of mu- 
 cus, little else than the waste of organs {as Liehig regards tlie gastric 
 juice, § 350), contributing nothing to digestion, and only useful as a 
 shield to the mucous surface (Blondlot, Traite de Analitiqtce de la 
 Digestion, p. 124, 126). 
 
 3761-. It appears, therefore, that all the prevailing physical views 
 of digestion, the chemical doctrines of secreted products, the healthy 
 and morbid processes of living beings, the modus operandi of morbific 
 and remedial agents, which completely shuts out the magnificent laws 
 of sympathy, and the whole bathos of the humoral pathology, have 
 been, in recent times, the work of the laboratory. Physiologists and 
 therapeutists, the British especially, appear to have forgotten that it is 
 their business to explore the facts and the laws of Organic nature, and 
 to have turned the whole matter over to the chemist (§ 349, d). They 
 have surrendered this high calling to the laboratory, and have bowed 
 in submission to whatever its acids and crucibles have pretended to 
 reveal as to the processes and laws of living beings. A vast number 
 have thus discarded their lofty pursuits, and have substituted for them 
 a most unnatural dependence upon the laboratory of the chemist. 
 
 The chemist has seized the opportunity with avidity ; since his em- 
 ployment with inorganic nature is mostly analytical, mostly exhausted, 
 while that which relates to living beings supplies an unbounded field 
 for the institution of great principles and laws, whether true or false, 
 and for the highest renown in philosophy. It is not remarkable, 
 therefore, considering the prizes are few, the competitors many, that 
 the " race is to the swift, and the battle to the strong," that the ambi- 
 tious chemist should abandon the mere work of analysis, and push his 
 inquiries into that magnificent department of nature where the richest 
 laurels may be gathered. Inorganic chemistry supplies no such op- 
 jwrtunities. Its work is analytical, and its principles few and simple ; 
 * An artificial fistulous opening in a dog's stomach (§ 366).
 
 PHYSIOLOGY. OKGANIC CHEMISTRY FUNCTIONS. 203 
 
 md this, alone, is ilie legitimate object of organic chemistry. That ob- 
 ject has been lately well expressed by Mr. Hoblyn, in his Manual of 
 Chemistry. Thus : 
 
 " The peculiar principles which exist in all organized beings are 
 distinct from those which operate on inorganic matters, and may be 
 denominated organic agents. Their mode of operation is mysterious. 
 The object of organic chemistry is to investigate the chemical history of 
 the products which occur in the vegetable and animal kingdoms, and 
 which are hence called organic substances." 
 
 I therefore say, let us look well to the doings of the chemist. Let 
 us properly regard his tampering with so profound a subject as phys- 
 iology, whether in its natural or morbid aspects. Let us scrutinize 
 his facts when he assails the experience of all the renowned in medi- 
 cal science through all past time, and declares that experience worth- 
 less (§ 350, mottoes'). Let us not, however, indignantly retaliate upon 
 him his attempts to overthrow the great fabric of medicine, or his ef- 
 forts to undervalue the labors and the doctrines of men wlio have 
 toiled in the field of organic nature, and have immolated themselves 
 in the chambers of the sick. Let us rather kindly advise the chemist 
 to cultivate modesty, and tell him, frankly, that, to comprehend the 
 laws and the processes of living beings, they must be perpetually the 
 objects of profound study, both in the natural state of the being and 
 in all the variations to which he is liable from the influences of mor- 
 bific and remedial agents. Let us tell him that he has acted wisely 
 in refraining from all such observations, and in making the laboratory 
 the exclusive theatre of his experimental inquiries. Either science, 
 analytical, and limited in principles and laws, as chemistry may be, is 
 enough for the compass of an individual ; and medicine transcends 
 the powers of the most gigantic mind. The physician, therefore, if he 
 aim at the highest practical usefulness, or at the science of medicine, 
 will find only the leisure to acquire the outlines of chemistry, and it 
 is equally certain that the chemist who aspires at a profound knowl- 
 edge of that department must spend his clays and his nights within 
 the precincts of his workshop, — Notes Ddd, Ggg, p. 1149, 1151. 
 
 And now let us remember, that there is not one name in all the 
 annals of medicine which rests for its distinction on the physical 
 and chemical doctrines of life. On the contrary, in every instance 
 where attempts have been made to carry the science of chemistry into 
 physiology, in all, and every such instance, the individuals who have 
 been so employed have sunk rapidly into oblivion ; unless here and 
 there a name, like Fourcroy's and Liebig's, which is rescued by lofty 
 genius, and by purely chemical labors in the inorganic kingdom. 
 
 376|, a. Finally, I will not forego this opportunity of bringing to 
 the support of opinions which I have hitherto advanced the following 
 extract from Judge Story's late address before the Alumni of Har- 
 vard University. It will be seen that the views of this distinguished 
 man are entirely coincident with those which I had expressed in a 
 former work. (See Medical and Physiological Commentaries, vol. i., 
 p. 331-333, 310, 307, 308, 327, 385-400 ; vol. ii., p. 666-677, 801- 
 815, 12, 13, 203, 644, &c.) 
 
 " I have said," says this eminent jurist, " that the tendency in our 
 day is to ultraism of all sorts. I am aware that this suggestion may 
 appear to some minds of an easy good-nature, or indolent confidence.
 
 204 INSTITUTES OF MEDICINE. 
 
 to be over-wrought, or too highly colored. But unless we choose 
 voluntai-ily to blind ourselves to what is passing before our eyes in 
 the daily intercourse of life, it seems to me impossible not to feel that 
 there is much which demands severe scrutiny, if not serious alarm. 
 I meddle not here with the bold, and yet familiar speculations upon 
 government and polity, upon the fundamental changes, and even abo- 
 lition of constitutions, or upon the fluctuating innovations of ordinary 
 legislation. These might, of themselves, furnish out exciting themes 
 for public discussion, if this were a fit occasion to introduce them. I 
 speak rather of the interests of letters — of the common cause of learn- 
 ing — of the deep and abiding principles of philosophy. Is it not pain- 
 fully true that the spirit of the age has broken loose from the strong 
 ties which have hitherto bound society together by the mutual cohe- 
 sions and attractions of habits, manners, institutions, morals, and liter- 
 ature 1 It seems to me, that what is old is no longer a matter of 
 reverence or affection. What is established, is not on that account 
 esteemed positively correct, or even salutary or useful. What have 
 hitherto been deemed fundamental truths in the wide range of human 
 experience and moral reasoning, are no longer admitted as axioms^ 
 or even as starting-points, but at most are propounded only as prob- 
 lems, worthy of solution. They are questioned and scrutinized, and 
 required to be submitted to jealous proofs. They have not even con- 
 ceded to them the ordinary prerogative of being presumed to be true 
 until the contrary is clearly shown. In short, there seems to me, at 
 least, to be abroad a general skepticism — a restless spirit of innova- 
 tion and change — a fretful desire to provoke discussions of all sorts, 
 under the pretext of free inquiry, or of comprehensive liberalism. 
 And this movement is to be found not merely among illiterate and 
 vain pretenders, but among minds of the highest order, which are ca- 
 pable of giving fearful impulses to public opinion. We seem to be 
 borne on the tide of experiment with a rash and impetuous speed, 
 confident that there is no risk in our course, and heedless that it may 
 make shipwreck of our best hopes, and spread desolation and ruin on 
 every side, as well on its ebb as its flow. The main ground, there- 
 fore, for apprehension, is not from undue reverence for antiquity, so 
 much as it is from dreamy expectations of unbounded future intellect- 
 ual progress ; and, above all, from our gross over- valuation and in- 
 ordinate exaggeration of the peculiar advantages and excellences of 
 our own age over all others. This last is, so to say, our besetting sin ; 
 and we worship the idol, carved by the cunning of our own hands, 
 with a fond and parental devotion. There are many even among the 
 educated classes, and far more among the uneducated, who imagine 
 that we see now, as men never saw before, in extent, as well as in 
 clearness of vision ; that we reason, as men never reasoned before ; 
 that we have reached depths and made discoveries, not merely in ab- 
 stract and physical science, but in the ascertainment of the moral and 
 intellectual powers of man, and the true structure and interests of gov- 
 ernment and society, which throw into comparative insignificance the 
 attainments of past ages. We seem to ourselves to be emerging, as 
 it were, from the darkness of by-gone centuries, whose glow-worm 
 lights ' show the matin to be near, and 'gin to pale their ineffectual 
 fires,' before our advancing radiance. We are almost ready to per- 
 suade ourselves that their experience is of little value to us ; ihat the
 
 PHYSIOLOGY. ORGANIC CHEMISTRY FUNCTIONS. 205 
 
 change of circumstances is so great, that what was wisdom once is 
 no longer such ; that it served well enough for the day, but that it 
 ought not now to be an object of desire, or even of commendation. 
 
 " Nay, the comparison is sometimes eagerly pressed of our achieve- 
 ments in literature with those of former ages. Our histories are said 
 to be more philosophical, more searching, more exact, more elaborate 
 than theirs. Our poetry is said to surpass theirs in brilliancy, imag- 
 inativeness, tenderness, elegance, and variety, and not to be behind 
 theirs even in sublimity, or terrific grandeur. It is more thoughtful, 
 more natural, more suggestive, more concentrative, and more thrill- 
 ing than theirs. Our philosophy is not, like theirs, harsh or crabbed, 
 or irregular; but wrought out in harmonious and well-defined pro- 
 portions. Our metaphysical systems and mental speculations are (as 
 we flatter ourselves) to endure forever, not merely as monuments of 
 our faith, but of truth ; while the old systems must fall into ruins, or 
 merely furnish materials to reconstruct the new — as the temples of 
 the gods of ancient Rome sei've but to trick out or ornament the mod- 
 ern churches of the Eternal City. Ay, and it may be so. But who 
 will pause and gaze on the latter, when his eyes can fasten on the gi- 
 gantic forms of the Coliseum, or the Pantheon, or the Column of Tra- 
 jan, or the Arch of Constantino 1 
 
 " May I not stop for a moment, and ask if there is not much delu- 
 sion and error in this notion of our superiority over former ages ; and 
 if there be, whether it may not be fatal to our just progress in litera- 
 ture, as well as to the permanent interests of society ? I would not 
 ask those who entertain such opinions to accompany me back to the 
 days of Aristotle and Cicero, whose works on the subject of govern- 
 ment and politics alone have scarcely received any essential addition 
 in principles or practical wisdom, down to this very hour. Who, of 
 all the great names of the past, have possessed so profound an influ- 
 ence and so wide an authority for so long a period 1 Jf time be the 
 arbiter of poetical excellence, whose fame is so secure as that of Ho- 
 mer and Virgil 1 Whose histories may hope to outlive those of Thu- 
 cydides and Tacitus 1 But I would limit myself to a far naiTower 
 space, to the period of the two centuries which have elapsed since 
 our ancestors emigrated to America. Survey the generations which 
 have passed away, and let us ask ourselves what have been their lit- 
 erary labors and scientific attainments 1 What the productions of 
 their genius and learning 1 What the amount which they have con- 
 tributed to meliorate the condition of mankind — to lay deep and broad 
 the foundations of Theology, and Jurisprudence, and Medicine — to 
 establish and illustrate the principles of free goveraments and inter- 
 national law — and to instruct as well as amuse the leisure, and to re- 
 fine the taste of social life 1 Unless I greatly mistake, a calm survey 
 of this whole matter would convince every well-balanced mind, that 
 if we may claim something for ourselves, we must yield much to the 
 scholars of those days. We shall find that much of our own fruits 
 have been grafted on the ancient stocks. That much of what we now 
 admire is not destined for immortality. That much which we deem 
 new is hut an ill-disguised plunder from the old repositories. And that 
 much which we vaunt to he true consists of old fallacies, often refuted 
 and forgotten, or of unripe theories, which must perish by the way- 
 side, or be choked by other weeds of a kindred gi'owth.
 
 206 INSTITUTES OF MEDICINE. 
 
 " The truth is, that no single generation of men can accoviplish muck 
 of itself or for itsef which does not essentially rest upon what has been 
 done before. Whatever may be the extent oi' variety of labors and 
 attainments, much of them will fail to reach posterity, and much which 
 reaches them will be felt, not as a distinct formation, but only as com- 
 ponent ingredients of the general mass of knowledge. Many of the 
 immortals of one age cease to be such in the next which succeeds it ; 
 and, at best, after a fitful season of renown, they quietly pass away, 
 and sleep well in the common cemetery of the departed. What is 
 present is apt to be dazzling and imposing, and to assume a vast im- 
 portance over the distant and the obscure. The mind in its perspect- 
 ive becomes affected by the like laws as those of the natural vision. 
 The shrub in the foreground overtops the oak, that has numbered its 
 centuries. The hill under our eye looms higher than the snowy Alps, 
 which skirt the edge of the hoinzon. 
 
 " But let us subject this matter to a little closer scrutiny, and see if 
 the annals of the last two centuries alone do not sufficiently admonish 
 us of the mutability of human fame, as well as that of human pursuits. 
 What a vast amount of intellectual power has been expended during 
 that period, which is now dimly seen, or entirely forgotten ! The 
 very names of many authors have perished, and the titles of their 
 works are to be gathered only from the dusty pages of some obscure 
 catalogue. What reason can we have to suppose that much of our 
 own labors will not share a kindred fate % But, turning to another 
 and brighter part of the picture, where the mellowing hand of time 
 has touched with its finest tints the varying figui'es. Who are there 
 to be seen but Shakspeare, and Milton, and Bacon, and Locke, and 
 Newton, and Cudworth, and Taylor, and Barrow, not to speak of a 
 host of others, whose works ought to be profoundly studied, and 
 should illustrate every library. I put it to ourselves to say, who are 
 the men of this generation to be brought into comparison with these., in 
 the extent and variety of their labors, the powers of their genius, or the 
 depth of their researches 1 Who of ourselves can hope to exercise an 
 influence over the human mind as wide-spread as theirs ] Who can 
 hope to do more for science, for philosophy, for literature, for theolo- 
 gy, than they % I put the argument to our modesty, whether we can 
 dispense with the products of their genius, and wisdom, and learning; 
 or may cast aside their works, as mere play-things for idlers, or curi- 
 osities for collectors of the antique % 
 
 " I have but glanced at this subject. It would occupy a large dis- 
 course to unfold it in its various bearings and consequences. But the 
 strong tendency of our times to disregard the lessons and the author- 
 ity of the past must have any thing but a salutary effect upon all the 
 complicated interests of literary as well as social life. It not only 
 loosens and disjoints those institutions, which seem indispensable to 
 our common happiness and security, but it puts afloat all those prin- 
 ciples, which constitute, as it were, the very axioms of all sound phi- 
 losophy and literature. In no country on earth is the danger of such 
 a tendency so pregnant with fearful results, as in our own ; for it 
 nurses a spirit of innovation, and experiment, and oscillation, which 
 leaves no resting-place for sober meditation or permanent progress. 
 It was the striking remark of an acute obsei-ver of the human mind, 
 that ' he who sets out with doubting, will find life finished, before he
 
 PHYSIOLOGY. FUNCTIONS. 207 
 
 becomes master of the rudiments ;' and that he who begins by pre- 
 suming on his own sense has ended his studies as soon as he has 
 commenced them." — Judge Story's Address, &c.* 
 
 376|, h. In parting, for the present, with organic chemistry . 
 would again pay my humble tribute, to a science of exalted worth, in 
 its vocation of laying open the constitution and laws of inorganic na- 
 ture, and in applying its results to many of the most useful purposes 
 of life. The physiologist venerates the science, does homage to its 
 cultivators, would do battle for its cause. In protecting the great In- 
 stitution which it is his province to illustrate, in preserving unsullied 
 the stupendous philosophy of Medicine, he makes no enci'oachment 
 on a sister science ; but, ever obedient to the voice of Nature, he wor- 
 ships in all her temples (i^ 1034). 
 
 4. DISTRIBUTION. 
 
 377. The fourth function common to animals and plants is distribu- 
 tion or circulation. In the former, after the food has become so far 
 assimilated as to receive the final act of appropriation, or, in other 
 words, after it is formed into blood, it must be distributed to all parts 
 of the body, for their growth, nutrition, &c. This office is performed 
 by the heart and blood-vessels in all perfect and superior animals, 
 and by the blood-vessels alone in the inferior tribes, and whenever 
 the heart is wanting. In the last instance the means are very similar 
 to those which carry on the circulation in plants. 
 
 378. The mechanism of circulation is shown by the function. In 
 the perfect animals the blood is expelled by the left venti'icle of the 
 heait into the aorta, and thence distributed to all parts of the body ; 
 where it is applied to nutrition and secretion, and undergoes depura- 
 tion by the excretory organs. Such as is not thus appropriated is 
 sent forward to the communicating veins, by which it is conveyed to 
 the right auricle, and from thence to the right ventricle, to be distrib- 
 uted to the lungs through the pulmonary artery, and returned, again, 
 to the left ventricle through the pulmonary veins and left auricle. In 
 the lungs, the venous blood is converted to arterial, and perfected foi 
 the various exigencies of organic life, by the joint agency of the pul- 
 monary mucous tissue and atmospheric air (§ 419, 827 b). 
 
 379. A remarkable exception occurs to the foregoing general plan 
 of the circulation in the transmission of venous blood from the ab- 
 dominal viscera to the liver, through the vena portae. It is also 
 anomalous, that this blood is appropriated, in part, to the formation 
 of an organic fluid, the bile, while the residue is transmitted to the 
 vena cava through the hepatic veins ; these veins being also the asso- 
 ciate medium for the return of blood from the hepatic artery (i^lOSl). 
 
 380. There are three principal distinctions between the blood senl 
 out by the left ventricle and that which is returned to the right : 1st. 
 The color of venous blood is a modena red ; that of arterial a bright 
 scarlet. 2d. Venous blood is more highly charged with carbonaceous 
 matter than the arterial. 3d. Venous blood will not support the life 
 of organs. 
 
 381. The blood supplies all parts with their means of nutrition, se- 
 cretion, &c., and is, itself, the stimulus by which its own circulatory 
 organs are excited to motion, and by which the formative and secre- 
 tory vessels are maintained in their action. The pahtdum vitce is, 
 
 * See a remai-kable parallel to the foregoint; in Tacitus' Dialogue concerning Ora- 
 tory. The coincidences should admonish us tlie more.
 
 208 INSTITUTES Cf MEDICINE. 
 
 therefore, remarkably distinguished from all other substances in na- 
 ture, in being equally the stimulus of the whole circulatory system, 
 and the substance acted upon and appropriated according to the na- 
 ture of every part in which it may circulate (§ 136). 
 
 It is the same with the sap of plants as with the blood ; both being 
 alike the pabvlum vitce. Each is every where converted into the 
 solid organs to which it is distributed, and into fluids and other prod- 
 ucts which have their special allotment in organic life ; and nothing 
 is formed which is not derived immediately from the blood or sap (§ 
 41-44, 847 c, 1053). 
 
 OF THE POWERS WHICH CIRCULATE THE BLOOD.* 
 
 382. Much of the philosophy of medicine is involved in a right es- 
 timate of the powers which carry on the circulation of the blood. 
 But, having set forth this subject extensively in the Medical and 
 Physiological Commentaries, I shall now limit my remarks to a state- 
 ment of the most prominent facts (§ 407, a). 
 
 383, a. A great error has prevailed of ascribing the circulation of 
 the blood to the propelling power of the heart alone. Another, less 
 common, imputes venous circulation to the action of the capillary ar- 
 teries ; while a still greater regards it as a hydrostatic phenomenon 
 dependent on the arterial column of blood. Another, subversive of 
 all principles in medicine, refers the circulation in the capillary ves- 
 sels — those instruments of all the essential organic processes — to cap- 
 illary attraction. Another supposes that the blood is moved in viitue 
 of its own inherent power. Another, that the globular portion is 
 composed of animalcula, which traverse the circulatory system by 
 their locomotive endowment. But, the most obnoxious to objection 
 is the latest speculation which flows from the universal doctrine of 
 Liebig, that 
 
 " All vital activity arises from the mutual action of the oxygen of 
 the atmosphere and the elements of the food ;" that " the life of ani- 
 mals exhibits itself in the continual absorption of the oxygen of the 
 air, and its combination with ceitain component parts of the animal 
 body ;" and that " the cause of the state of motion is to be found in 
 a series of changes which the food undergoes in the organism ; those 
 changes being the results of processes of decomposition, to which the 
 food itself, or the structures formed from it, or parts of organs, are 
 subjected." (See § 350, nos. 9, 10,^ 1054). 
 
 This last hypothesis imputes the circulation entirely to the chemical 
 action of oxygen gas upon the tissues and upon the blood itself; re- 
 jects, altogether, the propelling and suction power of the heart, over- 
 looks the respiratory movements, the peristaltic action of the intesti- 
 nal canal, the permanent contraction of the sphincters, the motions of 
 the iris, denies all vascular action, even in the face of such phenome- 
 na as blushing, and all other sympathetic movements, nor recognizes 
 a local morbid physiological determination of blood, or a morbid pro- 
 cess, or a physiological influence of therapeutical agents, but con- 
 strues all these unique results upon the same chemical phenomenon. 
 
 383, h. A modification, however, of this doctrine concedes an in- 
 strumentality of the heart in circulating the blood. The heart still 
 acts in virtue of the combustive process ; and so far the doctrine is 
 
 * The term powers, as here employed, comprehends the instruments of circtdation.
 
 PHYSIOLOGY. FUNCTIONS. 209 
 
 consistent. But it is fundamentally contradicted by the incongruity 
 of the two great sources of power at the apex and at the circumfer- 
 ence of the circulation, when contrasted with the exact balance which 
 prevails between the moving power of the heart and the circulation 
 of the blood in the capillary system. Nor is there to be found in na- 
 ture two such distinct sources of power for the accomplishment of a 
 specific effect as that which imputes the circulation of the blood to 
 an associate mechanical impulse by the heart and a chemical process 
 in the capillary blood-vessels (§ 129). 
 
 384. There are numerous elements concerned in the circulation of 
 the blood, each one of which I have endeavored to substantiate in a 
 former work.* — See also p. 934, ^ 1090. 
 
 1st. The heart possesses, through its vital properties, an active 
 power of dilating and contracting (§ 498, e, 1090), 
 
 2d. The arteries possess a similar power, though in a far inferior 
 degree. This has been determined by the application of irritants. — 
 {Medical and Physiological Comm., vol. ii., p. 147-152, 375-403.) 
 
 3d. The capillary arteries, or the reservoirs of blood to the ex- 
 treme vessels, have the same power, which is much more actively ex- 
 ercised than in the larger arteries. The capillaries are consequently 
 brought into greater action when stimulated by physical agents, as in 
 inflammatory diseases, or by the nervous power, as in blushing (§ 
 480, 1039), or as it lights up inflammation (§ 647^, 746 c, 973-974). 
 
 4th. The extreme vessels, or terminating series of the arterial sys- 
 tem, have, also, a like power of contracting and dilating actively, and 
 in a still greater degree than the capillary arteries (§ 136, 750). 
 
 5th. The extreme capillary veins have, also, a special action of the 
 foregoing nature, which aids in transmitting the blood from the arte- 
 rial system to the next larger series of veins. 
 
 6th. The larger veins possess the power of dilating and contracting 
 actively, according to the varying quantities of blood transmitted from 
 the arterial system. Their constant conatus to contract on their con- 
 tents assists in the transmission of the blood. 
 
 7th. All the cavities of the heart operate upon the principle of an 
 exhausting pump, during their dilatation. — Note Bb p. 1131. 
 
 385. All the foregoing powers (§ 384) concur together, according 
 to a consummate Design, in circulating the blood. All are important 
 elements ; no one adequate in itself, while each should be studied by 
 itself, as well as in connection with the whole (§ 74, 80, 117, 137, 143, 
 155, 156, 169/, 266, 3031 a, 306, 310, 311, 387, 399, 409/ 422, 
 514 h, 524 d, 525, 526 d, 528, 638, 733 h, 750, 764 h, 811, 847 c, 
 848, 902/ 905, 1054). The Exp. &c. are in the Commentaries.* 
 
 386. The contraction and dilatation of the heart and arteries are, 
 respectively, nearly synchronous. Although there be a perfect consent 
 of action between the capillaries, the extreme vessels, and the heart, 
 those vessels are not associated with the movements of the heart, 
 nor with each other, in the same way as the actions of the heart and 
 arteries ; and they are modified, also, according to the special func- 
 tions they perform in different parts (133 h, 135 a, 136). The case 
 of blushing shows us the law in regard to the capillaries (§ 476, &c.). 
 
 387. The final cause of motion in the veins is chiefly that of sub- 
 
 * Medical and Physiological Commentaries, vol. ii., p. 375-426, 147-152, and the Essay 
 on the Theoiies of Inflammation, ibid.
 
 210 INSTITUTES OP MEDICINE. 
 
 serving the arterial system ; and here the consent of action between 
 the veins and arteries is still more illustrative of the profound nature 
 of the principles and laws which govern the functions of organic life. 
 It has been, indeed, the universal doctrine that the capacity of the 
 veins is determined in a mechanical manner by the volume of blood 
 transmitted from the arteries ; but I have endeavored to show that the 
 supposed physical distension and elastic contraction of the veins are 
 without foundation, and would form a most serious obstacle to the cir- 
 culation of the blood. On the contrary, it appears that those actions 
 are not only of a vital nature, but that they are a perpetual illustra- 
 tion of sympathy, depending upon sympathetic relations of the veins 
 to the communicating series of arterial capillaries. 
 
 This peculiar constitution of the veins explains the reason why they 
 collapse when divided ; since their sympathetic relation to the arteries 
 is thus extinguished. The veins, indeed, appear to be not less sus- 
 ceptible of action from the stimulus of sympathy with the capillary 
 artei'ies than the iris with the retina (§ 514, k), whose phenomena so 
 clearly demonstrate the operation of that principle in developing sen- 
 sible motions ; but compounded as to veins of continuous and remote.* 
 
 The dilatations and contractions of the veins are, therefore, very 
 greatly effected by reflex nervous influences exerted upon them by the 
 varying states of the capillary arteries, as well as by the quantities of 
 blood they are employed in transmitting to the veins. These influ- 
 ences appear to be originally felt by the capillary series of veins, 
 where the organic properties are most strongly pronounced, and 
 thence propagated by continuous sympathy to the larger series (§ 498, 
 and Co7n7n., vol. ii., p. 520, 521, &c.), when reflex actions ensue.* 
 
 Did not a consent of action with the arteries (depending on the 
 princijjle of sympathy, § 452, 495, &c., 498) exist in the veins, the vi- 
 tal contractility, and the elastic property of the coats, must be me- 
 chanically overcome by the increased quantity of blood transmitted to 
 them. The blood must be forcibly injected into the capillary veins 
 by the vis a tergo, and in numerous parts of difficult penetration 
 by the finest injections of art. This is utterly repugnant to that Uni- 
 ty of Design which prevails in all parts of the organized being, and 
 would be leaving an important function to a fortuitous and inadequate 
 pi-ovision. Nor can it be consistently supposed that the phenomena 
 which appertain to one class of vessels are of a vital nature, and 
 those of the other, resulting in an anatomically associated series, 
 mechanical. 
 
 The veins possess, also, longitudinal fibres, by which they are fit- 
 ted for rapid and uniform motion over an extensive tract ; and this 
 action implies a predominance of continuous sympathy (§ 498). It is 
 also proved that the veins, like the heart and arteries, dilate actively 
 on the application of certain stimuli to their external surface. — 
 {Med. and Physiolog. Comm., vol. ii., p. 147-152, 375-401.) 
 
 388. Venous circulation is determined principally by the suction 
 or derivative power of the right cavities of the heart, but is aided by 
 the contractile power of the large veins, by the more specific action 
 of the capillary veins, and by the propelling power of the communi- 
 cating series of arterial capillaries. The contraction of the left ven- 
 tricle of the heart, and that of the large arteries, have little or no 
 agency in venous cii'culation. Their force is probably exhausted, or 
 
 ■* Continuous sympathy is continuous in fluerice of these Institutes (sec. 129 c, f, 498 a)
 
 PHYSIOLOGY. FUNCTIONS. 211 
 
 nearly so, when the blood has reached the terminal series of the arte- 
 rial system. 
 
 The blood is returned from the lungs to the left cavities of the heart 
 by the powers just stated. 
 
 It is not alone the dilatation of the auricles which constitutes the 
 derivative power, as had been supposed till 1 investigated this subject; 
 but equally, also, that of the ventricles [^ 1090). 
 
 389. In the Medical and Physiological Commentaries, I have ex- 
 amined every objection which has been alleged against the imputed 
 dependence of venous circulation upon the dilatation of the cavities of 
 the heart, and atmospheric pressure. One objection had been stated 
 with greater force and apparent plausibility than the rest, by Di"s. 
 Philip, Arnott, and other eminent men ; namely, that the pai'ietes of 
 the veins should collapse upon the supposed doctrine of suction. To 
 this objection I have replied, that the injecting power of the commu- 
 nicating arterial capillaries maintains the veins in a state of fullness. 
 The perfectly harmonious relation among the powers which circulate 
 the blood establishes a correspondence between the movements in 
 the venous and arterial systems, by which nature has duly provided 
 against so great an evil as apprehended. 
 
 390, a. The suction power of the heart, as I have endeavored to 
 show in the "Commentaries," is indispensable to the portal circula- 
 tion, and to that, also, of the lymphatics, lacteals, thoracic duct, and 
 umbilical vein ; though, doubtless, the independent action of these 
 vessels contributes to the motion of their contents. 
 
 390, h. In the foregoing work I have considered the objection rela- 
 tive to the occasional jet of blood from a vein wounded in venesec- 
 tion in certain conditions of disease ; and I purpose now, from its 
 ambiguous relation to my subject, adverting to the causes of the in- 
 termitting pulse that so often attends congested states of the liver. 
 This phenomenon has been long observed ; but no substantial cause 
 has been assigned. It is due, I apprehend, to two influences, one of 
 which is sympathetic, the other more or less mechanical. 
 
 The sympathetic is readily appreciated ; the mechanical, and most 
 important, requires explanation. In my Essay on Inflammation, and 
 in the present work, I have endeavored to show that the current of 
 blood is accelerated in the vessels immediately concerned in that 
 morbid process, notwithstanding the enlarged diameters of the vessels 
 (§ 711, &c.). But not so in venous congestion, unless the propelling, 
 and therefore, also, the suction power of the heart, be considerably 
 increased. It often happens, however, that the force of the heart, 
 in venous congestions of the liver, is even reduced below its ordinary 
 standard, however there may be an attendant hardness of the pulse 
 (§ 688). Now, therefore, since the veins undergo an enlargement in 
 their congested states, and since, also, the volume of blood which is 
 transmitted to the heart through the portal system is very large, if it 
 enter that organ in an unusual manner, it is highly probable that it 
 would embarrass its action. Such would be the effect of a sluggish 
 or irregular ingress, especially, as will be seen, if not correspondent 
 with the egress of blood. 
 
 But, it not unfrequently happens that the pulse becomes intermit- 
 tent, for the first time, after the hepatic affection has sensibly yielded. 
 This occurs, however, mostly, if not altogether, in rather intense
 
 212 INSTITUTES OF MEDICINE. 
 
 fonns t £ venous congestion, and wlicrc the force of the heart, and 
 therefore its suction power, are manifestly increased, so much so, 
 indeed, that practitioners, cautious of blood-letting, will venture upon 
 the remedy. An incomplete subsidence of the disease, and the 
 means of treatment, reduce the action of the heart ; and the suction 
 power being thus lessened, while the veins remain yet enlarged, the 
 blood moves with a tardy pace in the portal veins, and disturbs the 
 rhythmic action of the heart. 
 
 There is also another, and important element of this mechanical 
 cause, which consists in an interrupted balance between the blood 
 which enters the heart and that which is projected from it ; its en- 
 trance being rendered slow by the state of the portal veins, while its 
 projection is unembarrassed. If the pulse be merely intermittent, 
 and only so after several beats, excitement from exercise, but not 
 from the mind, will often restore, for a sliort time, the harmony of 
 both ventricles. Mental excitement, on the contrary, through nervous 
 influence, is apt to increase the intermission, and often adds an irreg- 
 ularity (§ 227, 509, &c.). But, unlike the simply intermitting, an ir- 
 regular pulse is commonly increased in its irregularity by violent 
 exercise, as well as by excitements of mind. The intermitting pulse, 
 on the contrary, is often most strongly pronounced in the horizontal 
 posture. Pvcflcx nervous influences enact a part in this phenomenon. 
 
 The nature of the sympathetic cause will be readily appreciated 
 by the accurate observer, when he considers how often intermis- 
 sions or irregularities of the pulse are increased by a full, and some- 
 times a scanty meal (§ 512), through reflex nervous actions. 
 
 Cerebral inflammation often gives rise to an irregular action of the 
 heart ; but here the cause is determined by the nervous power alone 
 (§ 226, &c.). In the case of the brain, also, the pulse is apt to be 
 more irregular than intermittent ; while in that of the liver it may 
 be both (§ G87, &c.). 
 
 391. The valves of the veins have been universally supposed to con- 
 tribute essentially to venous circulation, by supporting the column 
 of blood. This, however, I have endeavored to show, is a mistaken 
 opinion ;* for they are always open when the current of blood is pass- 
 ing. Like the valves of the heart their great final cause is to prevent 
 the reflux of blood when pressure operates, and to contribute to the 
 like design of the frequent inosculation of the veins. The supposed 
 co-operation of the voluntary muscles in venous circulation is also 
 merely accidental. 
 
 392, a. It appears, therefore, that the whole theory of the circula- 
 tion is strictly relative to the properties of life. The pressure of the 
 atmosphere, by which the blood is forced along the returning vessels, 
 is entirely incidental ; and, although the transit of blood from one 
 part to another is merely mechanical, its motion originates entirely ir. 
 vital agencies. The facts, of which the foregoing conclusions are 
 predicated, arc very numerous, and contribute to some of the most 
 important pathological and therapeutical principles. It may bo use- 
 ful to consider yet farther some of the most indisputable, and to re- 
 gard them, at the same time, in their connection with the laws of 
 which they are the foundation. 
 
 392, h. Although the vascular system contributes an important part 
 
 * Medical and Physiological Commentaries, vol. ii., p. 412, 426.
 
 PHYSIOLOGY. FUNCTIONS. 213 
 
 toward the common circulation, the heart possesses within itself a 
 general control over this gi-eat function of life. Had it been other- 
 wise, " a thousand causes might intervene, over which the organ, so 
 limited in influence, could have no control, to retard or divert the 
 course of the blood ; and which, by occasioning one short delay, might 
 pi-event its return forever." It is, therefore, not only the great mo- 
 tive source, through its contractile power, in the universal act of dis- 
 tribution, but, to effect a return of the venous blood, " it is made the 
 centre of atmospheric pressure and gravity, and designates the stage 
 in the circulation in which a deficiency of supply would be the last in 
 being felt. Hence it appears that the functions of the heart are per- 
 formed, and life preserved, notwithstanding long and copious dis- 
 charges of blood, which, upon any other hypothesis, must have been 
 fatal. For, according to these hypotheses, the heart, or at least the 
 auricles, are placed at the end of projection. They mark the highest 
 advance of the tide, and would first be abandoned by the retii'ing 
 fluid. They would be drained by every profuse hemorrhage, and the 
 heart would expend its energy in fruitless efforts to circulate a fluid 
 that came not within its reach." Upon any other theory, how could 
 what Armstrong calls " the beautiful balance between the right and 
 left sides of the heart" be preserved] How, otherwise, would the 
 circulation be restored in syncope ] In respect, also, to the absorbent 
 power, it is farther well said by Carson, that, " though we are not ac- 
 quainted with any data from which the power of the heart can be cal- 
 culated, there must exist, nevertheless, certain limits, within which it 
 must reasonably be supposed to be confined. If we consider that the 
 quantity of blood in circulation is neai-ly one fifth of the weight of the 
 whole body ; that this gieat mass is spread over an immense surface ; 
 that it is therefore subjected to great resistance from friction, espe 
 cially in the small vessels where each globule is to be rolled over a 
 fixed surface ; that the currents, in consequence of anastomosing 
 branches, arc perpetually flowing in opposite directions, and that at- 
 traction must powerfully prevail between the blood and small vessels; 
 when wc consider the mass moved, the motion with which it is moved, 
 and the resistance opposed, it is impossible to imagine that this labor 
 could have been performed by the propelling power of the ventricle ;" 
 besides the obvious objections of the liability of the curvature of the 
 aorta and the capillary arteries to be ruptured, and the exigencies of 
 the portal, placental, and lymphatic circulation (§ 390). 
 
 Again, "the two trunks of the ascending and descending cava meet 
 at the heart in such a manner as to form a straight line. The streams 
 of blood which are conveyed by these vessels to the heart are placed 
 at that point in direct opposition. Upon the supposition that the blood 
 is returned to the heart by a vis a tergo, this position of the vessels is 
 the most unfavorable that can be conceived for the ofHce that is as- 
 signed to them. The momentum of blood in one vessel would be de- 
 stroyed by that of the other ; or, if the current in the descending was 
 stronger than that in the ascending cava, the blood in the weaker 
 stream would be prevented from ever reaching the heart." 
 
 392, c. In the Medical and Physiological Commentaries, especially 
 in the Essays on Inflammation, and the Powers which Circulate the 
 Blood, I have exhibited a great amount of proof establishing the 
 vital actions of the capillary blood-vessels, and showing that the mo
 
 214 INSTITUTES OF MEDICINE. 
 
 mentum of the blood, as derived from the left cardiac ventricle, is 
 nearly lost in the capillaries. The opinion of Hunter, Bichat, Philip, 
 and other distinguished observers, to the same effect, being founded 
 upon the most ample investigations, vs^ould seem to leave no doubt 
 upon a question of such fundamental importance in the philosophy 
 of organic life. " Have they," says Wilson Philip, " who maintain 
 that the circulation is supported by the muscular power of the heart 
 alone, made even the rudest calculation of the degree of resistance 
 to be overcome in driving the blood through two capillary systems at 
 such a rate, that, in a given time, the same quantity shall be delivered 
 by the veins, which is thrown into the arteries ? Have they made 
 any estimate of the strengtli necessary in the different sets of vessels, 
 and particularly in the larger arteries, to sustain a power capable of 
 overcoming this resistance 1 Let them give what imaginable power 
 they will, they cannot make this power greater than the coats of the 
 vessels will bear without rupture" (^ 1054, 1056). 
 
 So completely arrested, indeed, is the momentum of blood when 
 it reaches the arterial capillaries, so manifest are the vital actions of 
 these vessels, and so unaccountably did Philip and Bichat overlook 
 the suction power of the heart, that they ascribed the circulation in 
 the veins entirely to the propelling action of the capillary arteries. 
 Owing to this limited view, Bichat was led to observe, that, " not- 
 withstanding all that has been written as to the cause of venous cir- 
 culation, there is an obscurity in it, in which there are but few rays 
 of light." The circulation of the liver embaiTassed him especially; 
 since any general hypothesis which should fail here must be wholly 
 abandoned (^ 390). He considered it, however, " incontestibly 
 proved, that when the blood has arrived in the general capillary sys- 
 tem, it is absolutely beyond the influence of the heart, and that the 
 left ventricle has no influence in the venous system." 
 
 392, d. The demonstrations of a direct nature, to show the inde- 
 pendent action of the blood-vessels (the veins as well as arteries), 
 are too numerous and various for concentrated observation. They 
 are scattered throughout this work, and many of importance occur 
 only in the Medical and Physiological Commentaries (vol. ii., p. 147- 
 152, 375-401). The original suggestions of many belong to myself, 
 ds, also, their general application to the subjects before me. It has 
 been one of my special objects to demonstrate an active dilatation of 
 all the blood-vessels, as well as their active contraction. The latter, 
 indeed, proves that the dilatation is active and vital. The greater 
 principle lies in the necessity of a counteracting power ; since active 
 contraction alternating with dilatation necessarily implies correspond- 
 ing principles of motion, or there would be a permanent state of 
 contraction or tonic spasm. The sanguiferous system, therefore, 
 would be devoid of function, and nothing but " stagnation" would 
 be the great law of organic nature (§ 748, 1039, 1090). 
 
 393. The doctrine of venous circulation, as I have expounded it 
 here, and proved it extensively in the '* Commentaries," is replete 
 with the most important physiological, pathological, and therapeutical 
 conclusions. It strikes a fatal blow at the whole mechanical hypoth- 
 esis and the stimulant treatment of venous congestion (§ 788-793), 
 as shown in my Essay on that affection. It determines all the great 
 fundamental points which have been in dispute respecting the circu-
 
 PHYSIOLOGY. FUNCTIONS. 215 
 
 lation of the blood. It proves that the propelling force of the left 
 ventricle of the heart is lost, or nearly so, in the extreme capillary- 
 arteries. It proves, what is of greater importance than all things 
 else in the Institutes of medicine, that the extreme vessels possess an 
 independent vital action ; since otherwise the blood could never be 
 carried forward in the veins by the power of suction (§ 389). But 
 that would not be the greatest oversight in the plan of organic na- 
 ture (^ 1039,1040). 
 
 394. The highest practical, as well as philosophical, conclusions 
 are involved in a correct estimate of the powers which determine the 
 circulation of the blood (§ 393). But there are no errors so prolific 
 of evil, and so derogatory to medical philosophy, as that which as- 
 sumes a passive state of the terminal series of the arteries, or that 
 circulation is carried on in that series by capillary attraction, or by 
 their oxydation (§ 383). 
 
 Were either of these hypotheses true, there could be none of the 
 organic products, as derived from the blood, no secretion, no nutri- 
 tion — not a principle in physiology, pathology, or therapeutics ; for 
 all the essential organic functions, and all the processes of disease, 
 are carried on by the terminal series of the arteries (§ 481 g, 483, &c.). 
 
 Consider the phenomena of sympathy ; contemplate the experi- 
 ments of Philip to determine the laws of the vital functions ; study 
 the laws of the nei"vous power in their relation to organic functions ; 
 observe how instantly mental emotions will variously affect the action 
 of the heart, or bring a suffusion of blood to the pallid face, or how 
 stimuli applied to the brain will as instantly produce corresponding 
 results (§ 481-485); and you will concede that these results of the 
 operation of the nervous power demonstrate the independent vital ac- 
 jdoxL of the capillary vessels, and overtui'n the physical and chemical 
 hypotheses of life. 
 
 395. The foregoing influence of the cerebro-spinal and ganglionic 
 systems upon the capillaries and extreme vessels is of the highest im- 
 portance in pathology, and in the philosophy and treatment of dis- 
 ease. These vessels are not only the instruments of disease, but they 
 sustain all the morbific influences which result in sympathetic dis- 
 eases, and upon these vessels all remedial agents exert their curative 
 effects, whether by their direct action, or through the instrumentality 
 of the nervous power (§ 222-233|, 456 a, 1039, Note Bb p. 1131). 
 
 396. Nor is it alone an active condition by which the terminal se- 
 ries of arteries is remarkably distinguished. Our various facts estab- 
 lish the no less important principles, that the several orders of term- 
 inal vessels have their vital properties and actions strongly pronoun- 
 ced, and that these properties and actions are peculiarly modified in 
 their natural state, both in a general sense, and in different parts, and 
 that they are liable to various other peculiar modifications from the 
 operation of morbific and therapeutical agents. Hence, all our cura- 
 tive means must have a steady and direct reference to the existing 
 condition of these extreme capillary vessels (§ 149, 150, &c.). 
 
 397. Of the extreme vessels physiologists have supposed, with great 
 reason, that thei'e are at least three series ; one being destined for nu- 
 trition, another for the secretion and excretion of the fluids, and an- 
 other series coinciding with the veins. 
 
 Without being disposed to submit this question, in the least, to the
 
 816 INSTITUTES OF MEDICINE. 
 
 microscope (§ 131), there might be allowed, according to Wagner, 
 what has probably been hypothetically suggested by the well-known 
 simplicity of nature, that there is " but one kind of termination in ref- 
 erence to an artery — a passage into a vein through a capillary vessel, 
 and an intermediate net-work." In this case, however, there must 
 either exist lateral projections from the terminal capillary, or there 
 must radiate from the " intermediate net-work" vessels whose office is 
 to distribute the blood from which are eliminated the materials for 
 nutrition, &c. 
 
 398. The extreme vessels which are destined for nutrition, secre- 
 tion, and excretion, elect from the blood, contained in their reservoirs 
 the capillary arteries, the precise elements that are necessary to the 
 formation of each peculiar compound throughout the body, and in 
 such uniform proportions and modes of combination as shall forever, 
 and without deviation, render them exactly conformable to the nature 
 of every part, as ordained at the Creation (§ 41-44). This is done 
 in virtue of the peculiarly modified states of irritability and other 
 properties of life, according to the exact office of every part. Yet 
 are these the vessels which are said to be under the sole government 
 of physical and chemical laws (§ 383), and whose morbid state in in- 
 flammation is constituted by a mechanical relaxation of their parietes, 
 and a stagnation and coagulation of their contents (§ 711, &c.) ! 
 
 399. In their natural state, the foregoing vessels admit but very few 
 of the red globules of blood, in virtue of their peculiarly modified ir- 
 ritability; and this, therefore, where the calibre surpasses the diam- 
 eters of the red globules. There is no mechanical "straining off oi 
 the finer from the coarser parts of the blood" by an inadequate capa- 
 city of those vessels which convey only white blood (§ 493, d). The 
 separation is effected in a homogeneous substance, and by causea 
 which are very foreign to "strainers" and "sieves" (§ 129, 135-138, 
 266, 750). The same principle interprets the admission of the red 
 globules into those serous vessels, in inflammation. In-itability is there 
 morbidly affected, and the usual process of vital decomposition of the 
 blood is, of course, aiTested (§ 327-329). The entire blood then finds 
 its way into the lymph vessels, as they are called ; and the organic 
 law by which that result is determined (§ 192, 278) is beautifully illus- 
 trated by two experiments ; one by Buniva, the other by Procter 
 The experiments also confirm the doctrines which I have taught as to 
 the character of the nei-vous power, and its agency in organic actions, 
 while both observers pursuing different routes, and attaining a com- 
 mon end through opposite effects, but by common principles relative 
 to the nervous power, illustrate and confirm the experiments of each 
 (§ 222-233|, 476, &c., 500). 
 
 Buniva had great difficulty in effecting an injection of an artery of 
 a living dog, till he divided the spinal cord, when, by thus withdraw- 
 ing the stimulus of the nervous power, the capillaries lost their pecu- 
 liar susceptibility, and the contents of the syringe passed freely on. — 
 Buniva (^ 1039, 1056). 
 
 In Procter's experiment, " a horse was killed by dividing the me- 
 dulla, the bowels turned aside, and the branch of the sympathetic 
 nerve, which joins the ischiadic, laid bare ; also, one of the arteries 
 of the leg. A wire applied to the positive pole of a galvanic bat- 
 tery, defended with sponge, was applied to the nerve, and the nega
 
 PHYSIOLOGY. FUNCTIONS. 217 
 
 tive wire to the artery. The positive wire was then drawn slowly 
 along the plates of a fifty-plate battery and the effect was certainly 
 not only to reproduce the pulsation in the artery, but also clearly to 
 excite circulation in the more minute vessels." A by-stander ex 
 claimed, " See how that pipe beats when they put on those wires !' 
 — Procter, on the Sympathetic Nerve. 1844. 
 
 To the foregoing may be added the experiment by Dr. Hall (§ 263) 
 which, it will have been observed, is insuperably opposed to his con 
 elusions as to the agency of the nervous system in producing organic 
 actions, and as examined in my Essays on " Vitality," &c. (p. 42 
 note). See, also, Experiments by Kriemer, § 485, and Philip, § 483 
 and Dr. Parry's case, § 487, gg. — Note Q, p. 1122. 
 
 5. APPROPRIATION, OR NUTRITION AND SECRETION. 
 
 400. Appropriation, like assimilation, is a comprehensive, though 
 less complex, function. It embraces what are commonly designated 
 as two functions, namely, nutrition and secretion. 
 
 401, a. A common fluid being formed, and distributed to the sever- 
 al parts of the animal and vegetable, is then appropriated to their 
 several uses. 
 
 401. b. Animals are distinguished by an unceasing change of the 
 materials of which they are composed. The actions of life disturb 
 the composition of parts, which, being thus unsuited for the purposes 
 of organization, and reduced to a fluid state, are returned to the 
 general circulating mass of blood, where they either again undergo 
 assimilation, or are eliminated and cast off" by the excretory organs. 
 To supply this waste is, in part, the office of appropriation, which 
 furnishes new molecules from the blood, in exact conformity with the 
 process of disintegration after growth is completed, but occuiTing in 
 excess while nutrition is engaged in rearing up the fabric to a state 
 of maturity. Appropriation is also the function through which those 
 secreted fluids, which act as auxiliaries in the processes of life, are 
 renewed in their original character. 
 
 402. Appropriation, therefore, whether it ref^r to the increase and 
 renewal of the solid parts, or to the production of useful fluids, being 
 equally a process of secretion, every organic product, vegetable or 
 animal, is the result of secretion. But appropriation, as applied to 
 the useful fluids that are formed from the blood or sap, is more com- 
 monly known as an act of secretion ; and though the next function 
 which will be considered, namely, excretion, is very analogous, yet the 
 final causes of secretion and excretion being entirely different, it is 
 proper that they should be arranged as distinct processes. 
 
 Since, however, nutrition, secretion, and excretion are very analo- 
 gous processes, secretion is a good generic term for the whole. Each 
 process consists of certain acts by which new formations are gener- 
 ated from the blood. All parts are first eliminated in a fluid state. 
 Such as are destined for nutrition assume the condition of the solids 
 which they supply as soon as eliminated : such as subserve the uses 
 of fluids remain permanently fluid. It is evident, therefore, that ap- 
 propriation, in a philosophical sense, is the highest act of assimila- 
 tion, but may be very propei'ly regarded as a function by itself 
 
 403. Every part of the body possesses a secreting apparatus, since 
 every part appropriates the blood to itself (§ 398).
 
 218 
 
 INSTITUTES OF MEDICINE. 
 
 404. The organs which generate the permanent fluid products are 
 very various, and more complex than such as carry on nutrition. The 
 former are either glands or simple membranes, acting in their com- 
 pound condition (§ 92). The immediate instruments consist of a sim 
 pie series of extreme vessels which pervade every part, and which 
 are every where so constituted, anatomically and vitally, that they 
 elaborate from the common nutritive fluid such compounds as are ex- 
 actly conformable to the nature of each part respectively (§ 41-44, 
 133, &c., 135 I, 188, &c., 205, &c., 233, 397, 398). 
 
 405. The variety of secreted products, solid and fluid, is greatei, 
 and the quantity more abundant in animals than in plants, and in pro- 
 portion, also, to the complexity of organization. 
 
 406. The following products of secretion which remain more oi 
 less fluid occur in the animal kingdom. The first six are common to 
 most animals : 
 
 1. Gastric juice. 
 
 2. Saliva. 
 
 3. Pancreatic juice. 
 
 4. Bile. 
 
 Concerned in digestion. 
 C Of the 
 
 5. Serous fluids. 
 
 { 
 
 6. Mucous fluids. 
 
 7. Tears. 
 
 serous tissues, 
 cellular tissue, 
 articular tissues, 
 chambers of the eye. 
 capsule of the lens, 
 labyrinth of the ear. 
 ^ Of the mucous tissue of the mouth. 
 
 " " nose. 
 
 " " pharynx. 
 
 " " larynx and 
 
 trachea. 
 
 " " lungs. 
 
 '• " stomach. 
 
 " " intestines, 
 
 urinary and genital organs, 
 skin of aquatic animals. 
 
 I 
 
 C Suet, and fat of cellular tissue. 
 
 Marrow of bones. 
 
 Liquids in the cryptee of the skin. 
 
 Cerumen of the ear. 
 
 Fatty fluid of prepuce. 
 I Many other oily products. 
 ^ Ink of the sepia. 
 J Liquids of insects, 
 j Virus of serpents, &c. 
 [^ Galvanism of torpedo, &c. 
 Humors of the spider, and of other insects, from which their 
 webs, cocoons, &c., are formed. 
 
 Germinal fluid. 
 
 Semen. 
 
 Product of vesiculae seminales. 
 
 Liquor of Cowper's glands. 
 
 Liquids in the foetal membranes. 
 
 The milk of mamraifera. 
 
 8. Fatty or oily liquids. < 
 
 9. Fluids of defense. 
 
 10. 
 
 11. Fluids necessary to the 
 preservation of the 
 species.
 
 IHYSIOLOGY. FUNCTIONS. 219 
 
 The foregoing fluids are variable according to the nature of the an- 
 imal, but always the same in each species, and analogous, respective- 
 ly, in all (§ 53, &c., 83). 
 
 407, a. In considering the mechanism and the function of appro- 
 priation, it devolves upon the Institutes of Medicine, as in all other 
 anatomical and physiological inquiries, to apply the whole to the elu- 
 cidation of the laws upon which the mechanism is founded, and un- 
 der which the phenomena take place. It will still be my pui-pose, 
 therefore, to interrogate the whole in their various relations, and to 
 illustrate the philosophy of the whole by contrasting the defects of 
 spurious systems. 
 
 407, h. The exact anatomical condition of the instruments of nu- 
 trition and secretion, as well as the functions themselves, can never 
 be brought within the cognizance of sense ; nor would it be of any 
 practical use to know them beyond what is revealed by the vital and 
 physical results (§ S3, 131). By these facts we are enabled to insti- 
 tute many of the most important conclusions in physiology. By 
 them, especially, we demonstrate the errors of the physical and 
 chemical doctrines of capillary circulation, and of the chemical and 
 mechanical hypotheses relative to secretion. By them, we show that 
 all the products from the blood, as well as effusions of blood in the 
 ordinary forms of capillai-y hemorrhage, find their way out of the 
 vessels through some vital act, and that the physical doctrines of per- 
 colation, and endosmose and exosmose, have no foundation in or- 
 ganic nature (§ 131, 275). 
 
 407, c. It has been also seen by demonstrations in respect to the 
 development of the ovum, that appropriation is conducted by the 
 same powers throughout the life of the being that were brought into 
 action by the stimulus of semen ; and it may be now added that the 
 coincidence is beautifully enforced by a progressive and uninterrupt- 
 ed march of that primary development, which was instituted in the 
 ovum, after the beginning of independent life (§ 63-81, 153-159). 
 
 408, The mechanical doctrine of filtration, which supposes the in- 
 calculable variety of secreted products to exist already formed in 
 the blood (§ 41), still disfigures the physiology of the schools, and 
 forms a prominent characteristic in the prevailing pathology of in- 
 flammation. To the whole of this subject, as well as to the chemical 
 hypotheses, I have given an extensive investigation in my Essays on 
 the Humoral Pathology, on the Vital Powers, on the Theories of In- 
 flammation, on Endosmose and Exosrnose, and on Diabetes, as em- 
 braced in the Medical and Physiological Commentaries. Many re- 
 markable assumptions, intended to sustain the physical rationale of 
 vital processes, are there examined and refuted. But, the explosion 
 of one error, it has been said, often prepares the way for another ; as 
 exemplified in the following quotation, relative to the hypothesis of 
 endosmose and exosmose : 
 
 " This permeability to gases," says Liebig, " is a mechanical prop- 
 erty, common to all animal tissues ; and it is found, in the same degrea 
 in the living as in the dead tissue." — Liebig's Ani?nal Chemistry.— 
 See, also, § 350, 1031 h. 
 
 409, a. When considering the subject of proteine in a former sec- 
 tion (§ IS), I reserved for this place all that was not immediately rel- 
 ative to elementary composition. What was there set forth should be
 
 220 INSTITUTES OF MEDICINE. 
 
 applied in connection with what I shall now advance in continuation 
 of the subject. 
 
 409, h. We have seen that, in opposition to the received doctrines 
 as quoted from Liebig in section 18, there is nothing in the secreted 
 products of animals, solid or fluid, that subsist on vegetable substan- 
 ces similar to the food, except in elementary composition, nor in the 
 blood itself; while it is also affirmed by Liebig, that " analogy, that 
 fertile source of error ^ lias urfortunately led to the very unapt com- 
 parison of the vital functions of plants with those of animals ^ But 
 the reader, who may have attended to the parallel columns, and the 
 sections on the chemical hypotheses of disease and therapeutics, will 
 be neither surprised at the inconsistencies now and formerly indicated 
 as to the prerogative of the vegetable kingdom in doing the whole 
 work of assimilation, and even trespassing upon that of appropriation^ 
 in behalf of the animal tribes, nor unprepared for a farther explosion 
 of the doctrine by its principal author. Let us, therefore, hear the 
 chemist yet farther in his contradiction of the great fundamental doc- 
 trine (§ IS). Thus : 
 
 "We must not forget," says Liebig, "that, in Avhatever light we 
 may view the vital operations, the production of nervous matter from 
 the blood presupposes a change in the composition and qualities of 
 the constituents of blood. That such change occurs is as certain as 
 that the existence of the nervous matter cannot be denied. In this 
 sense, we must assume that from a compound oi proteine may be form- 
 ed ^ first, second, third, ^c, product^ before a certain number of its 
 elements can become constituents of the nervous matter." 
 
 Again, having in view another special point, we are told that 
 
 " This much, at least, is undeniable, that the herbs and roots con- 
 sumed by the cow contain no butter ; that in hay, or the other fodder 
 of oxen, no beef suet exists ; that no hog's lard can be found in the 
 potato refuse given to swine ; and that the food of geese or fowls 
 contains no goose fat or capon fat;" — " that as yet no trace of starch 
 or sugar has been detected in arterial blood, not even in animals 
 which had been fed exclusively with those substances." — (See Comm., 
 vol. i., p. 674-682.) 
 
 And what gives special plausibility to these speculations is the con- 
 troversy which has taken place between " the Reformer" on one 
 side, and Dumas and other French chemists, on the other, respecting 
 the origin oi fat ; the former maintaining that it results from trans- 
 formations of sugar, starch, and other " vegetable proximates," while 
 the latter contend that not only this, but agree with Liebig that all 
 the other unique products of herbivorous animals are formed without 
 the aid of their complex assimilating organs, — that they are merely 
 applied as generated by the plant. In this latter doctrine is also seen 
 a striking display of the human mind to run into simple views of na- 
 ture ; overlooking all the complicated facts and the whole labyrinth of 
 animal organization, and making the ultimate sustenance of animal 
 life but one remove from the constituents of the atmosphei'e (§ SOS^^, 
 304, 305, 322). 
 
 And again, when chemical demonstrations cannot be resisted, 
 
 " We must admit," says Liebig, " as the 7nost important result of 
 the study of the composition of gelatinous tissue, and as a point unde- 
 niahly established, that, although formed from compounds of pioteine
 
 PHYSIOLOGY. FUNCTIONS. 22 J 
 
 it no longer belongs to the series of the compounds of proteine. No 
 substance analogous to the tissues yielding gelatin is found in vege- 
 tables." 
 
 Nay, not even in the blood itself; though, 
 
 " It is conceivable that membranes and tissues vi^hich yield gelatin 
 are formed from albumen by the addition of oxygen, of the elements 
 of watei', and those of ammonia, accompanied by a separation'of sul- 
 phur and phosphorus. At all events, their composition is entirely 
 DIFFERENT from that of the chief constituents of the blood" " But 
 there is no doubt that these tissues are formed from the constituents 
 of the blood" ! Q,. E. D. — Liebig's Animal Chemistry. 
 
 It will be thus seen that the chemist is finally coerced to the admis- 
 sion that many of the most important organic compounds depend 
 altogether upon the specific action of organs by which they are elab- 
 orated from the blood, and that he is even embarrassed with a " doubt" 
 whether " these tissues are formed from the constituents of the blood.'* 
 The admission is comprehensive. It betrays the factitious nature of the 
 whole physical rationale. It proclaims that eveiy secreted product is 
 different from the common source of supply, and different in every 
 part of the animal. Chyme differs from chyle, and blood from either. 
 Each differs in every species of animal, from man down to the white- 
 blooded tribes ; yet each, wherever existing, is forever the same in 
 the same species. And so with plants, even with such as seek for 
 ammonia and nitrates upon the dung-hill, or others that gather iodine 
 from the deep (§ 289, 350, nos. 26^, 77). Each product, therefore, is 
 generated in its unique characteristics by agents and processes which 
 are designed specifically for the formation of each. Nor would this 
 be doubtful to any observer who may pass along the various grada- 
 tions of the assimilating organs from their simple condition in plants 
 to that complexity which demanded the superaddition of the nervous 
 systems (§ 336, 356 a, 461, 478 5, 488^, 493 cc, 500 nn, 893 a, c, 893^). 
 
 If we take, now, the premises on which the chemist proceeds to 
 the exact conclusions which he sets forth in his formulae of organic 
 compounds, those who have been inattentive to his method will be 
 surprised at its destitution of all but vague conjecture, where organic 
 compounds are concerned ; and, for the unique nature of these com- 
 pounds the reader must turn to what I have said on the subject of 
 Composition. The following is the great starting point : 
 
 " The organs are formed from the blood, and contain the elements 
 of the blood. They become transformed into new compounds with 
 the addition only of oxygen and water. Hence the relative propor- 
 tion of carbon and nitrogen must be the same as in the blood. 
 
 " If, then, we subtract from the composition of blood the elements 
 of the urine, then the remainder, deducting the oxygen and water 
 which have been added, must give the composition of the bile. 
 
 " Or, if from the elements of the blood we subtract the elements of 
 the bile, the remainder must give the composition of urate of ammo- 
 nia, or of urea and carbonic acid" ! Q,. E. D. — Liebig's Animal Chem- 
 istry. — See Lehmann's opinion p. 780, ^ 1029, 1031 b. 
 
 Such, once more, is the basis of oiganic chemistry, with all the ap- 
 parent precision of mathematics in its extraction of a cube root ; yet 
 never the same in its analysis of the elementary composition of the 
 blood, avowing the homogeneous nature of that compound of 17 or
 
 222 INSTITUTES OF MEDICINE. 
 
 18 elements, and, finally, in the very midst of its mathematical accu- 
 racy, allowing that there is no one organic compound elaborated from 
 the blood by the living similar to the results of artificial processes. 
 This I have already abundantly shown, even in the present section, 
 and in another relative to it (§ 18). The same evidence abounds in 
 the parallel quotations (§ 350), and a glance at the " Animal Chem- 
 istry,''' or the " Organic" would supply other facts for my present 
 purpose. Thus, in the following sentences enough is conceded to 
 substantiate my position ; and it is worth the specific remark that 
 ** we know with certainty" that albumen and fibrin have not the same 
 composition. 
 
 " We must be careful not to deceive ourselves in our expectations 
 of what chemical analysis can do. We know, with certainty, that the 
 numbers representing the relative proportions of the organic elements 
 are the same in albumen and fibrin, and hence we conclude that they 
 have the same composition." 
 
 " If we reflect, that from the albumen and fibrin of the body all 
 the other tissues are derived, it is perfectly clear that this can only 
 occur in two ways. Either certain elements have been added to, or 
 removed from, their constituent parts," and so on. — Liebig's Animal 
 Chemistry. — Note N p. 1121. 
 
 409, c. If the viper be fed exclusively with any one substance, its 
 peculiar poison will be generated ; and so of the characteristic prod- 
 ucts of the civet, the cuttlefish, the skunk, the beaver, &c. ; each, 
 also, being always generated by one particular part. Here, then, are 
 tests for an important and compi'ehensive philosophy. From these 
 we may descend along a scale, where we shall find in some of the se- 
 creted products of every animal and plant certain prominent charac- 
 teristics which declare that not only these, but the less striking, also, 
 are as much dependent on special organization, and special powers 
 and actions, as the poison of the viper, or the fcetor of the skunk, or 
 the civet, or the beaver, or the ink of the cuttlefish, &c. AVill any 
 thing in nature, excepting the mucous tissue of the stomach, produce a 
 substance at all analogous to the gastric juice ] Is there any thing 
 analogous to semen in the blood % Can it be genera*:ed by any thing 
 but the testis (§ 83, b)% Can it be surmised that it is at all the prod- 
 uct of forces which govern the inanimate world % Consider the na- 
 ture of granulations, so obvious to the eye, and yet so analogous to 
 the products of nutrition. From whatever parts of the body they 
 spring up, they have all, originally, the same appearance. The same 
 in bone as in muscle. But, so various are the modifications of their 
 vital constitution, that they ultimately elaborate substances exactly 
 conformable to the nature of the tissues, respectively, by which the 
 granulations were generated. We know that there must be specific 
 powers to effect these results, and that in each tissue, and in the gran- 
 ulations thereof, the powers ai'e modified ; and we know, also, that 
 the results defy all explanation by any chemical or mechanical laws. 
 
 409, d. Carry the same principle to morbid conditions. Is not the 
 virus of hydrophobia generated exclusively by the salivary glands, 
 and by those glands in a particular state of disease, and probably, also, 
 by the canine and feline tribes alone % Does not every morbid prod- 
 uct require a specific mode of disease ] Is not this distinctly exem- 
 plified in scarlatina, measles, small-pox ; and, therefore, equally true
 
 PHYSIOLOGY. FUNCTIONS. 223 
 
 in less striking cases 1 Equally as true of common pus as of the pus 
 of variola 1 And here I would refer to what I have said, in my Es- 
 say on Inflammation, of the nature and formation of pus;* how its 
 formation is indiscriminately imputed by the same philosophers to a 
 spontaneous alteration of blood in the large vessels, to chemical ac- 
 tions in the small, and to the decomposition of dead animal matter; 
 how its analysis has led different chemists to opposite conclusions 
 both as to its nature and formation ; and how it is affirmed by the 
 chemist to be unchangeably the same, whether the product of an ab- 
 scess, of a chancre, or of the variolous pustule. The confusion in 
 these respects is very remarkable, showing the perfect inadequacy of 
 the principles by which the explanation is attempted ; while they, 
 who believe that animated nature operates by other forces, see noth- 
 ing but admirable simplicity, and a fountain of the highest practical 
 advantages to mankind (^ 653). 
 
 409, e. Again, do we not find remarkable relations between the 
 structure of secreting organs and the matter secreted (§ 346) ] Where 
 organization is most complex, the secretions are most compounded, 
 and, as the structure becomes more and more simple, so also do the 
 corresponding secretions. And yet, in the most simple membranes, 
 apparently of the same organization, the products, according to Cu- 
 vier and others, are almost as various as the different species of ani- 
 mals, consisting of fluids in some, and of air in others ; yet always the 
 same in each species. On the other hand, what complexity of organ- 
 ization in the liver of the higher animals ; yet all is precise, harmoni- 
 ous, and adapted to specific ends. Those ends, and that complexity, 
 are fatal to all the chemical and physical views of the functions of 
 assimilation and appropriation. And yet is the secretion of bile, 
 which, according to the chemists, is composed of forty different com- 
 pounds, and these made up of four or five elements, compared to 
 what is supposed to be a chemical evolution of carbon from the 
 blood; and the liver is also said, by. distinguished physiologists, to be 
 merely a " strainer of bile." We are told that " physiologists have 
 been induced to suppose that the structure of the kidney is such that 
 it allows the urea to percolate through the fine vessels emptying into 
 its pelvis, like the mechanical operation of sifting ox filtering, but de- 
 nies a passage to the other constituents of the arterial blood." But 
 how " deny" them ; why do they never escape ; why do not the con- 
 stituents of the bile come this way, and vice versa ? Is it more diffi- 
 cult for one substance to " sift and filter" its " passage" through one 
 set of vessel's than the other % The iatro-mechanical, it is true, are 
 Comparatively few with the iatro-chemical philosophers. The latter 
 have also greater zeal. They are more recently in a field full of se- 
 ductive novelties, and other allurements, while pure chemistry can 
 offer nothing but the details of analysis (^ 1032). 
 
 409, y! All the secreted fluids not only have an apparatus peculiar 
 to each, whose complexity \eorresponds remarkably with the com- 
 pound nature of their products, but they are all destined for import- 
 ant specific ends in the economy of living bodies ; a final purpose of 
 which chemistry and physics are wholly incapable. One would be 
 perfectly unsuited to the office of another, and would be even destruc- 
 tive of life, in most of the cases, should one product interchange with 
 * In Medical and. Physiological Commentaries, vol. ii., p. 181-204.
 
 224 INSTITUTES OF MEDICINE. 
 
 another (§ 129, 135-137). The saliva, gastric and pancreatic juices, 
 are designed for digestion; the blood being thus an almost direct 
 cause of its own reproduction (§ 323-325, 356 a). The bile sub- 
 serves three specific purposes, w^hich, when regarded in their connec 
 tion, supply one of the most remarkable instances of Design. This 
 fluid participates directly in the assimilation of food, is the important 
 cause of peristaltic motion, and performs, lastly, that inferior office, 
 which is often regarded as its only one, of contributing with the lungs, 
 kidneys, and skin, as an emulgent of the blood, though in a different 
 aspect from the organs of excretion (§ 415, 423). The products of the 
 serous membranes are designed, for the most part, to facilitate organic 
 and voluntary movements ; mucus serves, like the cuticle, to protect 
 its organ against offending causes, &c. ; the " humors" of the eye, and 
 of the internal ear, are media of communication between external ob- 
 iects and the nei'ves of sensation ; and they are wonderfully adapted to 
 the laws which they are intended to subserve. The semen, milk, fat, 
 animal heat, &c., are other remarkable examples of final causes which 
 secretion is intended to fulfill. To these might be added many others, 
 less important, but not less to our purpose ; as the poison of snakes and 
 of insects, the galvanism of aquatic animals, the ink of the sepia, the flu- 
 id from which the spider builds his house, and with which we cure in- 
 termittent fever, &c. And, when we regard, in connection, the bile, 
 the gastric juice, semen, milk, &c. — all derived from the homogeneous 
 blood, — and consider the uniformity of their respective composition 
 in health, their changes according to the alterations of the vital prop- 
 erties in disease, and these changes corresponding with certain modi- 
 fications of the vital phenomena, are we not moved with astonish- 
 ment at the total difference in their nature ] Is there any relief for 
 our astonishment but in a firm reliance upon powers that are equally 
 unique in their operation ] Would not amazement otherwise increase, 
 till it should prove that the human mind does not rightly interpret the 
 laws of nature, and is unjust to its own endowments 1 
 
 409, g. If we now survey the vegetable kingdom, we shall find all 
 things constituted upon the same plan. The poppy, digitalis, croton, 
 spurge, — every thing growing side by side in the same earth, the same 
 air, and watered with the same fluid, have, each one, its unique and 
 unvarying sap and secreted products ; an infinite variety of precise 
 combinations derived from about four simple elements (§ 41, 42). 
 Again, also, not only different species of plants when flourishing in the 
 same soil yield different products throughout, but the same species 
 have produced, from the day of their creation, the same identical 
 products, in all their parts, in every variety of soil and climate. And 
 so of all animals, whatever the variety of food. In the vegetable 
 kingdom, we are also amazed at the systematic Design manifested in 
 the coincidences between the various elementary combinations and 
 their virtues as vital stimuli, or as morbific or remedial agents, which 
 obtain among numerous species of many genera of plants, and which 
 are maintained in all the varieties of soil to which the plants may be 
 subjected. But, while these analogies prevail among the medicinal 
 properties of certain extensive groups of plants, the products of each 
 species, and of the several parts of the same species, have certain pe- 
 culiarities, and these, too, will depend, in many plants, upon the stage 
 of their advancement toward the flowering season, while they are not 
 influenced by soil, climate, &c. (§ 52, 155).
 
 PHYSIOLOGY. FUNCTIONS. 225 
 
 409, h. Apply what has now been said of the products from the sap 
 of plants to the formation of blood alone, which is composed of about 
 the same elements, and we see how vain the attempts to explain by 
 chemical laws even the formation of chyle ; its conversion even from 
 a white to a deep red color, and yet that color changing to white again 
 under the influence of slight disease ; and, finally, the vitality with 
 which the blood is endowed. And, notwithstanding the complexity 
 of the human body, its endless variety of food, and its artificial com- 
 binations and changes, has not the chemist given us a standard of the 
 composition of the chyle, the blood, the gastric juice, bile, saliva, milk, 
 &c., by which their morbid changes are to be tested in all countries, 
 at all seasons, at all ages of man and of the world % Has he not told 
 us that all this is so uniform in the natural state of the animal, so unlike 
 the results of chemical agencies, that when changes arise they are in- 
 dicative of changes in health? And does he not oifer to show, that 
 this alteration of the blood and secretions is so uniform under the same 
 circumstances of disordered health, that you may tell by it the nature 
 of disease and the appropriate remedy (§ 5, b\ a) 1 Is not this the 
 basis of practical humoralism 1 I grant the fact as to the relation of 
 specific changes in the secretions, the blood, also, and specific modifi- 
 cations of action. But is not all this in absolute opposition to what- 
 ever is known of the capricious operation of chemical forces 1 And 
 what shadow of proof is there, that these vital powers, which the chem- 
 ist now and then invokes to his aid, are not entirely adequate to the 
 physiological results that are ascribed to the forces of chemistry 1 
 
 409, Ml. As to the hypothesis which supposes that galvanism is 
 identical with the nervous influence, and the eflicient power in the 
 formation of animal products, it is fully contradicted by the many anal- 
 ogous compounds generated by plants. This subject will have been va- 
 riously considered in other places (§ 70-80, 409 k, 493 cc, 893 a, &c.). 
 409, i. And now, turning again to the mere physical theorist, if 
 there be any who cannot appreciate the objections which I have set 
 forth to their peculiar views of secretion, let them appeal to their or- 
 dinary habits of observation, and look at the condition of the blood 
 as reputedly laden with the various compounds which are supposed 
 to be strained ofl" from the great vital fluid. What an unphilosophical 
 mixture ! All the forty ingredients of the bile into which that homo- 
 geneous substance is separated by the various manipulations of the 
 chemist, — all the variety into which the urine is resolved by the same 
 ingenious devices, — mucus, saliva, gastric juice, albumen, gelatin, ce- 
 rebral substance, fat, tears, sweat, milk, semen, the germinal fluid, 
 &c., — nay, more, all the peculiar compounds which go to the forma- 
 tion of the different parts of the body ; and each one, and no other, 
 strained off" by that part alone which has been forever engaged in the 
 individual office of eliminating one exact compound, or one special 
 variety of compounds. Nor is this the end of the absurdities ; for 
 the same physical doctrine supposes that this principle is coextensive 
 with the vegetable kingdom, and that every species of plant and ani- 
 mal embraces in its circulating fluid special varieties, which, in the 
 aggregate, make up the many millions of specific and unvarying com- 
 pounds of which the organic kingdoms are composed (§ 41). Nor is 
 it a small part of the difficulties which surround tho mechanical and 
 cliemical hypotheses of secretion, that all these millions of compounds 
 
 P
 
 226 INSTITUTES OF MEDICINE. 
 
 are liable to exact variations, according to morbid changes in the 
 parts by which they are elaborated. 
 
 409, j. Is the chemical hypothesis of catalysis better calculated 
 than the mechanical to resolve the great problem which concerns the 
 formation of the millions of unique products from one common fluid, 
 and in conformity with the facts which have been hitherto stated 1 
 This doctrine is, doubtless, the most ingenious of any which has been 
 advanced by chemistry ; but it has little to sustain it even of the spe- 
 cious analogies supplied by inorganic processes. Indeed, so little is 
 catalysis sujjported by the phenomena of inorganic nature, that its 
 existence is denied by many able chemists. Thus : 
 
 " Liebig," says Mulder, "has been led to reject catalysis entirely, 
 and to give a totally different explanation of facts. He has assumed, 
 that chemical forces are in action in those substances which, accord- 
 ing to the supposition of Berzelius, are capable of exciting action, 
 though without taking part in that action ; and he thinks that by such 
 chemical action, another may be excited in other substances. . He 
 adopts the principle, indicated by La Place and Berthollet, that a 
 molecule, being put in motion, can communicate its motion to others, 
 if in contact with them. He apjilies this principle to yeast especial- 
 ly," &c. — Mulder's Chemistry of Vegetable and Aimnal Physiology. 
 
 In section 350|, d, is a brief statement of the catalytic theory as 
 advocated by Mulder; and in the Medical and Physiological Com- 
 mentaries (vol. i., p. 55-78) I have considered specifically the obsta- 
 cles to its application to organic processes, while it must encounter, 
 also, all that I have here alleged against the mechanical and other 
 physical doctrines. Nor is it the least objection to the whole chem- 
 ical system of organic life, that the two principal leaders in organic 
 chemistry "give a totally different explanation offacts^'' that make up 
 the essential attributes of living beings. Mulder affirms that Liebig's 
 theory, is an "assumption," while Liebig " rejects entirehf the cata- 
 lytic theory of Mulder. The medical reader will easily appreciate 
 the worth of Liebig's " assumption," by referring to its attempted 
 "explanation of facts" as revealed by disease. (See § 350, nos. 40, 
 41, 42, 44, 45, 3501, and Leiimann on Chemical Equations, § 1029). 
 
 409, k. In respect to the supposed agency of galvanism in the for- 
 mation of animal compounds through the medium of the nervous sj^stem, 
 the doctrine is consistently applied to the modifications which arise 
 from morbid processes ; but we have just seen (§ 409 hh) that the fun- 
 damental hypothesis is contradicted by the close analogy betAveen the 
 products of plants and animals, and by the absence of the nervous sys- 
 tem in the former, and therefore, a fortiori, galvanism has no connec- 
 tion with morbid products. Galvanism is also alike a stimulus to the 
 secretory functions of plants and animals, which farther establishes its 
 distinction from the nervous power (§ 113, 224, 226, 356 a, 399, 446 a, 
 461, 475-^, 493 cc, 500 nn, 512, 893 a, c, 893i, 902).— Note Y. 
 
 410. We may therefore Avell conclude that there is nothing so im- 
 portant in the whole compass of physiology, and in the philosophy 
 and practice of medicine, as a proper understanding of the vital con- 
 stitution, in their properties and functions, of those extreme vessels 
 by which nutrition and secretion are performed. Those are also the 
 instruments of all morbid processes, and those by which all morbid 
 products are elaborated from the blood. And since all healthy prod- 
 ucts ai'e clearly tlie result of processes to which there is nothing anal-
 
 PHYSIOLOGY. FUNCTIONS. 221 
 
 ogous in the world of dead matter, how obviously must all the prod- 
 ucts of disease, all those of inflammatory conditions, which vary but 
 little from the natural standard, be owing to the same vital processes 
 of those formative and secretory vessels somewhat diverted from their 
 natural states, and in which deviations disease must be allowed to con- 
 sist (§ 750, 1039, 1040, 1056J. 
 
 411. Finally, the function of appropriation is that which evinces, 
 more than any other, the existence of a vital principle. This princi- 
 ple, being admitted as the basis of that function, must be carried to ev- 
 ery other process of living beings. It is by appropriation that the new 
 elementary combinations, in their endless variety, are formed from 
 the blood or sap. By nutrition, which begins at the earliest develop- 
 ment of the embryo in the aspect of growth, under the government of 
 a peculiar power, as admitted by all, the organic being is carried for- 
 ward to full maturity, and maintained while life continues. At every 
 stage of his existence, it is the same process as that which was start- 
 ed by the impression of the semen upon the germ ; and, since no new 
 results are brought forth, no new powers can be called into opera- 
 tion. The living semen is the first stimulus of the organic properties 
 of the embryo, and in this respect it is analogous to those vital stimuli 
 which forever after maintain the same powers in action, and by which 
 the same nutrition, or the same elementary combinations, are effected 
 at every subsequent stage of existence. By nutrition, through the 
 operation of these vital properties, and according to specific plans in- 
 stituted by the Creator, and to be forever perpetuated by the substi- 
 tuted energy of the vital principle, all those forms of organic beings, 
 which pass by almost insensible gradations from the mushroom up to 
 the gigantic tree, and from the microscopic animalcule to the majesty 
 of man, are maintained in all their exact peculiarities, in all their anal- 
 ogies to each other, in all their vital and moral attributes. It is by 
 nutrition, that is to say, by the specific modes in which some three or 
 four principal elements are united together, and joined to pre-existing 
 parts of the same nature (§ 41, 42), that each animal or plant, accord- 
 ing to its species, acquires and maintains a specific configuration and 
 organization, exhibiting vital results that are peculiar to each, pro- 
 ducing specific germs that are developed in exact conformity with the 
 nature of the parent, and each pursuing forever a certain path which 
 was marked out for itself alone by the Hand which gave it existence. 
 Such, and far more, is the wonderful power, a power substituted for 
 the Creator Himself, which directs capillary circulation, and governs 
 the process of nutrition in the development of the embryo, in the ma- 
 turity of the being, and in the perpetuation of the species. 
 
 Briefly, then, the whole essential philosophy of organic life, all that 
 is important, or useful, or dignified in medicine, is directly relative to 
 the vital constitution, and the vital actions of the formative and secre- 
 tory vessels. Here is the labyrinth of life, here of disease, here the ul- 
 timate aim of medical philosophy (^ 1040). — Note I p. 1118. 
 
 6. EXCRETION. 
 
 412. Excretion is the sixth grand function common to animals and 
 vegetables. It is analogous to secretion, and is performed by analo- 
 gous organization ; though the differences in these respects are prob- 
 ably greater than betweea nutrition and secretion, in their ordinary- 
 acceptation f§ 402 404).
 
 228 INSTITUTES OF MEDICINE. 
 
 413. By excretion useless matter is elaborated from the blood and 
 ejected from the body. The results of this function, therefore, are 
 entirely different from those of secretion, which are destined for use- 
 ful purposes in the animal economy. 
 
 414. The terminal series of the arterial system, as with appropri 
 ation, are the immediate instruments *of the function of excretion. 
 But, like secretion, a compounded organization is necessary to excre- 
 tion. In this respect there appears to be about the same anatomical 
 variety allotted to secretion and excretion (§ 404). The same tissue, 
 indeed, and even the same part, may perform both functions ; as in 
 the lungs, and in the uterus (§ 135). 
 
 Notwithstanding, however, these coincidences, the final causes of 
 excretion and secretion are so very different (§ 413), the processes 
 which give rise to such opposite results should be regarded as differ- 
 ent functions. 
 
 415. The difference between secretion and excretion, ^s denoted 
 by their respective uses, is confirmed by the elementary constitution 
 of the products of these functions ; those of secretion being organic, 
 those of excretion inorganic. There is also reason to believe that 
 special elementary changes take place in the urine soon after its elim- 
 ination from the blood.* Urea may be also artificially produced ; 
 and such is not improbably the fact when chemically obtained from 
 blood, or even from the urine (§ 53, h, 1032 a, Lehmann). 
 
 416. The principal excreted substances are, 1st. Carbon ; 2d. Sweat ; 
 3d. Urine. The lungs, skin, and kidneys, are the organs by which 
 they are elaborated. The lungs and skin exercise their function, 
 principally, after nutrition and secretion have been performed, and 
 are, therefore, mainly concerned in excreting the waste parts of the 
 body ; though this devolves also upon the kidneys, especially in dis- 
 ease. 
 
 417. a. No one of the foregoing products is of an organic nature ; and 
 the supposed triumph of the chemist in manufacturing urea is no more 
 a proof of the dependence of organic compounds on chemical process- 
 es than any other transformation.t The sweat and the urine be- 
 ing liable to transformations as soon as elaborated (§ 415), and more 
 especially as every chemical agent by which their analysis is attempt- 
 ed necessarily changes their composition, their actual condition at the 
 moment of their production can never be known. Such, also, is true 
 of the analysis of every organic compound. The very analysis sup- 
 poses the generation of compounds or of elements in artificial modes ; 
 but the original compound being the product of the organic powers, 
 the transformation of its elements, whether spontaneous or effected by 
 the chemist, and through certain agencies, occurs in certain determi- 
 nate modes, and according to the influences which had been impressed 
 by the organs of life (§ 54, a). Besides, it is now fully admitted that 
 many very uniform and remarkable formations out of organic com- 
 pounds, and themselves, too, allied to organic substances, have no such 
 natural existence ; as hydrocyanic acid, narcotin, &c. (§ 42, 409). 
 Even Mao'endie threw in the way of proximate analyses the conclu- 
 sive fact that, " during the short transit from the vascular tubes to 
 your receiver, the component elements of the blood are found to effect 
 a new arrangement" (^ 1032 h, c). 
 
 * See Medical and Physiological Commentaries, vol. i., p. 526, 585, 602, 675-679. 
 t Lehmann says tbat— " We can liardly any longer enumerate urea among true organic sub- 
 etances." — IbSO.
 
 PHYSIOLOGY. FUNCTIONS. 229 
 
 417, b. When, therefore, I may speak of changes in the " compo- 
 nent parts" of organic compounds, I refer either to such as may be 
 wrought by organic processes, or by influences exerted by leSs ob- 
 vious causes, as in the case of the bile (§ 316), or to those chemical 
 transformations of a specific nature which depend upon chemical 
 agencies (a). 
 
 418, Carbon is the greatest excrement of animals, and is evolved 
 from plants. In the former it is effected by the mucous tissue of the 
 lungs, and often by the skin (§ 135); in the latter by the leaves (§ 303 1). 
 
 419, a. The excretion of carbon by the lungs is construed by the 
 chemists according to their rules of interpreting other organic actions. 
 But, as I have endeavored, in the " Commentaries," to establish the 
 vital character of this phenomenon, I shall only now advert to its phi- 
 losophy, and in connection with that which respects the production 
 of animal and vegetable heat (§ 433, &c.). They are thus associated 
 by myself out of regard to the confusion which has befallen them in 
 the hands of the chemist. But, appealing to him who sees in organic 
 nature its plainest contradistinctions from inorganic, I would, in this 
 place, submit to his understanding whether it be not probable that 
 the same philosophy attends the elaboration of carbon by the lungs 
 and by the skin, and whether that function of the skin in many animals 
 be not as much an organic process as the associate secretion of sweat ? 
 
 419, b. But, if the foregoing analogies be not sufficiently conclusive, 
 consider, next, the elaboration of that excrementitious matter, the 
 urine ; which all but the purely physical philosopher recognize as a 
 vital process. And, again, shall it be admitted that, while nature has 
 constituted the pulmonary mucous tissue, like that of the stomach, 
 intestine, bladder, &c., upon her universal plan of organization, and 
 endowed it with the vital function of generating mucus, she has depart- 
 ed from it in an isolated part of one and the same continuous tissue to 
 introduce, along with the vital, a chemical function 1 It is the same 
 argument as derived from the production of sweat, in its connection 
 with carbonaceous matter; and here the analogy brings into co- 
 operation every product of the living being, and establishes the whole 
 upon common principles (§ 447|^ c, 1032 b). 
 
 419, c. There remains, however, a demonstration from analogy 
 which is perfectly irresistible. We have already seen how differently 
 modified in their vital character are not only different tissues, and tis- 
 sues of the same apparent organization, but even different parts of 
 one and the same continuous tissue. We have seen this exemplified 
 in a variety of aspects, and especially by the specific nature of the 
 product of certain parts. We have seen, for example, that there is 
 nothing in nature but that part of the gastro-intestinal mucous tissue 
 which lines the stomach that will generate gastric juice, while, also, it 
 produces mucus (§ 133-136). Now, carry this to another part of the 
 same continuous tissue which lines the air-cells, and the inference is 
 plain that if the gastric juice be elaborated by a vital process, so also 
 is the carbonaceous matter. Nor can any objection be urged that 
 other parts of the mucous system do not contribute to the function of 
 decarbonization upon the ground that they are less delicate, and 
 therefore less permeable to the air, than the mucous portion of the 
 lungs, since, in some animals, that dense organ, the skin, performs the 
 Bame office. Nor is there a better chance for the application of en
 
 23t) INSTITUTES OF MEDICINE. 
 
 dosmose and exosmose, since atmospheric air is often in contact 
 with the mucous tissue of the stomach (^ 4475- c). 
 
 420. Perspiration or sweat, which is sensible and insensible, beino 
 elaborated by an organ of highly complex organization, is clearly a 
 product of organic actions ; and since the skin of some inferior ani- 
 mals, like the mucous tissue of the lungs, eliminates both mucus and 
 carbon, this coincidence of function in two very complex organs may 
 be considered worthy of some regard in forming the logical induction 
 to which the facts in the preceding section may seem entitled. 
 
 421. The excretion of urine is the next great source of depuration 
 to the blood. Like the other products of excretion, it contributes to 
 the process of assimilation by its depurating effects (^ 416). It is as- 
 tonishing, too, with what rapidity many substances appear in the urine 
 after their admission into the stomach ; often not more than five or ten 
 minutes intervening. This lapidity of excretion is particularly true 
 of all matter which is offensive to the organization. 
 
 422. a. There is a remarkable sympathy subsisting between the 
 kidneys and skin, by which, as it were, they interchange functions 
 with each other. We are all familiar with the fact that the urine is 
 most abundant in cold weather, and the perspirable matter most de- 
 ficient, and vice versa ; and, as a general principle, when one excre- 
 tion abounds, the other is lessened. This is true in disease as in 
 health (§ 129, 1032 a). It depends upon reflex nervous actions. 
 
 422, h. For the fulfillment of their final cause the kidneys possess 
 an exquisite susceptibility to the influence of the nervous power 
 (§ 188, &c., 226, 528). Hence arises the rapid and profuse excre- 
 tion of urine when fear and certain other emotions of the mind are 
 in operation. The same affii'mation, too, may be made of the skin, 
 though perhaps less extensively. This, too, is the reason why fear 
 so readily induces copious sweats. In either case, the phenomena 
 are owing to the direct development and determination of the nervous 
 power upon the organs, respectively. These phenomena, too, prove 
 the great susceptibility of the skin and kidneys to the influence of the 
 nervous power, and are a key to the whole philosophy of the inter- 
 changes of action between the skin and kidneys (§ 129, 230, 638^). 
 
 But there are, also, as may be inferred from the facts just stated, 
 great sympathetic relations between the skin and kidneys and many 
 other organs, though these relations are much more manifested by ef- 
 fects which arise sympathetically in the excretory organs than by the 
 influences of these organs upon other parts. This is mostly seen in 
 disease, and during the operation of remedial agents applied to the 
 stomach. So great, indeed, is the susceptibility of the skin and the 
 kidneys, in their excretory function, to remedial agents, that a large 
 variety have received the denomination of sudorifics, and another 
 class, diuretics. But, owing to the special vital constitution of the 
 skin and kidneys, by which they are rendered sensitive in their ex- 
 cretory function to a thousand slight influences, it is obvious that the 
 foregoing denominations of remedies convey hypotheses that are un- 
 founded, and of injurious tendencies. There are no better sudorifics 
 than fear and hot water ; no better diuretic than impending danger 
 (§ 246, 500, 892|, 1040); all through rf/Vec^ or rr^ea; nervous influence. 
 
 422, c. In respect to the foregoing principle as shown by diseased 
 ?.onditioT!s the facts are not less familiar. In such cases, an organ
 
 PHYSIOLOGY. FUNCTIONS. 231 
 
 which is naturally designed for secretion may sometimes, by a nioi-bid 
 increase of its products, take on the relative function of excretion, 
 and thus, both by morbific reflex nervous actions, and by copious 
 elaborations from the blood, diminish or suspend the excretion of 
 urine. In the cholera asphyxia this excretion would fail entirely, 
 even when the profuse intestinal discharges were unattended by the 
 usual perspiration. But, in the case of the intestinal affection, much 
 was due to the morbific, vital influences; since we often see the urine 
 increased by the active operation of cathartics,* Scarcely a morbid 
 state disturbs the organs of digestion without diminishing or increas- 
 ing the effete pi'oducts of the kidneys and skin, especially of the for- 
 mer organ. The kidneys, however, being designed for the mere pur- 
 pose of depuration, do not hold a corresponding sway over the great 
 organs of life, but mainly so as it respects their dependence upon 
 those organs (§ 129) ; while a greater reciprocity of sympathy be- 
 tween the skin and the essential viscera of life, and a predominant 
 sympathy between the skin and kidneys as organs of excretion, 
 evince the wonderful nature of Design in its provisions and limita- 
 tions, according to the final causes which directed the plan of organic 
 life (§ 325).— illustrated by heart in § 500 m, 687^-688, 694f , 826 cc. 
 
 423. How vain the attempt to refer any of the foregoing processes 
 and results to any of the forces or laws which rule in the inorganic 
 world ! The entire rationale rests upon the peculiar operations of 
 the nervous power, and its laws of reflex action (§ 222, &c., 446, &c., 
 455 c, 500). A balance of actions and products is thus perpetually 
 maintained, though, of course, with less uniformity and exactness in 
 sickness than in health. But nature, ever provident, has so constitu- 
 ted the properties of life, that when one organ, whether excretory or 
 secretory, becomes morbidly suspended in its function, the evil will 
 be felt by other organs, hy reflected nervous action; and they will 
 thus take on, as it were, the work of that suspended organ. If the 
 excretion of urine be wholly arrested, not only the skin, but many 
 other parts, may join in the concerted action of relief. But, no other 
 part will ever excrete urine, no more than the skin will secrete se- 
 men.t The absurdity of this prevailing doctrine is shown, at once, 
 by the fact that urine would excoriate the eliminating vessels of every 
 part excepting those of the kidney (§ 83 b, 133, &c.). 
 
 Organs of pure secretion, however, may take on, in consequence 
 
 . of the foregoing condition, the office of excretion ; that is to say, they 
 
 will elaborate, along with their natural fluids, the excrementitious 
 
 matters, In certain ^j/ec^Z/ar combinations, which, in the healthy state 
 
 of the kidneys, would appear in the form of urine (§ 417). 
 
 424. The philosophy of all that I have now said in respect to the 
 interchange of offices among the organs of secretion and excretion, 
 and of the dependence of the several products upon special condi- 
 tions of anatomical structure and modifications of the organic proper- 
 ties, is the same that is concerned in the process of lactation after 
 parturition, however different the remote and final causes. The mam- 
 mary glands sympathize with the new change in the uterine system, 
 and produce a fluid which is totally different from the blood, although, 
 like all other products, it is derived from that fluid. And, there 
 
 * See my work on the Cholera Asphyxia of New York, 1832. 
 
 t See Medical and Physiological Commentaries, vol. i., p. 526, 598, 603, 608.. 680.
 
 232 INSTITUTES OF MEDICINE. 
 
 would be just as much wisdom in supposing that the reflex nervou;? 
 action of the womb upon the mammary glands, at this critical junc- 
 ture, is a chemical phenomenon, as there is in refen-ing the elabora- 
 tion of milk to the capricious forces of chemistry, while its reputed 
 filtration from the blood, by others, is equally refuted by the sympa- 
 thetic nature of lactation in every species of mammifera (^ 1031, b). 
 
 425. The excretion of urine, more than the products of any other 
 part, may be affected by the absorption of unnatural agents into the 
 circulation. This is because many agents which will excite the ac- 
 tion of the kidneys are not offensive to the lacteals nor to the system 
 at large, and are therefore freely absorbed. Such are many saline 
 and alkaline substances, and others, again, which are natural to the 
 body, as aqueous fluids, &c. Those being either unnatural or re- 
 dundant rouse the action of the kidneys, as the proper organs for 
 their elaboration. The quantity of urine is thus increased ; and, 
 while the kidneys are thus stimulated they may be rendered the 
 means of excreting other matters, though in a very different condition 
 from their existence in the blood (§ 408). 
 
 426. In morbid states of all the principal organs the urine is remark- 
 ably liable to change. This arises from various causes. If the stom- 
 ach be the primary seat of disease, or, if its condition be disturbed 
 by reflected nervous influences of other diseased organs, as is almost 
 constantly the case, digestion is imperfectly performed, and the chyle, 
 in consequence, becomes more or less unfitted for the purposes of 
 nutrition and secretion. The kidneys, therefore, carry off more than 
 their wonted quantity of excrementitious matter, while this matter ap- 
 pears under conditions more or less varied from the natural product 
 (§ 425). The whole office of appropriatipn is, also, more or less im- 
 paired, which farther modifies the condition of the blood and the for- 
 mative action of the kidneys ; though a part of the office of excretion, 
 under these circumstances, devolves upon the skin and lungs (§ 416). 
 A third great cause of the variableness of the urine consists in un- 
 usual vital decomposition or wasting of the body, or of some of its 
 parts, when it devolves upon the kidneys to co-operate, beyond their 
 natural habit, with the lungs and skin, in removing the redundancy 
 of waste materials. A fourth cause of the urinary changes, and an 
 important one, lies in actual morbid states of the kidneys themselves. 
 The kidneys, however, are not often the seat of morbid affections be- 
 yond those of a simple functional and transient nature, as induced by 
 reflex nervous actions excited by the diseases of other parts ; but to 
 which influences the kidneys are extremely liable, and, therefore, to 
 consequent modifications of the urinary product. 
 
 427. Briefly, then, every alteration of the natural action of the kid- 
 neys, whether primary or sympathetic, and every defect in assimila- 
 tion and appropriation, is attended by some change in the urine ; while 
 an endless variety is imparted to it by the qualities and quantities of 
 the ingesta. From this circumstance, which should have prompted 
 other conclusions, has arisen the belief that the state of the urine 
 supplies some of the most important signs of pathological conditions, 
 not only of the kidneys themselves, but of remote organs with which 
 they may sympathize. From Hippocrates to our day, elaborate dis- 
 quisitions have appeared concerning the changes of the urine as indic- 
 ative of particular forms of disease, of their special seats, of the dif-
 
 PHYSIOLOGY. FUNCTIONS. 233 
 
 ferent stages of their rise and decline, and of their degrees of se- 
 verity and danger. The humoralists were apt to regard the unusual 
 conditions of this product, and other " vitiated secretions," as the 
 disease itself; and in this respect they are imitated by the humoral- 
 ists of the nineteenth century. Chemistry has been also brought to 
 bear upon the fluctuating states of the urine, and has increased the 
 factitious importance of a symptom which is often as likely to denote 
 some alimentary substance, or divers forms of disease, or imperfect 
 digestion, or some remedial agent, as the source from which it ema- 
 nates. 
 
 But, coming to the bed-side we find that all these critical obser- 
 vations are relics of the speculative ages of humoralism. Here, we 
 find that all that is practically useful in relation to the urine is gener- 
 ally best ascertained by mere inspection ; and upon this subject, we 
 have all, and more than is desirable, from Hippocrates himself. Those 
 philosophers, however, who are employed in interrogating disease by 
 chemical analyses are not often or long in the chambers of the sick. 
 They carry on the investigation of morbid processes in the laboratory 
 of the chemist, and then and there fabricate the appropriate reagents 
 (§ 5j, a). He who studies organic nature according to the method 
 of solidism and vitalism has neither the leisure for those most difii- 
 cult, unattainable, and laboi-ious analyses, nor would they have any 
 influence upon his judgment as to the pathology or treatment of dis- 
 ease, in the midst of such a multitudinous variety as is presented by 
 the vital phenomena of disease. Of one thing, also, we may rest as- 
 sured, that nature has supplied all those ready means for interpreting 
 disease that may be necessary for immediate action ; nor can we often 
 delay the treatment of acute disease for consultations with the labora- 
 tory. In respect to the blood, were it even practicable to learn from 
 analysis its variable conditions in disease, it would reflect no light upon 
 morbid states of the organs, since the qualities of that fluid vary with 
 every varying change in the vital conditions of the solids, and there- 
 fore, too, would fail to indicate, in the least, the appropriate remedies. 
 This is also true, in a general sense, of the urine and all other excre- 
 tions, and secretions. The ready sight, their sensible properties, the 
 vital phenomena, physical signs, experience, and general principles, 
 must be our guide. These may be sometimes facilitated by extraor- 
 dinary modes of observation, but which are always within the reach 
 and clear understanding of every practitioner; such as the usual 
 mode of examining the blood in inflammatory diseases, evapoi'ating 
 the urine in diabetes, &c. On the contrary, were the humoral doc- 
 trines correct the teaching and the practice of medicine should be re- 
 stricted to chemists alone ; since there is no branch of inquiry so dif- 
 ficult as organic analyses, while their uncertainty would soon imply 
 that the vis 7nedicatrix natures is the only ordination of nature for the 
 maladies of the human race (§ 691, 1033 b). 
 
 428. The menstrual fluid is another and a fourth product of excre- 
 tion ; and, from its close resemblance to the blood, in the human spe- 
 cies, it is one of the proofs that capillary hemorrhage is generally the 
 result of a secretory process. In the higher orders of animals, even a 
 clearer index of its origin is supplied by the intermixture of blood 
 with the periodic secretion of mucus, which, in lower orders, occurs 
 without blood. The menses, however, is a product sui generis, and is
 
 234 INSTITUTES OF MEDICINE. 
 
 specifically determined by the nature of the part (§ 135). Unlike 
 the other products of excretion, it is not essential as an evacuation, 
 though important to the function of generation. It is therefore pe- 
 culiar, also, in exerting imjjortant vital influences upon the genera- 
 tive system. 
 
 429. At certain periods of the year the female genitals of all ani- 
 mals undergo changes, by which they are developed or prepared for 
 generation ; as, for instance, the ovaria of birds become enlarged, the 
 vagina of rabbits and of other animals is tumefied with blood, increas- 
 ed in its vascular action, and pours out an unusual mucous or bloody 
 fluid. It is only at these periods that they are susceptible of impreg- 
 nation. 
 
 430. But woman is capable of impregnation at all times; and that 
 this may happen, her organs must be often developed and prepared 
 for the purpose. 
 
 The jjhilosophy of the whole of this preparation, however various 
 in different species, and at whatever intervals of time, is the same in 
 all. The several conditions depend upon changes in the vital states 
 of the generative organs, by which the sexual desire is excited, and 
 the germ rendei'ed susceptible to the stimulus of the semen. This is 
 the end and the aim of the whole. 
 
 431. It follows, therefore, that the periodical excretion of the men- 
 strual fluid is only essential to the office of generation, and not to the 
 whole system, excepting so far as this excretion is a healthy function ; 
 and the suspension of any function being a morbid condition, the 
 whole system may sympathize with the uterus when the menstrual 
 discharge is suspended. 
 
 432. Hence it follows, as a practical result, that all our prescrip- 
 tions for suspended menstruation must proceed upon the principle 
 that this excretion is a vital, and not a mechanical result ; and that its 
 suppression is owing to some morbid state of the uterus, either direct, 
 or sympathetic. 
 
 7. CALORIFICATION. 
 
 433. Calorification is the function by which plants and animals gen- 
 erate the heat which is peculiar to themselves. Chemistry, however, 
 has enjoyed a more undisturbed exposition of the nature of this func- 
 tion than even that of digestion ; nearly all but the most eminent 
 physiologists, such as Hunter and Bichat, having acquiesced in the 
 speculations and assumptions of chemists as setting forth the true phi- 
 losophy of animal, or, rather, organic heat (§ 333). 
 
 It is obvious, therefore, that few things in medical philosophy have 
 greater demands upon the physiologist than a right interpretation of 
 this great and wonderful function of organic life, that its philosophy 
 may be carried to the illustration of other organic processes, that all 
 may be seen as a system of consistent Designs, and that no foot-hold, 
 in the way of analogy, shall remain to him who would substitute arti- 
 ficial devices for the institutions and laws of Nature. The times have, 
 and always have had, a demand upon the physiologist for a critical 
 exposure of this extensive vitiation of medical philosophy. They urge 
 it upon him now mote than at former periods. Nothing has been 
 hitherto done but to express opinions ; and we now witness, as a con- 
 sequence, an almost universal substitution of the chemical and phys-
 
 PHYSIOLOGY. FUNCTIONS. 235 
 
 ical theories ol life, disease, and therapeutics, for the promptings of 
 the most obvious phenomena of Nature. Mankind, in masses, in the 
 aspect of Nations, are carried away by the simplicity of the chemical 
 dogmas, and by the confidence with which they ai'e uttered. They 
 have become incorporated in most of our works on Physiology, Med- 
 icine, Hygiene. Nor is this at all limited to the Medical Profession. 
 It is coextensive with society. It is ingrafted upon popular works; 
 carried into our colleges, academies, and even public schools. It has 
 become a part of the general plan of elementary education ; and it is 
 now most extensively an object, through voluminous publications, to 
 induce the whole race of mankind to regulate their food by chemical 
 analysis. Banners, I had almost said, are every where paraded, beai'- 
 ing the inscription from Liebig's Animal Chemistry, that 
 
 " To DETERMINE WHAT SUBSTANCES ARE CAPABLE OF AFFORDING 
 NOURISHMENT, IT IS ONLY NECESSARY TO ASCERTAIN THE COMPOSITION 
 OF THE FOOD, AND TO COMPARE IT WITH THE INGREDIENTS OF THE 
 BLOOD." 
 
 434. At the very outset of our inquiry, we discern the speculative 
 nature of the chemical philosophy from the vast difference in the sev- 
 eral hypotheses which have been advanced with equal confidence, 
 and which, for awhile, have been received with almost universal fa- 
 vor. The theory of Crawford, which is relative exclusively to the 
 lungs, and to the difference in the capacity for heat of venous and ar- 
 terial blood, will not soon lose its fascinating simplicity nor the plau- 
 sibility of its pretensions. Its elegance will stand forever in forcible 
 contrast with that deformity which is the idol of the present day. 
 Genius and taste will never cease to do their mournful homage to 
 one, while they turn from the other as from the distortions of a Pagan 
 deity. 
 
 A third hypothesis may be stated as contributing to the improba- 
 bilities of the whole, and which has not yet been fully supplanted by 
 the greater novelty. This is that which ascribes the evolution of or- 
 ganic heat to the passage of the common nutritive fluid to a solid state. 
 It has, even more than Crawford's, the merit of philosophical simpli- 
 city, and of an apparent foundation in nature, but far less of the spice 
 of genius. 
 
 435, a. The first two of the foregoing hypotheses have, as one of 
 their indispensable elements, the imion of the oxygen of the air 
 with the carbon of the blood, or with that of the body ; though, aa 
 E have endeavored to show in the Medical and Physiological Com- 
 mentaries, neither that act in respiration, nor the excretion of carbon, 
 has any greater connection with the production of animal heat than it 
 has with that of the gastric juice, or any other result of organic func- 
 tions. The whole of that subject ig investigated so extensively in the 
 work just mentioned, and, I may say, the speculations and assump- 
 tions which have been subsequently put forth by Liebig and his school 
 are, also, so fully considered in the same work, either as already ex- 
 tant, or as hkely to ensue, that I shall now limit myself to a statement 
 of the latest and most approved positions of chemistry, and to such 
 remarks and prominent facts as may be necessary to complete the in- 
 tegrity of those fundamental principles which are the main objects of 
 this work, and to show that nature operates in her several depart- 
 ments, respectively, by general and not by partial laws, and that a
 
 236 INSTITUTES OF MEDICINE. 
 
 Stable and perfect foundation may be thus laid, as it exists in nature 
 for the great superstructure of pathology and therapeutics (§ 2, 892) 
 435, h. The arguments and the facts which I have employed in the 
 foregoing Essay on Animal Heat must have been oftener approved than 
 avowed, since they have been freely adopted by some subsequent 
 writers without indicating the source from whence they were derived 
 (§ 906,^). — See Rights of Authors p. 919, no. 23. 
 
 435, c. I may be also permitted to make the following extract fiom 
 the Preface to the third volume of the Medical and Physiological 
 Commentaries, published four years subsequently to the first two vol- 
 umes. Thus : 
 
 " In respect to chemistry, the author may safely affirm that not a 
 fact has been subsequently disclosed that reflects the smallest light 
 upon physiology or pathology. The whole of that ground, wherever 
 chemistry has obtruded itself upon the science of life and disease, is 
 so amply explained in the former volumes of these Commentaries, 
 that not a substantial fact, nor a vague conclusion, has been put forth 
 by the school of Liebig, which is not there examined, anticipated, and 
 answered, as something which had already an existence, or was like- 
 ly to emerge from the speculative philosophy of the laboratory then 
 in almost universal vogue" (§ 1 Z>, 3501, 820 c).* 
 
 436, What, therefore, I may now say in refutation of this or of 
 other chemical doctrines of organic processes and results, will con- 
 sist, in part, of a summary view of some of the facts and arguments 
 which are arrayed in copious detail in the Medical and Physiological 
 Commentaries. And, truth being my only object, I shall begin the 
 subject under consideration with a statement of the opinions of some 
 of the most accurate and distinguished observers, which correspond 
 with my own. But to show, however, that nothing but opinions have 
 been expressed even by those who have comprehended the subject, I 
 shall quote from each author all that I have any knowledge of his hav- 
 ing said upon the question at issue, with the exception of the little 
 which occurs along with Hunter's observations upon the temperature 
 of trees. I will add, also, in proof of the necessity of these inquiries, 
 that no preceding attempt had been made to show the errors of the 
 chemical doctrines of digestion, and that I have incorporated in my 
 prefatory remarks to that investigation all that I could learn from the 
 distinguished authors whom I have there summoned in behalf of 
 philosophy. — See Rights of Authors p. 919, no. 22, 
 
 437, a. Let us, then, hear the great French physiologist. " The 
 extrication of caloric," says Bichat, " is a phenomenon exactly analo- 
 gous to those of which the general capillary system is the seat." — 
 " The disengagement of caloric is always subordinate to the state of the 
 vital forces^ — " The state of respiration has no influence upon the 
 actual heat of the body." — " When we place on one side all the phe- 
 nomena of animal heat, and on the other the chemical hypothesis, it 
 
 * That this opmion is not peculiar to myself appears from critical notices of the Com- 
 mentaries. Thus, for example, it is said by the distinguished author of the " Climate of 
 the United States and its Endemic Injluences," that, 
 
 " It will be seen that Dr. Paine, in fact, anticipates the whole chemical theory of Lie- 
 big, as set forth in his 'Animal Cliemistry.' This he does not only in his Essay on Vi- 
 tality, in which he controverts some of the German professor's opinions, advanced in the 
 ' Orf;anic Chemistry applied to Agriculture and Physiology! but likewise in his Medi- 
 cal and Physiological Commentaries, published before the appearance of either of Lie 
 big's works."
 
 PHYSIOLOGY. FUNCTIONS. 237 
 
 appears to me so inadequate to the explanation that I think every me- 
 thodical mind can refute it without my assistance^' — Bichat's General 
 Anatomy applied to Physiology and Medicine. 
 
 437, b. John Hunter, like Bichat, placed the elaboration of organic 
 heat upon the same vital grounds ; regarding it as a secreted product. 
 " It is most probable," he says, " that the power of generating heat 
 in animals arises from a principle so connected with life, that it can, 
 and does, act independently of circulation, &c., and is that power 
 which preserves and regulates the internal machine." — Hunter's 
 Observations on Certain Parts of the Animal Economy. 
 
 437, c. And thus Wilson Philip : " Among the secretions I havo 
 ranked the evolution of caloric, although not taking place on any par- 
 ticular surface, because it appeared to be performed by the same 
 power acting on the same fluid ; and because, like secreted fluids, it 
 fails when any considerable part of the influence of the brain or spi- 
 nal cord is withdrawn." — Philip's Experimental Inquiry into the 
 haws of the Vital Functions (§ 446, b). 
 
 437, d. And thus the philosophical Moore : " We must allow the 
 bodies of living animals and vegetables to form an original source of 
 heat, as much beyond our power of explaining as the source of the 
 sun's heat." — INIoore's Medical Sketches. 
 
 437, e. And Miiller thus : " From the expex'iments of Dulong and 
 Despretz, it results that, even if the chemical theory of respiration be 
 adopted, there must be still some other source of animal heat.'' "A gen- 
 eral source of animal heat is undoubtedly to be found in the organic 
 processes, in which, by the organizing forces on the organic matter, 
 heat is generated not in one, but in every organ of the body." Again, 
 " Since all organic processes are chiefly dependent on the influence 
 exerted by the nerves on the organic mattter of the body, it cajinot 
 appear wonderful if the reciprocal action between the organs and the 
 nerves is a main source of animal heat." — Muller's Physiology. 
 
 437, y. Tiedemann has the same view of the subject. " The only 
 point," he says, *' that can be regarded as placed beyond doubt is, that 
 the evolution of heat is a vital act which depends immediately on the 
 process of nutrition, the conditional and preservative cause of life. 
 The intensity of the evolution of heat, and the property of maintaining 
 itself at a certain temperatui'e proper to each species, are, in animals, 
 in direct ratio with the composition of their organization, and with 
 the sum and intensity of their manifestations of activity." — Tiede- 
 mann's Physiology. 
 
 437, g. Finally, it is even said by the distinguished chemical phys- 
 iologist, Dr. Carpenter, that, " It is evident that the chemical doc- 
 trine in its present form is insufficient to explain the phenomena of 
 animal calorification." — Carpenter's Human Physiology, p. 611. 
 Jjondon, 1842. 
 
 438, a. The very able Dr. Edwards, in his work on the Influence 
 jf Physical Agents on Life, maintains that " respiration and animal 
 heat stand related as cause and effect.'" This doctrine is maintained 
 by Edwards with great ability ; far more so than by all other authors 
 whom I have consulted. I thought it, therefore, important to dispose 
 of his facts and arguments, in my former work, as far as their plausi- 
 bility and my own advantage of the right position would admit. 
 There is much said, in the Gomnventaries, in refutation of that doc*
 
 238 INSTITUTES OF MEDICINE. 
 
 trine, which is at the foundation of Liebig's (§ 440), and to which 
 no farther reference will be made in this work (^ 1044). 
 
 438, h. Coming to the heterogeneous assumptions which distinguish 
 the school of Liebig, there was no difficulty in anticipating the nature 
 of such as might be relative to former theories. I had set forth the 
 various doctrines in their ample dimensions, and brought them to the 
 test of facts and philosophy. The combustion theory was then in 
 vogue, and nearly in the terms as expounded by Liebig. In descant- 
 ing upon its peculiarities I took for my guide the most recent and ap- 
 proved phraseology, which, it will be seen, is coincident with the sup- 
 posed novelty; and, although it had numerous and ai'dent admirers, 
 it passed into such oblivion, in the brief space of two years, that when 
 Liebig promulgated the same hypothesis, and in the same language, 
 it was hailed as one of the most brilliant achievements of that distin- 
 guished man (§ 349, d). The doctrine which had been thus nearly 
 expressed by Billing, in his " Principles of Medicine," was taken for 
 my text, and is now presented again, in its original typography. Thus : 
 
 " We have in the lungs a charcoal fire constantly burning, and 
 in the other parts a wood fire, the one producing carbonic acid gas, 
 the other carbon ; the food supplying, through the circulation, the veg- 
 etable or animal yi;c^, from which the charcoal is prepared that is burn- 
 ed in the lungs. It is thus that animal heat is kept uj)." — Billing, 
 1838 (§ 447^ a, no. 4, 1044). 
 
 438, c. Somewhat pi-ior to Billing's day, Roget had embellished his 
 " Bridgewater Treatise on Animal and Vegetable Physiology," by 
 the following graphic desci'iption of the apparatus, and the office 
 which each part fulfills in the generation of animal heat. Thus : 
 
 " The food supplies \\\q fuel, which is prepared for use by the di- 
 gestive organs., and conveyed by the pulmonary arteries to the place 
 where it is to undergo comhustion. The diaphragm is the bellows 
 which feeds the furnace with air ; and the trachea is the chimney 
 through which the carbonic acid, which is the product of combustion, 
 escapes." — Roget (§ 350f ,y). 
 
 438, d. Now, the only fundamental difference between the forego- 
 ing and Liebig's hypothesis is this : The former supposes the com- 
 bustion to take place in the lungs, the latter in every other part ex- 
 cepting the lungs, where, as will be seen, a special provision is made 
 for the temperature of those organs (§ 447^,/"). 
 
 That no imaginary obstacle may lie in the way of the vital theory, 
 and that truth may have the advantage of rival doctrines by their close 
 apposition, and that knowledge may not be limited to the facts and 
 deductions of unadulterated science, it remains to show, by a series of 
 quotations from Liebig's Animal Chemistry, that the doctrine of the 
 dependence of organic heat upon the chemical process of combustion 
 has gained nothing from the Laboratory at Geissen ; while the atten- 
 tive reader will find in the extracts themselves the most ample proof 
 of its untenable nature. This, indeed, may have been well anticipa- 
 ted from what I have shown of this philosopher's regard for facts and 
 consistency in section 350. Indeed, the same incongruities, the same 
 contradictions, and worse assumptions, go to form the whole fabric of 
 Liebig's disquisitions upon animal heat, as I have shown to make up 
 his jumble respecting digestion, and other great functions, as well as 
 properties of living beings (^ 1044).
 
 PHYSIOLOGY. FUNCTIONS. 239 
 
 1 shall endeavor to execute my task with the same efficiency as 
 was attempted in relation to the chemical views of digestion (§ 350), 
 in the earnest hope that the chemist may discern the error of his 
 ways, and leave to the student of Organic Nature those difficult prob- 
 lems which concern the highest welfare of man, and whose consist- 
 ency, in their philosophical bearing, cannot be disturbed without laying 
 in ruins every principle in physiology, and carrying death into the 
 chambers of the sick (§ 4 a, 5, 5^ a, 3761, 376f b, 819, &c.) 
 
 440, a. Let us begin, then, with a statement of the doctrine as sum- 
 marily delivered by Liebig in his work on Animal Chemistnj, and 
 we shall see from the first proposition that it is essentially the old 
 speculation (§ 438, h), alike based upon artificial expedients, and upon 
 the assumption that the living organism is a mere chemical apparatus, 
 destitute of all properties and laws that are not common to dead 
 matter. 
 
 1. " It is evident that the supply of heat lost by cooling is effected by 
 the mutual action of the elements of the food and the inspired oxygen, 
 which combine together. The animal body acts, in this respect, as a 
 furnace which we supply icith fuel." " In order to keep up in the 
 furnace a constant temperature, we 7nust vary the supply of fuel accord- 
 ing to the external temperature, that is, according to the sujfply of oxy- 
 gen.^' — Ani?}ial Chemistry. 
 
 It will be seen, from the close of the foregoing quotation, tliat a 
 capital error is made in assuming a law that the quantity of food is 
 regulated by the temperature of the air (§ 440 cc, no. 12). That 
 assumption is carried out in opposition to all well-known facts ; while 
 it is also assumed as a law, that animal heat, whatever its uniformity 
 in the warm-blooded animal, or its instability in the cold-blooded, de- 
 pends upon the relative law of the temperature of the air and the 
 quantity of food consumed, although this law is virtually contradicted 
 by various other requisites for the promotion and maintenance of ani- 
 mal heat. But let us have another unqualified proposition which de- 
 fines the law in relation to the dependence of animal heat upon exter- 
 nal temperatui'e and the food consumed. Thus : 
 
 2. " In different climates, the quantity of oxygen introduced into the 
 system by respiration varies according to the temperature of the ex- 
 ternal air. The quantity of inspired oxygen increases with the loss 
 of heat by external cooling, and the quantity of carbon or hydrogen 
 necessary to combine with this oxygen must be increased in the same 
 ratio." — Animal Chemistry. 
 
 Now compare the following, 3, 4, and 5, with the preceding 1 and 
 2, and observe the conflict between them, and the contingencies upon 
 which the great law is made to depend that determines a uniform 
 temperature. Thus : 
 
 3. " The quantity of oxygen consumed varies according to the tem- 
 perature and density of the air, according to the degree of motion, 
 labor, or exercise, to the amount and quality of the food, to the com- 
 parative warmth of the clothing, and also according to the time within 
 which the food is taken" ! A proposition mostly relative to man, and 
 unfounded as to him (§ 440, c). 
 
 4. " The quantity of food is regulated by the number of respirations, 
 by the temperature of the air, and by the amount of heat given off to 
 ihe surrounding medium" ! (§ 447, c).
 
 240 INSTITUTES OF MEDICINE. 
 
 5. '* The inutual action between the elements of the food and the oxy- 
 gen conveyed by the circulation of the blood to every part of the body is 
 THE SOURCE OF ANIMAL HEAT." " For a given amount of oxygen the 
 heat produced is, in all cases, exactly the same J' — Liebig's Animal 
 Chemistry (§ 447, c, 1048). 
 
 6. " There is not the smallest support to the opinion that there ex- 
 ists, in the animal body, any other unknown source of heat, besides 
 the mutual chemical action between the elements of the food and the 
 oxygen of the air." — Animal Chemistry. 
 
 No farther comment is necessary to indicate the complexities and 
 contradictions involved in the foregoing quotations ; such as " the quan- 
 tity of oxygen consumed depends on the amount and quality of the 
 food," while " the quantity of food is regulated by the number of res- 
 pirations," that is, by " the quantity of oxygen consumed," &c. 
 
 If, also, we now add to the foregoing, 1, 2, 3, 4, 5, 6, other contin- 
 gencies upon which it is assumed that animal heat depends, we shall 
 have such a variety of accidental circumstances to interpret the uni- 
 form temperature of each individual of every species of animal, and 
 that, too, according to the constitutional peculiarities of each species, 
 that the nature of the chemical rationale will be sufficiently obvious. 
 Thus : 
 
 7. " Where the food contains meat, fat, and wine, by reason of the 
 hydrogen in those kinds of food which is oxydized, and which, in being 
 converted into water, it evolves much more heat for equal weights." 
 
 8. " The cooling of the body, by whatever cause it maybe produced, 
 increases the amount of food necessary. The mere exposure to the 
 cold air, &c., increases the loss of heat, and compels us to eat more 
 than usual. [ ! ] The same is true of those who are accustomed to 
 drink large quantities of cold water. It increases the appetite, [ ! ] and 
 persons of a weak constitution find it necessary, by continued exer- 
 cise, to supply to the system the oxygen required to restore the heat 
 abstracted by the cold water" ! — Animal Chemistry . 
 
 440, b. Here I pause for a moment to advert to the ground of the 
 assumptions in the quotations 7 and 8. The reason is one which goes 
 conclusively to the vital theory of animal heat. When wine, for ex- 
 ample, is taken into the stomach, an evolution of heat ensues as soon 
 as the stimulant is swallowed, in virtue of its stimulant effect on that 
 organ. In the same way meat stimulates more than vegetables, and 
 will light up a glow upon a cold surface before its digestion has be- 
 gun (§ 512, Z»). In respect to the superiority of cold water in pro- 
 voking hunger, there is no other way of explaining the philosophy 
 against the fact than by supposing " the Reformer" was pledged to 
 the popular cause of temperance. But since wine, brandy, &c., far 
 more than cold water, " increase the appetite" and " compel us to eat 
 more than usual," and since these fluids are said to yield a far greater 
 amount of "fuel" to the system than the food itself (whose main ob-- 
 ject is also supposed to supj^ly the means of combustion), it should 
 follow, upon our author's premises, that less food would be necessary 
 to the pui-poses of life in proportion to the quantity of alcohol con- 
 sumed, and therefore that wine should, in reality, diminish the appe- 
 tite and " compel us to eat less than us/aal" (nos. 4, 7 ; § 441, e). 
 
 It may be worth observing, also, in respect to the " cold water," 
 that the assumption is foundec upon several important mistakes ;
 
 PHYSIOLOGY. FUNCTIONS. 241 
 
 namely, 1st, That the appetite is virtually regulated by the condition 
 of the calorific process ; 2d. That " the animal body bears the same 
 relation to surrounding objects (in respect to an interchange of calor- 
 ic), as any other heated mass" (no. 14) ; and, 3d. That drinkino' 
 cold water diminishes the temperature of the body (§ 442, b, c, d, e). 
 And the most strenuous and extensive efforts have been made to choke 
 down these absurdities under the penalty of being lampooned as an 
 enemy to " experimental philosophy" (§ 5|, a). I have no doubt, 
 however, that they will forcibly remind the reader of the parallel quo- 
 tations, and of the pathological and therapeutical principles which 
 emanate from them in the two subsequent sections. 
 
 440, bb. As to the "fat" (no. 7), the chemist assumed that to be an 
 important source of animal heat because it is one of the best sub- 
 stances for combustion " in the air or in oxygen gas" (no. 10) ; and 
 this hypothesis conducts him to the ludicrous mistake of I'egarding it 
 equally, and in the same aspect, as a source of animal heat, whether 
 It be taken as an article of food and converted into chyme, or consist 
 of food which has been converted into the fat that makes up a part of 
 the consumer. The uniform temperature, therefore, among a variety 
 of other things, will depend not only on the amount of fat eaten, but 
 on the amount formed out of the blood. This leads our author to 
 say that, 
 
 9. " If we were to go naked, like certain savage tribes, or if in 
 hunting or fishing we were exposed to the same degree of cold as the 
 Samoyedes, we should be able with ease to consume ten pounds of 
 flesh, [ ! ] and perhaps a dozen of tallow candles into the bargain, daily, 
 as warmly-clad travelers have related with astonishment of these 
 people. [ ! ] We should then, also, be able to take the same quantity of 
 brandy or train oil without bad effects, because the carbon and hydro- 
 gen of these substances would only suffice to keep up the equilibrium 
 between the external temperature and that of our bodies." — Animal 
 Chemistry {^ 1050). And yet Alcohol is not absorbed § 350, no. 94, 
 
 And that, too, in a critical work on science which professes a rigor- 
 ous adherence to facts, as the only apology for a contemptuous deris- 
 ion of long-established doctrines, and as the only basis for the attempt- 
 ed substitutes. But let us now turn from " fat" as a combustible 
 substance, via the digestive apparatus, to " fat" as appertaining to 
 the organized tissues (§ 1048, 1049). — Note N p. 1121. 
 
 10. " The formation oi fat depends on a deficiency of oxygen. 
 But, in this process, in the formation of fat itself, there is opened up 
 a neio source of animal heat. The oxygen set free in the formation 
 of fat is given out in combination with carbon or hydrogen, and there 
 must have been generated by the formation of carbonic acid or water 
 as much heat as if an equal weight of carbon or hydrogen had been 
 burned in air or in oxygen gas." — Liebig's Organic Chemistry , &c. 
 
 Introductory to the foregoing quotation, we are told, that, 
 " The production of fat is always a consequence of a deficient sup- 
 ply of oxygen, for oxygen is absolutely indispensable for the dissipa 
 tion of excess of carbon in the food." 
 
 And then we are refeiTed, in illustration, to the " lean, muscular, 
 einewy limbs that are exhibited with pride by the Bedouin and Arab of 
 (he desert" (c). But what says the variety in respect to fat, and oxygen! 
 -nd heat, that prevails among the tenants of the ocean, who have but ono 
 
 Q
 
 242 INSTITUTES OF MEDICINE. 
 
 common supply of food 1 Contrast, for example, the blubber of the 
 whale, who breathes with lungs, with many a lean, voracious, cold- 
 blooded animal that respires with gills. The hypothesis, therefore, 
 falls (no. Ill, and § 443,4). Or, if it survive such difficulties, take, 
 then, tlie following statement, designed as an important basis for the 
 combustion theory, and which should have had a place among our au- 
 thor's pathological doctrines (§ 350i). But our present interest liea 
 in the fact that it appears, after all, that it is not " true without excep- 
 tion," that " the production of fat is always in consequence of a defi- 
 cient supply of oxygen." Thus : 
 
 " Exercise and labor cause a diminution in the quantity of the men- 
 strual discharge ; and when it is suppressed in consequence of dis- 
 ease, the vegetative life is manifested in a morbid productio?i of Jut" / 
 
 H^re is another " most trustworthy observation," and " perfectly 
 conclusive" as to our author's doctrine. Thus : 
 
 " The quantities of oxygen which a whale and a carrier's horse can 
 inspire in a given time are very unequal. The temperature, as well 
 as the quantity of oxygen, is much greater in the horse." — Liebig's 
 Animal Chemistry, &c. 
 
 Now the temperature of the whale in the frozen seas is more than 
 100° Fh., nor can the " carrier" bring up that of his horse to a higher 
 degree, with the aid of a tropical sun. It is evident that our author 
 has regarded the whale as a cold-blooded fish. 
 
 440, c. I shall not now stop to inquire farther into the factitious na- 
 ture of the foregoing doctrine, but go on with other extracts in which 
 the author endeavors to sustain his great law of animal heat (5. 6), 
 and expound by other contingencies that exact temperature which 
 distinguishes every warm-blooded individual of every species of ani- 
 mal, and according to the nature of the species, and with scarce a va- 
 riation, at all seasons, in all climates, at all ages, with all kinds and 
 quantities of food, from him who "devours 10 lbs. of flesh and a dozen 
 tallow candles into the bargain, daily, and the same quantity of brandy 
 and train oil without bad effects" (no. 9), to him who, like " old Cor- 
 naro," lives on "half an egg a day;" and whether clad in the flannels 
 and woolen broadcloths that are preferred as matters of comfort by 
 many inhabitants of tropical climates, or absolutely naked, with Fah- 
 renheit at 40° and lower, like the Petcherai Indians (442, h) ; or, wheth- 
 er sleepirig or waking, sitting or standing, running or walking, in an 
 ice-house or in an oven, in all past time, now, and forever ; whatever 
 statements our " Reformer" may make to the contrary notwithstand- 
 ing. It will appear, therefoi'e, that the following affirmations should 
 be carefully considered, before they are admitted as appendages to 
 the general law ; namely, 
 
 11. "Our clothing is merely an equivalent for a certain amount of 
 food. [ ! J The more warmly we are clothed the less urgent becomes 
 the appetite for food, [ ! ] because the loss of heat by cooling, and con- 
 sequently the amount of heat to be supplied by the food, is diminish- 
 ed" (no. 9, and 12, and § 442 a,c, 1047, 1048, 1049). 
 
 Here our author predicates two important errors of the hypothesis 
 which they are intended to sustain ; the assumptions and the hypoth- 
 .esis being mutually designed to support each other. 
 
 11-|. But again; having seen that (in the language of Mr. Ancell, 
 •'the Rf former's" interpreter) "the deposition of fat is supposed to
 
 PHYSIOLOGY. FUNCTIONS. 243 
 
 act as a substitute for free respiration in the production of heat" (no. 
 10), we shall not be surprised to learn that " its absorption answers 
 as a substitute for food in the production of animal heat." So it is ex- 
 tensively affirmed in the work on Animal Chemistry. 
 
 Why, then, is the temperature of a very fat ox and a very lean one, 
 or of a very fat man and a very lean one, exactly the same in each 
 Bpecies, respectively 1 Why does the fat man sustain a much less 
 exaltation of heat than the lean one when emaciation is in rapid 
 progress in febrile diseases 1 Why those daily periodical evolutions 
 of heat (100° to 110° Fh.) in the emaciated subject of phthisis, sub- 
 sisting on barley-water ; and respiring with lungs unfitted for half 
 their usual functions ? And this leads me to state the chemical phi- 
 losophy of mania and delirium, which flows immediately from the 
 subject before us ; and by which we learn, also, what is more im- 
 portant, the extent of our author's theory of combustion. Thus : 
 
 " In the progress of starvation it is not only the fat which disap- 
 pears, but also, by degrees, all such of the solids as are capable of be- 
 ing dissolved. In the wasted body of those who have suffered starva- 
 tion the muscles are shrunk and unnaturally soft, and have lost their 
 contractility. All those parts of the body which were capable of en- 
 tering into a state of motion have served to protect the remainder ot 
 the frame from the destructive influence of the atmosphere. [ ! ] To- 
 ward the end, the particles of the brain begin to undergo the process 
 of oxydation, and delirium., mania, and death, close the scene." 
 
 This construction of the cause of delirium and mania is conformable 
 to the author's hypothesis of thought, mental emotions, &c. (§ 349, e) ; 
 but that the phenomena are due to totally different influences " in the 
 progress of starvation " is shown by the uniform preservation of the 
 intellectual powers in the most emaciated subjects of phthisis pulmo- 
 nalis (§ 441, c). — See Index II, Article Hunger. 
 
 440, CO. But, we are only beginning with the contingencies which 
 contribute to the fundamental principle of animal heat, and which are 
 designed to interpret its remarkable uniformity, yet variety, in differ- 
 ent species of the warm-blooded tribes, and its variableness in the cold- 
 blooded, and to bring the general doctrine into correspondence with 
 a great law of caloric which prevails in the inorganic world ^§ 440 e, 
 no. 14). 
 
 12. " In cold and temperate climates, the air which incessantly 
 strives to consume the body [ ! ] urges man to laborious efforts in or- 
 der to furnish the means of resistance to its action, while, in hot 
 climates, the necessity of labor to provide food is far less urgent" 
 (§ 445, b). — Afii?nal Chemistry. 
 
 In the first place, all animals are overlooked in the foregoing state- 
 ment, and our philosopher is actually regarding man as the only liv- 
 ing creature who has a temperature above the surrounding atmo- 
 sphere J for it surely will not be said of animals that they must work 
 harder for a supply of food in temperate than in warmer climates. 
 Nor will the reader fail to observe that much of the statements and 
 reasoning, throughout, is predicated specifically of man, and of man, 
 too, in a state of health. 
 
 As to the necessity of more " laborious efforts to provide food" in 
 cold than in hot climates, a very different philosophy lies at its bottom 
 than assigned by Liebig, which consists in the greater necessity of
 
 244 INSTITUTES OF MEDICINE. 
 
 labor to cultivate the earth and raise the means of supply in the foi.' 
 mer than the latter sections of the globe. It is evident, also, thai 
 " the Refoi-mer" had not only man exclusively in view, but in that 
 part of the contrast which relates to " hot climates," he was thinking 
 alone of the indolent and luxurious master, without reference to the 
 slave, who toils the day long under a torrid sun for his own scanty 
 subsistence and his master's too. — Note Oo p. 1141. 
 
 But again, although man be compelled to work in cold climates 
 "to provide food" to keep up his temperature, while this "necessity 
 for labor is far less urgent in hot climates," the cold-blooded finny 
 tribe, and the warm-blooded whale, and beasts of prey are quite on 
 an equality, in that respect, in all regions of the earth. 
 
 440, d. But, we are yet far from the end of the " contingent influ- 
 ences" which modify the exact law of animal heat (nos. 5, 6), and 
 which go to the preservation of its exact uniformity. One of our au- 
 thor's hypotheses, which will be soon stated (no. 14), betrays him into 
 a mistake, which has been often made and as often exposed. Thus : 
 
 13. " The contraction of muscles produces heat; but the force ne- 
 cessary for the contraction has manifested itself through the organs 
 of motion, in which it has been excited by chemical changes. The 
 ultimate cause of the heat produced is, therefore, to be found in these 
 chemical changes." — Animal Chemistry. 
 
 Now, setting aside the sophistry of this reasoning in a ciicle, we 
 have the simple proposition that " tlie contraction of musclti 'produces 
 heat s^' and evidently because " a piece of caoutchouc, when rapidly 
 drawn out, forcibly contracts again, with disengagement of heat." 
 And to this conclusion the " Reformer" was impelled by his funda- 
 mental doctrine that the living and the dead are undistinguishably 
 governed by the same properties and laws, as implied by no. 14, and 
 as extensively set forth in § 350. This assumption as to the effects 
 of muscular motion I have sufficiently noticed in my former Essay on 
 Animal Heat ; but it may be now said that it is disproved by the uni- 
 formity of animal heat in all warm-blooded vertebrata, under all cir- 
 cumstances of rest and exercise. When the latter is sufficient to give 
 an impulse to the general circulatory and other organs, an increased 
 evolution of animal heat is liable to happen, like an increased flow of 
 saliva, sweat, or any other secreted product ; but it does not happen 
 with any certainty, and is never due to the physical causes assigned ; 
 neither the mechanical one of "muscular contraction," nor the "chem- 
 ical changes." 
 
 440, e. I come now to one of our philosopher's parallelisms of or- 
 ganic and inorganic beings in respect to their great laws and functions, 
 and which necessarily flows from the grand physical hypothesis that 
 the living body is a mere chemical apparatus. Thus : 
 
 14. " The animal body is a heated mass, which bears the same 
 
 RELATION TO SURROUNDING OBJECTS AS ANY OTHER HEATED MASS. 
 
 It receives heat when the suiTounding objects are hotter,' it loses 
 heat when they are colder than itself;" — Animal Chemistry. (See 
 § 350|, e, 1044 a, b). 
 
 Thus we have throughout a consecutive series of mistakes and blun- 
 ders, emanating from a false position in respect to the fundamental 
 constitution of living beings ; while this perversion of nature is the 
 monomania of materialism. But there remains much of the like na- 
 ture yet in prospect.
 
 PHYSIOLOGY. FUNCTIONS. 245 
 
 From the last proposition, and from the common level in which liv- 
 ing and dead objects are regarded, and in his unacquaintance vi^ith 
 physiological facts, the chemist has been betrayed into the supposition 
 that all the contingent circumstances which I have now stated (nos. 
 ,1-14) contribute, along with the fundamental law, 5 and 6, to the pro- 
 duction and maintenance of that uniform temperature by which every 
 warm-blooded vertebrata is distinguished, while every other product 
 of the tissues is forever variable in quantity, and which are to explain 
 lequally, also, the vicissitudes of the cold-blooded race, and all the 
 diversities of temperature which spring from disease. 
 1 The plainest facts in " experimental philosophy" contradict the as- 
 sumption, and place the generation of animal heat upon its own inde- 
 pendent ground. If we enter an apartment heated to 260° F., the 
 temperature of the body remains unaffected ; and equally so in a bath 
 of water, where all evaporation is prevented. If we pass the day in 
 an ice-house, or dwell in an atmosphere at 50° below the zero of 
 Fahrenheit, it is all the same (§ 442, c, d). If water, at zero, be 
 dashed on the body, a glowing heat is instantly lighted up on the sur- 
 face ; and so it is upon the cold and shriveled skin of the starving 
 man as soon as food shall have entered his stomach. A flash of indig- 
 nation, or an impulse of shame, will, on the instant, set the whole face 
 in a state of " combustion ;" the face being then said, by common 
 consent, to "burn" (§ 441, c).* 
 
 With the last proposition (14) goes another which has the concur- 
 rence of all ; namely, 
 
 15. " The heat given off to the surrounding medium is restored 
 within the body with gi-eat rapidity." — " All living creatures, whose 
 existence depends on the absorption of oxygen, possess within them- 
 selves a source of heat independent of surrounding objects." 
 
 16. And (for the third time, 5 and 6), " This disengagement of 
 heat is, uniformly and under all circumstances, the result of the com- 
 bination of a combustible substance with oxygen." — Animal Chem- 
 istry. 
 
 Such a chemical machine, with an internal source of heat, and con- 
 stantly liable to elevations and depressions of temperature from "sur- 
 rounding objects like any other heated mass," could possess no sta- 
 bility of temperature, — none comparable with the inanimate objects 
 by which its own internal source of heat is said to' be influenced ; and 
 when we superadd the various other contingencies, the varying quan 
 tities and qualities of food, variableness of respiration, the oxygen 
 respired, clothing, climate, season, weather, rest or exercise, age, fat, 
 candles, train oil, and rum, which are said to have important influen- 
 ces on animal heat (nos. 1-14), and then caiTy out the assumed rela- 
 tion of the living body to " surrounding objects," and thus identify it 
 with a " heated mass" of iron, a thousand other modifying contin- 
 gencies present themselves, which, in connection with the " internal 
 independent source of heat," should render the temperature of the 
 living warm-blooded vertebrata variable at every moment, while that 
 of the cold-blooded animal should be distinguished by the greater uni- 
 formity. 
 
 It need scarcely be added, that the warm-blooded vertebrata are 
 remarkably exempt from the law which chemistry, to be consistent, 
 imputes to them as conductors of caloric (no. 14). And herein, as 
 
 * How absurd does the doctrine of combustion appear in the presence of those Metv- 
 tal Emotions which instantly light up a glow on the surface of the body !
 
 246 INSTITUTES OF MEDICINE. 
 
 every where else, chemistry betrays the fallacy of its fundamental as- 
 sumption (nos. 5, 6, 16). The warm-blooded vertebrata are espe- 
 cially contradistinguished from " other heated masses, in their relation 
 to surrounding objects," by their resistance of heat from external ob- 
 jects (§ 441 c, 442 c) ; and this contradistinction is not only shown by 
 universal experience, but forcibly so by the comparative relation 
 which cold-blooded animals and " other heated masses bear to sur- 
 rounding objects." These animals depend mostly for their tempera- 
 ture upon that of the surrounding medium, and consequently sustain 
 much of the relation of " other heated masses." Still, they possess 
 not only a feeble power of generating heat, but, what is more to my 
 purpose, they have a corresponding power of resisting its ingress from 
 surrounding objects, since it was ascertained by Crawford that "« 
 living frog acquires heat more slowly than a dead oneT — London 
 'Philosoph. Trans., 1781, p. 485. 
 
 It is also worthy of remark, that the chemist has mistaken the rise 
 of animal heat, when occasioned by the heat of a fire, for that inter- 
 change of caloric which takes place between inanimate substances of 
 different temperatures. The phenomenon is peculiarly a fact for the 
 vitalist, since, in the former case the rise of heat is due to the action 
 of caloric as a stimulant to the organic functions (§ 1881). 
 
 On the other hand, when the temperature falls from the direct ac- 
 tion of cold upon the living body, it is from the abduction of heat from 
 the superficial capillaries alone, by which the calorific function is ar- 
 rested not only in the skin,but may be, by reflex nervous action, through- 
 out the body. And what also forcibly shows the vital nature of this 
 phenomenon is the frequent and speedy exaltation of the cutaneous 
 heat after its sudden reduction by the application of cold water (i^ 1044). 
 
 440, yi In the midst of so much error and confusion, it is no diffi- 
 cult matter, as already seen (§ 350), to paralyze an author by an ex- 
 posure of palpable contradictions in fundamental doctrines. As an 
 example of this nature in relation to the present subject I shall place 
 in opposition the following statements : 
 
 Affirmative. 'Negative. 
 
 17. " In whatever way carbon IS. " Carbon never combines 
 may combine with oxygen, the act at common temperatures with ox- 
 of combination cannot take place ygen, so as to form carbonic acid." 
 without the disengagement of heat. "There is no example oI car- 
 It is a matter of indifference wheth- hon combining directly with oxygen 
 er the combination take place at a at common temperatures ; but nu- 
 HiGH or at a low TEMPERATURE ; merous facts show that hydrogen, 
 the amount of heat liberated is a in certain states of condensation, 
 constant quantity." possesses that property. Lamp- 
 
 " In the foregoing pages, it has black which has been heated to red- 
 been assumed that it is especially ness may be kept in contact with 
 CARBON and hydrogen which, by oxygen gas, without forming car- 
 combining with oxygen, serve to bonic acid. The spontaneous in- 
 produce animal heat." flammability of the charcoal used 
 
 " The carbon of the food, which in the fabrication of gunpowder 
 is converted into carbonic acid has been correctly ascribed to the 
 within the body, must give out ex- hydrogen which it contains in con- 
 Bctlv as much heat as if it had siderable quantity ; for during its
 
 PHYSIOLOGY. FUNCTIONS. 247 
 
 been directly bunied in the air or reduction to powder, no trace of 
 
 in oxygen gas." carbonic acid can be detected in 
 
 " The 13-9 oz. of carbon which the air surrounding it. It is not 
 
 are daily converted into carbonic ioxmedi. walW the tenijoerature of the 
 
 acid in the body of an adult, mass has reached the red heat. 
 
 evolve 197477 degi'ees of heat, The heat which produces the in- 
 
 which is sufficient to raise the tem- flammation is therefore 7iot caused 
 
 perature of 370 lbs. of water to hy the oxydation of the carbon.'^ — 
 
 98*3'^, the temperature of the hu- Liebig's Organic Chemistry ap- 
 
 man body." — Liebig's Animal plied to physiology , &c., p. 263, 
 
 Chemistry., 1842. [See, also, nos. 311. 
 o, 6, 16.]' 
 
 440, g. These contradictory doctrines were put forth in different 
 works, but almost simultaneously, and each was designed to sustain 
 important hypotheses that regarded, respectively, the negative and 
 the affinnative statement. But, even in the work on Animal Chem- 
 istry., a subject collateral to the general hypothesis of animal heat 
 leads the author to a partial contradiction of his all-pervading idea of 
 the ready combustion of carbon at temperatures as low, at least, as 
 those of cold-blooded animals ; since, upon that collateral subject, he 
 says, ""at the temperature of the (warm-blooded) body, the affinity of 
 hydrogen for oxygen far surpasses that of carbon for the same ele- 
 ment." (See § 441, e.) 
 
 440, h. I shall not undertake to decide whether oxygen unites sin- 
 gly with carbon or hydrogen, in the living body, or along witii other 
 elements from which the carbon is ultimately excreted, nor is it the 
 province of these Institutes to inquire into a truth which belongs to 
 the laboratory. In my former Essay on Animal Heat, I have exam- 
 ined this subject in its physiological aspect adversely to the chemical 
 doctrine, and in confonnity with the great law which excludes the 
 formation of all inorganic compounds within the living organism, as 
 set forth by chemistry (§ 38, 39, 419). 
 
 440, i. Of the remaining subsidiary causes, that relative to the bile 
 should not be neglected. It is thus summarily expressed by Liebig's 
 interpreter, Mr. Ancell : 
 
 19. " These facts, and the reasoning founded upon them, have led 
 Liebig to the conclusion that the function of the bile is to support 
 respiration and produce animal heat, by presenting carbon and hy- 
 drogen in a very soluble form to the oxygen of aiterial blood." — Mr. 
 Ancell, iii London Lancet, 1843. 
 
 The reader will, therefore, the more readily comprehend the doc- 
 trine of " the Reformer" as stated in the following language. Thus : 
 
 " In the carnivora the bile contains the carbon of the metamorphos- 
 ed tissues. This carbon disappears in the animal body, and the bile 
 likewise disappears in the vital process. Its carbon and hydrogen are 
 given out through the skin and lungs as carbonic acid and water ; and 
 hence it is obvious that the elements of the bile serve for respiration 
 and for the production of animal heat." — Animal Chemistry. 
 
 That may answer for the "carnivora ;" while the graminivora de- 
 pend more upon their "fat," and other tribes upon their special al- 
 lotments. 
 
 Having already adverted to the true uses of the bile (§ 314-316,
 
 248 INSTITUTES OF MEDICINE. 
 
 409y), I shall proceed to say, without stopping to inquire how the 
 foreo'oino' " facts" were ascertained, that this part of the doctrine will 
 hardly abide the test of morbid conditions. It often happens, for in- 
 stance, when the production of bile is nearly or wholly arrested, that 
 the temperature of the body is exalted above its natural standard, 
 while at other times, when the bile is redundant, the temperature 
 sinks below its equilibrium. This, too, is familiar to physicians as 
 occurring in the progress of the same disease ; and I have thus intro- 
 duced this subject more for its bearing upon physiology and disease, 
 than on account of its perversion by the chemist (^ 1031 b). 
 
 441, a. Having now set forth the principal doctrine, and the most 
 important contingencies which are brought to its support, I shall pro- 
 ceed to make some farther comments both upon the doctrine and its 
 auxiliaries, and present a variety of facts in confirmation of the phys- 
 iological theory of animal heat. 
 
 441, 5. In the first place, it is worthy of farther remark in regard 
 to a principal element of the main hypothesis, that scarcely any two 
 individuals, of whatever species, consume the same quantities of food 
 in a o-iven time, while society abounds with habitual examples, where, 
 under the same circumstances of age, health, sex, climate, tempera- 
 ture, employment, &c., there is every gradation in quantity from a 
 daily consumption of many pounds to a few ounces, or with slight va- 
 riations as to quantity in many individuals. Without, however, now 
 revertino- to the preceding relative statements of our author, let us 
 adduce another for the sake of its logic and precision. Thus : 
 
 " The consumption of oxygen in equal times may be expressed by 
 the number of respirations. It is clear that in the same individual the 
 quantity of nourishment required must vary with the force and num- 
 ber of the respirations." — Ani??ial Chemistry. 
 
 Immediately after this quotation, which has for its object an adjust- 
 ment of " the quantity of nourishment required" for the assumed 
 amount of carbonic acid generated in the body, we are told that, 
 
 " A child, in whom the organs of respiration are naturally very ac- 
 tive, requires food oftener than an adult." 
 
 Thus, therefore, according to this statement (which has the merit 
 of being true, not only as it respects a " child," but all young animals), 
 the author has presented a fact subversive of his hypothesis relative 
 to the source of animal heat ; since, if a " child" and all young ani- 
 mals consume more food and oxygen in the ratio of their size than 
 men and adult animals, the power of evolving heat should be gi-eater 
 in the young than in the adult. But the experiments of Edwards, and 
 others, have demonstrated that young warm-blooded animals may be 
 cooled do^vn rapidly to near the temperature of the surrounding ail', 
 which is impracticable with adults. But Edwards adds the fact, 
 which farther confirms the vital doctrine of the generation of animal 
 heat, that " the rajnd 2>rogress which they make in acquiring the power 
 of producing heat is wonderful." The same facts are applicable to a 
 " child," though probably less so than to unfledged birds, puppies, &c. 
 (§ 153-155, 442 a, 445 /). I may finally add, that the whole of this 
 subject is extensively considered in my former Essay on Animal Heat. 
 
 441, c. Nor can I neglect refemng the reader to the facts which 
 I have arrayed in the Commentaries upon the subject of food, with a 
 view as well to the humoral pathology as to the chemical doctrine of
 
 PHYSIOLOGY. FUNCTIONS. I| 249 
 
 animal heat, — how the northern savages, as known by obseiTation, 
 and from the necessity of the case, consume much less food than the 
 civilized man of the temperate and even equatorial climates; the for- 
 mer, also, often breaking his fast only at distant intervals. There,* 
 too, may be found a multitude of corresponding facts in relation to the 
 endurance of Fasting without any sensible influence on the human 
 system, — a general survey, also, of the habits of animals in relation to 
 temperature, and which, like many of my arguments and other facts, 
 have been advantageously employed by subsequent writers to accom- 
 plish what I had already done. I have urged the fact, in respect to 
 animals, that they enjoy, ex necessitate rei, but a scanty supply of food 
 in the arctic regions, and that, when gorged with the same sustenance 
 on their removal to warmer climates, they still maintain nearly their 
 original constitutional temperature ; and there may be found a series 
 of facts as to the relative temperature of the warm-blooded and the 
 cold-blooded tenants of the deep, which, side by side in the arctic seas, 
 subsist on food of the same quality ; the whale, with a temperature ot 
 102° F., and the far more voracious shark, whose heat is down to a 
 lower standard. There it is urged, that when the emaciated hiberna- 
 ting animal is roused by pricking, &c., ay, even by exposure to a still 
 lower temperature, 25° F., his heat suddenly rises from 39° to 97° F. ; 
 besides a multitude of similar proofs which should be examined in 
 connection with what I have said extensively on the influence of th-e 
 nervous system upon the generation of organic heat in the wann-blood- 
 ed vertebrata (^ 1047, 1050). 
 
 How poorly accords our author's assumption as to the gi'eater vo- 
 racity of polar animals with the well-known facts relative to the hy- 
 enas, tigers, lions, crocodiles, vultures, cormorants, &c., that range in 
 temperate and equatorial quarters ! And what answer will chemisti-y 
 make to the poor ability of all tropical animals to bear even the au- 
 tumnal cold of the temperate zones, whatever the quantity of food"? 
 
 But the facts are " the things," and let us, therefore, have them 
 (§ 5i, a). They will show how far " the animal body bears the same 
 I'elation to surrounding objects as any other heated mass" (§ 440 c, 
 no. 14), and how far a large supply of food is necessary to the same 
 animal temperature ih frozen regions as appertains to the inhabitants 
 of warmer climates. 
 
 In the Commentaries, then, I have called to witness, against the 
 assumptions which I am again employed in refuting, the half-staired 
 bears, and foxes, and reindeers, and hares, and even small birds, sub- 
 sisting on a scanty amount of half-frozen food, and respiring and sur- 
 rounded by an atmosphere at 30° to 50° below the zero of Fahrenheit ; 
 yet maintaining about the same temperature as when transported to 
 a southern climate. I have said that " in 15 out of 16 foxes, the tem- 
 perature was 100° to 1063°, in the other 98° ; the thermometer rang- 
 ing below zero from 3° to 32° Fh, Capt. Lyon found that the tetro 
 albus maintained its temperature at 50° below zero. It was, also, 
 equally so with the smallest birds" (§ 442 b, 446 d, 1046-1050). 
 
 After what has been stated, however, of" tallow candles," "labori- 
 ous eflbrts," " heated masses," " clothing," &c. (§ 440, nos. 9, 11, 12), 
 the reader will not be surprised at our author's statement that, " every 
 
 * Medical and Physiological Commentaries, vol i., p. 691-695. Also, the Essaj' on An- 
 Vmal Heat, in vol. ii.— 1840.
 
 250 p INSTITUTES OF MEDICINE. 
 
 owe knows that the animals of prey in the arctic regions far excvad in. 
 voracity those of the torrid zone." And yet " every one knows" that 
 the consumption of food is universally gi'eatest where it is most abun- 
 dant, and therefore least where it is assumed to be most abundant. 
 
 And what will the disciples of chemistry say to the fact that the 
 low-born of the North of Europe, the exiles of Siberia, &c., often get 
 little more than bread made from the wood of trees, and a wardrobe 
 equally expressive of their destitution of the " comforts of life" (§ 442 
 h, and Cojnmcntaries, vol. i., p. 691-698) ] What is the contrast in 
 temperature between the well-fed loungers of Europe and the half- 
 starved laborers of the same countries '? AVhat, again, between the 
 slave and his master % One, too, feasting on animal food and othei 
 highly " combustible matter," in the shape of brandy, porter, wine, 
 &c., while the other gets nothing but potatoes, yams, or bread, at 
 best, and limpid water (nos. 7, 8) ? Their temperature is alike. The 
 only contrast in the case is between truth and error. Is the balance, 
 then, to be found in the difference of clothing (no. 11)1 Exactly 
 otherwise ; for the man of ease is incased with flannels and broad- 
 cloths, and lives in heated apartments (no. 14), while he of the shovel 
 or the hod is no less contented and comfortable in rags, and whether 
 he repose upon a bed of straw or a bank of snow. And here I may 
 add, what is equally fatal to the chemical hypothesis, that this house- 
 less sans culottes will maintain his warmth better with water than with 
 rum, and that, the more he consumes of the " combustible substance," 
 the greater will be his danger from frost (nos. 7, 9, Note Oo p. 1141). 
 
 It is also manifest that the ever-varying quantities and qualities of 
 food employed by man in temperate and torrid zones, while his 
 heat is always nearly the same, 'shows, with my other facts, that it is 
 less dependent on food than are other products of organization. More 
 especially is this demonstrated in many acute diseases, where the 
 temperature of the body, or of particular parts only, is often greatly 
 exalted, and where, too, the patient is wholly deprived of food, and 
 emaciation so far advanced that not only the "fat," but the veiy " tis- 
 sues" are nearly " consumed." 
 
 Without inquiring into the hypothesis that meat is more combustible, 
 and yields a greater quantity of heat than vegetable matter, it is im- 
 portant to place their relations to the calorific function in the proper 
 physiological aspect. 
 
 There is no doubt that the generation of heat is more promoted by 
 animal than by vegetable food, until the system is accommodated to 
 the latter by its habitual use ; and even then the preponderance will 
 be in favor of the former in high northern latitudes. The princi- 
 ple to which I now advert depends upon the law of vital habit and 
 that which relates to the virtues of different natural stimuli, and is as 
 foreio-n from chemistry as any two subjects can be from each other 
 (§ 136, 150-152, 188f, 442, 512 Z>, 535-568). 
 
 The whole philosophy, then, which concerns the greater tendency 
 of animal than of vegetable food to promote the generation of heat, 
 consists in the fact that animal is a greater stimulus than vegetable 
 matter to the organic functions (§ 188^, 512 h). The fact is demon- 
 strable, as I have said, while the food lies yet undigested upon the 
 stomach of the famished wayfarer; and eveiy one knows that his 
 warmth will be thus instantly increased to a greater degree by cold
 
 PHYSIOLOGY. FUNCTIONS. 251 
 
 meat than by cold potatoes (§ 512, h). And so is it, to a greater ex- 
 tent, with the alcoholic liquors which the chemist assumes are burned 
 in the recesses of the organization (nos. 7, 9).* The principle which 
 concerns the whole is exactly the same as when warm water lights 
 up a glow upon the surface, or determines perspiration, or an act of 
 vomiting. Here, too, in all this development of heat, as in the other 
 results, is involved a magnificent agency of the nervous system, but 
 which to the chemist is impenetrable darkness (§ 350, no. 97, 500 wn, 
 512 b). — See a curious coiitradiction about alcohol, p. 172, nos. 43, 94. 
 Those that have but imperfect views in physiology may compre- 
 hend the merits of this subject by considering the relative effects of 
 animal and vegetable food in fevers and inflammations. An ounce of 
 the mildest broth may raise the temperature many degrees, while a 
 liberal supply of appropriate vegetable food would have no such in- 
 fluence ; though a great exaltation of temperature would ensue upon 
 solid vegetable food that should not undergo digestion. The reason 
 of all this gives the right interpretation to the relative effects of ani- 
 mal and vegetable food in the generation of heat in ox-dinary states of 
 the system, or till habit may interpose its influence. Irritability be- 
 ing in an exalted state in febrile affections is more than usually sus- 
 ceptible of the stimulus of animal food, and hence the increase of vas- 
 cular action and the greater evolution of heat, both from the direct ef- 
 fect of the food and the exciting reflex nervous actions it occasions. 
 
 Where vegetable food remains undigested, in the foregoing case, it 
 becomes a morbid irritant to the stomach, and the cause of reflex 
 nervous influences that augment the fever or the inflammation, and thus 
 engenders a rise of temperature (§ 137 d, 150-152, 222, &c., 512, &c.). 
 The same philosophy is applicable to differences in climate. Little 
 vegetable food is consumed in the arctic regions, and, as little animal 
 food should be eaten by man in the equatorial. Nature has ordained 
 this allotment to men and animals, by a scanty vegetation at the north, 
 while she appears to have limited her provision of animal food in 
 tropical climates to the wants of the carnivorous race. To the north 
 she has given beasts and birds, but with a stinted hand, and has been 
 scarcely more liberal of the tenants of the deep. To the tropics a 
 profusion of esculent roots, fruits, &c. ; and has displayed a munifi- 
 cence in animal and vegetable creation throughout the vast temperate 
 regions. This ordination of nature is particularly suited to the exi- 
 gencies of the human constitution. Animal food is especially stimu- 
 lating to all the functions of man, and therefore to that which gen- 
 erates heat. Irritability is greater, more susceptible to the action of 
 stimuli, in equatorial than in other climates. The tropical heat is its 
 measure of endurance ; and when the stimulus of animal food is su- 
 peradded, the tropical man is extremely pi-one to fever, and dies 
 early. If wine, brandy, &c., be added also, so much the worse ; but 
 not because it is "burned" in the body (§ 188, &c., 615, &c., 618). 
 Our author's philosophy, however, is too much of a curiosity to be 
 neglected, and should have gone along with the pathological induc- 
 tions (§ 350i). Thus: 
 
 " The Englishman in Jamaica sees with regret the disappearance 
 of his appetite, previously a source of frequently-recurring enjoy- 
 ment; and he succeeds, by the use of Cayenne pepper and the most 
 powerful stimulants, in enabling himself to take as much food as he 
 * Alcohol appears to be in certain degrees digested, and in that state of transform' 
 ation it undergoes absorption. — JSote N p. ]]21.
 
 252 INSTITUTES OF MEDICINE. 
 
 was accustomed to eat at home. But the whole of the carbon thus 
 introduced into the system is not consumed. The temperature oi 
 the air is too high, and the oppressiv,e heat does not allow him to 
 increase the number of respirations by active exercise, and thus to 
 proportion the waste to the amount of food taken. Disease of some 
 kind, THEREFORE, cnsues" — Animal Chemistry. 
 
 Again, also, for a like physiological reason that animal food is too 
 stimulating for man in tropical climates, vegetable is not sufficiently 
 so for the obtuse irritability of the northern man (§ 191, 585, &c.) ; 
 and it is therefore true in this acceptation that the arctic man would 
 be more likely to freeze upon vegetable than animal food, despite of 
 the superabundance of carbon in the former (§ 447, h). But, as I 
 have said, and shown, he may, by the mere force of habit, come to 
 endure the cold nearly as well upon vegetable as on animal diet 
 1§ 442 h, 535, 1048). 
 
 I will also say, that it is a vulgar prejudice that " train oil and tal- 
 .ow candles" are appropriate food for man in any climate (§ 440 h, 
 no. 9). The arctic, like every other man, would soon perish upon 
 these indigestible substances. They would yield him neither flesh 
 nor "fuel." And, having thus come again upon the philosophy of 
 " fat" as a source of heat when taken into the stomach (§ 440, hh), the 
 chemist is evidently embarrassed by the contrast which is presented 
 by certain graminivorous and carnivorous animals (§ 440, ?') ; and so 
 he clears the way by the following assumptions, which have only ref- 
 erence, also, to a limited number of two genera of animals (§ 440, cc). 
 The conclusion of the extract is a good specimen of our author's mode 
 of disposing of former observation, and a profitable commentary upon 
 what is requisite in " experimental philosophy" (§ 350, mottoes a-e, 
 and no. 28). Thus : 
 
 " We know, in fact, that the graminivora expire a volume of car- 
 bonic acid equal to that of the oxygen inspired, while the carnivora, 
 the only class of animals whose food contains fat, inspire more oxy- 
 gen than is equal in volume to the carbonic acid expired. Exact ex- 
 periments have shown, that in many cases only half the volume of ox- 
 ygen is expired in the form of carbonic acid [3501 n, 440y) nos. 17 
 and IS, 447iy]. These observations cannot be gainsayed, and are 
 far more convincing than those arbitrary and artificially produced 
 phenomena, sometimes called experiments [by the " digestive mix- 
 ture," retoits, acids, lamp- wick, &c. %\ ; experiments which, made, as 
 too often they are, without regard to the necessary and natural con- 
 ditions, possess no value, and may be entirely dispensed with ; espe- 
 cially, when, as in the present case, Nature affords tlie opportunity for 
 observation, and when we make a rational use of that opportunity." 
 
 It remains only to say of the foregoing, that the chemist was not 
 duly mindful of the fact that all the principal tenants of the deep, 
 warm-blooded and cold-blooded, are alike carnivorous; and that the 
 exalted temperature of the blubber-whale, the porpoise, &c., breath- 
 ing, also, with lungs, and in their comparison with the low tempera- 
 ture of their associates that respire with gills, contrasts forcibly with 
 those carnivorous animals whose respiration of oxygen is said to pre- 
 vent an accumulation of fat. Such, I mean, is the fundamental doc- 
 trine of "fat" (§ 440 hh, no. 10). But since animal food, especially 
 fat, contains m(^re of the "fuel" than vegetable food, how does it hap-
 
 PHYSIOLOGY. FUNCTIONS. 253 
 
 pen, acceding to the foregoing statement as to the relative propor- 
 tions of oxygen consumed and carbonic acid expired by the graminiv- 
 orous and the carnivorous animal, respectively, that the former should 
 surpass the latter in the' formation of fat] 
 
 Wherever, therefore, we look at the " facts" of the organic chem- 
 ist, we find ourselves not only in the midst of contradictions, but em 
 ployed in refuting assumptions that are opposed by universal experi- 
 ence (§ 5i). That experience I had employed in the Commentaries 
 for the very purposes to which its adverse assumptions are now con- 
 secrated by the disciples of the " improved philosophy" (§ 349 d, 3501). 
 
 441, d. In the case of the hibernating animals (§ 441, c), the ex 
 cessive cold, and mechanical in-itation, in rousing the calorific func- 
 tion, operate as a stimulus to the nervous system, and thus restore the 
 organic functions, and the natural temperature as a consequence, 
 along with the other organic products ; though the heat more per- 
 fectly than any other. In a less degree, cold is a sedative to the hi- 
 bernating animals (§ 188j, 743). . This, also, is an example illustra- 
 tive of the opposite influences of vital agents, according to their in- 
 tensity of action, and the circumstances under which they are applied, 
 and of the wonderful adaptation of the natural agents of life to the pe- 
 culiarities of jaarticular species of organic beings (§ 191, 446 cZ, 500 6). 
 
 The impression of cold, or mechanical imtation, in the foregoing 
 case, is transmitted from the skin to the cerebro-spinal axis, where 
 the nervous power is developed and radiated abroad upon the or- 
 ganic properties of the entire body, by which they are brought into 
 operation (§ 222-233, 500, 512, &c., 638, 1044, h\ 
 
 Respiration and other organic functions nearly cease during the 
 state of torpor ; but the restoration of heat is far more than com- 
 mensurate with the progressive return of respiration. Of all the 
 products, an evolution of heat takes the lead, as indispensable to the 
 other important results. This appeal's to have been seen by Liebig. 
 Nor is there any principle in physiology, nor any facts, which will 
 at all explain the operation of cold in diminishing respiration, or cir- 
 culation, till it has first reduced the temperature of the surface. And, 
 were the chemical hypothesis true, the hibernating, and the young of 
 other warm-blooded animals, should not sustain the remarkable re- 
 duction of heat which is produced by an atmospheric temperature of 
 45^ F., since more oxygen is then consumed than at higher tempera- 
 tures. There can be no such positive exceptions to a fundamental 
 law. If peculiarity of constitution be assigned as the cause, then is 
 the chemical hypothesis abandoned, and the vital theory admitted. 
 
 It is therefore apparent, that the reduction of temperature depends 
 essentially on other causes than diminished respiration. The con- 
 verse of this must be equally true ; and when heat, therefore, is re- 
 stored, the first step in the process is an increased action of the cap- 
 illary blood-vessels, through the stimulus of the nervous power (§ 
 222, &c.), by which an evolution of heat is immediately started ; and 
 then begins an increase of the respiratory movements. " Wo can al- 
 ways hasten respiration," says Bichat, truly, " by making an animal 
 suffer; but an acceleration of the pulse is always prior to that of res- 
 piration, which appears to be determined by it." — (See § 484, Exp. C.) 
 
 441, e. That is a test. If the heat rises without oxygen, it certain- 
 ly does not, in such a case, depend upon combustion. The "earners"
 
 254 INSTITUTES OF MEDICINE. 
 
 must be regularly supplied (§ 447^, a). I have said that Liebig ap- 
 pears to have been sensible that internal heat is important to the or- 
 ganic processes, though vastly more so in the w^arm-blooded than the 
 cold-blooded race, and his statement upon this subject is one of his 
 numerous contradictions of the hypothesis which he assumes. Thus : 
 
 " It is obvious that the cause of the generation of force is 
 diminished, because, with the abstraction of heat, the intensity of tJie 
 vital force diminishes. It is also obvious, that the momentum of force 
 in a living part depends on its proper temperature." " The increase 
 of mass is effected in living parts by the vital force. The manifesta- 
 tion of this power is dependent on heat ; that is, on a certain temper- 
 ature peculiar to each specific organism." " The abstraction of heat 
 must be viewed as quite equivalent to a diminution of vital energy." 
 — Liebig's Animal Chemistry . 
 
 Now, according to this reasoner, "in the animal body we recognize 
 as the ultimate cause of all force only one cause, the chemical action 
 which the elements of the food and the oxygen of the air mutually ex- 
 ercise on each other." 
 
 We are also told that " the mutual action between the elements of 
 the food and the oxygen conveyed by the circulation of the blood to 
 every part of the body is the source of animal heatJ'' — Liebig's Ani- 
 mal Chemistry. 
 
 But, we have just seen that the same reasoner affirms that these 
 very movements are "dependent on heat" (§ 350, no. 17|, &c.). 
 The cause depends upon the effect, and the effect depends upon the 
 cause (§ 440, y). And how could it be otherwise Avith an hypothesis 
 BO estranged from nature ] Indeed, our author not unfrequently quits, 
 entirely, the chemical ground of animal heat, as we have seen of 
 many other assumptions (§ 350), and gives way to the simple dictates 
 of nature. For example, 
 
 " Certain other constituents of the blood may give rise to the for- 
 mation of CARBONIC acid in the lungs. But, all this has no connec- 
 tion with that VITAL process by which the heat necessary for the 
 support of life is generated in every part of the body." — Liebig's 
 Animal Chemistry. 
 
 And yet it is both a doctrine of this philosopher in physiology and 
 medicine, that the evolution of animal heat is a purely chemical pro- 
 cess, and that carbonic acid cannot be formed in the body without the 
 disengagement of heat (§ 350, no. 17^ ; § 440, no. 17). Taking, also, 
 in connection the two parts of the foregoing quotation, we have one 
 of those palpable contradictions of a fundamental assumption which 
 are the never-failing characteristic of false doctrines. There is the 
 double affirmation that carbonic acid resulting from any other source 
 than a vital process is not a cause of animal heat, and that animal 
 heat is alone generated by a vital process. (See, particularly, § 440, 
 nos. 6 and 16.) Or, allowing what the language does not admit, the 
 dependence of animal heat upon carbonic acid " generated in every 
 part of the body," we should then have the curious phenomenon in 
 chemistry of the production in the animal body of carbonic acid by a 
 chemical process and by a vital process, while that of the former, the 
 very gist of the doctrine, does not, as avowed, contribute to animal 
 heat (§ 1044). 
 
 441, y; Again, it is reiterated, that " the mutual action between the
 
 PHYSIOLOGY. FUNCTIONS. 255 
 
 elements of the food and the oxygen conveyed by tlie circulation oftht 
 blood to every part of the body is the source of animal heat" (^ 350, 
 no. 3). 
 
 Now, frogs have a feeble power of generating heat, as have " all 
 living creatures whose existence depends on the absorption of oxy- 
 gen" (§ 443, c). But, these animals contradict our author's hypothesia 
 as to the " carriers of oxygen," not only in its relation to animal heat, 
 but other importanc matters, such as the production oi force, oi motion, 
 &c. (see'§ 350, nos. 3, 4, 8). Spallanzani, for instance, deprived a 
 number of frogs and toads of the heart, large blood-vessels, &c., 
 and buried them in the snow, along with others which retained their 
 circulation and vivacity. The whole soon became completely torpid, 
 and " appeared as if frozen." In a few hours they were all removed 
 to a warm situation, where all of them began to leap and make theii 
 escape ; the reanimation being apparently as perfect in those which 
 had been deprived of blood as in those which had not. When ex- 
 posed to greater degrees of cold they perished in equal times (§ 441^ 
 d, 443 b, 494). 
 
 How simple an experiment, therefore, may overthrow the most pop 
 ular hypothesis in philosophy. It cannot be true of frogs that will 
 leap and jump without blood, as well as frogs with blood, after being 
 " apparently frozen," that their independent source of heat is owing 
 to " the oxygen conveyed by the circulation of the blood," any more 
 than their " amount of motion is proportional to the quantity of oxygen 
 inspired and consumed in a given time by the animal" (§ 350, no. 8). 
 And then, too, according to our author, 
 
 " Since physiology has proved that the globules of blood take no 
 share in the process oi nutrition, it cannot be doubted that they play a 
 part in the process of respiration." Especially in white-blooded ani 
 mals. — Liebig's Animal Chemistry. 
 
 From all which it is more and more apparent, that " the Reformer" 
 was employed about a plan of human chemistry rather than of animal 
 chemistry (§ 440, c). 
 
 The foregoing subject is farther continued in § 443-445. 
 
 44I2-, a. What has been said in the preceding section of the hiber- 
 nating and cold-blooded animals is true, in principle, of all other an- 
 imals who suffer only a partial reduction of temperature. The differ- 
 ences do not arise from different fundamental laws, but from different 
 modifications of the properties of life in different species of animals, 
 and at different ages of the same individual (§ 155, 185, 191). There 
 are many animals that approximate the hibernating in their feeble 
 power of maintaining heat ; and others, again, which sustain interme- 
 diate relations to the more perfect of the warm-blooded vertebrate. 
 *' The high temperature," says Edwards, in his Influence of Physical 
 Agents on Life, " which seems to characterize the mammalia and 
 birds, does not belong to them exclusively, since examples of it are 
 found among insects ; and, on the other hand, among the mammalia 
 themselves (as the hibernating), which, at certain periods, present the 
 principal phenomena of the cold-blooded vertebrata ; and, lastly, a 
 great number of non-hibernating mammalia and birds, in the early 
 periods of their life, show, as far as the phenomena of heat are con- 
 cerned, a strong resemblance to the cold-blooded animals." 
 
 It may be thence inferred, that what is so remarkably conspicuous
 
 256 INSTITUTES OF MEDICINE. 
 
 in the torpid hibernating animals is only the result of a law that pre^ 
 vails throughout the animal kingdom. This law extends equally to 
 the vegetable kingdom, which possesses a far greater power of gen- 
 erating heat than frogs and other cold-blooded animals. The trees 
 and shrubs which belong to northern climates have, also, exactly the 
 peculiarity of the hibernating animals, while those of tropical regions 
 maintain a greater uniformity of temperature, and are destroyed by a 
 degree of cold in which some northern herbaceous plants spring into 
 active life, and pierce their way through snow and ice, 
 
 441^, h. And this leads me to say, that, through the same law, the 
 warm-blooded vertebrata have their standard of heat modified by cli- 
 mate ; and even man himself sustains variations of l'^ to 2° F. And, 
 as I have said in my former Essay on Animal Heat, it is important to 
 remark, as showing the entire independence of this phenomenon of 
 respiration, this change does not take place till such as remove from 
 one climate to another shall have been for some time subjected to the 
 new condition of vital stimuli. It is the result of acclimation, and, 
 trivial as it may seem, it is full of the most insti'uctive illustration to 
 a reflecting mind. The phenomenon, I say, is owing to permanent 
 modifications of the vital constitution, and is of the same nature as the 
 change of temperament which the melancholic undergoes on passing 
 from the temperate to the equatorial regions (§ 602), and about which 
 the law of vital habit is interested (§ 561, 585, 602, 603, 1047). 
 
 4411, c. It is equally a fatal circumstance to the chemical hypothe- 
 sis, that the standard of heat is lowest in cold, and highest in hot cli- 
 mates, whatever the amount of clothing, &c., since more oxygen is 
 respired in the former, and, according to our author, a far greater 
 quantity of " fuel" is consumed both by the mouth and by oxygen gas 
 (§ 440, nos. 8, 9, &c.). It is not difficult, therefore, to understand the 
 bearinor of the followingf statement: 
 
 " The most trustworthy observations prove that in all climates, in 
 the temperate zones as well as at the equator or the poles, the tem- 
 perature of the body in man, and in what are commonly called warm- 
 blooded ammaAs, is invariabli/ tJie same." — Liebig's Ani?nal Cheynistnj. 
 
 And why, again, is the temperature of man higher in tropical than 
 in temperate climates 1 The reply is another proof of the tampering 
 of chemistry with a subject utterly beyond its reach; since the heat 
 of the tropics operates gradually as a vital stimulus to the calorific 
 function, and thus slowly establishes that condition by which an ex- 
 alted temperature is determined throughout the universal body (§ 350, 
 no. 65, 441 c, 445 e). 
 
 44 li, d. Nor may I neglect the striking characteristic of the Ggg, 
 which possesses the power of resisting cold " in a degree equal to 
 that of many of the inferior animals." This is one of the facts which 
 led Mr. Hunter to believe that the vital properties are capable of 
 generating heat independently even of circulation (§ 441, y), while its 
 greater evolution is seen to be the result of those properties in active 
 operation through the mature organization (§ 65). The former con- 
 dition, associated, also, with the power of resisting the causes of putre- 
 faction, is a beautiful illustration of the nature of life, that it is an ac- 
 tive, not a passive state, that it consists essentially of power, and that 
 its laws are specific. But, how will the combustion hypothesis dis- 
 }X)se of the internal source of heat in the eg^l
 
 PHYSIOLOGY. FUNCTIONS. 257 
 
 442, a. In respect to the affirmation that "clothing is merely an 
 equivalent for a certain amount of food" (§ 440, no. 11), I have addu- 
 ced, in my former Essay, many facts to prove that our clothing is 
 greatly a matter of habit, and this is shown by the facts which will be 
 soon presented. It is, indeed, a forcible illustration of the nature of 
 the properties of life, of the dependence of animal heat upon vital ac- 
 tion, and of its obedience to the law of vital habit, and to the consti- 
 tutional law by which all results shall be so regulated as to maintain 
 the integi'ity of organic processes, and, therefore, a unifoi-m tempera- 
 ture of non-hihemating warm-blooded vertebrata ; while, as I have 
 endeavored to show in the same work, the modifications of these pro- 
 cesses in hibernating and cold-blooded animals, as well as in the veg- 
 etable kingdom, are not only perfectly consistent with what is observ- 
 ed of the non-hibernating warm-blooded vertebrata, but go to con- 
 firm the whole philosophy which is founded upon the phenomena of 
 these animals. 
 
 There, too, I have shown by an examination of facts, that the rapid 
 change in the power of elaborating heat in early life depends on the 
 same common principle which determines the changes in all other 
 functions and results, that they are all on a par in principle, and that 
 the rapid increase of the resistance of cold in the young of the warm- 
 blooded vertebrata proves the vital character of the calorific function 
 (§ 153-159, 441 5, 1047, 1048). 
 
 442, h. In illustration of the law of vital habit as it respects the 
 power enjoyed by man of resisting cold (§ 441, c), and in farther dis- 
 proof of the assumption that a living animal is "like any other heated 
 mass in relation to the temperature of surrounding objects," I shall 
 quote from the Commentaries one of the facts which are there present- 
 ed for the purpose which is now in view. Thus : 
 
 " Mackenzie says, that some of the northern savages follow the 
 chase in the coldest weather with only a slight covering. Lewis and 
 Clark state, that two Indians slept upon the snow during the night 
 in a light dress, when the thermometer was 40 degrees below the 
 zero of Fahrenheit. The man was uninjured ; the boy had his feet 
 frozen. Now it is evident that no civilized man could sustain such an 
 exposure. The phenomenon is owing to the poicer of habit in rela- 
 tion to the forces of life, and is utterly insusceptible of explanation on 
 any other principle." — Comvientarics. — See § 1047, 1048. 
 
 On the other hand, an individual froze to death in the woods of 
 Peacham, Vermont, on the night of the 7th of June, 1817; notwith- 
 standing, also, he was full, to intoxication, of the most combustible 
 substance (§ 440, no. 9). 
 
 But, again, we are informed by Captain Wilkes, that, when the 
 thermometer was at 40° F., " the Petcherai Indians were entirely 
 naked, with the exception of a small piece of seal-skin, only sufficient 
 to cover one shoulder, and which is generally worn on the side from 
 which the wind blows, affording them little shelter against its pierc- 
 ing influence." 
 
 Again, says Captain Wilkes, "On the 11th of March, three bark 
 canoes arrived, containing four men, four women, and a girl about 
 sixteen years of age, four little boys, w\^ four infants, one of the latter 
 about a week old, and quite naked. The thermometer was at 46*^ 
 
 R
 
 258 INSTITUTES OF MEDICINE. 
 
 Fh." — Wilkes's Narrative of the United States Exploring Expedi' 
 tion, vol. i., p. 121, 124. 1845. 
 
 The foregoing, in relation to the infants, should be considered m 
 connection with what has been ascertained by Dr. Edwards as to tho 
 comparative inability of infants to bear a cold atmosphere, when un- 
 accustomed, and with what is known of hereditary constitution (§ 
 447 h, 540, 561. See, also, Medical aiid Physiological Commenta 
 rics, vol. ii., p. 27, 52, 56, 69-74). 
 
 " The power of the Russian Zincali of resisting cold," says Barrow, 
 " is truly wonderful, as it is not uncommon to find them encamped in 
 the midst of snow, in slight canvas tents, when the temperature is 30^ 
 or 40^ below the zero of Fahi'enheit." — Barrow's Zincali of Spain. 
 
 No two individuals under apparently eqvial circumstances, of the 
 same health, age, sex, and with the same quantities and qualities of 
 food, clothing, &c., are alike in the power of resisting cold. Place 
 them in a temperature at zero of Fahrenheit, and one will perish 
 while the other will not suffer. One shall enjoy a glow of warmth 
 from athletic exercise, while the other shall perish with the same 
 counteracting means. It is a common event to witness the blasters, 
 in the vicinity of New York, at work in winter with heavy drills in 
 their naked hands, while others, unaccustomed, would be frost-bitten 
 at the same temperature. The difference is manifestly owing in part 
 to a difference in constitution, but especially to the influence of habit, 
 which engenders the power of enduring intense degrees of cold, and 
 which no chemical principles can possibly expound (§ 535-568,1047). 
 
 442, c. The foregoing facts show us, also, how it has happened that 
 animals have spread abroad from the spot where they were created, 
 and become specifically adapted to different climates. The element 
 of their adaptation was implanted in their vital constitution at the 
 time of their creation, and relates to almost all physical agents. And 
 so with vegetables, which may be gradually transplanted from the 
 equator to high northern latitudes, where they also undergo changes 
 of organization (§ 155, 535, 538, &;c.). Thus do we also again bring 
 the philosophy of physiology to the overthrow of that infidelity which 
 departs from the Mosaic account of organic Creation (§ 74, 350|, h-n). 
 
 442, d. Again, do the beasts or the birds of the polar clime change 
 their fur or their plumage when transported to a temperate region 1 
 What, for example, answers the white bear, with which we are all 
 familiar 1 And yet their temperature sustains but a slight change, 
 though a change subversive of the combustion theory (§ 441 c, 441-2). 
 Here, too, in truth, they consume a far greater quantity of food ; and, 
 if the chemist's hypothesis as to an interchange of caloric with the at- 
 mospheric air be adopted (§ 440, no. 14), these transj^lanted creatures 
 should sustain a very exalted rise of temperature. But, upon the 
 physiological action of external heat, as a vital stimulus, the high tem- 
 perature of a warm climate would much more than compensate for 
 any supposed deficiency of oxygen (§ 440 e, 441^- c, 1047). 
 
 " And then, on the other hand," turning again to man, and as 1 
 have said in the Commentaries, " are the experiments of individuals 
 subjecting themselves to an excessively high temperature without sus- 
 taining any sensible variation of heat. This was fully demonstrated 
 by Blagden, Banks, Fordyce, Solander, G. Home, Dundas, Dr. North, 
 Phipps, Seaforth. and Dobson, who exposed themselves to260^ F."* 
 
 * CI. Bernard's late Experiments of this nature upon animals do not affect these facts or the plii- 
 osphy. They were like those of graduated poisons. — 18G0.
 
 PHYSIOLOGY. FUNCTIONS. 259 
 
 442, e. We see, then, in the various demonstrations, which have 
 now been made, of the power of all warm-blooded, non-hibernatin"- 
 vertebrata to maintain a uniform degree of heat under the greatest 
 vicissitudes of atmospheric temperature that are compatible with life, 
 a proof of a most astonishing law of the living body, in perfect con- 
 flict with the laws of caloric as they exist in the inorganic world. 
 " AVe know it" as exactly as we comprehend the nature and opera- 
 tion of the most precise law in physics. It is, in itself, demonstrative 
 of the government of living beings by specific forces. It establishes 
 a positive distinction between these forces and the organized structure. 
 If I am not right in this construction, I say, once more, let the ground 
 of objection be shown. I mean not the usual denial, or by renewed 
 misrepresentations of my statements. The objections must be found- 
 ed upon a broad and ptilosophical survey of all the phenomena of 
 heat that relate to living objects as they may be modified by natural 
 causes, or by morbid states of the system ; and the ground must cover 
 the general physiological condition of organized beings. How wide 
 fi'om all this are the assumptions, and those mostly relative to man 
 (§ 440, c), that have been lately consecrated as the true " experimen- 
 tal philosophy" of animal heat''(§ 349 d, 1047) ! 
 
 443, a. As my former Essay embraces an extensive range of inquiry 
 into the facts and philosophy attending the calorific function in the 
 cold-blooded race, I shall now add only a few remarks to what I have 
 already stated upon this subject, and as suggested by the present stage 
 of my inquiry (§ 44iy, 441^ a). 
 
 443, b. Frogs and other cold-blooded animals are supplied with 
 capacious lungs ; and, however it may be argued that their consump- 
 tion of oxygen is less than that of warm-blooded animals, they have, 
 nevertheless, the same respiration, nutrition, vital decomposition, and 
 the same " charcoal fire," in the ratio of the food consumed, and yet 
 is their tempei-ature principally regulated by that of the suiTOunding 
 medium. They also emit a large amount of carbonic acid, which 
 proves a free consumption of oxygen and a liberal supply of food. All 
 this is as essential to frogs as to man ; and they equally perish 
 when deprived of atmospheric air, and so of all the cold-blooded finny 
 tribe (§ 350, no. 17-|, and § 440, no. 10). And what will chemistry 
 answer to the exalted temperature which attends the inflammations 
 of the cold-blooded vertebrata ? 
 
 Chemistry must here be consistent, and in being so it necessarily 
 abandons the hypothesis that the evolution of heat, in warm-blooded 
 animals, depends on the union of oxygen with the carbon and hydro- 
 gen of the body, and that it occui's in the ratio of that combination. 
 "7;i the animal bod?/," says Liebig, " the food is the fuel ; with a prop- 
 er supply of oxyqen toe obtain the heat given out during its combus- 
 tionr (Also, § 440, nos. 5, 6, 17.) 
 
 443, c. The difference in the law regulating temperature is owing 
 to a difference in vital constitution, of which the chemist takes no ac- 
 count (§ 440, no. 12). But, there are also many other peculiarities 
 in the vital phenomena of cold and warm-blooded animals which are 
 due to the same condition of constitution, and by which their relative 
 power of generating heat is shown to depend on a common cause, 
 and which is common to all the phenomena. It is this which ren- 
 ders cold-blooded animals greatly subject to the temperature of the
 
 2tJ0 INSTITUTES OF MEDICINE. 
 
 RurrouTJtling medium, but whicli also enables them to resist its influ- 
 ence by some 2 or 3 degrees at all seasons of the year. 
 
 443, d. If" the chemist resort to difference of constitution in explain- 
 ing the foregoing phenomena, as is generally done, he resorts to the 
 properties and functions of life, and abandons his own ground. In 
 one case he says, it is because they are cold-blooded, and in the other, 
 because they are warm-blooded, and so on. Such, indeed, is the fact. 
 But, is it not because the organization and vital endowments are 
 not adapted to the same generation of heat in one case as prevails in 
 the other ; and this, too, when the organization may be in a high de- 
 gi'ee simple (§ 409, e) ? 
 
 444, Let us, therefore, settle this question by reference to an animal 
 without lungs, or gills, and in which, also, the temperature is clearly 
 influenced by causes which can alone operate as vital stimuli. The 
 temperature, for example, of a hive of bees is at about 90° F., when 
 the air is at 40°, and upward of 70° in winter. Their power of gen- 
 erating heat is also increased during the breeding season. This phe- 
 nomenon corresponds with the observations that I have made upon 
 vegetables ; having found the temperature highest when the leaves 
 and blossoms are putting forth. — [Medical and Physiological Commen- 
 taries, vol. ii., p. 75-78.) 
 
 445, a. Still more conclusively, than the obvious dependence of or- 
 ganic heat in the cold-blooded vertebrata, insects, &c., upon vital 
 principles, do the phenomena of vegetable heat evince the same great 
 law of organic nature. This subject has been ably explored by John 
 Hunter, and, as I have intimated in the foregoing section, has re- 
 ceived a careful attention from myself. Senebier, also, saw the ther- 
 mometer rise from 79° to 143° F., when placed in the midst of a 
 dozen spathes of the arum cordifolium, at the time of opening their 
 sheaths. And so Huber, and others. 
 
 445, b. That fact, and the ability of plants to generate a tempera- 
 ture often far above the earth or the surrounding atmosphere, are so 
 apparent that they are universally admitted ; but obtain from the 
 chemist no farther notice. Indeed, the following is all that we have 
 from Liebig on the subject of vegetable heat. Thus : 
 
 " All living creatures, whose existence depends on the absorption 
 of oxygen, possess within themselves a source of heat independent of 
 surrounding objects. This truth applies to all animals, and extends, 
 besides, to the germination of seeds, to the flowering of plants, and to the 
 maturation of fruits." — Animal Chemistry. 
 
 And yet is the " combustive process" always in progress, more or 
 less, in all parts of vegetable organization. The question, therefore, 
 arises as to the motive for not only concealing an important fact, but 
 in thus implying, by circumstantial statements, that no other parts of 
 vegetables "possess within themselves a source of independent heat." 
 The very fact that such a source belongs to seeds in their germinating 
 state, &c., is sufficiently conclusive that it extends to every part of the 
 plant, and " the Reformer" could not have been ignorant that the very 
 *igg resists a temperature below the freezing point in virtue of its in- 
 ternal source of independent heat. 
 
 But, all this is fatal to our author's hypothesis. Eggs do not con- 
 sume oxygen, have no " caniers of oxygen," and trees, it is said, do 
 not " burn" like the animal body (§ 302, 303|). Consequently, the
 
 PHYSIOLOGY. FUNCTIONS. 261 
 
 chemist, to carry out his hypothesis of animal heat, must maintain the 
 anomaly that seeds, flowers, and fruits, during their development, are 
 the only parts of the vegetable vv^orld. that possess " an independent, 
 source of heat." The secret of all this w^ill be farther seen in the fol- 
 lowing passage : 
 
 '14:5, d. " The distinguishing character of vegetable life is a contin- 
 ued passage of matter from the state of motion to that of static equilib-' 
 rium. A plant produces within itself no cause of motion'''' (see § 350, 
 nos. 7, 8, 10, and § 440, nos. 5, 6, 8, 9, 12, &c.). " In a word, no 
 waste occurs in vegetables. [ % ] Waste, in the animal body, is a 
 change in the state or in the composition of some of its parts, and 
 consequently is the result of chemical action." — Liebig's Animal 
 Chemistry. 
 
 And, again : " Analogy, that fertile source of error, has unfortu- 
 nately led to the very unapt comparison of the vital functions of plants 
 with those of animals." — Liebig's Organic Chemistry, &c. 
 
 445, e. Thus is the problem solved. There is either no heat gen- 
 erated by plants, or, otherwise, the chemical doctrine of animal heat 
 is radically false. To show how this may be I shall now introduce 
 an abstract of some observations made by myself on the temperature 
 of trees. It is unnecessary to state the mode in which the observa- 
 tions were conducted, or the precautions adopted, as they are record- 
 ed in the Commentaries. 
 
 On the 9th of April, 1839, in a neighboring forest, the following re- 
 sults were obtained : 
 
 Range of the thermometer in the shade during the observations, 
 which lasted six hours, from 38° to 52° F. Near freezing at sunrise. 
 A dead upright tree was selected as a standard of comparison. 
 Its diameter was 12 inches. The temperature of this tree, at the close 
 of my observations, was 45° at the centre and in all other parts (§ 
 440, nos. 14, 15, and 16). 
 
 Juglans squamosa, 
 
 diameter 10 inches. 
 
 48° 
 
 Buds slightly enlargin 
 
 Do. do. 
 
 6 
 
 49^'' 
 
 do. 
 
 Fagus sylvatica. 
 
 " ]0- " 
 
 40° 
 
 Buds swelling. 
 
 Cluercus tinctoria. 
 
 7 
 
 49° 
 
 No buddinsr. 
 
 Castanea Americana, 
 
 TO 
 
 50 
 
 do. 
 
 Betula nigra, 
 
 4 
 
 51° 
 
 Flowering. 
 
 Salix Babylonica, 
 
 18 
 
 53 
 
 Buds unfolded. 
 
 Do. do. 
 
 18 
 
 53° 
 
 do. 
 
 Pinus Canadensis, 
 
 18 
 
 54° 
 
 
 Platanus occidentalis, 
 
 18 " 
 
 50° 
 
 No budding 
 
 Do. do. 
 
 6 
 
 54° 
 
 do. 
 
 Do. do. 
 
 4 
 
 55° 
 
 do. 
 
 Juniperus Virginiana, 
 
 4 <i 
 
 55° 
 
 
 Robina pseudacacia, 
 
 3 
 
 62° 
 
 do. 
 
 Populus IsBvigata, 
 
 4 « 
 
 62° 
 
 In bloom. 
 
 Do. do. 
 
 " 4 
 
 64° 
 
 do. 
 
 Do. do. 
 
 3 
 
 63° 
 
 do. 
 
 Do. do. 
 
 3 
 
 65° 
 
 do. 
 
 Do. do. 
 
 " 2 " 
 
 67° 
 
 io. 
 
 Do. do. 
 
 T) _1' • .^1 .i • 
 
 
 68° 
 
 do. 
 
 were correct, I should find an elevation of vegetable heat as the 
 warmth of the season increased, and the energy of vegetable life be- 
 came more exalted, on the l&th of the same April I made another 
 visit (§ 4411, c). 
 
 Range of the thermometer in the shade during the observations, 
 which lasted five hours, from 40° to 65°.
 
 2(i2 INSTITUTES OF MEDICINE. 
 
 Temperature of two dead, dry, upright birch trees, one eight 
 inches in diameter, the other six inches, at end of observation 60° in 
 all their parts. Temperature of the earth six inches below surface 
 47° in shade, at close of observation. Probably 50° at two feet. 
 
 Be tula nigra, 
 
 diameter 15 inches, 
 
 54° 
 
 Buds swellinj^. 
 
 Platauas occideutalis, 
 
 6 
 
 59° 
 
 do. 
 
 Quercus wens, 
 
 8 
 
 62° 
 
 do. 
 
 Do. do. 
 
 2i " 
 
 73° 
 
 Buds much more advanced 
 
 Do. tiuctoria, 
 
 18 
 
 65° 
 
 Buds swelling. 
 
 Do. do. 
 
 6 
 
 66° 
 
 do. 
 
 Juuiperus Virginiana, 
 
 5 
 
 64° 
 
 
 Do. do. 
 
 " 2 " 
 
 79° 
 
 
 Acer rubram, 
 
 13 '• 
 
 65° 
 
 In bloom. 
 
 Castanea Americana, 
 
 4 
 
 66° 
 
 Buds swelling. 
 
 Comus Florida, 
 
 " 2 " 
 
 68° 
 
 5 Flower-buds advancing; liu 
 I leaves. 
 
 Fa^s sylvatica. 
 
 12 
 
 68° 
 
 Buds opening. 
 
 Ju<?lans alba 
 
 4 
 
 75° 
 
 Buds swelling. 
 
 Do. do. 
 
 1 
 
 83° 
 
 Buds larger. 
 
 Do. do. 
 
 5 " 
 
 82° 
 
 Buds opening. 
 
 445, y! It is abundantly manifest from the foregoing observations 
 that vegetables possess a vital power of generating heat, according to 
 the activity of their organic forces ; and I carry the analogy to the 
 animal kingdom. The temperature was not influenced by that of 
 the earth, as seen by the pi-eceding statement. The heat of the lat- 
 ter, however, was not ascertained at the first observation. It appears, 
 also, that the power of generating heat is greater in proportion to the 
 youth of trees. This remarkable fact is not only especially indicative 
 of the vital agencies in the generation of vegetable heat, but is worthy 
 of notice on account of its opposition to what obtains in the animal 
 kingdom in respect to age. It corresponds, also, with observations 
 upon herbaceous plants. The difference depends upon the relative 
 difference in organization and vital properties at the corresponding 
 pei-iods of life. — Comvi. Also, § 153-155, 441 i-i^ 1054. 
 
 445, g. It is a fundamental principle, therefore, that " ilie general 
 l^henomena of the disengagement of heat remain always the same in an- 
 imals with lungs, ifi those icithout them, and in plants, all of which 
 have an independent temperatureT — Bichat. 
 
 446, a. The relation of the nervous power to animal heat is the 
 same as that of all other products of animal organization ; its influ- 
 ence, however, being sometimes remarkably pronounced in the elabo 
 ration of heat, as seen in the quick transition of the hiberaating animal 
 from temperatures below 40° to upward of 90° F. This subject, how- 
 ever, has been so extensively investigated in my former work that I 
 shall only say now that the elaboration of animal heat does not depend 
 on the nerv'ous power, as often maintained, but, like other functions of 
 animals,is only influenced by it (§ 183-185, 188, 222-233, 489, 492, 500). 
 These are variously affected by varying influences exerted upon the 
 cerebro-spinal and ganglionic systems, as, of course, ai-e also the se- 
 creted products in a corresponding manner. In the perfectly natural 
 state, the nervous system has no important agency in the production 
 of the phenomena, but may become powerfully instrumental in modi- 
 fying the properties, and actions, and products of life, when unusual 
 conditions exist, or when unusual impressions are transmitted to the 
 cerebral and sympathetic centers. Analogy, also, as supplied by 
 the vegetable kingdom, affords the strongest presurrtptive evid.ence 
 that the nervous system may have no active participation in the elab-
 
 PHYSIOLOGY. FUNCTIONS. 263 
 
 oration of heat, in the natural condition of the body, while this induc- 
 tion is strengthened by what is known of other secreted products in 
 both of the animated kingdoms. Still, in respect to the animal king- 
 dom, the mere existence of the cerebral and ganglionic systems, their 
 remarkable properties and susceptibilities, and their intimate connec- 
 tion with all parts of the organization, '\^^ prima facie, conclusive that 
 they have important offices in relation to animals, and that their pres- 
 ence, in the natui-al state of the complex being, is indispensable to the 
 integrity of every function. This, as will have been seen, has been ex- 
 perimentally ascertained in relation to many ; and that unusual, or 
 sudden impressions that are not unnatural, as the operation of the pas- 
 sions, for instance, may be extensively and profoundly propagated 
 from the brain to other organs. It has been fully demonstrated that 
 the natural condition of the secretions depends upon the integrity of 
 the nervous connection between the secerning organs and the cerebro- 
 spinal axis ; while it has been equally shown that the organic func- 
 tions, and all vascular action, may be immediately and powerfully 
 influenced by impressions made upon the brain and spinal cord, 
 whether in a direct manner, as in Philip's Experiments, or indirectly 
 through reflex nervous action, as in blows upon the stomach, sur- 
 gical operations, the action of medicines and of poisons upon the in- 
 testinal canal, &c., the ganglionic nerve being the principal medium. 
 
 Assuming, then, that animal heat is also a secreted product, it 
 would come philosophically under the common law ; and since it ap- 
 pears from expei-iment, that animal heat depends even more upon 
 the presence of the brain than an imperfect production of gastric 
 juice and other secreted fluids, and may be as powerfully influenced 
 through the nervous system, the physiological analogy between heat 
 and other secreted matters becomes quite apparent ; while it ex- 
 plains the remax'kable effect of a low atmospheric temperature in 
 developing heat in the torpid hibernating animal (§ 441, 441^ c) ; 
 and thus conducts us, also, to the philosophy of the operation of oth- 
 er causes in modifying animal tempei-ature (^ 461, 1032 c?, 1044). 
 
 To maintain the foregoing conclusion, I have examined, in my for- 
 mer Essay, the merits of Brodie's, Philip's, Chaussat's, and other ex- 
 periments upon the nervous system, the phenomena of hibernating 
 animals, the modifications of temperature that spring from injuries, 
 diseases, and other affections of the nerves, &c., the admissions of 
 distinguished chemico-physiologists, and. other important considera- 
 tions. Some of these facts in relation to the nervous influence upon 
 animal temperature will appear in the next following section. 
 
 446, h. It should be said, however, that it has been stated by some 
 that the experiments of Philip conflict with those of Brodie and 
 Chaussat, which establish an influence of the nervous power over the 
 phenom-ena of animal heat. But that is an error ; since the deduc- 
 tion of Philip himself from his own observations ascribes to the ner- 
 vous power what is due to the organic power. Thus : 
 
 " That the maintenance of animal temperature is a function of the 
 nervous system, properly so called, appears from a variety of facta 
 generally known ; the temperature either of a part or of the whole 
 body being lessened by any cause that impairs the action of particu- 
 lar nerves in the former instance, or of the whole nervous system in 
 die latter." — Philip, on Acute and Chronic Diseases, p. 48.
 
 264 INSTITUTES OF MEDICINE. 
 
 Again he says, " I here consider it as proved, by experiments al- 
 ready laid before the reader, that the evolution of caloric is a function 
 of the nervous influence." — Philip's Inquiry into the Laivs of the Vi- 
 tal Functions, Exp. 77. (Also, § 437, c, Note Aa p. 1131.) 
 
 446, c. It is, of course, erroneously stated by " the Reformer," that, 
 " by the division of .the pneumogastric nerves, the motion of the stom- 
 ach and the secretion of the gasti-ic juice are an-ested." The juice is 
 only modified in quality, w^hile it is actually increased in quantity (§ 
 461, 489). 
 
 " The Reformer" has also high conceptions of the agency of the 
 nervous system in organic results, notwithstanding they are all exclu- 
 sively due, in his estimation, to the merest chemical processes (§ 350). 
 " Every thing in the animal organism," he says, " to which the name 
 of motion can be applied, proceeds from the nervous apparatus." 
 Our author, however, is entirely mistaken in his opinion that " the 
 singular idea that the nerves produce animal heat has obviously arisen 
 from the notion that the inspired oxygen combines with carbon in the 
 blood itself." Nevertheless, we are told by our author that " every 
 thing i?i the anivial organism to which the name of motion can he ap 
 plied proceeds from the nervous aj^paratus ;^' and we are also told that 
 without this motion there can be no animal heat (§ 350, nos. 3, 17^, 
 6, 7, ISi, 19). 
 
 But, take the ordinary construction of those who mingle together 
 but virtually contradistinguish, the powers and processes of living and 
 dead matter, and impute to the nervous influence no small share, along 
 with chemical agencies, in the production of heat and other products 
 of the livinsr orsranism, we are asked to sanction one of the most un- 
 philosophical and incongruous medleys of powers, processes, laws, 
 and principles, acting and reacting upon each other, that ever pre- 
 sented itself for well-merited satire. The nervous power is also apt 
 to be regarded by the chemico-vitalist, as by the chemist, a mere 
 chemical agent. But, we shall have seen that this construction is en- 
 cumbered with difliculties (§ 222, &c., 451/, 500 nn, 638^). 
 
 446, d. The modifying influence of the nervous system upon the 
 generation of animal heat being established not only by experiments, 
 but especially, also, by facts relating to morbid states of the system, 
 to which I shall soon advert, and by all that is philosophical in physi- 
 ological science , and when we consider, also, how easily and rapidly 
 the nervous influence may be determined upon the vascular system 
 (as in blushing), and upon the organic viscera, we have an intelligible 
 explanation of the operation of a very low degree of cold in recall- 
 ing into action those vessels upon which depends the exaltation of 
 temperature in the torpid hibernating animal (§ 441 d, 441^ a). That 
 the intensity of the cold, like the mechanical irritant (§ 441, c, d), op- 
 erates, also, in a direct manner, upon the organic properties, as in 
 other instances of foreign agents, is undoubtedly true (§ 189). The 
 law being also universal explains the influences of other causes, in 
 health and disease, in modifying animal temperature, and only regards 
 the agency of respiration, like that of digestion, &c., as being instru- 
 mental in perfecting the blood, and thus adapting it to the uses of the 
 various organs which are concerned in the elaboration of heat and 
 other products. 
 
 447. a. Whatever is true, in a fundamental sense, of the production
 
 PHYSIOLOGY. FUNCTIONS. 265 
 
 of lieat in the natural state of the organic being, must be equally so in 
 its morbid conditions. It is true, we are told by " the Reformer," 
 that " we cannot investigate the laws of life i?i an organized being which 
 is diseased ;^' but we have seen that this will not hold in experience 
 or philosophy (§ 303|). It serves, however, its useful purpose in the 
 chemical doctrine of animal heat. But, since the truth is just the re- 
 verse (§ 160, 163), I shall present from the Commentaries, in this sec- 
 tion, a series of facts which contribute an important light upon the 
 physiology of calorification, and upon the general constitution of or- 
 ganic beings. We shall learn yet farther, by this demonstration, that 
 the evolution of animal heat is exactly on a par with all other secreted 
 products, and has a corresponding dependence upon decarbonized 
 blood, and can be regarded in no other aspect (§ 764, c). And here 
 our author's philosophy is consistent, since he imputes alike the for- 
 mation of animal heat, and all other products, even the circulation of 
 the blood, nay, all diseases, yea, death itself (§ 350, no. 46), to the 
 union of oxygen gas with the elements of food, — Note Ddd p. 1149. 
 
 447, b. Indeed, it cannot be too often said, as shown by the ques- 
 tion before us, that the phenomena supplied by diseased conditions 
 are often the most important in illustrating the properties and laws of 
 organic beings ; and upon no question have they a gi'eater bearing 
 than the one under consideration. Morbid states are only physiolog- 
 ical changes, and the resulting products and phenomena are simply 
 modified conditions of such as are more natural, and are dependent 
 upon the same laws, the same causes, the same functions as deter- 
 mine the healthy results (§ 155, 156). This is an undeniable propo- 
 sition. In the conflict of doctrines, therefore, which are predicated 
 of the perfectly natural phenomena, we should seek for the light of 
 such as emanate from diseased conditions ; and here the chemist is 
 even more disqualified for investigation than in the dark mazes of 
 physiology. To him, the vast field of pathology, which every where 
 stamps with falsehood his chemical views of life, is as hidden as undis- 
 covered regions ; and since all pathological and therapeutical conclu- 
 sions necessarily refer to the natural physiological conditions, their 
 impracticability, absurdity, and destructiveness, when deduced from 
 the chemical premises, as clearly demonstrate the shallowness of their 
 foundation. The student of organic nature, therefore, appreciates, as 
 he deplores, the ignorance which is received as the light of knowl- 
 edge (§ 349, ^). 
 
 447, c. It should be considered, also, in respect to the vast differ- 
 ences in temperature that spring from morbid conditions, whether 
 high or low, the diet is often the same, very spare, or when the tem- 
 perature is most exalted, as in active forms of fever and inflammation, 
 there is a total abstinence from food. Consider, also, the brute ani- 
 mal under the same circumstances, abstaining totally, yet suffering a 
 very exalted temperature (§ 440, nos. 1, 4, 5). 
 
 I shall proceed, therefore, to a statement of some of the important 
 facts which are supplied by disease, as set forth in my former Essay 
 on Animal Heat. For the authorities quoted, see the Essay. 
 
 447, d. Diseases of the brain supply a variety of facts which illus- 
 trate our inquiry. Thus, in phrenitis, one arm, or one side of the 
 body, is colder than the other. " That the temperature of a paralyzed 
 part is generally below the normal standard is now universally admit-
 
 266 INSTITUTES OF MEDICINE. 
 
 ted." That this is owing to impaired vitality, is also shown "by the 
 frequent failure of nutrition in the paralyzed part, as well as other co- 
 incident phenomena. In a case related by Mr. Earle, he found the 
 temperature at 70° F., in the hand of a paralyzed arm, while that of 
 the opposite hand was 92°. He could also effect a temporary res- 
 toration of temperature by electricity and by blisters. "The circula- 
 tion of the blood did not appear to have suffered, the pulse at the wrist 
 being synchronous, and equally strong with that of the other limb." 
 In an injury of the sympathetic nerve, Chaussat saw the temperature 
 fall from 1048S= to 78-8° F., in ten hours. 
 
 On the other hand, there is a remarkable exaltation of temperature 
 m a part at the invasion of tic douloureux. So, when the nerves are 
 mechanically injured. There was a patient at St. George's Hospital, 
 whose temperature rose 11° F., in consequence of an injury of the 
 spinal column ; and this took place when the respirations did not ex- 
 ceed ^i;e or six in a minute. It is stated by Dr. Macartney and other 
 observers, that when the principal nerve of an extremity is divided, 
 the temperature of the limb is immediately exalted several degrees. 
 The philosophy of this is well expounded by an advocate of the chem- 
 ical doctrine. "We should be disposed," he says, "to regard it as 
 due to the temjDorary excitement of the molecular changes by the ir- 
 ritation produced by the section of the nerve, and propagated to its 
 extremities." Now apply this language to the exaltation of tempera- 
 ture in any inanimate substance, however produced, and we mayap- 
 preciate the merits of the chemical solution in the former instance. 
 
 " In some subjects of insanity," says Dr. Cox, of Fish Ponds, "who 
 were under strong coercion in the horizontal position, with the head 
 much elevated, whose face was red, and the vessels turgid, the differ- 
 ence of heat was very obvious, varying 10, 12, and even 15 degrees." 
 
 In apoplexy, the temperature has been known to rise, after death, 
 a number of degrees above the natural standard; and its persistence 
 lias been found so uniform in apoplexy, that Dr. Cheyne regards it as 
 a diagnostic symptom. The temperature of a lawyer, dead of apo- 
 plexy, was so high at twenty-four hours after death, that Portal delay- 
 ed an examination of the body. The same phenomenon is observed 
 after death from other diseases, — especially when the nervous system 
 has been unusually concerned in the morbid jH-ocess. 
 
 " In opening bodies at the Hotel Dieu," says Bichat, " I have ob- 
 served that the time in which they lost their animal heat was very va- 
 riable ; that a body continues warm a greater or less time, especially 
 among those who have died suddenly of an acute affection, in the par- 
 oxysm of an ataxic fever, for example, or by a fall ; for those who 
 die of a chronic disease, lose almost immediately their caloric. The 
 difference in the first is often three, four, or even six hours. This 
 phenomenon arises from the fact, that whenever death is sudden, it 
 interrupts only the great functions ; the tonic action of the parts con- 
 tinues for a greater or less time after. Now this action disengages a 
 little caloric from the blood that is in the general system." " When 
 the disengagement of caloric has ceased in the body, that which re- 
 mains in it becomes in equilibrium with that of the external air, ac- 
 cording to the general laws of this equilibrium. Now these laws be- 
 ing uniform, their effect would be the same in every case." 
 
 Again, sometimes the temperature in apoplexy is greatly depressed
 
 PHYSIOLOGY. FUNCTIONS. 26*7 
 
 Defore death takes place ; and this, too, while the circulation is such 
 as to admit of blood-letting. Two cases of violent apoplexy ("vio- 
 lento paroxysmo") are recorded in the Ephemerides Germanii, in 
 which the blood, as it flowed from the veins, was actually cold. Mor- 
 gagni mentions an instance of another affection in which the blood 
 flowed " in an icy cold stream" from the arm. Thackrah saw a sim- 
 ilar phenomenon. So, also, De Haen. I need scarcely say, also, that 
 when respiration is extremely labored and slow in apoplexy, the nat- 
 ural temperature is often either undiminished or considerably exalted. 
 Our familiarity with the fact, however, only increases its importance, 
 and shows, by the frequency of the coincidence, that respiration can 
 be only remotely concerned with the generation of heat. 
 Here is another variety in apoplectic affections : 
 " While a gentleman," says Mr. Hunter, " who was seized with an 
 apoplectic fit, lay insensible in bed, covered with blankets, I found 
 that his whole body would, in an instant, become extremely cold in 
 every part, continuing so for some time ; and as suddenly would be- 
 come extremely hot. While this was going on alternately, there was 
 no sensible alteration in his pulse for several hours." 
 
 Here is another case, from the same observer, not less fatal to the 
 theory of respiration : 
 
 " A man fell from his horse, and pitched on his head, and produced 
 all the symptoms of a violent injury. There was concussion, and per- 
 haps extravasation of blood. The pulse was at first 120, but came to 
 100, and sometimes to 90, and was strong, full, and rather hard. He 
 was very Jiot in the skin, but breathed remarkably slow, only half the 
 common frequency." Other injuries exalt the temperatui'e in other 
 modes of an equally vital nature. Thus, extirpation of the kidneys 
 through the increased stimulus of the blood, often raises the temper- 
 ature of the body more than six degrees. 
 
 The following case, by Mr. Hunter, also, seems also to have been 
 intended for our special purpose : 
 
 " February, 1781, a boy, about three years old, appeared not quite 
 so well as common, being attacked with a kind of shortness of breath- 
 ing in the night. It had become excessively oppressive about five 
 o'clock on Sunday morning, so difficult that he appeared dying for 
 want of breath. The common rate of breathing in such a boy is about 
 thirty inspirations in a minute. At 10 o'clock, he was drawing his 
 breath with a jerk, — about two and a, lialf inspirations, or even less, 
 in a minute. Pulse sixty,yam^, slow. On tying up the arm, the vein 
 did not appear to rise in the least, so that the blood did not go its round. 
 Viod^ purplish, especially the lips. He had ^jine warmth on the skiti 
 all over the body, although in a room without afire, — not covered with 
 more clothes than common in the month of February, with snow fall- 
 ing at noon."- — Hunter. 
 
 This, and the preceding case, appear to differ in some physiolog- 
 ical details. In the former, the disposition of the capillaries to gener- 
 ate heat seeiTis to have been a good deal determined by the cerebral 
 influence ; in the latter, the alteration of the vital forces was probably 
 owing to other causes. Like other cases, therefore, which I have re- 
 cited, they serve, by their variety, to illustrate the vital nature of the 
 principles which are mainly concerned in the production of animal 
 heat. But, standing alone, they must either subvert the hypothesia
 
 2fi8 INSTITUTES OF MEDICINE. 
 
 which concerns respiration, or we must have a chemical theory for 
 the natural state of the body, and a vital one for its morbid conditions. 
 This would be clearly absurd ; at least, if there be any such thing as 
 philosophy, or any consistency in the powers and functions of life. 
 These examples show us, also, how very probable it is, that all our 
 chemical hypotheses in relation to life ai-e the mere offspring of habit, 
 or imitation, or of narrow observation. It is certainly hard to give 
 up the fruit of great toil and research ; but it is harder for others to 
 endure it, who prefer to be instructed by the voice of nature, rather 
 than by artificial results.* 
 
 I shall present other examples to the foregoing effect, as supplied 
 by morbid conditions of the system ; since these, more than experi- 
 ments, conduct us to the true philosophy of animal heat. 
 
 Every physician is familiar with the variations of temperature in 
 disease ; which, indeed, engage his attention in almost every case. It 
 is often exalted when respiration is slow, and again depressed when 
 breathing is hurt'ied ; and it is one of the most common phenomena 
 to find it different, by many degrees, in different parts of the body, 
 and under every variety of respiration and circulation. It will, there- 
 fore, be my purpose only to mention a few of the more unusual in- 
 stances. 
 
 Dr. Philip has known the temperature of the skin at 74° Fh. in 
 the cold stage of an intermittent, while in the hot staere it rose to 105°. 
 Craigie found it at 107°, and 109°. Here the respiration and circu- 
 lation are often most accelerated during the cold stage. This, with 
 the vast difference in temperature, refei's the depression of heat to 
 other causes than the mere constriction of the capillaries in the cold 
 stage. Here, too, as in all analogous cases, we have a coincident 
 diminution of all other secretions. Piorry has seen the temperature 
 in six cases of typhoid fever varying from 108° to 117° ; and in one 
 of these, the blood was at 113° Fh. In phthisis, he has known it at 
 114°, and in a case of pneumonia, the blood was 113°. Prevost 
 found the temperature of the body at 110° in tetanus. Granville says 
 it sometimes rises in the uterine system to 120° Fh., and that it de- 
 pends on the degree of action in the organ. In hydrophobia, where 
 respiration is probably always accelerated, Currie found that " there 
 was no increase of animal heat in any one of five cases." 
 
 " The Reformer" says that, ^^for a given amount of oxygen the heat 
 produced is, in all cases, exactly the same ;^^ and that *' the consumption 
 of oxygen in equal times may be expressed by the number of respira- 
 tions^' (§ 440, no. 5 ; 441, b). But, in stating this, he did not reply to 
 the following interrogatories propounded in my former Essay. Thus : 
 How is the natural temperature maintained in consumption, where res- 
 piration is sometimes so greatly impaired as not to be compensated 
 by any acceleration of its movements ] Or why is it, when the lungs 
 are impervious from condensation, and their function otherwise great- 
 ly impaired by destructive ulceration, the heat rises habitually in the 
 afternoon, even to 114° Fh., and that, too, without any previous re- 
 duction of temperature, and often without any increase of respii'ation ? 
 
 * I commend, also, to our minute philosophers Mr. Hunter's experiment upon tlie carp. 
 It was partly intended to illustrate a vision of oui- author, by which, as he says, "like other 
 schemers, he thought he should make his fortune." But our author had not only tlie good 
 sense to abandon it, but the magnanimity to hold it up as a weakness of the human an 
 derstandina:.
 
 PHYSIOLOGY. FUNCTIONS. 269 
 
 Why do the palms of the hand. " burn" when the rest of the surface 
 is cool ] Will chemistry explain 1 Will it explain, also, at the same 
 time, the analogous phenomena, and the vicissitudes of heat and cold, 
 the quick transitions from one to the other, that are forever perplex- 
 ing the physician in his treatment of continued, remittent, and inter- 
 mittent fevers 1 Will chemistry maintain, in conformity vs^ith it^ doc- 
 trine, that these periodical evolutions of heat are due to paroxysmal 
 combustions of the tissues, especially where little remains to undergo 
 the process, respii-ation obstructed, and yet a high exaltation of tem- 
 perature 1 Explain, I say, all this in conformity with the " oxygen 
 and fuel" system, and vitalism will surrender to the devices of human 
 ingenuity. 
 
 Why is it, that when the general temperature of the body is at 
 some 85° Fh. it may exist at the scrobictihis cordis at 106° and up- 
 ward %* Mr. Malcolmson states, that in the Asiatic cholera " the 
 skin is sometimes colder during life than after death, and a partial rise 
 of temperature over the trunk is frequently a fatal symptom." I have 
 witnessed the same phenomena. Mr. M. also observes that beriberi 
 supplies analogous instances ; and that when the temperature was 
 extremely reduced, " it was not different when the limbs were closely 
 wrapped in woolen, or when the thermometer was held between the 
 soles of the feet or hands, and free evaporation carefully prevented." 
 Is it not obvious, in these instances, that the power of generating heat 
 was lost in consequence of modified vascular action ; and if so, then 
 the generation of heat depends upon vascular action, and is, of course, 
 a vital product. This, too, is most emphatically shown, in the instan- 
 ces here and elsewhere stated, by the " partial rise of temperature 
 over the trunk" just antecedently to death. It is analogous to those 
 cases in which profuse perspiration breaks out in syncope, or as pa- 
 tients are in the act of expiring. It grows out of a powerful reflex 
 nervous influence upon the vires vitce, by which a sudden change of 
 action is induced in the elaboi^ating vessels {^ 637). 
 
 Why is the temperature often exalted in congestions of the lungs, 
 " where life is endangered by diminished communication with the 
 air;" and why, in such a case, will " the abstraction of blood dimin- 
 ish the power of producing heat,"t although, by this means, we ex- 
 tend the communication of the lungs with the air ? Or, again, in 
 congestions of other organs, when the respiration is natural, the cir- 
 culation in the lungs unobstructed, but the animal heat greatly re- 
 duced, why does it happen that the abstraction of blood will at once 
 exalt the temperature without affecting the respiration, or even in- 
 creasing the force or frequency of the general circulation (§ 961, d) % 
 
 In the latter cases, the rationale appears to be, as I have endeavor- 
 ed to explain in my Essay on Blood-letting, that a direct change is 
 exerted by the abstraction of blood upon the instruments of all vital 
 actions, by which the calorific, as well as other functions, are improv- 
 ed or restoi'ed. It is here, animating these minute vessels, that we 
 shall find the principles residing by which we are to account for all 
 the remai'kable phenomena of animal heat. As the operation of these 
 forces is modified, whether by natural or artificial causes, so will be 
 the phenomena which depend upon them. This is universally Ituq 
 
 * See my Letters on the Cholera Asphyxia, and other authors upon this disease. 
 t Edwards, on the Influence of Physical Agents on Life, p. 275.
 
 270 INSTITUTES OF MEDICINE. 
 
 of all the manifestations of the organic forces, whether they consist of 
 vital phenomena, or of material products. The function of respira- 
 tion is just as much concerned with one as with the other, and prob 
 ably no more. It aids, like the chylopoietic viscera, in perfecting the 
 gi'eat material from which bile, urine, the gastric juice, &c., are elab- 
 orated by the vital properties and their instruments. And just so is 
 respiration concerned in the production of animal heat. 
 
 Again, " sympathy," says Bichat, " as we know, has the gi'eatest in- 
 fluence upon heat. According as this or that part is affected, there is 
 disengaged in others more or less of this fluid. How does all this 
 happen 'i In this way : the affected organ acts sympathetically on the 
 tonic forces of the part ; these being raised, more caloric than usual is 
 disengaged. It is precisely the same as in sympathetic seci'etions or 
 exhalations. Whether the vital forces are raised by a stimulus direct- 
 ly applied, or by the sympathetic influence they receive, the effect 
 that results from it is exactly the same" (^ 1044, a, b). 
 
 And again, the same accurate philosopher : " Each system has its 
 own degree of heat." This fact was not so well known in Bichat's 
 time as now. But it was his induction from general principles. ] 
 shall only advert to the example of the dog's nose, which is familiar 
 to all. Hunter, however, rendered the fact sufficiently obvious ; — 
 Davy and others have confirmed it. Now, how exactly all this cor- 
 responds with what is known of the vital endowments of particular or- 
 gans. Where they are most strongly pronounced, there the temper- 
 ature is apt to be highest, there the phenomena of organic life pre- 
 dominate, and there it is that morbific causes make their most fre- 
 quent and deep impressions, and develop the most exalted tempera- 
 ture. — (See Essay on Venous Congestioji, § 8, 9, in Comm., ^ 1045). 
 
 447, e. Finally, I come to what I consider an experimentum crucis, 
 supplied by an able philosopher, and by one of the most able defend- 
 ers of the chemical doctrine of animal heat. He states that great dif- 
 ferences arise as to oxygen, during the respiration of atmospheric air: 
 
 " The real causes are chiefly certain inherent differences in the state 
 of the venous blood, which are indicated, indeed, by other physiologi- 
 cal facts, but by none so unequivocally as by this variety in the' power 
 of altering the oxygen of atmospheric air. The first cause is a differ- 
 ence in the degree of venosity or venalization of the blood in passing 
 through the capillaries." The second and last " cause of diversity in 
 the action of venous blood on atmospheric air is a difference in the 
 proportion of coloring matter contained in the blood." 
 
 Now, if the chemical doctrine have any foundation, its advocates 
 should show that there is a greater, or, at least, as great a consump- 
 tion of oxygen in those states of the system which are attended by an 
 exaltation of temperature, as in the natural condition of the body. On 
 the fcontrary, however, they show just the reverse of this. Thus, the 
 high authority whom I have just quoted : 
 
 " The inferior action of the blood on the oxygen of the air in its 
 passage to the arterial state simply indicates, that it is less removed 
 frorn a state of arterialization, that is, partakes less than usual of the 
 characters of venous blood. Accordingly, the least alteration of oxy- 
 gen invariably occurs in those febrile diseases where the circulation 
 is much excited^ and the respiration at the same time free. These con- 
 ditions exist most especially in acute rheumatism ; and it was, there-
 
 PHYSIOLOGY. FUNCTIONS. 271 
 
 fore, in cases of this disease that the four instances of diglit action (on 
 the air) formerly mentioned have occurred. On all these four occa- 
 Bions the blood was evidently more florid than usual, and in the in- 
 stance where the loss of oxygen was only 0-57 of a cubic inch, the 
 stream from the vein was so bright, that the gentleman who opened 
 it had at first some suspicion that he had opened the artery."* 
 
 Here, also, we have, from a distinguished chemist, a philosophical 
 resort to the modified condition of the system in disease, for an inter 
 pretation of the wonderful peculiarity of living organized matter in 
 manifesting the power of generating heat. 
 
 447, f. We have thus again seen that the chemical hypotheses 
 which immediately concern the functions of resj^iration are surround- 
 ed by too many exceptions to come within the pale of nature. These 
 exceptions meet us every where in the habitual state of the animal, 
 and in the history of disease they become almost as multiplied as the 
 individual cases. Here it is that we may most successfully contem- 
 plate the law and its operations, in the various modifications which it 
 sustains from the influence of remote causes, and those within the 
 body. Among the latter, are those of the mind, and the derange- 
 ments to which the lungs are liable, both in their general and organic 
 functions. But far more frequently, and more profoundly, is animal 
 temperature directly exalted, or diminished, by affections of the stom- 
 ach and of the nervous system. I need scarcely repeat, it would be 
 absurd to have one theory to explain the phenomena of heat in 
 health, and another in disease. It would be a violation of all philoso- 
 phy, as well as a reckless disregard of all facts. According to the 
 common designs of nature, there cannot be one law for the genera- 
 tion of heat in the healthy state of the body, and another which deter- 
 mines the exalted heat of fever and of local inflammations. While 
 the various functions proceed in their natural manner, the evolution 
 of heat, like the other products, remains without any radical alteration. 
 But when the latter are disturbed in their nature! character, the former 
 is liable to corresponding variations, which can be explained only on 
 the principle that the power of generating heat is as much an attri- 
 bute of vitality as any that may be concerned in the process of dis- 
 ease, and that their various modifications are constantly determined 
 by analogous causes. It is a broad, fundamental principle, that " the 
 general phenomena of the disengagement of heat remain always the 
 same in animals with lungs, in those without them, and in plants, all 
 of which have an independent temperatui"e." 
 
 447, g. Some chemical philosophers, like the able Edwards, in 
 treating of animal heat, have called to their aid the " constitution^^ of 
 animals to explain certain anomalies which defy the chemical hypoth- 
 esis. We hear much about the " power of the system to generate 
 heat," without being let into the secret in what that constitution, and 
 that power, consist. To allow that the forces of life have a large and 
 uniform share in the generation of animal heat, would make a repul- 
 sive medley, in its connection with the chemical hyj^othesis. Now 
 that " constitution," and that " power," are something more than ideal ; 
 something different from the organized structure ; for, in the latter 
 case, many variable phenomena, in adults, proceed from unvarying 
 conditions of structure (^ 1047). 
 
 * Dr. Christison. in Edin. Med. and Surj.'. Journ., 1831, p. 101, 102.
 
 272 INSTITUTES OP MEDICINE. 
 
 Just SO is it with all the varying conditions of animal heat. Ir 
 health, the varieties are owing to peculiarities in the natural condition 
 of the vital properties ; in disease, they arise, like all the other changes 
 from morbid alterations of those properties ; and, if the blood sustain 
 any want of its proper influences from defect of respiration, this will 
 contribute toward the modifications of temperature in the same way 
 that it affects the other results of life, and, I apprehend, in no other. 
 
 Although Dr. Edwards derives some illustrations regarding the con- 
 nections of the phenomena of animal heat with respiration from cer- 
 tain morbid conditions of the body, as in asphyxia from carbonic acid, 
 syncope, the cold stage of intermittents, &c., yet it is manifest that he 
 looks upon disease as supplying facts which it is prudent not to inves- 
 tigate. " The question now is," he says, " what is the influence of 
 the respiratory movements on the temperature of the body, when 
 they are raised beyond the rate of health ] We cannot answer this 
 inquiry by observations on the sick. The circumstances are then too 
 complicated to admit of oiir deriving conclusions from thcm^ — Op. cii. 
 
 In this conclusion I do not at all agree. It is an unwarrantable 
 abandonment of nature for the contrivances of art. Morbid conditions, 
 above all others, give us a clew to the true philosophy. The vital 
 properties are altered by disease, and with them there is a change in 
 all the phenomena and results, of which the modifications of animal 
 heat are one. Hence, it appears to me, that a very obvious "conclu- 
 sion" may be deduced. 
 
 447, h. In respect to the natural differences in constitution that are 
 denoted by apparently contradictory facts in relation to animal heat, 
 they are as clearly constituted by natural modifications of the same 
 forces, which are as much, or more influenced by other causes than by 
 respiration ; whose power of evolving heat in young animals is great- 
 ly and rapidly depressed by the operation of cold, notwithstanding 
 the respiration is accelerated, during the first stages of the decline of 
 temperature ; but which, again, as the same animals advance in life, 
 acquire the power of completely resisting the same cause without the 
 former acceleration of the respiratory movements ; " the animals thus 
 passing from the state of cold-blooded to that of the warm-blooded," 
 while in the hibernating mammalia generation of heat still goes on 
 although respiration have come to a stand, or, when the cold be- 
 comes intense, is carried to its highest pitch by the very cause which 
 had produced its great decline ; or, the same forces maintain a uniform 
 state of heat when the respiratory movements are greatly accelerated 
 by external heat, and resist equally the heat of the sun-ounding me- 
 dium; or, such is their natural susceptibility they niay^ be so 
 influenced by season, that their power of producing heat is said to be 
 less when its production is greatest ; which power " may be varied, in 
 some, by suitable food and a graduated temperature ;" which " is gen- 
 erally diminished in natural sleep, though modifications occur which 
 chano-e the relation;" which is so modified in the cholera asphyxia, 
 that the temperature may greatly fail while respiration is accelerated, 
 and the lung.s free from congestion ; or, is undiminished in asphyxia 
 from carbonic acid, " when the respiratory movements are no longer 
 seen ;"* or may attain, as in apoplexy, preternatural vigor after res- 
 piration and circulation have entirely ceased. 
 
 * Portal says tliat the heat has been known to remain very high in these cases, as in 
 apoplexy, for many hours after death. — Sur I'Apop
 
 FHYSIOLOGY. FUNCTIONS. 273 
 
 " Constitution," then, and the "power of generating heat," mani- 
 festly relate to the vital properties, and to nothing else. The united 
 operation of these powers, through their instruments of action, results 
 in the elaboration of bile, gastric juice, heat, &c., from the blood. 
 That particular determination by which they eliminate heat, in all 
 parts of the body, may be called a law, though it is but the joint re- 
 sult of the vital powers, concurring in a certain manner to a specific 
 effect. The result is variously affected by climate, season, the quality 
 and quantity of food, stimulants and sedatives, cold or warm air ap 
 plied externally or to the lungs, by morbific agents, and other causes; 
 or, as the vital properties happen to sustain peculiarities in relation to 
 individuals, age, &c., so will the generation of heat be modified when 
 respiration is exactly the same ; and along with those modifications 
 of heat are variations, more or less coincident, of other products. The 
 causes are obvious from the effects. The former are few and simple ; 
 the latter are diversified without end (^ 1047). 
 
 Most of the reasoning which abounds in authors who believe animal 
 heat to depend specifically upon respiration, or the result of a chemi- 
 cal process, consists in reconciling difficulties by referring them to 
 the vital powers, and sometimes to the entire exclusion of the chemi- 
 cal hypothesis. True, they do not say vital powers. They would 
 otherwise be non-conformists. They speak of " constitution" — " the 
 power of evolving heat," — yet turn into ridicule the only true philos- 
 ophy, and the only possible thing which they themselves can mean. If 
 they hazard the " term vitality,^' it " is employed for the want of a bet- 
 ter," but " without any connection with the mystification which some- 
 times attends its use ;" while others, like Dr. Elliotson, can see noth- 
 ing in " animal heat," "but a -pecuWox state only;" and here, as in the 
 case of " vitality," Dr. E. " adopts the common language in speak- 
 ing of animal heat," to make the subject intelligible. 
 
 It is from the blood, like all other animal products, that heat is de- 
 rived. And since decarbonization, and, perhaps, an absorption of ox- 
 ygen, is indispensable to the healthy performance of all other func- 
 tions, it is doubtless important to the generation of heat ; though man- 
 ifestly less so in the latter instance, since we see the evolution of heat 
 sometimes going on when respiration is nearly, or quite extinct; 
 while in the cold-blooded animals it exerts but little, if any, influence 
 upon temperature. Decarbonization of the blood, and probably the 
 absorption of oxygen, are among the numerous processes by which 
 its vivification is perfected, and by which it is prepared for an elabora- 
 tion of the various animal products, and in animals of a certain consti- 
 tution for the evolution of heat. When respiration ceases, all the 
 most important functions immediately fail; but it is remarkable that 
 the evolution of heat appears to be the very last. 
 
 I conclude, therefore, that the elaboration of animal heat, and all 
 other secretions, are on a par in regard to principle. It is true, a cer- 
 tain proportion of latent heat may be extricated by the conversion of 
 blood into the solid parts. But this would be counterbalanced by a 
 corresponding change of the solids, particle for particle, into fluids. 
 This appears to me to be fatal to a late doctrin^which imputes animal 
 heat to this cause ; as well, also, to the condensation of gases. Be- 
 sides, what becomes of the principle of condensation where the tern 
 perature rises after apparent death (§ 447, d) 1 Where is oxygen gas ]
 
 274 INSTITUTES OP MEDICINE. 
 
 447|, a. In my former Essay I have also considered the hypothe- 
 sis relative to the absorption of oxygen gas by venous blood, and the 
 conditions under which it was supposed to unite with carbon, in the 
 process of respiration. It only remains now to state circumstantially 
 the views entertained by Liebig upon this subject. 
 
 1. " During the passage bf the venous blood through the lungs, it 
 absorbs oxygen from the atmosphere. Farther, for every volume of 
 oxygen absorbed, an equal volume of carbonic acid is, in most cases, 
 given out," 
 
 " The globules of venous blood experience a change of color, and 
 this change depends on the action of oxygen." 
 
 " The red globules contain a compound of iron ; and no other con- 
 stituent of the body contains iron." 
 
 " The compound of iron in the blood has the characters of an ox- 
 ydized compound." " No other metal can be compared with iron 
 for the remarkable properties of its compounds." 
 
 2. Many " observations, taken together, lead to the opinion that the 
 globules of arterial blood contain a compound of iron saturated with 
 oxygen, which, in the living body, loses its oxygen during its passage 
 through the capillaries." 
 
 The last quotation is a universal theory with our author. By it " the 
 Reformer" interprets all motion, the generation of all power in the 
 animal body, the circulation of the blood, inflammation and fever, 
 obesity and emaciation, the various phenomena of life, and even 
 death itself. " The oxygen of the air and the carriers of oxygen" 
 are all in all. The " carriers lose their oxygen during their passage 
 through the capillaries," when a " combustion of the tissues is set 
 up," which is the true and only cause of the principle of life, of its 
 extinction at death, and of all the unique phenomena of the animal 
 creation (§ 350, nos. 3, 4, 5, 7, 8, 9, 10, 15, 18, 19, 46 ; § 440, nos 1 
 4, 5, 6, 8, 9, 10, 11, 12, 14, 16, 1054). 
 
 It is not, therefore, remarkable that " the Reformer" should have 
 considered animal heat as life itself, — both the cause and effect of 
 life (§ 441 e, 440, nos. 8, 9, 11, 12, 14, 16), — since every known 
 process and result in the animal " machine" is due to " combus- 
 tion." 
 
 3. " The compound, rich with oxygen (no. 2), passes, therefore, by 
 the loss of oxygen, into one far less charged with that element. One 
 of the products of oxydation fonned in this process is carbonic acid. 
 The compound of iron in the venous blood possesses the property of 
 combining with carbonic acid, and it is obvious that the globules of 
 the arterial blood, after losing a part of their oxygen, will, if they meet 
 with carbonic acid, combine with that substance (§ 440y, no. 18, and 
 K). When they reach the lungs, they will again take the oxygen they 
 have lost ; for every volume of oxygen absorbed, a corresponding 
 volume of carbonic acid will be separated ; and they will again ac 
 quire the power of giving off oxygen." 
 
 " In their return toward the heart, the globules which have lost 
 their oxygen combine with carbonic acid, producing venous blood ; 
 and when they reach >he lungs, an exchange takes place between this 
 carhonic acid and the oxygen of the atmosphere.'" 
 
 "The ORGANIC COMPOUND o{ iron, which exists in venous bljod, 
 recovers in the lungs the oxygen it had lost; and, in consequence of
 
 PHYSIOLOGY. FUNCTIONS. 275 
 
 # 
 
 this absorption of oxygen, the carbonic acid in combination with it is 
 separated." 
 
 4. " Hence, in the animal organism, two processes of oxydation 
 are going on ; one in the lungs, the other in the capillaries. By 
 means of the former, in spite of the degree of cooling, and of the in- 
 creased evaporation which takes place there, the constant temperature 
 of the lungs is kept up ; while the heat of the rest of the body is sup- 
 plied by the latter." — Animal Chemistry (§ 438, h, c). 
 
 447^, ^. If, therefore, we exclude the vegetable kingdom as an im- 
 portant element in our interpretation of organic heat, we shall have 
 seen by this fundamental hypothesis as to the globules of blood that 
 there can be no doubt that the general theory of animal heat has 
 been founded upon certain speculations relative to a limited number 
 of red-blooded animals, and often, as we have reason to suppose, to 
 man alone. It takes no cognizance of all those white-blooded races 
 that possess no ferruginous globules, and therefore no " earners of 
 oxygen gas," and whose temperature in some instances, as in the 
 bee, approximates that of the human race (§ 444). However much 
 a general theory may draw upon contingencies for its support, it must 
 be universally applicable to the same combination of phenomena. 
 It will not answer to have " ferruginous carriers of oxygen" for one 
 class of animals, and something very different for another class, to 
 explain what is common to both.* 
 
 447 J, c. In the former Essay I have devoted to the questions rela 
 tive to the elimination of carbon from the blood, and the formation of 
 cai-bonic acid, all the attention which the subject might otherwise now 
 require ; and in another section of this work an argument is present- 
 ed to sustain my former conclusions (§ 419). In the foregoing Essay 
 I have endeavored to show that the distinguished chemical theorist, 
 Dr. Edwards, is right in his position, that 
 
 " Carbonic acid is not formed at once, in the act of respiration, by 
 the combination of the oxygen of the air with the carbon of the blood, 
 but is entirely the product of exhalation.^' — Edwards. 
 
 I there urged, that the carbonic acid evolved from the chest does 
 not exist in the state of that inorganic compound in the blood ; but 
 that the carbonaceous matter exists in intimate union with the blood, 
 from which it is eliminated in the form of carbonic acid gas by the 
 joint agency of the pulmonary mucous tissue and oxygen ; the former 
 taking the lead in the process (§ 419). The carbon of the blood is 
 thus readily convertible into carbonic acid while undergoing that 
 special vital process of the mucous tissue. I may quote from the 
 Commentaries a remark which is not less extensively applicable in 
 these Institutes. Thus : 
 
 " Before going farther, I may say, that, in having employed, as I 
 shall continue to do, the established phraseology of chemical science, 
 I have assigned many reasons in my first volume, as I shall others in 
 my Essay on Digestion, for believing that every product of the ani- 
 mal system, including the excrementitious, is differently constituted in 
 its elements from such as result from the agency of chemical forces ; 
 that, what we may find in our test glasses and crucibles has been 
 really different before, or at the time of its elimination from the 
 body. Chemical changes may accrue in excrementitious substances 
 immediately after their elaboration; and the ultimate combination 
 
 * I have abstracted blood resembling milk, of a slightly reddish tint, from a patient 
 in an ardent state of remittent fever, soon followed by recovery.
 
 276 INSTITUTES OF MEDICINE. 
 
 may be uniform, especially where, as in carbonic acid, only two ele- 
 ments are ultimately concerned." — Med. and Phys. Comm., ut cit. 
 
 Although our author, while employed about the chemical rationale 
 of organic products, speaks of them as though they were generated 
 by the living organism as he is accustomed to observe them in tlie 
 laboratory, and looks upon carbonic acid as equally the product of 
 the organization as of the combustion of carbon (or, in his own lan- 
 guage, "the animal body acts in this respect as a furnace which we 
 supply tvithfitel,"" § 440, no. 1), he now and then yields to the force 
 of facts, and even allows, at one time, that the iron of the red glob- 
 ules exists in the state of an "organic compound" (no. 3, this sec- 
 tion).— Note Rp. 1123. 
 
 447i, e. It is also important to consider that the absorption of oxy- 
 gen from the air, and the excretion of carbonaceous matter, take place 
 through a highly organized tissue, and the moment life ceases, so also 
 do these processes, notwithstanding artificial respiration. The same 
 tissue, too, which performs those functions, secretes, also, a mucous 
 fluid. This secretion being distinctly the result of vital action, it will 
 hardly be insisted that the same tissue is simultaneously performing, 
 in respect to another product, a mere chemical, or the physical func- 
 tions o? endosmose and exosmose (§ 419). There is here the same in- 
 congruity as we have seen of the chemical theory of digestion, in es- 
 tablishing antagonizing processes for the conversion of food into chyme 
 (§ 358, 360, 374). 
 
 447^, y. It remains now to notice, of the foregoing quotations (§ 
 447^ a, nos. 3 and 4), another of those extraoi'dinary mistakes in fun- 
 damental principles, and where pure chemistry is concerned, which 
 so much abound in our author's work on A?ii?nal Chemistry. 
 
 In the first place, we had been told again and again, that " animal 
 heat is produced by the combination of oxygen with carbon or hydro- 
 gen," and in no other way (§ 440). That is the combustion theory, 
 and without it there is no animal heat (§ 440, no. 6). 
 
 By referring, however, to § 447-|- a, 2 and 3, it will be seen that 
 oxygen does not unite with any combustible substance in the process 
 of respiration, but only with an oxyd of iron; and that in no. 4, it is 
 asserted that by this supposed union of oxygen with iron " the con- 
 stant temperature of the lungs is hep)t up, in spite of the degree of 
 cooling, and of the increased evaporation which takes place there." 
 *' Hence,'" says Liebig, " in the animal organism, two processes of oxy- 
 dation are going on ; one in the lungs [the union of oxygen with an 
 " organic compound of iron"], the other in the capillaries [the union of 
 the absorbed oxygen with carbon, &c.]. By means of the former, in 
 spite of the degree of cooling, and of the increased evaptoration which 
 tahes place there, the constant temperature of the lungs is heft tip ; while 
 the heat of the rest of the body is supplied by the latter." — Liebig. 
 
 The general concurrence, even of chemists, in the foregoing expo 
 sition of the laws of animal heat, can alone justify any farther com- 
 ment. But the work must be efficiently done to operate as a perpet- 
 ual barrier to the pernicious invasions of chemistry. 
 
 I say, then, in whatever aspect the foregoing statement may be re- 
 garded, it is deeply discreditable even to chemical philosophy. In 
 the first place, a distinct chemical provision is made for the "lungs" 
 and for " the rest of the body." respectively, for the maintenance of
 
 PHYSIOLOGY. FUNCTIONS. 277 
 
 the same uniform temperature in all the parts, while it is assumed 
 that the union of oxygen with the iron of the blood is exactly equiv- 
 alent as a source of heat, and under all circumstances, to the union of 
 oxygen with carbon and hydrogen in the process of combustion ; 
 without regarding the auxiliaries, " clothing," " laborious efforts," 
 " cold water," &c., which are brought to the aid of the chemical pro- 
 cess in " the rest of the body." 
 
 But that is not the worst of the doctrine ; for it denies to the lungs 
 any participation in that combustive process which is not only the 
 foundation of animal heat " in the rest of the body," but of every re- 
 sult which appertains to life. Chemistry, of course, abandons the 
 ground ; but it must carry with it a mortification which is due from 
 the physiologist (§ 350, mottoes a, h, c, d, e), and a farther recognition 
 of the justice of the rebuke administered by Hunter (§ 350, no. 97). 
 
 It will have been seen, however, that the foregoing is only one of 
 a constant succession of blunders whenever the chemist trespasses 
 upon organic life. And were we to look yet farther into the last of 
 the series, it would be found laden with objections. The physiologist, 
 for example, has a right to insist that the general doctrine shall apply 
 as well to the lungs as to the " rest of the body," and that there is an 
 equal combustion of both. The chemist, therefore, necessarily places 
 the temperature of the lungs at 196°, in making the union of oxygen 
 with the iron of the blood equivalent to the combustive process. And 
 having thus rectified the hypothesis, we find ourselves presented with 
 a fundamental auxiliary to the general principle, that its integrity may 
 be preserved in the lungs which are beyond the reach of " clothing," 
 while the surface of the body, which is more exposed to the operation 
 of cold, is left to the general principle supported by the contingencies 
 of dress, along with those other provisions, " food," " laborious ef- 
 forts," "candles," &c., that are designed for the maintenance of the 
 same temperature in " the rest of the body" which is accomplished 
 by the two chemical processes in the lungs (§ 440, nos. 10, 11, 12, 
 13, 14). 
 
 While now adverting to the subject of carbonic acid in its supposed 
 relation to animal heat, I will place in contrast two doctrines by our 
 author, which make up a part of his system of pathology, as the best 
 evidence I can offer, in parting forever with Organic Chemistry, of 
 the sincerity of the motives which have governed the demonstrations 
 I have endeavored to make in behalf of sound philosophy, the honor 
 of my profession, and the best interests of man (§ 1 b, 350}, 376| b, 
 820). 
 
 Chemistry as founded on the basis Physiology as founded on tJie ba- 
 of'-'' 'Experimental PhilosopJiy." sis of'^ Experiinental Philosophy.^' 
 
 " We find, in point of fact, that " If we consider the fatal acci- 
 the living blood is never, in any dents which so frequently occur in 
 state, saturated with carbonic acid ; wine countries from the drinking 
 that it is capable of taking up an of what is called feather-wine, we 
 additional quantity, without any can no longer doubt that gases of 
 apparent disturbance of the func- every kind, whether soluble or in- 
 tion of the globules. Thus, for soluble in water, possess the prop- 
 example, after drinking efferves- erty oi permeating animal tissues, 
 cing wines, beer, or mineral wa- as water permeates unsized paper
 
 278 INSTITUTES OP MEDICINE. 
 
 ters, more cai'bonic acid must ne- This poisonous wine is wine still 
 cessarily be expired than at other in a state of fermentation, which is 
 times. Less, however, will be increased by the heat of the stom- 
 given out after the use of vat and ach. The carbonic acid gas which 
 still wines, than after Champagne." is dasenv^agedi, penetrates through 
 — Liebig's Animal Chemistry. the par ietes of the stomach, through 
 
 the diaphragm, and through all the 
 intervening membranes, into the air- 
 cells of the lungs, out of which it 
 displaces the atmospheric air^ — 
 Liebig's Animal Chemistry (§ 350, 
 nos. 24, 43). 
 
 448, a. The main objection to the vital doctrine of animal heat, or 
 that which places it on the common ground of secreted products, 
 seems to have arisen from a difficulty of comprehending the manner 
 in which heat can be generated by any process than such as has been 
 most familiar to the senses. The objectors, however, have no diffi- 
 culty in assuming that the " nervous power governs the chemical for- 
 ces in the formation of animal heat." This admission of the instru- 
 mentality of the nervous power is founded upon certain irresistible 
 facts which chemistry cannot appropriate, and goes very far in allow- 
 ing the 'force of analogy which refers the production of animal heat 
 to the same great principles of life that are known to preside over all 
 other products of animated beings. 
 
 448, b. But, is there any stability to the doctrines which relate to 
 the evolution of caloric in the inanimate world ? None at all. Even 
 Lavoisier's hypothesis is overthrown. 
 
 " A new theory is, therefore," says Turner, " required to account 
 for the chemical production of heat. But, it is easier to perceive the 
 fallacies of one doctrine, than to substitute another which shall be 
 faultless, and it appears to me that chemists must, for the present, be 
 satisfied ivith the simfle statement, that energetic chemical action does, 
 of itself , give rise to increase of temperature^ — Turner's Chemistry. 
 
 448, c. Let us now borrow from the same distinguished chemist, 
 an example by which the foregoing statement is sustained, and which 
 will remove all difficulty as to the problem that animal and vegetable 
 heat are elaborated by the organic force through the instruments of 
 vital action, according to the other products of organic beings. Facts 
 will receive their proper interpretation, an important analogical in- 
 duction will remain inviolate, while the uniformity of other secreted 
 products, coinciding with the uniformity of temperature, or each va- 
 rying together under the same vital influences, expounds the latter 
 phenomenon and corroborates the vital interpretation. Thus, Turner : 
 
 •' It is a well-known fact, that increase of temperature frequently 
 attends chemical action, though the prodticts contain much more insen- 
 sible heat than the substanccb from which they iv ere fanned. This hap 
 pens remarkably in the explosion of gunpowder, which is attended 
 by intense heat ; and yet its materials, in passing from the solid to 
 the gaseous state, expand to at least 250 their volume, and conse- 
 quently render latent a large quantity of heat." — Turner. 
 
 448, d. Now, although it be allowed that phenomena of the fore- 
 going nature may have been explained by supposed differences be-
 
 PHYSIOLOGY. FUNCTIONS. 279 
 
 tween specific and latent heat, they show us that heat exists, and is 
 developed, under different conditions ; and to expound the variety of 
 results in the mineral world, it has been necessary to multiply yet 
 farther the natural states of caloric (§ 448, c, 1085). 
 
 448, e. As showing farther, also (c), that there is some obscurity 
 attending the phenomena of ordinary combustion, I may quote the 
 high authority. Dr. Kane, to that effect, who says, that, 
 
 " Laying aside altogether the attempt at deducing the phenomena 
 of combustion from any change in the amount of latent or specific 
 heat in the bodies which enter into combination, it remains only to be 
 admitted as a general and independent principle, that chemical com- 
 bination is a source of heat and light. It is, however, impossible to 
 aiTest inquiry at that point ; and, accordingly, the speculations of phi- 
 losophers have been directed, in seeking a cause for the phenomena 
 of combustion, to the disengagement of electricity," &c. — Kane's 
 Elements of Chemistry, 1841. 
 
 448,^/1 Now, however it may be that the results are the same in 
 the inorganic world, upon the theories either of caloric or electricity, 
 the remarkable differences in views in that respect show the difficul- 
 ties which chemistry must encounter when it approaches the philoso- 
 phy of organic heat ; and this, especially, when we consider the vital 
 nature of the development of electricity and light in living animals. 
 —(See Medical and Physiological Commentaries, vol. i., p. 107-119.) 
 
 The physiologist undertakes no explanation of the modus in which 
 organic heat is elaborated. He avoids all inquiries of that nature, 
 although he might proceed to interrogate the manner in which the 
 vital principle operates with as much propriety as the chemist " spec- 
 ulates upon the cause of the phenomena of combustion." But, in do- 
 ing this, he would trespass upon inscrutable difficulties, and encumber 
 philosophy with useless hypotheses. 
 
 8. GENERATION. 
 
 449, a. The eighth and last great function common to animals and 
 plants is generation. This function, being alone designed for the per- 
 petuation of the species, is not necessary to organic life. It is here, 
 however, in all the processes that are connected with the formation 
 of the germ, and of semen, in the preparation of the generative or- 
 gans for impregnation, in the mental andphysical circumstances attend- 
 ing the act of copulation, in the impregnation of the ovum, in the de- 
 velopment and growth of the foetus, in the sympathetic influences of 
 the uterus upon the mammas which result in the formation of milk, 
 and in all their individual and connected designs, and in their great 
 final cause of perpetuating the species, and in the various incidental 
 provisions which are supplied for the fulfillment of that end, that 
 chemistry and physics may be as effectually banished from physiol- 
 ogy as by the demonstrations which I have made in relation to the 
 germ, or by those which respect digestion, or organic heat, or the 
 nervous power. — See Youth p. 376-380, § 578. 
 
 449, h. What may be the extent in which the male participates in 
 producing tlie offspring it is impossible to know ; probably as impos- 
 sible as a knowledge of Creative Energy. We know, however, that 
 the male and the female impress, alike, their own moral, vital, and 
 physical character upon it. But the mother supplies the germ, also.
 
 280 INSTITUTES OF MEDICINE. 
 
 449, c. In another work I have examined the merits of the old doc- 
 trines of seminal animalcula, and their germinal character ; lately re- 
 vived along with other illusions or pretensions of the microscope. 
 The subject is scarcely worthy a renewed discussion (§ 131). 
 
 449, d. It may be finally said, that whatever is true of the essen- 
 tial physiology of generation, as it relates to animals, is equally so of 
 plants. The coincidences, too, which are so striking in this function 
 of the two organic kingdoms, remove every ambiguity which^has been 
 supposed to attend the more important functions of plants, confirm 
 the vital character of the whole, and, with the universal analogies, re- 
 fer the whole to the same properties of life which caiTy on the organic 
 functions of the animal kingdom. It were impossible, according to 
 the ways of nature, that a function, like generation, which depends in 
 animals upon a vital condition of all other processes, and which is a 
 great final cause of all those processes, should, in plants, depend on 
 others of a different nature. By the coincidences, therefore, in the 
 function of generation between animals and plants, I prove a like 
 coincidence in the vital character of all the organic functions of both 
 animated kingdoms (§ 185, 1052 c). 
 
 But little can be said relative to the function of generation, beyond 
 certain important relations that have been considered, that can serve 
 as a ground for Institutes in Medicine (§ 63-81). Its more extended 
 consideration belongs to elementary works on physiology. 
 
 11. PECULIAR, OR ANIMAL FUNCTIONS, 
 
 A. Functions of Relation. 
 
 1, SENSATION. 
 
 450, a. Having distinguished three kinds or principal modifications 
 of sensibility, namely, common, specific, and syiyipathetic, and as sen- 
 sation is performed through that property, there are naturally three 
 modifications of the function ; to wit, common sensation, specific sen- 
 sation, and sympathetic sensation (§ 194-204, 1037 h). 
 
 450, h. The nerves are the organs of the functions, and the nervous 
 centres the recipients of the transmitted impressions. But, it is im- 
 portant to remark, that the parts most essential to sensation are the 
 extremities of the nerves at their origin and termination, and that the 
 trunks are, mainly, the conductors. This is also true of voluntary mo- 
 tion, and of those involuntary movements that are excited by the ner- 
 vous power. The nerves of the organic viscera, therefore, follow this 
 rule, as it respects all natural, morbific, and remedial agents. A neg- 
 lect of this consideration has led to fallacious conclusions in medicine 
 from experiments on the trunks of nerves (§ 110-117, 826 d). 
 
 450, c. Common and specific sensation require a continuity of the 
 nerves with the brain, and a co-operation of the mental power per- 
 ception. Sympathetic sensation may be excited in the brain, or spi- 
 nal cord, or certain parts of the ganglionic system, either in their 
 connected state, or when disconnected. In their most natural con- 
 dition it is probable that all the parts concur more or less together in 
 giving rise to sympathetic sensation ; though some parts more than 
 others, according to the nature of the impressions transmitted and the 
 part from which they are transmitted (§ 201, 1037).
 
 PHYSIOLOGY. FUNCTIONS. 281 
 
 450, d. Coinmon sensation appertains to all parts, and is the cause 
 of pain. In the natural state of the body it is inappreciable, but may 
 be greatly roused by injuries and by disease. Its intensity will then 
 depend upon the nature of the part and the exciting cause. It is apt 
 to be most exquisite in parts where specific sensation is least ; as in 
 tendons, ligaments, membranous tissues, &c. (§ 19S). 
 
 450, e. Specific sensation corresponds with specific sensibility. It 
 is the function through which we acquire a knowledge of external 
 things, and is, therefore, the great inlet of knowledge. It has, of 
 course, the several modifications which appertain to specific sensibil- 
 ity (§ 199, 200) ; consisting, indeed, of five apparently different func- 
 tions. The expanded nerves of sense, which are the organs of this 
 function, it is supei-fluous to say, are supplied with auxiliary means, 
 such as the various appendages to the retina, to the auditory nerve, 
 &c. A close analogy exists among the whole, and they may be 
 brought more or less to the aid of each other. Although a common 
 function, its remarkable modifications are shown by their uses, respect- 
 ively, and by the necessity of certain specific stimuli to each. As 
 with common sensation, the specific kind requires the aid of percep- 
 tion. The rationale of the entire function is far more wonderful and 
 incomprehensible than that of sympathetic sensation and its various 
 results which terminate in the influence of the nervous power on or- 
 ganic actions, and for which the grossest doctrines in chemistry and 
 physics have been substituted, because the vital interpretation is " in- 
 conceivable," or cannot be subjected to the ci'itical inspection of that 
 far more obscure, but acknowledged, causation in the chain of per- 
 ception, specific sensation (§ 222-237). What can task the under- 
 standing more than the step in the process of intellection as connected 
 with the functions of sense ; beginning with light and its properties, 
 or wdth the odor which none but the dog can discern, or the abstrac- 
 tions that convey to the mind all the varieties in taste, or the modified 
 undulations of air which render so distinct from each other all the 
 gradations of sound, from the ^olian harp to the braying of a jack- 
 ass ; the impressions of each upon the extremities of the nerves of 
 sense, one alone upon the eye, another alone upon the nose, and an- 
 other upon the ear alone ; the transmission of these impressions along 
 the trunks of the nerves to their other extremities in the brain, and in 
 each of the cases through the aid of some special mechanism ; theii 
 excitement of the brain and the co-operation of the mind, by which 
 the nature of the primary impression is discerned, and the external 
 objects realized by the inward immaterial agent according to their 
 real material existence (§ 188|, d, 500, nn)1 
 
 450, J". The common hypotheses which have been propounded to 
 explain specific sensation, such as the motion of a nervous fluid, gal- 
 vanism, vibration of the nerves, the passage of light, of undulations of 
 air, &c., to the brain, betray a general disposition to avoid the phe- 
 nomena of life for those which are manifested by inanimate objects. 
 But, of this I have already had enough (§ 189, 234-237). 
 
 451, a. The action of material objects upon the mind through the 
 function of sensation, and the astonishing influences of mental emo- 
 tions upon irritability (§ 188, a), and of the will in acts of voluntary 
 motion ^ 227, 1st, 233), bring the laws of organization and those of 
 the immaterial mind and instinct into harmonious relation ; while the
 
 282 INSTITUTES OF MEDICINE. 
 
 nature of mind and the impressions it receives illustrate the character 
 of the vital properties (§ 450 e, and Medical and Physiological Com- 
 mentaries, vol. i., p. 92-102). 
 
 451, b. Impressions upon the brain through the medium of specific 
 sensation leave no transcript; and perception of objects without sen- 
 sation, as in reveries and dreams, has led to a denial of the material- 
 ity of the world ; supported, too, by far gi-eater ingenuity than those 
 objections to a vital principle which are regardless of all its unique 
 phenomena. 
 
 451, c. It has been seen that pei'ception is necessary to sensation, 
 in the usual acceptation of this function, which is essentially mental. 
 This term, however, is employed to represent the cerebro-spinal im- 
 pressions which give rise to involuntary motions, whether in animal or 
 organic life ; and " feeling" is used by Mr, Hunter, and others, to de- 
 note the susceptibility of organs to the existing condition of each oth- 
 er, by which their concerted action is maintained through the medium 
 of the nervous system. It is obvious, however, that the mind takes no 
 cognizance of those impressions which result in involuntary motions; 
 no pei'ception, no act of the will, is excited, so far as it respects the 
 direct results. And, although there be an analogy between all the 
 influences of sensation in animal life, it reaches least to the move- 
 ments which spring from the nervous system in organic life, since the 
 impressions made upon the brain through specific sensation never af- 
 fect the organic actions ; while there is a perfect idenlity of effect be- 
 tween those impressions which give rise to involuntary movements in 
 animal and organic life.* 
 
 451, d. As the term sensation, therefore, has a very different import 
 in the different cases ; and as in one the transmitted impressions ter- 
 minate in exciting an act of the mind, while in the other no such act 
 is called into operation ; but differently, also, from the former case, the 
 nervous power is excited in the nervous centres and then reflected 
 with the effect of a vital agent upon all other parts (§ 226) ; and since, 
 also, the impressions through specific sensation must be exerted upon 
 the brain, while in the latter case the results may be equally pro- 
 nounced whether the impressions be made exclusively upon the brain 
 or on the spinal cord or organic nerve, I have made a third distinction 
 in sensibility to separate its office in the function of sympathy from its 
 province as described under the varieties of common and specific 
 sensibility, and to avoid the confusion which has hitherto prevailed 
 by an indiscriminate use of the term sensation (§ 194, 199^, 201, 204, 
 453, 523, 1037 h). 
 
 451, e. This third distinction in sensibility I have called sympa- 
 thetic sensibility (§ 201) ; and this conducts me to a third distinction 
 in the corresponding function, and which should be known by the 
 same epithet (§ 464-467, 473 c, no. 5, 474, no. 4). 
 
 The epithet sympathetic denotes the special function of sympathetic 
 sensation, which has been suflSciently described in the preceding sec- 
 tion, and in what has been said of sympathetic sensibility (§ 201-204). 
 
 451, y*. The considerations made in § 450, e, illustrate the vital phi- 
 losophy of sympathetic sensation as one of the functions concerned in 
 the transmission of impressions from one part to another through the 
 medium of the nervous centres, and in which the nervous power is 
 the agent by which the reflected impressions are exerted (§ 222, &c.). 
 
 * If specific or common sensation affect organic actions, it is through some mental emo< 
 tion which it excites. The mind is the efficient cause, p. 77-79, note.
 
 PHYSIOLOGY. FUNCTIONS. 283 
 
 The fads in the former case bear with the strongest force of analogy 
 in demonstrating the entire absence of all chemical agencies in the 
 phenomena of the nervous power. The alliance of the whole, through- 
 out the mental and physical results of specific sensation, places the 
 whole upon common ground in respect to principle ; and if it be true 
 that nervous agency in one case is chemical, it is equally so in all, and 
 equally so with perception itself (§ 188^, d). Other demonstrations 
 to the same effect will be presented in another section (§ 500, nn). 
 
 2. SYMPATHY, OR REFLEX ACTION OF THE NERVOUS SYSTEM. 
 
 452, a. I now enter upon the consideration of a function which be 
 longs not only to animal life, but has far greater and more important 
 relations to the organic life of animals. Althouo^h it have no existence 
 in the ves:etable kingdom, where its anatomical medium is also want- 
 mg, it does not bestow those sti-iking distinctions in the organic life 
 of the two animated departments of nature which the importance of 
 the function, and the presence of the nervous system, in the animal 
 economy, would denote. The organic actions are essentially alike in 
 both, conducted in both by common properties appertaining Icf the 
 various tissues and organs, and only influenced in animals by reflex 
 and direct action of the nervous power as a vital agent (§ 185). 
 
 452, h. Nevertheless, it is a function of wonderful characteristics, and 
 can be appreciated only by an extensive investigation of its endless vari- 
 ety of phenomena. And yet is this function extensively ridiculed by 
 enlightened men ; and even Miiller, who has written more luminously 
 upon its laws than any other observer, applies them only in certain 
 natural processes, considers the nervous power the actual cause of 
 motion, construes the function of absorption according to the physical 
 rationale, defends the hypothesis of endosmose and exosmose in ex- 
 tenso, interprets all the secreted products upon chemical principles, 
 expounds diseases by the humoral pathology, and recognizes no ther- 
 apeutical influences of medicine but through its absorption into the 
 circulation. For all this he was well commended by the British and 
 Foreign Medical Review, while the same critical survey of that re- 
 markable work on Physiology stamped its displeasure upon those 
 doctrines of life which render the work a proud monument of the age. 
 
 Again, no one has employed his knowledge of the laws of sympa- 
 thy more usefully than Bichat. " The word," he says, "is of but little 
 consequence, provided what it expresses is understood." And yet, 
 while he also affirms that " we know the principle exists," he also 
 says, that the " word is only a veil for our ignorance in respect to the 
 relations of the organs to each other" (§ 234). 
 
 452, c. Sympathy is the most important function which is peculiar 
 to animals ; since upon it depend, very greatly, the right performance 
 of the organic functions, and a vast range of pathological conditions, 
 and the greatest amount of therapeutical influences. It also over- 
 throws the venerable doctrines in humoralism, in all their contempla- 
 tions of vitiated blood, morbid lentor, "living putrefaction," and of 
 those conformable therapeutical means which were invented under 
 the significant names of incisives, deobstruents, inviscants, incrassants, 
 diluents, attenuants, astringents, relaxants, refrigerants, &c. 
 
 453. Sympathy has been commonly reputed as one of the proper- 
 ties peculiar to animals ; but it is not only a function, but one of great
 
 284 INSTITUTES OF MEDICINE. 
 
 complexity, since it involves the united operation of sensibility and 
 the nervous power. The result of that concerted action is sympathy, 
 or reflex nervous action. This is the established acceptation ; but the 
 nervous influence often operates through motor nerves alone, as in men- 
 tal and physical excitements of the nervous centres ; and hence, in part, 
 my preservation of the generic term sympathy (§ 638^). 
 In the farther prosecution of this subject, I shall consider, 
 I. The general uses of the nervous systems. 
 11. The different orders of nerves (§ 462, &c.). 
 III. Exp. to determine the Laws of the Vital Functions (§ 476, &c.). 
 rV. The varieties or kinds of sympathy (§ 495, &c.). 
 V. The laws of sympathy, and their application to pathology and 
 therapeutics; the latter being peculiar to myself (p. 912). 
 
 I. OF THE GENERAL USES OF THE NERVOUS SYSTEMS. 
 
 454, a. The phenomena of the nervous systems (the cerebro-spinal 
 and ganglionic), in their connection with organic processes, forcibly 
 declare how broad is the gulf between the properties and laws of dead 
 and living beings, and how vast, magnificent, and profound is the sci- 
 ence of life in its vai'ied aspects of health and disease. 
 
 454, h. The nervous system having no existence in plants has given 
 rise to the fundamental distinction of "animal and organic life" (§ 96— 
 123), although in animals it belongs to both lives. 
 
 454, c. The cerebro-spinal system appertains particularly to the organs 
 of animal life, though it contributes largely to the organic viscera (§ Hi- 
 ll?, 224, 233|, 356 a, 409 Z;, 461, 478 h, 4881 493 cc, 647^ 893^). 
 
 The ganglionic system is universally appropriated to the organs of 
 organic life, and pervades every part of the animal ; since organic ac- 
 tions are carried on as well in the organs of animal life as in the organ- 
 ic viscera, and require the influences of this system (§ 115). 
 
 455, a. The great final cause of the brain is to subserve the intel- 
 lectual powers in man, and instinct in the lower animals (§ 241, 454 J, 
 500 p). But reason and instinct would avail but little were their op- 
 erations circumscribed by the limits of their organ. Hence the brain 
 is prolonged into nerves, and various connections are thus established 
 with all parts of the body, and with the external world. Admirable 
 as is this Design of associating in harmonious action the immaterial 
 with the material parts, it would still be defective, and the economy 
 of nature obviously violated, were not an organ so prominent in the 
 animal mechanism rendered subservient to the great purposes on which 
 its existence depends. Therefore that other system, the ganglionic, 
 has been established, with intimate connections with the cerebro-spinal, 
 through which they co-operate together, especially after independent 
 life begins. Nevertheless, the essential influences in organic life de- 
 volve mostly upon the ganglionic system, whose principal otfices, besides 
 that of combining the organic functions (§ 113), consist in so modifying 
 the functions as to variously affect the secretions in their quantity and 
 quality (the organic in their vital constitution), and in supplying the 
 stimulus of nei"vous influence to the muscular tissue in organic life 
 (§ 224, 356 fl, 422, 461, 461^, 473 c, 475i, 483 c, 4881, 500 g, m, 
 524 d, no. 7, 889 g, 892|, 893 a, c, 893i, 902 ff). 
 
 455, b. It appears, therefore, that one of the great secondary uses 
 of the cerebral system is that of co-operating with the ganglionic in
 
 PHYSIOLOGY. FUNCTIONS. 2®l 
 
 establishing a circle of sympathies among the organs of organic life 
 and preserving the whole in that harmony of action that is indispensa- 
 ble to the life of complex animals. 
 
 455, c. Thus we learn that the various parts of the organic mechan 
 ism of animals are not only indispensable to each other, but that a cer 
 tain established influence of one upon the other is necessary to each, 
 and that the functions of the whole may be fatally deranged, eithei 
 directly, by causes that may inteiTupt the common chain by which the 
 relations are established, or indirectly, as by a blow on the stomach, 
 or by poisons acting upon some part of the intestinal mucous tissue, 
 or by withdrawing some particular organ from the symmetrical whole 
 (§ 109, 129). 
 
 455, d. Whatever, indeed, may affect the powers and embarrass the 
 functions of the cerebro-spinal system, will more or less disturb this con- 
 cert of action, may modify the functions of every part, and may derange 
 the whole series of vital phenomena. The nature of the disturbances 
 will depend entirely upon the nature of the impressions produced upon 
 the nervous systems, as well as upon the rapidity and violence with 
 which the impressions are made. Direct injuries do it in one way, 
 and according to their nature and extent. Morbific, or other causes, 
 acting upon other parts, affect the nei-vous centres, and consequently 
 give rise to remote derangements, in other ways, according to theii 
 nature, and the violence with which they operate. Medicines do the 
 same thing, and according to their nature, their dose, and according 
 to the nature of the part, as well as the existing state of the part to 
 which they are applied, or that of other parts upon which they may 
 act sympathetically. Intricate reflex nervous actions, in all these 
 cases, are liable to spring up, and that, too, in rapid succession (§ 222- 
 233|, &c.). 
 
 455, e. The same laws, precisely, are concerned throughout. We 
 do not, however, witness the display of reflex nervous actions in health 
 as in disease, or as when remedial agents operate ; since, in the nat- 
 ural state of the body, the nervous influence is more or less in equilib- 
 rio ; operating uniformly and equally on all the organic viscera, and 
 thus maintaining: amonoc them one concerted, harmonious action. But 
 this power being constituted with the greatest sensitiveness to the va- 
 rious conditions of all parts, that it may transmit the existing condition 
 of each one to the whole (as strikingly seen in the almost instant inter- 
 change of function between the kidneys and skin, on the contact of 
 cold air, &c., § 422), it necessarily happens that when the state of any 
 one part is varied from its natural standard, that part will transmit an 
 unnatural influence to the brain and spinal cord, will develop the ner- 
 vous power in an unnatural manner, and thus produce disturbances in 
 other parts (§ 350, no. 19). The alterative influences, therefore, of 
 morbific and remedial agents necessarily result from the natural phys- 
 iological laws of the nervous system in connection with the instability 
 of the organic properties, nor can it be otherwise. The principle is 
 absolutely ingrafted upon the constitution of animals. 
 
 A5o,f. I say, therefore, that when unusual causes operate, whether 
 upon the nerv'ous centres or upon remote parts, they necessarily de- 
 velop the nerv'ous power in greater intensity than it exists in health ; 
 when it is reflected abroad upon various organs, and with the greatest 
 variety of effect. The parts upon which it may fall will depend upon
 
 286 INSTITUTES OP MEDICINE. 
 
 their existing susceptibility and the nature of the remote causes; and 
 the nature of the effects produced will depend greatly upon the par- 
 ticular virtues of the morbific or remedial agents ; for it is also an im- 
 portant law that the nervous power itself will be altered according to 
 the particular nature of the impression which may be produced upon 
 the part on which the agent may exert its direct effect (§ 222, &c.). 
 
 455, g. The actions which are thus influenced through the connect- 
 ing medium of the nerves are not alone the great general functions of 
 organs, such as digestion, the action of the heart, &c., but, also, those of 
 their minute constitutional organization. Here it is, indeed, that mor- 
 bific and remedial agents exert their principal effects (§ 483, &c.). 
 
 456, a. In the ordinary rhythm of the organic system, however, the 
 capillary and extreme vessels are not as dependent on the nervous 
 influence for the precision of their functions, as the complex organs 
 (§ 455, e). It is greatly with these vessels as with the analogous ones 
 in plants. They have an independent function in each particular part, 
 the performance of which does not require so much a harmonizing nerv- 
 ous influence as in the collective sense. Herein also is seen a reason of 
 the absence of a nervous system in plants, while it is more or less neces- 
 sary to animals. The vessels go up continuously from the roots to the 
 leaves, and continuously back again, and there are only vessels ; no 
 complex organs. Each part of a plant has within itself an organiza- 
 tion adequate, or nearly so, to its independent existence. It is other- 
 wise, however, with animals. Here, other essential parts are superad- 
 ded to the simpler mechanism, are made dependent on each other, and 
 a certain correspondence of action rendered necessary to the integrity 
 of the whole. For the fulfillment of these ends the nervous system is 
 also superadded, with its wonderful attribute, the nervous power, that 
 a perpetual change of influences shall be maintained among the great 
 organic viscera, while it is also made instrumental in exciting and 
 modifying the organic functions of every part, and thus also afi'ecting 
 the nature of the products (§ 226, 232, 399, 446 a, 461, 473 c, 483 c, 
 485, 489, 512, 746 c, 846, 889 g, 902, 952). 
 
 456, h. Hence it is that slight influences upon the nervous centres 
 will determine the nervous power, with a very manifest effect, upon the 
 capillary and extreme vessels, as seen in blushing, and in the experi- 
 ments by Philip (§ 227, 477, &c.) ; and coming to the ordinary opera- 
 tion of disease, and of morbific and remedial agents, we have constant 
 demonstrations of the great susceptibility of these vessels to the action 
 of the nervous power, and of strong reciprocal sympathies among them, 
 and of consequent changes in the products (§ 394, 1040). 
 
 457. One of the most sticking peculiarities of the ganglionic system 
 is that of its not transmitting the influences of the will to the organs 
 which it supplies, notwithstanding it is so intimately combined with the 
 cerebro-spinal nerves ; while, on the other hand, the passions operate 
 more powerfully through the ganglionic than through the cerebro-spinal 
 nerves (§ 476 c, 500 e). 
 
 This fact shows us at once that the sympathetic system must have 
 certain special functions ; and when we trace out its anatomical con- 
 stitution, and its distribution to the essential parts of organic life, we 
 perceive that one special ofiice must be that of maintaining a harmony 
 of actions among these parts ; and experimental observation confirms 
 this induction. Consequently, from the exquisitely delicate nature of
 
 PHYSIOLOGY. FUNCTIONS. 287 
 
 this high office the nerve is rendered intensely susceptible, and from 
 the intimate manner in which it pervades the organic tissues it ia 
 made to exercise a profound and somewhat governing influence upon 
 their organic actions (§ 456 &, 1040). 
 
 458. The relations of the cerebro-spinal and ganglionic systems to 
 each other, their special or mutual functions, and those of individual 
 nerves, all having their distinct individuality, yet all more or less re- 
 lated and concurring in harmony, and for important purposes in ani- 
 mal and organic life, supply the most complex and astonishing in 
 stances of Design to be found in nature ; and their natural attributes, 
 existing under the most absolute laws, afford a ready interpretation of 
 the endless phenomena of reflex actions, as the result of disease, 
 or of morbific or remedial agents. 
 
 459, a. All parts of the nervous centres are not only more or less 
 mutually connected in function, but all parts of the nervous system 
 are subordinate to the brain. There are no distinct, separate, and 
 independent influences, of an involuntary nature, exerted by any 
 parts of the nervous centres in their state of integrity. They all con- 
 cur more or less together. This is experimentally demonstrable, as 
 well as denoted by the natural phenomena. If, therefore, it should 
 appear from experiments upon the spinal cord, for example, while 
 connected with the brain, through any remaining communications, 
 that the influences are determined by the cord alone, we may be as- 
 sured that the brain has participated (§ 201, 473, 481, Exp. 15). 
 
 459, h. I have said in my Essay on Bloodletting (in Med. and 
 Phys. Comm.), that the injuries which are inflicted on the spinal cord, 
 to determine the specific functions which have been assigned to it, 
 are so severely propagated to the brain, and may so affect the prop- 
 erties of that organ, that the results which appear to flow from the 
 spinal cord may be actually due to the cerebral influence, or to an in- 
 terruption ©f that influence when the spinal cord is divided or de- 
 stroyed. Both principles, in the latter case, may act in co-operation ; 
 the cerebral influence being determined through the superior nerves 
 and the ganglionic system, and otherwise impressed by a reflected 
 influence from below that part of the spinal cord, where its direct 
 connection with the brain is interrupted (§ 481, Exp. 12, 15). 
 
 While, therefore, the brain remains, experiments upon the spinal 
 cord are entitled to much less confidence than those wliich are made 
 upon the brain. But even when the brain is removed, the vital prop- 
 erties of all parts become so profoundly modified in consequence, that 
 we can scarcely infer with accuracy the specific functions of the spinal 
 cord fi'om subsequent experiments (§ 477, &c.). 
 
 459, c. The late experiments by Dr. Stilling, with strychnia applied 
 to the spinal cord, are entirely consistent in their results with the fore- 
 going remarks (J). From these experiments he supposes that the 
 spinal cord is greatly independent of the brain, and that when divided 
 in numerous places, each portion is capable of the same influences 
 upon the parts it may supply, as when the whole cord is in its natural 
 state. Thus, when the small portion connected with the fore-legs is 
 separated from the rest of the cord by two incisions, and strychnia is 
 applied to this isolated part, the legs will be convulsed. Still, how- 
 ever, there are remaining and important communications of this ap- 
 parently isolated part with the head, and with all other parts of the
 
 288 INSTITUTES OF MEDICINE. 
 
 spinal cord, which will forever embarrass these critical inquiries, un- 
 less there be a removal of the brain (§ 473 a, no. 2, 473 c, 494 d, 514 e). 
 459, d. " The experiments of M. Le Gallois," says Wilson Philip, 
 " prove, in the most satisfactory manner, that a principal function of 
 the spinal marrow is to excite the muscles of voluntary motion, and 
 that it can perform this office independently of the brain, as after the 
 removal of the brain. Yet we constantly see injuries of the brain im- 
 pairing the functions of the spinal maiTow. Of this apparent incon- 
 sistency, M. Le Gallois justly remarks, that two facts, well ascertain- 
 ed, however inconsistent they may seem, do not overturn each other, 
 but only prove the imperfection of our knowledge." 
 
 Now, in the foregoing case, there is no difficulty in reconciling the 
 facts by the interpretation which I have given to tlie action of the will 
 and of the nervous power. The will operates as an exciting cause to 
 the nervous power, which then determines voluntary motion. But, 
 the motions are never voluntary after the removal of the brain ; but 
 the nervous power pervades the whole system of motor nerves, and 
 when stimuli are applied to the spinal cord after removing the brain, 
 the nervous power becomes an exciting cause of involuntary motions 
 (§ 226, 473, 500). 
 
 459, e. Every principal part of the nervous system has a certain 
 special office which is exercised in conjunction with the whole. " The 
 cerebrum does not act like the cerebellum, nor the cerebellum like 
 the medulla oblongata, nor the medulla oblongata like the spinal cord 
 and nerves. In the cerebral lobes resides the faculty by which the 
 animal thinks, wills, recollects, judges, becomes conscious of sensa- 
 tions, and commands its movements. From the cerebellum is derived 
 the faculty which co-ordinates the movements of locomotion ; from the 
 tubercula bigemina or quadrigemina, the primordial principle of the 
 action of the optic nerve and retina ; from the medulla oblongata, the 
 motor or exciting principle of the respiratory movements ; and, lastly, 
 from the spinal cord, itself, the faculty of blending or associating into 
 combined movements the partial contractions immediately excited by 
 the nerves in the muscles of animal life." 
 
 459, yi Enough, however, is known to show us, that when the cere- 
 bro-spinal and sympathetic systems exist as a whole and unimpaired, 
 they act more or less as a whole ; but that different parts have certain 
 peculiarities of function, and that when injuries befall any part of 
 these great systems, a portion of the whole may perform certain cir- 
 cumscribed functions, at least for a limited time, and often, perhaps, 
 as perfectly as the whole apparatus in its stajte of integrity (§ 201, 
 515, 516 d, no. 8). _ 
 
 Impressions, as I have said, when transmitted through sympathetic 
 sensibility, may be received either by the brain, spinal cord, or certain 
 parts of the ganglionic system ; and either connectedly or independ- 
 ently. But, in the natural state of the nervous system, all such im- 
 pressions, when received especially by an individual part, are doubt- 
 less propagated to the other parts, and institute that harmonious con- 
 currence in all the parts which renders the whole nervous system in- 
 strumental in determining the ultimate phenomena. This is even 
 true of so local a phenomenon as the contraction of the sphincter mus- 
 cles, however that contraction may be maintained after destruction of 
 the brain and of the superior parts of the spinal cord (§ 461^, a). Th«se
 
 PHYSIOLOGY.^ — FUNCTIONS. 289 
 
 conclusions are warranted in experiment, and by all that is known of 
 the dependence of the harmonious relations of organs upon the presiding 
 influence of the nervous system. There must be harmony there as a 
 fundamental requisite (§ 129). 
 
 459. g. In the application which I have made of the nervous power, 
 in the present and in my former works, to the theory of disease and 
 to the modus operandi of remedial agents, it is important to regard 
 the whole nervous system in its unimpaired relations to its own and to 
 other parts. 
 
 460. No experiments upon the sympathetic nerve can show that it 
 is more than tributary to the organic processes; for- the moment any 
 unusual impressions are made upon it, the nervous influence is unnatu- 
 rally excited, and determined with more or less violence upon the or- 
 ganic properties, and thus deranges the functions. 
 
 461. It is an assumption to say that the nerves are the generating 
 sources of the secreted products, however certain it may be that they 
 influence the organic processes and their results. If the products are 
 altered by impressions made upon the brain or nerves, it is because the 
 nervous influence is preternaturally determined, as a morbific agent, 
 upon the organic viscera, and because the nervous influence exerts 
 naturally a modifying effect upon the products of organic actions. A 
 division of the pneumogastric or of any other nerve may have all the 
 effect of a morbific agent, producing congestion and inflammation ; the 
 very division of the nerve determining a shock of the nervous power 
 upon the organic properties of the part to which the nerve is distrib- 
 uted. But, in the instance of dividing the pneumogastric nerve the 
 gastric juice and the pulmonary mucus are secreted in preternatural 
 abundance. Digestion, however, becomes at once greatly impaired ; 
 but even that may be more or less restored by rousing the nervous in- 
 fluence in the divided portion of nerve leading to the stomach by means 
 of galvanism, or other irritants applied to the nerve, thus perfecting the 
 juice (§ 226, 409 k, 446 a, c, 489, 493 cc). 
 
 461-2^, a. The brain and spinal cord are not necessary to the organic 
 life of the foetus, not even to the action of the sphincter muscles ; since 
 both have been wanting in the full-grown human fcetus (§ 459/). In 
 the foetal case reported by Dr. Clark in the London Philosojyhical Trans- 
 actions (1793, p. 154), in which it is said that there Avas no trace of 
 nerves, it cannot be doubted that the sympathetic existed, since the 
 laws in respect to the organic compounds of animals are as applicable 
 to such a monster as to the perfect being, and since also these com- 
 pounds in the latter case are imbued with special vital conditions 
 through influences of the sympathetic nerve upon the secreting ves- 
 sels. The sphincter ani, the heart, «&;c. requii'e the stimulus ; feut there 
 was no anus in the above case (§ 409 h, 473 c, 483 c, 488|, 493 c, d). 
 
 461^, h. Hence it appears that the sympathetic nerve is, to a certain 
 extent, independent of the brain and spinal cord, and the relations of 
 the latter to the former become most important after independent life 
 begins (§ 224, 473 c, 483 c). 
 
 461^, c. In brief, then, the influences of the cerebro-spinal and sym- 
 pathetic systems are more or less reciprocal in organic life. And, 
 although sympathies may be combined by the ganglia of the sympa- 
 thetic nerve, as in contiguous sympathy (§ 497), this nerve transmits 
 the impressions it receives to the brain and spinal cord in the same 
 
 T
 
 290 INSTITUTES OF MEDICINE. 
 
 way as the cerebral and spinal nerves, and influences are propagated 
 from the cerebro-spinal axis upon either system of nerves, and the or- 
 gans they supply, in a like manner (^ 111-117, 227-230, 455, 893). 
 
 11. OF THE DIFFERENT ORDERS OF NERVES. 
 
 462. Corresponding with the two important functions of the brain 
 and spinal coi'd, those of receiving impressions fi'om external objects, 
 and of generating the nervous power, are two orders of nerves ; 
 whose distinct characteristics were first pointed out by Sir Charles 
 Bell. It is the office of one of these orders of nerves to transmit the 
 impressions to the nervous centres, and of tlie other to serve as a me- 
 dium for the exercise of the nervous power upon all parts of the 
 body. This combined function establishes the more complex one of 
 sympathy, or reflex nervous action. 
 
 463, a. The foregoing anatomical discovery only establishes what 
 was before known of the laws of sympathy by accurate observers of 
 nature. The general attributen of sympathy were understood by 
 Hippocrates, and were at the foundation of no small part of his med- 
 ical philosophy and practical habits. From the origin of medicine to 
 the present time the subject has engaged the attention of the medi 
 cal world. Its impoitant outlines were originally drawn from the vi 
 tal phenomena alone. We learn from Plato, a cotemporary of Hip- 
 pocrates, that the general doctrine of sympathy, in its application to 
 the cure of disease, was considered fundamental by physicians. Thus: 
 " Occulorum morbosos affectus sanari non posse, nisi prius curetur 
 caput, neque caput nisi prius curetur corpus, neque coi'pus sine ani- 
 mo, aiebat medicus quidem apud Platonem." Galen writes of it. 
 
 463. 1). When the nervous system became understood, this knowl- 
 edge aided greatly an analysis of the laws of sympathy. " Glisson, 
 in 1677, speaks of an influence being '■reflected^ from one nerve at its 
 origin upon other nerves, so as to cause consensual movements." 
 Unzer, in 1771, was close upon Bell's discovery, and Whytt and 
 Monro also earned on the inquiry in conformity with the designs of 
 structure. In 1784, Prochasca established the theory of reflex action 
 of the nervous system. This great theory has been recently analyzed 
 and reduced to a system of magnificent laws by Professor Miiller, to 
 which Dr. Hall and others have also made some contributions. 
 
 464. But, the present century contributes to medicine a discovery 
 which lays open the precise mechanism that subserves the laws of 
 sympathy. It consists, essentially, in having demonstrated the two 
 orders of nerves (§ 462). With this mechanism, in its connection 
 with the phenomena of sympathy, we move forward with unerring 
 certainty to the exposition of principles and laws which are as pecu- 
 liar to organic beings as their structure and results, and as determinate 
 as the mechanism is replete with consummate Design. 
 
 465. The posterior roots of the spinal nerves, which have a gang- 
 lion upon them, denote the part appropriated to sensation, or to such 
 impressions as may be transmitted from the periphery to the centre. 
 The anterior roots, which are without a ganglion, exercise the motor 
 function, and that range of influences upon which all the immediate 
 and important results of sympathy depend (§ 226, &c.). The fibres 
 of these roots are gathered into bundles, forming the nerves, and are 
 thus distributed to various well-known parts; and what is of the high
 
 PHVSIOLOGY. FUNCTIONS 291 
 
 esL moment in organic life, and mainly important to the purposes ot 
 these Institutes, these nerves contribute to the great sympathetic (§ 
 111-117, 129, 500 e-m, 514 c, d, 515, 520, 891^^, k, 893 a, c, 1037 b). 
 
 466. The motor and sensitive fibres of a common nerve do not 
 unite, but are even distributed separately in the organs w^hich they 
 supply.* They have, therefore, no action upon each other except 
 through the nervous centi-es. The phenomena, at least, declare it. 
 
 467. All the late anatomical investigations of the spinal cord by 
 Stilling, Van Deen, Budge, and others, go to confirm the foregoing 
 conclusions (§ 465, 466). They have also probably indicated the 
 anatomical mediums, in the spinal cord, by which impressions are 
 conducted to the brain, and influences transmitted from that organ. 
 Stilling, for instance, supposes that the longitudinal fibres of the 
 posterior gray substance of the cord transmit the sensitive impres- 
 sions to the brain, and that the longitudinal fibres of the anterior 
 gray substance are the medium through which the will operates in 
 voluntary motion. — See ^ 1037 b. 
 
 468. The foregoing discovery has led to the knowledge that one of 
 the functions of a nerve may be destroyed without impairing the oth- 
 er. If the posterior root be paralyzed or divided, sensation is de- 
 stroyed, but not the power of motion. So, on the other hand, if the 
 anterior root be divided or paralyzed, voluntary motion is destroyed, 
 but not sensation ; and, as organic motion is independent of the will, 
 it is only influenced, not destroyed, by this injury of nerves (§ 205-208, 
 226, 257, 500). — See later observations, ^ 1037 b. 
 
 469. The two orders of nerves occur in the great sympathetic, and 
 appertain, also, to those nerves which proceed directly from the brain, 
 where they are either compounded, as in the spinal nerves, or make 
 up, respectively, distinct nei-ves of sensation and motion. 
 
 Those which proceed from the brain are distributed into three 
 classes : 
 
 1st. " Nerves of special sense ; namely, the olfactory, optic, and 
 auditory nerves. 
 
 2d. "Mixed nerves with the double roots; the trigeminus, glosso- 
 pharyngeus, ( 1 ) and the par vagum with its accessory, and, in several 
 mammalia, the hypoglossus. 
 
 3d. " Single-rooted nerves, for the most part of motor function, 
 which are either themselves entirely motor, and receive sensitive 
 fibres from other nerves, or which, if their roots contain sensitive 
 fibres, still cannot be classed with the double-rooted nerves. These 
 are the occulo-motorius, the trochlearis, the abducens, and the facial 
 nerve." — Muller. 
 
 470. The nerves of the sympathetic system are exquisitely endow- 
 ed with that modification of sensibility which I have denominated 
 sympathetic sensibility (§ 201-203, 451, &c.). This modification is 
 not less strongly pronounced in the sympathetic system than specific 
 sensibility in the nerves appropriated to the organs of sense ; for it is 
 through this medium that all the organic viscera " feel," as it were, 
 the condition of each other. 
 
 The nerves of the ganglionic system have only an involuntary mo- 
 tor influence upon the parts to which they are distributed. 
 
 " It being shown that the sympathetic regularly receives fasciculi 
 of motor and sensitive fibres from the spinal nerves, as their motor 
 
 * This is \nferaWe from the phenomena, and /row these the laws are deduced (I) 131, 990^ c).
 
 292 INSTITUTES OF MEDICINE. 
 
 and sensitive roots, the existence of a similar relation between it and 
 those cerebral nerves vehich are analogous to the spinal nerves, in hav- 
 ing double roots, becomes very probable." — Muller, 
 
 Laws of the Action of Motor Nerves of tlie Cerebrospinal System. 
 
 471. 1. " The motor influence is propagated only in the direction 
 of the nervous fibres going to the muscles, or in the direction of the 
 ramification of the nerve ; and never in a retrograde course." 
 
 2. " The application of mechanical or galvanic irritation to a part 
 of the fibres of a nerve does not affect the motor powder of the w^hole 
 trunk of the nerve, but only of the insulated portion to which the 
 stimulus is applied." 
 
 3. " A spinal nerve entering a plexus, and contributing with other 
 nerves to the formation of a great nervous trunk, does not impart its 
 motor power to the whole trunk, but only to the fibres which form its 
 continuation in the branches of that trunk." — Muller. 
 
 Laws of iJie Action of Sensitive Nerves of the Cerehro-spinal System 
 
 472. 1. "When the trunk of a nerve is irritated, the sensation is 
 felt in all the parts which receive branches from it. The effect is the 
 same as if all the ultimate ramuscules had been irritated." 
 
 2. " The sensation produced by irritation of a branch of a nerve is 
 confined to the part to which the branch is distributed, and generally, 
 at least, does not affect the branches which come off" from the nerve 
 higher up, or from the same plexus." 
 
 3. " When, in a part of the body which receives two nerves of sim- 
 ilar function, one is paralyzed, the other is inadequate to maintain the 
 sensibility of the entire part. On the contrary, the extent to which 
 the sensibility is preserved corresponds to the number of the primi- 
 tive fibres unaffected by the lesion." 
 
 4. " When different parts of the thickness of the same nerve are 
 separately subjected to irritation, the same sensations are produced 
 as if the diffei-ent terminal branches of these parts of the nerve had 
 been irritated." The sensations, however, are greatly less in the for- 
 mer instance (§ 826, d). 
 
 5. " The sensations excited in the minute elementary fibres are trans- 
 mitted from the surface of the brain, without being communicated to 
 the other fibrils of the same nervous trunk." — Muller. 
 
 The foregoing laws are relative to specific sensations, and are more 
 or less applicable to sympathetic sensation (§ 450, 451). 
 
 Of the Spinal Cord. 
 
 473. a. 1. "In a physiological point of view, the spinal cord so far 
 agrees with the nerves that it propagates actions of the nerves, which 
 enter it, to the brain, just as the cerebral nerves communicate impres- 
 sions made on them immediately to the sensorium commune ; and 
 that it communicates the influence of the brain to the nerves arising 
 from itj which thus receive, through the medium of it, the cerebral 
 influence, just as if they arose from the brain itself. In other respects, 
 however, the spinal cord diffei's essentially from the nerves in possess- 
 ing properties which belong to it as a part of the central organs, and 
 do not reside in the nerves (§ 459).
 
 PHYSIOLOGY. FUNCTIONS. 293 
 
 2. "All the cerebral nerves are immediately subject to the influ- 
 ence of the brain, and all the spinal nerves are subjected to the same 
 influence through the medium of the spinal cord. As soon as the 
 transmission of this influence is interrupted, impressions on sensitive 
 nerves cease to be propagated to the sensorium, and the brain loses 
 the power of voluntarily exciting the motor action of the nen'es which 
 are withdrawn from its influence. When the communication of the 
 brain and spinal cord with the nerves is interrupted by wounds, pres- 
 sure, or paralysis, all the branches which are given off below Xhe af- 
 fected spot cease to be voluntarily excited by the motor action ; and 
 the action of external stimuli on the same parts produces no sensation. 
 
 473, b. " Those branches, on the contrary, which come off from 
 the nerve above the point of injury are still subject to the influence of 
 the brain and of volition, and, when irritated, give rise to sensation." 
 
 473, c. " The parts of a nerve below the injured point presei've, 
 however, their motor power for a certain time. It is merely the influ- 
 ence of the brain upon them that is lost. The nerve does not lose its 
 excitability to external agents until it has been several months cut off 
 from intei'course with the brain" (§ 459 c, 461). 
 
 In organic life impressions may still be propagated to and from the 
 brain upon parts situated below the point of interruption, through the 
 sympathetic nerve, and although there be no other medium of com- 
 munication than by the connection of the sympathetic nerve with the 
 blood-vessels. This is an important consideration in forming conclu- 
 sions from certain experiments upon the nerves, with a view, in part, 
 to ascertain the modus operandi of morbific and remedial agents in 
 their action upon organs distinct from each other. 
 
 3. " In man and the higher animals the spinal cord stands in the 
 same relafion as all the cerebral nerves to the brain. It is to be re- 
 garded as the common trunk of the nerves of the body ; although it is, 
 besides this, distinguished by special properties." 
 
 4. " The fibres of the spinal cord pass through the medulla oblon- 
 gata to reach the sensorium commune. All the primitive fibres of the 
 nerves terminate in the brain ; those of the cerebral nerves immedi- 
 ately, those of the spinal nerves through the medium of the spinal 
 cord." 
 
 5. " The spinal cord has the property of reflecting irritations of its 
 sensitive nerves upon the motor nerves, but without itself perceiving 
 the sensation" (§ 201-204, 451 d-i51f, 1037 b). 
 
 " The spinal cord, even when separated from the brain, and without 
 any external stimulus, can excite automatic movements." 
 
 6. " The spinal cord, although capable of exciting the motor nerves to 
 automatic actions, nevertheless, in the healthy state, leaves a great 
 part of the motor nerves, those supplying the muscles of locomotion 
 more especially, in a quiescent state ; while on others it exerts a con- 
 stant motor influence (§ 500, k). It thus maintains constant involun- 
 tary contractions, which are arrested only by the spinal cord becom- 
 ing paralyzed. The motions of this kind are, 1st, those of muscles 
 which are also subject to the influence of the will, as the sphincter 
 ani ; 2d, those of muscles not subject to the influence of the will, as 
 the sphincter vesicae urinariae, the muscular coat of the intestines, 
 &c," — MiJLi.ER. Those muscles may be aSected by the will (^ 500 e). 
 
 474. 1. " The activity of all the special functions of the nerves in
 
 294 INSTITUTES OF MEDICINE. 
 
 detennined by the central organs, partly under the influence of tho 
 mind, and partly independently of this influence." 
 
 2. " The central organs connect all the nerves into one system. To 
 this even the sympathetic nerves do not form an exception." 
 
 3. " The central organs are the exciters of the motor nerves which 
 conduct the motor influence of the nervous principle to the muscles. 
 This motor influence may be constant, as we see in the case of the 
 sphincters ; secondly, it may be evidenced in intermittent rhythmic 
 movements, such as those of respiration ; and, thirdly, the motor influ- 
 ence may issue voluntarily from the sc7isorium commune (the part oi 
 the brain on which the mind acts) to the central organs ; this senso- 
 rium commune being subject to the spontaneous actions of the mind. 
 
 " The motor nerves are affected by this motor influence in two ways. 
 First, the nerves of one class act as mere conductors of it. In their 
 normal state they do not exert this power spontaneously, but only when 
 excited by the central organs. These are the motor nerves of the ce- 
 rebro-spinal system. 
 
 " Secondly, the nerves of the other class, which are quite withdrawn 
 from the influence of the sensorium commune, as far as regards vol- 
 untary actions [not the passions], are likewise capable of being excited 
 to constant oxiA. pei-iodical action by the central organs. But they pre- 
 sent the peculiarity of affording independent discharges of the nervous 
 influence ; although, after a time, communication with the central or- 
 gans is found to be necessary for the production of the nervous power. 
 Such ai'e the sympathetic nerves with regard to their motor actions." 
 
 The first of the foregoing varieties of motor influence is the exciting 
 cause of voluntary motion. By the second I interpret, mostly, the 
 operation of morbific and remedial agents upon parts not immediately 
 connected with the direct seat of their action, and the phenomena of 
 sympathetic diseases, and other sympathetic results among separate 
 parts. — See Bights of Authors p. 912. 
 
 The former part of the next following law, and § 473 c, no. 5, have 
 led me to distinguish the third kind of sensibility and sensation, which 
 T have denominated sympathetic (§ 201-204, 451). Thus : 
 
 4. " Impressions conveyed by the sensitive nerves to the central or- 
 gans are either reflected by them upon the origin of the motor nerves, 
 without giving rise to true sensations, or are conducted to the sensori- 
 um, the seat of consciousness." 
 
 5. " The nervous influence is g-enerated in the central orrans." 
 This as not universally true, since " The maintenance of tJic excitability 
 in the nerves docs not, Jioicever, depend solely on the continuance of the 
 influence of the central organs on them., hut also upon their own activ- 
 ity ^ MULLER. 
 
 It is Still a problem whether the " activity" of the nerves here spo- 
 ken of be not equivalent to a partial production of the nervous power. 
 There are many facts which appear to denote a low degree of this 
 office (§ 224, 461, 497). 
 
 475. It remains now to say, under the present section, that it is im- 
 portant that the hypothetical words motor and sensitive, and senso-mo- 
 tory, do not betray us into the belief that the nerves are the causes Oa 
 motion, or that there is any sensation connected with the organic phe- 
 nomena of sympathy (§ 201-215, 257, 222-233, 451). The term " ex- 
 cito-motory'" is far preferable to motor ; and se7isitive it might be diffi- 
 cult to improve The term reflex involves profound philosophy.
 
 PHYSIOLOGY, — FUNCTIONS. 295 
 
 475i. Although the nervous power is the only immediate exciting 
 cause of voluntary motion (§ 258), the mind is a I'emoter cause (and 
 therefore a substantive agent), and so far voluntary motion is on com- 
 mon ground with motions in organic life, where, for example, the blood 
 is the remote exciting cause for the heart and blood-vessels, food for the 
 intestine, acting upon their lining tissues (§ 136), while the nervous 
 power, by reflected action, is the stimulus for the muscular tissue in 
 natural states. But all muscles may be made to act by other stimuli (§ 
 243-246, 476 c, 498 e, 500 m, o, 514/, 647^, 1042).— Note A. 
 
 III. Experiments to determine the Laws of the Vital Func- 
 tions. 
 
 1st. On the Principle on wliicli the Action of the Heart and Vessels oj 
 Circulation depend. 
 
 476, a. I now come to certain important experiments by different 
 observers, especially by Dr. A. P. Wilson Philip, as contained in his 
 work on the Laws of the Vital Functions. It was the main object of 
 those experiments to demonstrate the independence of organic func- 
 tions of the nervous system ; to show that those functions arise from 
 the organic properties (§ 183, &c.) ; and they are perfectly triumph- 
 ant. They have been often repeated, and their results as often veri- 
 fied. It may, therefore, be thought that a simple reference to those 
 results would answer the objects of the present work. But, an age of 
 materialism requires a constant appeal to the senses, as the only recog- 
 nized mode of reaching the understanding (§ 234, 350J k) ; and, I have 
 in view not only the great original objects of those experiments, but 
 what is still more practically important, and peculiar to myself, the 
 application of the laws of the nervous system which they illustrate 
 to the operation of morbific and remedial agents, having especially em- 
 ployed them for the last purpose to demonstrate the philosophy of the 
 operation of loss of blood, in the Medical and Physiological Commen- 
 taries., vol. i., p. 161-173, &c. The experiments show us how it is 
 that morbific or remedial agents, when applied to a part, may develop 
 and modify the nervous power, and reflect it with various effect upon 
 other parts (§ 226). They also place all the processes of living beings 
 upon purely vital grounds ; even the vegetable kingdom, by the force 
 of an incontrovertible analogy (^ 1041. — Also, Rights of Authors). 
 
 476, h. Prior to the time of Haller, the nervous power was consid- 
 ered, in one way or another, as indispensable to the motions of the 
 heart, and the brain was the seat to which the power was referred. 
 Whytt had just before laid the foundation for rejecting the supposed 
 necessity of the nervous system to organic life. Haller then took up 
 the inquiry, and carried it forward by a multitude of experiments, and 
 overthrew the doctrine of the necessity of the nervous system to or- 
 ganic actions (§ 167). The experiments of Philip confirm those of 
 Haller, while, also, they are more conclusive. But he is entitled to 
 the greater credit of demonstrating, experimentally, that organic ac- 
 tions are influenced by the nervous power, although it was clearly 
 known to Whytt, Haller, and Prochasca, that such an influence ob- 
 tains ; while Haller, like Philip, separates it entirely from the natu- 
 ral relations of the nervous system to the organic functions. Pro- 
 chasca, also, had ascertained, near the close of the last century, about 
 all that is now more distinctly known of the doctrine of reflex nervous
 
 296 INSTITUTES OF MEDICINE. 
 
 action, or remote sympathy ; but the nature of the principle, and the 
 remarkable distinction in the constitution of the anatomical medium, 
 were not shown till demonstrated by the experiments of Bell and 
 Philip (§ 462-469). Hunter, reasoning upon the natural phenomena 
 of healthy and morbid conditions, contributed largely to the inquiry 
 Bichat followed immediately after, and pointed out the natural distinc- 
 tion of the two lives, analyzed the tissues (§ 86-88, 96-101), and de- 
 veloped, more than his predecessors, the nature of the vital proper- 
 ties, and construed all the phenomena of life, healthy and morbid, by 
 the normal and abnormal states of the properties of life. 
 
 476, c. It has been a question of difficult solution, how the pas- 
 sions should affect so sensibly the actions of the heart, while the 
 will has no influence upon this organ. And so of all other or- 
 ganic viscera. This problem I have explained by showing that 
 the will is a distinct element of the mind, as the passions are equally 
 distinct. One determines the nervous power upon the voluntary 
 organs, the other upon the involuntary ; each having their great, 
 specific, final causes (§ 188^ d, 205-208, 226, 233,481 ^>, 486, 487,7i, 
 492, no. 7, 500 d-k, 951). In the latter respect, the passions are 
 exactly analogous to the influence of morbific or other foreign 
 agents that may operate either directly or indirectly upon the brain ; 
 being, like those agents, capable of modifying the nervous influence 
 in its relation to the actions of organic life, while the will is incapable 
 of such modifying effect upon the nervous influence in its relation to 
 the actions of animal life (§ 226-228, 233, 500 d-k). The principle 
 depends greatly upon the fact that the will limits the nervous influence 
 to cerebro-spinal nerves (except § 500 dd, e), while mental emotions act 
 chiefly through the sympathetic (§ 500 5r,893 a,c, 893-^, 1067, 1072 &).* 
 
 476^, a. The researches of Le Gallois upon the influence of the 
 medulla oblongata and the spinal cord on organic actions led immedi- 
 ately to those by Wilson Philip, and others who embarked in the same 
 inquiry. Le Gallois very happily analyzed the relations of the me 
 dulla oblongata to the respiratory function, and the various move- 
 ments of the process, and showed that it was the most mortal part of 
 the body, by its immediate control over that function. The subse- 
 quent discoveries of Sir Charles Bell as to the sensitive and motor 
 nerves have shown, also, that it is in the medulla oblongata that the 
 nervous respiratory influences have their centre. 
 
 4765, b. Le Gallois' experiments upon the spinal cord, and his in- 
 ductions from them, and as sanctioned by others, are remarkable ex- 
 emplifications of the fallacies to which results, artificially obtained, 
 may conduct us, and supply a forcible illustration of the propensity of 
 the mind to grasp at a single fact, and to draw important conclusions 
 from it, to the exclusion of all others, however contradictory. It is 
 mainly, however, as to the supposed dependence of the functions of 
 the heart, intestines, and other organic viscera, upon the spinal cord, 
 that these errors relate. A general summary of the observations will 
 aid the inquirer after the philosophy of this subject. I am the more 
 induced to present this outline from the misapprehensions which con- 
 tinue to surround the subject, even in the ranks of the most erudite 
 physiologists. Thus, Dr. Marshall Hall, in his late Memoir on the 
 Nervous System{\ 841), inculcates the following doctrines : "TAe s}n- 
 nal riKirroio,^'' says Dr. WaW,'-'- exclusive of the cerebrum., is the source 
 * Also my work on the Soul and Lnstinctive Pkinciple, edition 1870.
 
 PHYSIOLOGY. FUNCTIONS. 297 
 
 of animal hfe?' — " The irritability of the muscles of organic life de- 
 pends, prohahhj, on the ganglionic system" (§ 188-193. Also, my Es- 
 say on the Modus Operandi of Remedies, p. 42, in Med. and Phys 
 Com?n., vol. iii.). — '^ 1041. 
 
 476^, c. Such were the results of the experiments, and such their 
 novelty, that, having led their author to the conclusion that the func- 
 tions of the heart, and other organic viscera, depend upon the nervous 
 power of the spinal cord, the doctrine was received with eclat by the 
 French Institute, and, indeed, by all Europe, in defiance of the well- 
 known fact that foetuses have been born alive without brain and spi- 
 nal cord, that the heart will palpitate for hours after its removal from 
 the body, that the intestines will roll about upon the table, when air 
 and injuries, not the nervous power, are exciting causes. They sim- 
 ply took, as the ground of their conclusion, the safety of excision of 
 the brain, or of its removal from the cranium, contrasted with the de- 
 structive effects of crushing the spinal cord (§ 456, 461^ a, 490, 498 e). 
 
 4761, d. The foregoing conclusion was inferi-ed from the interrup- 
 tion of circulation by destroying the spinal cord by a wire thrust down 
 the spinal column. The action of the heart, however, was not wholly 
 arrested; but it failed to circulate the blood in the large arteries. 
 This was supposed to be owing to a privation of the nervous power, 
 by which the heart became enfeebled. Le Gallois also supposed that 
 the actions of the heart were irregularly performed, which was also 
 an error. 
 
 Next, he destroyed only small portions of the spinal cord, and the 
 results led to the conclusion that it is not from the whole spinal cord 
 that every part of the body derives its organic life, but from that part 
 of it only from which the nerves are supplied. And, although this 
 philosophy is wrong, the conclusion is right, that in destroying any 
 particular part of the spinal cord, we only impair life in those parts of 
 the body which con-espond to that part (§ 507-510). 
 
 476|, c. Now, although rabbits twenty-two days old have no diffi 
 culty in living for some time after the head is cut off, yet the fact was 
 ascertained that the destruction only of the spinal cord destroyed life, 
 at that age, in less than four minutes ; respiration ceasing first. This 
 experiment, especially, led to the belief that the principle of life upon 
 which the heart depends resides in the spinal cord. 
 
 Le Gallois next ascertained that the destruction of either the dor- 
 sal or cervical portion of the spinal cord was fatal to rabbits of the 
 foregoing age, even in a shorter time than that of the lumbar portion; 
 that'is, in about two minutes. The results, however, as to time, va- 
 ried at different ages ; and death took place soonest in parts that were 
 opposite to the portion of the cord destroyed. 
 
 Now this sudden abolition of life, from a partial destruction of the 
 spinal cord, was imputed by Le Gallois to the loss or extinction of the 
 circulation ; and this, regarded as a remote result, was in part true. 
 But, as will have been seen, the immediate and essential effect con- 
 sisted in the destruction of the organic properties of the heart and 
 blood-vessels, by determining upon them, and all other parts em- 
 braced within the compass of experiment, a pernicious nervous influ- 
 ence by the sudden destruction of the spinal cord (§ 226, 227, 510) 
 It also appeared to follow (and such was the conclusion), that the 
 power, on whicli the motion of the heart depends, resides in the whola
 
 298 INSTITUTES OF MEDICINE. 
 
 of the spinal marrow; since the destruction of either ce."vical, dorsal, or 
 lumbar portion, arrested the circulation. But here, again, we see the 
 error of the conclusion ; since a fatal nervous influence would be 
 equally propagated upon the heart, not only through the continuous 
 parts of the spinal cord and brain, but through the sympathetic nerve, 
 by destroying any one of the three portions of the cord, and this, too, 
 without the bsart being intrinsically dependent for its motions upon 
 any part jf the spinal marrow (§ 458, 459). 
 
 476^, y! Such, however, was the effect of the foregoing influence 
 upon the powers of the heart ; and, as the blood-vessels are, also, pros- 
 trated in their action by the same cause, it is obvious, if the extent 
 over which the blood circulates be lessened in proportion as the heart 
 is enfeebled, the circulation will be prolonged in parts coiTesponding 
 with the portions of the spinal cord that are not destroyed. It is only 
 necessary, therefore, to apply ligatures around the principal arteries, 
 to answer the intention. Hence, rabbits live much longer if the aorta 
 be tied near its emersion from the diaphragm, before destroying the 
 respective parts of the spinal cord. By the same rule, also, if the 
 head be cut off", before destroying the cervical portion of the spinal 
 marrow, life is supported much longer than when the head is on. 
 
 476^,^. It appears, therefore, that death resulted in Le Gallois' 
 experiments partly from the propagation of the nervous power upon 
 the vital properties, not only of the heart, but of all the organic vis- 
 cera, and in part, also, by withdrawing the regulating medium of 
 concerted actions, and thus deranging the organic relations (§ 129, 
 455, 510). 
 
 476|, h. Le Gallois found, to his surprise, and beyond his explana- 
 tion, that if the spinal cord be slowly destroyed, the effects were great- 
 ly different from such as resulted from its sudden destruction ; that is 
 to say, the circulation was at once arrested when the cord was sud- 
 denly destroyed, but not so when gradually destroyed. This fact, in 
 itself, is subversive of his principal conclusions ; and the difference in 
 results depends upon the greater violence of the nervous power when 
 suddenly, than when more slowly excited (§ 479). This is also shown 
 in paroxysms of joy and anger. These passions may kill on the in- 
 stant, if suddenly excited, but never when gradually produced, what- 
 ever their ultimate intensity (§ 230). So a blow upon the region of 
 the stomach, which shall not exceed in force ten pounds, may destroy 
 life instantly, when a weight of one hundred pounds, gradually ap- 
 plied, may be wholly innoxious (§ 509). This is a very important law 
 of the nervous influence, as it is in constant operation in the produc- 
 tion and cure of diseases, whether the effects depend upon physical or 
 mental causes. It is owing to the suddenness with which the nervous 
 power is developed, that syncope may be occasioned by a very small 
 loss of blood (§ 940, 961, 974), or when it proceeds from offensive 
 sights, nauseous odors, or any mental emotion (§ 944). It is owing 
 to the same principle, in part, that blisters often give more relief when 
 they operate rapidly than slowly. It is an especial reason why emet- 
 ics are often so suddenly curative in croup, &;c. ; all having their as 
 tonishing foundation in a common principle (^ 893 i, 902 ^). 
 
 477, a. I now approach the important experiments which overthrovc 
 Le Gallois', and all the conclusions which were so extensively de- 
 rived from them as to organic actions, and through which, in part, I
 
 PHYSIOLOGY. FUNCTIONS. 293 
 
 interpret all the laws of remote sympathy, all the effects of moroinc 
 and remedial agents upon distant parts when applied to the stomach, 
 or skin, or lungs, &c.; of the remote influences of disease, and all the 
 effects of the passions; of blows upon the epigastrium, and the sud- 
 denly pernicious influences of surgical operations ; in short, every un- 
 usual phenomenon which can be supposed to happen through the 
 agency of the nervous power. It will be seen, also, that they coiTob- 
 orate, and are corroborated by, all the conclusions which I shall have 
 drawn as to the nervous power, and its laws of reflex nervous action, 
 from the phenomena of natural and morbid conditions, and from the 
 discoveries in relation to the two orders of nerves (§ 464).* 
 
 Unless otherwise stated, the experiments are by Philip. A large 
 number are omitted, as unnecessary to my purposes. 
 
 477, b. Experiment 1. " A rabbit was deprived of sensation and 
 voluntary motion by a blow on the occiput. Respiration ceased, but 
 was kept up artificially. The spinal marrow was then laid bare from 
 the occiput to the dorsal vertebree. The chest was next opened, and 
 the heart was found beating with considerable force. The whole 
 cervical portion of the spinal marrow was then removed, and without 
 affecting the action of the heart. The skull was then opened, and the 
 whole brain removed, so that no part of the central organs remained 
 above the vertebree. There was, however, no abatement of the ac- 
 tion of the heart. By suspending artificial respiration, however, 
 about an hour and a half after the removal of the brain, the heart 
 ceased to beat; but its action was again restored on renewing the 
 respiration; that is, on receiving oxygenated blood. 
 
 Exp. 2. " Having rendered a rabbit insensible by a blow on the 
 occiput, Philip destroyed the whole spinal marrow by a hot wire. 
 Respiration was supported artificially, and, on dividing the carotid ar- 
 tery, the blood spouted out. 
 
 Exp. 3. "A rabbit was rendered insensible by a blow on the occiput, 
 and artificial respiration performed. The spinal maiTow, from the 
 base of the skull to the beginning of the dorsal vertebraj, was removed, 
 and the remaining part of it was destroyed by a hot wire. The carot- 
 id artery was then found beating, and, on dividing it, the blood rushed 
 out with great force, ^;er saltum. 
 
 Exp. 4. " In another rabbit, insensibility was produced in the forego- 
 ing manner, the whole spinal marrow removed, and artificial respira- 
 tion not performed. The carotid artery being divided, dark-colored 
 blood flowed per saltum. The lungs were then inflated, and florid 
 blood began to spout out of the artery. 
 
 Exp. 5. " In this experiment the rabbit was rendered insensible, but 
 not motionless, by a blow on the occiput, and natural breathing con- 
 tinued. The spinal cord was then destroyed by a hot wire. A femo- 
 ral artery was now opened, and the blood spouted out. Then the 
 other femoral artery was opened, from which the blood flowed copi- 
 ously, and continued to flow for seven minutes ; when one of the cai"ot- 
 ids was opened, from which blood issued in a full stream, and till most 
 of the blood was evacuated. 
 
 Exp. 6. " The brain of a frog and the spinal marrow, as low as the 
 
 dorsal vertebrae, were laid bare. The thorax was t4ien opened, and 
 
 the heart found acting vigorously. The part of the spinal man'ow 
 
 which had been laid bare was then removed, but without at all affect- 
 
 * See Rights of Authors p. 912.
 
 300 INSTITUTES OF MEDICINE. 
 
 ing either the motion of the heart, or the passage of blood through it 
 The brain was then removed with the same result. 
 
 Exp. 7. " The brain and spinal maiTow of a frog were removed at 
 the same time. On opening the thorax the heart was found perform- 
 ing the circulation freely. 
 
 Exp. 8. " A ligature was applied to the neck of a frog, the head cut 
 off, and the spinal marrow destroyed by a wii-e. The circulation in 
 the web continued afterward, for many minutes, as vigorous as in that 
 of a healthy frog. 
 
 Exp. 9. " The spinal marrow and brain of a frog were destroyed by 
 a wire. The animal appeared quite dead for several minutes, during 
 which the circulation was seen in the web as vigorous as in that of a 
 healthy frog." 
 
 478, a. The foregoing and following experiments disprove the con- 
 clusions derived from Le Gallois', that the power, on which the motion 
 of the heart depends, resides in the spinal cord, and in all parts of it. 
 They also establish, what had been sufficiently shown by the heart 
 when severed from the body, that its action may be continued Avithout 
 brain and spinal cord ; and the proof extends equally to the blood-ves- 
 sels. " From various trials," says Dr. Philip, " we found that the cir- 
 culation ceases quite as soon without, as with the destruction of the 
 spinal marrow. Loss of blood seems to be the chief cause." " The re- 
 sult is still more striking in cold-blooded animals, in which death takes 
 place so slowly that the circulation continues long after the total de- 
 struction of the brain and spinal marrow" (§ 257). 
 
 478, b. The experiments prove, what will be more fully shown, that, 
 to influence the heart and vessels through the main nervous centres an 
 impression must be made cither upon the brain or spinal cord. But 
 the sympathetic nerve, with its central ganglia, was present, by which 
 an exciting influence was propagated upon the great organs and blood- 
 vessels; and however the heart and intestines maybe maintained in 
 muscular action when severed from the body (§ 264), the whole nerv- 
 ous mechanism, especially the ganglionic, is engaged, in natural states, 
 in reflecting exciting influences upon those organs, the blood-vessels, 
 (fee, and thus, also, modifying the organic products (§ 113, 356 a, 399, 
 456 a-459 g, 461, 473 c, 475^, 476 c, 483 c, 889 g, 952). *» 
 
 478, c. The experiments prove, in connection with others to be re- 
 lated of the same nature, that the actions of life are carried on by pow- 
 ers or properties inherent in each part (§ 184). 
 
 478, d. They prove that Avhen death suddenly follows a division of the 
 medulla oblongata, or a simple removal of the brain and spinal cord, it 
 does so essentially by abolishing respiration, or rather as in § 510. 
 
 479. A practical consideration of great moment grows out of the 
 difference in the modes in which the foregoing experiments weie per- 
 formed by Philip and Le Gallois, and' the vast difference in the re- 
 sults. The discrepances in results were owing entirely to a difference 
 in the size of the wires by which the two experimenters destroyed the 
 spinal cord ; Le Gallois having employed a wire that filled the cavity 
 of the spinal column, and thus destroyed the spinal cord suddenly, 
 while Philip used a smaller wire, and destroyed the cord gradually ; 
 or it was removed, along with the brain, without farther injury to them. 
 In Le Gallois' experiments, therefore, the nervous influence was sud- 
 denly and powerfully transmitted through all the nerves leading from 
 
 ♦ See late Experiments with poisons, Note B p. 1113. — 1862.
 
 PHYSIOLOGY. FUNCTIONS. 301 
 
 the spinal cord, as well as the sympathetic; while in I'hilip's, it was 
 BO gi-adual and imperfect, that it was not determined with destructive 
 violence upon the organic properties of the heart and blood-vessels, 
 though always with a more or less prostrating effect at first. So, too, 
 of the sudden or gradual destruction or removal of the brain. What, 
 also, is thus true of the heart and blood-vessels (as will farther appear), 
 is equally so of all the other organic viscera (§ 476| It, 509, 510, 947). 
 
 2d. On the Relation which subsists between the Heart and Vessels of 
 Circulation, and the Nervous System ; and the Influence of the Ner- 
 vous Syste7n vpon the Capillary Blood-vessels. 
 
 480. The following experiments are much more important than the 
 preceding in ascertaining the existence of the nervous power, how it 
 may be variously excited, how variously modified by artificial causes, 
 and how it may be determined with various effects upon the organic 
 functions. These, with another group relative to the stomach and in- 
 testines, open to us the modus operandi of the passions in organic life, 
 of morbific and remedial agents in their effects upon parts distant 
 from the direct seat of their operation, of sudden deaths from injuries 
 distant from the nervous centres, of the sympathies from diseases, 
 &c. ; when taken in connection with what is known of the sensitive 
 and motor nerves, and the reflections of the nervous power, as set 
 forth in the laws relative to this subject (§ 462-470, 512-524). 
 
 The object in producing insensibility was to prevent all agitation of 
 the animals, that the effects of the stimuli, &c., might be most advan- 
 tageously observed. 
 
 Experiments relative to the Heart in its Connection with the Nervoui 
 
 System. 
 
 481, a. Expcrime7it 10. A rabbit was deprived of sensation and 
 voluntary motion by a blow on the occiput, artificial respiration per- 
 formed, and the brain and cervical part of the spinal marrow laid bare. 
 The thorax was then opened, and the heart observed to beat with 
 strength and regularity. Spirit of wine was then applied to the spi- 
 nal marrow, and a greatly increased action of the heart was the con- 
 sequence. It was afterward applied to the brain with the same 
 effect. The increase of action was immediate and decided in both 
 cases, and as great in one as in the other. The effect of the blow 
 upon the head, in all the cases, was to lessen the frequency of the pul- 
 sations ; as generally happens in apoplexy. 
 
 Exp. 11. The foi'egoing experiment was repeated, with the differ- 
 ence, that the whole of the spinal cord was laid bare. The motion 
 of the heart was nearly, if not quite, as much influenced by the ap- 
 plication of the alcohol to the dorsal, as to the cervical portion of the 
 spinal marrow ; but it was very little influenced by its application to 
 the lumbar portion. 
 
 481, b. We see, therefore, that experiments 10 and 11, independ- 
 ently of the more important ones which follow, illustrate the most 
 essential elements that are concerned in remote sympathy, and in the 
 operation of the passions upon organic actions, in their connection 
 with what has been said of the sensitive and motor neiTes and their 
 relations to each other (§ 462-475). When, for instance, a morbific 
 or remedial agent, applied to the stomach or skin, influences a remote
 
 302 INSTITUTES Of MEDICINE. 
 
 part, and produces, or removes, disease in that part, its primary im- 
 pression is transmitted to the brain and spinal cord by the sensitive 
 nerves, where the impression acts upon the central organs just as the 
 alcohol did in the foregoing experiments, and, like that, it develops 
 the nervous power which is then reflected through the incident nerves 
 upon remote parts, just as it was to the heart in the application of the 
 alcohol; the incident nerves in organic life being the sympathetic. 
 
 As to the passions, they are exactly equivalent to the action of 
 agents applied dii-ectly to the brain, and develop and modify the ner- 
 vous power in the same direct manner. Such as are exciting are 
 analogous in their effects to those of alcohol ; such as are depressing, 
 to those of tobacco, opium, 8cc. (§ 227-230). From the equal effect 
 of the alcohol, also, when applied directly to the spinal cord, it is evi- 
 dent that the nervous power is also generated in this part, as it is, 
 more or less, in all the nerves. 
 
 When, however, the nervous influence is developed by the prima- 
 ry action of alcohol on the stomach, and the action of the heart is in- 
 creased in consequence, the development of the nervous influence is 
 reflex ; just as it is in respiration (§ 500). But, in all these cases, 
 the nervous influence is developed in the brain and spinal cord by 
 the transmitted impression, just as it is by the alcohol when applied 
 directly to the nervous centres ; the transmitted impression being ex- 
 actly equivalent to the direct action of the physical agent upon the 
 central parts (§ 1074). There is no absorption of alcohol, p. 172, no. 94. 
 
 481, c. It is now important to observe in the relative experiments 
 upon the brain and spinal cord, that when they exist in connection, 
 the influence of agents applied to the cord, in developing the nei'vous 
 power, may be mostly exerted upon the brain (§ 459, 481 e). 
 
 Ejp. 12. " Preparation the same as in Exp. 10 and 11, excepting 
 only the anterior part of the brain was laid bare. The spirit of wine 
 applied to this part of the brain produced as decided an effect on the 
 motion of the heart as in Exp. 10 and 11. The spirit of wine was 
 washed off", and a watery solution, fii'st of opium, then of tobacco, was 
 applied, with the effect of an increase, but of a much less increase of 
 the heart's action, than arose from the spirit of wine. The increased 
 action was gi'eater from the opium than from the tobacco. The Jirst 
 effect of both was soon succeeded hy a more languid action of the heart 
 than that which preceded their application to the brain. This effect 
 was greatest and came on soonest when the tobacco was used ; and 
 there was always observed, for the experiment was frequently repeat- 
 ed, an evident increase in the action of the heart when the tobacco was 
 loashed off. This was also seen, though in a less degree, when the 
 opium was washed off". Little or none of this debilitating effect was 
 observed when the spirit of wine was used. After its stimulating ef- 
 fect had subsided, the action of the heart returned to only about the 
 same degree as before the application of the stimulus. 
 
 Exp. 13. " The foregoing experiment was repeated on an animal of 
 cold blood. In this case a frog was deprived of sensibility, in less than 
 a minute, by immersing the hind legs in the tincture of opium. Alco- 
 hol, and watery solutions of opium and tobacco, were applied to the 
 brain and spinal cord, as in Exp. 12, and with precisely the same ef- 
 fects. The application and washing offoi the stimulant and sedatives 
 were frequently repeated in this experiment with the same results-
 
 PHYSIOiiOGY. FUNCTIONS. 303 
 
 ft is remarkable that we could affect the motion of the heart by the 
 agents applied to the brain and spinal marrow after they had all 
 ceased to produce an effect on the muscles of voluntary motion through 
 the medium of the nervous system. The action of the heart could be 
 also influenced by these agents applied to the brain and spinal mar- 
 row long after the circulation had ceased.''' Of course, therefore, no 
 action by absorption. 
 
 Exp. 14. " This experiment only differed from the last in the cer 
 vical part of the spinal marrow and lower part of the brain being re 
 moved, and the agents applied only to that part of the brain which 
 lies between the eyes of the frog. Spirit of wine, opium, and tobac- 
 co, thus applied, affected the motion of the heart quite as much, and 
 precisely in the same way, as when they were applied to the entire 
 brain or spinal marrow. 
 
 " The action of the heart, in the foregoing experiment, could be in- 
 fluenced by agents applied to the brain and spinal marrow long after 
 the circulation had ceased." — Note B p. 1113. 
 
 481, d. In Exp. 12, 13, and 14, we have an illustration of the mod- 
 ification of the nervous power according to the nature of the agents 
 employed, while the effects correspond with such as are produced by 
 the same agents when taken into the stomach (§ 226, &c.). It will be 
 also observed that the effects are parallel with those of the different 
 passions ; those of the alcohol corresponding with the effects of anger 
 and joy, and those of opium and tobacco with such as arise from grief, 
 fear, &c. I hold that the doctrine which I have propounded as to 
 modifications of the nervous power is established by these experi- 
 ments ; though abundantly shown by the phenomena arising from 
 morbific and remedial agents. There is no other intelligible solution 
 of the problems which they supply. In the experiments, too, it will 
 be conceded that the nervous power was the efficient remote cause of 
 the results; whence it follows that the nervous power must be in dif- 
 ferent states when it is excited by alcohol, opium, and tobacco, cor- 
 responding with the differences in effects (Rights of Authors, p. 912). 
 
 481, e. The foregoing Exp. 12, 13, and 14, independently of the 
 multitude of other facts, also completely refute the doctrine of the op- 
 eration of moi'bific and remedial agents by absorption. It will be ob- 
 served that in these experiments the action of the heart could be influ- 
 enced by the agents applied to the brain and spinal cord " long after 
 the circulation had ceased." This circumstance, besides its bearing 
 upon the doctrine of absorption, shows us how the heart is roused into 
 action, in cases of syncope, by the application of stimulants to the 
 nose, cold to the surface, &c. (§ 945). 
 
 Exp. 15. '•' The spine of a rabbit was divided near the head, and 
 the spinal marrow destroyed by means of a wire. Spirit of wine was 
 then applied to the brain, which influenced the action of the heart as 
 readily, and to as great a degree, as it does when the spinal marrow 
 is entire" (p. 321, \ 494 e, Exp.— Note B p. 1113). 
 
 481,y! This experiment demonstrates the difficulty of forming prop- 
 er conclusions as to the special functions of the brain and spinal cord, 
 and of different parts of the brain, by any experiments (§ 459, a). It 
 shows, however, that the action of the heart may be as powerfully 
 influenced through the brain when the spinal marrow is destroyed, as 
 when it is entire. The ganglionic nerve resolves the joi^oblem.
 
 304 INSTITUTES OF MEDICINE. 
 
 481, ^^•. I now come to those experiments which farther illustrate 
 the principle concerned in the sudden production of death by blows 
 on the epigastric region, surgical operations, small loss of blood, joy. 
 anger, &c. They also go to interpret the modus operandi of morbific 
 and remedial agents as to their rapidity and intensity, especially when 
 taken in connection with Exp. 10-15, and others which are to follow. 
 The effects now supposed depend on the rapidity and intensity with 
 which the nervous power may be excited, and reflected not only upon 
 the heart, blood-vessels, stomach, &c., but upon the brain itself, as also 
 upon the manner in which the nervous power may be modified by the 
 nature of the agent, as in Exp. 12 and 13. 
 
 If the head and spinal marrow of a frog be removed, the heart 
 continues to perform its functions perfectly for many hours, nor does 
 it seem at all immediately affected by their removal. But, we find 
 the effect very different when the most sudden and powerful agent is 
 applied to them. If they are even destroyed by being sliced away, 
 the heart, after this mode of destruction, beats on as usual. But, if 
 either the brain or spinal cord be instantly crushed, the heart feels it 
 immediately and forcibly. Thus : 
 
 Exj). 16. " The thorax of a large frog being opened, the brain was 
 crushed by the blow of a hammer. The heart immediately perform- 
 ed a few quick, weak contractions. It then lay quite still for about 
 half a minute. After this, its beating returned, but it supported the 
 circulation very imperfectly. In ten minutes after, its vigor was con- 
 siderably restored ; when the spinal marrow was crushed by one 
 blow. The heart then beat quickly and feebly for a few seconds, 
 and then seemed wholly to have lost its power. In about half a min- 
 ute, it again began to beat, and in a few minutes acquired considera- 
 ble power, and again supported the circulation. It beat more feebly, 
 however, than before the spinal man'ow was destroyed. It ceased to 
 beat in about an hour and a half after the brain had been destroyed. 
 In another frog, after the brain and spinal marrow had been wholly 
 removed, the heart beat nine hours, gradually becoming more lan- 
 guid." 
 
 Exp. 17. " The foregoing experiment cannot be performed in the 
 same way on warm-blooded animals, but it may be performed in a 
 way equally satisfactory. In two rabbits the brain was crushed by a 
 blow. In both the heart immediately beat with an extremely feeble 
 and fluctuating motion. The anterior part of the brain only was 
 crushed in another rabbit, with the same result. A strong ligature 
 was thrown around^the neck of a fourth rabbit, and at the same mo- 
 ment it was tightened, the head was cut off". The heart continued 
 beating regularly, in this case, and not more quickly than in health. 
 All the rabbits were of the same age." 
 
 Exp. 18. The following is still more conclusive : 
 
 " The anterior part of the brain of a rabbit was crushed by a ham- 
 mer. No motion of the heart was perceived by applying the hand to 
 the side. The head was cut off*, about three quarters of a minute af- 
 ter the brain had been crushed. No blood spouted out, and very lit- 
 tle ran from the vessels. A strong ligature was passed round the 
 neck of another rabbit of the same age. It was suddenly tightened, 
 and the head cut off". In this instance the heart was found beating 
 regularly under the finger for about three quarters of a minute. At
 
 PHYSIOLOGY. FUNCTIONS. 305 
 
 the end of this time, the ligature was slackened, and the blood spout- 
 ed out to the distance of three feet, and continued to spout out with 
 great force, till nearly the whole blood was evacuated," 
 
 481, li. The last of the foregoing comparative experiments goes 
 with others in demonstrating the error of the common opinion, that 
 when the action of the heart and blood-vessels, or other organic func- 
 tions, fail by crushing the brain, it is owing to the withdrawal of the 
 nervous influence. But, still more conclusive is the fact that the en- 
 tire brain and spinal cord may be removed without any present effect 
 •ipon the actions of the heart and blood-vessels, as in Experiment 7. 
 By this, and other considerations, I have endeavored to show that 
 •allien syncope arises from loss of blood, it is not owing, as has been 
 mpposed, to the failure of the nervous influence upon the organs of 
 circulation, but that this influence increases on the approach of syn- 
 cope, is a principal cause of the paroxysm, and is actually greatest 
 when the paroxysm is complete (§ 947, 948, and Medical and Phys- 
 iological Commentarits, vol. i., p. 168-176). 
 
 482, The preceding experiments determine a variety of important 
 points, of extensive physiological, pathological, and therapeutical ap- 
 plication, and to which brief references were made. The whole should 
 DC viewed in connection, and also with such as are to follow ; while 
 a constant reference should be had to the laws of sympathy, as set 
 forth in the fifth division of our subject. 
 
 Experiments relative to the Arteries in their Connection with the Ner- 
 vous System. 
 
 483, a. The next important step in our inquiry is to ascertain, in a 
 more specific manner than the preceding experiments, how far the ves- 
 sels of circtdation are capable of being influenced through the brain and 
 spinal cord (^ 1040). 
 
 To determine the foregoing problem, it is first necessary to settle 
 another ; namely, how far the vessels of circulation can support the mo- 
 tion of the blood independently of the heart. That the small arteries 
 possess this power in an eminent degree has been already rendered 
 suflttciently certain ,(§ 392, 393. Also, Med. and Phys. Comm., vol. ii., 
 p. 145-151, 398, 422, &c.). But we now arrive at the same knowl- 
 edge by another process. — Note CI p. 1122. 
 
 As a comparative experiment, Philip passed a ligature round all 
 the vessels attached to the heart of a frog, and then cut out the heart. 
 " On bringing the web of one of the hind legs before the microscope, 
 the circulation was foxmd to be vigorous., and continued so for many 
 minutes ; at length gradually becoming more languid." 
 
 Now, if the heart be allowed to remain, whatever impression made 
 upon the brain shall suddenly diminish or arrest the circulation in the 
 capillary arteries, will prove that these vessels, as well as the heart, 
 may be influenced by the nervous power. 
 
 Experiment 19. " The web of one of the hind legs of a frog was 
 brought before the microscope, and while Mr. Hastings obsei^ed the 
 circulation, which was vigorous, Dr. Philip crushed the brain with a 
 hammer. The vessels of the web instantly lost their power, the cir- 
 culation ceasing. In a short time the blood again began to move, but 
 with less force than natural. This experiment was repeated, with the 
 
 U
 
 306 INSTITUTES OF MEDICINE. 
 
 same result. If the hrain he not completely crushed, the blow increases 
 the rapidity of the circulation in the wehy 
 
 The next experiment corresponds with those of the foregoing, which 
 denote that the effects of the neiTOus power upon the organic proper- 
 ties and functions depend upon the manner in which it is developed, 
 modified, and reflected. Will galvanism explain them (^ 893 a) ? 
 
 Exp. 20. " The spine of a frog was laid open at the lower end, 
 and a wire, of nearly the same dimensions with the cavity of the 
 spine, forced through it, as in Le Gallois' experiments. The circu- 
 lation was found to have wholly ceased in the web of the hind leg." 
 
 Now mark the contrast when a small wire was employed ; for, in 
 another frog the spinal cord was destroyed by introducing in the same 
 way, and moving in various directions, a wire much smaller than the 
 cavity of the spine. The frog soon appeared to be quite dead ; but 
 the circulation in the web was found to be vigorous. 
 
 Exp. 21. " Part of the cranium of a frog was removed, the web 
 of one of the hind legs brought before the microscope, and the cir- 
 culation in it observed. The animal was now rendered insensible 
 by the immersion of the other hind leg in laudanum. The insensi- 
 bility did not in the least affect the circulation in the web before the 
 microscope. Spirit of wine was then applied to the brain with an ev 
 ident increase of the velocity of the blood in the web. The same ef- 
 fect was produced in a less degree by watery solutions of opium and 
 tobacco. After the tobacco had been applied for about half a minute, 
 the motion of the blood was much less rapid than before its applica- 
 tion. On washing off the tobacco, the velocity of the blood teas increased, 
 and was again lessened on applying it. This was repeated several 
 times with the same effects. When the circulation in the web had 
 almost ceased after the tobacco had been washed off, its velocity was 
 increased on applying spirit of wine to the brain." 
 
 Analogous experiments, but varied from the foregoing in some of 
 the details, gave the same results. 
 
 483, b. It may be proper to add, that Dr. Hall attempted to inval- 
 idate Philip's, experiments with alcohol, &c., applied to the nervous 
 centres, by repeating just one of them, and that one the least impor- 
 tant of any. It was the least important because it was made upon a 
 cold-blooded animal, and because, also, the state of insensibility was 
 produced by laudanum ; the experiment being no. 21, or the last of 
 the foregoing series. Of that experiment he says that the motions of 
 the heart were not affected on applying alcohol to the brain. It does 
 not appear that he tried the effect of the infusions of opium and tobac- 
 co, nor that he repeated those far more important experiments upon 
 warm-blooded animals. 
 
 The difference in the results is of the easiest explanation. By Dr. 
 Hall's method of producing insensibility by the long-continued and 
 extensive application of laudanum to the surface of the animal the 
 sedative effect of the nervous influence was so powerfully determined 
 upon the circulatory organs, that alcohol, when applied to the brain, 
 failed of rousing the action of the heart. In Philip's experiment it is 
 obvious that the cutaneous application of the laudanum was of short 
 duration, and this was only relative to a few upon frogs. Dr. Hall, 
 indeed, seems to have been aware that this objection might be raised 
 against his experiment ; for he remarks that, " I believe that there
 
 PHYSIOLOGY. FUNCTIONS. 307 
 
 may be one difference between Dr. Philip's experiment and my own 
 (that is), I might apply the laudanum viore effectually^ It is this dif- 
 ference which makes all the difference in the results (^ 484 a, Ex. C. D). 
 
 Finally, the force of Dr. Philip's experiment is increased by the 
 very objection which has been made to the production of insensibility 
 by laudanum ; since his subsequent application of a watery infusion 
 of opium to the brain influenced the heart and blood-vessels as in 
 those cases where insensibility had been effected by other means. 
 And so of the following like experiments by Alston, and by Dr. Hall 
 himself. 
 
 483, c. There is one more fact connected with the present stage of 
 my inquiry, which it may be well to consider, and by which Dr. Half 
 would invalidate, still farther, the conclusion drawn by Dr. Philip 
 from his experiment of crushing the brain. In this experiment the 
 action of the heart is temporarily suspended. Now, Dr. Hall would 
 argue that this suspension is not the result of any special influence ex- 
 ercised by the brain over the heart, during the act of violence, be- 
 cause the same effect will follow when the stomach is violently crushed 
 after removal of the brain and spinal cord. Thus : 
 
 " In an eel, in which the brain had been removed, and the spinal 
 marrow destroyed, the stomach was violently crushed with a hammer. 
 The heart, which had previously beat vigorously sixty times in a min- 
 ute, stopped suddenly and remained motionless for many seconds. It 
 then contracted ; after a long interval it contracted again, and slowly 
 and gradually recovered an action of considerable frequency and 
 vigor." 
 
 Dr. Hall, therefore, argues that the nervous system had no agency 
 in transmitting influences of the injured stomach to the heart, and 
 that, " the organic structures (meaning others than the nervous) must 
 have been the medium through which the effect of the violence was 
 conveyed to the heart." 
 
 I need not go far to indicate the capital error of Dr. Hall's conclu- 
 sion, so opposed to the phenomena of the passions, and the well-knowTi 
 effects of cerebral hemorrhage, and blows upon the head. It is suffi- 
 cient, notwithstanding the removal of the brain, and the desti-uction ot 
 the spinal cord, in the case of the eel, that the whole ganglionic sys- 
 tem, all the spinal nerves, and the pneumogastric besides, remained 
 entire. It was therefore through this vast range of most important 
 nerves, through the great solar plexus of the sympathetic, through the 
 whole of the anancephalous system of nei-ves (§ 461^), that the ner- 
 vous influence was propagated to the heart by crushing the stomach 
 of the animal. Had, however, the brain and spinal cord been per- 
 mitted to remain, the demonstrations of nervous influence upon the 
 heart would have been more strongly pronounced. Nor was it a fair 
 experiment to have selected a cold-blooded animal, and so tenacious 
 of life as the eel, to contrast an important result with such as had 
 been obtained by a very different experiment upon a warm-blooded 
 animal. — Note B p. 1113. 
 
 But, as I have said, slight blows over the stomach of a man may 
 destroy his life in an instant, when they would be haiToless to an eel. 
 Hunter, and others, relate instances of instant death when extirpa- 
 ting a testicle, or performing minor operations ; and Mr. Travers, and 
 others, from lancing a thecal abscess of the finger, and other similar
 
 308 INSTITUTES OF MEDICINE. 
 
 slight causes. Here, it cannot be denied, that a fatal nervous influ- 
 ence was thus reflected over the whole frame of a man, without call- 
 ing to the explanation "the ten thousand" facts that are well estab- 
 lished as to the influence of the nervous power upon organic actions; 
 while we thus anive at the obvious conclusion, that it is through the 
 same principle blows upon the epigastrium, crushing the liver, and 
 similar injuries, produce their fatal effects. 
 
 But, if we concede to Dr. Hall the inconsistency in which he is in- 
 volved by his experiment, and by his dii'ect affirmation that sympa- 
 thies in organic life are owing to the mutual influences of organs among 
 each other, and without the agency of the nerves with which they are 
 supplied, it would not affect the principle which relates to sympathy 
 in its aspect of an important law which is constantly concerned in dis- 
 ease and in the operation of remedial agents. The dispute would then 
 turn only on the nature of the cause upon which the function of sym- 
 pathy depends ; while the very cases of disease which Dr. Hall pro- 
 duces to illustrate the existence and nature of the principle are fatal 
 to his humoral hypothesis, and go to my doctrine of reflex nervous action. 
 But the accuracy of all Dr. Philip's experiments has been fully as- 
 certained by numerous physiologists. 
 
 484, a. I shall now introduce a series of experiments by other hands 
 which illustrate, still farther, the applicability which I have indicated 
 as to the preceding experiments. 
 
 In the Edinburgh Medical Essays for 1733, vol. v., p. 128, are to be 
 found the first experiments which I shall now mention, and which ap- 
 pear to have been neglected by later observers. They were made by 
 Dr. Alston, who had no theory in view to embarrass his vision or 
 judgment ; and yet I have met with no reference to them. 
 
 Exp. A. " I conveyed," says Alston, " through a small glass tube a 
 ie-vf drops of a solution of opium in water into a frog's stomach, and 
 putting the animal into a glass cylinder, adapted it so to a good mi- 
 croscope, that we had a distinct view of a part of the membrane be- 
 tween the toes of its hinder foot, where the circulation of the blood 
 may be easily seen. My design was, since I found opium killed frogs, 
 to observe if there was any visible change made by it in the blood it- 
 self, or in its motion. Neither of us could, indeed, see any alteration 
 of the blood as to its consistence, color of the serum, magnitude, fig- 
 ure, or color, of the red globules ; hut we very distinctly saw a surpris- 
 ing diminution of the hlood's velocity, for it did not move half so swift- 
 ly as it naturally does in those creatures. We alternately looked at it, 
 again and again, and in less than half an hour saw the velocity of the 
 hlood gradually increase. The uneasy frog recovered its wonted vig- 
 or, and the blood its common velocity." 
 
 The foregoing experiment was repeated, after awhile, upon the same 
 frog. Alston goes on thus : 
 
 Exp. B. " I put the frog into a basin of clean water, and allowed it 
 half an hour to refresh itself; then gave it another dose of opium. The 
 blood then moved yet slower than it did the first time, and its velocity 
 gradually decreasing, it at length stagnated, first in the smaller, then 
 in the larger vessels, and in about a quarter of an hour the animal died."* 
 The experiments were frequently repeated, with the same results. 
 
 Exp. C. The following experiment was performed by Dr. Marshall 
 Hall: 
 
 * WuYTT, in 1755, made similar experimenta with the same effect. — WoBKS, 4to, p. 310-327 So3 
 
 Isoic, p. 320.
 
 PHYSIOLOGY. FUNCTIONS. 309 
 
 " I applied laudanum," he says, " over the back part of a frog, care- 
 fully avoiding its contact vv^ith the web. In less than half an hour, its 
 respiration and all sensibility had ceased, and the capillary circulation 
 became, at the same time, more indistinctly pulsatory in the arteries, 
 and more and more slow and feeble in the capillary vessels and veins. 
 This effect became gradually more marked, and in two hours the cir- 
 culation Jiad ceased almost entirely in all the three sets of vessels. 1 
 now washed off the laudanum, and placed the frog in water. The cir- 
 culation at first gradually , afterward more speedily, returned, and he- 
 came very vivid and vigorous, even before there was the slightest 
 RETURN OF RESPIRATION (§ 441, d). The respiration and sensibility at 
 length also returned completely. The laudanum was reapplied and 
 again removed with precisely the same effects. The insensibility was 
 SO perfect that the eyes w^ere not retracted on being touched. The 
 recovery was prompt and complete." — See § 483 h. 
 
 Exp. D. The foregoing experiment was repeated with opium and 
 water ; when the effects were less rapid, but " at length the circulation 
 in the web ceased, and the animal became affected with complete te- 
 tanus." 
 
 Exp. E. " The same effect was produced more speedily on indu- 
 cing the animal to swallow a few drops of the opiate solution."* 
 
 484, b. I have now to notice six principal points relative to the ex- 
 periments A, B, C, D, and E. 
 
 1st. In Dr. Hall's experiments (C and D), the opium was applied 
 to the skin exclusively. 
 
 2d. The effects were exactly the same as obtained by administering 
 opium by the stomach (Exp. A, B, and E). 
 
 3d. The effects in both cases were similar to those obtained by 
 Philip from applying opium to the brain, both in cold and warm- 
 blooded animals. 
 
 4th. The experiments by Hall and Philip fully corroborate the ob- 
 vious conclusion from Alston's (Dr. Hall's being only a repetition of 
 Alston's), that opium does not produce its effects by absorption into 
 the circulation (as is especially supposed of this agent), since in all 
 the experiments, and the same with tobacco in all (§ 483, Exp. 
 21), the effects upon the circulation went off as soon as the solu- 
 tions were washed from the skin, or from the brain, and returned 
 when they were again applied, and again promptly disappeared when 
 the solutions were washed off. Brodie's experiment with tobacco is 
 also in direct proof of its universal operation through the nervous 
 centres (§ 904, b, 1088 h, c).t -Notes B I pp. 1113, 1118. 
 
 5th. It appears from the foregoing facts, that the circumstances at- 
 tending the effects of opium upon the system at large are the same, 
 whether it be applied to the nervous centres, to the stomach, or to the 
 skin. It follows, therefore, in connection with what is known of the 
 influences which the brain and spinal cord may exert on the actions 
 of organic life, that the remote effects of opium, applied to the stom- 
 ach or skin, are produced by a modification and reflected action of the 
 nervous power upon distant parts (§ 224, 226, &c.). 
 
 Here, then, we see, more and more clearly, the propriety of the ap- 
 
 Elication which I have made of Philip's experiments, and which will 
 ecome more strikingly obvious by connecting them with the sequel, 
 • Hall, on the Influence of the Brain and Spinal Marrow upon the Circulation, p. Ill 
 
 t Whttt applied opium to a frog after destroying the brain and spinal cord, when the heart waa 
 
 much lesa affected than when applied in the natural state. — Works, p. 513 See § 483 c, aa to syrrf 
 
 patlietic nerve, and § lOSS b, as to skin.
 
 i)10 INSTITUTES OF MEDICINE. 
 
 and with the lesults of Sir C. Bell's discovery. Let us suppose, for 
 instance, that we have no other knowledge of the principle upon which 
 remote sympathy depends, than the natural phenomena which are con- 
 stantly manifested. We should certainly know, from these results, 
 that such a principle exists ; but where, or how developed, or how 
 varied in its influences, we could not know with certainty without di- 
 rect experiment. With the advantage, therefore, of such experiments 
 as Philip's, we arrive at the clearest demonstration of the manner in 
 which effects now under consideration are brought about, and thus put 
 an end to the worst speculations in medicine. But, before reasoning 
 from these experiments we should know the manner in which impres- 
 sions are transmitted to the brain and spinal cord by the nerves of 
 sensation, how they are reflected from these central organs, and the 
 obvious results which follow in animal life, and how these results cor- 
 respond with similar effects in organic life (§ 500). The foundation 
 of an important philosophy is thus laid by demonstration, and render- 
 ed acceptable to those who rely only upon the plainest testimony of 
 sense (§ 234). 
 
 6th. Again, I say, since the action of opium, through the stomach 
 or skin, upon remote parts, is different from that of tobacco, alcohol, 
 &c., and since each produces, respectively, the same effects when ap- 
 plied directly to the brain or spinal cord, and, in all the cases, by ex- 
 citing and reflecting the nervous power, it follows that this power, like 
 the organic powers, is capable of being modified in its nature accord- 
 ing to the nature of the causes by which it is developed (§ 224-233, 
 494 c).— Note B p. 1113. 
 
 485. Finally, Kriemer has multiplied experiments to a great extent 
 with reference to the part which the arteries take in the circulation, 
 and they all concur in proving their independent action, and that they 
 may be powerfully affected by impressions made upon the nerves. 
 When he tied the crural nerve of quadrupeds it lessened immediate- 
 ly the jet of blood from the femoral artery. The same experiment 
 on frogs arrested the capillary circulation in the web of the foot. 
 What is also an important fact as showing an alteration of the organic 
 properties of a part by the nervous influence, he observed that the ar- 
 terial blood passed on to the veins without being converted into ve- 
 nous blood (§ 399, 507, 952)=^— Note a p. 1122. 
 
 3d. On the Principle on which the Action of the Muscles of Voluntary 
 Motion depends, and the Relation which they hear to the Nervous 
 System. 
 
 486. Philip next proved by experiments that the muscles of volun- 
 tary motion, like the heart and blood-vessels, are independent of the 
 brain and spinal cord, as it respects their excitability and power of 
 motion ; but that they are alike capable of being stimulated through 
 the nervous system. "We do not, surely," he says, "in the experi- 
 ments which have been laid before the reader, see any difference in 
 the nature of the muscular power of the heart, and that of the muscles 
 of voluntaiy motion, except their being fitted to obey different stimuli ; 
 a difference which we find in the two sides of the heart itself" (§ 136, 
 188i-190). Nevertheless, the nerves supply the mmeJzate stimulus. 
 
 * This anticipates the analogous experiments which have been lately made by CI. 
 Bernard.— 18G0.
 
 PnyslOLOGY. FUNCTIONS. 311 
 
 4th. Interesting Experiments were made hy Philip to ascertain the 
 comparative Effects of Stimuli applied to the Brain and Spinal Mar- 
 row on the Heart and Muscles of Yoluntary Motion. 
 
 487, a. I shall state only a few of the important practical conclu 
 sions. Thus : " Another circumstance, which appears to be of gieat 
 importance in tracing the cause of the different effects of stimuli ap- 
 plied to the brain and spinal marrow, or the muscles of voluntary and 
 involuntary motion, is, that the heart obeys a much less powerful stim- 
 ulus than the muscles of voluntary motion do. We have seen that 
 only the most powerful chemical stimuli affect them, while all that 
 were tried readily influenced the action of the heart and blood- 
 vessels." This should be considered with § 493 cc^ 500 m, 687-|^-688. 
 
 487, h. The foregoing shows us the distinction between the irrita- 
 bility of the heart and voluntary muscles, &c., how it is differently af- 
 fected in organic and animal life by the same agents, how the nervous 
 power acts upon that irritability according to the nature of the agents 
 by which it is excited, whether they be applied directly to the nervous 
 centres or to the stomach, &c. (§ 133-162, 1881-190, 205, 206, 208, 
 209, 222-233, 256, 484, 500 m, 826 cc, 893^). ' 
 
 487, c. It is also an important fact, as well in a therapeutical as 
 physiological sense, and especially as distinguished from the action of 
 the will and other things (§514 d), that, as the animal approached a 
 state of death, he found that, "after all stimuli applied either to the 
 brain or spinal cord had ceased to produce any excitement in the mus- 
 cles of voluntary motion, both chemical and mechanical stimuli, so ap- 
 plied, still increased the action of the heart ; and the irritating agents 
 more than the mechanicar (§ 224, 500 m, nn, 637, 694f, 829, 893 L). 
 
 487, d. It was also found by comparative experiments on the ac- 
 tions of animal and organic life, " that irritating or depressing agents, 
 such as alcohol, alkalies, opium, tobacco, &c., applied to the brain, 
 and spinal cord, exert a greater power over the heart than mechani- 
 cal stimuli (such as variously injuring the structure of the brain), 
 while the mechanical stimuli exert a greater power over the muscles 
 of voluntary motion than the agents possessing peculiar intrinsic vir- 
 tues" (References above). 
 
 487, e. Again, it was found " that stimulating every part of the 
 brain and spinal cord equally affects the action of the heart (also, the 
 stomach and lungs), while the muscles of voluntary motion are only 
 excited by stimuli applied to the parts of those organs from which 
 their nerves originate ; that stimuli applied to the brain and spinal 
 cord never excite irregular action of the heart, while nothing can be 
 more irregular than the action they excite in the muscles of voluntary 
 motion ; that their effect on those muscles is felt chiefly on theiv first 
 application, but continues on the heart (and blood-vessels) as long as 
 the stimulus is applied^'' (§ 233|^, 506, 516, no. 6). 
 
 487, y! In connection with this comparative inquiry, Philip has a 
 remark which is worthy of deep consideration. " It is tme," he says, 
 " that although the heart is only influenced by agents applied to a 
 large portion of the brain, we may conceive them so applied as to 
 produce irregular action in it; and we find that certain irritations of 
 the nervous system have this effect. But it is evident that the heart, 
 not being subject to stimuli whose action is confined to a small por-
 
 312 INSTITUTES OP MEDICINE. 
 
 tion of this organ, and being equally affected through all parts of it; 
 must render it much less subject to irregular action ; which may be 
 one of the final causes of the heart (whose regular action is of such 
 importance in the animal economy) being made subject to the whole, 
 and not to one part of the brain, and readily accounts for our not be- 
 ing able to produce irregular action in it by experiments upon the 
 brain and spinal marrow." " When, indeed, the source of the nerves 
 of the heart is considered, it will be found to derive its nei-vous influ- 
 ence from every part of the nervous system, and not very remarkably 
 from any one pait; a circumstance which particularly corresponds 
 with the results of the foregoing experiments," — and with the phe- 
 nomena of sympathy as manifested in disease (§ 500 ??i, 1032 (?), 
 
 Analogous observations are also applicable to all the other organic 
 viscera ; which farther proves that a great final cause of the gangli- 
 onic system is to unite the organs of organic life in one concerted 
 action, while, also, it subserves their functions {^ 488^, 46H a, 1041). 
 
 487, g. By the same facts we may explain why the heart and other 
 organic viscera are affected through the brain, and spinal cord, after 
 their power is so far weakened as no longer to convey the influence 
 of a stimulus to the muscles of voluntary motion. As these muscles 
 obey stimuli applied to only a part of the brain, or spinal cord, where 
 the nerve supplying a muscle originates, if the impression on this part 
 be not sufficiently strong to produce a muscular movement it cannot 
 be assisted by any other part of the brain or spinal cord. Thus, it 
 was found by Dr. Philip, " that a blow which affects the brain gener- 
 ally, without materially injuring it, produces comparatively little ef- 
 fect on the muscles of voluntary motion, because no one part of the 
 brain suffers greatly ; but it produces a great effect on the heart, be- 
 cause this organ feels the su?n of all the impressions. (And so of the 
 stomach, liver, intestines, &c.) The nervous system, therefore, may 
 be so far exhausted (or affected) as not to admit of the vivid impres- 
 sions necessary to excite the muscles of voluntary motion, and yet ca- 
 pable of those which influence the heart," blood-vessels, &c. This is 
 strikingly seen in apoplectic affections. — Note B p. 1113. 
 
 The philosophy of this subject is farther explained in the following 
 luminous manner by Dr. Philip : " Here," he says, " the question 
 arises, by what means is the one set of organs (that is, the heart, 
 stomach, &c.) subjected to the influence of evei-y part of the brain 
 and spinal man-ow, while others are influenced by only small parts 
 of those nervous centres % In these latter instances, we see directly 
 proceeding from those small parts the nerves of the parts influenced. 
 In the former instances, we do not see, in any case, nerves going di- 
 rectly from all parts of these organs to the parts influenced ; but we 
 always see this part receiving nerves from a chain of ganglions, to 
 which nerves from all parts of the brain and spinal marrow are sent. 
 It is therefore evident, from direct experiment, that the nerves issu- 
 ing from the ganglions convey to the parts, to which they send nerves 
 the influence of all the nerve(8 which terminate in these bodies." 
 
 By the same philosophy, so clearly founded in nature, we readily 
 interpret the vast extent of influences which may be propagated from 
 the stomach, or other parts in organic life, by morbific and remedial 
 agents, through impressions transmitted to the brain and spinal cord 
 by way of the ganglionic system ; while, also, all parts of the nervoup
 
 PHYSIOLOGY. FUNCTIONS. 313 
 
 centres may be influenced in their organic condition by impressions 
 upon any distant part (§ 230). This apphcation, too, of the foregoing 
 philosophy is divested of prejudice, since it was not contemplated by 
 the experimenter [^ 1038). 
 
 487, gg. " The following case, related by the distinguished Di. 
 Parry, on the arterial pulse, might alone be regarded as proving the 
 existence of two sets of nerves in the extremities; the one supplying 
 the muscles of voluntary motion, the other the powers supporting the 
 circulation, and strikingly illustrates what has been said on this sub- 
 ject. 'I have seen,' says Parry, 'a total loss of pulse in one arm 
 with coldness, but complete power of motion in that part ; while the 
 other arm was warm, and possessed a perfectly good pulse, but had 
 lost all power of voluntary motion' " (§ 113, 224, 399, 500 nn, 893^). 
 
 487, h. We may now readily perceive, from the vast difference in 
 the results between the influence of the nervous power upon animal 
 and organic life, how the muscular power, or strength, as it is usually 
 called, may be excessively prostrated at the invasion of disease, while 
 organic actions may be as greatly increased, or if depressed, they may 
 be so modified as to require the application of remedies from which 
 we might shrink if we regarded alone the prostration of the voluntai'y 
 muscles. It is an ignorance of the principle which operates in these 
 cases (as in the vast range of congestive fevers), and reasoning from 
 the prostration of muscular power to a supposed analogous state of 
 the great powers of life, and thus mistaking mere prostration of ani- 
 mal life for absolute "debility''^ of the organic viscera, that has led so 
 extensively to the administration of stimulants and tonics, where 
 bloodletting and analogous agents are most imperatively required. 
 The mind, too, is inoperative in all these conditions, and the volun- 
 tary muscles languid, in consequence ; and the very failure of the 
 will to rouse them into action, where drowsiness has contributed its 
 effect, has been often regarded as an evidence of that " debility'''' 
 which calls for the "stimulant plan of treatment" (§ 473, 961,893^). 
 
 It cannot, therefore, be too strongly enforced, that in all cases of 
 sudden prostration at the invasion of fever the nervous power has a 
 principal agency in the phenomenon, — that its influences on animal 
 and. organic life are widely different, — that it simply fails to stimulate 
 the voluntary muscles, and hence the greater amount of apparent 
 "debility ;" while in relation to the organic processes, it has been so 
 modified as not only to exalt, or perhaps depress, the forces of life, 
 but to alter profoundly their very nature (§ 476 c, 500 h, nn, 893^). 
 
 There is nothing in the whole range of medical philosophy so prac- 
 tically important as these considerations (§ 569, 961, 967). It is a 
 subject, however, which requires thought for its proper understand- 
 ing, as well as a comprehensive view of profound laws in physiology. 
 It is therefore repulsive to the many, who will rather rest upon the 
 simple chemical and physical hypotheses than contemplate Nature in 
 her dignified and rational aspects. The charm of simplicity which 
 hung around the celebrated theory of John Brown encircles, also, the 
 humoral and other chemical hypotheses, and adds its fatal delusion to 
 those prevailing doctrines (1068 a). — Notes Ee p. 1133, Ff p. 1135. 
 
 488. An important remark is made by Philip at the close of his 
 experiments relative to the functions of the heart, blood-vessels, and 
 voluntary muscles, and their essential independence of the nervous
 
 314 INSTITUTES OF MEDICINE. 
 
 system, which goes to corroborate the conclusions I have draAvn as to 
 the agency of the nervous power in the healthy and morbid processes, 
 of its modifications according to the nature of the agents by which it 
 is developed, &c. ; and this the more so, as Dr. Philip had formed no 
 such inferences, but regarded the nervous power as the galvanic fluid, 
 stimulating the various parts of the system, and a mere chemical agent 
 in the formation of the secretions. I refer particularly to the clause 
 in italics. 
 
 " It not only appears," says Dr. Philip, " from the experiments 
 which I have laid before the reader, that the power of the heart and 
 vessels of circulation is independent of the nervous system, but that 
 that of the muscles of voluntary motion is so likewise, and that these, 
 like the former, are only suhjected to this system in the same way in 
 which they are suhjected to every other agent that is capable of exciting 
 them. Thus we find, that all the moving powers of the animal body, 
 as far as we have hitherto traced them, are independent of the ner- 
 vous system, but that this system is equally capable of acting as a 
 stimulus to them, although in different ways, whether they are subject 
 to the influence of the will or not" (§ 133-162, 188|-190, 222-233, 
 205, 206, 208, 209, 256, 476 c, 484, 500 h, m, 826 cc, 893^). 
 
 488^. I shall now advert, once more, to the remarkable distinction 
 between the operations of the nervous power as manifested in animal 
 and organic life (§ 90-110). In animal life, the nervous power con- 
 stantly influences, in a sensible manner, all the involuntary actions, 
 and is obedient to the will in respect to all the voluntary muscles 
 (§ 245, 476 c, 500 /*). Its intensity of action, and consequent mani- 
 festations, depend upon the force or intensity of the exciting causes. 
 For these habitual functions of the nervous power the cerebro-spinal 
 system is specifically pi'ovided. Coming to the organs of organic life, 
 we find them supplied with a system of nerves remarkably different 
 from the cerebro-spinal, and a corresponding difference in the laws of 
 nervous influence. This system serves as a medium through which the 
 cerebro-spinal operates in organic life, possesses in its ganglia centres 
 of reflex action which combine tributary influences from different parts 
 of the cerebro-spinal, unites the organic viscera, supplies the stimulus 
 to organic muscular tissue, and contributes a vitalizing effect upon or- 
 ganic compounds through a modifying influence upon the organic func- 
 tions (§ 224, 220, 409 k, 456 a, 461^ a, 473 c, 475^, 500 m, 893 a, c.) 
 
 But there is this coincidence in the actions of the two lives ; name- 
 ly, the power which generates motion, both in animal and organic life, 
 is independent of the nervous system (§ 205-215); but the nervous 
 power is equally capable of influencing its operation, though in differ- 
 ent modes (§ 226-233, 454-461^, 500, 893i). 
 
 489. The question is investigated by Philip, ^^ whether the power of 
 secretion is also independent of, though influenced by, the nervous system." 
 
 Though settled by experiment, the analogies supplied by the vegeta- 
 ble kingdom are amply conclusive that the nervous system is only an 
 excitant to the function of secretion, and dispenses a modifying influ- 
 ence upon organic compounds (§ 224, 409 h, 456 a, 461^ a, 488^, 893^). 
 
 From Philip's, and the experiments of others, it results, for exam- 
 ple, that a division of the pneumogastric nerves either destroys or 
 greatly impairs the digestion of food. But, says Philip, " it deserves 
 notice, that the food, in such cases, is found covered with apparently
 
 PHYSIOLOGY. — FUNCTIONS. 315 
 
 the same semi-fluid which we find covering the food in a healthy stom- 
 ach ;" and " the lungs are found distended with a frothy fluid, which fills 
 the bronchi and air-cells" (§ 461). 
 
 It follows, therefore, that the function of secretion, and its products, 
 are so far independent of the nervous system as to be only influenced 
 through that system. Such is the inevitable conclusion from the ex- 
 periments themselves ; and yet their author was led into an important 
 error by his hypothesis of the identity of the nervous power and gal- 
 vanism (§ 409 h/i, k, 493 cc, 893^, 902, 905 a, 1040). 
 
 5th. On the Principle on which the Action of the Alimentary Canal depends. 
 
 490. Philip destroyed separately, and simultaneously, the brain and 
 spinal cord, and, in other instances removed both at the same time. 
 In all the cases " the motion of the stomach and intestines continued 
 till the parts became cold, so that when the intestines exposed to the 
 air have lost their power, that of those beneath still remains." " It 
 appears from these experiments that the power of the stomach and in- 
 testines, like that of the heart and blood-vessels, resides in themselves, 
 and is wholly independent of any influence derived from the nervous 
 system." This is true as to the moving jwwer ; but the experiment is 
 defective in neglecting the sympathetic nerve, by whose reflex action 
 the peristaltic movements were maintained (§ 889 g). In § 476^ c the 
 air and mechanical irritation were equivalent to the stimulus of the 
 nervous power (§ 473 c, 478 b, 483 c, 462-464, 498 e). 
 
 6th. On the Itelation which the Alimentanj Canal and Lungs hear to the 
 
 Nervous System. 
 
 491. Direct experiments, as in the foregoing cases, by agents ap- 
 plied to the brain and spinal cord, show that the stomach, intestines, 
 and lungs may be influenced through the nei'vous centres. '' It often 
 appeared," says Philip, " that spirit of wine applied to the brain and 
 spinal marrow increased the motion of the canal ;" that " the stomach, 
 like the heart, is capable of being influenced by every part of the brain 
 and spinal marrow" (§ 487 g). For these important investigations the 
 reader is referred to the work itself. 
 
 Review of the Inferences from the preceding Experiments. 
 
 492. The following inferences are made by Dr. Philip in relation to 
 his various experiments, and it will be seen that they are generally 
 correct, and may be applied to the most important problems in phys- 
 iology and practical medicine : 
 
 1. " That the vessels of circulation possess a power capable of sup- 
 porting a certain motion of the blood independently of the heart. 
 
 2. " That the power both of the heart and vessels of circulation is 
 independent of the brain and spinal marrow. 
 
 3. " That the nervous influence is capable of acting as a stimulus 
 both to the heart and vessels of circulation. 
 
 4. " That the nervous influence is capable of acting as a sedative 
 both to the heart and vessels of circulation, even to such a degree as 
 to destroy their power. 
 
 5. " That the effect of the sedative is not the result of an excess of 
 stimulus, but, like excitement, the direct operation of the agent. 
 
 6. " That the power of the muscles of voluntary motion is independ-
 
 316 INSTITUTES OF MEDICINE. 
 
 ent of the nervous system, and that their relation to this system is of the 
 same nature with that of the heart and vessels of circulation, the ner- 
 vous power influencing them in no other way than as other stimuli 
 and sedatives do. 
 
 7. " That the cause of the muscles of voluntary and involuntary mo- 
 tion appearing, at first view, to differ essentially in their nature, is their 
 being excited by stimuli essentially different ; the former being al- 
 ways excited by the nervous influence, the latter, though occasionally 
 excited by this influence, in all their usual functions obeying other 
 stimuli. [This must be qualified as in § 456 a, 461^ a, 488^, 893^.] 
 
 8. " That the brain and spinal marrow act, each of them, directly 
 on the heart, as well as on the muscles of voluntary motion, 
 
 9. " That the laws which regulate the effects of stimuli applied to 
 the brain and spinal marrow, or the heart and muscles of voluntary 
 motion, are different. 
 
 [This affirmation can be made only of certain diffei'ences in the modea 
 in which vital agents affect the heart and voluntary muscles. A com-- 
 mon principle is at the foundation of the whole (§ 500, h, 893^).] 
 
 10. " That mechanical stimuli applied to the brain and spinal mar- 
 row are better fitted to excite the muscles of voluntary motion, and 
 chemical stimuli the heart. 
 
 11. " That the heait obeys a much less powerful stimulus applied to 
 the brain and spinal marrow than the muscles of voluntary motion do. 
 
 12. " That stimuli applied to the brain and spinal maiTow excite 
 irregular action in the muscles of voluntary motion. 
 
 13. " That no stimulus applied to the brain and spinal marrow ex- 
 cites irregular action in the heart or vessels of circulation, nor is their 
 action rendered irregular by sedatives, unless a blow, which crushes a 
 considerable part of the brain or spinal marrow, be regarded as a sed- 
 ative. 
 
 14. " That the excitement of the muscles of voluntary motion takes 
 place chiefly at the moment at which the stimulus is applied to the 
 brain and spinal marrow, while that of the heart may generally be per- 
 ceived as long as the stimulus is applied. 
 
 15. " That after all stimuli applied to the brain and spinal marrow 
 fail to excite the muscles of voluntary motion, both mechanical and 
 chemical stimuli, so applied, still excite the heart. 
 
 16. " That the vessels of secretion, like the vessels of circulation, 
 are independent of, but influenced by, the nervous system. 
 
 17. " That the peristaltic motion of the stomach and intestines is 
 independent of the nervous system, [excepting its stimulus ^ 478 i]. 
 
 18. " That their motion is capable of being influenced through the 
 nervous system. 
 
 19. " That the stomach and lungs, like the sanguiferous system, are 
 influenced by every part of the brain and spinal marrow. 
 
 20. " That the proof of the vessels possessing a principle of motion in 
 dependent of their elasticity, which bears the same relation to the ner- 
 vous system as the excitability of the heart, not only as far as respects 
 the kind of influence which they derive from that system, and the 
 way in which it is supplied to them, but also as far as respects the pur- 
 poses for which it seems to be bestowed on them, affords a strong ar- 
 gument for believing that this power is of the same nature with thaf 
 
 )f the heart."
 
 PHYSIOLOGY. FUNCTIONS. 311 
 
 493, a. It is remarkable that the sagacious mind of Dr. Philip should 
 have fallen into the error of deducing fi-om his experiments the iden- 
 tity of galvanism and the nervous power, and the dependence of the 
 secreted substances upon that principle. " The vessels of secretion," 
 he says, " only convey the fluids to he operated upon by the nervous in- 
 fluence." Here the " influence" is regarded strictly as a chemical 
 agent. But, at the same time, he unavoidably concludes that "the 
 vessels of secretion, like the vessels of circulation, are independent of, 
 but influenced by, the nervous system ;" galvanism, however, being 
 the supposed agent in all the cases.* And yet Dr. Philip, through 
 the light of galvanism, is led to the contradictory statement, " that, 
 although the powers of circulation are independent of the nervous 
 system, those of secretion are very far from being so." And, as to 
 the products themselves, had he, or had others subsequently, consid 
 ered the simplicity of the laws of Nature, and the remarkable Unity 
 of Design which prevails in the fundamental constitution of all organic 
 jDeings, from the humblest plant up to man, it never could have been 
 entertained that the powers which circulate the blood, like those of 
 the sap in the vegetable kingdom, and govera the action of the secre- 
 ting vessels, are not derived from the nervous system, and yet that the 
 formation of the secreted products is the work of the nerves. There 
 is nowhere in Nature so great a violation of consistency ; while, also, 
 /secretion is just as much a function of vegetables as of animals (§ 638). 
 I am not, however, unmindful of the indisposition to predicate of final 
 causes, or of any obvious Design, the intentions to be fulfilled, or any 
 principle in philosophy which maybe involved in the Plans of the Cre- 
 ator (§ 350y, kk). But, since every thing in nature emanates from its 
 fundamental constitution, I can have little doubt that we shall be grad- 
 ually led to recognize the connection of philosophy with the Works 
 of its Author, and to acknowledge that in all philosophy we are em- 
 ployed in seeking out the Institutions which He spoke into existence, 
 and in doing which we may derive much assistance from going be- 
 yond the immediate phenomena, and thus, also, render philosophy 
 and natural Religion, and of course, therefore, Revelation, subservient 
 to each other, 
 
 493, b. Dr. Philip also adopted the eiTor, which had been long 
 propagated, of regarding the brain as a mere galvanic battery, and 
 of course designed for the generation of galvanic fluid, and thus gave 
 a farther impulse to those chemical hypotheses of life which have so 
 extensively usurped the place of medical philosophy, was compelled 
 to embrace these hypotheses himself, and thus to advance the very 
 eiTors which have contributed to obscure the light which his experi- 
 ments reflect upon every department of medicine (§ 350, nos. 5, 18- 
 20, 42). It was his misfortune to have come upon the stage just at 
 the overthrow of that philosophy which had been so highly advanced 
 by Hunter, Bichat, Cullen, and their compeers, and the revival of the 
 exploded physical and chemical doctrines of life, and of the humoral 
 pathology. But his experiments must endure forever. 
 
 493, c. Again, having assumed that " the brain and spinal marrow 
 are necessary to the function of secretion," Philip raises an objection 
 vvrhich he foresaw would prevail. This objection consists in the ma- 
 
 * See Medical and Physiological Commentaries, vol. i., p. 52-68, 107-119, where the 
 snbjcct of galvanism is ftiUy examined.
 
 318 INSTITUTES OF MEDICINE. 
 
 turily of the foetus without brain and spinal cord ; and to defend tb^ 
 chemical hypothesis, and the assumed identity of the nervous power 
 and galvanism, and neglecting the sympathetic nerve, he assumes, that, 
 when the brain and spinal marrow are absent, the uterus performs the 
 functions of those parts to the foetus ; that is, it acts exactly as the 
 brain and spinal cord in supplying the nervous power.* But this con- 
 jecture, independently of the absence of every fact, is contradicted by 
 the total want of the requisite analogy between these two systems of 
 organs. To give gi-eater plausibility to the hypothesis, Philip remarks, 
 that " no writer has before attempted to explain the difficulty." 
 
 493, cc I shall have introduced many flicts to disprove the depend- 
 ence of animal products upon galvanism or catalysis. The agency 
 of the former, as we have seen, is positively contradicted by the fact 
 that plants, which are destitute of nerves, generate compounds very 
 similar to animal (§ 409 hli) ; and farther on is an argument drawn 
 from the electrical circle (§ 893 a). Again, cerebro-spinal nerves sim- 
 ply excite the voluntary muscles, while the sympathetic not only excites 
 the organic muscular tissue, but exerts a peculiar vitalizing influence 
 upon the organic products (§ 893^). Now, I submit that no reason 
 can be assigned why galvanism should, according to Chemistry, act as 
 a decompounding agent upon the blood when exercised through the 
 sympathetic nerve, but not through cerebro-spinal nerves — especially 
 as Chemistry alleges that it is an oxydizing agent of all muscular fibre. 
 It need scarcely be added that whatever nervous influence is exerted 
 upon the blood, it is, in all parts, through the sympathetic nerve (§ 
 111-117, 224, 226, 356 a, 409 lih, h, 456 a, 461, 475^, 488|, 893i). 
 
 493, d. Moreover, the eminent man who has contributed so largely 
 to the philosophy of life falls into another common error now taught 
 by the schools. Thus : " It is not to be overlooked," he says, " that 
 the vessels convey the fluids to be operated upon by the extreme parts 
 of the nervous system in a peculiar Avay. By the diminished capacities 
 of the capillary vessels the blood is divided as by a fine strainer, some of 
 its parts being too gross to enter the smaller vessels." " This," he adds, 
 " is necessary to prepare the blood for the due action of the nervous 
 influence" (§ 188, &c., 399, 408-411, 748). 
 
 Now, what can be more inadmissible than the comparison of the liv- 
 ing, organized vessels, whose actions are j^roved by Dr. Philip to be in- 
 fluenced by the nervous power, to a set of dead, inorganic tubes ? 
 
 In consequence of the foregoing mechanical hypothesis. Dr. Philip is 
 compelled to give in his adhesion to the present physical doctrines of 
 inflammation, as set forth in the sequel (§ 748, &c.). This, too, may 
 be regarded as a principal reason why his experiments have not been 
 applied to the philosophy of disease and therapeutics (§ 476 a). 
 
 Philip thus lost the opportunity of applying his observations to any 
 useful or practical purpose. Nevertheless, his very misapprehension 
 of their true import, and his diversion from the path of Nature, impart 
 to them that inestimable value which belongs to the conviction that 
 the facts lead only to the truth where they were intended for the sup- 
 port of error (§ 5^, 188^ d). — See Rights of Authors, p. 912. 
 
 494, a. In concluding this important subject, I shall bring up the 
 
 late experiments by Van Deen, Stilling, Budge, and others, by which 
 
 those of Philip have been again confirmed, and the results extended. 
 
 * This ma}- he placed in the same category as some other "vicarious functions" 
 of distinguished physiologists, as in § 83 6, 1086.
 
 PHYSIOLOGY. FUNCTIONS. 3J9 
 
 It will be seen that they have a very specific bearing upon the doctrines 
 of humoralism (§ 819, &c.), and upon the modus operandi of morbific 
 and remedial agents (§ 893, &c.). It might have been useful to have 
 stated them in immediate connection with either of those subjects; 
 but they should form a part of the combined force which marches in 
 advance upon the regular plan of organization. 
 
 494, b. Exp. — After Fontana had made more than 6000 experiments, 
 in which he employed more than 3000 vipers, and caused to be bitten 
 more than 4000 animals, to extort the conclusion that the poison of the 
 viper kills all animals by acting upon the blood, the whole of those 
 6000 experiments were overturned by a single one by Girtanner; 
 ehowing that the poison will kill frogs entirely deprived of blood in as 
 short a time as it kills those which have not lost their blood. 
 
 The conclusive nature of Girtanner's experiment has been entirely 
 disregarded by subsequent humoralists, whether as it respects the oper- 
 ation of morbific, or of remedial agents ; or more probably the experi- 
 ,ment is unknown to most, or forgotten. — Note Aaa p. 1146. 
 
 The late experiments by Van Deen and Stilling are of the same 
 import as Girtanner's, and again call upon physiologists to return 
 upon the path of nature. Of these experiments I shall present one or 
 two only, as being sufficient for every intelligible purpose connected 
 with my subject. — Note B p. 1113. 
 
 It should be premised, that when all the viscera, the heart, blood- 
 vessels, &c., are removed from frogs, so that nothing remains but bones, 
 muscle, and nerves (as was done in Girtanner's experiment), the ani- 
 mal will hop about for half an hour, and appear in all respects as nat- 
 ural as in its perfect state. (See, also, Spallanzani, § 441,^) 
 
 494, c. Ex}). — The frogs being thus completely eviscerated, and all 
 vascular connections with the spinal cord destroyed. Van Deen di- 
 vided the cord through the third vertebra, "and then introduced within 
 the mouth a drop or two of the acetate of strychnia. In a few min- 
 utes, the parts above the section of the cord were affected with spasm, 
 while those below were unaffected. 
 
 494, d. ExjJ. — Again, Stilling also eviscerated many frogs, after the 
 foregoing manner, and, on applying acetic acid to the skin, as late as 
 half an hour after the evisceration, he excited reflex movements. 
 
 494, (id. Observe, too, how an important modification of these ex- 
 periments goes to the same conclusion. Stilling exposed the spinal 
 cord of a frog thus completely eviscerated, and touched it with a so- 
 lution of the acetate of strychnia, which gave rise to the same gen- 
 eral tetanus as when strychnia was applied to the mouth or skin. 
 Even an isolated portion of the cord would give rise to spasm in parts 
 supplied by that portion, on being touched with the solution. From 
 this fact, Stilling draws the conclusion, that if the cord be divided in 
 numerous places, each portion is a nervous system in itself, and capa- 
 ble of transmitting influences through communicating motor nerves, 
 independently of the brain, or of other parts of the cord (§ 459, 828). 
 
 In the foregoing experiments, which are only examples of a great 
 variety by the same physiologists, we have another full confirmation 
 of the preceding ones by Philip with the additional advantage of oth- 
 er agents to obtain th(i corresponding results. Nor will the reader 
 fail to observe that the same remarkable phenomena occurred in the 
 eviscerated frogs when acetic acid was applied to the skifi as when the
 
 S20 INSTITUTES OF MEDICINE. 
 
 acetate of strychnia was applied within the mouth, as in Van Deen's 
 experiment (§ 494, c). This is an important element in interpreting 
 the sympathetic influences of remedial and morbific agents when ap- 
 plied to the surface of the body(i^ 1088 b). 
 
 It will be also seen that the foregoing experiments upon the skin 
 coincide with those by Alston, made in 1733 (§ 484).* 
 
 These observations put at rest Midler's interpretation of the action 
 of prussic acid in producing instantaneous death when a drop is ap- 
 plied to the tongue, and which has been extensively employed by the 
 humoralists to preserve the purity of their doctrines. The more we 
 consider the profound familiarity of the Berlin Philosopher with the 
 laws of the physirological state of the nervous system, and his full rec- 
 ognition of the vital principle and all its attributes, the more are we 
 surprised at his universal doctrine of physical absorption, and his ex- 
 treme defense of the humoral pathology, as evinced in the following 
 extract from his Elements of Vhysiology. Thus : 
 
 " The rapid effects of prussic acid can only be explained by its pos- 
 sessing gi-eat volatility and power of expansion, by which it is enabled 
 to diffuse itself ilirougTi the blood more rapidly than that fluid circu- 
 lates, to permeate the animal tissues very quickly, and in a manner 
 independent of its distribution by means of the blood," &c. And yet, 
 in the same paragraph he states that nux vomica, which is not vola- 
 tile, will produce the same speedy death (§ 500 c, 826 c, 827 d. Also, 
 Med. and Phys. Comm., vol. i., p. 565, 569, text and notes). 
 
 And again, says Miiller, " My experiments, as well as many others, 
 instituted by well-known physiologists, prove that, before narcotic 
 poisons can exert their general effects on the nervous system, they 
 must enter the circulation" (^ 657, 827 J-829, 904 b, 1032 d, 1066). 
 
 Miiller's doctrine, I may also say, that the absorbent vessels have 
 no visible orifices, and his physiological construction of their func- 
 tion, leads him to the propagation of errors which have vitiated the 
 whole fabric of physiology and medicine. The doctrine may be sum- 
 marily expressed in the following language of its author. Thus : 
 
 " The primary phenomenon of the immediate absorption of sub- 
 stances in solution into the blood is \he jjcrmeation of animal tissues 
 by the fluids. The property of permeation by fluids possessed by 
 tissues, even after death, depends upon their invisible porosity, and is 
 termed imbibition^ Some of the consequences may be seen in sec- 
 tions 289, 291, 350, no. 24, 350^ n, 514^ h.—See § 1089. 
 
 494, e. What I have now stated of the experiments by Van Deen 
 and Stilling relates particularly to influences exerted in animal life, 
 though, like Philip, they have corresponding experiments in organic 
 life. These it would be superfluous to repeat, especially as some of 
 the foregoing involve a complex agency of the ganglionic nerve (§ 516, 
 no. 13). 
 
 Budge, however, has lately made a multitude of experiments witli 
 a view to the physiological relations of the cerebro-spinal and sympa- 
 thetic systems. There is novelty about them, and they go far in sus- 
 taining my philosophy of remote sympathy, and in all its wonderful 
 details, and in corroborating that philosophy which I originally set 
 forth in the " Commentaries" as to the modus operandi of morbific and 
 remedial agents (Rights of Authors, p. 915), — Note Aaa p. 1146. 
 
 It will be observed, also, of Budge's experiments, that they are anal- 
 
 • Whttt's experiment of killing froj^a deprivecl of heart by giving them opium (1755) ia also per- 
 fectly conclusive against absorption by the intestine — Works, 4to, p. SOO-302, 310, 320.
 
 PHYSIOLOGY. FUNCTIONS. 321 
 
 ogous to those which have been made by introducing different agents 
 into the stomach capable of affecting the great nervous centres, and 
 thus deducing the special influences of certain functions of the brain 
 upon distant parts. The experiments in which the nervous centres 
 were irritated should be, particularly, compared with those by Philip, 
 in which he employed alcohol and tobacco. Thus : 
 
 Exp. — The heart of a frog having ceased to beat but once in four- 
 teen seconds, the anterior cords of the cervical portion of the spinal 
 marrow and of the medulla oblongata were imtated, when the heart 
 beat once in three seconds. On first irritating the posterior cords, no 
 effect ensued. In other experiments the action of the heart was re- 
 stored, after it had ceased to beat, by irritating the anterior cords of 
 the medulla oblongata with a needle, or by caustic potash. So, also, 
 irritation of the corpus callosum reproduced the actions of the heart. 
 Irritation of the cerebellum restored the movements of the stomach, 
 and brought on vigorous contractions of the colon and urinary bladder. 
 The last two organs were also affected in the same way by irritating 
 the anterior part of the spinal cord (p. 303, ^ 481 e, Exp. 15). 
 
 The young student should be careful not to confound these move 
 ments with those of continuous sympathy, as exhibited in § 498, &c. 
 The foregoing are effected by a determination of the nervous power 
 upon the organic properties of the several parts (§ 222, &c.). 
 
 IV. OF THE VARIETIES OR KINDS OF SYMPATHY. 
 
 495. We have hitherto seen that the several properties of life are 
 distinguished by remarkable modifications, and that in some of the 
 instances the varieties are so great as to amount to distinctions in 
 kind (§ 133-163, 175, 177, 185, 190, 191, 197, 200, 215, 217, 219, 
 220, 226-230). And so, also, more or less, of the functions. The 
 same rule obtains as to sympathy, this function having been divided 
 by Mr. Hunter into remote, contiguous, and contimious (§ 452, &c.). 
 
 496. Remote sympathy is the principal condition of the function. 
 Its office is the transmission of impressions, whether natural, morbif- 
 ic, or remedial, to and from parts separate from each other, or differ- 
 ent parts of a compound organ, or through which the nervous influ- 
 ence is determined on parts which receive the primary impressions, 
 or when that influence proceeds from direct impressions, physical or 
 mental, upon the cerebro-spinal system itself (§ 230). In the last case, 
 the rationale of the function is very analogous to that of voluntary 
 motion (§ 233). In the former, it is reflex action of the nervous system. 
 
 497. Contiguous sympathy is a circumscribed condition of re- 
 mote sympathy. Its peculiarity is shown by the effects of blisters, 
 leeches, and various other external applications, in relieving internal 
 disease, in proportion as they are applied most immediately over the 
 internal part. Doubtless the centre of this kind of sympathy, or 
 where the nervous power is excited and reflected, is the ganglia 
 of the ganglionic system, or perhaps some plexus of nerves, or some 
 parts of the sympathetic nerve itself (§ 473, no. 2, c ; ^ 516 d, 893 a, 
 905). It should be observed, however, in these cases, that remote 
 sympathy, in its clear acceptation, is brought into action (^ 1038). 
 
 ITie apparent effects of contiguous sympathy, however, may be 
 sometimes explained, especially in consecutive morbid processes, by 
 
 X
 
 322 INSTITUTES OF MEDICINE. 
 
 the irritation from enlarged vessels, or from effusions of coagulable 
 lymph, or dryness of surface, &c., as in pleurisy and ophthalmia, 
 
 498, a. Continuous sympathy is independent of the nerves, except 
 as they enter into compound tissues. It is most strongly pronounced 
 when unusual stimuli operate, and it always occurs in the tissue, or 
 another continuous with it, upon which the primary impression is 
 made. I would prefer calling it continuous influence (^ 1042). 
 
 498, h. Its mode of propagation consists in the condition of a par- 
 ticular part of a tissue, where some impression is made upon the or- 
 ganic properties, being extended to other paits continuous with it, in 
 uninterrupted succession ; though the changes may be much more in- 
 tense in some parts of the tissue than in others (§ 516, no. 2). 
 
 498, c. In the natural condition of the being the operation of this 
 principle is strikingly manifested in the various sensible motions of 
 plants. For example, 
 
 " To excite the motion of the leaflets and petiole of the mimosa, it 
 is not necessary that either the intumescence itself, or even the leaves, 
 should be touched. The stimulus may be applied to a more or less 
 distant part. Even the roots transmit the excitation to the leaves. 
 M. Dutrochet moistened a small portion of the roots of the mimosa 
 with sulphuric acid, and, before there was time for the absorption of the 
 acid to have taken place, the leaves became folded" (§ 289). — Mul- 
 i-er's Physiology. 
 
 And yet we learn from able physiologists that the whole connect- 
 ed movements of plants, in their circulation, and other organic ac- 
 tions, depend upon purely physical causes (§ 257, 261, 289-291, 293, 
 294, 303, 304, 1053-1055). 
 
 498, d. In the animal body, I have shown that the contractions and 
 dilatations of the veins are greatly owing to continuous sympathy, the 
 immediate exciting causes consisting in the existing state of the com- 
 municating arteries and the variable quantities of transmitted blood. 
 Here, too, as in the circulation of the sap, the propagation of the con- 
 tinuous sympathy or continuous influence is exceedingly rapid, and 
 results in a corresponding development of motion (§ 794, 795). 
 
 498, e. Again, as exemplifying the existence of continuous sympa- 
 thy, and its independence of proper nervous action, take another fact 
 from the animal kingdom, showing the action of other stimuli ; 
 
 In the heart of many animals, " cut out and left undisturbed until 
 the frequency of its beats shall have so far diminished that considera- 
 ble intervals intervene between the contractions (or if it have entirely 
 ceased to beat), mechanical irritation by means of a needle excites a 
 contraction which cannot be confounded with the regular beats; and, 
 at whatever part the irritation be applied, the reaction is the same as 
 if the whole heart had been irritated ; that is to say, there ensues a 
 contraction not at one point only, but of the whole organ." — Muller's 
 Physiol. A central ganglion would be necessary to nervous action.* 
 Bichat says of the foregoing experiment, if the action of the heart 
 be allowed to cease entirely, and the organ be then pricked, it will 
 not only begin to act again, but that a dilatation of the cavities will 
 sometimes take place first. The action, too, may not begin till some 
 seconds after the part is irritated (§264,265, 475^, 516 d, 637, 647^). 
 498, y. Continuous sympathy is an important element in the physi 
 ology of disease and of therapeutics. This is conspicuously seen in 
 * See Notes A p, 1111, Bb p. 1131.
 
 PHYSIOLOGY. FUiSrCTIONS. 323 
 
 the propagation of inflammation from a central point. In a thera- 
 peutical sense, it is seen in the relief of hepatic congestions by leech- 
 es applied to the anus ; when, besides the direct effect from loss of 
 blood, the peculiar vital impression which is made upon the organic 
 properties of the mucous tissue of the rectum by this mode of ab- 
 stracting blood is propagated progressively along the whole tract of 
 the membrane up to the duct of the liver, along which it is extended 
 to the organ itself, whose secretion is thus, in part, increased, and the 
 organ otherwise brought under a salutary influence. But, it is also 
 true, that the imjjression which is made upon the intestinal mucous 
 membrane is propagated to the brain and spinal cord by way of the 
 sympathetic nerve, from whence the nervous power is reflected upon 
 the liver, skin, &c., with a salutary effect, through the motor fibres of 
 the same nerve ; and thus remote sympathy is simultaneously brought 
 into operation (§ 523, no. 6. Also, Medical and Physiological Com- 
 mentaries, vol. i., p. 135, &c.). — Rights of Authors, p. 912. 
 
 498, g. The continuous impression, in the foregoing case, upon the 
 intestinal mucous membrane, is equivalent, in principle, to that which 
 is produced by cathartics ; so that reflex' nervous influences may 
 be propagated from all parts of the canal, as well as from the verge 
 of the anus. Exactly the same order of influences springs from ene- 
 mas and suppositories, whether of a sedative or purgative nature 
 (§ 526). In all the cases, the functions of the liver are reached 
 through the instrumentality of the intestinal mucous tissue, just as 
 mechanical irritations of the conjunctiva, or of the membrane of the 
 mouth, affect the lachrymal, or the salivary glands (§ 923, 524 a).* 
 
 498, h. Whether continuous sympathy will give rise to reflex nerv- 
 ous actions, and to what extent, will depend greatly upon the nature of 
 the causes and the tissue affected (§ 135-152). It is strongly mani- 
 fested in all irritations of the alimentary mucous tissue, but is seen but 
 little or not at all in irritations of the muscular tissue, animal or organic. 
 
 499, The brain and spinal cord are, therefore, the sources of gen- 
 eral reflex nervous action ; but the ganglionic system not only partici- 
 pates in all the reflected actions upon the organic viscera when pro- 
 ceeding from the cerebro-spinal, but supplies in its ganglia, plexuses, 
 «S:c., local centres of reflex action known as contiguous sympathy (§ 
 455, 456 a, 458, 459, 473 c, 478 b, 483 c, 490, 893 a, 905 a). 
 
 500, a. Remote sympathy may depend either upon impressions 
 made upon the sensibility of parts distant from the nervous centres, 
 or directly upon the centres themselves. In one case the function is 
 associated with sympathetic sensation, in the other it is not (§ 451). 
 
 500, b. When made upon distant parts, the impression is transmit- 
 ted to the nervous centres through nerves of sensation or the sensitive 
 fibres of compound nerves, and brings the nervous power in those 
 centres into unusual operation, from which this power is reflected 
 through nerves of motion, or the motor fibres of compound nerves, 
 upon the irritability of other parts, or of the part which sustained the 
 primary impression, and thus gives rise to those various results which 
 are the prominent phenomena of reflex nervous action (§ 455 d, 464- 
 471), and which for brevity, I call remote sympathy, or sympathy. 
 
 500, c. The ordinary results of remote sympathy will follow im- 
 pressions made directly upon the nervous centres, and, indeed, upon 
 the trunks of nerves (§ 474, 507). These impressions maybe made 
 * See Note U p. 1126.
 
 .324 INSTITUTES OF MEDICINE. 
 
 upon the brain and spinal cord, and by all kinds of physical agents, 
 and by the mind and its passions. The physical and the mental 
 are alike operative. They rouse the nervous power, and modify 
 't according to the nature of the cause, as in the former case (Z») ; 
 when it is transmitted to other parts, as in the more complex 
 process (§ 222-233, 476-492). If the brain or spinal cord be ir- 
 ritated by the direct application of alcohol, it will increase the ac- 
 tion of the heart and blood-vessels ; or, on the contrary, their action 
 will be diminished by the application of tobacco, opium, &c. (§ 476, 
 &c.). And just so with the different passions, and emotions. Jo) 
 produces a lively action of the heart and all the cutaneous vessels ; 
 anger a more violent state of general arterial excitement ; shame suf 
 fuses the face in one way, and love in another ; fear subdues the ac- 
 tion of the heart and capillaries, induces palpitation, covers the body 
 with a cold sweat, and leads to unwonted micturition ; jealousy is at- 
 tended by other remarkable results in organic life ; grief undermines 
 digestion, &c. Disgusting sights, like emetics, produce vomiting, as 
 will even their recollection. These cases are all coincident with 
 those in which organic actions are influenced by irritating the brain 
 or spinal cord mechanically, and involve exactly the same essential 
 principle which is concerned in the most complex processes of reflex 
 nervous action (^ 476, &c., 508), I call it direct action (^ 227). 
 
 500, d. The operation of the will, in producing voluntary motion, 
 follows the same rule as that of the passions. Each is equally a cause 
 of development of the nervous power. The will merely acts as a stim- 
 ulus to the brain, by which the nervous power is developed and trans- 
 mitted to the voluntary muscles, where, by its operation upon mobil- 
 ity, through irritability, voluntary motion is produced (§ 215, 226, 233, 
 243-246, 258, 467, 476 c, 8181, 1072 h). 
 
 " Irritability," says the able Macbride, " is to be held as a requi 
 site foundation for the power of voluntary motion ; for, if we may be 
 allowed to make a comparison, the soul would be no more capable 
 of moving any particular muscle, or set of muscles, if their fibres, in 
 general, had not the property of irritability, than a musician would be 
 capable of bringing music out of a violin, if its strings were not en- 
 dowed with the property of elasticity" (§ 189, 206). 
 
 And this shows, us, also, the final cause of the exquisite endowment 
 of all muscles in organic and animal life with ii-ritability, while they 
 possess only a low degree of sensibility (§ 193, 206). 
 
 We thus see, too, another remarkable exemplification of the man- 
 ner in which the nervous power is so excited by the nature of the ex- 
 citing cause that it shall give rise to voluntary motion. That the will 
 acts as a stimulus, only, to the brain, and that voluntary motion is ex- 
 cited by the stimulus of the nervous power is manifest from the co- 
 incidence between voluntary motion and the spasmodic affections of 
 the same muscles that arise from irritations of the gums or of the in- 
 testinal canal. The same is shown by the spasmodic actions induced 
 by nux vomica, in paralytic affections ; which also illustrates the dis- 
 tinction between irritability and sensibility, and shows that motion 
 is effected by the organic properties (^ 184 a, 188, 193, 195, 206, 208). 
 In this case, sensibility may be very obtuse in the affected limb, while 
 the agent will exert a greater spasmodic effect on the paralyzed than 
 on the sound muscles. This greater effect is owing to the morbid
 
 PHYSIOLOGY. FUNCTIONS. 325 
 
 development of irritability. And what farther illustrates the philoso- 
 phy as to the action of the nervous power upon irritability in rousing 
 paralyzed muscles, is the opposite effect of conia ; for, in this case^ 
 conia paralyzes the muscles without impairing sensibility (§ 487,^^). 
 
 In all these cases of spasmodic action the irritations are propac^a- 
 ted upon the cerebro-spinal axis, and prove an exciting cause of the 
 nervous power; in the case of the will the irritation is direct in its 
 analogous function of voluntary motion. But the coincidence is more 
 perfect between the voluntary movements and the involuntary ones that 
 are consequent upon irritations of the brain or spinal cord, as in Philip's 
 Experiments, where the physical irritations are direct, and, therefore, 
 upon common ground with the will and the passions (§ 477, &c.). 
 
 500, dd. The action of the will generally terminates in the muscles 
 moved, but gives rise to reflex actions in roosting, &c., by placing the 
 muscles in a rigid position, which acts as an exciting cause.* Mental 
 emotions are but rarely reverberated in cases like transient blushing, 
 but commonly give rise to reflex actions when they operate profoundly, 
 as in vomiting, fear, grief, kc. (^ 500 i, k, 514 f-m, Index IL, Roosting). 
 
 500, e. Motion is produced in muscles that are partly voluntary and 
 partly involuntary (as those of respiration) tlirough the principles now 
 stated; and the modus operandi of their involuntary movements also 
 illustrates fully the philosophy of voluntary motion. Thus, in the in- 
 voluntaiy act of respiration some peculiar impression upon the lungs, 
 arising, perhaps, from Avant of air, is the cause of that development and 
 transmission of the nervous power to the respiratory muscles which in- 
 duces an action precisely similar to that which is excited in the same 
 muscles by an act of the will. The only apparent difference is, that in 
 the latter case the nervous power is excited by the will, and not, as in 
 the other case, by an impression transmitted to the brain from the pul- 
 monary mucous membrane. It appears to be a common phenomenon, 
 also, for the will to determine the nervous power upon the muscular coat 
 of the intestine, just as it is by the reflex nervous action of a cathartic. 
 This is evinced by the quickened peristaltic action when on the way 
 to the temple of Cloicina. It is an example, too, in which the will is 
 seen to exert a retai'ding as well as accelerating effect upon the intes- 
 tine. The will has a still greater control over the muscular coat of 
 the bladder, by which that organ is excited into action in the voluntary 
 discharge of urine (§ 518). In the foregoing cases, however, the will 
 commonly operates upon the organic muscles through its associate ac- 
 tion upon the muscles of the abdomen andperinaeum (§ 243, 519). 
 
 Here, also, is presented another fact in proof of the exactness of 
 Design, another display of the special modifications of the properties 
 of life, since it is here, if any where in organic life, that the will may 
 be instrumental in carrying out the final causes of nature, while there 
 is no reason to suppose that the will can exert an influence on any 
 other part of the truly organic system (§ 72-74, 136, 181^ d, 199). 
 
 500, ee. The principle concerned in the foregoing voluntary and in- 
 voluntary movements is the same as when an emetic operates ; only, 
 in this instance, the peculiar impression transmitted from the mucous 
 tissue of the stomach, through the sensitive fibres of the pneumogastric 
 nerve, modifies and directs the nervous power in a way peculiar to 
 itself; so that besides taking its reflected course through the respira- 
 tory nerves of motion, and exciting convulsive instead of respiratory 
 * See p. 891, § 1077. and Note A p. 1111.
 
 326 INSTITUTES OF MEDICINE. 
 
 movemeiits, it falls upon various other parts, and may thus simultane- 
 ously induce copious perspiration, establish profuse secretions from 
 the liver, intestines, &c., and break up croup, or pneumonia. Exactly 
 the same law, also, is concerned when other remedial or morbific 
 ao-ents exert their effects upon parts remote from the direct seat of 
 their operation. See Rights of Authors, p. 912. 
 
 500, y. The foregoing analogy between voluntary and spasmodic 
 motions, and the mixed motions of respiration, extends to those move- 
 ments which are generated or influenced by the passions, and between 
 the whole there is a close analogy with the effects of all physical 
 agents, and all morbid states, which influence organic actions through 
 reflex impressions of the ganglionic nervous system. The passions, 
 also, like physical causes, produce involuntary movements in animal 
 as well as organic life (§ 245, 844). 
 
 500, g. Different orders of nerves are, however, concerned in the 
 transmission of impressions, more or less, according to the natm-e of 
 the exciting causes. Thus, the nerves of volition are not those by 
 which organic processes are influenced. Even in the voluntary mus- 
 cles the irritability which is relative to their organic functions, as, also, 
 sensibility, may be morbidly exalted, and yet the muscles be incapable 
 of obeying the will, as often happens in paralysis (§ 487, gg). Again, 
 other muscles, as those of respiration, are influenced both through the 
 will and by reflex nervous action. And while, in these respects, 
 we can recognize no anatomical distinction, either in stinicture or re- 
 lation of the parts, this inscrutable phenomenon is not less paradoxical 
 than the agency I have ascribed to the nervous power in the produc- 
 tion and cure of disease ; while yet more astonishing is the institution 
 of different orders of nerves, even of fibres in common nerves, for the 
 transmission of impressions to the nervous centres, and from those cen- 
 tres to the circumference ; and more surprising still is the reception 
 and transmission of impressions from these centres (§189,234, 450 e). 
 And still more remarkable is the manner in which the will, the pas- 
 sions, and other exciting causes of motion, through the agency of the 
 nervous power, pass over intermediate nerves, and elect, as their mo- 
 tor channel, those which are variously disconnected in their anatomi- 
 cal relations (§ 233f ).=* And here we may observe, farther, the analo- 
 gy which subsists between the modus operandi of the will, and of phys- 
 ical agents, in developing motion {d'). In all the cases, whether vol- 
 untary or involuntary, or mixed, as in respiration, the nervous power 
 is roused and transmitted through motor nerves upon the iriitability 
 of all the parts that may be influenced (§ 188, 205). In the case of 
 the will, and the passions, and of the immediate action of physical 
 accents upon the nervous centres, the development of the nei"vous 
 power is direct ; but, when causes operate upon the nervous extremi- 
 ties, the nervous power is, of course, developed by impressions trans- 
 mitted to the central parts (^ 113, 224, 475i,_89U g, _893i,_1072). 
 
 500, li. Again, we learn from the foregoing considerations, that, 
 since the will determines voluntary motion, but has no influence upon 
 organic actions, with the exceptions stated (e) ; and since, on the con- 
 trary, the passions operate powerfully in organic, but imperfectly and 
 only in an involuntary manner in animal life, and as judgment, per- 
 ception, and reflection, exert no appreciable influences in either life, 
 unless as morbific causes, or sometimes lessening the action of the 
 * See NoTK Aa p. 1131.
 
 PHYSIOLOGY. — FUNCTIONS. 32'^ 
 
 heart, while each manifests special relations to the nervous system, 
 it appears that all these causes or properties are distinct elements of 
 the mental and instinctive principle ; just as irritability, sensibility, 
 mobility, &c., are distinct properties or elements of the vital principle 
 (§ 175 b, 183, 188| d, 234 c, 476 c), or equivalent {§ 1067, 1072 b). 
 
 500, i. Consider, again, how different agents applied to different 
 parts will affect particular organs, remotely situated, in a very uni- 
 form manner, and, by common consent, through the nervous system ; 
 as the respiratory muscles, for example (§ 137). " The whole system 
 of respiratory nerves can be excited to action by irritation of any part 
 of the mucous membrane, from the mouth to the anus, from the nos- 
 trils to the lungs." This irritation may be established, and result in 
 increased respiratory movements, by mechanical agents, as by tickling 
 the fauces, and by many others through their intrinsic virtues, as to- 
 bacco applied to the nose. But, what is more remarkable, respiration 
 may be also accelerated by impressions made upon particular parts of 
 the surface of the body, as by tickling the feet; and again, by a strong 
 light impinging on the retina ; and yet, again, by hope and fear, by love 
 and hatred. These examples embrace all the varieties that occur be- 
 tween the simple act of respiration and coughing, sneezing, and con- 
 vulsive spasm. Again, another modified order of movements maybe 
 induced in the same muscles by agents of yet other virtues ; as from 
 the irritation of emetics. Mechanical irritations of the throat may 
 also determine either coughing or vomiting; and here, as with the in- 
 creased respiratory movements, certain irritations of the surface, as 
 tobacco to the soles of the feet, will excite the abdominal muscles to 
 the act of vomiting. In this last case, however, the irritation is first 
 transmitted, by reflex action, to the mucous tissue of the stomach (§ 
 504), from whence it is returned to the nervous centres, and from thence 
 reflected upon the respiratory muscles, the skin, &c. (§ 504, 514 cl, Jc, I). 
 
 It will be thus seen, that these various agents, acting upon different 
 parts, give rise to analogous or similar phenomena through the me- 
 dium of the nervous power, but they involve a great variety of sensi- 
 tive nerves, while the motor nerves are about the same in all the 
 cases. This reflex nervous action is our medical calculus. 
 
 500, j. But, the foregoing complexity, which must find its solution 
 in the attributes of the nervous power operating through its anatomi- 
 cal medium, is vastly increased by the coincident phenomena which 
 may be determined by the will and by mental emotions. Thus, in- 
 creased respiration, coughing, vomiting, &c., may be produced by an 
 act of the will ; gi'ief occasions weeping and sighing ; joy, laughter ; 
 yawning gives rise to yawning in another ; disagreeable recollections 
 produce vomiting, &c. 
 
 500, Jc. It is readily seen that a common philosophy must interpret 
 all the foregoing effects. The fundamental cause is the same through- 
 out. It is every where the influence of the nervous power ; but what 
 Btrange variety in the remote exciting causes ! Nor is this all ; for the 
 same great and simple law obtains in all voluntary movements. Let 
 us also especially remark the parallel which exists between the deter- 
 mination of the will upon particular muscles, according to its own 
 choice, and thus constantly passing over, or isolating, various motor 
 nerves, or, yet more remarkably, sending its influences through cer- 
 tain branches of a compound nerve and holding in passive subjection
 
 328 INSTITUTES OF MEDICINE. 
 
 all the rest, and of those agents which we have just seen to extend 
 their influence specifically to the nerves of respiration, and those of a 
 remedial or morbific nature which, like the will, elect and avoid the 
 nerves without reference to order (§ 2335, 492, no. 6). This aston- 
 ishing phenomenon is perpetually in progress in health among all the 
 organic viscera ; and when we consider, also, how the well-trained 
 juggler brings into simultaneous action almost every voluntary mus- 
 cle, and each one in obedience to the foregoing law of elective influ- 
 ence, we shall readily comprehend how disease, and morbific and 
 remedial agents, give to the nervous power the same complex direc- 
 tion in organic life. But even more remarkable are the various in- 
 tonations of voice, and especially such as form the melody of song. 
 Each one, every variation, whatever the succession of change, is de- 
 termined by an act of volition, rousing, and determining the nervous 
 power, with all the rapidity and mutations of thought, with varying in- 
 tensity, and incalculable changes of direction, and compounded in an 
 endless manner, upon those muscles which are the immediate instru- 
 ments of the vocal apparatus (^ 234 e, 473 c, no. 6, 526 (V). 
 
 All the effects of mental emotions are so many coincidences with the 
 operation of remedial and morbific agents. Like the will, their effects 
 may be limited to excito-motory nerves, but they are apt to institute 
 reflex nervous actions ; each emotion, too, acting upon particular parts 
 according to its own particular nature (§ 500 c). Take, as an example 
 for the whole, the coincidences between the effects of disgust and emet- 
 ics. The latter irritate the gastro-mucous tissue and give rise to vom- 
 iting, as in § 500 ee. Equally, therefore, must disgust institute the 
 same chain of causation ; but by first determining the nervous influence 
 as a nauseant upon the stomach (§,514 i, c, 1067 aa, 1072 ft, 1077). 
 
 500, I. In what has been said, therefore, of the various exciting 
 causes of motion in the respiratory muscles, alone, we have a great el- 
 ement by which we readily attain the philosophy of those analogous ex- 
 amples in which morbific and remedial agents establish changes in or- 
 gans where the nervous communications with the direct seat of the mor- 
 bific or remedial action may be obscure, or far less manifest than with 
 other parts on which no sympathetic influence is simultaneously exert- 
 ed. And, coming also to those complex influences which hold the iris 
 in complete obedience to the great final cause for which it was ordained, 
 and many other equally demonstrable but intricate problems relative to 
 the nerves, and those others which concern an unintermitting action of 
 the nervous power in maintaining some of the most exact and obvious 
 conditions of animal life, as seen in the permanent contraction of the 
 sphincter muscles, we have a flood of light upon the subject which will 
 not fail to dissipate every remaining obscurity, and establish forever an 
 impregnable barrier against the chemical and physical doctrines and all 
 the corruptions of the humoral pathology (§ 1072 a). 
 
 500, m. If we now consider the actions of the heart and blood-ves- 
 sels both in their natural state and under morbid influences, it will be 
 seen that no chemical or humoral dogmas can have the most remote 
 connection with the philosophy of medicine ; for here will be found a 
 concentration of phenomena which embraces not only the physiological 
 conditions upon which all their fluctuations that emanate from the 
 modified states of other parts depend, but a correspondence in the phe- 
 nomena, that are wholly exclusive of every interpretation which can be
 
 PHYSIOLOGY. — FUNCTIONS. 329 
 
 rendered by chemistry or humoralism within the entire range of pathol- 
 ogy and therapeutics, and a full confirmation of my doctrines relative 
 to the nervous system. In the first place, then, we have seen that the 
 motions of the circulatory organs depend upon the nervous influence, 
 as the immediate exciting cause, reflected upon the muscular tissue 
 (§ 475J-488^, 493 cc, 514/), and that in consequence of this suscep- 
 tibility (§ 422 h, 487 a, 892|), and of the liability of the nervous influ- 
 ence to endless modifications according to its exciting causes (§ 227, 
 230, 894 b, 904 a, 990^), that influence, both reflex s^nH direct (§ 222 a, 
 227, 903, 990^)5 is constantly modifying the actions of the heart and 
 arteries, as seen in the operation of multitudinous external natural 
 causes and the multifarious effects of mental emotions, while other 
 things, except when intermixed with the blood, fail of such influences 
 (§ 233f , 630 c), and of all which Chemistry and Humoralism do not 
 pretend to make any explanation. Therefore, by parity of reason all 
 the disturbances of the circulatory organs that proceed from affections 
 of other parts, and all the remote effects of medicines, poisons, &,q., are 
 equally estranged from those assumptions, and in all the cases the fluc- 
 tuations in the circulatory organs depend equally as in the natural con- 
 ditions upon reflex or direct action of the nervous power, and as will 
 appear (§ 687^^-688, 694f, 826 cc) we examine the pulse (when the 
 heart is not diseased) for the purpose alone of ascertaining how far and 
 in what manner the pathological conditions of other parts, or the oper- 
 ation of remedies, &c., may reflect the nervous influence upon the cir- 
 culatory organs, and not in the least to ascertain how the blood is af- 
 fected or the remedies may be absorbed — See ^ 829, 1088 * 
 
 500, n. Contrasted with the foregoing should now be stated the doc- 
 trine of the chemical school, as it comes applauded from the laboratory. 
 The source of motion with this school, voluntary and involuntary, is the 
 same with that which Liebig assigns for thought, namely, a chemical 
 change in the substance of the organ (§ 350, nos. 5J, 7-10). In this 
 way, too, the chemist expounds the balance between waste and nutri- 
 tion ; and for this purpose sleep has been ordained, the approved phi- 
 losophy of which is the following : 
 
 " Now, since in different individuals," says Liebig, " according to the 
 amount of force consumed in producing voluntary mechanical effects, 
 unequal quantities of living tissue are wasted, there must occur in ev- 
 ery individual, unless the phenomena of motion are to cease entirely, a 
 condition in which all voluntary motions are completely checked ; in 
 which, therefore, these occasion no waste. This condition is called 
 sleep. Now, since the consumption of force for the involuntary motion 
 continues in sleep, it is plain that a waste of matter also continues in 
 that state ; and if the original equilibrium is to be restored, we must 
 suppose that during sleep an amount of force is accumulated in the form 
 of living tissue exactly equal to that which was consumed in voluntary 
 and involuntary motion during the preceding waking period." — Lie- 
 big's Animal ChemisU-y. 
 
 I have quoted the foregoing on account of its appearance of a ration- 
 al philosophy and logical method, but apprehend that it has no better 
 foundation than the gaseous doctrine as presented in § 350^ n. 
 
 500, nn. But again, I ask the chemist for the primary cause of those 
 chemical changes in which originate the acts of the mind, &c., and 
 which call us from the sleeping to the waking state (175 c, 349 e, 
 * Also, § 481, 494, Note Ll p. 1140.
 
 330 INSTITUTES OF MEDICINE. 
 
 3503 ggy I ask the chemist, and the physical philosopher of life, to 
 explain the mechanism and the laws of sympathy by the application 
 of any principle in phy;iics or chemistry. Let the chemist consider, 
 that in every process of remote sympathy there are involved very di- 
 verse, yet very precise effects, and that he must have one species of 
 chemical change for the transmission of impressions through the sen- 
 sitive nerves to the nervous centres, another for the impressions ex- 
 erted upon those centres, another for the reflection of the influences 
 through the motor nerves, and yet another for the effects exerted at 
 the ultimate destination of this amazing round of never-ending influ- 
 ences, as indispensable to the process of respiration ; and coming to 
 morbid states, there must be another series of chemical changes con- 
 forming, respectively, to the nature of every morbid influence and 
 product (§ 188^ d, 464, 451/, 649 b, 675, 487^^, 1076). 
 
 Take any single attribute of the nervous system, and we shall find 
 it as remarkably distinguished from all things else as is the mental 
 principle. The power which appertains to that system, and presides 
 over the whole life of animals, is just as unique in all its operations. 
 The distinction alone, in various aspects, between the condition of the 
 sensitive nei'ves, or the sensitive fibres of compound nerves, and those 
 which are appropriate to the motor influence, — those which convey 
 impressions to the central parts and those which transmit them to all 
 parts of the organization, to the organic structure of the fountain 
 itself, — those, I say, which serve to awaken the mind, or to stamp on 
 the nervous centres, with all the precision of thought, an inconceivable 
 variety of influences which are unceasingly in progress in every other 
 part, but with no other appreciable result than the movements which 
 follow in all the organic constitution, contrasted with the totally dis- 
 tinct prerogative of those nerves, and those fibres of compound nerves, 
 which give rise to the distant movements and changes, — place, at an 
 unutterable distance, all analogy with the recognized imponderable 
 substances and with every other agent or power in the mineral king- 
 dom (§ 451 c, 453). But, I would not so far speculate upon the na- 
 ture of the nervous power as even to assume for it a place among the 
 imponderables, which the physical philosopher, upon no better evi- 
 dence, unhesitatingly avows as the condition of light, heat, and that 
 more inscrutable substance, imponderable magnetism, which awakens 
 no sensation, and produces no effect upon organic life. Least of all 
 would I place the principle of life, or its element the nervous power, 
 upon a par with the imponderables in their designated condition as 
 material " fluids," nor claim for the latter a distinct individuality 
 (§ 175, hh). The true physiologist attempts not problems which have 
 no relation to principles and laws, and which divert philosophy from 
 its practical uses. It is true, he argues the existence of the principle 
 of life, its remarkable attributes, its contradistinction from all other 
 agents, upon the ground of the philosopher in physics, that he may 
 meet the obti'uder with his own ratiocination. He tells him that his 
 premises are the same, only more various, distinct in their nature, 
 and more demonstrative. He points him to his "undulations" of 
 light, the velocity of their movements, the prismatic analysis, its 
 confirmation by life, his imponderable mystery which spans the globe, 
 its co-operation with the electric fluid, their instant transmission of 
 a disturbing cause to the ends of the earth, making the recoi'd at one
 
 PHYSIOLOGY. FUNCTIONS. 331 
 
 of its poles ere the impulse has ceased which began at the other 
 (§ 175 hb, 1881 d, 234 c, d, e, 281, 872 a, 892 ^>,892^ v, 893 q, 904 «). 
 
 500, 0. Let us now observe, summarily, the wonderful system of 
 analogies which Nature has ordained among the vital stimuli, and learn 
 from this, and from the same system of relationship which distinguish- 
 es other parts in the great chain of existences, that her laws are sim- 
 ple where the phenomena are various and complex, and that all her 
 designs and operations are susceptible of reduction to a few general 
 principles, which, when once known, illuminate the darkest labyrinth, 
 and serve us instead of the voluminous facts which have been gradu- 
 ally accumulating for ages. One principle is a key to a thousand phe- 
 nomena; and as new ones spring up, having analogies with such as 
 are known, the principle comes to their ready interpretation. 
 
 In respect to the analogies among the vital stimuli, the mind, being 
 connected with the body, and acting upon it both directly and through 
 the nervous power, should naturally be one of them ; and here we find 
 it operating in peculiar ways upon the irritability both of organic and 
 animal life, — first directly upon the brain, and then producing volun- 
 tary motion through the nervous power, or so affecting the organic 
 states as to be a morbific or a curative agent. Just so with foreign 
 agents. Irritate the brain and spasms will follow, while the same ir- 
 ritation goes to the recesses of organic life. The natural stimuli of 
 life maintain the vital actions by exciting the vital properties. But, 
 there are many foreign agents which are morbific, and these operate 
 in the same way, only, at the same time, they alter the nature of the 
 vital properties ; and it is exactly in this way, also, that the mind and 
 its passions produce disease. The impressions, however, in the former 
 case, may be reflected from the nervous centres, while in the latter, 
 they originate in those centres. Again, there are other foreign agents 
 which aid in restoi'ing the diseased properties and actions to a healthy 
 state, and their principle of operation is exactly similar to that of the 
 mind when this agent aids in the removal of disease (§ 1067). 
 
 Take next the blood, the natural vital stimulus of organic actions, 
 which makes its impressions upon the same properties and develops 
 the nervous influence like the mind and foreign agents. But, unlike 
 the latter, it is a living agent, and calls into action the properties of 
 life for the purpose of being itself acted upon, that it may be incorpo- 
 rated with the organized structure and receive the plenitude of those 
 powers through which it becomes a part of the organized tissues, that 
 this new formation may again generate the same fluid, and be acted 
 upon, in its turn, by other blood. Its analogy, therefore, to the men- 
 tal principle relates especially to its property as a vital agent. But, 
 we find in the nervous power an agent of more extensive analogies 
 with the blood, since this agent, like the blood, not only affects the 
 organic properties and actions, but is also exquisitely susceptible oi 
 modifying influences, of changes in its nature, from the action of the 
 mind and from external morbific and remedial agents, — acquiring even 
 the very character, as an operating cause, which appertains to the 
 agents, respectively, that may call it into action (§ 223-232). The 
 range of analogies is, therefore, coextensive between the nervous pow- 
 er and all other vital agents (§ 74 a, 188^ d). And so of the semen 
 in its action upon the organic properties of the ovum ; infusing, also, 
 not only a physical, but a mental constitution into the ovum. The
 
 332 INSTITUTES OF MEDICINE. 
 
 corporeal and mental attributes of both parents are, in consequence, 
 blended together (§ 63, &c., 475|). 
 
 Consider, finally, the hibernating animal, whose general modifica- 
 tion of irritability (§ 191) is so constituted with a reference to preser- 
 vation against low degrees of external temperature, that mechanical 
 irritation, heat, and a variety of agents applied to the surface, shall so 
 awaken the nervous influence that his temperature will suddenly rise 
 from below the 40th degree of Fahrenheit up to its natural standard of 
 98°. But the curious fact attending this remarkable law of preserva- 
 tion is the same result from an intensity of cold that would otherwise 
 destroy the animal (§ 441, d). — Note Aa p. 1131. 
 
 500, p- In respect to the subserviency of the brain to the operations 
 of the mind, I. will add in farther explanation of what I have said in 
 section 241, that, whatever may be the reality, the apparent instru- 
 mentality of the brain in the functions of the will and percei^tion is 
 greater than in those o^ judgment, reflection, and imagination ,' or, if 
 it be preferred, the concurrent action of the mental faculties in man 
 and animals determines the results which are commonly ascribed 
 to the loill as a property of the mind. The greatest apparent final 
 cause of the brain in respect to the connection of the Soul with the 
 body, and especially the Instinctive Principle, is to serve as a me- 
 dium of communication with the voluntary muscles through the 
 nervous influence. 
 
 In respect to perception, we discover the relation of the mind to 
 the brain in another aspect, and, also, another analogy between the 
 will and physical agents as vital stimuli. Through sensibility the 
 brain is acted upon, and this impression rouses the mind, or its prop- 
 erty, perception, and sensation is the resulting effect (§ 175, c). 
 
 501, a. Sympathy is active when it produces sensible effects. It is 
 passive when its effects are insensible, as in the natural rhythm of the 
 organic system. It is either reflex or direct nervous action (-^ 638J)._ 
 
 501, b. In the perfectly natural condition of sympathy in organic 
 life the nervous influence is a mere regulator of the organic proper- 
 ties. Its natural operation is disturbed by morbific and remedial 
 agents, and by mental emotions. 
 
 501, c. It is mostly in conditions of disease that we notice the re- 
 sults of sympathy. In health we see only the universal harmony ; 
 unless disturbed by a blush, or by the abundance of urine when cold 
 chills the suiface, or fear exerts its more mysterious sway. Disease 
 affords the striking examples of display in the nervous power, and 
 these examples are what most engage the attention of the physician. 
 To trace out their complexity, as one part after another gives rise to 
 disease consecutively in each, and as each may exasperate the morbid 
 states of the whole, or as remedial agents may institute corresponding 
 circles of reflex action, are the most important and difficult objects of 
 medicine. 
 
 502, a. Diseases generally begin with little agency of the nerves. 
 Morbific causes make their impression upon the vital constitution of 
 some particular part, when it commonly happens, sooner or later, 
 that the affected state of the part is felt by the nervous centres, from 
 whence a disturbing nervous influence is transmitted to other parts 
 C§ 133-154, 188-193, 516, no. 7, 657, 666). 
 
 502, b. In all the foregoing cases, therefore, where remote parts be- 
 come the scats of morbific action, as in pneumonia and idiopathic fever,
 
 PHYSIOLOGY. FUNCTIONS. 333 
 
 sympathetic sensibility is affected by the primary morbific cause as an 
 important element in establishing the remote predisposition (§ 149, 
 201, 451 h, 559, 660, 666). 
 
 502. c. Remedial agents may operate directly upon a part and re- 
 store its morbid properties and functions without reflected nervous 
 action. This is apparent only where the remedy is applied directly 
 to the tissue affected ; but, in all other cases the nervous power is the 
 medium of transmission. Upon these fundamental principles, the 
 main art of therapeutics is or should be founded (227, 644-6470. 
 
 503. When disease, or morbific, or remedial agents transmit their 
 influence from any part to the brain and spinal cord, and there develop 
 and modify the nervous power, the modification corresponds with the 
 nature of the impression which is transmitted to the nervous centres. 
 These transient modifications of the nervous power are similar, in 
 principle, to the changes which occur in the organic properties, and 
 which essentially constitute the disease. The passions also modifv 
 the nervous power in ways peculiar to each ; and, in all the cases, 
 corresponding effects are produced upon the condition of diseased 
 parts upon which the nervous power thus modified may be reflected. 
 That is to say, the nature of the nervous power is variously modified 
 in all the cases ; and, therefore, like external morbific or remedial 
 agents of different virtues, modifies the vital states according to its own 
 acquired modifications. The nervous power, therefore, thus acquires, 
 more or less, the virtues of the exciting causes, and becomes, more or 
 less, a substitute for them (§ 226). 
 
 504. Various circles of sympathy are generated by the action of 
 remedial agents upon the stomach, intestines, &c. The first impres- 
 sion of the agent may set in motion a great range of reflex nervous 
 actions; as the operation of emetics (§ 500, i) ; and, as new impres- 
 sions are sympathetically instituted they become the points of depar- 
 ture for other reflex nervous actions, and react upon and increase those 
 in which they originate. (§ 902,^, Note D p. 1114). 
 
 505. When the nervous power is excited by remedial agents of 
 positive virtues it is essentially morbific, like the remedial agents 
 themselves. Each is, therefore, curative only by inducing new mor- 
 bid conditions by which the natural recuperative tendency of the vital 
 properties is brought into operation. The great difference is, that 
 morbific agents alter the vital conditions more profoundly and more 
 permanently than the remedial (^^ 854 c-858, 893 d, e, 894 &-901). 
 
 506. Impressions once made upon any part may continue for an in- 
 definite time after the cause is withdrawn, and may continue to de- 
 velop and modify the nervous influence, and direct its operation upon 
 other parts, as when the agentwas in operation (^^ 516, no. 6). Thus, the 
 operation of many active remedial or morbific agents will continue to 
 be exerted upon the system at large, for a longer or shorter time, af- 
 ter they shall have been thoroughly removed from the stomach, &c. 
 Inflammations excited by cantharides, issues, wounds, &c., hold an 
 unceasing operation, curative or morbific, upon remote parts. The 
 specific impression made by the virus of the mad dog becomes establish- 
 ed in the bitten part, and generates a morbific reflex nervous action 
 till, through the law of cumulation, an explosion of disease ultimately 
 follows (§ 558, a). The same principle, exactly, is applicable to mer- 
 cury, when a small dose, or its external application, produces saliva-
 
 334 INSTITUTES OF MEDICINE. 
 
 tion, or when miasmata give rise to fevers in a month, or six months, 
 after their direct operation has been withdrawn. The principle is 
 constantly illustrated in natural states of the body ; as where the 
 sphincters remain permanently contracted after the expulsion of the 
 urine or fecal matter (§ 514, <;, 516, no. 6, 1059, ISTote Aaa p. 1146). 
 Here, tlien, we have another important law to interpret the true 
 modus operandi of remedial and morbific agents (§ 503). 
 
 507. The nervous power pervades the whole system of motor 
 nerves ; and, although its active operation in the ordinary function 
 of sympathy be developed mainly, if not altogether, in the central 
 parts, it may be brought into operation by irritating any of the motor 
 nerves (§ 473 c, 499). A division, or other injury of nerves going to 
 the organic viscera, as the par vagum, may destroy their functions, or 
 otherwise affect the vital constitution and products of the part, or in- 
 duce inflammation, by the shock of nervous power thus inflicted on 
 the organic properties of the part (§ 461, 485, 489, 950, 1032 d). 
 
 508. The nervous systems are as liable as other parts to be affect- 
 ed in their organic condition by the nervous power, which, in the 
 samo way, may be actively determined upon them. But, there is this 
 difference. When any part of the nervous system is the seat of dis- 
 ease, it is liable to produce greater disturbances in remote parts than 
 other organs when diseased. These disturbances are occasioned by 
 the direct propagation of the nervous power, but they are apt to be 
 less of a moi'bid nature than when produced by the more complex 
 process of reflex action (^ 500, a-c). 
 
 509. The nervous power may extinguish life with great instanta- 
 neousness. When rapidly fatal, the causes by which it is brought into 
 operation mus]> be violent and sudden in their action (§ 455, d). Ex- 
 amples occur in the fatal effects of joy, anger, blows on the epigastric 
 region, drinking cold water, prussic acid, sudden death from small 
 losses of blood, apoplexy, &c. (§ 479, 1040). 
 
 In the case of joy, anger, and apoplexy, the nervous power is de- 
 veloped in a direct manner (§ 500, c), and destroys mainly by its sud- 
 den determination upon the organic properties of the brain and heart. 
 Blows on the stomach give the same determination through reflex 
 nervous action, as do also cold water and prussic acid (§ 476^^, h). The 
 mode of death from small losses of blood will be explained under the 
 philosophy of the operation of its loss (§ 943, 946, &c.). 
 
 In the foregoing cases, the nervous power is also determined with 
 violence upon the stomach and intestines, and upon the whole capil- 
 lary system of blood-vessels {§ 481, &c., 490). The general effect is 
 also increased by the injury sustained by the brain itself 
 
 510. The foregoing modus operandi of the several agents is similar 
 to the causation of sudden death from injuries of the brain or spinal 
 cord. Thus : 
 
 If the spinal marrow be suddenly destroyed, or only one half of it, 
 by a large stilette, life is immediately extinguished. The modus op- 
 erandi appears to be the following: — 1st. An injury of the vital prop- 
 erties of all the organic viscera. 2d. A violent interruption of the 
 concert of organic actions. 3d. An interruption of respiratory move- 
 ments. 4th. A pernicious nervous power is propagated from the cord 
 to the organic powers of the brain. 5th. Pernicious influences are 
 propagated by the organic viscera to the cerebral and ganglionic sys-
 
 PHYSIOLOGY. FUNCTIONS. 335 
 
 tems, — thus greatly increasing the destructive nervous influence upon 
 themselves (§ 455, c). They are complex circles of nervous infllu- 
 ence, but are determined by exact laws, and each circle has its distinct 
 individuality, although involved in each other. 
 
 A like explanation is also applicable when a sudden destruction of 
 life is effected by crushing the brain, 
 
 511. It is upon the principle that the effects of the nervous influ- 
 ence depend upon the exact nature of the impressions made upon the 
 nervous centres, whether direct or indirect (§ 226, 500), that we must 
 explain the differences in the results of slightly-varied experiments 
 relative to these parts; those,forinstance,bywhich the brain or spinal 
 cord is slowly destroyed interrupting the harmony of actions and the 
 organic functions more gradually, and therefore less fatally, than such 
 as produce their destructive effects with greater rapidity (§ 476|^). 
 
 V. THE LAWS OF SYMPATHY, OR REFLEX ACTION OF THE NERVOUS 
 SYSTEM, AND THEIR APPLICATION TO PATHOLOGY AND THERAPEUTCIS. 
 
 General Facts and Laws relative to t/ie Cerebrospinal and Ganglionic 
 
 Systems. 
 
 512, a. The various nervous communications of the intestinal canal 
 with the brain and all other organs are demonstrative of the ascend- 
 ant influence which the stomach, particularly, possesses when acted 
 upon by remedial agents. We see all this exemplified, analogically 
 at least, in the endless remote derangements which follow the com- 
 mon irritations and morbid states of the organ, as, also, of the intes- 
 tines. We see, indeed, the whole in natural progress. When, for 
 example, hunger operates, an actual sensation is then felt by the 
 brain, and the mind, of course, participates (§ 323). Numerous and 
 complex influences may be thus brought into operation, of which the 
 stomach is the primary source. The will, being excited, brings into 
 action all those muscles which are necessary to obtain a supply of 
 food, and other muscles to effect its mastication, and convey it to the 
 stomach. Various sympathetic organic influences are, in the mean 
 time, taking place, which it is unnecessary, as it might be difficult, to 
 explain. INIany of these organic influences spring from the mind it- 
 self. Thus, the brain feeling the sensation of hunger, the salivary 
 glands begin to pour out their fluid at the sight or smell of food, or 
 even at its expectation. The food establishes an influence upon the 
 nervous centres, by which an exciting nervous power is constantly 
 reflected upon other parts. The bile, saliva, &c., are thus increased, 
 while the mind contributes a direct nervous influence towards these 
 results. The stomach being supplied with its wants, all these influ- 
 ences cease, and a new order arises. Cut off the par vagum and 
 none of them will obtain, unless feebly through the ganglionic and 
 spinal nerves. When the food has undergone digestion, and the ex- 
 citing impression is removed from the stomach, all the reflected influ- 
 ences of the brain and spinal cord cease in consequence. 
 
 512, b. The vascular action and the glow of warmth, which are 
 lighted up in the skin of the fasting, half-frozen traveler, and his in- 
 vigorated strength before digestion has made any advances, and the 
 flow of bile which is determined by the action of food on the stom- 
 ach, esoecially where the food is of an animal nature, are manifestly
 
 336 INSTITUTES OF MEDICINE. 
 
 owing to an exciting reflex action of the nervous system ; or, again, the 
 copious perspiration, and other results, which often follow immediate- 
 ly a draught of hot water, illustrate the whole philosophy of this ap- 
 parently entangled subject of sympathy, whether in relation to natu- 
 ral, morbific, or remedial agents ; and we learn from these obvious 
 examples that the essential principle is simple, and readily explains 
 all the diversified phenomena, which are effects of reflex and direct 
 nervous actions, whose original starting point is the gastro-intesti- 
 nal mucous membrane. But when, in the case of the food, it shall 
 have been digested, and have entered the circulation, some of its ear- 
 liest and strongest demonstrations may have disappeared. It is wor- 
 thy of remark, too, that such is often the immediate effect ofTood upon 
 the great nervous centre, that sleep is almost irresistible, or apoplexy 
 follows, " paulo post prandium,"* as no unusual result ; the nervou3 
 power being reflected, in the former case, upon the organic prop- 
 erties mildly and agreeably, in the latter with sudden and destructive 
 violence (§ 226-233, 441 c, 476^ A, 500-511, 1040). 
 
 513. Physiological conditions, like the foregoing, are so intelligible 
 as to be peculiarly important in illustrating coincident problems in 
 pathology and therapeutics. Whenever well-pronounced reflex nerv- 
 ous actions are propagated from one organ to others through the cere- 
 bro-spinal and ganglionic systems in their natural states, and by nat- 
 ural stimuli, as by food, these influences are generally greatly increas- 
 ed, as well as modified in kind, by morbific and by remedial agents 
 (§ 524, no. 1). 
 
 514, a. The foregoing considerations lead me to the statement of 
 one of the most important laws in physiology, which is alike applica- 
 ble to the cerebro-spinal and ganglionic systems, namely : 
 
 " When impressions, made by the action of external stimuli on sen- 
 sitive nerves, give rise to motions in other parts, these are never the 
 result of the direct reaction of the sensitive and motor fibres of the 
 nerves on each other. The irritation is conveyed by the sensitive 
 fibres to the brain and spinal cord, and is by those communicated to 
 the motor fibres" (^ 455, 462-472). — Muller. 
 
 The foregoing law is in operation in all cases of remote sympathy, 
 whether of a physiological, pathological, or therapeutical nature (§ 455, 
 c-h). It is clearly exemplified in the natural process of respiration, 
 oy the analogous results of emetics, &c. In respiration, the want of 
 air is felt through the medium of the sensitive fibres of the pneumo- 
 gastric and sympathetic nerves, and appears to be concentrated about 
 the medulla oblongata. The nei"vous power is thus developed, and is 
 then reflected upon the various motor nerves which supply the mus- 
 cles of respiration ; when the action of these muscles follows as a con- 
 sequence (§ 233, 462-472, 500). 
 
 514, h. The only remarkable difference in the physiology of vomit- 
 ing from that of respiration consists in the primary impression being 
 made upon the same nerves in the mucous tissue of the stomach, and 
 the convulsive movement of the abdominal muscles. A radical dif- 
 ference, however, obtains in the influences which may be exerted by 
 an emetic upon the organic states ; especially in their diseased condi- 
 tions. This, too, will depend greatly upon the cause of vomiting ; 
 and so of every other agent, according as it may be natural, morbific, 
 or remedial. When the effects depend upon reflex nervous influences, 
 * A term of frequent occurrence among Authcis who wrote in Latin.
 
 PHYSIOLOGY. FUNCTIONS 33T 
 
 the morbific and remedial agents so modify the nervous power that it 
 alters the existing condition of the organic properties and functions of 
 all parts upon which its positive action may fall (§ 129, 226, 227). 
 
 If the stomach itself be the seat of disease, even its mucous tissue, 
 the remedial effect of any agent may not be wholly, or principally, 
 due to its direct action upon the organ, but may be also exerted 
 through a chain of causation exactly similar to that by which the re- 
 spiratory muscles are thrown into action in respiration or vomiting. 
 This must be obvious enough in the case of peritoneal disease of the 
 stomach ; and it is equally true of diseases of its mucous coat, that the 
 impression of the remedy is transmitted, more or less, through the 
 sensitive fibres of the pneumogastric and ganglionic nerves to the 
 brain and spinal cord, when the nervous power is reflected, with an 
 alterative effect, through the motor fibres of the same nerves upon the 
 mucous, as upon the serous, tissue of the stomach. The same philos- 
 ophy applies to the muscular coat of the stomach in the action of an 
 emetic, and to the same tissue of the intestines when peristaltic move- 
 ments are excited by cathartics (§ 657 a, 658, 889 a, 902 g). 
 
 Again, the bile which is ejected during the action of an emetic or a ca- 
 thartic may have been mostly generated under their influences ; the emet- 
 ic or the cathartic establishing a hilific reflex nervous action over the liver, 
 in conjunction also with continuous sympathy (§ 498) ; and those influ- 
 ences, in connection with the more efficient direct irritation of the intes- 
 tinal mucous tissue, instituting the increased product of that membrane. 
 These palpable facts associate themselves with the immediate exciting 
 cause of the muscular movements in vomiting and defecation, and with 
 an endless extent of analogous results that flow from other unusual influ- 
 ences, and thus evince the dependence of the whole upon the foregoing caus- 
 ations, of which alterative reflex nervous actions are apt tobe the principal. 
 
 514, c. We thus comprehend how an emetic of the most simple na- 
 ture may suddenly arrest a paroxysm of hooping-cough, or of spas- 
 modic asthma, or of hysteria. The emetic, through the foregoing 
 process, induces new movements in the affected muscles, and thus 
 ends the paroxysm. Dr. Greenhow, for example, has lately related, 
 in the London Medical Gazette, the case of a man, who was affected 
 with a choking, as if a ball was rising in his throat, and shortly after 
 a violent hiccough began, which continued for several days. About 
 the eighth day, his wife, sister, and maid-servant, " got into the same 
 state ;" the affection being communicated in the last three cases or in- 
 duced by the operation of the mind (^ 227, no. 1, 844 a). " It was a 
 painful spectacle, though a somewhat ludicrous one, to see four indi- 
 viduals all hiccoughing at the same time." Opium, valerian, asafoet- 
 ida, camphor, magnesia, &c., failed entirely of affording relief. "How- 
 ever, somethmg taken by the maid-servant made her vomit, and from 
 that moment the complaint ceased. A mustard emetic was immedi- 
 ately ordered for the others, when the sister and wife were also re- 
 lieved ; but not so the husband, whose attack, however, was always 
 suspended by vomiting, but soon returned." In the case of the hus- 
 band, there was present a state of disease, which continued to repro-' 
 duce the paroxysms ; but in the other three there was little else than 
 the spasmodic action of the muscles. Dr. G. says he " always after- 
 ward found that vomiting put an end to attacks of hysteria, and be- 
 lieves that the dread of an emetic has often had the effect of checking 
 
 Y
 
 338 INSTITUTES OF MEDICINE. 
 
 ail hysterical attack;" in which case the mind develops a controlling 
 nervous influence. — Note Cc p. 1132, 
 
 514, d. Consider, next, an example of the manifestation of sympa- 
 thy between the skin and other parts, as indicative of the modus ope 
 randi of remedial and morbific agents when they establish their influ- 
 ences upon distant parts through the medium of the skin. 
 
 Volkmann, in pointing out the great difference between the trunks 
 and the minute terminations of the nerves in the power of exciting 
 reflex motions, prefers the skin for illustration ; which, he says, sur- 
 passes all other organs in the property of exciting these motions. When 
 an animal, for example, is under the influence of opium, the slightest 
 touch of the skin is frequently sufficient to give rise to strong spasms, 
 while reflex actions excited by irritating the distinct nerves of the 
 skin are generally less. The philosophy is the same when cold air, 
 or cold water, restores a patient from a state of syncope. A drop of 
 cold water, when snapped upon the face, rouses the subject by trans- 
 mitting an impression through the cutaneous nerves to the nervous 
 centres, which instantly develops an exciting nervous influence that is 
 then reflected upon the muscles of respiration, and upon the heart and 
 extreme blood-vessels. The same law governs, also, the constant mu- 
 tual interchange of action between the skin and alimentary canal, the 
 skin and kidneys, &c., whether in health or disease. From these ex- 
 amples of a great fundamental law, we readily obtain the modus 
 operandi of mercury, iodine, blisters, issues, &c., when applied to the 
 skin, and of cold in reducing hernia (§ 224, 232, 527 h, 1088 h, c). 
 
 514, e. With the qualifications stated in sections 458, 459, it is "a 
 general law, that, whenever general spasms are excited by local im- 
 pressions, the phenomenon depends on no other communication be- 
 tween the sensitive and motor fibres than exists in the spinal cord. In 
 many cases, however, local irritation of the nerves gives rise, not to 
 general, but to local muscular spasms." " In the contraction of all 
 the perineal muscles in expelling the semen, which are excited by 
 irritation of the sensitive fibres of the penis, the spinal cord is the 
 medium of communication between the sensorial impressions and the 
 movements." — Muller. 
 
 514, y! Many "muscles invested by sensitive membranes, and are 
 not themselves exposed to the direct stimulus, can only be excited to 
 action by irritation of the sensitive property of their investing mem- 
 brane, the transmission of this irritation to the nervous centres, and 
 the propagation of the motor influence from the nervous centres to 
 themselves. Thus, the contractions of the glottis and air-passages, 
 excited by the contact of irritating gases, are not the immediate result 
 of the irritation of the parts themselves, but of the excitement of the 
 sensitive fibres distributed to the mucous membrane and the reflected 
 iiyfluence of the brain and spinal cord upon the motor nerves of the 
 muscles. The movements of deglutition belong to this class. The 
 stimulus of the morsel in the fauces excites the act of deglutition. In 
 this case, the sensitive nerves which transmit the impression to the 
 •nervous centres are, according to Dr. Reid, the glosso-pharyngeal, the 
 superior laryngeal, and the branches of the fifth, sent to the soft palate 
 and isthmus of the fauces. The motor nerves for the movements of 
 deglutition are the pharyngeal branches of the par vagum. A like 
 explanation applies, also, to the irritations of the sphincter ani and the
 
 PHVSIOLOGY. FUNCTIONS. 339 
 
 sphincters of the bladder. The muscles cannot be themselves stimu- 
 lated by the excrement and the urine ; but these matters act upon the 
 sensitive nerves of the mucous membrane and excite the spinal cord, 
 which, as if constantly charged, with motor influence, reacts upon the 
 muscles. In this case the phenomenon appears to depend on no other 
 communication between the sensitive and motor fibres than exists in 
 the spina] cord. Hence, after injury of the spinal marrow, these 
 sphincters become relaxed." — Muller. 
 
 The operation of cathartics involves more complex laws. These 
 are agents of specific virtues, and are capable of modifying the vital 
 states of the intestinal canal and of parts remotely situated. Their di- 
 rect impression is exerted upon the intestinal mucous tissue ; but the 
 muscular is brought into increased action both by contiguous and re- 
 mote sympathy (§ 497). This renders it manifest that reflex nervous 
 action is concerned in the ordinary peristaltic movements that are in- 
 duced by the natural contents of the alimentary canal (§ 475^, 490) ; 
 nor, indeed, is it conceivable that either the intestinal muscular tissue 
 or that of the heart can be reached in any other way than by the stim- 
 ulus of the nervous influence excited as in § 475^, 490. But in the 
 case of cathartics, something more happens. The influence being ex- 
 tended to the nervous centres, the nervous power is propagated through 
 motor fibres of the pneumdgastric and sympathetic nerves upon the in- 
 testinal mucous tissue, by which the various influences of these agents 
 are increased, as in the experiments by Wilson Philip (§ 113, 224, 226, 
 4751, 491, 889 a, 1042, 1088 cZ).— Notes A p. 1111, Bb p. 1131. 
 
 514, g. The sphincters remain contracted after the expulsion of the 
 faeces and urine. This is owing to the permanence of the impression 
 upon the mucous tissue, which maintains an excitement of the nervous 
 influence till the excrements are again deposited. And so of the con- 
 tinued influences of remedial and morbific agents long after the agents 
 themselves have ceased to operate ; the impressions remaining upon the 
 parts where their direct action had been exerted. In this way miasma- 
 ta, the virus of the mad dog, mercurial and other remedies which may 
 be slow in the full development of their effects, establish their influences 
 where their direct action may fall, and these are subsequently and 
 slowly propagated to other parts by unceasing alterative reflex nervous 
 actions (§ 516, nos. 2 and 6, 578 cZ, 657 a). See also roosting (§ 500 dd). 
 
 514, h, More complex examples of the law with which this section 
 was begun will be presented hereafter. Such as have been stated are 
 intended as introductory to the series of laws which are soon to fol- 
 low. But we see from examples already produced, that when sym- 
 pathies are set up in one part they may become the cause of sympa- 
 thies in other parts, and that in this manner remedial and morbific 
 agents, which begin their action on some given part, may establish 
 very complex sympathetic effects, each modifying the others through 
 new influences upon the nervous power (§ 228). When the food, for 
 instance, as in § 512, induces vascular action and warmth in the skin 
 before digestion commences, that organ excites salutary reflex nervous 
 influences on the digestive organs, and thus promotes digestion. When 
 tartarized antimony, in small doses, induces a sudorific nervous in- 
 fluence, the skin becomes the source of many reflex nervous actions 
 upon other organs ; thus showing, also, that it is not the perspiration, 
 but the vital change in the organ itself, which leads to results that can-
 
 340 INSTITUTES OF MEDICINE. 
 
 not be imitated by any other mode of exciting this excretory function 
 And so, more or less, of other parts upon which the antimony may 
 exert its primary sympathetic eftect (§ 863, e, 902 g). 
 
 Thus it happens, that whether certain remedial agents are ajDplied 
 to the stomach or skin, reflex nervous actions are propagated to each, 
 as well as from each to other organs, while each, in its turn, reflects 
 the impressions back to the brain and spinal cord, from whence they 
 are again returned with increased intensity ; or organs not before in- 
 volved are ultimately brought under their influence f§ 129 h, 674 d). 
 And so of disease of any given organ ; which is only equivalent to the 
 influences of morbific causes (§ 647, 660). 
 
 If two or more remedial agents be united, it is readily seen that 
 their combined effect may be extended from the stomach to various 
 parts of the body, and thus other alterative reflex actions propagated 
 among themselves, and variously determined upon other parts {\ 872 c). 
 
 514, i. We may now regard an example which presents a union of 
 the physiological, pathological, and therapeutical principles, as set 
 forth by myself, in their relation to the nervous influence ; all refera- 
 ble to one common law in its connection with modifications of the ner- 
 vous power (§ 226). Thus : " Certain cases," according to Marshall 
 Hall, " as hydrophobia, epilepsy, hysteria, and certain remedies, as 
 stiychnia, cantharides, &c., not only induce augmented excitability, 
 but manifest their effects upon the organs which are physiologically 
 under the dominion of the excito-motory power." 
 
 514, k. Finally, a glance at the physiology of the contraction of the 
 iris may aid our understanding of the complex sympathetic influences 
 of morbific and remedial agents, and of the applicability of the follow- 
 ing physiological laws to the modus operandi of such agents. 
 
 It is first worthy of observation, that the iris maybe pricked with a 
 knife without exciting contraction, while it is exquisitely sensitive to 
 the action of light (§ 74 a, ISS-I^ d, 136, 137). The co-operation of a 
 sensitive and motor nerve, through the medium of the brain, is neces- 
 sary to this phenomenon. The impression upon the retina, being 
 transmitted to the brain through the optic nerve, is reflected upon the 
 iris through the motor ciliary nerve. This may, perhaps, open the 
 eyes of the chemist as to the true doctrine of vision (§188^ d, 500 nn). 
 But it is a more interesting fact, that when one eye is closed, and the 
 other open, the pupil of the closed eye will follow, in a measure, the 
 movements of the open eye ; and this will happen to an amaurotic eye 
 when the sound one is exposed to the stimulus of light. This sympa- 
 thy between the two eyes, as well as in other respects, and the har- 
 mony between the two ears, involve very delicate considerations as to 
 the influences of the nervous centres, and may be employed in tracing 
 out the philosophy of many obscure interchanges of action among dif- 
 ferent organs, either in their natural states, or when they are disturb- 
 ed by morbific or remedial agents (^ 1072, a, note). 
 
 514, I. A multitude of illustrations may be brought to the same 
 purpose, which show us, also, how complex may be the influences of 
 morbific and remedial agents, and how the mind may participate, 
 when these agents operate upon the organic properties which con- 
 duct the insensible movements. Thus, sneezing is commonly produ- 
 ced by the action of stimuli upon a nerve of common sensibility dis- 
 tributed from the fifth pair to the mucous tissue of the nose, and the
 
 PHYSIOLOGY. FUNCTIONS. 341 
 
 reflection of this irritation upon the respiratory nerves. But the 
 stimulus of the sun's light may produce sneezing by acting first upon 
 the optic nerve, and through that medium upon the nervous centres. 
 The nervous power thus developed is reflected upon the Schneiderian 
 membrane through the motor branches of the fifth pair which im- 
 parts common sensibility to the nose (§ 1 98). Here a new sensation 
 arises, which is sent back to the brain and spinal cord, the nervous 
 power again developed, and, according to relations between that 
 membrane and. the respiratory organs, and the nature of the re- 
 mote cause, the nervous power is reflected upon the respiratory- 
 muscles, when sneezing follows as the result of the convulsive 
 movement. (See, in connection, § 188| d, 500 n7i.) 
 
 The mind itself will do the same thing by dwelling intensely on a 
 former paroxysm of sneezing. Here the nei-vous power is excited in 
 a direct manner by the mind, and is then, as in the foregoing case, 
 directed upon the nasal branch of the fifth pair. And so of sympa- 
 thetic yawning, sympathetic micturiaon, vomiting from disgust, hcc. 
 
 514, m. The olfactory nerve is mostly endowed with specific sensi- 
 bility, and is only excited by odors, while they have no such effect 
 upon the nasal branches of the fifth pair, unless the odors be at the 
 same time of a pungent nature ; and then it is the pungency, not the 
 odor, that operates. Odors affect the mind agreeably or disagreea- 
 bly. The smell of a rose may have no other effect than that of so 
 impressing the brain as to give rise to a pleasurable sensation. But, 
 in some constitutions its impression will excite a variety of reflex ner- 
 vous actions. Its effect may be at first pleasurable, but followed 
 immediately by the transmission of a disturbing influence to the 
 heart, or stomach, or even to the intestines. The heart may be thus 
 depressed in its action, the stomach nauseated, and the bowels have 
 been purged by the same cause. Hence the poet's expression, to 
 " die of a rose in aromatic pain." Even the recollection of disagree- 
 able results from offensive odors brings on nausea and vomiting (§ 
 500,2, A^. See, in connection, ^ 188 j, d). — Note Dp. 1114. 
 
 Laws of Action of the Sympathetic Nerve, and the Propagatioii of Iiiv- 
 pressions in it. 
 
 514^, a. Having now, and in former sections (§ 471-475, 477-496, 
 500), stated the most important facts and laws which relate to the 
 cerebro-spinal system, whether acting independently, or in connec- 
 tion with the sympathetic nerve, I shall proceed to speak of those 
 which concern especially the latter system. But the cerebro-spinal 
 is so interwoven with the sympathetic nerve, it is obvious that the 
 influences which appertain to the brain and spinal cord must be more 
 or less common to the ganglionic nerve (§ 115, 4.58-460, 893 a). 
 
 514J, b. The following laws are generally inferable from what has 
 been already said of .the nervous power, and of sympathy. But, I 
 have deemed it most useful to the young student of medicine, and 
 possibly to the more advanced, to present them in a brief and sys- 
 tematic form, with comments of a practical nature. The quotations 
 are from Miiller, unless otherwise stated. In this branch of physiol- 
 ogy Miiller is emuiently philosophical ; and in thus adhering to the 
 path of nature, he is arrayed in opposition to those chemical and 
 physical views with which he has thought proper to oblige the mate-
 
 342 INSTITUTES OF MEDICINE. 
 
 rialists of the age, and which prevail in other parts of his work on 
 Physiology. After variously expounding the laws of the vital prin. 
 ciple, and reasoning as a philosopher upon the abstract subject of re- 
 flex nervous influence, like Marshall Hall, and others, he cuts loose 
 from all analogies, and from the whole philosophy of the vital prop- 
 erties. As in the equally remarkable case of Wilson Philip, he as- 
 cribes all the organic functions and products to physical and chemi- 
 cal agencies, — maintaining that, 
 
 " The formation of any one of the peculiar secretions, the essential 
 proximate constituents of which do not exist in the blood, presupposes 
 the operation qf a special chemical apparatus, whether this be a mem- 
 brane or a gland.^'' Of all morbid states, he affirms, that " All these 
 phenomena are owing to a noxious 'matter absorbed into the blood, or 
 generated in itT 
 
 The same humoral interpretation is applied to the modus operandi 
 of remedies, which, like morbific agents, are supposed to be taken into 
 the circulation by endosmosis or by capillary attraction, and it is quite 
 '■'■uncertain^'' he says, '■'^ whether the matters are first received into the 
 blood-vessels or lymphatics^ — Muller's Elemetits of Physiology. Also, 
 Medical and Physiological Commentaries, vol. i., p. 37, note, 56, note, 
 565, 570, 684, 685 ; and this work, § 494, dd. 
 
 I have thus adverted again to the discrepances in the views of this 
 philosopher, that the reader may appreciate the value of his luminous 
 exposition of the laws of sympathy, since they contemplated no theo- 
 retical conclusions in pathology or therapeutics, 
 
 515. It is still a controverted question how far the sympathetic 
 nerve is independent of the brain and spinal cord, though in their nat- 
 ural state the intimate physiological relations of the latter to the for- 
 mer admit of no doubt (§ 459). Microscopical investigations have 
 been carried on extensively with reference to this inquiry by Valentin, 
 Volkmann, Bidder, Midler, Remack, Henl6, Purkinje, Rosensthat, Pap- 
 penheim, and some others less known in the walks of physiology. As 
 may be readily supposed from the nature of the investigation, and the 
 means relied upon, there has been great discrepancy, and even entire 
 opposition, in the principal statements and conclusions ; all tending 
 to strengthen my objections to the use of the microscope in anatomical 
 and physiological inquiries (§ 131.* A\so, Med. and Phys. Comtn.,\o\. 
 i., p. 699-712; and Examination of Revieios, in vol. iii., p. 6, 89). 
 
 We know enough, however, of the relations of the sympathetic 
 nerve and cerebro-spinal systems, and of their connections with other 
 parts, and enough of the phenomena which grow out of those rela- 
 tions, to lay down the important laws of sympathy ; and these are 
 what we require for practical purposes. 
 
 Of the Actions of the Sympathetic Nerve iii Involuntary Motions. 
 
 516, a. 1. "All the parts subject to the influence of the sympathet- 
 ic nerve are incapable of voluntary motion," except as in § 500 e. 
 
 2. " The parts which are supplied with motor power by the sympa- 
 thetic nerve still continue to move, though more feebly than before, 
 when they are separated from their natural connections with the rest 
 of the sympathetic system, and wholly 7-ciaoved from the hodyT 
 
 This is an important fact, as contributing to prove that the viscera 
 
 of oi'ganic life obey not only the nervous power, but other stimuli, and 
 
 * Observations have become more accurate and f^reatly multiplied, but the essential 
 oV)jections remain, as in most other phj'siological processes. — 1860.
 
 PHYSIOLOGY. FUNCTIONS. 343 
 
 that all the essential processes are carried on by properties peculiar to 
 themselves (§ 184, 188, 205-216, 222-232, 475^, 476-492, 494, 500), 
 though constantly influenced by the nerves (§ 456 a, 746 c). 
 
 516, b. Clear demonstrations of the foregoing law abound in the his- 
 tory of organic life. That in relation to the extirpated heart, where the 
 air and mechanical irritants were equivalent to the nervous stimulus, 
 illustrates the subject (§ 264, 498 e, 637). 
 
 516, c. Again, if the intestines be removed from the body, and some 
 part of them irritated, their motion is increased, " and this effect con- 
 tinues long after the stimulus is withdrawn, and does not immediately at- 
 tain its greatest degree." And so with the heart. Its contractions may 
 not begin till some seconds after it is irritated, and they may then be 
 long continued (§ 516, nos. 6 and 7). This does not show, however, that 
 the nerves do not supply the natural stimulus of the muscular tissue, 
 but only that other stimuli will excite its action (§ 475 1, 478 b, 490). 
 
 516, d. We'l^ave, therefore, in these examples, a type of all the move- 
 ments which arise from continuous sympathy* (§ 498, 524, no. 2), and 
 a proof of the existence of the organic properties, of their independence 
 of the nervous system, and of the active, vital nature of the dilatation of 
 the heart (§ 498 e). The principle is of great moment in a pathological 
 and therapeutical aspect. We see, for example, that the direct facts, 
 and the analogy supplied by the active dilatation and contraction of the 
 lioirt, substantiate a rythmic, consentaneous movement of the arteries 
 (§ 384). We carry this with the other facts to pathological conditions. 
 Thus, when the extreme capillaries of the skin, as of the finger, for in- 
 stance, or any other part, are irritated mechanically, or by any chemic- 
 al or other agent, an inflammation may be excited at the point irritated ; 
 just as the heart, or intestine, is roused into action by the prick of a pin. 
 The inflammation then extends, progressively, from the point irritated, 
 the finger throbs, its principal artery begins to pulsate, and finally the 
 radial. And so of the irritation of the ducts of glands, by which the 
 glandular secretion is increased. Generally, also, remote sympathy, or 
 reflex action of the nervous power, is simultaneously brought into efiect. 
 
 3. "Hence, all the parts endowed with motion and supplied with 
 nerves from the sympathetic, are, in a certain degree, independent of the 
 brain and spinal cord." This can apply only to the structures of organ- 
 ic life, and as they may enter those of animal life — thus distinguishing the 
 cerebro-spinal from the ganglionic system (§ 215, 233, 475^, 487, 893J). 
 
 4. " The central organs of the nervous system can, however, exert 
 aij active influence on the sympathetic nerves and their motor power"' 
 (§ 222-232, 475). 
 
 This is a very important physiological fact to the physician, and is 
 fully established by the experiments of Philip, Valentin, Miiller, and 
 others, and is conspicuously shown by the effects of the passions. 
 
 It is through the liability of the whole body to be influenced by the 
 nervous power of the brain and spinal cord through the sympathetic 
 nerve, and as generated by the central parts of that nerve that I in- 
 terpret the whole philosophy of sympathetic diseases, and the operation 
 of all morbific and remedial agents when they affect parts that are dis- 
 tant from the direct seat of their action. — Rights of Authors p. 912. 
 
 5. "The experiments of Dr. Philip tend to show that distinct 
 parts of the sympathetic, and the movements dependent upon them, 
 * Continuous influence of these Institutes (§ 129 e,/, 498 «).
 
 344 INSTITUTES OF MEDICINE. 
 
 a3 of the heart, foi* example, do not derive their nei-vous influence 
 from distinct regions of tlie brain and spinal cord ; but, on the contra- 
 ry, that the whole brain and spinal cord, or every part of them, can 
 exert an influence on the motions of the heart," of the capillary blood- 
 vessels, of the intestinal canal, &c. (§ 476-492, 494 d). 
 
 6. Next follows a most important physiological law, when applied 
 pathologically and therapeutically, and by which I explain the con* 
 tinned operation of morbific and remedial agents long after the ces- 
 sation of their direct action. 
 
 " The movements excited in organs which are under the influence 
 of the sympathetic nerve, by irritation applied to them or to their 
 nerves, are not transitory and momentary contractions. They are 
 either enduring contractions, or they consist of a long-continued modi- 
 fication of the ordinary rhythmic action of the organ. Hence, in these 
 organs, the reaction consequent on the irritation is entirely of longer 
 duration than the action of the stimulus'^ (§ 514 g, 516, no. 2, c, 487 c). 
 
 Now, what is true of the nervous influence as it respects its effect 
 on the great organs is, according to the experiments of Dr. Philip, 
 and others, equally so of the small blood-vessels, and the vessels of se- 
 cretion, and as a consequence, of their products. 
 
 The foregoing law is founded upon experiments in which the irri- 
 tation produced by agents is not directly morbific, such as galvanism 
 and mechanical irritants. If such causes, therefore, will continue to 
 derange the actions of the organic viscera after the operation of the 
 causes is withdrawn, those which are truly morbific will continue in 
 action longer, and establish disease more permanently through the 
 same channel. And so of remedial agents. The law is shown, nat- 
 urally, by the unabated contraction of the sphincter muscles after the 
 evacuation of urine and of fecal matter (See Belladonna &c., p. 674). 
 
 This physiological law, therefore, is of vast moment in interpreting 
 the effects of remedial agents, corresponds with that natural condition 
 which is set forth in § 514,^, shows us how the influence of an emetic 
 or cathartic may continue to be felt by the lungs, the brain, &c., long 
 after their most characteristic effects are over ; or how an uninter- 
 rupted and cumulative action of the foregoing natui'e may be main- 
 tained by small and repeated doses of mercury, antimony, &c., or by 
 the peculiar change which leeches establish in the vessels to which 
 they are applied, and, finally, how a morbific cause of yet other spe- 
 cific virtues may, by its momentary action on the mucous tissue of the 
 stomach, or lungs, &c., be kept up in those tissues long after the re- 
 mote cause is withdrawn, and progressively shed a morbific influence 
 over all the organs of the body ('§ 150, 498/ 545, 549, 550, 558 a, 
 559, 666). The impression is maintained, in all the cases, upon the 
 organic constitution of the organs immediately impressed, for an in- 
 definite time after the agents themselves have ceased their operation. 
 While that impi'ession remains the influence which has been thus ex- 
 erted continues to modify, more or less, the vital nature of the parts, 
 and to be reflected with various effect upon distant organs. We 
 have seen the simple physiological elements operating through the 
 combined media of the cerebro-spinal and sympathetic systems, in 
 § 514, f, g, as it respects the permanent contraction of the sphinc- 
 ter muscles, and in the explanation which I have given of the persist- 
 nnce of their contrrction after the expulsion of the urine and faeces.
 
 PHYSIOLOGY. FUNCTIONS. 345 
 
 Now, thaf principle which physiologists have limited to an expla- 
 nation of the natural phenomena in relation to the sphincters is most 
 extensively applicable in resolving the problems of disease and of re- 
 medial influences, and I shall carry it, in connection with the forego- 
 ing law, far into the labyrinth of organic life, as it may fall under the 
 cognizancQ of the pathologist and therapeutist. In the aspect, alone, 
 of its bearing upon the amount and frequency of doses, &c., in the 
 treatment of disease, the law is of incalculable magnitude (§ 857), 
 The same impressions which are left upon the bladder and rectum 
 after the evacuation of their contents, and which continue to propa- 
 gate reflex nervous actions to the sphincter muscles, and thus maintain 
 them in a state of contraction till the urine or the faeces again accu- 
 mulate, equally appertain to morbific and remedial agents. Hence 1 
 deduce an important practical rule for the regulation of doses, the 
 frequency of their repetition, the order of their application, &c., ac- 
 cording to the nature of disease, the nature of the agents employed, 
 the duration of their effect, &c. ; all of which is amply sustained by 
 the results of practice, especially those which so constantly accrue from 
 excessive doses, and their repetition before the influences of the pre- 
 ceding shall have duly abated, or where other means should have 
 been substituted. There is nothing, I say, of greater practical impor- 
 tance in the whole circuit of medicine than what is involved in this 
 section, and in those which I shall have brought to its illustration. 
 We must attend to the physiological facts. The effects of mistaken 
 practice are entirely insufficient to enlighten the understanding. Phys- 
 iology must be bi'ought back as the basis of pathology, the ground- 
 work of therapeutics ; keeping ever before us those natural laws 
 through which the evil and the good of practical medicine are essen- 
 tially determined. However various the causes and the phenomena, 
 a concurrence of principle and of laws obtains- among the whole ; 
 which is the surest proof that the doctrines here taught have their 
 deep foundation in nature (§ 237). There is nothing that can assure 
 us more emphatically of the importance of sweeping away the chem- 
 ical and physical doctrines of life, of disease, of therapeutics, than the 
 facts about which I am now interested, and the mischief which has 
 arisen either from removing pathology and therapeutics from their 
 proper foundation, or in dei'iving their foundation from the laboratory 
 of the chemist (§ 5h a, 350|, 350^, 819, &c.).— Note Ff p. 1135. 
 
 7. The next following law shows that the organs of organic life are 
 essentially a system by themselves, that their actions are carried on 
 by their own inherent powers, and are essentially independent of the 
 nerves, and that the great oflSce of the sympathetic nerve is to pro- 
 vide a stimulus, and animalize organic compounds. It will be seen, 
 however, that a common error occurs, that " tJie immediate cause of the 
 involuntary motions lies in the symjpailietic nerve'"' (§ 516, no. 2). 
 
 *' The immediate cause of the? involuntary motions, and the cause 
 of their type, lies neither in the brain nor in the spinal cord, but in 
 the sympathetic nerve itself. Even the influence of the ganglia is not 
 necessary. The branches of the sympathetic going to an organ may 
 be entirely removed, the twigs distributed to the substance of the or- 
 gan only being left, and the motions will be maintained as before, the 
 reciprocal action between the muscular fibres and these ultimate ner- 
 vous twigs being apparently adequate to their production."* 
 * See Note Bb p. 1131.
 
 346 INSTITUTES OF MEDICINE. 
 
 The phenomena are the same in plants. They depend, not on the 
 nervous power, but on the organic properties of every part. This ap- 
 pears from Miiller himself, who says that, " to excite the motion of 
 the leaflets and petioles of the mimosa, it is not necessary that either 
 the intumescence, or even the leaves, should be touched. The stimu- 
 lus may be applied to a more or less distant part" (§ 184, 207, 208, 
 233, 257, 490, 502, 524, no. 2). Had Miiller said the exciting instead 
 of the " immediate cause," there would have been less objection ; but 
 the present case is like that in § 2G4, 498 e, 516 c, 1042. 
 
 8. Now follows the great law, that, notwithstanding the foregoing 
 separate nature of the organic properties and their essential independ- 
 ence of the nervous power, the organic properties are constantly influ- 
 enced through the cerebro-spinal and sympathetic systems. What is 
 said, however, of the "extreme branches of the sympathetic" must be 
 regarded as erroneous (no. 7), though it be certain that influences may 
 be determined by reflex action through the ganglia and plexuses of the 
 sympathetic nerve (§ 459). The law is thus expressed by Miiller: 
 
 " Although, from the foregoing observations (no. 7), it is certain that 
 the extreme minute branches of the sympathetic have still the power 
 of regulating the movements of the parts not subject to the will (when 
 such parts are abstracted from the body), yet it is not less true that 
 both the brain and spinal cord, and the ganglia themselves, when in 
 a state of irritation, exert an influence on these movements as long as 
 the contractile organs are connected with them through the medium 
 of the nerves. The brain and spinal cord are, however, also to be 
 regarded as the source of the power of the sympathetic itself, which 
 would, without them, become exhausted" (§ 473 c, 524, no. 6). 
 
 The last clause of the foregoing law is inapplicable to the foetus 
 without brain and spinal cord (§ 493 c). As to the exciting cause of 
 motion in the extirpated heart and intestine, the question is important 
 only as it relates to the proof that motion depends essentially upon 
 properties inherent in the tissues, and as involving an implication that 
 the sympathetic nerve embraces in its minute ramifications centres of 
 reflex nervous actions. In its larger branches such centres probably 
 exist (§ 262, 263, 473 c, 498 e, 516, nos. 2, 3, 1042). 
 
 The preceding law involves the sum of reflected nervous actions, of 
 the operation of the passions, and of other direct cerebro-spinal influ- 
 ences on the organic viscera (§ 227, 230). 
 
 9. I would vary the phraseology of the following law, to render it 
 more conformable with the facts. I do not believe that the sympa- 
 thetic nerve is any longer charged with the influence derived from the 
 brain and spinal cord than during its connection with those parts. So 
 far as this nerve manifests an influence after that connection is sever- 
 ed, it is itself the source of that influence ; and this conclusion is sus- 
 tained by the foetus without brain or spinal cord (§ 1038). 
 
 " It results," says Miiller, " from the fact already stated (nos. 7 and 
 8), that the sympathetic nerve is charged, as it were, with nervous 
 power by the bram and spinal cord, which may be regarded as the 
 sources of nervous influence ; but that, when once charged, it con- 
 tinues to emit this influence in the manner peculiar to itself, even 
 when the farther supply is, for a lime, diminished" (§ 516, nos. 7 and 
 8 ; § 520, 524, no. 5). 
 
 If the " fact" show anything, it is a certain independence of tho
 
 PHYSIOLOGY. FUNCTIONS. 347 
 
 sympathetic of the cerebro-spinal system, which becomes strongly 
 pronounced when the latter is wanting in the foetal state, or when de- 
 ranged in some chronic maladies. 
 
 10. The next law shows that the action of agents is incomparably 
 greater upon the minute terminations of the nerves than upon their 
 trunks. It is equally applicable to the cerebro-spinal as to the sym- 
 pathetic. Thus : 
 
 " The influence of narcotics locally applied to the sympathetic 
 nerve, does not extend to the distant organs which the nerve sup- 
 plies ; but these organs may be paralyzed by the direct narcotization 
 of the minute nervous fibrils which are distributed to them." 
 
 The principle is general, extending to all other agents, and has 
 been misapplied by Miiller, and many others, to sustain the humoral 
 pathology (§ 826, d. Med. and Phys. Comm., vol. i., p. 563, 564). 
 
 11. The next following law will be seen to be important in inter- 
 preting some of the various phenomena of sympathy, when they orig- 
 inate in the sympathetic nerve. Thus : 
 
 " The laws of reflection (in the cerebro-spinal system) stated in the 
 third chapter of this section prevail, likewise, in the actions of the 
 sympathetic nerve. Strong impressions on parts supplied by the 
 sympathetic nerve may be propagated to the spinal cord [and brain], 
 and give rise to motions of parts which derive their nerves from the 
 cerebro-spinal system." 
 
 As an illustration of this law, "Volkmann has observed convulsions 
 of the body produced by irritating the intestines of a decapitated 
 
 With the head on, and in animals more susceptible than frogs, the 
 foi'egoing law becomes extensively applicable to agents applied to the 
 intestinal canal, or other viscera that are especially supplied by the 
 sympathetic nerve. Thus, nux vomica produces spasmodic action of 
 the voluntary muscles, while opium, &c., relieves them in the same 
 way. Indeed, it is well ascertained that all the spasmodic movements 
 of the voluntary and respiratory muscles that arise from affections of 
 the abdominal organs depend upon irritations transmitted to the brain 
 and spinal cord, and their subsequent reflection upon cerebro-spinal 
 nerves. Hence, also, the action of the abdominal muscles in the 
 vomiting excited by imtation of the intestines, by irritation of the kid- 
 neys, of the uterus, &c. And so of the natural movements of the re- 
 spiratory muscles (§ 500, 839 g, 891^ g, k, 903 a, 902 g). 
 
 12. " Impressions on parts of which the nerves are derived from 
 the sympathetic are communicated to the spinal cord and brain, and 
 excite the motor influence of the sympathetic nerve by reflection." 
 
 The foregoing law is an extension of no. 4, and is the most impor- 
 tant of well-ascertained laws in medicine, as explaining all the sym- 
 pathetic influences of disease, all the influences of remedial and mor- 
 bific agents exerted upon parts distant from the seat of their direct 
 action ; except such phenomena as may also fall more or less under 
 the laws 11 and 13, in connection with which this law should be con- 
 sidered. — {Med. and Phys. Comm., vol. i., p. 569-572.)* 
 
 13. " Reflected action of the sympathetic, from an impression com- 
 municated to the spinal cord by cerebro-spinal nerves, is a frequent 
 occurrence" {^ 893 a, c). 
 
 The " frequency of the occurrence" is such, that it is through the 
 * See Rights of Authors, p. 912.
 
 348 INSTITUTES OF MEDICINE. 
 
 foregoing law, and the 12th, that remedial agents opei'ate upon the 
 organic system when applied to the skin, that diseases of the skin af- 
 fect the abdominal viscera, that the contact of cold air suddenly in- 
 creases the excretion, or the discharge, of urine, &c. The 12th law 
 is involved, since both the cerebro-spinal and sympathetic nerves of 
 the skin are the media of transmitted impressions. The chain of in- 
 volved influences is of the highest importance, pathologically and ther- 
 apeutically. As one of a thousand illustrations, if tobacco applied to 
 the skin produce vomiting the effect is first propagated to the ner- 
 vous centres, from which it is reflected upon the stomach through the 
 motor fibres of the par vagum and sympathetic nerve. This irritation 
 of the stomach is equivalent to a direct impression from tobacco upon 
 its mucous tissue (§ 503). It is then returned to the nervous centres 
 through the sensitive fibres of the par vagum and sympathetic nerve, 
 and reflected upon the respiratory muscles through the motor nerves 
 of those organs (§ 113, 224, 226, 475^, 500 k, 893, 893^). 
 
 But there are other profound influences, and other circles of sym- 
 pathy simultaneously established. The organic properties of the 
 stomach are affected, reflex nervous actions are reverberated upon 
 the skin, displayed in the heart and blood-vessels, in the liver, and oth- 
 er important organic viscera, while these influences also mutually re- 
 act upon the several organs, respectively, and involve other parts, 
 such as the uterus, the kidneys, the bladder, the voluntary muscles, 
 the sphincters, the senses, the mind, &c., in the deep complexity of 
 results. And all this astonishing consecutive series of effects, moving 
 forward under the most precise and fundamental laws of nature, and 
 all the work of a moment, is set in motion by the simple application 
 of a leaf of tobacco to the sole of the foot (§ 502, 902^). 
 
 517. Finally, the nervous power may be determined upon the or- 
 ganic properties of the brain, or of any part of the nervous system, by 
 physical and mental causes, with much of the variety of effect which it 
 produces on other parts (§ 230, 512, 1040).— Note Q, p. 1122. 
 
 518, a. " In certain organs, which are subject to the influence of 
 the sympathetic and of the cerebro-spinal nerves at the same time, a 
 voluntary influence seems to be exerted only after the long continu- 
 ance of a centripetal or sensitive impression." 
 
 So far as this principle is operative, it goes to demonstrate the re- 
 markable peculiarities, the versatile and complex nature, of the func- 
 tions of the nervous system (§ 500,^' and k). The urinary bladder, 
 for example, which is under the influence of the will, presents the fol- 
 lowing phenomenon : " The will does not come into operation until 
 a considerable accumulation of urine has taken place ; in other words, 
 not until the fluid has made a long-continued impression on the sensi- 
 tive nerves of the bladder, and through the medium of these upon the 
 cerebro-spinal axis" (§ 500, e). 
 
 518, b. Analogies evidently occur in the viscera over which the will 
 has no control, while the facts are illusti*ated by the principle as ascer 
 tained in the foregoing manner ; such, for example, as the long incuba- 
 tion of miasmata, of the hydrophobic virus, mercurial influences, &c., 
 and the sudden accession of the phenomena to which they respectively 
 give rise (§ 500 e, 514 g, 516, no. 6). In sections 500,^;' and k, are 
 some remarkable facts which will deter us from rejecting diflficult 
 problems in sympathy (§ 473, no. 6, 523, nos. 6 and 7).
 
 PHYSIOLOGY. FUNCTIONS. 349 
 
 519. The following law is a farther exemplification of the forego- 
 ing comments (§ 518, b), and should be considered in connection with 
 the 11th and 12th laws. Thus : 
 
 " Many parts which are supplied by the sympathetic nerve, and ca- 
 pable of involuntary motion only, become associated with the motions 
 of parts subject to volition ; a part of the voluntary motor influence 
 being communicated involuntarily to them ; just as in the associate 
 motions of the voluntary muscles." 
 
 Of this, examples are afforded by the iris, the vesicula seminalis, 
 and intestine (§ 500, e). It is in this way the will affects the iris. 
 
 520. The problem is propounded by Miiller, " Can reflex phenom- 
 ena be produced in the sympathetic nerve through the influence of the 
 ganglia, and independently of the brain and spinal cord V 
 
 He is disposed to answer the question negatively, and observes that, 
 " We are at present entirely ignorant as to whether irritations in one 
 organ ever, through the medium of the sympathetic, give rise to sym- 
 pathetic movements in another." And yet when he comes to reason 
 from the phenomena of nature, he remarks that, " in many cases, it is 
 probable that the reflections are produced through the medium of the 
 sympathetic alone;" and again, that in such cases, "it is probable 
 that the sympathetic nerve alone is engaged in the production of the 
 phenomena." This is enforced by the considerations, that, " the pe- 
 culiarity of the organic or sympathetic nerves, namely, the difficulty 
 of distinguishing either origin or termination of them, their want of 
 (definite) arrangement into trunks and branches, and the increase in 
 their course which they frequently undergo, is certainly in favor of 
 their actions being propagated in all diixecliona from the central points 
 of the ganglia^ 
 
 Tliis was tlie old doctrine, which concerned itself mostly about 
 the sympathetic nerve, and the fact is distinctly evinced by many 
 of the phenomena of contiguous sympathy (§ 497), and by the fcetus 
 without brain and spinal cord. It seems, also, to have been shown 
 by the experiments of Henle, Grangier, and Valentin, upon the in- 
 testines. But careful attention is necessary, in these cases, to distin- 
 guish what is due alone to the independent organic properties of 
 any part, from that which is owing to an influence exerted upon 
 those properties by the nervous power (§ 222, &c., 507, 516, nos. 7 
 and 8, 1038). In the former case other stimuli operate (^ 490, 498 e). 
 
 521. " It is not proved, and several facts have been observed 
 which are opposed to the belief, that the ganglia can exert an insula- 
 ting action so as to impede the transmission of motor influence frorr. 
 the brain and spinal cord" (§ 523, no. 4). 
 
 All the phenomena of sympathy in organic life appear to be oppo- 
 sed to this belief. 
 
 522. " It is not certain that the ganglia are the cause of the parts 
 supplied by the sympathetic nerve being withdrawn from the influ- 
 ence of the will." 
 
 It is probable that the cause is inscrutable, since it is owing to pe- 
 culiarities in the vital as well as mechanical constitution of the two 
 systems of nerves. We see, however, that influences are as readily 
 transmitted from the brain to the organic viscera as the will operates 
 on the voluntary muscles ; and while the passions scarcely operate in 
 animal life, they have a powerful and rapid effect on organic.
 
 350 INSTITUTES OP MEDICINE. 
 
 Laws of the Sensitive Functions of the Sympathetic Ncrte. 
 
 523. 1. " The sensations in parts, the nerves of which belong to 
 the sympathetic system, are faint, indistinct, and undefined ; distinct 
 and defined sensations being excited in them only by violent causes 
 of irritation" (§ 201, b). 
 
 2. " The sensitive impressions received by the sympathetic nerve, 
 although conveyed to the cerebro-spinal axis, may not be perceived 
 by the sensorium" (§ 199|, 451). 
 
 3. " The impressions which give rise to reflex motions, when con- 
 veyed to the spinal cord by the sympathetic nerve, are, in most in- 
 stances, not productive of sensations ; while those impressions which 
 are received by cerebro-spinal nerves always give rise to sensations" 
 in natural states. The refex is our sympathetic sensation (§ 201, 451). 
 
 4. " The ganglia of the sympathetic nerve do not prevent the 
 transmission of centripetal actions in that nerve to the spinal cord. 
 They have not an insulating power over its centripetal currents" 
 (§ 521, 1038). 
 
 5. " The ganglia are likewise not the cause of the impressions on 
 the sympathetic nerve being unattended with true sensation." 
 
 6. " In many cases, irritation of a violent nature in organs supplied 
 by the sympathetic nerve gives rise to sensations in those parts. In 
 otlier cases, the irritation being less violent, the sensations in the 
 parts affected are indistinct, while distinct sensations are present in 
 other parts supplied with cerehro-spinal nerves'^ (§ 518, V). 
 
 We have examples of the first kind in inflammations of the intes- 
 tines and liver; of those of the second kind, in the troublesome itch- 
 ing of the nose and anus in affections of the intestinal canal, and pain 
 of the shoulder in hepatic and cardiac diseases, of itching of the 
 glans penis in chronic affections of the bladder and kidneys. 
 
 7. " The secondary sensations in cerebro-spinal nerves, consequent 
 on irritation of the branches of the sympathetic, occur especially at 
 the extreme parts of the organs affected." 
 
 Morbid states of the stomach produce a sense of irritation in the 
 throat ; and nothing is more common than obstinate inflammation of 
 the mucous tissue of the fauces from gastric derangements, which are 
 not inflammatory.* In all these cases, remote and continuous sympa- 
 thy are more or less in combined operation. An ignorance of the 
 laws which govern in such instances leads many physicians to apply 
 their remedies to the parts where the sensation is felt, or the inflam- 
 mation appears. There is also a special sympathy between the ex- 
 tremities of the intestinal mucous membrane. Smoking, for instance, 
 often brings on an attack of the piles ; though an intermediate chain 
 of morbific influences is also propagated to the anus through the 
 stomach and liver (§ 498/, 514 h, 689 I). 
 
 Laivs of the Organic Functions of the Sympathetic Nerve. 
 
 524, a. 1. "When, in consequence of impressions on sensitive 
 nerves, secretions take place in distant parts, the brain and spinal 
 cord are probably the medium of communication." Thus, " impres- 
 sions on internal mucous membranes, as by hot drinks, frequently 
 give rise immediately to a general sweat." 
 
 * Diphtheria and FothergilVs Sore-throat are merely sympathetic results of profound, 
 insidious, venous congestion of the abdominal organs (§ 689 /) — Note Kk p. 1140.
 
 PHYSIOLOGY. FUNCTIONS. 351 
 
 This is precisely similar to what I have said of the effect of food m 
 lighting up a warmth in a cold skin (§ 512). 
 
 The foregoing law is true, in a general sense (§ 455, 458, 459, 490 
 493 b, 516, nos. 7 and 8). It lies at the foundation of the whole doc- 
 trine which I have projected of alterative reflex action, through 
 which I interpret all diseases that spring up as consequences of each 
 other, and the operation of morbific and remedial agents upon parts 
 remote from the seat of their direct influence. It is variously express- 
 ed in the preceding laws. 
 
 If hot water operate upon the stomach and transmit its influence 
 through the cerebro-spinal and sympathetic system to the whole sur- 
 face of the body, it is clearly in the same way that tartarized antimo- 
 ny produces a sweat over the whole cutaneous organ when it deter- 
 mines nausea, or the act of vomiting, and therefore, also, when it acts 
 upon the stomach in a more insensible manner. And so of the re- 
 mote influences of other remedies, or of morbific agents, or of gastric, 
 or any other primary disease. If it be the principle as laid down 
 physiologically, it must be equally the same for analogous effects in 
 disease, or in its treatment. — See Rights of Authors, p. 913. 
 
 2. " There prevails a consent of action between the different parts 
 of a secreting membrane. Thus, the state of one spot influences the 
 condition of the whole extent of a mucous membrane" (§ 498y, 516, 
 nos. 2, 3, and 7). 
 
 This is the continuous sympathy as expounded in this work. It is 
 more or less manifested in most of the diseases of all tissues, and al- 
 though not a function of the sympathetic nerve, I have retained tht- 
 law under that denomination (§ 141, 498, 520, 923). 
 
 3. " A particular state of one organ, such as inflammation, or a se 
 creting action in it, often causes the production of a similar state in 
 other parts." 
 
 This proposition is intended in a specific, not in the general sense 
 in which disease of one part gives rise, by reflex action, to diverse af- 
 fections of other parts. It refers to peculiar states of disease in which 
 remote sympathy is often remarkably characterized. Thus, "inflam- 
 mation of the testicle may be replaced by inflammation of the parotid ; 
 erysipelatous inflammation of the skin may be transferred to the mem- 
 branes of the brain ; suppression of the secretion of one organ may 
 give rise to inci-eased secretion in another." So of the extension of 
 rheumatism and gout from one part to another of very different or- 
 ganization (§ 142, 893 n, 905 a). 
 
 524, h. Where sympathies of the foregoing nature arise, there is 
 often a special relation of natural functions between the respective 
 parts, as between the uterus and mammae. Or such relation appears 
 to be pronounced only by morbid states, as between the parotid and 
 testis, and the parotid and mammae, in the mumps (§ 142). 
 
 524, c. As resulting from the foregoing (no. 3), though apparently 
 the reverse of it, we have the important reflex influences, that when 
 disease springs up in distant parts as a consequence of some affection 
 of other parts, the secondary affection often proves curative of the 
 primary one. It is the same, in principle, as when blisters, setons, 
 &c., relieve some internal malady. Many sympathetic diseases have, 
 as it were, a great final cause, as a part of the natural constitution of 
 animals. The ordinary forms of inflammation which supervene on
 
 352 IN'STITUTES OF MEDIf/INE. 
 
 venous congestion often relieve a more formidable affection of the 
 veins (§ 803, 804, 905. Also, Med. and Phys. Covim., vol. ii., j). 519- 
 524). Inflammation of the bronchial mucous membrane, or of the 
 pleura, supervening on pneumonia, may assuage the latter affection- 
 Phthisis, supervening on gastric disease, sometimes removes the lat- 
 ter condition. Eruptions of the skin relieve disease of the internal 
 viscera. The hepatic action which leads to morbid redundances of 
 bile mitigates cerebral or other congestions and inflammations, and 
 the effusion relieves the liver ; while it is the tendency of inflamma- 
 t'on of all parts to relieve itself by some morbid product, whether the 
 disease be primary or secondary. Nature, in these cases, has suppli- 
 ed indications for the hand of art ; and, instead of waiting for the in- 
 direct and spontaneous course, we should abstract blood, or hasten 
 to establish those changes which result in increased secretions, &c. 
 While, also, we are accomplishing these results, which, abstractedly 
 considered, are depletive, we are acting, at the same time, upon the 
 diseased properties, eitjier by a direct impression upon them by the 
 remedies, or indirectly by reflex nervous action (§ 503). But this is 
 mainly true of the natural processes as it respects spontaneous hem- 
 orrhage. All the other natural effusions are greatly wanting in those 
 direct remedial effects which are exerted by therapeutical agents that 
 lead to similar products. 
 
 " The principle of the balance of sympathy teaches us how we must 
 avoid aggravating the morbid condition of one organ by the means 
 which we apply to another ; but it also teaches us how we may pro- 
 duce a change in the state of one organ directly inaccessible to us by 
 effecting an appropriate change in another." — Mullek. Here Miiller 
 is any thing but a humoralist, as, also, throughout his disquisition on 
 the laws of sympathy ; though in other places he lays down the broad 
 doctrine that morbific and remedial agents produce their effects by 
 absorption into the circulation (§ 494 dd, 514| h. Also, Med. and 
 Phys. Comm., vol. i., p. 563-571). 
 
 524, d. It might seem, at first glance, that the fact of the vital prop- 
 erties and actions being liable to disease is inconsistent with the great 
 laws of recuperation and self-preservation. But it is not so ; since 
 morbific agents being permitted, their occasional deleterious action 
 grows out of the natural constitution of the properties of life, which 
 is physiologically designed for the healthy processes. That these 
 processes may be carried on, the properties of life must be susceptible 
 of being acted upon by foi'eign agents, as food, &c., and universally 
 by the blood. They must also be liable to modifications in their na- 
 ture, that certain specific functions may be instituted from time to 
 time, as the pi'ocesses of gestation, lactation, &c., and the powers oi 
 all other parts must be so constituted as to adapt themselves to these 
 transient modifications. And so of other changes, as from infancy to 
 childhood, from childhood to puberty, &c. (§ 153-159). Now the 
 changes which arise in disease are analogous to those of gestation, 
 lactation, and more remotely to those which occur at puberty; and they 
 are, therefore, necessary consequences of the natural and essential 
 constitution of the vital properties when noxious agents act upon them. 
 We therefore return again to our proposition that it is even a neces- 
 sary consequence of the final cause of the adaptation of the properties 
 of life to the influence of salutary agents. And hence, also, the natu-
 
 PHYSIOLOGY. FUNCTIONS. 353 
 
 ral law of adaptation (§ 136) extends to morbid states of the system ; 
 being, fox* example, the principle already adverted to, which pro- 
 tects the general system against those morbid changes in the blood 
 that ensue upon local diseases, and diseased parts against the irrita- 
 tion of their morbid products {§ 74, 129, 137 c, 143 c, 150-152, 155, 
 156, 387, 524 c, 944 c, 980, 1019, 847-850). 
 
 4. " The ganglia appear to be the central parts from Avhich the 
 vegetative influence is distributed to the different organs." 
 
 5. " This radiating influence appears to be, in a certain degree, in- 
 dependent of the brain and spinal cord" (§ 520, 516, no. 9). 
 
 6. "It appears, however, that the brain and spinal cord are the 
 main source whence the power of the organic nerves is gradually ren 
 ovated" (^ 1038). 
 
 7. The sympathetic nerve modifies organic functions and their prod- 
 ucts, and supplies the stimulus of the nervous power to muscular fibre 
 in organic life (§ 224, 455 a). Every organ, through this channel, is 
 rendered sensitive to the condition of each other, and they so interchange 
 their influences upon each, that the whole are maintained in those rel- 
 ative states of action which are most conducive to the good of the whole. 
 From the exquisite susceptibility of the nervous power, and of sympa- 
 thetic sensibility, which is so conspicuous in this function, arise those 
 disturbances that are inflicted by organs upon each other, and the re- 
 flected influences of remedial and morbific agents (§ 113, 224, 455, 461, 
 4611, 475i 487 /^, 500 g, 516 d, nos. 7-9, 647^, 893, 8931). 
 
 SYMPATHIES OF THE INDIVIDUAL TISSUES KEFLEX AND CONTINUOUS. 
 
 Sympathies of Similar Tissues. 
 
 525, a. Enough, perhaps, has been said upon this subject(^ 85-117, 
 133-143). We have seen that tissues of a similar vital constitution 
 have the greatest tendency to sympathize with each other ; but it is 
 not necessary that the secondary disease should be of the same na- 
 ture as the primary, though such is apt to be the case (§ 140, 141, 
 149-152). 
 
 The most frequent instances of morbid sympathies in tissues of the 
 same nature, but remote from each other, occur in the following or- 
 der (§ 162) : 
 
 1. The venous tissue, in the form of venous congestion (§ 786, &c.). 
 
 2. The fibrous tissue, as in rheumatic inflammation. 
 
 3. The serous tissue, as seen, especially, in dropsical affections. 
 
 4. The mucous tissue. 
 
 5. The cellular tissue. 
 
 6. The lymphatic tissue. 
 
 7. The nervous tissue. 
 
 8. The arterial tissue. 
 
 9. The muscular tissue. 
 
 10. The osseous and cartilaginous tissues. 
 
 525, b. When similar tissues sympathize with each other, the sym- 
 pathetic disease and its phenomena are apt to be similar to the pri- 
 mary affection ; while, in the case of sympathies arising among dif- 
 ferent tissues, the phenomena are different in each, even though the 
 primary and secondary affections be of the same general natuie, as, 
 
 Z
 
 354 INSTITLTES OF MEDICINE. 
 
 however, they are not wont to be. When like tissues sympathize 
 with each other, the diseases and the phenomena are most analogous; 
 because the same tissue in different compound organs has, respect- 
 ively, modifications of the organic properties that are more alike than 
 those of different tissues. And hence, mainly, the greater difference 
 between the primary and secondary diseases of different tissues (§ 
 133-140). 
 
 525, c. When disease springs up in tissues of the same organiza- 
 tion, but remote from each other, as in rheumatic inflammation of the 
 fibrous tissues, for example, the piimary affection often exists in some 
 other part or parts, as the digestive organs, and is generally of a dif- 
 ferent character from the secondary affection. In these cases, which 
 are common, the successive secondary affections may be more owing 
 to reflex influences of the parts primarily diseased than to the sym- 
 pathetic influence of the tissue secondarily affected upon other parts 
 of its own denomination. This is an important practical considera- 
 tion, for upon its just estimate will depend much of the treatment in 
 any given case of disease (§ 902 m, 905). It is also equally true that 
 the sympathetic affections which supervene among compound organs 
 are apt to be more or less different from the primary affection. 
 
 526, a. Tissues morbidly affected sympathize, continuously, in their 
 several parts, most readily in the following order (§ 133-136, 498) : 
 
 1. The venous tissue, in congestion or sub-inflammation. 
 
 2. The lymphatic tissue. 
 
 3. The cellular tissue. 
 
 4. The mucous tissue. 
 
 5. The fibrous tissue. 
 
 6. The serous tissue. 
 
 7. The glandular tissue. 
 
 8. The dermoid tissue. 
 
 9. The nervous tissue. 
 
 10. The muscular tissue. 
 
 11. The cartilaginous and osseous tissues. 
 
 12. The arterial tissue. 
 
 Owing to the peculiar vital constitution of each tissue, disease is 
 apt to be confined to that which it fii-st invades, but tq, disturb the 
 condition of other parts with which it may be associated (§ 133—136). 
 There are, indeed, some striking exceptions to the generqj rule ; as, 
 rheumatic inflammation of the ligaments is often propagated to the 
 heart, and sometimes to a mucous tissue. Inflammation of the pul- 
 monary air-cells is vei'y apt to be extended to the serous tissue of the 
 lungs, or inflammation of the liver to its investing membrane. In- 
 deed, the serous membranes generally participate •in the morbid 
 states of the other tissues with which the^ are associated ; nor can 
 mach intensity of disease affect any tissue without disturbing, more 
 or less, the condition of its associate tissues. But there is much va- 
 riety in these respects, even in continuous organs, as between the 
 stomach and the small and large intestines. If the mucous coat of 
 the small intestine be actively inflamed, it is frequently the cause of a 
 like condition in the peritoneal coat, when the mucous inflammation 
 may subside as a sympathetic consequence ; thus representing the 
 doublo operation of the law in i^ 524, no. 3. But, however severe-
 
 PIIVSIOLOGV. FUNCTIONS. 35!) 
 
 ly the mucous coat of the stomach maybe affected, with inflammation, 
 the disease is rarely propagated to the serous tissue of the organ, but 
 far more readily to the serous or other tissues of the lungs, &c. 
 
 In respect to the arterial tissue, when we regard the extreine and 
 capillary series as the instruments of all diseases, and, therefore, al- 
 ways involved in morbid action in the diseased states of all other tis- 
 sues, it must rank as the first in its liability to continuous and remote 
 sympathetic influences (§ 1040). 
 
 The arterial tissue itself is but little subject to other conditions of 
 morbid action; and when the large arteries become inflamed in any 
 pai't, the disease remains very circumscribed. They have, also, no 
 great action in their natural state ; it being their office, mainly, to 
 serve as conduits for the blood. Nevertheless, they are constantly 
 liable to sympathetic irritations, either by continuous influence or re- 
 flected nervous action. The next series, or the capillary arteries, 
 are reservoirs of blood to the extreme vessels ; and to meet the exi- 
 gencies of this function, they have their vital properties and actions 
 more strongly pronounced, and are readily and manifestly influenced 
 by the nervous power, as abundantly shown in blushing, &c. (§ 512, b). 
 Hence, from this natural, physiological constitution, this series of the 
 arterial system is more liable than the larger to irritations and aug- 
 mented actions, as manifested in most inflammations (§ 715—719). 
 
 We come next to the extreme series, in which the capillary arte- 
 ries terminate ; and here we find the vital properties developed in an 
 eminent degree. This is known from their being the essential in- 
 struments of all healthy and morbid processes ; and the changes in 
 their phenomena and products during disease evince the rapidity and 
 great extent in which these properties and actions may be modified 
 by the nervous power, and which are brought about in an instant of 
 time when that power is developed by the mind (§ 227, 500, 516 d). 
 Reflex nervous action plays an incessant and extensive round among 
 this extreme series of vessels, both in health and disease. A breath 
 of cold air may arrest the secretion of sweat, and simultaneously de- 
 termine an increased flow of urine, or fear will as suddenly aug- 
 ment both excretions. Coming to disease, and the influence of reme- 
 dial agents, this natural relationship of the extreme vessels, and the 
 same physiological principle, are at the foundation of the principal 
 philosophy. Indeed, the organic properties being now more suscep- 
 tible than in health, and the nervous power more intensely developed 
 by morbific and remedial agents, its operation must be more rapid, 
 extensive, and profound, in the latter than the former case. Hence, 
 in part, inflammations, &c., are liable to spring up in rapid succession 
 in various remote organs, after their invasion of any onepart(<^ 1056). 
 
 526, b. Next, as to the venous tissue. Here the sympathies are 
 great, both of the remote and continuous kind, particularly the latter 
 (§ 498). It is especially through the natural physiological sympathies 
 of the veins, that I have endeavored to show how they co-operate in 
 circulating the blood, as also the error of the physical doctrine of ve- 
 nous congestion, which supposed that this most prevalent and fatal 
 disease depends on obstacles to the circulation and consequent stag- 
 nation of the blood. I have, therefore, endeavored to expound the 
 pathology of this affection upon purely vital grounds, and in conform- 
 ity with physiok)gical laws (§ 786, &c.). The main physiological prin-
 
 356 INSTITUTES OF MEDICINE. 
 
 ciple of a sympathetic nature, however, should be stated in connec- 
 tion with the subject before us. The venous radicles possess a vigor- 
 ous action which is constantly influenced, through continuous sympa- 
 thy, by the corresponding state of the capillary arteries, and by the 
 quantities of blood transmitted to them ; and that the trunks of the 
 veins have a most visible action is shown by their rapid contraction 
 and dilatation when cold or heat may operate upon the skin. This 
 action is simultaneous, or nearly so, over a large extent of the veins, 
 and is the result of continuous sympathy with the arterial system, as 
 well as dependent on the quantities of blood transmitted and upon re- 
 flex nervous action. But, when an increased quantity is transmitted, 
 the enlargement of the veins is in no respect mechanical, but produced, 
 in part, by the greater impression which is thus made upon the ex- 
 quisite susceptibility of the organic properties of the veins. 
 
 From these few remarks as to the vital endowments of the veins, 
 and of the active functions they perform, it is evident that they must 
 be quite liable to morbific influences, and that remote and continuous 
 sympathy of a morbid nature must have a ready operation among 
 them (§ 74, 117, 137, 155, 156, 387, 422, 514 A, 524 d). 
 
 526, c. In respect to the lymphatic system, the principle of continu- 
 ous sympathy, as in the veins, is strongly exhibited under the influence 
 of irritating agents. If a lymphatic become inflamed at some point in 
 the skin, the inflammation may extend rapidly along the course of the 
 vessel, while the glands, also, will take on the same condition. Here 
 is the great bulwark of humoralism. Here it is, and in the lacteals, 
 that the humoral pathologists suppose that morbific agents enter the 
 circulation and corrupt the blood, or remedial ones are equally absorb- 
 ed, and transmute it from a morbid to a healthy state ! But, since the 
 needle, whose prick may propagate an extensive inflammation along 
 the course of a lymphatic vessel, is not absorbed, nor the leeches which 
 remove the inflammation, we may rest satisfied that the poison of the 
 viper, of the mad dog, &c., do not produce their effects upon the prin- 
 ciple of absorption (§ 268, &c. Also, Med. and Phys. Comm., vol. i., 
 p. 480-514).— Also \ 494 a-e, 514 g, 828-829. 
 
 Diseases of the lymphatic glands are especially owing to constitu- 
 tional predispositions, as in scrofula. When disease is developed in 
 any one or more of these glands, others readily take on the same state 
 of inflammation. While, therefore, under special circumstances, re- 
 mote sympathy predominates in the lymphatic glands, the continuous 
 form is mostly witnessed in the lymphatic vessels. 
 
 In the great plan of organic Design, those inlets of the absorbent 
 system, the lacteals, are greatly exempt from morbific influences. 
 
 526, d. Sympathies between the brain, spinal cord, and nerves, and 
 between the nerves themselves, are more or less in progress, in the 
 natural state of the body. Their phenomena, however, are not very 
 •manifest, unless the nei-\'es of some particular part sustain an irrita- 
 tion (§ 501). Thus, the irritation from stone in the bladder occasions 
 morbid sensations in the penis. Other examples occur in § 523, no. 6. 
 When disease is produced, sympathetically, in the brain, or spinal 
 cord, or nerves, by morbid states of other organs, it is not due, as sup- 
 posed by Miillei", to sympathy with the nerves of the parts so affected, 
 but to the morbid change in the general vital constitution of such parts. 
 Tn this respect, the sympathies of the nervous system" with other or-
 
 PHYSIOLOGY. FUNCTIONS. 357 
 
 gans observe the same laws as apply to other sympathizing parts 
 both as to disease and its resulting reflex nervous actions (^ 230). 
 
 It is difficult to analyze the sympathies which occur, specifically, in 
 the nervous tissue, since it is the medium through which remote sym- 
 pathies take place. Continuous sympathy we know to be of very 
 limited extent, and have every reason to believe that the great final 
 cause of the nervous system is protected by an unusual exemption of 
 this system, especially such parts as supply the organic viscera, from 
 severe morbid conditions, which never fail to inflict great injuries upon 
 other parts. It is also true that diseased conditions of the nervous 
 tissue are not easily reached by remedial agents ; and the injury they 
 inflict on other parts constantly reacts in maintaining morbid states of 
 the nervous tissue. 
 
 The sympathies of which I am speaking refer to the changes which 
 may be produced in the organic state of the nervous system, not to 
 the transmission of impressions, nor to the development and influences 
 of the nervous power, excepting so far as this power may be produc- 
 tive of direct changes in the organic properties and actions of the ner- 
 vous tissue (§ 230). The general convulsions that arise from irritation 
 of the nervous expanse in the intestinal canal, or from teething, &c., 
 imply no absolute disease of any part of the nervous system ; but only 
 a strong development of the nervous power, and its forcible reflex ac- 
 tion upon the muscles that may be spasmodically affected (§ 223-226, 
 233, 500, 891-1- b, g, k, 8931 993, 934 5).— Note Q, p. 1122. 
 
 I therefore think that authors, as Marshall Hall, for example, in his 
 work on the Nervous System, are Virong in considering " all convul- 
 sive affections to be diseases of the true spinal or excito-motory sys- 
 tem." On the contrary, I apprehend that in most of these cases there 
 is no actual disease of any part of the nervous system ; and it is of no 
 little practical importance that this question should be rightly settled. 
 The " principal causes," says Dr. Hall, " are dental irritation acting 
 through the fifth nerve ; gastric irritation acting through the pneumo- 
 gastric ; and intestinal irritation acting through the spinal nerves." 
 
 Now, we have variously seen how the nervous power may be pre- 
 ternaturally excited, and determined with various effect upon the or- 
 gans of organic and animal life ; being so constituted as to be exquis- 
 itely susceptible to a vast variety of natural causes (§ 226, 227, 500). 
 The muscles of animal life are naturally under the powerful influence 
 of the nerves ; this being a special ordination in relation to the ner- 
 vous power and the mobility of muscles of animal life, to enable the 
 will to detei'mine the nervous power so as to produce voluntary mo- 
 tion, and other causes to render it subservient to respiration (§ 205, 
 208, 226, 233, 500 c). Hence convulsions readily spring up; while, 
 from the nervous system being designed for vital objects in organic 
 life, preternatural influences of the nervous power give rise to other 
 phenomena in that division of life. Owing, also, to these constitu- 
 tional peculiarities, as well as to the natural modifications of the vital 
 properties of the animal muscles, the nervous power, when determin- 
 ed with violence upon them, rarely occasions disease ; while in respect 
 to the same properties in the organic system, where they have a dif- 
 ferent modification, and the nervous power a different physiological 
 function, it readily proves morbific (§ 133-150, 452-456, 893J). 
 
 We have, therefore, all the elements that are necessary to show that
 
 358 INS'HTUTES OF MEDICINE. 
 
 Dr. Hall's pathology is wrong. The convulsions to which he refer? 
 as actual diseases of the spinal system affect the muscles of animal 
 life, upon which the will may operate with violence in an instant, or 
 which are perpetually held in action by the nervous power fcjr the per- 
 formance of the resjiiratory movements, and to caiTy out the office oi 
 the sphincters. A slight irritation, therefore, propagated to the nej-- 
 vous centres may rouse these natural motions into irregular and more 
 violent ones, without producing any more disease in the nerves or the 
 muscles than is produced by the operation of the will, or by those 
 causes which maintain the movements of respiration. Again, if a cere- 
 bro-spinal nerve be irritated, convulsions are produced, and the same 
 is done by a shock of the electric fluid. Now, these results are ex- 
 actly analogous to the natural convulsions which are supposed to de- 
 pend on "disease of the true spinal system of nei-^^es." If we analyze 
 the supposed cases, the same conclusions will follow. When, in one 
 case, the gum is lanced down ujion the tooth, the convulsions may 
 cease immediately. In another, or when the convulsions depend on 
 gastric or intestinal irritation, a dose of morphia, or an emetic, or an 
 enema, or warm bath, will generally remove the convulsions veiy 
 speedily, and they are not apt to return (i^ SQSg^). 
 
 Diseases of the membranes of the brain or spinal cord, or of the 
 substance of the brain or of the spinal cord itself, do not often occa- 
 sion convulsions ; which, indeed, are commonly independent of any 
 disease of the nervous system. When, however, they do give rise to 
 convulsive movements, or when such result follows an affection of a 
 nerve, as in traumatic tetanus, there is no morbid state sympatheti- 
 cally induced in any other part of the nervous system, but the convul- 
 sions are owing to a propagation of the nervous power upon the mus- 
 cles as in the foregoing cases. Here, the disease of the nervous tis- 
 sue is exactly equivalent, in developing the nervous power, to the 
 ii'ritation propagated to the nervous centres by dentition, intestinal 
 irritation, &c. It sometimes happens, therefore, that a division of the 
 affected nerve, in tetanus, will at once remove the spasms. 
 
 When, therefore, convulsions arise from dentition, or intestinal irri- 
 tation, we apply our remedies to the gums, &c., and not to the spi- 
 nal cord, or to its nerves. Such as may depend upon disease of the 
 nervous centres, or of a nerve, are obstinate, and the treatment is 
 then dii'ected with a special reference to the part which may be thus 
 affected. Here the nerve-action is direct, there reflex (^ 227, 500 c, d). 
 
 Here, also, we learn the importance of an intimate acquaintance 
 with the laws of the nen'ous power, and of correct theory. Convul- 
 sive movements, under most circximstances, have a very similar chai-- 
 acter ; and to ascertain their causes, we must apply ourselves to other 
 symptoms and other considerations. Nevertheless, they are apt to 
 have certain differences in some affections. Those of tetanus have 
 the strongest peculiarities ; and here there is a very limited state ot 
 disease at the wounded part, but idiopathic tetanus may depend upon 
 intestinal disease. But, there is often a comj)lete resemblance be- 
 tween the ordinary convulsions from dentition, and gastric, and intes- 
 tinal irritation, and those of hysteria and epilepsy ; whatever may be 
 the exciting causes in either case. Since, therefore, it may be of the 
 highest importance to ascertain the particular causes, we institute a 
 diagnosis through other attending facts (^ 893J).
 
 PHYSIOLOGY. FUNCTIONS. 359 
 
 Si/inpathies of Dissimilar Tissues. 
 
 527, a. Morbific reflex nervous actions occur less frequently among 
 organs of different organization than among many of those which are 
 constituted aUke, with the exception of the mucous tissue of the ali- 
 mentary canal and other parts, and between the skin and other parts. 
 Between these two organs and all others there is, on the part of the 
 latter, the most intimate connection by reflex nervous actions, especial- 
 ly the mucous tissue of the stomach (§ 512) ; and it is through this nat- 
 ural relation, and the increased susceptibility of diseased parts, that re- 
 medial agents so readily exert their effects upon the diseases of all or- 
 gans, when such agents are applied to the intestinal canal or to the skin 
 (§ 113, 465, 516 d, nos. 12, 13, 889 g, 891^ g, k, 892 g, h, 893 a, c). 
 
 527, b. Morbific reflex nervous actions between the alimentary ca- 
 nal and other tissues are variously considered in the progress of this 
 work. Those between the skin and other tissues deserve farther con- 
 sideration in this place. Their predominance and intensity between 
 that organ and the alimentary mucous tissue are shown in the depend- 
 ence of a vast proportion of cutaneous eruptions upon primary dis- 
 ease of the latter tissue. There is great reason to believe that such 
 is the fact even in rela-tion to measles, scarlet fever, and small-pox, 
 when it occurs spontaneously, and probably also in the inoculated 
 form ; though, in the last case, there must be first a reflected influ- 
 ence from the artificial pustule of the skin upon the intestinal mucous 
 membrane, from whence the influence is propagated back to the whole 
 surface of the body (§ 902, m). This construction, so opposed to the 
 humoral pathology, is sustained by the analogy which is supplied 
 by most other cutaneous affections, and by the direct fact that the 
 eruption of scai'latina and of measles appears in the mucous membrane 
 of the throat before it does upon the skin. The eruption, especially 
 of measles, is apt to be preceded, also, by inflammation of the mu- 
 cous tissue of the eye, the nose, and lungs, as well as by cough. But, 
 as will have been seen, it is not necessary that the secondary, or sym- 
 pathetic, disease should be like the primary ; especially in parts that 
 are dissimilar (§ 527, d). If this pathology as to the consecutive or- 
 der of developments be true. It Is of great practical importance ; since 
 it assures us that great care must be bestowed upon the intestinal mu- 
 cous membrane, as a principal seat of the radiating morbific Influen- 
 ces. But the severity of small-pox, &c., depends greatly upon the ex- 
 tent of the cutaneous affection, and its consequent reaction upon the 
 abdominal organs (p. 347, § 516 d, no. 13); and hence the advantage 
 of moderating the eruptions by local applications. Can humoralism 
 explain ? Why such definite periods of rise and decline (§ 654 b) "? 
 
 Sympathies between the skin and kidneys are naturally instituted 
 for special exigencies of the animal economy ; but these organs are so 
 constituted in their relative susceptibilities, that the great final cause 
 of their physiological relations shall not be defeated by the propagation 
 of morbific reflex nervous Influences from one to the other (§ 422, &c.). 
 
 Sympathies between the mucous and serous tissues are compara- 
 tively rare in health, and, therefore, in disease. Since, also, the same 
 principles, in a general sense, are concerned in the remote influences 
 of remedial agents, we thus understand why medicine taken inwardly 
 has so moderate an effect upon peritonitis, or pleuritis, &c. ; and this
 
 360 INSTITUTES OF MEDICINE. 
 
 philosophy is clearly confirmed by the ready action of cold upon the 
 skin in developing inflammation of the pleura, and by the manner in 
 which that inflammation may be often overcome by blisters or other 
 initants applied to the skin. Indeed, so extensive are the natural 
 sympathetic relations of the skin to most internal parts that there is 
 scarcely an inflammation of an internal tissue or organ that may not 
 be more or less mitigated by irritants applied over the neighboring 
 surface, if the application be not prematurely made(^ 514 d, 893 a, c). 
 
 There is a very intimate sympathy betw^een the fibrous membranes 
 and the cartilaginous and osseous tissues, w^hich leads to the determi- 
 nation of morbific reflex nervous influences among them {^ 141, b). 
 
 527, c. Sympathies of different tissues with each other, of much in- 
 tensity, are more common in parts that are distant than among the 
 tissues of one and the same compound organ. 
 
 527, d. "When disorders arise among different tissues, they are, as 
 1 have said, apt to be more or less different from the primary affec- 
 tion, or if alike, their phenomena more variable than among tissues 
 of the same organization (§ 525). The primary affections may be 
 mild while the sympathetic are severe. This relative mildness and 
 intensity is constantly seen in the supervention of inflammations and 
 congestions in remote parts as consequences of some minor derange- 
 ment of the stomach, or other digestive organs, and in the manner in 
 which severe diseases of all parts are subdued by the action of reme- 
 dial agents upon the stomach. So, again, the action of cold upon 
 the skin induces, by reflex action, inflammation of any of the tissues 
 of the lungs, or of the intestines, uterus, liver, ligaments, &c. ; but 
 here no actual disease is produced in the skin, and the morbific agent 
 is also of a negative nature. Hence a difficulty, notwithstanding its 
 importance, of detecting the original source when a complex series 
 of sympathetic affections has ensued (§ 514 d, h, 527, b). 
 
 HympatJiies of Individual Tissues in tlieir Relation to each other %n 
 Compound Organs, and with entire Organs. 
 
 528. "When any tissue of a compound organ becomes the seat of 
 disease, the influence of such disease is felt, more or less, by all the 
 tissues of such an organ, where the primary disease is at all severe ; 
 especially in the organs of organic life. The tissues, as we have 
 seen, which are secondarily affected may or may not sustain the same 
 character of disease as the original affection ; and this will depend 
 much upon the nature of the organ. The sympathies, for instance, 
 between the different tissues of the lungs are far greater than be- 
 tween the different tissues of the stomach, and I may say, indeed, of 
 any other organ. If the mucous coat of the stomach be even severe- 
 ly inflamed, the disease generally remains limited to that tissue, and 
 will far sooner give rise to inflammation of the pulmonary mucous 
 membrane than it will be extended to the cellular, muscular, or se- 
 rous tissue of the stomach, however much it may otherwise disturb 
 their functions. On the contrary, however, it is quite otherwise with 
 the lungs ; especially when the cellular or parenchymatous tissue of 
 these orrrans is actively inflamed, or when chronic disorganizing 
 inflammation invades the same tissue. In either of the cases, the in- 
 flammation is apt to be propagated, sooner or later, both to the serous 
 and mucous tissues of the organ (§ 115-117, 129, 132-155). And
 
 • PHYSIOLOGY. FUNCTIONS. 361 
 
 here may be observed a wise ordination of Nature for the ultimata 
 relief of so grave a disease as acute or chronic inflammation of the 
 main substance of the lungs ; an augmented seci'etion of mucus or 
 serum contributing to that result, in connection with a reflected sym- 
 pathetic influence of the action which is necessary to those increased 
 products (§ 74, 117, 129, 137, 155, 156, 387, 422, 524 d, 525). When 
 these redundant secretions take place, the general law is that the 
 primary and secondary inflammations begin to abate. The salutary in- 
 fluence of the secondary disease^ independently of the depletive effect, 
 is seen in the frequent abatement of chronic muco-inflammation of 
 the lungs or of the stomach when it may supervene in one organ or 
 the other as a sympathetic consequence of a primary inflammation of 
 either, the philosophy of which is fully expounded in ^ 905 a. 
 
 SYMPATHIES OF COMPOUND ORGANS WITH EACH OTHER. 
 
 529, a. Compound organs generally sympathize most readily with 
 each other in proportion to the relation of certain functions which they 
 may perform, and the importance of those functions, the stomach al- 
 ways excepted (§ 528). These groups or systems of organs have been 
 already specified, and the sympathies to which they respectively give 
 rise among their component parts sufficiently designated (§ 124-130, 
 
 149, 150). 
 
 529, b. Morbid sympathies are influenced by a great variety of ac- 
 cidental causes, although they depend essentially upon the constitu- 
 tional relations of the various parts of the organism to each other. One 
 of the most remarkable is the determination which is given to reflec- 
 ted nervous actions by almost inappreciable impressions exerted by 
 morbific and remedial agents upon some particular part, according to 
 the nature of their virtues, one agent ultimately involving the whole 
 system in morbid action, or one remedy being as extensively curative 
 (§ 149) ; while others, far more intense and rapid in their operation, 
 are very circumscribed in their analogous sympathetic effects (§ 149, 
 
 150, 163). In the case of the morbific agents where many organs 
 are brought into sympathetic derangement, the various results may 
 be mostly due to the action alone of a single cause, as with the mias- 
 mata of fever, the yirus of small-pox, of scarlatina, &c. ; or, the com- 
 plex results may be greatly owing to the united action of many causes. 
 In the case of remedial agents, their effect as to extent, intensity, &c., 
 will depend much upon the exact nature of the pathological states. 
 
 530. Having now arrived at the end of our long journey over the 
 enchanting paths of sympathy, I cannot but hope that they, to whom 
 the mere physiological explorations may be new, will have gained 
 many treasures that will adorn their knowledge, and render medicine 
 a subject of their profound veneration and care. An attentive sur- 
 vey of all the facts will assure them how far they have lived on in ig- 
 norance, how much intellectual enjoyment has been lost, how they 
 have been beguiled into the chemical and physical doctrines of life ; 
 and, if what I have propounded of the applicability of the natural 
 laws of reflected actions of the nervous system to pathology and 
 therapeutics be founded in truth, the realities of Nature and the sub- 
 stitutes of art will strike with greater force, and supply a never-failing 
 source of advancing knowledge, a shield against the corruptions of 
 ignorance or ambition, a guide to practical habits, and a blessing to
 
 302 INSTITUTES OF 3IEDICINE. • 
 
 the sick. The natural laws of the nervous system are settled by dem- 
 onstration ; as well settled as the laws of gravitation, or any of the 
 most undoubted in physics or chemistry. Such as are immediately 
 applicable to the higher and more difficult branches of medicine 1 
 have selected from authors who have had no such objects in contem- 
 plation, that they might come unalloyed with the suspicions attendant 
 on theory. My attention, in this respect, has been mostly turned to 
 the great Prussian Physiologist, by far the gi'eatest of the age, and to 
 the invaluable experiments by Wilson Philip. I commend them again 
 and again to all those who would study medicine as founded in Na- 
 ture, and escape the temptations which have been devised for the 
 gratification of indolence, or for the accommodation of imbecility. We 
 have seen it said, in high quartei's, that " the time is approacbing when 
 the foundation of practice on the laws of Organic Chemistry will form 
 the distinction between the enlightened physician and the mere pre- 
 tender" (§ 5* a, 289-292, 349 d-Zl&l, 438-448). I repeat the decla- 
 ration as expressing the ascendant spirit of the age, and that all who 
 may be disposed to encounter the threatened degradation may duly 
 realize the importance of a firm determination to maintain their 
 ground (§ 440, b). 
 
 B. Functions especially relative to the Mental Principle and Instinct 
 
 531. The present subdivision of Peculiar Functions having no spe- 
 cial relations to organic life embraces but transient subjects for con- 
 sideration in this work (§ 450). It comprehends, 
 
 1st. Voluntary motion. 
 
 2d. Functions by which the mind and instinct act on external objects 
 
 3d, Other mental and instinctive functions. 
 
 532. The subject of voluntary motion has been already sufficiently 
 examined (§ 215, 227, 232, 256, 257, 486, 487, 500). 
 
 533. The functions by which we act on external objects are per- 
 formed through volition and the voluntary muscles. The philosophy 
 is the same as in § 532. 
 
 534. a. The brain co-operates with the mind, and with the in- 
 stinctive principle, in the acts of intellection or instinctive functions 
 (§ 241, 500 o, p). 
 
 534, h. Although the soul be an immaterial and imperishable sub- 
 stance, it is so associated with the brain that a healthy state of this 
 organ is generally necessary to the ordinary functions of the mind, as 
 it is, also, to those of instinct. 
 
 In a general sense, the mental functions suffer in proportion to the 
 extent and suddenness of cerebral disease ; and the same is true of 
 the influences of the brain upon organic life. There is not always, 
 however, a correspondence between injuries and diseases of the brain 
 and the resulting affections of the mental principle. Apparently 
 slight injuries or diseases of the organ will suspend or abolish the 
 faculties of the mind, while in other cases their integrity is pre- 
 served under the most appalling affections of the brain. It is also re- 
 markable in those cases where the mind is least affected or unimpair- 
 ed, that the organic functions are apt to suffer least, — [Med. and Phya 
 Comm., vol. ii., p. 139, note.) 
 
 * 
 
 * 
 
 Subject continued in Appendix, article Soul & Instinct.
 
 rHYSIOLOGY. FUNCTIONS. 363 
 
 VITAL HABIT. 
 
 535. Vital habit relates to the modifications of functions, and the 
 variations of their results, in organic and animal life, as arising from 
 the repeated or continued operation of natural, morbific, or remedial 
 agents. It frequently happens, however, that the single application 
 of a vital agent will establish this condition (§ 516 d, no. 6; § 545), 
 
 This simple principle is at the foundation of some of the most pro- 
 found and comprehensive laws in medicine (Rights &c., p. 919, no. 19) 
 
 536. The functions of organic beings, plants as well as animals, are 
 liable to great and more or less durable changes from the foregoing 
 causes. I have applied the epithet vital to distinguish this constitu- 
 tional law from those ordinary p?ij/sical habits which are almost pecu- 
 liar to man, and of which vital habit is a common result. 
 
 537. The functions of animal life, in man especially, are more un* 
 der the influence of vital habit than the organic. The latter are vari- 
 ously affected, as to habit, by climate, season, food, and morbific and 
 remedial agents, and by disease. The results of habit are most im- 
 portant in its relation to the groups of causes now mentioned. 
 
 538. Habit is liable to be more strongly pronounced in plants and 
 animals by certain influences, particularly domestication, climate, and 
 soil, than in man. Thus, as to vegetables, the ricinus communis is an 
 annual herbaceous plant in America, while in India and Spain it is a 
 woody perennial tree. The acquired power of enduring cold is stri- 
 kingly manifested in man, animals, and plants (§ 442, 104G-1050), 
 
 539. a. The philosophy of vital habit consists either in a tendency 
 of any given condition of the vital states to remain without change, 
 as a consequence of its duration, or in certain impressions or changes 
 that are produced in irritability, sensibility, and mobility, in their re- 
 lation to each operating cause, by which their susceptibility to the 
 action of the particular cause or causes is diminished or increased 
 (§ 176-215), The philosophy is alike applicable to the properties of 
 the mind as to those of the vital principle, and, of course, to the func- 
 tions of each (§ 173-176). 
 
 539, b. In animal life, therefore, habit concerns the senses, volun- 
 tary muscles, and the intellectual and instinctive faculties. In organ- 
 ic life, it I'efers to the organic properties and functions of every part, 
 whether organic or animal, and takes in the various and important 
 influences of the nervous system (^ 110-117, 224, 226, 495, &c,). 
 
 539. c. Since, also, the influence of habit in either life generally 
 relates to the particular agents only by which it is induced, we learn 
 the advantages of interchanging cathartics, anodynes, &c, (§ 149, 163, 
 550). And so of the different modes of exercise, as it concerns both 
 organic and animal life ; and so, too, of the employments of the in- 
 tellectual faculties, that a due improvement may be imparted to each 
 (§ 565, 566, 855, 872 a). 
 
 540. The principle of habit is every where the same; always rela- 
 tive to impressions, more or less durable, upon the vital or mental 
 constitution. The analogy is perfect throughout, in all its details, 
 and is utterly subversive of eveiy chemical or physical view of life or 
 disease (^ 1047). 
 
 541. It illustrates the instability of the vital properties (^ 177-223).
 
 364 INSTITUTES OF MEDICINE. 
 
 542. The modifications arising from vital habit exercise an impor- 
 tant sway in the treatment of disease ; since remedial agents must be 
 varied in kind, force, quantity, time of repetition, &c., according to 
 the artificial modifications of irritability and sensibility, especially the 
 former (§ 150, 188-204, 857). 
 
 543. Habit is liable to obtain under the repeated or continued op 
 eration of almost all agents which are capable of affecting the vital 
 or mental properties. Exceptions occur in sensibility as it respects 
 pain from injuries, and in the ordinary pleasures of sense, which are 
 always about the same, however frequently repeated. But the pain 
 on tasting acrids, the nausea from tobacco, &c., may cease to be pro- 
 duced by repetition of the causes. So, also, of the bougie, music, 
 landscapes, the verdure of spring, &c., which are more or less varia- 
 ble in effect. An interval of suspension, however, in these cases, re- 
 stores the original effect of the causes. 
 
 544. It is by vital habit that morbific agents, such as miasmata, 
 cease to be injurious. This is most likely to happen if the individual 
 reside from infancy in the miasmatic region, or, in the unacclimated, 
 after recovery from an attack of the miasmatic disease. Such is the 
 philosophy of acclimation (§ 539, 551) ; and the same is alike appli- 
 cable to tobacco, &c., and to its ultimate conversion into a luxury. 
 
 545. Sometimes the single application of a particular agent will so 
 confirm the intensity and permanence of habit that it becomes for- 
 ever afterward inoperative. Such is not unfrequently the case with 
 miasmata, and it is conspicuously shown in small-pox, measles, scar- 
 latina, &c. And so of vaccination in its relation to small-pox ; though 
 repetitions of the vaccine disease may be necessary to even a tempo- 
 rary exemption from small-pox, while at other times the effect goes off", 
 leaving individuals exposed to small-pox (§ 350, no. 45, 543). All this 
 shows, too, a near identity between the vaccine and variolous dis- 
 eases (§ 75-79, 552 a, 654 h, Note Aaa p. 1146). 
 
 546. The law of habit applies extensively, also, to remedial agents ; 
 these having the eflTect, by repetition, of lessening or increasing the 
 susceptibility of organs to their respective virtues. 
 
 547. Habit, in respect to remedies, as, also, to morbific causes, dem- 
 onstrates their reflex nervous influences, and that they do not operate 
 by absorption. Introduce the agents with any frequency into the cir- 
 culation, there will be no such manifestations of the laws of habit. 
 
 548. a. The effects of habit in organic life are generally most per- 
 manent when induced by causes of unceasing and long-continued op- 
 eration, such as climate, the presence or absence of light, &c. There is 
 then some very persisting or permanent modification of the organic 
 properties, and sometimes very remarkably of the structure (§ 74, 
 538, 545). 
 
 548, b. The foregoing law is of very extensive application in the 
 philosophy of disease, and replete with practical bearings. Its illus- 
 trations are constantly seen in the obstinacy of chronic diseases, and 
 in the comparative ineflSciency of remedies when the treatment of 
 fevers is neglected for a single day. 
 
 548^, a. In a general sense, the natural vital stimuli, such as food 
 which is of easy digestion, heat, water, &c., for obvious final causes, 
 produce, like the blood, nearly the same impressions upon the organic 
 properties, at every age, and at every hour, under equal circumstan 
 ces C§ 136> 137). — See Causes, Final, Index I.
 
 PHYSIOLOGY. FUNCTIONS. 365 
 
 548J, h. Nevertheless, ceitain kinds of food, and analogous stimuli, 
 as wine, &c., come within the law of habit. This is where the kin<l 
 of food may not be natural to the age of the individual (§ 568) ; or 
 when it may be at first oppressive or detrimental at any age, it may 
 become, by use, inoffensive and nutritious. During the first experi- 
 ments the food may escape the stomach undigested, having, also, irri- 
 tated that organ, induced headache, &c. But, in a process of time, 
 the iriitability of the stomach becomes adapted, by habit, to the pres- 
 ence of that particular kind of food, its ready digestion follows, and 
 all sympathetic results disappear. It is exactly the same law that 
 renders tobacco, asafoetida, &c., luxuries (§ 543). 
 
 549. The law of habit, in respect to morbific and remedial agents, 
 follows the law which governs the relative duration of disease when 
 produced by remedial agents and such as are truly morbific. Disease 
 excited by the former, if not in great intensity, soon subsides sponta- 
 neously ; but when by the latter, it is far more lasting. This princi- 
 ple, also, as it relates to remedial agents, is at the foundation of their 
 curative effects (§ 893, &c., 926). 
 
 550. Since habit subsides in various degrees, and at various times, 
 after the removal of its causes, and the properties of life acquire, 
 therefore, more or less, their original susceptibility to the particular 
 agents or causes (§ 539, 543), and since the effects of remedial agents 
 are commonly transient in respect to habit (§ 549), we may, in most 
 cases, soon resume the suspended remedy, and obtain its original ef- 
 fect (§ 539 c, 857). And just so of acclimation ; its influences ceasing 
 on change of residence, when miasms will be again morbific on return- 
 ing to the former acclimated region. And so of pleasure and pain (§ 
 543). The coincidences demonstrate the fallacy of humoralism (§ 665). 
 
 551. Again, it is through the principle of vital habit that we must 
 interpret the ability of the system to sustain, with the same or dimin- 
 ished effect, increased doses of remedial agents, as opium, tartarized 
 antimony, &c., while this peculiarity will be limited to the agents 
 which are thus employed. The eighth of a grain of tartarizad anti- 
 mony may produce vomiting at the first dose ; but, by gradually in- 
 creased doses every two hours, it may be sometimes raised in twelve 
 hours, by lessening gastric irritability in relation to its own virtues, 
 to two grains at a dose, without vomiting again (§ 556). But gastric 
 irritability will not be thus reduced in relatimi to any other emetic. 
 And so of miasmata, &:c. ; and I may add to § 544, that if the unac- 
 climated pass gradually through a series of climates having gradations 
 of miasmatic intensity, he will ultimately reach its highest virulence 
 with far greater safety than if he plunged at once into its fury. Should, 
 however, epidemic influences occur of an unusual nature, he will still 
 be as much, or more exposed to their malign effects than in uninfect- 
 ed countries (§ 150). 
 
 552. a. Other parallels hold, also, in the foregoing cases (§ 551). If, 
 for example, the antimony be suspended for twelve hours, gastric ir- 
 ritability will recover its natural relation to that substance, &c. And 
 so of the miasmatic agent, if the acclimated subject retire to a salubri- 
 ous region, and subsequently revisit the insalubrious (§ 557, b). 
 
 552, b. Again, the»antimony impresses the system in the ratio of its 
 action upon the stomach, or of the duration of its action. Fever, or 
 pneumonia, &c., will fail to be assuaged unless the gastric effect be
 
 366 INSTITUTES OF MEDICINE. 
 
 kept up, if the agent be employed in its small alterative doses. Oi* 
 a single dose, operating as an emetic, may at once overthrow the dis* 
 ease (§ 524 a, no. 1). And so of miasmata ; since, in the case sup- 
 posed (§ 551), the individual may be gradually brought under its in- 
 fluence, till, at last, its greatest intensity may produce an explosion of 
 disease ; or, this may ensue w^ith great rapidity in the same subject if 
 the gradual acclimation be neglected (§ 514 g^ 516 c, 518 h, 557 h). 
 
 553. No two agents being precisely alike in their effects, habit will 
 vary according to the exact nature of its causes (§ 150, 191, 649). 
 Some, like antimony, often lessen irritability with great rapidity, and 
 the property will recover its relation to the agent after a short inter- 
 val of suspension. Others as frequently require a much longer time, 
 and irritability will take various intervals of repose, often months or 
 years, to recover its relation to these agents. 
 
 554. It is fundamental in medicine that the foregoing intervals (§ 
 553) are not long as it respects remedial agents, in their ordinary use, 
 but much longer m respect to the truly morbific causes. In the case, 
 for instance, of acclimation (§ 551), if the subject return to a salubri- 
 ous climate, it may be many months, or years, before the system will 
 have recovered its susceptibility to the miasmatic agent, 
 
 bbb. The foregoing exemplification of habit in respect to morbific 
 and remedial agents (§ 554) is allied to the principle which lies at the 
 foundation of disease, and of its cure by remedies, whether physical 
 or mental. Disease consists, essentially, in a more or less permanent 
 alteration of the organic properties ; while remedial agents establish 
 more transient alterations, which enables the morbid properties and 
 actions to obey their natural tendency to a state of health. 
 
 556, a. Vital habit appears, also, under an aspect opposite to that 
 of diminished irritability. It then presents itself more in the condi- 
 tion of a morbid change of the organic conditions. Thus, tartarized 
 antimony, instead of reducing gastric irritability, as in § 551, may ex- 
 alt it ; so that, beginning with the eighth of a grain, as in the former 
 example, but without an emetic effect, and I'epeating it without even 
 increasing the dose, vomiting will take place at the second or third 
 dose (§ 514 g, 516 c and d, no. 6). In these cases, we must some- 
 times progressively reduce the dose to the fiflieth part of a grain, or 
 vomiting will ensue. In this particular case irritability is also increas- 
 ed in its relation to ipecacuanha, and to most other irritants (§ 841). 
 
 556, h. This lets us into the philosophy of the most successful mode 
 of overcoming habitual and obstinate constipation, by small doses of 
 cathartic medicine, repeated once or twice daily ; as the fourth of a 
 grain of blue pill, and half a grain or a grain of aloes. The irrita- 
 bility of the intestine is thus permanently exalted, by which it is soon 
 rendered so sensitive to the increased quantity of bile as to require 
 a diminution or discontinuance of the medicine. The impression of 
 each dose remains till the next is repeated (§ 514 g, 516 c, 516 d, no. 
 6). The law of increased susceptibility is brought into operation § 
 137, <i, and alterative reflex action increases the bile {^ 889 Z, m). 
 
 What I have thus stated in this section involves some of the most 
 important philosophy in medicine. In its practical natui-e it takes in 
 a wide range of therapeutical problems, some (Jf the most essential of 
 which are relative to the dose or the amount of a remedy, and the prop- 
 er time for its repetition (§ 857).
 
 PHYSIOLOGY FUNCTIONS. 367 
 
 556, c. The foregoing principle is farther shown by the effect of sa- 
 line and other cathartics in promoting salivation when given a few 
 hours after the exhibition of a full dose of calomel. The fact was as- 
 certained by George Fordyce, and has been often verified in my own 
 person after the use of blue pill. The mercurial agent will not ex- 
 ert, in the cases supposed, this profound constitutional effect with- 
 out the subsequent aid of the other agents, which so increase intesti- 
 nal irritability, and that of the whole system, that the mercury operates 
 with greater local and general intensity ; a fact, by-the-way, which is 
 also opposed to the doctrine of operation by absorption. J ust so, too, 
 bloodletting increases the susceptibility of the system to the constitu- 
 tional and local action of mercury, cathartics, and many other agents, 
 while it also lessens much their doses. A common principle lies at 
 the foundation of the whole (§ 150, 890^°-, 892^ u, 893 q, 904 c, 1088). 
 
 556, d. Augmented irritability, sensibility, and mobility, in their 
 proper relation to habit, depend often upon peculiar states of the 
 stomach, on constitution, climate, &c. Hence in some climates cer- 
 tain remedies, as antimony, are borne much better than in others; ca- 
 thartics often exalt irritability (especially of the direct seat of action) 
 in an intense degree, &c. 
 
 But other influences in connection with the foregoing are often in 
 operation, and may be the main cause of the effects which are, at oth- 
 er times, due to the causes now supposed. Thus, cathartics are lia- 
 ble to be surrounded by such influences, especially by increased irri- 
 tability from the presence of disease, or as the effect of passion, or 
 the play of sympathy, or the bile may be increased in quantity or in 
 its stimulating virtues. These modifying influences may be variously 
 applied. 
 
 557, a. The difference in the I'esults of the same remedy in anal- 
 ogous conditions of disease often depends upon, and illustrates, the 
 law of habit. Thus, an emetic and cathartic, exhibited near the in- 
 vasion of continued fever, will often break up the disease ; but not so 
 if the fever have been neglected for twenty-four hours. The moi'bid 
 action is then under the power of habit. On the contrary, an emetic 
 will often remove an intermittent fever of long duration if administer- 
 ed during the intermission. Plere, the febrile action being greatly 
 suspended at regular intervals, the force of habit is constantly broken, 
 and nature puts on its recuperative tendency (§ 555, &c., 715, 926). 
 
 557, b. A special exception occurs, however, in the abstraction of 
 blood as it regards its remedial effects upon disease which has ac- 
 quired the force of habit. In active or chronic forms of inflammation, 
 and in fevers of considerable duration, general bloodletting, particu- 
 larly, when carried to its just extent, may at once subvert the disease, 
 or, at least, greatly cripple its force and its habitual tendency. Here, 
 an impression is simultaneously and powerfully made upon the whole 
 circulatory system, and that which is thus exerted upon the immedir 
 ate instruments of disease is greatly advanced by reflex nervous actions 
 from all parts of the capillary blood-vessels (§ 921, 931-934). There 
 is, therefore, a clear analogy in a and b with the modus operandi of 
 miasmata when they prove the exciting as well as predisposing cause 
 of disease near the first moment of their contact with the body (§ 
 552, b) — philosophically considered (^ 654 a). 
 
 558, a. The principle involved in § 556 embraces what is called the
 
 368 INSTITUTES OF MEDICINE. 
 
 cumulative effect of remedies, and of which digitalis, hydrocyanic acm, 
 mercury, narcotics, &c., supply examples, in their small repeated 
 doses (§ 514, g). And yet some of the same agents, as the narcotics, 
 by longer use, will establish the opposite condition of habit, or that of 
 diminished effect ; thus illustrating the different aspects of the laws of 
 vital habit. 
 
 558, b. In the cumulative aspect of habit, the agent, as digitalis, oi 
 mercury, or cantharides, for instance, establishes progressive impres- < 
 sions on the vital states, proportioned to the amount and frequency of 
 the dose, cceteris paribus (§ 926). When that impression reaches a 
 certain degree of intensity, the organic properties are brought into so 
 full a relation with the morbific virtues of the agent, that they under- 
 go, abruptly, a greater change ; when the phenomena of full mercu- 
 rial action, of digitalis, &c., take place suddenly, and perhaps with 
 violence. The last is morbid, and exactly the same as we have seen 
 of the progi'essive operation of miasmata (§ 552, h). But we often 
 see manifested by digitalis, prussic acid, &c., the same variety of 
 habit as was stated of tartarized antimony in § 551, since we must 
 often increase the dose to maintain the original effect. And so, ao^ain, 
 of miasmata (§ 551). This, however, is not true of some of the cumu 
 lative remedies, such as the mercurial (^ 516, d, no. 6). 
 
 558. c. And now, to illustrate the alterative reflex action of reme 
 dial agents by the process of removing the morbid effects of the fore- 
 going cumulative remedies (Z»), we have but to interrogate the only 
 possible manner in which we may speedily subdue those effects by 
 other remedies, and as explained in \ 891 J A:, 984 h. 
 
 559. Exactly the same philosophy (§ 558) is applicable to what is 
 called predisposition to disease (§ 148, 503, 538, 539, 544, 547, 552 
 h). Nevertheless, predisposition may differ from the cumulative im- 
 pression of remedies in being established by a single, and even mo- 
 mentary action of the morbific agent, when the organic states may go 
 on with their morbid tendency till an explosion follows, as in § 148, 
 653. So, often, of a single dose of mercury in respect to its curative 
 effects (§ 514, g). But, the difference lies in the greater intensity of 
 the agent, or in a gi'eater susceptibility of the subject to its action, or 
 in both (§ 549, 666, 516 d, no. 6). 
 
 560. Another aspect of habit, as it respects morbific agents, and 
 which goes with the rest to illustrate important principles in medi- 
 cine, is the tenacity of many diseases, as shown in periodical returns 
 of intermittent fever, at inters'als of months, even after the subject 
 shall have removed to a climate exempt from the causes. Here the 
 original impression remains (§ 514, ^), and frequently, also, some lo- 
 cal form of disease, by which the general predisposition is maintained, 
 and its explosions more or less produced (§ 148). 
 
 561. What concerns the acquired habits that appertain more or less 
 to the constitution of all men, and Avhich have a modifying, and often 
 a great, influence in determining the operation of morbific and reme- 
 dial agents, comes entirely within the foregoing principles relative to 
 vital habit ; and this is more obviously true of the accidental modifi- 
 cations of temperament that arise in individuals from the influence of 
 climate, heat, cold, &c. (§ 78, 442 h, c, 535, 539). Where the pecu- 
 liarity of constitution is transmitted from parent to child the modify- 
 ing causes have, of course, onerated upon the ancestor. But the
 
 PHYSIOLOGY. FUNCTIONS. 369 
 
 transmitted peculiarity is equivalent to that which is generated by the 
 direct action of the modifying agent (§ 75-80, 585, 587, 591, 659). 
 
 Here, too, we may observe how the incubation of fever, for a week 
 or for months, is analogous to the slow progress of the artificial tem- 
 peraments ; though, in the former case the remote causes may operate 
 for an hour only, and thus establish a tendency in the organic proper- 
 ties to advance in their morbid predisposition, till, reaching a certain 
 amount of change, a development of fever is suddenly displayed •, 
 while, in the artificial temperaments the changes are commonly the 
 result of the continued operation of the remote cause. 
 
 562. The luxuries and customs of civilized man affect his natural 
 constitution upon the same principles as morbific agents produce dis- 
 ease, or as the remedial alter the properties of life back again to a 
 state of health. In all the cases, the results are owing to impressions 
 variously made upon the properties of life (§ 191 h, 535, 539). 
 
 563. So simple is Nature in her elementary laws that the periodi- 
 cal desire of food, and many little usages of the body, fall, more oi 
 less, under the comprehensive law which I have exemplified by prom- 
 inent instances of habit. And here, too, we glance at the philos- 
 ophy of instinct in its magnificent relations to certain natural habits ; 
 and realize, also, in the phenomena, the principles which are con- 
 cerned in the analogous relations of the will to voluntary motion (§ 
 500, c-h). 
 
 564. In my last proposition I was on the borders of education, which 
 is mostly confined to animal life, or extended to both where animal 
 and organic are associated in functions. 
 
 Education is allied to habit in its philosophy, as manifested both in 
 the cultivation of muscular power and the properties of the mind 
 (§ 175 h, 241). 
 
 5^5, a. Education often improves some of the animal functions at 
 the expense of others ; but this mostly where some are more the sub- 
 jects of cultivation than others, as seeing, hearing, &c., or the muscu- 
 lar action of the arms, &c. (§ 539, c). When one sense, as sight, is 
 extinct, others, as hearing and touch, become very exquisite. In the 
 case of the muscles, mobility is augmented, and their nutrition in- 
 creased ; in that of the senses, sensibility. 
 
 565. h. A more critical analysis, in the case of the muscles, shows 
 us that mobility in organic, and its modification in animal life, are 
 both advanced (§ 205, 215). Hence result the increase of voluntary 
 power and the increased size of the muscles. By this muscular ex- 
 ercise the function of digestion is also increased, the elaboration of 
 bile, and important vigor is imparted to the whole organic mecha- 
 nism. The principle is exactly the same as in all the preceding ex- 
 amples relative to vital habit. 
 
 566. a. This chain of exact analogies brings us to the properties of 
 the mind, which are improved upon the same principle (§ 175 h, 241, 
 565). Here, as in the foregoing instances (§ b^b), one or more of the 
 properties is apt to be exalted at the expense of the i-est (§ 539, c). 
 The poet, therefore, thinks differently from the man of cultivated judg- 
 ment ; the lawyer is prone to sophistry and skepticism ; the mathema- 
 tician is wrapped in abstract truths, and deficient in practical business ; 
 the clergyman, from his well-disciplined trust in Revelation, and his 
 scholastic habits, suffers that trust to degenerate into credulity, and too 
 
 A A
 
 370 INSTITUTES OF MEDICINE. 
 
 often patronizes homoeopathy, or delights in animal magnetism, or even 
 in the anti-scriptural speculations of the geologists. The history of na- 
 ture is nothing to the chemist out of his laboratory ; in physiology he 
 is like the astrologer among the stars. Shall I speak of the physi- 
 cian ? It is said by Samuel Johnson that he is more apt to cultivate 
 all the powers of his understanding, and all departments of nature, 
 together, and that he has therefore been more distinguished for an en- 
 lightened and comprehensive view of the various subjects for reason 
 than any other class of mankind. 
 
 56G, h. And now we are prepared to comprehend the analogies be- 
 tween those impressions which are brought about by the habitual ac- 
 tion of external objects upon the senses, and in which the mind is con- 
 cerned, as in the satiety of spring, the increasing enjoyment of paint- 
 ing, sculpture, and music, and the increasing acumen with which 
 their beauties and refinements are discerned, and, also, those other 
 changes that are incident to the organic properties from the habitual 
 use of tobacco, of stimulants to the nose, to the stomach, &c., or such 
 as arise from tartarized antimony, acclimation, and those moral influ- 
 ences through which the black skin, the low forehead, and the flat 
 nose, are rendered more beautiful to the African than the analogous 
 features of the white man, or which render the flattened head, and the 
 scarified face, an ornament to the eye of the American Indian, or the 
 deformities of the corset, or the artificial rump, elegances in polished 
 society, while the few that worship at the Graces' shrine become ob- 
 jects of dislike. The same fundamental philosophy obtains through- 
 out. 
 
 567. From the foregoing analogies between the mental and vital 
 powers (§ 566), it appears that the former are cultivated through the 
 medium of the senses and brain, and as well by external influences as 
 by the operation of the sensorium commune, upon the same principle 
 that the vital properties are influenced, more or less permanently, by 
 the operation of foreign agents (§ 175 h, 241). The impressions in 
 respect to mind, however, are more complex, since, in this case, they 
 come to the spiritual part through material organs. 
 
 568. We may now see the nature of the analogies between the 
 special injuries which result from too much or improper food in the 
 early stages of life, and crowding the mind with study or with topics 
 beyond its easy comprehension ; and those between the ultimate adap- 
 tation of the properties of the stomach to what was once offensive, and 
 the corresponding development of the properties of the mind and of 
 its organs by which it sustains what had been detrimental to both, and 
 to the general health. These principles He deeply at the foundation 
 of a proper elementary education of the mind (175 Z>, 548J h, 567). 
 
 STRENGTH, AND VTEAKNESS OR DEBILITY. 
 
 569. a. Much of what has been now considered under the various 
 aspects of habit is often vaguely defined by the terms strength, and 
 u'calcness or debility. The terms are without any true meaning, and 
 have led to very extensive practical errors. If the finger become in- 
 flamed, muscular action is impaired in the hand, or arm. This is call- 
 ed weakness, debilitjf, both of the vessels which are engaged in the 
 morbid process, and of the muscles. But, bloodletting, either gen- 
 eral or by leeches, will cure the disease and restore muscular action.
 
 PHYSIOLOGY. FUNCTIONS. 371 
 
 Here the nature of the remedy contradicts the supposed philosophy 
 (§ 743, 801, 964). 
 
 569, b. Strength and dehility are, also, often confounded, leading 
 to still greater confusion and error. Thus, manifestations of full 
 muscular power are said to denote strength, while the high vascular 
 action of inflammation is supposed to depend on debility. The for- 
 mar is also often seen in deplorable states of disease where debility 
 is thought to reign supreme. On the contrary, also, the mere pros- 
 tration of voluntary motion at the very invasion of disease is as con- 
 stantly considered a state of debility, however exalted may be inflam- 
 matory or febrile affections upon which that contingency in animal 
 life may depend. Tonics and stimulants, therefore, have their sway 
 according to these supposed imaginary conditions, — imaginary, since 
 disease consists neither in one nor the other, so far as they have any 
 intelligible import. The designations, for the most part, are borrow- 
 ed from the inorganic world ; and even at this day some physiologists 
 are making experiments upon the dead muscular tissue by immersing 
 it in solutions of tonics and astringents, to learn the value, and the 
 modus operandi, of those agents when applied to morbid states of the 
 living being. Dr. Adair Crawford, for example, in his Experimental 
 Inquiry into the Effects of Tonics and Astringents (1816), attributes 
 their influence entirely to the tanning process, by which physical co- 
 hesion is established. His pi'emises are those upon which the illus- 
 trious and able Pringle, and his compeers, rested the same conclu- 
 sion ; animal membranes having been immersed in various infusions, 
 and comparisons made of their resistance to weight with the same 
 membranes soaked in watei*. Strength was implied in the former in- 
 stance (^ 487 A, 1001-1008, 1019, 1068).— Notes Ff p. 1 135, Ii p. 1139. 
 
 569, c. If strength and weakness, or debility, be applied to organic 
 states, it must be in a totally different acceptation from their ordinary 
 meaning. In their vital applications, they can relate alone to any 
 present condition of the vital powers. In this sense, the greatest 
 strength of the body consists in a natural performance, by all the or- 
 gans respectively, of the functions appropriate to each, without ei- 
 ther borrowing from the others any assistance which it does not con- 
 stitutionally enjoy, and without taking upon itself any undue amount 
 of labor. In a state of undisturbed health, and temperate habits, the 
 functions of all organs move on in harmony, each administering to the 
 others a certain allotted contribution. But, in impaired constitutions, 
 the whole of this natural harmony is more or less disturbed. Digestion 
 is imperfectly performed, and every meal tasks the stomach beyond its 
 natural ability. The other organs suffer, sympathetically, in conse- 
 quence, and often seem to bend their actions toward a co-operative 
 effort in aid of the diseased actions of the stomach. In this sense, 
 therefore, all the powers of the system may be said to be unnaturally 
 tasked. But, in the mean time, all the sympathizing organs are them- 
 selves afflicted, and just in proportion as they sympathize with the 
 stomach. The food escapes from this organ in a half-digested state, 
 in which chemical changes have also occurred. These changes beget 
 acids and flatulence, and, as the crude mass traverses the intestines, 
 it ii-ritates, and increases the sympathetic derangement of those or- 
 gans, while these, again, reflect back pernicious influences upon the 
 stomach and all other parts. Increased and unnatural mucus, diar-
 
 372 INSTITUTES OF MEDICINE. 
 
 rhoea, &c., follow in the train of intestinal symptoms, urged on by an 
 unhealthy production of bile ; while an offensive taste in the mouth, 
 a foul breath, or a coated tongue, tell us of the sympathies which are 
 going on in that region. The red or tui'bid urine shows us that the 
 kidneys have joined in the disordered actions. The pulse may be 
 languid, or it may beat high, according as inflammation may be ab- 
 sent, or have set in as one of the sequelae ; but according to the acci- 
 dental state of this symptom tlie degree of weakness is greatly meas- 
 ured in this complex and very common condition of disease (§ 423). 
 But, whatever the symptoms, the system is said to be xoedlc^ to be de- 
 hilitated. There is, however, no truth in this construction, as it is 
 ordinarily understood. The powers may be all exalted ; aftd that 
 this is generally so, is shown by the increased secretions from the 
 liver and intestines ; while it is fully demonstrated by the nature of 
 the curative means, which consist especially of a low diet. The sup- 
 posed debility is nothing but an altered condition of the properties 
 and functions of life, and the very remedies which the idea of debility 
 would suggest, such as stimulants and tonics, are generally aggrava- 
 ting causes. Such is the exaltation of irritabihty, especially in the 
 intestinal canal, that it may not bear even the stimulus of broth, nor 
 the mechanical irritation of solid food. 
 
 569, d. The nearest approach to the popular sense in which debili- 
 ty is properly applied consists in the exhaustion of the organic pow- 
 ers that attends the advanced stages of prolonged disease. — See § 487 h. 
 So far, therefore, as debility has an existence, and as connected with 
 disease, it is nothing but a symptom resulting from some modified con- 
 dition of the functions of one or more organs, in which the true patho- 
 logical cause consists, and to which alone our remedial treatment should 
 be addressed. The humoral terms ancemia, leuccemia, cachexia, and 
 chlorosis, in their connection with iron and debility, are, therefore, re- 
 sponsible for an incalculable amount of mortality. But as I have said, 
 much of this symptom (always mostly so in the early stages of disease) 
 is owing to the failure of the Will to act upon the voluntary muscles 
 (§ 487 h, 961); and Avhen this circumstance is duly considered it may 
 result in a profitable inquiry into the probable extent of mortality that 
 may be ascribed to the tonic and stimulant treatment of disease (§ 621 a, 
 1001 a, 1065 c, 1068 a). No writer who has discarded loss of blood 
 as a principal remedy for inflammations and congestions, or inculcated 
 " the stimulating plan," has survived his own generation excepting 
 John Brown, and his work exists only as a curiosity in medical litera- 
 ture (§ 1068 a). The practice is perpetuated by individual prejudices 
 and impulses (§ 960 g), not by the authority of enlightened or recog- 
 nized experience, nor by any thing in the pathology of disease (p. 872). 
 569, e. Finally, I may conclude this subject with the nervous lan- 
 guage of Southwood Smith {On Fever): Thus — even "in the intense 
 forms of congestive fever, I look upon the notion of debility to be 
 an error not less palpable in its nature, than destructive in its conse- 
 quences ; and if the havoc it produces do not confer upon it a pre-emi- 
 nence as bad as that of the very disease of which it is supposed to con- 
 stitute the essence, it at least entitles it, in comparison with every oth- 
 er error in medicine, to the distinction recognized in society between 
 the hero and the murderer. The one destroys a single human being 
 now and then, but the other numbers its victims by thousands."
 
 PHYSIOLOGY. AGE. 373 
 
 FIFTH DIVISION OF PHYSIOLOGY. 
 
 MODIFICATIONS OF THE VITAL PROPERTIES AND 
 FUNCTIONS ARISING FROM AGE, TEMPERAMENT, 
 CONSTITUTION, SEX, VOLUNTARY HABITS, &c. 
 
 570. The differences among individuals, and classes of mankind, 
 which arise from age, sex, temperament, &c., may be regarded in 
 the light of qualifications of the four preceding grand attributes ot 
 organic beings. 
 
 571. Organic beings are liable not only to permanent changes in 
 their constitution from external influences, but to others of an inhe- 
 rent nature. Constitution and temperament supply examples of the 
 former ; age and sex of the latter. 
 
 572. These changes (§ 571) consist in varying conditions of the 
 properties of life, and possess, therefore, not only important relations 
 to the physical agents of life, but modify, according to their different 
 circumstances, the operation of morbific causes, and our therapeutical 
 treatment. 
 
 573. All the foregoing conditions spring from the natural instabili- 
 ty of the vital properties ; and such as are brought about by external 
 influences involve exactly the same philosophy that is concerned in 
 vital habit (§ 177, 539). Under the present division of Physiology, 
 however, the modified conditions are, in a general sense, of a far more 
 permanent nature than such as I have assigned to vital habit. 
 
 I. AGE. 
 
 574. As our bodies undergo progressive changes from the time of 
 birth to the end of life, the duration of human existence has been di- 
 vided into five periods ; namely, 1st. Infancy ; 2d. Childhood ; 3d. 
 Youth ; 4th. Adult or middle age ; 5th. Old age. They mark the 
 times during which the greatest physiological changes take place. 
 
 575. The differences which grow out of age consist in variations of 
 the external form, and of the forms and density of the internal parts, 
 of variations of structure, and of natural modifications of the vital 
 properties and functions. Upon these last depend all the other chan- 
 ges (§ 153-155, 237). 
 
 1. INFANCY. 
 
 576. a. Infancy extends from the time of birth to the end of the 
 first dentition. 
 
 576, h. At this age the fluids predominate. The organs are now 
 softest. The bones are imperfectly ossified. The muscles small. 
 The arteries are as numerous as in the adult, but more capacious. 
 The cutaneous veins small, while those of the brain, and some other 
 internal organs, are well developed. The skin warm, thin, and deli- 
 cate, covered with soft hairs and underlaid with fat, which, in the 
 adult, is removed to the internal viscera ; acute in iiTitability, obtuse 
 in sensibility. The eyes are. large, but inobservant, resting, for the 
 most part, on dazzling objects. The organ of hearing is imperfect 
 and dull, and attracted only by acute or loud noises. The nose small
 
 374 INSTITUTES OF MEDICINE. ^ 
 
 and irritable, sensitive in the nasal bi-ancli, but dull in the olfactory. 
 Taste indiscriminate. Sensibility and initability are highly develop- 
 ed in the intestinal canal. The teeth are making their way, one after 
 another, till at the end of two and a half years, the first dentition is 
 completed. Digestion and nutrition are in rapid progress, and the 
 secretions and excretions copious. The appetite great, and returns 
 almost as soon as appeased. The development of the digestive sys- 
 tem keeps pace with the progress of the teeth, and when eight or ten 
 shall have appeared, the stomach is ready for a gradual change of nu- 
 triment. The limbs are feebly controlled. Sleep is often repeated 
 and long continued, being scarcely interrupted for the first week, even 
 by hunger, so powerfully is the new being under the influence of its 
 foetal habits. Few mental impressions being made there is no trou- 
 ble from dreams. Sleep is therefore calm while the organs maintain 
 their healthy round. It is all sleep or all wakefulness, with but little 
 of the revery of later years. The pleasures are sensual and without 
 alloy, but very limited. The gratification of appetite is the highest 
 enjoyment, and hunger the greatest suffering. Judgment and reflec- 
 tion are in a dormant state. The mind is easily irritated, but as easi- 
 ly appeased ; and crying is as natural and salutary as laughing at a 
 later age. 
 
 576, c. The most important peculiarities of infancy, physiologically, 
 pathologically, and therapeutically considered, are the general imper- 
 fect development of sensibility, and the greater general development 
 of irritability, mobility, and sympathy, than at any other period of life. 
 
 576, d. As the diseases of infancy, like other ages, correspond with 
 the physiological characteristics (§ 155, 156), they are not liable to be 
 aggravated by causes which operate through common and specific 
 sensibility ; but the greater development of irritability, especially of 
 the brain and intestinal canal, than at any other period of life, subjects 
 the infant to a pi'edominance of cerebral and intestinal diseases. It 
 is owing, also, to this physiological condition of the alimentary canal 
 that any excess of food is readily rejected by the stomach. But iiri- 
 tability, in being thus susceptible of the influences of the natural vital 
 stimuli, that all its contingent purposes may be fulfilled, is especially 
 liable to morbific impressions (§ 137 d, 150). It is owing to the im- 
 perfect development of the cutaneous veins in infancy, and childhood, 
 that there is an absence of varix ; and, on the other hand, cerebral 
 congestion and hydrocephalus are now common, because the cerebral 
 veins, and the brain itself, are large and highly endowed with irritabili- 
 ty. Croup also prevails, and is more or less attended with a produc- 
 tion of coagulable lymph, because of a peculiar natural modification 
 of the organic properties of the mucous tissue of the larynx, which 
 changing at later periods gives rise to catarrhal inflammation (§ 134, 
 135). Morbid sympathies are common and strongly pronounced, es- 
 pecially between the intestinal canal and the skin, and between the 
 former and the brain. The sympathies, however, are mostly on the 
 side of the skin and the brain, the primary affections being in the in- 
 testinal canal. Next, the lungs are liable to pneumonia, but most so 
 after dentition begins. The appearance of the teeth is attended with 
 some new physiological conditions, and dentition aggravates or gives 
 rise to intestinal derangements, disturbs the natural sympathies of or- 
 gans, and provokes convulsions of the voluntary muscles (§ 526, d).
 
 PHYSIOLOGY. AGE. 375 
 
 576 e. Diseases being rapid and active in infancy, and injurious 
 Bympaihies speedily and powerfully determined, it is obvious that 
 remedies must be prompt, decisive, and of quick operation. But, it 
 is also an important consideration that nature is now strongly recupe- 
 rative ; that the same physiological susceptibilities of infants to dis- 
 ease, and to its rapid advances, render them also peculiarly sensible to 
 remedial agents, when timely and happily applied ; and that they now 
 operate speedily and with power on account of the great development 
 of irritability, mobility, and sympathy (^ 150). Hence it is, that mild- 
 er means which fail at adult age may succeed under apparently the 
 same circumstances in infancy. An emetic, therefore, or cathartic, or 
 alterative doses of tartarized antimony, &c., may become a substitute 
 for a certain quantity of blood, whose abstraction in the same condi- 
 tion of disease would be indispensable at adult age ; or leeching may 
 be sufficient in the former case, when general bloodletting would be 
 necessary in the latter. But, since the dangers of disease are great- 
 er, and there is less time for delay, in the diseases of infants than of 
 adults, we should be sure of the right before we decide on neglecting 
 or procrastinating the more vigorous treatment. This observation, 
 however, is intended to apply especially to the abstraction of blood. 
 Active internal remedies should be delayed in cases of doubt. On the 
 other hand, an early loss of blood is far less likely to be detrimental ; 
 and where it may be required, but delayed, the chance of its useful 
 application may be lost, not only through the advances of disease, but 
 by the prostrating effects of other remedies (§ 155, 156, 925 a, b, c, 
 964 d, 974 c, 1058 p). 
 
 576, y. It may be finally said of the characteristics of infancy, that 
 ihe first few weeks of independent life are marked by peculiarities 
 which go to illusti'ate the philosophy of life as expounded in these 
 Institutes. Sleep, for example, is remarkably continued ; cutaneous 
 sensibility so dormant that injuries of the surface are scarcely felt, 
 &c. But it is in organic life that we meet with functions that are 
 destined for speedy modifications, of which the generation of heat is 
 the most remarkable (§ 441, b). 
 
 2. CHILDHOOD. 
 
 577, a. Childhood extends from the age of two and a half to fif- 
 teen or seventeen years in males, and to fourteen or sixteen in fe- 
 males. 
 
 577, b. Irritability, and the other organic properties, become mod- 
 ified, and variously, in different parts. Those of the brain settle 
 down into that modification which is only necessary to established 
 functions (§ 156) ; or, at most, do but undergo slighter changes at the 
 subsequent periods of life. Consequently, the brain sheds a new in- 
 fluence over other organs ; and irritability, being less strongly pro- 
 nounced in all other parts than in infancy, they are less disposed to 
 sympathize with diseases of the brain, and of each other, or the brain 
 with them. The digestive system has undergone manifest changes ; 
 and here, too, irritability is particularly diminished. Solid food has 
 become indispensable, while it was inadmissible in early infancy ; is 
 less frequently desired, and can be digested only when taken at 
 longer intervals. The secretions and excretions have lessened, as a 
 consequence of the changes in the organic states.
 
 376 INSTITUTES OF MEDICINE. 
 
 Sensibility, especially specific, had made advances in infancy, and 
 increases rapidly in childhood. The various organs of sense are 
 turned with increasing attention to surrounding objects. This de- 
 notes an increase of perception and with it the other mental faculties 
 hold a progressive but more tardy pace. As knowledge pours in, 
 the faculties of the mind increase in an increasing ratio. The or- 
 gans of speech are unfolded, and there is great volubility of tongue 
 The skin has become less delicate, and the sub-cutaneous fat has un- 
 dergone diminution (§ 440 hh, 440 c, no. 11^, 441 c). The chin loses 
 its double character, and the general features acquire a contour in 
 which that of infancy is nearly lost. They reflect the operations of 
 the mind, and beam with enjoyment when not disturbed by the angry 
 passions that now spring up along with knowledge and reason. 
 
 577, c. The foregoing new state of things gives rise to new dis- 
 eases, or to new modifications of infantile diseases. Morbific causes 
 operate according to the new modifications of the vital properties. 
 There are new and modified circles of sympathy (§ 156, 566). New 
 parts become the seat of disease, as the ligaments, the mesenteric 
 glands, the lymphatic glands, the joints. Disease, too, is now ajst to 
 result in disorganization, from which infancy is greatly exempt. "VVe 
 have seen that some diseases become less frequent, as those of the 
 brain. The diminution of intestinal irritability lessens the frequency 
 and force of abdominal derangements ; and this relative exemption 
 cuts off that exuberance of sympathies which was displayed in the 
 intestinal irritations of infancy. Croup disappears at the age of 
 twelve. Among the new causes of disease may be reckoned the 
 passions, and the new avenues of external influences through the 
 senses ; though the absence of grief and the predominance of hope 
 are favorable to childhood. This is the age when severe mental labor 
 does its worst with the constitution. 
 
 577, d. Remedial agents bear a general relative correspondence 
 with the new physiological conditions, like the morbific, as we have 
 seen of infancy, varied, however, from the latter by the modifications 
 induced by disease (§ 149, 150). 
 
 3. YOUTH. 
 
 578, a. Youth extends from the end of childhood to the age of 
 twenty or twenty-five years. 
 
 578, h. As the characteristics of infancy pass by imperceptible de- 
 grees into those of childhood, so do those of the latter gradually fade 
 into the condition of puberty. New phenomena are alike presented 
 by the mind and body ; all springing from natural modifications of 
 the same powers which conducted the development of the ovum 
 through all its stages to that of the infant ; which carried along the 
 exact vicissitudes of infant life to that of childhood, and which trans- 
 form the child into a being capable of procreating his species. The 
 developments of structure go hand in hand with those of the vital 
 powers, the latter always taking the lead, according to the oi-dination 
 of the Creator ; and for Whose direct Agency, as exerted at the begin- 
 ning of organic life, these formative powers are designed as a subor- 
 dinate substitute, — always fashioning the new being according to the 
 ^jriginal model (§ 63, 64, 155). 
 
 The most remarkable peculiarity by which youth is introduced is
 
 PHYSIOLOGY. AGE. 371 
 
 the development of the organs of generation, which, as in plants, may be 
 regarded, in a physiological sense, as the great final object of the devel- 
 opment of all the other organs from the embryo state ; new beings be- 
 ing thus produced that other new ones may follow. Such, then, being 
 the ultimate tendency of all the physical and vital developments, it ob- 
 viously follows that a new condition has taken place in all the animal 
 and organic powers at the age of puberty, and that the development 
 of the generative organs will, in their turn, so modify the conditions 
 of life as to carry out the design of nature in perpetuating the species. 
 
 578, c. Specific sensibility is now at its acme of development, and 
 its corresponding mental power, perception, is in full and rapid oper- 
 ation. Knowledge of external things pours in as rapidly as the eye 
 can glance from object to object, or the ear distinguish the tones of 
 music as they run into each other. The mind now seizes this knowl- 
 edge, and appropriates it more extensively than before to the improve- 
 ment of its own powers. It compares phenomena with each other, 
 observes their resemblances and contrasts, and as the judgment, un- 
 der this exercise of reflection, acquires maturity, it deduces the greal 
 laws by which the phenomena are regulated, and finally carries them 
 up to the very powers from which they emanate. But it does not so 
 clearly follow that the provision which nature has made for the right 
 government of the mind or the body will be duly employed. No 
 sooner, indeed, are we born, than abuses begin, — if not on the part 
 of infancy, on that, at least, of its natural guides and protectors. The 
 stomach is crowded with solid food instead of its natural fluid, or 
 when solids become appropriate the least appropriate are often se- 
 lected. The properties of life being thus abused, they suffer, and not 
 unfrequently perish in consequence. The passions, yea, even anger, 
 ..are designed for our happiness or for our protection. But judgment is 
 permitted to fail of its legitimate sway, and the passions are let loose 
 to fill us with disease, to imbitter our corporeal and intellectual exist- 
 ences, to incarcerate our bodies, or to hang us upon the gallows. 
 
 Coming to the abstract operations of mind, do we not find a like 
 abuse of the understanding 1 Do we not constantly find that the 
 knowledge which has been acquired is perverted to the worst conclu- 
 sions ] Are not the phenomena of nature which are opposed to each 
 other made to assume resemblances, and such as are clearly allied 
 equally estranged ] And do we not then, by this abuse of reason, 
 proceed to refer these incongruous results to common laws and com- 
 mon causes ] We need not go beyond the subjects before us for an 
 affirmative answer. Are not all the unique phenomena of life, all 
 those which mark the distinctions between infancy, childhood, and 
 youth, all those which attend the consummation of the body for the de- 
 velopment of the generative organs, for the production of the ovum, 
 of the seminal fluid, even sexual desire itself, and its ultimate termina- 
 tion in new beings, ay, the very thoughts which go up to Heaven, 
 most extensively referred, at this thinking, speculative age, to the for- 
 ces which rule over dead, inorganic matter 1* But there is a stage of 
 human existence, which that modified materialism that acknowledges 
 a soul has not yet dared to invade. That stage begins when both pa- 
 rents infuse themselves into their future offspring, when a new soul, 
 like a new body, is generated ; and it extends .throughout the foetal 
 development. The same processes, as we have seen, are now in prog- 
 * See my work on the Soul and Instinctive Pkinciple, edition 1870.
 
 378 INSTITUTES OF MEDICINE 
 
 ress as at every subsequent stage of life. The same powers, theie- 
 fore, and no others, are alike at all times the causes of the coincident 
 results (^ 65-76). 
 
 Returning to the characteristics of youth, we find that the testes 
 now enlarge, and secrete the seminal fluid ; the uterus becomes rap- 
 idly unfolded in its powers and structure ; the menses take place ; 
 and, in both sexes, the arrangements for generation are established. 
 While these peculiar changes are in progress, sensibility and irrita- 
 bility are acutely susceptible, and give rise to restlessness, impatience, 
 and often to anxiety and distress, without absolute disease. The 
 mammae also prepare for the work of nutrition, swell out, and assume 
 that peculiar rotundity which is considered the beau ideal of beauty. 
 The beard puts forth. The face swells with blood, that the features 
 may be supplied abundantly with the material which is necessary for 
 their full development ; and it is now that physiognomy begins to 
 take its rank among the sciences. The muscles obtain greater firm- 
 ness, greater power, and greater action. The cutaneous veins enlarge 
 beyond their former capacity. The organs of speech undergo another 
 change, as denoted by the hoai'se and rough voice. The body spreads, 
 becomes firm and erect, and often shoots up, in early youth, with 
 amazing rapidity. 
 
 So much elaboration of structure, and the institution of the gen- 
 erative functions, cannot fail, according to our doctrine of life, as sour- 
 ces of many new reflex nervous actions, of new diseases, or mod- 
 ifications of former disease. The principle, indeed, is fundamental, 
 that diseases vary according to the natural variations that may spring 
 up in tlie vital states of different parts, or of the entire body, at differ- 
 ent periods of our existence (^ 150, &c.). These fluctuations of the 
 natural states of the system, as also disease itself, and its very cure, 
 as we have seen, grow out of the natural instability of the properties 
 of life (§ 177). The natural instability, or liability to definite changes 
 at the progressive stages of life, is ordained not only for the new phys- 
 ical developments that are taking place, but also for certain incidental 
 conditions, such as gestation, lactation, &c. (§ 155, 156). Will chem- 
 istry explain 1 
 
 We consequently find that the concerted action of organs is liable 
 to be disturbed at the beginning of youth, independently of disease. 
 The heart beats irregularly, respiration is hurried, or slow, or labori- 
 ous, and fluctuates as the passions rise or fall, or as the mind may 
 happen to poise; and the heart, and the cutaneous vessels of the face, 
 obey the same influences. These susceptibilities may be more or less 
 extended to all other parts, without the intervention of disease. Among 
 these physiological results are frequent bleedings of the nose, head- 
 ache, constipation, and partial disturbances of digestion. So, also, is 
 that pain and distress which attend menstruation, and all the reflex 
 nervous influences which are inflicted upon the system at large during 
 the progress of this excretion. It is the vital, not the chemical pow- 
 ers, which are thus disturbed, but not morbidly affected (§ 237). 
 
 578, d. Where, however, nature introduces so much novelty there 
 must be new diseases, and new sympathetic results of a morbid char- 
 acter. And now mark the coincidence between the progressive de- 
 velopment of the vital states and their liability to morbid affections. 
 The uterus, for instance, has hitherto been merely in a vegetative
 
 PHYSIOLOGY. AGE. 379 
 
 State. It lias had no specific function, and its organic pi'operties Jmve 
 existed only in that condition which is essential to nutrition. This 
 organ, therefore, has been scarcely liable to any disturbance, not even 
 of a sympathetic nature ; for the organ, hitherto, has taken no part in 
 the general operations of the body. And how clearly this illustrates 
 the laws of reflex nervous action in their application to disease, 
 and exposes the absurdities of the humoral pathology! But, as puber- 
 ty arrives the uterus takes on its specific function ; and, that this may 
 be performed there must be a great modification of the organic life 
 of this organ. Agreeably, therefore, to the universal law the uterus 
 must be now liable to direct disease, and to morbific reflex nerv- 
 ous actions from diseases of other organs ; while primary diseases of 
 the uterus, in their turn, develop sympathetic affections in other and 
 distant parts. Diseases of the digestive organs inflict diseases upon 
 the womb, and menstruation is suspended as one of the consequen- 
 ces. Again, when the uterus is most actively engaged, as during 
 menstruation, it should, according to our principles, be most liable to 
 disturbance, either from the direct operation of foreign causes, or 
 from reflex nervous influences of other diseased organs. Accordingly, 
 even exposures to a chilling atmosphere, damp and cold feet, &c., 
 will so disturb the uterus, when engaged in excreting the menses, as 
 to arrest its function. And what are the frequent consequences 1 A 
 long chain of sympathetic diseases, which, from the beginning of their 
 primary cause, we might as well attempt to explain by lunar influ- 
 ence, or by the ebbing and flowing of the tides, as by any principle 
 in the humoral pathology, or by any laws that rule in the world of 
 dead matter. And yet does the intellectual world abound with phys- 
 ical hypotheses of life and disease for the interpretation of phenome- 
 na of which those now under consideration are only simple elements. 
 Now, too, the mammae, for the first time, have their organic powers 
 brought forth, to be in readiness for the secretion of milk. And 
 mark, as we go along, the harmony of Design, and the coincidence 
 between the preparation of the mammas and that of the uterus. The 
 development of the latter takes the lead, while that of the mammas 
 is the work of sympathy, and this ascendency is maintained in the 
 pregnant state. And yet we are told that final causes should have no 
 place in philosophy. But the mammae, like the uterus, now, and for 
 the first time, become the seat of morbid conditions ; and, from what 
 we have seen of their natural relations to the uterus, we readily com- 
 prehend the reason why they inflame when the uterus undergoes its 
 sudden and violent change in parturition, and why the secretion of 
 milk is now started, and why they are liable to diseases, such as car- 
 cinoma, which, at least, seldom occur before this organ is brought un- 
 der the uterine influences {§ 138, 524 b, d). How forcibly do all 
 such problems admonish the chemist and physical philosopher to re- 
 gard all others relative to life, in its natural and morbid conditions, as 
 a part of that great whole, of which the former are only more striking 
 examples ! 
 
 Again, the testes now, also, for the first time, have their vital state 
 so modified as to perform their function of secreting semen (§ 155). 
 Of course, therefore, for the first time, these organs should be liable 
 to morbid affections, should now, for the first time, sympathize with 
 the diseases of other parts, and inflict reflex actions upon dis-
 
 380 INSTITUTES OF MEDICINE. 
 
 tant organs. But, besides the general functions, susceptibilities, and 
 influences in which the testes, the uterus, and the mammae now par- 
 ticipate in common with other organs, there are some special charac- 
 teristics relative to each part that reflect no little light upon our doc- 
 trines of life and disease. The development of the testes, for exam- 
 ple, exerts a powerful reflex nervous influence on the changes which 
 are simultaneously going on in other parts, as denoted by its well- 
 known effect upon the voice. If the parotids be invaded by mumps, 
 the testes and mammae are liable to inflame by sympathy, &c. The 
 natural and pathological conditions harmonize together ; the latter be- 
 ing strongly associated through the nervous system with the new devel- 
 opments of structure and modifications of the vital states, all of which 
 are owing essentially to alterative reflex nervous influences unceasingly 
 excited by the evolution of the generative organs (§516 d, no. 6). 
 
 From the vital elaborations which are in progress about the face, 
 it is liable to eruptive affections, and the throat to inflammation. Ar- 
 ticular rheumatism is now more rife than in childhood, and more so 
 than at any other stage of life. If disposition to scrofula exist, it still 
 manifests itself, as in childhood, in the lymphatics of the neck ; but 
 now, especially, it invades the lungs. This, therefore, is the age for 
 tuberculous phthisis. The brain, having already nearly acquired its 
 plenitude of development, and moving on in quiet stability of its or- 
 ganic powers, and the mental faculties employed in undisturbed op- 
 erations, is comparatively exempt from disease. The passions, it is 
 true, are now at work ; but they are not of the morbific kind, either 
 as it respects the brain or distant organs. Anger is the worst, but 
 goes off" in explosions. Envy has not been whetted. Grief is tran- 
 sient. Malice has not had its incentives. Avarice awaits the matu- 
 rity of judgment. Hope and love hold a sway over the whole, and 
 these are conducive to health, whfen love does not run into excess. 
 Nevertheless, there are transitions from excessive hilarity to the 
 gloom of melancholy, and the mind by fits is fanciful, and by fits is 
 dull. But, by more than all things else, it is subject to depressing in- 
 fluences from the development of the generative organs, and this in 
 proportion to its rapidity ; and the state of the mind, as to its dull- 
 ness, is an index of what is in progress for the procreation of the 
 species. When the organs of generation have attained their matu- 
 rity, the mind acquires its equilibrium ; and its faculties, by this pro- 
 cess, have obtained an immense accession to their vigor. These in- 
 fluences are alike felt by both sexes. As youth approaches the adult 
 state, the body, like the mind, increases in vigor, and is capable of 
 all the labor of maturer years. Now is the period for athletic exer- 
 cise, and feats of strength, and now the awkwardness of youth sub- 
 sides into the gracefulness and dignity of manhood (^ 237) . 
 
 4. ADULT OR MIDDLE AGE. 
 
 579, a. Manhood begins at the age of twenty to twenty-five, and 
 reaches to about sixty years. 
 
 579, h. At the beginning of this age, all the faculties of the mind 
 are approaching their state of maturity. " He," says Zimmerman, 
 " who, at thirty years of age, is not an able minister, an able general, 
 or an able physician, will never be so." The stature of the body is 
 .soon completed, its form perfected and all the organs fully devel
 
 PHYSIOLOGY. AGE. 381 
 
 oped. "We have, therefore, but Httle novelty in disease during the 
 age of manhood, except such as may spring from the operation of 
 new accidental causes. The buoyant hilarity of youth is succeeded 
 by greater steadiness of mind, tempered by sobriety and judgment. 
 The passions are now in full operation, and those of the worst kind 
 become more strongly pronounced ; of which, avarice and envy are 
 predominant. The disappointments and the trials of life have be- 
 come manifold, and fall with their heaviest effect ; and, as one suc- 
 ceeds another, hope is more or less supplanted by anticipation of evil. 
 The passions, therefore, at this period of life, are of a morbific na- 
 ture, and lay deeply the foundations of disease, or emban-ass the op- 
 eration of our curative means, and the salutary efforts of nature. 
 Diseases of the digestive organs, especially, and their sympathetic re- 
 sults, are the frequent consequences of grief and disappointment. 
 And, although the appetite has diminished, and is less frequent than 
 at former ages, habits have become more artificial, temperance gives 
 way to excesses, and the activity of youth yields to sedentary pur- 
 suits. Numerous arts, and the seductions of the stAdy, call us, also, 
 from the genial influence of the open air, and in various other ways, 
 contribute morbific influences. 
 
 Most of the injurious tendencies which are superadded to the age 
 of manhood beset, in the first place, the organs of digestion ; dyspep- 
 sy being one of the most frequent forms in which disease is now 
 presented, and can-ies in its train a multitude of sympathetic evils. 
 It is not, however, till the age of thirty-five that these manifestations 
 become common, unless the foundation have been laid, as is fre- 
 quently the case, by violations of nature in childhood or in youth, or 
 by transmitted predisposition. This is also the period of pregnancy ; 
 and, although a natural condition, the artificial habits of society have 
 so modified the natural state of the system, that pregnancy, parturi- 
 tion, and the period of nursing, give rise to no small amount of dis- 
 ease. For the same reason, also, menstruation is often inteiTupted, 
 while this interruption deranges other organs. Owing, in no small 
 degree, to these acquired peculiarities and the diseases of women, 
 midwifery has become a distinct and important department of medi- 
 cine. From forty-five to fifty menstruation ceases, and with it the 
 period of childbearing. This new change in the uterus is apt to de- 
 velop sympathetic disturbances in other parts, and to become a cause 
 of disease in the uterine organs. But, as a compensation, there is 
 now an exemption from those maladies and that suffering which re- 
 sult from the menstrual function. 
 
 From the age of 45 to 70, the cerebral veins take on that peculiar 
 modification of congestion which results in a secretion of blood, and 
 which, as occuiTing in the brain, determines the common form of 
 apoplexy. This condition decreases toward the age of 70. But, I 
 shall not dilate farther upon the peculiarities of this era of life, since 
 they are all referable to the great principles which govern the char- 
 acteristics of every other period, and all require the same considera- 
 tions in the aspects of pathology and therapeutics. As at all other 
 stages of existence, also, the characteristics of manhood are grad- 
 ually changing till they are finally blended or disappear in those of 
 old age, or that stage of life when it is very erroneously supposed that 
 "fAe machi7\e is wearing out" (^^ 237, 581 b, 584 b, 633).
 
 382 INSTITUTES OF MEDICINE. 
 
 5. OLD AGE. 
 
 580. The last period of life has been subdivided into incipient or 
 green old age, which extends from 60 to 70 ; confirmed old age, or 
 caducity, from 70 to 85 ; and decrepitude, from 85 years, upward. 
 
 581, a. More remarkable changes now take place in certain parts 
 of the organization than from the beginning of youth upward ; but, 
 &,s they occur not in the essential organic parts, modifications of the 
 organic properties and functions are less the cause of certain promi- 
 nent phenomena than the physical deviations in comparatively unes- 
 sential parts ; such as ossification of the cardiac valves, of the arteries, 
 &c. The senses are failing as an avenue of knowledge. The eye 
 becomes dim, and the ear is only arrested by acute, or distinct, or 
 loud noises. The motions of the body are slow, the back stiff", and 
 more or less curved. The intervertebral cartilages, also, shrink, and 
 the stature lessens in consequence. The joints and tendons become 
 rigid ; the sutures coalesce ; the skin is darker and more wrrinkled ; 
 the fat retires from the circumference to the internal organs, by 
 which the superficial veins are rendered more prominent, and the eyes 
 sunken. 
 
 581, h. Nevertheless, rigidity and other changes go on in the most 
 essential organization, which are principally characterized by a nat- 
 ural decline of the vital properties and functions ; but none are ab- 
 rupt, and there are no new functions introduced, and none are arrest- 
 ed. All these new conditions, too, as at all other stages of life, are 
 the work of the organic properties, — always creative, but ultimately 
 giving rise to physical changes of a suicidal nature, and which end in 
 their destruction. Irritability and sensibility are, therefore, upon the 
 wane, and mobility is alike embarrassejl by the foregoing physical 
 changes. The nervous system has mostly played out its part. 
 
 581, c. The mind, too, in ordinary cases, is going with the organic 
 powers ; but it is worth observing, as a characteristic distinction be- 
 tween the soul and the organic properties which animate its abode, 
 that genius rarely weai's out. It sparkles as bright as ever when the 
 flickering lamp of life is but dimly seen. 
 
 581, d. The decline of the mental powers is accompanied by a 
 subsidence of the passions ; and as sensibility also fails, former mor- 
 bific causes and avenues to disease are thus greatly diminished. 
 
 581, e. The old man waits his certain doom in calm serenity, or 
 only impatient for its approach. He is satiated with the pleasures of 
 life ; perhaps because he can enjoy no longer. His reminiscences 
 are rather of his pains than of his delights, because the former are 
 more indelibly established, and are not now counteracted by present 
 enjoyments. 
 
 582, From what we have now seen of the physiological conditions 
 of old age it is evident that diseases vary but little from those which 
 prevail after 40 or 45 years ; only from the gradual embarrassments 
 sustained by the organic powers disease is apt to be less violent, 
 while, also, for the same reason, there is less of the recuperative abil- 
 ity. Apoplexy, palsy, organic affections of the heart, and urinary dif- 
 ficulties, are the predominating accidents of old age. 
 
 583, a. Although, therefore, morbific causes are less energetic in 
 old age than at other stages of life, remedial agents are, also, less op-
 
 PHYSIOLOGY. TEMPERAMENT. 383 
 
 erative, nature less recuperative, diseases less easily arrested, are 
 Booner beyond the reach of art, and often eventuate suddenly in death, 
 without having attained any degree of severity. Life often snaps when 
 the old man is quaffing his wine, or as he " shoulders his crutch to 
 show how fields were won." 
 
 583, b. Hence it is apparent that remedies must be prompt and ef- 
 ficient in proportion to the exigencies of disease ; as is more exten- 
 sively set forth in the article on Bloodletting (§ 1014). 
 
 584, a. Finally, it appears from the characteristics of life at its va- 
 rious stages ; the progressive variations in the vital states ; the suc- 
 cessive developments of important organs ; of the new functions which 
 are instituted and again extinguished ; till we come to that period 
 when the properties of life lay the foundation of their own ruin by in- 
 stituting disorganizations of structure ; and from what, also, we have 
 seen of the corresponding modifications of disease at the various eras, 
 and of the new ones which appear, with their new train of sympa- 
 thies, it is obvious, I say, that there must be some corresponding va- 
 riation of treatment which may be relative to a common character of 
 disease (§ 117, 134-160). But, at every varying stage of life, all 
 things proceed upon established laws ; and, however modified the 
 powers which may be in operation, and by which every result is 
 brought about, and whether so by nature, or by morbific causes, or 
 by art, there are precise laws by which all the phenomena are deter- 
 mined according to the particular combination of existing circumstan- 
 ces. It is an important object of art to find out all the conditions 
 which may attend any given state of the properties and functions of 
 life, whether natural or morbid, that the most appropriate regimen 
 may be adopted, or remedial agents be applied with the greatest pre- 
 cision. In all this the nervous system demands a critical attention. 
 
 584, b. Every remedy would always operate in one uniform way, 
 were the conditions of the vital properties and functions, and the struc- 
 ture which they animate, always the same ; just as the blood always 
 affects the heart and vessels in one uniform manner, in health. But, 
 such is the instability of the properties of life, and such, in consequence, 
 the variableness of morbid conditions, that these modifications are 
 rarely precisely the same in any two instances, or at any two succes- 
 sive days. To find out these varieties, and to adapt accordingly the 
 general principles of treatment, and in their relatively specific details, 
 is one of the highest and most difficult aims of medicine ; and demands, 
 as an indispensable qualification, a profound knowledge of the phi- 
 losophy of life. 
 
 TI. INDIVIDUAL AND GENERAL PECULIARITIES, CONSISTING OF TEMPERA 
 MENT, CONSTITUTION, IDIOSYNCRASY, AND NATIONAL ATTRIBUTES. 
 
 A. Temperament, Constitution, Idiosyncrasy. 
 
 585, a. Under our fifth division of physiology we have next in or- 
 der the Temperaments, &c., or those peculiarities of life which natU' 
 rally distinguish one individual from another. The temperaments, 
 therefore, may be regarded as embracing the innate as well as ac- 
 quinid peculiarities of constitution ; for, although the latter depend 
 upon causes that are relative alone to the individual, the former, or 
 innate constitution, has been brought about, at some anterior genera-
 
 384 INSTITUIES OF MEDICINE 
 
 tion, by the physical agencies of hfe. This is the true temperament, 
 , and belongs to masses of mankind. 
 
 5S5, b. Idiosyncrasy is only a variety of temperament and constitu- 
 tion, and like those, therefore, depends upon some peculiar modifica- 
 tion of the properties of life, especially in-itability ; but only so in re- 
 lation to a very few particular agents. It is peculiar to individuals, 
 rather rare, and may be hereditary or acquired. This peculiarity is 
 not unfrequently the cause of the favorable or deleterious effects of 
 certain remedial agents, of certain kinds of food, &c. We see the 
 important principle illustrated every day, every hour. Here is a sub- 
 ject who is salivated by the external application of a few grains of 
 mercurial ointment, and in whom syphilis, or fever, may be speedily 
 extinguished by this simple use of the remedy. But here is another, 
 in whom the internal administration of an ounce of calomel may pro- 
 duce no constitutional result, and make no impression upon syphilis. 
 Or, it may be in another case of extreme susceptibility to the action 
 of mercui-y, that the agent always displays the effects of a profound 
 poison, aggravating fever and syphilis, or, in the absence of disease, 
 greatly deranging all the functions of life. Most men are poisoned 
 by the slightest contact with the rhus vemix ; but now and then an in- 
 dividual handles it with impunity. Muscles, and some other animals, 
 ai-e always poisonous when eaten by some people, though generally 
 good articles of food. 
 
 585, c. Constitution comprehends all the peculiarities of the indi- 
 vidual, — the temperament, idiosyncrasy, conditions relative to age, sex, 
 habits, &c. It is therefore liable to many variations at all periods of 
 life. The prevailing characteristics of each of the elements may re- 
 main, but yet so modified that what is known as constitution may be 
 " broken down." 
 
 585, d. The same principle is concerned throughout, whether in 
 respect to constitution, temperament, or idiosyncrasy. It is the same 
 as prevails habitually in respect to the naturally modified irritability 
 of different organs in man, and in all animals, and in plants ; that 
 which renders urine innoxious to the bladder, but morbific to all 
 other parts, — that which renders the eye susceptible to the undula- 
 tions of light, the ear to the undulations of air ; and so on (§ 133-159). 
 The principle, and its everlasting, unchanging laws, are every where, 
 in all that relates to organic beings, whether in respect to the system 
 in its abstract condition, or as relative to external agencies. It is a 
 great and wonderful principle, a perpetual study for the philosopher, 
 ever pregnant of variety, ever illustrative of the peculiar character of 
 the properties of life, of their natural modifications, of their instability, 
 and forever supplying fresh sources of interpretation of the laws which 
 the properties and actions of life obey. 
 
 586. It is evident, therefore, that temperament, constitution, and 
 idiosyncrasy, are constituted by certain acquired or transmitted con- 
 ditions of the vital properties, which form a part of the natural or ha- 
 bitual state of each individual, and from which arise various degrees 
 and kinds in the susceptibilities to the action of physical agents, and 
 certain peculiarities, also, in the material condition and conformation 
 of parts, especially the external. By studying these sensible peculiari- 
 ties, as well as the phenomena of life in their natural and morbid con- 
 ditions, we infer the peculiarities of the natural vital conditions in dif-
 
 PHYSIOLOGY. TEMPERAMENT. 385 
 
 ferent individuals, or their natural constitution and temperament, or 
 any more remarkable idiosyncrasy. They reach, also, to the mind, 
 which is apt to bear certain relative peculiarities to those of the or- 
 ganic states. 
 
 588. In the farther consideration of this subject, I shall regard those 
 peculiarities of constitution which are mostly of a determinate nature, 
 and include them under the general denomination of temperament. 
 
 589. The physiological differences between temperament, idiosyn- 
 crasy, and constitution, are neither great, nor of much practical im- 
 portance. Indeed, so allied are they in principle, that a common 
 philosophy determines the remedial treatment, which is always more 
 or less modified by temperament. Each should be considered along 
 with the modifying influences of habits, climate, &c. 
 
 590. Temperament and constitution do not depend, as supposed by 
 some writers, upon the special development of particular organs ; 
 though this is true of some of the vicissitudes of age (§ 153-159, 596). 
 The former have their foundation in the system at large, and are apt 
 to be transmitted by one or both parents; or the transmitted pecu- 
 liarities may come from a remote ancestor, and not from the imme- 
 diate progenitor. This last peculiarity is analogous to one of the 
 characteristics of the scrofulous diathesis, where it passes over one 
 generation and reappears in the third. 
 
 591. It appears, therefore, that temperament, whether innate or ac- 
 quired, is due to the slow operation of causes upon the vital constitu- 
 tion ; just as we have seen of the law of vital habit (§ 535-568). In 
 the latter case, the modifications are more or less transitory ; but may 
 be so ingrafted as to be transmitted, for a time, like the permanent 
 temperaments, from parent to child, as seen of some diseases, such as 
 lues, or of predispositions to disease of a transient nature, as in small- 
 pox, or even ordinary fever. Coming to hereditary disease of a per- 
 manent nature, as scrofula, we run from the transitory phenomena of 
 vital habit, by an intimate analogy, into the permanent temperaments; 
 and from these we are conducted by the same philosophy, which re- 
 spects the operation of physical agents in modifying the properties of 
 life, to those more remarkable peculiarities which spring uj^in ani- 
 mals from domestication, and in plants from changes of climate and 
 soil (§ 75-80, 143-147, 220, 327-331, 559, 561-563, 659, 666 b, 
 674). 
 
 592. It is scarcely probable that differences in temperament have, 
 often, any appreciable effect on the elementary composition. Differ- 
 ences, however, obtain in respect to structure, as seen in the general 
 form, the proportions of the limbs, the features, &c. ; while more re- 
 markable corresponding analogies are witnessed in the herbaceous and 
 arborescent habits of the same plant, as it may be subject to the influ- 
 ences of a tropical or cold climate, as the ricinus communis (§ 538). 
 
 593. Great differences arise not only in respect to the influences 
 of the same remedial agents from the mere circumstances of temper- 
 ament, but morbific causes may be equally various in their operation. 
 The same causes may also be very apt to affect one temperament, 
 while they will rarely have an effect on another temperament (§ 142 
 145, 740). The nervous system is much interested in those modifications. 
 
 594. The temperaments, as designated by the ancients, and re- 
 >:ained by the moderns, are divided into the sangv,ine, the melancholic ^ 
 
 B B
 
 386 INSTITUTES OF MEDICINE. 
 
 the choleric, and the plilegmatic. The artificial habits of the modems 
 have added a fifth, or the nervous. 
 
 595. It is not usual to find all the attributes of each temperament 
 united, while some of the whole may be blended in the same individ- 
 ual. Nevertheless, the characteristics of one or another generally 
 predominate. 
 
 596. Temperament is most distinctly pronounced at adult age, af- 
 ter the influences of development have ceased (§ 590). 
 
 1. THE SANGUINE TEMPERAMENT. 
 
 597. a. Unlike the other temperaments, the characteristics of the 
 sanguine are perpetuated from infancy, and perhaps, therefore, may 
 be considered the most natural. The skin remains soft and delicate ; 
 the limbs rounded and full ; the superficial veins, unlike those of in- 
 fancy, large, conspicuous, and blue, especially about the head and 
 temple ; the complexion fair, florid, and animated ; the eyes large and 
 blue ; the hair light, or red, or of intermediate hues. 
 
 597, b. Sensibility and imtability are strongly pronounced; the 
 great development of the latter giving the principal determination to 
 the sanguine temperament. The blood, in consequence, stimulates 
 the heart to more frequent, high, and regular action, maintains the 
 capillaries in a lively and plethoric state, and thus determines the 
 redness and softness of the skin. Other vital stimuli also operate 
 with greater intensity than in other temperaments. For the same 
 reason, the secretions and excretions are rapid and copious, and are 
 little liable to vacillation, in the ordinary conditions of health. All 
 things else move on in a corresponding manner; the whole assem- 
 blage of which beautifully illustrates the true philosophy of life. 
 
 The great development of sensibility contributes, also, its consid- 
 erable part to this temperament. The senses are ever on the alert ; 
 and here, as with irritability, external objects make their impressions 
 with great effect and rapidity. Perception is rapid, reflection quick, 
 imagination lively, memory prompt. The succession of ideas is too 
 rapid for comparison, and hence the judgment is infirm, unless asso- 
 ciated^ith genius ; when it is distinguished for eccentricities. This 
 is exemplified in the poet, Byron, and in the warrior, the Marshal 
 Duke of Richelieu, — " that man, so fortunate and brave in arms, light 
 and inconstant, to the end of his long and brilliant career." 
 
 597, c. Inconstancy and levity are the great moral attributes of the 
 sanguine. Variety and enjoyment never satiate. Devoted to sensual 
 gratifications, they are in love with all female beauty, and are incon- 
 stant to a mistress, if not to a wife ; yet are they honorable in all 
 things else. It has been said of Newton, that he was of the sanguine 
 temperament ; but, had he been so, it is replied, " he never would 
 have carried, as he did, his maidenhead with him to the grave, at the 
 age of fourscore." Nor do the senses afford that leisure for profound 
 meditation, nor admit of those intellectual operations which are in- 
 dispensable to the mathematician and astronomer ; whose habits, also, 
 ai'e more adverse to this than to any other temperament. 
 
 The sanguine is eminently generous or prodigal, and the end of 
 gain is the purchase of pleasure. Quick in anger, he is soon cool ; 
 or he is impelled to hasty decisions that arc soon regretted. A chal- 
 lenge to a duel would be gladly abandoned, did not a sense of pride
 
 PHYSIOLOGY. TEMPERAMENT. 387 
 
 uige him on to the combat. Revenge and envy have no hold upon 
 this constitution. 
 
 597, d. It is evident, therefoi'e, that the prevailing diseases of the 
 sanguine temperament are active and inflammatory ; that the organs 
 sympathize I'eadily and greatly w^ith each other, and that the sympa- 
 thetic affections are disproportionately greater than the primary af- 
 fections. Infancy always partakes of this temperament; but if it be 
 truly constitutional, the infant is liable to extraordinary demonstrations 
 of its fundamental nature. The irritation of a tooth, for example, is 
 more apt to produce convulsions, and intestinal derangements still 
 more so, or to lay the foundation of cerebral disease, &c. At adult 
 age, slight disturbances of the womb bring on hysteria, or indigestion 
 contributes to a more sudden accession, more violent phenomena, and 
 a more rapid progress, and lights up the flame of other diseases more 
 speedily, and more violently, than in other temperaments. Anger, 
 being quick and vehement, here displays its instant effect in develop- 
 ing inflammations, and hemorrhages. But love is too instable to un- 
 dermine the health ; and as envy, grief, and jealousy, torture not the 
 mind, so do they not the body. The nervous system is in lively force. 
 
 697, e. As external causes, whether natural or morbific, make 
 their impressions rapidly and profoundly upon the sanguine tempera- 
 ment, and its diseases being active and violent, remedial agents should 
 be prompt, and decisive, as in infancy; but here, also, for the reasons 
 which are relative to the first period of life, and for such as are as- 
 signed in section 597 b, remedies are also profound and speedy in 
 their operation. And since the prevailing disease of this tempera- 
 ment is inflammation, bloodletting is the principal means of cure, and 
 will require but little co-operation from other agents. If early appli- 
 ed, and carried to its proper extent, it will often nearly extinguish 
 the most violent inflammations during its fii'St application. The test 
 of this extent will be also more exactly determined in this than in 
 other temperaments by the subsidence of symptoms during the prog- 
 ress of the operation. It is in this temperament, also, that the philos- 
 ophy of the vital influences of loss of blood is most evidently shown 
 (§ 191), and morbific and therapeutical aspects of reflex nervous actions. 
 
 2. THE MELANCHOLIC TEMPERAMENT. 
 
 598, a. The melayicliolic temperament has certain points of resem- 
 blance to the sanguine, though they are strongly contradistinguished. 
 The general external aspect of the latter is cheerful ; that of the mel- 
 ancholic, dry, stern, or gloomy, and excites no liveliness in others, 
 though it command respect and even admiration. The solids pre- 
 dominate in the melancholic ; the capillaries show less blood, though 
 the veins are large and more prominent, but less transparent thah in 
 the sanguine ; and, unlike the latter, the skin is darkish, or inclining 
 to yellow, thick, coarse, and hard to the lancet. The blood flows 
 more freely from the sanguine when the skin is pricked ; and this ex- 
 emplifies the state of the capillary circulation at large. The same 
 principle obtains, therefore, in the pulmonary circulation, and hence, 
 in part, the blood is darker in the melancholic than in the sanguine. 
 The eyes of the former are darker and less prominent than in the lat- 
 ter ; and the hair is dark, coarse or stiff; eyebrows large, black, and 
 -■ften projecting; the muscles and tendons, like the superficial veins
 
 388 INSTITUTES OF MEDICINE. 
 
 Stand out, from the absence of that cutaneous fat which gives rotun- 
 dity to the body of the sanguine (§ 440 bb, 440 c, no. II5, 441 c). 
 
 598, b. It is easily seen, therefore, that irritabiUty and sensibility 
 are comparatively dull in the melancholic. External objects do not 
 make the strong and rapid impression upon the senses as in the san- 
 guine ; and, from the obtuseness of irritability, the action of the heart 
 is slower, the capillary blood-vessels are less charged with the vital 
 fluid, the secretions and excretions less, and more slowly performed 
 (§ 191). The nervous system evinces great stability of functions. 
 
 598, c. The melancholic temperament is the principal abode of ge- 
 nius ; embracing a large proportion of those great men who have un- 
 folded the laws of nature, or have made the highest advances in the 
 arts, or have astonished the world with deeds in arms, or with the 
 achievements of the statesman, or the orator, or the painter, or the 
 poet. The melancholic is the man of men. I had almost said, in 
 moral constitution, he is perpetuated, unchanged, from the model ot 
 his race. Here is witnessed the highest intellectual renown at the 
 very dawn of manhood ; and here it is that we so often meet with ge- 
 nius struesline with those adversities which aiTest the ambition of 
 other temperaments. The melancholic is forever mdomitable ; rismg 
 in determination as obstacles rise before him. Inflexible in purjDOse, 
 the passions are disciplined to urge on an arduous enterprise, or if 
 allowed to become impetuous, it is to accomplish the decisions of the 
 understanding. With equal facility he concentrates his mind upon 
 abstract inquiries, or at the next moment sends it abroad over the 
 widest theatre of its operations. He is bold and brave, never fearing 
 death, nor wantonly incurring danger. He moves steadily forward, 
 though he does not move till the path before him has been explored. 
 His imagination, therefore, is of the highest order, being disciplined 
 by the sterner faculties. It is such an imagination as is always an 
 element of genius ; such as contemplates the realities of life and the 
 truths of Revelation. He is thoughtful, gi'ave, or sad, but may tune 
 his mind to great elevation and great sublimity and enthusiasm, and 
 often soars on poetic wings through the regions of Heaven. The san- 
 guine, on the contrary, delights in the romance of fiction. 
 
 Honor holds its empire in this temperament, however it may be 
 wanting in human sympathies. If pledged to a good or a bad action, 
 it is fulfilled. The melancholic is generally fervent but dignified in 
 his attachments, or looks with indifference or with scorn upon human- 
 ity. A few, like Tiberius, are fearful, perfidious, suspicious, and 
 cruel ; and others, like Nero, or Richard, insensible to danger, and 
 ever ready for the work of death. 
 
 598, d. As with sensibility and imtability in their natural aspects, 
 so is it in their relation to morbific and remedial agents. The coin- 
 cidence is universal. The former are slow in establishing morbid 
 changes, many are inoperative which readily light up the flame of dis- 
 ease in other temperaments ; and the passions, a prolific cause with 
 others, are subdued by the melancholic into mere agents of the un 
 derstanding. But when morbific causes have made their impression, 
 the dullness of irritability and mobility explains why disease is apt to 
 be obstinate, and why remedial agents operate with less rapidity than 
 in the sanguine. The vital properties and functions being slowly sus- 
 ceptible of morbid changes, they are slowly altered from their morbid 
 states, and with this coiucide the actions of the nervous system.
 
 PHYSIOLOGY. TEMPERAMENT. 389 
 
 It is easily inferred that the diseases of the melancholic are mostly 
 of the diofestive orsrans, and that their i-emoval is tedious. It is also 
 manifest that these, and other affections, are slow in developing dis 
 eases of other parts, and that the brain and the mind must be most 
 likely to sympathetic disturbances. Hence it is that hypochondriacism 
 and insanity are apt to supervene on the melancholic temperament. 
 
 Cathartics are demanded more by the melancholic than by any 
 other temperament ; though their exigencies have a special relation 
 to the disorders of the digestive functions. Bloodletting, also, is often 
 necessary to reach these chronic maladies ; and, although its delay in 
 the grave forms of inflammation be less hazardous than w^ith the san- 
 guine, its necessity is as great, and its extent and frequency of repe- 
 tition are greater. It is here, too, that the greatest demand is made 
 upon the materia medica for auxiliary means. 
 
 3. THE CHOLERIC TEMPERAMENT. 
 
 599, a. The CJioleric is intermediate between the sanguine and mel- 
 ancholic temperaments ; and although it form the sanguineo-melan- 
 cholic, it possesses characteristics which give to it an individuality. 
 
 The skin has greater fullness of the capillaries than in the melan- 
 cholic, and therefore greater softness, and warmth, but less than in 
 the sanguine. The pulse is intermediate in fullness and frequency. 
 The secretions and excretions moderate and uniform ; the healthy 
 functions performed with regularity and ease. 
 
 599, b. The passions are easily roused, though not impetuous, and 
 therefore less transient and less easily appeased than in the sanguine, 
 though not so persevering as in the melancholic. The choleric is te- 
 nacious of his own rights, but less disposed to infringe upon the rights 
 of others than the melancholic, while he has less generosity than the 
 sanguine. The higher faculties of the mind coiTCspond with the oth- 
 er characteristics of this temperament, being generally distinguished 
 ■for their moderation. 
 
 599, c. Irritability and sensibility holding an intermediate degree 
 between those of the sanguine and melancholic, external agents op- 
 erate with a relative effect and rapidity; so that the organic func- 
 tions move on without frequent or profound interruptions, and dis- 
 eases yield to a more compound treatment, though less readily than 
 to the simpler means required by the sanguine, but more speedily 
 than in the melancholic. 
 
 4. THE PHLEGMATIC, OR LYMPHATIC TEMPERAMENT. 
 
 600, a. The 'Phlegmatic is characterized by slothfulness of mind, 
 and by a simpler display of vegetative life than any other tempera- 
 ment. The flesh is soft, the countenance pale, the hair delicate, and 
 the fat amounts to an encumbrance. The limbs are rounded, feeble, 
 and without expression. The veins are small, and lie deep. The 
 pulse is small, feeble, and soft; arteries small, and the capillaries de- 
 ficient in blood. Irritability is dull. The secretions and excretions 
 are performed slowly, and their products are thin or watery. Sensi- 
 bilif.y is also obtuse, and perception weak, which greatly circum 
 scribes the senses as an avenue to the mind ; while 
 
 "Fat bolds ideas by the legs and wings" 
 (§ 440 U, 440 c. no. \\\, 441 c).
 
 390 INSTITUTES OF MEDICINE. 
 
 But, with all the intellectual dullness and bodily indolence which 
 distinguish this temperament, it is obstinate, fearful, suspicious, and 
 avaincious. The nervous system is blunt and on the side of evil. 
 
 600, h. The organic properties of the phlegmatic are easily liable 
 to inten-uption, though morbific causes, unless intense in their nature, 
 make their impressions feebly. The mind, and its predominant pas- 
 sions, have, of course, but little agency in the production of its dis- 
 eases. Disturbances, however, seem to arise from the mere inertia 
 of the vital powers ; and when morbific causes make strong impres- 
 sions the properties of life often go down at once to near the verge 
 of extinction. So, also, do active remedial agents operate with a 
 relative effect. Emetics are scarcely admissible ; violent cathartics 
 prostrate excessively ; and any unnecessary extent of bloodletting 
 breaks down the whole energies of the body. This temperament, 
 therefore, requires great moderation of treatment (§ 150). 
 
 5. THE NERVOUS TEMPERAMENT. 
 
 601, a. The Nervous temperament displayed itself feebly among 
 the ancients, but has been brought to a high maturity by the progress 
 of civilization. It is the only temperament where the primary causes 
 may be traced, which consist mainly of such as are attendant on indo- 
 lence and sedentary pursuits. It involves alike, therefore, the rich 
 and the poor, the sensual devotees of fashion and the plodding shoe- 
 maker, the laborious student and the readers of romance. 
 
 601, h. The nervous temperament is founded upon the sanguine, 
 or the sanguineo-melancholic, and is either transmitted, or springs up 
 originally in the individual. It is therefore the most artificial of all 
 the temperaments, and is susceptible, individually, of great improve- 
 ment. It is shown externally by a general aspect of feebleness, a 
 spare body, and small, soft muscles, which are incapable of much ex- 
 ertion. 
 
 601, c, Disturbing reflex nervous actions are the leading char- 
 acteristic. Irritability is also strongly pronounced. Hence, slight 
 disturbances, even of unimportant parts, give rise to greatly dispro- 
 portionate sympathies in the more important organs ; and these sec- 
 ondax-y results will be still more intense if the primary disease be seat- 
 ed in any important organ. 
 
 The functions are constantly subject to irregularities, especially 
 those of the abdominal viscera. If the subject be addicted to the 
 causes of this temperament he is rarely free from indigestion, and an 
 attendant train of other evils, according to the nature of his indul- 
 gences br pursuits. Diseases, however, are not as violent as with 
 the sanguine, nor as profound as with the melancholic. The mind is 
 irritable, but the passions not violent, though they readily disturb the 
 organic functions. Such as display themselves depend much upon 
 the habits and occupation of the subject. 
 
 601, d. Remedial agents operate with power ; the same coinci- 
 dences existing between their effects and those of a moi'bific nature, 
 as in other temperaments. Moderate impressions, therefore, made 
 upon the intestinal canal are sensibly felt by remote parts ; and in this 
 temperament, particularly, the peculiar principle upon which leeching 
 operates is well illustrated (§ 145, 147, 914, &c.).
 
 PHYSIOLOGY. RACE. 391 
 
 General Remarks on Temperament. 
 
 602, a. Different epochs of life appear often to partake of a par- 
 ticular temperament ; one subsiding into another. The sanguine is 
 most characteristic of infancy and childhood ; the melancholic and 
 choleric of middle age ; and the phlegmatic of old age. 
 
 602, b. The several temperaments are also often blended, more or 
 less, with each other in the same individual, though the characteristics 
 of one generally predominate. When combined in the same individ- 
 ual, they are called the sanguineo-melancholic, the sanguineo-phleg- 
 matic, &c. They are also liable not only to the foregoing modifica- 
 tions from age, but from sex, climate, habits, education, &c. So great, 
 indeed, is the influence of climate, that a change of residence (as from 
 a northern to a tropical country) will sometimes gradually transmute 
 one temperament into another ; and this is particularly true of the 
 sanguine, the melancholic, and the choleric. 
 
 602, c. The foregoing accidental influences are sometimes such as 
 to generate anomalies, in which it is difl[icult to recognize any distinct 
 features of the prevailing modifications of temperament, and which 
 may disappear with the individual, or be transmitted to his descend- 
 ants. 
 
 602. d. All the varieties comprehended in this section are more or 
 less liable to modifications of a common form of disease, and require 
 corresponding variations in the details of treatment. They concur to- 
 gether, therefore, in forming a part of the difficulties of medicine, and 
 in demonstrating the complete abstraction of organic beings from the 
 forces and laws of the inorganic (§ 659). 
 
 603. I say, organic beings in their most comprehensive sense (§ 
 602, d). For are not the varieties which have sprung from domesti- 
 cation, and cultivation, among animals and plants, and which are 
 equally, and more perfectly transmitted than temperament, constitu- 
 tion, &c., in relation to man, integral parts of a common principle ] 
 Exactly the same philosophy lies at the foundation of the whole, and 
 is another broad field of evidence to substantiate the unity of the Vi- 
 tal Principle, of its common laws and functions throughout animated 
 nature, and presents the whole in a magnificence of Grandeur, a Har- 
 mony and Unity of unfathomable Designs, which stamps an unutter- 
 able contrast on the confusion and imbecility of the chemical and 
 physical hypotheses of life. (See Climate.) 
 
 B. Races of Mankind. 
 
 604. Corresponding, in principle, with Temperament, &c., though 
 different in their manifestations, are those peculiarities which have 
 distinguished mankind into various Races. They correspond more 
 nearly, in the physical characteristics, with those sensible changes 
 which are established by the domestication of animals, and by the 
 cultivation of plants (§ 603). As with many species of the latter, the 
 varieties of mankind have existed without change as far back as his- 
 tory begins its record. This circumstance has often led the specula- 
 tive mind to imagine as many original ancestors as it may distribute 
 the human species into varieties of race (§ 350|, kk). But, with ex- 
 actly the same reason may we ascume that the black and the white 
 barn-yard fowl, and all the other varieties of this animal, or the red
 
 392 INSTITUTES OF MEDICINE. 
 
 and the white potato, and other varieties of this root, the sloe and 
 the plumb, the crab and the apple, are equally distinct, and that 
 each has descended from a distinct original progenitor. Or take the 
 yet more remarkable transmutation of a salt and bitter weed into the 
 varieties of the cabbage and cauliflower by transplanting it from 
 the sea-shore into the rich mold of gardens, and which are as dissimi- 
 lar as each from the original species. 
 
 605, a. The attributes of Race are mostly of a physical and moral 
 nature ; and, unlike the temperaments, but analogous to the foregoing 
 varieties of animals and plants (§ 604), they are not attended by any 
 special modifications of the propeities and functions of life ; but all the 
 races ai'e liable, individually, to the physiological conditions of tem- 
 perament. The general attributes, therefore, admit of no physiolog- 
 ical, pathological, or therapeutical applications. 
 
 605. h. And here it is worthy of remark, as illustrative of the com- 
 mon nature of the properties and functions of life, that other changes 
 to which animals and plants are liable from unaccustomed physical 
 agents are attended by distinct modifications of their vital states, and 
 remarkable variations of structure. An animal, for example, trans- 
 ferred from the tropical to colder regions, undergoes a change in its 
 hairy or woolen vesture, or from summer to winter in the same cli- 
 mate. The tree, transplanted from the tropics to a northern latitude, 
 may be made to resist the inclemencies of winter, and finally puts on 
 a denser bark, and a hibernaculum for its leaf and flower-buds. Or 
 yet more strikingly, what is herbaceous in equatorial regions may be- 
 come a shrub or a tree in temperate climates. These mutations, 
 therefore, are strictly analogous to the temperaments of man. Or, 
 again, what is more emphatically characteristic of the analogies of na- 
 ture in any of her grand departments consists in the fact that the va- 
 rieties which are constituted by hybrid animals and plants are, equal- 
 ly with the foregoing, both in respect to cause and effect, correspond- 
 ing phenomena with the varieties of temperament (^ 72). 
 
 606. From what is known of the analogous varieties among differ- 
 ent species of animals and plants (§ 604), we shall have little difficulty 
 in referring the characteristics of race to the influence of physical 
 agents upon the properties of life ; and of these there are none so ob- 
 vious as climate. Like temperament, &c., the whole falls under the 
 laws of vital habit (^ 535, &c.). 
 
 607. Perhaps there is no better classification of Race than Lace- 
 pede's; who reckons only the European Arab, the Mogul, the Ne- 
 gro, and the Hyperborean. These have been variously subdivided. 
 
 Blumenbach's division of the races is also simple and just; namely, 
 the Caucasian, the Mongolian, the Ethiopian, the American, and the 
 Malay. The Caucasian variety answers to the European Aiab of 
 Lacepede; the Mongolian to the Mogul; the Ethiopian to the Negro; 
 the American embraces all the natives of North and South America, 
 excepting the Esquimaux ; and the Malay includes the inhabitants of 
 Sumatra, Borneo, New Holland, and many other islands of the South 
 Sea ; most of whom speak the Malay language. 
 
 608. The Eui'opean Arab comprises the people of Europe, Egypt, 
 Syria, Arabia, Barbary, Tartary, Persia, the North American In- 
 diana, &c. 
 
 The fundamental characteristics are an oval face from forehead to
 
 PHYSIOLOGY. SEX. 39tj 
 
 chin, a prominent skull anteriorly, a long nose, skin more or less 
 white, and long, straight hair. 
 
 609. The Mogul race is composed of the Chinese, the inhabitants 
 of Eastern India, Tonquin, Cochin China, Japan, Siam, and the South 
 American Indians. This race is more numerous than all the others. 
 
 Its characteristics are a flattish forehead, eyes turned rather oblique- 
 ly outward, cheeks prominent, oval face between the two cheek bones. 
 
 610, a. The Negro, a native of Africa, possesses the most perfect 
 characteristics. The black skin, the low, flat forehead, the depressed 
 nose, the thick lips, the crisped hair, the dullness of understanding, and 
 the acuteness of his senses, mark him as the greatest phenomenon 
 among the physical changes of our species. This is the only race of 
 whom it can be surmised that the change has been miraculous. 
 
 610. h. The bondage to which the Negro has been subjected has 
 naturally excited the sympathies of the humane, and has led them to 
 assume in his behalf an ideal rank in the scale of mind. I would not 
 oppose this harmless prejudice were it not in collision with fundamen- 
 tal laws which it is my duty to interpret, as far as may be, as nature 
 teaches. The brain has sustained in this degraded race (degraded 
 as well by nature as by man) that failure of development, which, 
 as universally admitted, stamps the white man with intellectual inferi- 
 ority- But, degraded as is the Negro in mind, in body, and in bond- 
 age, he is yet a man, and, like the rest of the human family, descend- 
 ed from common parents. His very imbecilities, therefore, entitle 
 him the moi'e to our sympathies and protection (^ 1078, s). 
 
 611. The Hyperborean stands, also, in strong relief from the rest 
 of mankind. This race comprises the Laplanders, the Esquimaux, 
 Saraoiedes, Ostiacs, Tschutski, &c. 
 
 They have Iwoad faces, flat features, swarthy skin, and are stinted 
 in growth. In the scale of intellect they rank next above the Negro. 
 
 III. SEX. 
 
 612. Certain physiological differences in the sexes appear to have 
 been impi'essed originally upon the constitution ; and this, indeed, was 
 necessary to the perpetuation of the species. But, although our first 
 parents were created in a state of maturity, there were ingrafted up- 
 on the constitution {^ 64 &c.) the laws of development for natu- 
 ral growth, and which are designed to conduct the individual to that 
 mature condition in which he came from the Hands of the Creator. 
 
 613. Besides the special difference in the organs of generation, 
 woman is of a lower stature than man, less rigid in organization, soft- 
 er and more delicate in her skin and complexion, abounds more with 
 cutaneous cellular tissue and fat, (§ 440 hh, 440 c, no. Ill, 441 c), 
 which gives greater rotundity to her limbs and greater concealment 
 to the muscles. Laws of nervous system more strongly pronounced. 
 
 Her mind is quick in its operations, arrives earlier at maturity, but 
 is less vigorous, than in man. The passion of love, although indom- 
 itable, is more a sentiment with her than with the other sex. She 
 seems, however, especially designed for the repi-oduction of the spe- 
 cies, and for the early care of her offspring. 
 
 614. Sensibility, irritability, and therefore mobility, are more ex- 
 quisite than in the male, and, for a like reason, she is more suscepti- 
 ble, as with the infant, and the sanguine and nervous temperaments,
 
 394 INSTITUTES OF MEDICINE. 
 
 to the action of morbific causes. Sympathy predominates, also, in 
 the female ; and hence local diseases are more apt, than in the other 
 sex, to disturb other parts. But she is not, therefore, more liable to 
 death ; since the vital powers being more strongly pronounced, they 
 are more recuperative, and the same susceptibility to morbific causes 
 renders her, also, more susceptible of the genial effect of remedial 
 agents. What Providence has denied to one. He has given to the 
 other. 
 
 IV. CLIMATE. 
 
 615. The influences of climate in modifying the physiological 
 character of man are great and various, and still greater and more 
 various in predisposing him to disease. The physiological effects of 
 climate are also strongly shown in animals, though often far less in 
 their organic than their animal economy ; while in the vegetable tribes 
 these or analogous results are often strongly manifested in organic 
 life. The nervous system takes its usual modifyiug share (^ 578 d). 
 
 616. I shall speak now mostly of those permament effects of cli- 
 mate which are known under the denomination of temperaments, for 
 the purpose of illustrating still farther the radical changes which may 
 be established in the vital states by physical agencies (§ 585-603). 
 This, also, will show how profoundly climate may operate in dispos- 
 ing the organic functions to a state of disease, and will contribute, 
 with what has been said in other places, in inducting us into a knowl- 
 edge of the philosophy which relates to predisposition to disease, 
 
 617. The extremes of heat and cold are conducive to the foiTnation 
 of the sanguine temperament, either in maintaining it as an inherited 
 peculiarity, or in developing it out of other constitutions. But, it is 
 mainly the dry heat of the tropics which goes to the formation of the 
 sanguine temperament. The phlegmatic and sanguineo-phlegmatic 
 belong mostly to warm climates, especially to such as are moist. The 
 choleric and melancholic occupy the temperate regions ; and here, 
 therefore, we may look for the demonstrations of genius. The chol- 
 eric and melancholic gradually merge into the sanguine, or phleg- 
 matic, in tropical regions (^ 1047). 
 
 618. a. The philosophy of life, as already expounded, enables us 
 to comprehend the manner in which the foregoing transitions and va- 
 rieties are brought about; while the changes confirm that philosophy 
 (§ 617). Thus, when the melancholic migrates from the temperate 
 to a tropical climate the uninterrupted and powerful action of heat 
 upon irritability and sensibility renders these properties more and 
 more susceptible to the action of blood, and all vital stimuli. The 
 secretions and excretions become, in consequence, more abundant ; 
 morbific and remedial agents manifest corresponding variations in 
 effect; and since, also, the organic properties of the brain sustain the 
 modifications incident to other organs, and the senses acquire greater 
 liveliness, the whole character of the mental faculties takes on that of 
 the sanguine temperament, and what was once an uninterrupted efful- 
 gence of mind dwindles down to occasional scintillations. This is 
 especially the course of the transplanted melancholic if the tempera- 
 ment incline to the sanguine. But here, as with the choleric, or 
 where the sanguine and melancholic are distinctly associated, if the 
 temperament lean to the phlegmatic the vital properties are rather
 
 PHYSIOLOGY. CLIMATE. 395 
 
 depressed by heat, and the functions of the body and mind are more 
 slowly and feebly performed ; being influenced even by the vicissi- 
 tudes of season, and by the daily atmospheric changes. 
 
 In the tropics, therefore, man is indolent, given to pleasure, and 
 lives only for himself. With the natives of high northern lati- 
 tudes the properties of life are under the perpetual influence of 
 cold, which fails, in consequence, of its usual action as a stimulus in 
 temperate climes, and all the functions are slowly performed ; save 
 only the generation of heat, which has its special final cause. 
 Growth must therefore be slow and stinted, and there must be [ccetcris 
 paribus) great capability of resisting morbific causes, and a gradual 
 recovery from disease. As the temperate climates hold an interme- 
 diate rank in their vital relations, it must be here that we shall find 
 mankind representing the most perfect attributes of their nature. 
 
 618, h. The same philosophy holds in respect to animals and plants, 
 since all observation teaches that they are as sensibly affected, in cer- 
 tain aspects, by the diversities of climate, as the human race ; being, 
 also, like man, subject to modifications from education, soil, &c. (§ 
 605, b), allowing for differences in organization and life (§ 185). 
 
 619, We thus see that climate contributes largely to the formation 
 of temperament, and exerts direct modifying influences upon the gen- 
 eral character of disease. In this last acceptation it embraces all the 
 predisposing causes which appertain to different regions ; such as the 
 various kinds of miasmata, temperature in its general aspect and as 
 liable to vicissitudes, moisture and dryness, and other obvious condi- 
 tions. Physiological principles lie at the foundation of the whole. 
 
 620, a. From the considerations which have been now made, as 
 well as for other reasons, chronic diseases should abound in the tem- 
 perate zones, while they are comparatively rare in equatorial climates. 
 Consumption is a gi-and characteristic of the former, especially of the 
 sea-board and other humid regions.* 
 
 620, b. The principle about which the facts just stated are concerned, 
 as well as others that are relative to climate, is well illustrated by the 
 rapidity with which the chronic maladies of horses yield to tropical in- 
 fluences ; a large proportion of these animals which are destined for 
 the West India markets being thus affected, and thus relieved. 
 
 621, a. The remarks which have been now made in respect to cli- 
 mate lead me to indicate an important duty of the physician as it re- 
 spects the inhabitants in an individual sense ; though I have in view 
 its philosophical as well as practical bearing. 
 
 * True, it has been lately stated on the authority of the British Army Statistics, that 
 consumption is more rife on the West India stations than in any other quarter of the globe ; 
 from which the conclusion was drawn that the disease was especially incident to those 
 climates. This important fallacy I have pointed out in the Medical and Physiological 
 Commentaries (vol. ii., p. 619-622). In that work, also, especially in the Essays on Blood- 
 letting, and on the writings of M. Louis, I have set forth the facts, which, with the pre- 
 ceding, and others of a coincident nature, enforce the importance of rejecting all ai-my sta- 
 tistics, and other hospital reports, as forming any proper foundation for gi-eat pathological 
 and therapeutical conclusions ; and have endeavored to show that all such conclusions 
 should be dravm exclusively from the private wallis of the profession, where the consti- 
 tution is natural, the habits good, and disease early and judiciously treated, and where, 
 especially, the superintending physician is, bona fide, the prescriber and critical observ- 
 er, and more anxious for the recovery of his patient than for a post mortem examination. 
 Hospital reports represent nature in her most distorted aspects, the treatment of disease 
 being often begun at its moribund stages, and when the system is full of organic lesions- 
 this treatment, too, often experimental, and without reference to fundamental ijhysiolog- 
 ical principles (§ 623).
 
 396 INSTITUTES OP MEDICINE. 
 
 The native and the acclimated are apt to possess very different sus- 
 ceptibilities from the new-comer, from which it results that the treat- 
 ment of their diseases, respectively, should be more or less governed 
 by these considerations ; while it will be, also, the impor!,ant business 
 of the physician to point out to the stranger the means of averting the 
 new morbific influences to which he is subjected, and his modified 
 susceptibilities. The means are various, and of the highest moment. 
 It was from their neglect, as I have shown, that the mortality from 
 consumption has been so great upon the West India stations, and the 
 Report of which has led to so many theoretical and practical errors (§ 
 620, note). And as to the importance of a proper adaptation of treat 
 ment to the acute forms of disease upon the same military stations, 
 it is only necessary to consider the appalling contrast between the re- 
 sults of practice as introduced by Robert Jackson, and that which im 
 mediately preceded his superintendence as surgeon-general. By di- 
 minishing, also, the allowance of " salt beef and rum" to the sick, he 
 saved the British government $400,000 per annum. And who does 
 not know that it is the same now as in Zimmerman's day 1 "I know," 
 says Zimmerman, " a certain Esculapius who has fifty or sixty pa- 
 tients every morning in his antechamber. He just listens a moment 
 to the complaints of each, and then arranges them in four divisions. 
 To the first he prescribes bloodletting ; to the second a purge ; to the 
 thii'd a clyster ; and to the fourth change of air ! The same vulgar 
 prejudice leads people to have a great idea of the practice of large 
 hospitals. I have seen, in my travels, some of the largest hospitals 
 in Europe ; and I have often said to myself, Heaven, surely, will have 
 pity on these miserable victims" {i} 1065 c, 1068 a). — NoTEFp. 1114. 
 
 621, b. In connection with the foregoing should appear the modifi- 
 cations which arise from peculiarities in the specific nature of the 
 remote causes of disease, which are almost as vai'ious as the causes 
 themselves. We know, indeed, that the pathological cause of inflam- 
 mation may be varied by the manner in which wounds are inflicted ; 
 and more various, therefore, must be the exact modifications which 
 are determined by agents which possess specific properties. To know 
 those modifications presupposes, in no small degree, a knowledge of 
 their special causes. They demand a great versatility of treatment 
 where common principles may apply ; and this may be determined 
 more by a knowledge of the remote causes than by any resulting phe- 
 nomena (§ 644, &c.). 
 
 V. HABITS, OR USAGES. 
 
 622. It now remains to speak briefly of the last subdivision of our 
 fifth grand division of Physiology. Under the denomination of Habits 
 are included the various pursuits of mankind, their social and political 
 relations and institutions, their modes of living in respect to food, ex- 
 ercise, clothing, &c. ; with a special reference to their physiological 
 and pathological influences, which are great and numerous. 
 
 Much of this subject is considered under the direct physiological 
 aspect of vital habit (§ 535, &c.), and the same principles obtain 
 throughout. The usages of man not only variously modify his vital 
 condition in a transient manner, but, like the eflfects of climate, incom- 
 patible habits may establish permanent and transmissible changes ot 
 constitution. The glass-blower, the brazier, the painter, the type
 
 PHYSIOLOGY. HABITS. 397 
 
 settei', &c., have, respectively, modifications of a common disease, 
 vv^hich are still different from those of the sedentary divine, lawyer, 
 and shoemaker. And so of the various pursuits which demand more 
 or less exercise in the open air. 
 
 623. Habits, in their most extended sense, open upon us a field for 
 endless observation. Here it is, in the neglect of the natural means 
 of preserving health, in the pinches of poverty, in the filth of indo- 
 lence, in Bacchanalian indulgences, and in the various resources of li- 
 centiousness, we meet with nature so turned from her physiological 
 condition, that when disease sets in it presents the most embarrassing 
 anomalies. The. hospitals of all countries, especially of Europe, show 
 a disgusting amount of these artificial deformities. And yet are they 
 sent forth as legitimate grounds for important conclusions in patholo- 
 gy and therapeutics (§ 620, note). 
 
 All the foregoing varieties of disease, which grow out of deleteri- 
 ous habits, or pursuits, may yield to the substitution of natural means, 
 or to change of employment. 
 
 624. As to the active treatment of the cases last recited, I can only 
 say, that, while the great principles obtain as in less artificial states, they 
 demand greater modifications of practice than all other special condi- 
 tions that are incident to man. But, let us remember, that when we 
 meet with phrenitis, or pneumonia, or any other grave inflammation, 
 ay, or even erysipelas, affecting the most broken-down constitution of 
 the most dissolute man, stimulants will be pernicious, and he must 
 take his chance from a modified antiphlogistic plan. 
 
 625. Under the category of habits may be arranged the modifica- 
 tions which are exerted upon the constitution by subdued diseases. 
 There are many affections which leave their subjects not only unusu- 
 ally susceptible of morbific agencies, but modify the pathological 
 character of the diseases which may subsequently spring up. The 
 dyspeptic affections that follow recoveries from fever are more obsti- 
 nate, and require a more varied treatment, than such as arise from 
 simple indolence, or even from high living. Syphilis, though cured, 
 predisposes to an obstinate form of rheumatism, which requires a dif- 
 ferent detail of treatment from that which is induced by cold, or by 
 hepatic and intestinal disease. 
 
 625^. The usages and habits of man supply a fruitful field of inquiry 
 into the modifying influences of the nervous system upon his organic 
 states, and for tracing out their analogies with those reflex actions which 
 contribute to the development of structure, and most remarkably at the 
 age of puberty, when the evolution of the generative organs, starting 
 in the same inscrutable laws of organic life as are provided for the anal- 
 ogous organs in plants, establishes that profound labyrinth of reflected 
 nervous actions which bring under their sway the whole animal fabric, 
 and through which we may look as a guide at all the more obscure re- 
 lations of the nervous system to the organic fluctuations of man and 
 animals, even the exalted grade of their organic compounds, and to 
 which influences are owing, in part, the peculiarities that distinguish 
 the animal from analogous conditions of the vegetable tribes ; while, 
 also, we may find in the same pronunciations of the generative organs 
 a clear physiological ground for interpreting the mochis ojjerandi of mor- 
 bific and remedial agents and the multifarious influences of organs upon 
 each other either for good or for evil (^514 g-?n, 578, 896 902 i-m).
 
 398 INSTITUTES OF MEDICINE. 
 
 SIXTH DIVISION OF PHYSIOLOGY. 
 
 THE RELATION OF ORGANIC BEINGS TO EXTER. 
 NAL OBJECTS. 
 
 626, a. That division of physiology which concerns the relations 
 between living beings and external nature is very comprehensive, 
 and brings into immediate connection the three great departments of 
 medicine ; and it is an object of these Institutes to consider the sub- 
 ject under this limited aspect. Here it is that these several branches 
 meet together, and here it is that we learn that pathology and thera- 
 peutics are only modified aspects of physiology. They are all imme- 
 diately interested about the properties of life ; physiology regarding 
 the healthy influences of external agents upon those properties, pa- 
 thology their morbific effects, and therapeutics those changes which 
 are exerted upon the morbid properties by remedial agents. A com- 
 mon principle is, therefore, concerned throughout. All the diversified 
 results, whether physical, or vital, are directly dependent upon the 
 existing condition of those properties. That condition is ascertained, 
 in all its mutations, by the resulting phenomena, 
 
 626, h. Upon this ground, also, as upon that of the more internal 
 economy, may be utterly exploded all the chemical and physical hy- 
 potheses of life and disease ; since, were any of those doctrines 
 founded in truth, the action of external causes should be directly upon 
 the composition and structure. And so should the blood itself upon 
 the sanguiferous system, urine upon the bladder, bile upon the intes- 
 tine, &c. 
 
 The moment we begin the study of effects as manifested by living 
 beings, whether induced by internal or external causes, or those 
 which arise from the action of living beings upon outward objects, we 
 find ourselves surrounded by an endless variety of phenomena which 
 denote the existence of a formative principle, upon which all the im- 
 pressions are made, and which is the primary cause of all that are made 
 upon external bodies, — which moves the body from one place to an- 
 other, exerts all the changes that are effected in food, elaborates that, 
 and that only, from the universal mass which is suitable for the for- 
 mation of blood, which governs all the processes of organization, 
 which is susceptible of alterations in its condition in consequence of 
 the action upon it of many external objects, which is liable to analo- 
 gous influences, healthy and morbid, from the operations of the mind 
 and its passions, and which possesses an inherent tendency to return 
 from a morbid to its natural state, the essential cause of preservation. 
 Surrender these doctrines, and all our reasoning about organic be 
 ings, all our physiological and medical philosophy, would be a mere 
 jargon of words. Hence it may be always seen, that those philoso- 
 phers who deny the existence of a principle of life, or substitute the 
 chemical forces, are driven to the necessity of speaking and writing 
 as if allowino- its full operation the moment they concern themselves 
 about the phenomena' of life. They must have, and they know it, a 
 peculiar cause for effects so peculiar as those of organic beings. 
 
 627. In my examination of the constitution of the different tissues,
 
 PHYSIOLOGY. EXTERNAL RELATIONS. 399 
 
 and of the properties and functions of life, the topics embraced with- 
 in the present division of Physiology came, unavoidably, under anal- 
 ysis ; and have been variously reproduced when investigating the 
 laws of vital habit, the influences of age, temperament, climate, &;c. 
 But little, therefore, remains to be added. 
 
 628. In regarding our relations to external objects we should 
 carefully discriminate between irritability and sensibility, the two 
 properties through which the relations are established ; the former 
 connecting organic life, the latter animal life, with the external world 
 (§ 188, &c., 194, &c.). Vegetables, therefore, hold their connection 
 through irritability alone ; so that their organization is intimately as- 
 sociated with outward objects. The connecting anatomical structure 
 in the organic life of animals consists of the alimentary canal, the 
 lungs, and the skin ; in plants, of the radicles and leaves (§ 268, &c.). 
 630, a. In organic life, as has been already seen, agents of all 
 kinds operate through the medium of irritability (§ 188). Their ef- 
 fect depends upon the degree, and the kind of irritability, and upon 
 the kind, energy, and quantity of the agents (§ 133, &c.). Owing to 
 changes in the degree of irritability the same stimulus or sedative, 
 and in the same quantity, does not always produce the same amount 
 of effect. It will be more, or less, on one day than on another, even 
 at one hour than another. This is constantly exemplified in the natu- 
 ral states of the body, but distinctly in disease, when irritability is 
 also modified in kind as well as in degree. The law is of great im- 
 portance in medicine, and is subject to many contingent influences, 
 both in health and disease, especially that of vital habit. These in- 
 fluences involve some of the most difficult and delicate considerations 
 in the practice of medicine, and more so from nervous complications. 
 630, b. Again, the alterations of irritability in morbid states, 
 whether in degree or kind, will depend upon the virtues of the mor- 
 bific agent, and upon the natural modification of the vital properties 
 in any paiticular part. This combined condition, and according to 
 its nature, requires particular adaptations of remedies, whose opera- 
 tion, also, will be in conformity with their own virtues, and with the 
 natural and acquired conditions of the organic properties (§ 150, &c.). 
 The principle is, also, equally true of all diseases in their develop- 
 ment of sympathetic affections. 
 
 630, c. From what has been said of the natural modifications of the 
 vital properties in different parts, and of the specific relation of nat- 
 ural and remedial agents to those various conditions, it is obvious that 
 the same morbific agent will affect one organ more or less differently 
 from what it will another part (§ 133, &c.). Cantharides will not of- 
 fend the stomach, but will excite inflammation of the bladder, and of 
 no other part, in its proper therapeutical doses. And just so, though 
 less remarkably, of the ordinary causes of disease. Cold and damp- 
 ness constantly excite inflammation of the mucous coat of the nose, 
 trachea, and lungs, while they far more rarely affect other parts. 
 One poison strikes at the brain, another at the liver, and another at 
 the skin, though their primary action may be often exerted upon the 
 stomach. Other directions, however, may be given to each of these 
 morbific causes when they are brought to act upon parts which are 
 already diverted from their natural states, and will be liable to other 
 variations from the numei'ous accidental influences by which every
 
 400 INSTITUTES OF MEDICINE. 
 
 indhidual is surrounded. It is these fluctuating influences which 
 render measles, scarlet fever, the intennittent and yellow fevers, ty- 
 phus, &c., more malignant at one time than at another, or more vio- 
 lent in one person than another. The same law obtains even in re- 
 spect to idiosyncrasy, as in those subjects who are not affected by the 
 poison of the rhus, &c. (§ 585, b). The differences result mainly 
 from different modifications of instability, and corresponding influen- 
 ces of various causes, not from " absorption and elective affinity." 
 
 630, d. As all morbific agents differ in their kind, so are the effects 
 of all more or less different from each other. Each one, or according 
 to their combined influences, other circumstances being equal, affects 
 the organic states in one uniform way ; and this is as true of the ma- 
 laria which generate typhus and yellow fever, the plague, &c., as of 
 the virus of small-pox, measles, hydrophobia, &c. The differences 
 in results will, of course, be most strongly pronounced when the mor- 
 bific causes differ most from each other. 
 
 630, e. Many important pi'actical considerations grow out of the 
 principles involved in this section (§ 630), and which will come up for 
 general remark under the remote causes of disease (§ 644, &c.). As 
 an illustratidn, in greater detail, of a single element of this complex 
 subject, let us now analyze the compounded influences which impart to 
 measles, scarlatina, &c., their epidemic character, and their gi-eater 
 complexities when thus distinguished than in their sporadic form ; and 
 it will be seen, also, that the same principles are of extensive applica- 
 tion to individual cases of all forms of disease, whatever be the nature 
 of the compounded causes. Take, in the first place, epidemic fevers, 
 epidemic dysentery, epidemic bilious pneumonia, &c. Here the causes 
 may be mainly some special miasmata of intensely morbific properties, 
 though more or less aided by the use of stimulants and stimulating food, 
 &c., operating as predisposing causes subordinate to the miasmatic or 
 essential cause (§ 648 c, 650-659, 602-663, 666, 870 aa). Coming to 
 the contagious diseases, each malady has a more clearly defined predis- 
 posing cause, which is always generated by the special morbid states 
 of these diseases respectively (§ 653). But in these affections when 
 oceurring epidemically, and sometimes in their sporadic forms, the mi- 
 asmata that are indispensable to fevers contribute their malign influ- 
 ences in rendering the system more susceptible to the morbific effects 
 of the contagious principle, increase the intensity of its operation, and 
 lay the foundation of those local congestions of the abdominal organs 
 which arg attendant on epidemic fever, epidemic bilious pneumonia, 
 &c. (§ 961-970, 1002-1005), just as stimulants and stimulating food 
 operate in these miasmatic diseases. The same philosophy is applicable 
 to the malignant cholera, which has for its indispensable cause some 
 specific atmospheric virus, but often greatly promoted in its morbific ef- 
 fects by the predisposing causes of miasmatic fevers, and which concur 
 in instituting the local congestions that are incident to those fevers (§ 
 654 a). The principle is the same, also, with those diseases where a 
 predisposition to some specific form is impressed upon the constitution, 
 as in scrofula, rheumatism, lues, &c. (§ 72-73, 75-79), and which mod- 
 ifies, or is modified by, the miasmatic influences that generate fevers 
 (§ (j52 b, 660-062, 858), Superficial diseases, such as "putrid sore 
 throat," erysipelas, &c., often spring from profound abdominal conges- 
 tions, and are apt to be fatally mistaken for simply local affections 
 (§ 689 /, 961 a, 970 c).— Note Oo p. 1141.
 
 PHYSIOLOGY. DEATH. 401 
 
 SEVENTH DIVISION OF PHYSIOLOGY. 
 
 DEATH. 
 
 631. Organic beings die ; nothing else. What is it, then, that dies; 
 and why, in consequence, do living beings return to the mineral king- 
 dom 1 The functions, it is answered by many philosophers. But 
 the functions are merely results. It is their causes, then, that perish. 
 And what are the causes 1 The chemical philosophers answer, the 
 forces which are capable of so many results in the inorganic world, — 
 the chemical forces. But the facts contradict that philosophy; for no 
 sooner is the organic being dead, than we witness an exactly oppo- 
 site series of results as the effects of chemical changes. We witness, 
 [ say, a demonstration of chemical results beyond any other example 
 in the natural world, and it is then only that we witness them at all. 
 The causes which are withdrawn must have been as peculiar as the 
 universal phenomena that have disappeared, and as opposite to those 
 chemical forces which take possession as their power of resisting 
 them during life is unquestionable. These causes have been called 
 the vital properties, which, like the powers or properties of the mind, 
 are elements of one principle, which is known by the name of the 
 vital principle. It is the extinction of this substantive principle which 
 essentially constitutes death, as its existence essentially constitutes 
 life. Those who deny its existence are generally, also, materialists in 
 respect to the soul, if they be not chargeable with a greater vice. 
 
 632, a. The tendency to death, in man alone, having been intro- 
 duced since his creation, the properties of life must have undergone 
 some miraculous change. Man was created imperishable. By sin 
 
 ■ came man's death, by perseverance in sin, a farther abbreviation of life. 
 We must admit this doctrine of Holy Writ, and apply it philosophi- 
 cally. We may not reason as to the Order of Providence, had the 
 material man been immortal. Doubtless, ample "room" would have 
 been provided for his indefinite multiplication, at least in the ultimate 
 abode of the translated Prophet. 
 
 632, Z». But, assuming that life has been shortened from a thousand 
 years to " three-score and ten" by the agency of physical causes, 
 there must have been a miraculous change in the condition of the in- 
 organic world, since it has been without change, in its relations to 
 disease, up to the earliest records ; but the very face of the earth as- 
 sures us that there has been neither a natural nor a supernatural change 
 in the condition of matter, or in the laws of inorganic nature. We 
 are therefore compelled to take the Revelation of Heaven as it 
 stands ; or, in denying one part, to deny, also, the longevity of pri- 
 meval man; which Avill obliterate all common ground between the 
 disputants. — Notes C p. 1113, Pp p. 1142, Gio. p. 1145. 
 
 633. Life does not generally reach what may be called its natural 
 termination. We have already seen that its natural extinction is the 
 work of its own progressive movements ; that it is the result of tlie 
 same creative operations that developed the ovum into the new-born 
 offspring, — that continued the same process through the various stages 
 of life xrp to the time of full maturity, — that still went on with the 
 
 C c
 
 402 INSTITUTES OF MEDICINE. 
 
 work of superaddition, till at last, by the progressive condensation of 
 organs, by clogging the sanguiferous system with interstitial deposits 
 of bony matter, &;c., it loses its control over its own instruments of 
 action, and fails for want of means to carry on its productive opera- 
 tions. It is not, therefore, from any natural failure of the properties 
 of life, or any " wearing out of the machinery," as is commonly sup- 
 posed, that life ultimately becomes extinct, but from the prolongation 
 of that process by which it laid the substratum for those active oper- 
 ations, which, when once begun, must be continued in uninterrupted 
 progress along with the original creative function (§ 63-82, 123, 170 c, 
 175 b, 176, 237, 584). This ultimate effect, as well, also, as the ex- 
 posure of life to the influence of morbific causes, is a striking exem- 
 plification of the Order of Providence in carrying out His final pur- 
 poses in the natural world, where the general plan has been miracu- 
 lously diverted from its original design (§ 632, b). 
 
 634. The principal elements in the production of death may be 
 found in the modes by which it may be suddenly effected. 1st. By the 
 failure of the circulation, as in syncope. 2d. By the failure of respira- 
 tion. 3d. By sudden and pernicious determinations of the nervous pow- 
 er upon the circulatory and other important organs. 4th. By the same 
 determination of the nervous power upon the organic properties oi 
 the brain, as seen in instant death from apoplexy, anger, joy, surgical 
 operations, blows on the stomach, &c., though, in these cases, there 
 is also a pernicious nervous influence propagated to the heart, &c. (§ 
 230, 510, 511). Death from syncope is immediately owing to the 
 failure of the heart to supply other parts with blood ; though the ner- 
 vous power is especially instrumental in prostrating the organs of cir- 
 culation (§ 940-942, 947-949). Death from abolition of the respira- 
 tory function is owing especially to a consequent failure of the decar- 
 bonization of the blood. It is remarkable how speedily a loss of con 
 gciousness, and, of course, of all sensation, is sustained by the suspen- ■ 
 sion of this function ; and it may be of interest to some to know the facts 
 as lately experienced in my own person. Being precipitated into a 
 stream of water by the upsetting of a stage (my head through the win- 
 dow of the carriage), and perfectly conscious when first beneath the 
 watei", the reflections which occujiied my mind could not have contin- 
 ued one minute. There remains the most distinct recollection of that 
 brief period. The subsequent details, till consciousness was restored 
 may not be without an interest. My momentary efforts at extrica- 
 tion were defeated by the weight of the passengers, and I continued 
 to occupy the foregoing position till nine of them, and mostly females, 
 could be lifted through the uppermost door, and while the carriage, 
 heavily laden with baggage, could be rolled over. This process con- 
 sumed at least some seven or eight minutes, and three or four more 
 had elapsed after my extiication before signs of reanimation began to 
 take place.* A large assemblage of farmers from the neighboring 
 fields were standing around, when the first moment of consciousness 
 was announced by a noise as of distant speakers, and a simultaneous 
 view of the spectators. Vision was at once perfect; but the sounds 
 advanced pi-ogressively nearer and nearer, and within a quarter of a 
 minute had identified themselves with their proper sources ; when, 
 also, consciousness was completely re-established. It may be also worth 
 saying, that only a very slight uneasiness attended the suffocation. 
 
 * I have lieen since informed that the interval was more thaatwentj' minutes. No- 
 thing was done toward reanimation.
 
 PHYSIOLOGY. DEATH. 403 
 
 635. Nothing extinguishes life more immediately than a destruction 
 of all the functions of the brain, whether by a direct injury of the or- 
 gan, or by an abolition of tlie circulation. The effect is nearly as great 
 when interrupting the respiratory process by dividing the medulla 
 oblongata. But in this case the influences are different from such as 
 obtain in diseases of the brain, or in injuries done to that organ. If 
 sufficient to embarrass or to suspend respiration, the nervous power is 
 determined with a pernicious effect upon all the organic viscera ; but 
 very variously, according to the nature of the injury or of the disease 
 (§ 478-482, 510, 634, 948). A simple removal of the brain and spi- 
 nal cord occasions death not only by suspending respiration, but by 
 interrupting their influence upon the great organs of life ; which must 
 be also true within greater limits of the division below the medulla 
 oblongata. In the former case, as we have seen, no pernicious influ- 
 ence of the nervous power is determined upon the organic viscera ; 
 in the latter, a direct violence being inflicted upon the spinal cord, a 
 destructive effect is propagated upon the organic properties, which 
 reaches to the brain itself (§ 129, 455, 456, 476* h, 478, 479, 489, 
 507, 1032 d, 1037). 
 
 636. Death from disease generally depends upon complicated 
 causes, and upon profound aftections of more organs than one. In a 
 general sense, also, the particular mode of death will depend upon 
 the organs diseased, upon the violence and kind of affection, and upon 
 the particular condition of other parts. 
 
 637. It is rare that absolute death takes place at once in all parts. 
 Evidences of this are seen in the peristaltic movements, in the con- 
 traction of the voluntary muscles, in the discharge of the arterial blood 
 into the venous system, in the occasional exaltation of heat, &c., after 
 apparent death (§ 447, d). We have seen, also, how remarkably the 
 heart may be roused into action long after its pulsations have ceased 
 (§ 262, 498 e, 516 d, no. 7), continuing, in some animals, to pulsate 
 with a " rustling noise for ten hours after being hung up to dry" 
 {M.ed. and Physiolog. Comm., vol. i., p. 17). In other instances, the 
 heart has been " often seen to raise a weight of twenty pounds," soon 
 after apparent death ; and Lord Bacon states that he has seen the 
 heart of a criminal, when the organ was thrown into a fire, leap up 
 one foot and a half, and to continue these movements, with a 
 gradual decrease, for the space of seven or eight minutes (§ 188, 233, 
 264, 265, 475|^, 498 e, 647-2). In my work on the Cholera Asphyxia 
 of New York, 1832, I have spoken of contractions of the voluntary 
 muscles which continued in progress, drawing up the legs, &c., for an 
 hour and a half after apparent death (p. 141). These contractions took 
 place without the application of any exciting cause, apparently like the 
 movements of the extirpated heart and intestine (§ 262, 476^ c, 490, 
 498 e) ; but the latter are due to the stimulus of the air or other phys- 
 ical causes. There remains, therefore, no other conceivable exciting 
 cause of the contractions than the stimulus of the nervous power arising 
 from influences incident to the radical change in the organic constitu- 
 tion, analogous to that development which is attendant on syncope, 
 and which in this case, besides its powerful demonstration upon or- 
 ganic actions, often induces spasm of the voluntary muscles (§ 948). 
 The analogies in this respect, and such as are represented in section 
 500, are strongly in favor of reflex nervous action, while the corres-
 
 404 INSTITUTES OF MEDICINE. 
 
 25onding action of the extirpated heart and intestine may seem to be. 
 opposed to it. The analysis, also, of sympathy which I have made in 
 preceding sections (500, &c.) shows a special difference in the mo- 
 tive constitution of the organic viscera and of the voluntary muscles, 
 and in the relative agency of the nervous power as it respects their 
 motions. In the former case this power is particularly a modifying 
 agent in organic actions ; in the latter it is simply an exciting cause 
 (§ 188, 205, 215, 222, &c., 258, 500, 524 d, no. 7, 891^ g, k, 893^). 
 
 If the foreoroinor construction be true, then the muscular contrac- 
 tions which follow, after apparent death, from blows upon the limbs, 
 are equally due to the development and action of the nervous power 
 (§ 516 d, nos. 8, 9) ; and the whole conclusion is farther strengthened 
 by the involuntary movements of decapitated animals, and by the mus- 
 cular contractions which are effected by the stimulus of galvanism, 
 both in life and apparent death, and especially when consequent on 
 pricking the skin after removal of the head. The latter case, indeed, 
 is exactly analogous to motions produced in the limbs of the human 
 subject by mechanical violence ; since in the case of the decapitated 
 animal there is no direct irritation of the muscles, and, therefore, no 
 joossible mode of propagating the impression upon the skin to the 
 muscles, excepting by reflex nervous action. All this, too, shows 
 us that, whatever differences may exist between the vital constitution 
 of man and animals, and among animals, they are essentially consti- 
 tuted alike, subject to the same fundamental laws, and having only 
 modifications ingrafted upon them. — Note A p. 1111. 
 
 It may be thought that all this is a useless refinement in philoso- 
 phy. But such is not my opinion ; nor have I any doubt that better 
 minds will carry out these suggestions to more important develop- 
 ments in the philosophy of life. Even in death itself much may be 
 gained that will be useful in physiology ; and if we follow the organic 
 being till he is resolved into elementary substances, we shall gather 
 something at every stage of the process that will contribute light to 
 organic science, and yield an interest to the study of putrefaction (§ 
 />4 a, 56, 62 e).
 
 PHYSIOLOGY. ITS UNITY OF DESIGN. 
 
 SUMMARY CONCLUSION OF PHYSIOLOGY. 
 
 638. From what has been hitherto said, it appears that medicine, 
 in all its branches, is a perfect whole, bound together by intimate re- 
 lations and dependences, nowhere contradictory, but all in unison, 
 and irresistibly flowing from one great system of Unity of D-esign, 
 which is the grand characteristic. The foundation is laid in the Prin- 
 ciple of Life, and its various attributes. The demonstrations of that 
 principle, and of those attributes, begin with the elements of organic 
 beings, their number, the modes in which they are united, &c. ; and 
 the sameness of the principle throughout, and the coincidences in its 
 laws, are attested by every fact in physiology and medical philosophy. 
 
 By recurring to the demonstrations already set forth, it will be seen 
 that my fundamental ground is clearly established ; for, whether it be 
 the elements of organic beings which are combined in peculiar num- 
 bers, proportions, and modes, and forever in one peculiar and exact 
 manner in every distinct part of every organic being, and which are 
 maintained in combination against the adversities of disease, and 
 against those chemical agencies which may produce their almost in- 
 stant dissolution when the vital chain is severed ; and whether we con- 
 sider, also, the remarkable nature of those elements, and that in the 
 animal kingdom, especially, nitrogen gas abounds in the various tis- 
 sues, notwithstanding the entire kingdom is far more liable, than the 
 vegetable, to chemical decomposition after death ; or, whether we 
 pause at the threshold of life, and consider all the unvarying facts at- 
 tendant on the development of the ovum, how one part after another 
 spi'ings into existence in a never-deviating, foreordained manner, and 
 as each part may be necessary to the next succeeding, how the same 
 exact process of formation, and no other, is continued till the being 
 becomes again a subject for the mineral kingdom ; how the semen, 
 also, is a type of all the various subsequent agents of life ; how we 
 may here detect the nascent causes of transmitted disease, operating 
 in conformity with those which play their part in the external world ; 
 how mind itself is impressed upon the embryo, and how the intellect- 
 ual peculiarities of either parent maybe ingi'afted upon the offspring, 
 as are their physical traits, their temperament, their constitution, their 
 very manners, — where, I say, all is uniformity in the grand movement 
 of organization, and nothing but coincidences in the fluctuations that 
 may arise from preternatural causes, and always the same according 
 to the precise nature of those causes ; or, if we follow the immature 
 being to its state of maturity, and observe that the progress of devel- 
 opment is always the same, under equal circumstances, at every stage 
 of its progress, whether in the animal or the plant, and notice, also, 
 the coincidences which obtain between the two organic kingdoms, as 
 in the changes of tissues, in the variations of products, up to the con- 
 summation of the whole in that pei-fect state which is characterized 
 by the development of the generative organs, the flower, the ovum, 
 the seed, and the mutual office of sexual intercourse ; or, whether it 
 be a corresponding exact organization and vital endowment of every 
 part of every organic being, yet different in every organ, and often so 
 in different parts of one and the same continuous tissue as it traverses
 
 406 INSTITUTES OF MEDICINE. 
 
 different parts of the compound organism ; or, whether we regard 
 the products of each organ, or of each tissue, or of the several parts 
 of a continuous tissue, respectively, and observe that they are forever 
 the same in the same animal or plant, under equal circumstances, yet 
 different in every part, and more or less different from each other in 
 every species, whatever the similitude, or consider that the same 
 products are forever modified in health and in disease in one exact 
 manner, under any given modifying influences, whether natural, mor- 
 bific, or remedial ; or, whether we interrogate the nature of the rela- 
 tions by which external or internal causes divert the phenomena from 
 their natural states, and observe that the results depend upon the ex- 
 act original and acquired nature of the part and the nature of the in- 
 fluences, and that they are in perfect harmony with such as emanate 
 from the natural stimuli of life ; or, whether we consider how the 
 manifestations of disease denote, like those which emanate from the 
 natural stimuli of life, an established difference in the closely-allied 
 constitution of the same or diflerent tissues, and different parts of a 
 continuous tissue, as in the inflammatory affections of various parts of 
 the mucous, or the serous tissues, and the more remarkable peculiari- 
 ties attending the inflammations of the lining membrane of the veins, 
 — prostrating the circulation and giving to fever its malignancy ; or, 
 whether it be a small current of air impinging upon the neck, which 
 will suddenly induce an attack of catarrh, or of pneumonia, or of 
 rheumatism, when no such effect may follow an equal exposure of any 
 other part of the surface, or even of the entire skin for an equal time ; 
 or whether, in a remedial aspect, leeches, or a warm bath applied to 
 the feet, may restore menstruation when the same applications to oth- 
 er parts might be insufficient, or other analogous phenomena which 
 abound in the history of morbific and remedial agents ; or, if we con- 
 sider the philosophy which concerns the first act of inspiration as gen- 
 erated by the contact of air with the surface of the body, and that it is 
 exactly the same as that which is relative to the first inspiration in syn- 
 cope when cold water or cold air are applied to the face, or stimulants 
 to the Schneiderian membrane, and even the same when the mucous 
 tissue of the lungs becomes the point of departure, — the same, too, 
 which concerns all those modifications of respiration which are known 
 as coughing, laughing, crying, sneezing, hiccough, — the same as ob- 
 tains when light, impinging upon the retina, produces either a con- 
 traction of the iris or a paroxysm of sneezing, — the same as when a 
 leaf of tobacco applied to the sole of the foot may disturb every func- 
 tion of the body, — the same when cathartics, or emetics, or altera- 
 tives, &c., may send their influences abroad through the medium of 
 the gastro-intestinal mucous membrane, — the same when shame mounts 
 to the face, or fear expels the blood from the surface, or covers it with 
 moisture, or stimulates both kidneys and bladder, or as anger con- 
 vulses the heart and braces up the animal muscles, — the same, in prin- 
 ciple, whether one or the other be applied in a physiological, patho- 
 logical, or therapeutical sense ; or, whether we regard the organism 
 as a whole, and consider how all parts concur in harmony together ; 
 how numerous parts are supplied by natural stimuli, consisting of 
 blood or of products from it, which conspire together in maintaining the 
 good of the whole, but either of which would be offensive to other 
 parts, and disturb the hai'mony of the whole ; or how the nervous
 
 PHYSIOLOGY. ITS UNITY >DF DESIGN. 407 
 
 power sheds its regulating influence upon all parts of the animal 
 mechanism, and how, through that same power, from its natural sus- 
 ceptibility to the existing healthy state of every organ, both external 
 and internal causes may lay the foundation of disease, or effect its re- 
 moval, or occasion the most violent commotions, or extinguish life in 
 a moment ; or, whether we consider that the same relative facts pre- 
 vail in respect to the vital signs that distinguish the physical products, 
 and that they go hand in hand together, under the same established 
 or contingent influences, natural, morbific, or remedial ; oi", whether 
 we scrutinize the coincidences between the facts that are relative to 
 the changes that happen at the different eras of life, and to gestation, 
 lactation, &c., and such as are brought about by morbific and reme- 
 dial agents, and consider that the latter are a necessary consequence 
 of the natural mutability of the fundamental constitution from which 
 the former emanate ; and that those which are natural are an exact 
 type of the influences and their mode of production when morbific or 
 remedial agents operate upon distant parts by impressions exerted 
 upon the stomach or skin, or when disease of one organ gives rise to 
 disease in another ; or, whether we regard the con-esponding facts which 
 are relative to vital habit, or those which result from the influences 
 of climate, &c., and which bestow the radical modifications that form 
 the peculiarities of temperament, &c., and see, also, that all these varia- 
 tions are produced by causes that operate through the same fundamen- 
 tal constitution ; or, whether our hygienic and therapeutical treatment 
 may be greatly regulated by each of the foregoing conditions, wheth- 
 er natural or acquired ; or, whether it be the peculiarities of idiosyn- 
 crasy that render certain ordinary articles of food morbific to certain 
 individuals, or the analogous constitution of marine and terrestrial 
 plants which demands for the former the briny waters of the ocean, 
 while they are fatal to the latter ; or, whether, in like way, the mere 
 approach within ten feet of the poison rhus will produce a violent 
 erysipelatous imflammation over the whole surface of one person, 
 when even the handling the plant will never affect another; or, 
 whether the rolling of a few blue pills with the fingers will establish 
 salivation, and affect the adult constitution of some, while a pound of 
 calomel taken by the stomach will not affect others in a similar man- 
 ner, and rarely at the early stages of life ; or, whether it be blood- 
 letting, or the mercurial or the antimonial alteratives, that are often 
 baffled by the precise modifications of the specific forms of active in- 
 flammation, while they readily subdue the common form and many 
 specific chronic inflammations, and whose differences in results de- 
 note the modifying influences of the remote causes of closely analo- 
 gous affections ; or, whether mercurial agents be strictly morbific in 
 their action upon the salivary glands, while they are simultaneously 
 and powerfully curative of hepatic and other diseases ; or, whether a 
 mercurial cathartic will induce salivation if the susceptibility of the 
 system be increased by the associate use of other cathartics or by loss 
 of blood, when, per se, no such effect may be produced; or, whether 
 the same effect follow the mitigation of fever, when no extent of the 
 remedy may reach the constitution in high grades of febrile action ; 
 or, whether the bite of the mad dog will produce hydrophobia in 
 all mammalia, while the disease cannot be imparted by any other 
 than the caniae and feline tribes ; or, whether the poison of the rat-
 
 408 INSTITUTES OF MEDICINE. 
 
 tle-snake, or of the wourari tree, or numerous other poisons which 
 are certainly and rapidly fatal when inserted beneath the skin, be 
 perfectly innoxious when taken into the stomach or applied to the 
 surface of the brain ; or, whether it be the virus of the small-pox, of 
 measles, &c., that effects certain modifications of the vital states rel- 
 ative to each particular agent, and to no other, that forever protect 
 the system, in a general sense, against a second attack ; or, whether 
 it be the cow alone, as with other animals in respect to the virus of 
 hydrophobia, that can so modify the variolous poison as to generate 
 in man the equally protective vaccine disease ; or, whether the sus- 
 ceptibility sometimes remain so as to give rise to another modifica- 
 tion, while the varioloid, in its mildest state, but not the vaccine, will 
 generate, by contagion, in the unprotected, the most virulent form of 
 the original disease ; or, whether it be the analogous miasmata that 
 only slowly extinguish the susceptibility to their morbific effects after 
 repeated attacks of the particular forms of fever which they are, re- 
 spectively, capable of producing, or, if the subject thus acclimated re- 
 move to another region, his original susceptibility may return, — being 
 analogous, also, to those physical agencies which establish the temper- 
 aments, and which change from one to another as the old influences 
 may cease, and new ones operate, while analogies, in these respects, 
 are also supplied by the variolous' and vaccine diseases ; or, whether 
 it be bloodletting, or an emetic, or a cathartic, that produce their al- 
 terative effects with a rapidity proportioned to the rapidity in which 
 their sensible operation goes on ; or, whether it be the alterative in 
 small doses, and in its abstract sense, that slowly establishes analogous 
 changes in the morbid states ; or, whether an alterative, as antimony, 
 for example, must be generally increased in its successive doses to 
 keep up the effect of the first dose, or, if there be, in respect to an- 
 timony, a suspension of the remedy for at least twelve hours, wt 
 must then go back to the original smaller quantity to avoid an exces 
 sive effect ; or, whether, on the other hand, other alteratives, like 
 mercury, or foxglove, or cantharides, or arsenic, or quinine, or ipecac- 
 uanha, will manifest no sign of their influence for several succes- 
 sive doses, but will, at last, without any increase of the dose, sud- 
 denly display the full effect of their virtues ; or, whether by associa- 
 ting ipecacuanha with the sulphate of zinc, the latter will so exalt the 
 susceptibility of the stomach that the two agents, otherwise une- 
 qual in time, will simultaneously co-operate in their emetic effects 
 or whether, in the same way, a diffusible stimulant, associated with 
 a permanent tonic, will quicken greatly the action of the latter ; 
 or whether, in like manner, and like the virus of small-pox, of mea- 
 sles, &c., or like the miasmata, it be opium, or hyoscyamus, or 
 digitalis, or mercury, &c., that reduce or increase the suscepti- 
 bility of the stomach and of the general system in relation to 
 the virtues of each agent, respectively, but to those of no other ; 
 or, whether we consider other examples of vital habit, and observe 
 how pungent stimuli cease to annoy the nose, the mouth, the stomach, 
 &c., but only so Iti relation to each of the agents, respectively, or how 
 tobacco, which is morbific in most diseases, and originally offensive 
 to all, finally becomes the most universal luxury of man ; or whether 
 we consider the manner in which the alteratives, in there small and 
 oft-repeated doses, maintain their influence, and extend their silent
 
 PHYSIOLOGY. ITS UNITY OF DESIGN. 409 
 
 invasions upon disease, or how emetics, or cathartics, continue to 
 propagate their curative effects after their complete expulsion from 
 the body, and see that the principle is disclosed by the natural phe- 
 nomenon of the permanent contraction of the sphincter muscles, which, 
 although the urine or the contents of the rectum be evacuated, are 
 maintained in equal contraction by the irritation which remains upon 
 the mucous tissue, and through which the nervous power is uninter- 
 ruptedly reflected upon the sphincter muscles ; or whether we re- 
 gard the coincidence between respiration, spasmodic affections, and 
 the voluntary movements of the respiratory, or of other muscles, and 
 observe that each is alike due to the jiropagation of the nervous pow- 
 er upon those muscles ; or whether we contemplate the same vital 
 agent in its production or removal of disease, and in its absolute mode 
 of operation, and see that the changes which are thus effected consist 
 in some alteration of the natural or morbid states, and according to 
 the nature of the remote cause, whether it be positive, like mercury, 
 or negative, like cold, or immaterial, like the mind and its passions, 
 and according, also, to the special exercise of one mental power or 
 another, or the operation of one passion or another, and thus proving 
 the susceptibility of the nervous power to various modifications that 
 coincide with the virtues of the remote cause, and a coincidence, in 
 this respect, with the changes which are perpetually exhibited in the 
 organic vital conditions, and which are even brought about by the ner- 
 vous power itself; or, whether we realize the foundation of these last 
 phenomena in the naturally exquisite susceptibility of the nervous 
 power to various influences, that it may constantly operate as a regu- 
 lator of the rhythmic movements of all parts, and through a law of the 
 nervous system by which all parts are exquisitely sensitive to the con- 
 dition of each other, and through which all remote morbific and re- 
 medial influences are exerted ; or whether, in like way, inflammations 
 are varied in their character by contused, and punctured, and incised 
 wounds, or more greatly so by all animal and vegetable poisons, 
 whether morbid or natural, and mostly so according to the special na- 
 ture of the remote causes, respectively, or, if subordinate influences 
 diversify the effects of many principal causes, there be others which 
 control all other influences, as in small-pox, measles, scarlatina, &c. ; 
 or whether in fever, as in inflammation, there be analogous varieties, 
 corresponding, in like manner, with the special virtues of each cause, 
 while the fundamental pathology is of one common nature in all the 
 varieties of inflammation, and of another common nature in all fevers ; 
 or whether an ephemera be the type of the intermittent, the remittent, 
 and continued fevers, and of their several modifications, and consider 
 how the paroxysms of the intermittent commonly observe established 
 intervals of twenty-four, forty-eight, and seventy-two hours, or, if the 
 usual time be anticipated or delayed, the paroxysms are then apt to 
 go on with the particular irregularity with which they began, or when, 
 by regular anticipations of the period of each last preceding paroxysm 
 they approach the night, one paroxysm is often lost ; or whether we 
 look at the effects of all our best and most universally remedial agents, 
 as bloodletting, mercury, antimonials, cathartics, &c., and see that they 
 are strictly morbific to the healthy system, in their remedial doses, 
 and that, therefore, they are at least equally so in their action upon 
 diseased organs, yet contributing to their cure ; and while, also, we
 
 410 INSTITUTES OF MEDICINE. 
 
 know that neither such nor other agents can, of themselves, transmute 
 the morbid organic changes to those conditions which are natural to 
 the being, we yet discern the reasons of their favorable effects in the 
 spontaneous and successful efforts of unaided nature, and in those 
 epeedy recoveries from morbid states that are induced in the healthy 
 system by remedial agents, in their remedial doses, and thus infer 
 that remedies only contribute to the cure of all diseases by instituting 
 morbid changes that are more conducive to the naturally recuperative 
 process ; or, whether the cure of intermittents be effected by bark, or 
 arsenic, or cobweb, or opium, or an emetic, or bloodletting, or absti- 
 nence, or by an emotion of the mind, &c. ; or whether it be stimulants 
 or sedatives, bark or bloodletting, conjointly or separately, that may 
 subdue many inflammations, acute or chronic, and thus, also, prove 
 the near identity of the pathological state in all the varieties, and that 
 nature recognizes no such opposite conditions as active and ^as^iVe in- 
 flammation ; or whether it be the abi"upt removal of pertussis by an 
 hour's exposure to the open air where all other means had failed, or 
 the improvement of an ulcerated limb by the same temporary influ- 
 ence ; or whether ice, or ipecacuanha, or common salt, or opium, or 
 bloodletting, or the sulphates of zinc, and of copper, or catechu, or 
 kino, &c., will alike aiTest capillary hemorrhage or redundant secre- 
 tions, by modifying the action of the capillary vessels ; or whether loss 
 of blood, and tartarized antimony, or a dash of cold water upon the 
 surface of the body, or even a warm bath, be far better " refrigerants" 
 than pounds of ice, or of lemonade, taken into the stomach ; or wheth- 
 er, among the " sudorijlcs,^^ the drinking of hot water, of mint-teas, 
 &c., will excite a more immediate and more profuse perspiration than 
 tartarized antimony, or ipecacuanha, &c., and the fonner exert no 
 other apparent effect, while the latter may be profoundly curative or 
 morbific, or bloodletting surpass the whole in all these respects ; or 
 whether it be the " sialogogue," like horse-radish, which only exerts 
 an effect on the salivary glands through a continuous irritation along 
 the salivary ducts, or mercury, which induces salivation only by consti- 
 tutional influences ; or, whether we turn our attention to other corre- 
 sponding laws, and to other analogous coincidences, and consider, for 
 example, how all but chyme is prevented from passing the pyloric ori- 
 fice, how all but the air is excluded from the lungs, how all but chyle 
 from the lacteals, how all but white blood from the serous vessels of the 
 arterial system, notwithstanding the far greater diameters of some than 
 those of the red globules, and yet that when the irritability of one is mor- 
 bidly affected, as in indigestion, solid food will pass out of the stomach ; 
 or of another, as when certain morbid impressions are made upon the 
 lacteals, the deleterious agents may obtain a sparing admission; or of 
 another, as in inflammation, the red globules are allowed to pass freely 
 in ; or, if we glance at those more astonishing phenomena which at- 
 tend the generation of animal heat, and observe that all non-hiberna- 
 ting mammalia maintain one uniform temperature, under all circum- 
 stances of food, clothing, &c., whether at the poles or at the equator, 
 yet each species, respectively, possessing a temperature of its own, 
 and that the very giant of the mammiferous trilse, in the midst of 
 everlasting icebergs, obeys this law of uniform and exalted heat, — 
 exalted not less than four degrees above that of man ; or turn our 
 admiring contemplation to the few exceptions that occur in the hi-
 
 PHYSIOLOGY. ITS UNITY OP DESIGN, - 41] 
 
 Dernating group, and see how that temperature, which is equally uni- 
 form under all torrid and temperate degrees of the circumambient 
 air, sinks down as the thermometer descends from 40° F. till the ani- 
 mal scale reaches nearly the freezing point, and then rises, with a 
 bound, to its original exalted standard, while the mercury goes on to 
 the point of zero ; or, if we drop from this gradation in analogy, to 
 the cold-blooded race, and observe how they obey the physical law 
 of an interchange of caloric with the surrounding medium, yet within 
 the limitation of a specific and independent power of maintaining a 
 counteracting influence that preserves them at a few degrees of heat 
 above the lowest of the external medium which may be endured, — 
 eating, digesting, and perfoi-ming, too, the same organic functions as 
 the mammalia ; or, if we consider, also, the same peculiarities in the 
 living egg, and their absence where its incubating property is extinct; 
 or, if we turn ourselves to the vicissitudes of temperature which at- 
 tend the phenomena of disease, and remark how they correspond 
 with all the admitted vital changes, — risinor, in one case, to a desrree 
 of mtensity where there is almost a total privation of food, and an ex- 
 tensive destruction of the lungs, or sinking, in another, to an almost 
 icy coldness, where the subject is plethoric and the stomach is crowd- 
 ed with food and alcoholic stimulants ; or whether, also, we regard 
 the same principle in its natural state, as seen in the process attend- 
 ing the reproduction of the stag's horn, or in that of lactation, and 
 consider that here is the fundamental element implanted in the con- 
 stitution for great and wise purposes, and that every other consideration 
 points us directly to the natural constitution itself for an interpretation 
 of every phenomenon in the history of animal temperature, and dedu- 
 ces a coincidence between these phenomena and those of the organic 
 processes, under every aspect of stability, individuality, and of change; 
 or whether it be a thousand other diff*erent, but analogous considera- 
 tions, relative to the influences of foreign, natural, morbific, or reme- 
 dial agents upon man or other organic beings ; or whether we again 
 look to the mind and its passions, and see the long exercise of judg- 
 ment impairing digestion, while imagination comes in as a speedy re- 
 storative ; or whether it be anger or joy, like a blow on the stomach, 
 or like the shock of a surgical operation, that strike us dead in a mo- 
 ment, or grief that does but slowly undermine, or hope that throws 
 its balmy influence over every disease, by whatever cause produced ; — 
 whether, I say, it be one or the other of the considerations now men- 
 tioned, or thousands of thousands of similar import, which crowd the 
 history of living objects, each and all are in harmony with each other, 
 and concur together in one universal demonstration of the peculiar con- 
 stitution of animated beings as distinguished from the inorganic king- 
 dom, and declare their essential dependence upon one principle, name- 
 ly, a Vital Principle, of various elements or properties, whose definite 
 character in their natural conditions, and whose instability or liability 
 to permanent and temporary modifications and changes, and whose 
 disposition to return from such as are only temporary to their original 
 state, lie at the foundation of all the phenomena, will explain every 
 phenomenon, and whose unity as a whole is supported by every phe- 
 nomenon of organic beings. This consideration, therefore,^ assures us 
 that we have already compassed the general philosophy of life, of dis- 
 ease, and of medicine ; and we contemplate with admiration the a^m-
 
 412 INSTITUTES OF MEDICINE. 
 
 plicity, yet complexity, of the principles, the stupendous whole, as it 
 swells from the comparatively simple phenomena of the development of 
 the ovum, when the properties of Hfe are exposed to no influences that 
 shall affect their instable nature, till we have traversed the animal king- 
 dom in all its exposures to those influences, and have witnessed the in- 
 calculable variety of change which the organic properties and functions 
 sustain in consequence of those exposures, and observe that the whole 
 immense system, all the variety, springs from the simple influences of 
 external and internal causes upon the properties of life, and that slight 
 changes in these properties, like the differences which prevail among 
 the results of their natural modifications in different animals, and in dif- 
 ferent parts of a common or a continuous tissue, give rise to all the dif- 
 ferences between health, disease, and convalescence ; — in the contem- 
 plation of all these things, I say, we are employed in witnessing the most 
 comprehensive and sublime system of Unity of Design, and enjoy the 
 conviction that we are cultivating a science whose foundations are laid 
 in the most Consummate Wisdom (§ 1085). — Note Re p. 1145. 
 
 REVIEW OF THE LAWS OF REFLEX ACTION OF THE NERVOUS SYSTEM, AND 
 AS APPLIED PATHOLOGICALLY AND THERAPEUTICALLY. 
 
 638|. A large space has been given to the consideration of the nerv- 
 ous system, especially to experimental observations upon it, for the 
 purpose of developing the Laivs of Reflex Nervous Action^ or, as I have 
 called them, also, for obvious advantages, Remote and Contiguous Sym- 
 pathj^ or, indifferently, Sympathy. All this inquiry has been made 
 Avith a sole reference to the application of those laws to many important 
 problems in Physiology, particularly nutrition, secretion, modifications 
 of structural development, calorification, and circulation, and to erect- 
 ing upon them a substantial and philosophical fabric of Pathology and 
 Therapeutics, which still lies extensively before us, and for the purpose, 
 also, of simultaneously accomplishing the overthrow of the chemical and 
 physical doctrines now prevailing in all the departments of medicine. 
 Although I am about to enter upon the specific application of the Laws 
 of Reflex Action of the Nervous System to Pathology and Therapeutics, I 
 have, nevertheless, been constantly employed in exemplifying the mor- 
 bific and therapeutical aspects of those laws as founded upon their nat- 
 ural conditions. An indispensable requisite for this application is a rea- 
 sonable proof of the modification of the nervous power according to the 
 nature of the cause, whether physical or moral, by which it is brought 
 into pi'eternatural operation, nor is there any other consistent or intelli- 
 gible mode of interpreting the great range of pathological and therapeu- 
 tical problems, and the multifarious displays of the passions in organic 
 life, according to their individual natui*e. The whole of the Author's phi- 
 losophy upon this vast subject is predicated of the well-established laws 
 of reflex action of the nervous system, nor is he aware of any fact by 
 which that philosophy is contradicted, Avhile, besides the admitted prem- 
 ises, it is sustained by the whole history of morbific and remedial agents, 
 and by the diseases which grow out of, and are maintained by, each other. 
 It may be finally added, that, although the Author has shown that the 
 passions, the will, cerebral diseases, and other causes acting directly upon 
 the nervous centres, develop and project the nervous power without the 
 intervention of sensitive nerves, he has also shown that the essential phi- 
 losophy is the same as that which respects reflex nervous action (^ 453).
 
 PATHOLOGY. 413 
 
 PATHOLOGY. 
 
 639, a. Having now laid a broad foundation for the superstructuie 
 of pathology and therapeutics, in the exposition of the properties, the 
 functions, and the laws of organic beings in their natural states, and 
 in contrasting the philosophy of the more difficult problems with those 
 interpretations which have been borrowed from the phenomena of 
 the inorganic world, that nothing may obstruct our way, and that 
 whatever is true in any of the conflicting views may shine with great- 
 er lustre, I am thus prepared to go on with those lofty objects about 
 which the healing a'.t is immediately interested. I say, to go on; for 
 in all my physiological inquiries I have endeavored to indicate their 
 relations to the ultimate branches of medicine, and to approach these 
 branches already prepared with a connected view of their depend- 
 ence upon natural institutions. The complexities in physiology give 
 rise to corresponding intricacies in pathology and therapeutics, and it 
 has been therefore necessary to explore the ground-work in such vuri- 
 ous methods, and with such variety of illustration, as shall impart to 
 pathology and therapeutics a consistency in principles, a ready inter- 
 pretation of their endless problems, and give to the hand of art en- 
 lightened confidence and firmness in the right. I have designed that 
 this right shall follow naturally and easily from the premises hitherto 
 laid down, and if I have come short of that, then have I failed in fun- 
 damental requisites. No system in physiology can stand which is not 
 true to Nature in her altered aspects ; none that does not come to her 
 interpretation under all the varied conditions and phenomena of dis- 
 ease ; none whose elements conflict with each other (§ 516 d, no. 6, 
 524 a, 524 d). There must be clearness, individuality, harmony, dem- 
 onstration. I claim not that I have accomplished all this. I do but 
 say that I have attempted it, and with an earnest hope that the effort 
 may not prove abortive. As much has been said, and much remains, 
 which is original with myself, and generally relative to the most pro- 
 found and important topics, and, as there has existed the necessity of 
 exhibiting in a satisfactory manner those conflicting errors which 
 have obtained such general ascendency, I have been impelled to all 
 the amplitude of inquiry which may obtain either the acquiescence of 
 the profession in the doctrines which I have taught, or their ready re- 
 jection (§ 1, 285, 1067). — See Rights of Authors, p. 912. 
 
 639, b. Pathology concerns the changes which the vital propei- 
 ties and functions undergo in disease, and the resulting changes in 
 the vital and physical signs, and finally reaches to those lesions of 
 organization that fall within the purview of morbid anatomy (§ 695, 
 &c.). 
 
 Pathology consists essentially, therefore, of those modified states of 
 the physiological conditions which constitute disease. 
 
 640. Such, also, are the relations between the natural physiological 
 conditions and those diversions which make up disease that the latter 
 often reflect the most important light upon the natural ones. The 
 properties of life, in all their aspects, as well as their corresponding
 
 414 INSTITUTES OF MEDICINE. 
 
 functions, are not unfrequently best comprehended through the phe- 
 nomena which distinguish their various departures from the normal 
 standard (§ 198, 303|). Chemists, therefore, cannot be physiologists. 
 
 641. Pathology is divided into general and special. The first con- 
 siders diseases in common ; the second treats of the particular history 
 of diseases. A distinction has been also made into medical and sur- 
 gical pathology ; but it is unfounded in nature, though it may be con- 
 venient in practice. 
 
 642, a. As all diseases have their remote causes, which often reflect 
 much light upon pathological conditions, these should be embraced in 
 the department of pathology. 
 
 642, b. The vital properties are so susceptible in their nature that 
 the good, as well as the evils of life, is constantly inflicting disease. 
 Whatever is salubrious in due proportions becomes morbific in excess. 
 The mildest nutriment in excessive quantities, or at unseasonable 
 times, — an unrestrained indulgence of the passions, — inordinate exer- 
 cise, &c., prove the instability of the vital powers. We are also sur- 
 rounded by agents of noxious virtues, some of which we may avoid, 
 but covet as luxuries, — while others, if we would avoid, are beyond 
 our control (§ 150, 152). 
 
 643. We are therefore led to consider pathology under three prin- 
 cipal heads ; namely, 
 
 I, Remote Causes of Disease. 
 II. Proximate or Pathological Causes. 
 III. Symptoms. 
 
 1. REMOTE CAUSES. 
 
 644. The remote causes of disease are the first in the series. By 
 their deleterious action on the properties of life they give rise to 
 those changes which constitute the proximate or pathological causes, 
 or the essential conditions of disease (^ 188-192). 
 
 645, a. Remote causes are subdivided into predisposing and exci- 
 ting or occasional causes. 
 
 645, b. The predisposing causes are the most important; being in- 
 dispensable to all idiopathic fevers, and to all specific forms of disease. 
 
 645, c. The exciting or occasional causes are such as develop an at- 
 tack of disease after the predisposing have laid the foundation. The 
 latter, therefore, may produce their full impression, and the subject 
 escape an attack, unless afterward exposed to the exciting causes. 
 The predisposing, however, often operate with such intensity as to 
 prove exciting, also ; as in small-pox, measles, hydrophobia, poisons, 
 injuries, malaria, &c. (§ 559). But the mildness, or intensity, of 
 many of these affections, as in the contagious diseases, may depend 
 upon the antecedent operation of other modifying causes ; whether 
 of' a predisposing or pi-otective nature (§ 630 e). 
 
 Again, the exciting cause often consists of something which, under 
 ordinary circumstances, may be perfectly inoffensive ; such as a full 
 meal, a few glasses of wine, privation of sleep, anxiety, grief In 
 such cases there has always been an antecedent predisposing cause 
 in operation ; but either of the foregoing may operate both as predis- 
 posing and exciting causes. 
 
 646, a. Remote causes are either internal or external. 
 
 646, b. The internal consist, for example, of the passions, laborious
 
 PATHOLOGY. REJIOTE CAUSES. 415 
 
 Study, retention of the faeces, hereditary predispositions, &c. (§ 75-80, 
 144, 561). 
 
 646, c. The external consist, 1st. Of such as are ordinarily sahitary, 
 but become morbific by their excessive or too frequent use, or when 
 used at undue seasons, or when the body is disqualified for their use. 
 8d. Such agents as injure mechanically the structure of our bodies. 
 3d. The great class of truly morbific agents, which embraces a large 
 variety in the several departments of nature, comprehending, even, a 
 large proportion of the materia medica, when exceeding the thera- 
 peutical doses, or when employed in these doses under circumstances 
 of health (§ 177, 191 b, 237-240, 524 d, 854 c-/, 893, 900, 901, 905). 
 
 647, Among the most important of the internal remote causes of 
 disease ai'e morbid conditions already formed. They may be either 
 exciting or predisposing, or operate as conjoint causes. In the former 
 case other causes have brought about the predisposition. Thoy are 
 the great fountain of sympathetic developments. 
 
 647^. The nervous influence, reflex or direct, is the immediate remote 
 cause (predisposing or exciting), of nearly all disordered states beyond 
 the seat of the direct action of other causes (§ 222-2334). 
 
 648, a. The predisposing causes are general and specific. 
 
 648, h. The general are such as may be in simultaneous operation 
 upon many individuals, and. are, then, mostly connected with the at- 
 mosphere, giving rise to influenza, and other catarrhal affections, &c. 
 Of these there are commonly several in combined operation ; though 
 there is generally one more important than the rest, especially in 
 acute forms of disease. 
 
 They consist, also, of all those causes which give rise to the various 
 forms of common inflammation, and all other conditions of disease 
 which do not fall under the next subdivision. 
 
 648, c. The specific causes form a far more numerous class than 
 the general. They consist of all the natural or healthy and morbid 
 poisons, animal and vegetable, and the principal agents of the materia 
 medica. Each of these will generally establish the predisposition by 
 itself alone, and is generally the exciting as well as the pi-edisposin<T 
 cause. Among these causes must be ranked all those which generate 
 idiopathic fever ; and these being of vegetable origin must float in 
 the atmosphere, and around the multitude. They are, tiierefore, the 
 main causes of epidemics, properly so called (§ 650, 663). Such 
 causes are generally aided in the development of disease by others 
 which are simply exciting (§ 654, a). 
 
 648, d. The predisposing causes of sporadic diseases are apt to be 
 more numerous than those of epidemics. 
 
 649, a. Remote external causes do not produce their effects indis- 
 criminately on all parts to which they are applied. Some are per- 
 fectly inert upon the skin, while others exert their principal effects 
 upon this organ. And so of other parts. The surfaces upon which 
 they operate are, 1st. The mucous tissue ; 2d. The skin ; 3d. The 
 surface of wounds and abraded parts ; 4th. By being forced into the ' 
 vessels when wounds are made by instruments charged with poisons. 
 It is in the last two ways alone that many of the most active poisons 
 produce their effects ; such as the hydrophobic virus, the poison of 
 serpents, the poison of dissection-wounds, &c. 
 
 649, h. Some parts of a continuous mucous tissue &i'e more suscep-
 
 416 INSTITUTES OF MEDICINE, 
 
 tible than other parts of the same tissue (§ ISSr-lSl). And so of the 
 skin. A curi-ent of cold air, for example, striking the neck more 
 readily produces catarrh than when impinging on any other part ; 
 while its direct action upon the healthy mucous tissue of the lungs is 
 never deleterious (§ 136). Mensti-uation is most readily suppressed 
 by cold applied to the feet, &c. 
 
 The foregoing facts depend upon a principle of vast importance in 
 evei-y branch of medicine. Thus, in relation to the pulmonary intes- 
 tinal mucous membrane, we learn from it, physiologically, that the 
 generation of gastric juice, and the elaboration of carbon from the 
 blood, are conducted by special vital processes, &c. (§ 135, 419), and 
 this, with various other relative facts, such as the variety in effects of 
 natural stimuli, goes to illustrate what is denoted by morbid phenom- 
 ena of the special susceptibilities of different parts of a continuous tis- 
 sue to the action of moi"bific causes, and how the same disease pre- 
 sents important varieties in the several parts ; and, carrying these im- 
 portant considerations to therapeutics, we readily come to a distinct 
 apprehension of the reason of the differences, local and constitutional, 
 which spring from the action of the same remedy upon one part or 
 another of that same tissue ; as, for example, why tartarized antimony 
 may relieve croup by its action upon the stomach, but may kill in the 
 same case by an equal effect upon the intestine. And now, casting a 
 glance at the universal body, we see the same law prevailing in other 
 tissues, and among all parts which differ in organization. These com- 
 bined circumstances open an immense field of philosophi-cal and prac- 
 tical inquiry, and should forever employ the physician in a critical 
 study of the therapeutical relations of the various articles of the ma- 
 teria medica to one part or another, in their local and sympathetic 
 effects, and according to the precise pathological conditions of all the 
 parts which are likely to feel the influence of the remedy, or as it may 
 affect the more natural conditions of other parts, and, therefore, their 
 favorable or unfavorable reflected sympathies (§ 129-152, 500, n?i, 
 514 7i, 6381). 
 
 649, c. There are probably but few ordinary morbific agents which 
 affect the skin in its sound state, though some may which are not sus- 
 pected. Cold is one of the most remarkable. There are but a few 
 of the active poisons of the materia medica that affect either this or- 
 gan sensibly, or other organs sympathetically through it. Mercury, 
 tartarized antimony, and cantharides, are among the strongest ex- 
 amples of the action of remedial agents upon the skin, and through 
 that organ upon remote parts. But, while blue pill, and the blue 
 mercurial ointment, which are demonstrably not absorbed, produce in- 
 flammation of the salivary glands, and affect the system at large, after 
 their application to the skin, they exert no more manifest effect upon 
 the skin itself than when a cold current of air gives rise to pneumonia 
 or rheumatism (§ 657 a). And since the foregoing preparations of mer- 
 cury are no more absorbed than the cold air, it is evident that their di- 
 rect action, like that of cold, must be exerted through the cuticle upon 
 the susceptible properties of the skin (§ 514 d, 826 c, 1059, 1088 5). 
 
 Cantharides and tartarized antimony, on the contrary, affect the skin 
 sensibly, and in a direct manner, and other parts, as in the foregoing 
 case, by sympathy. But, tartarized antimony applied to the skin will 
 not induce nausea, nor affect the constitution at large, whatever its
 
 PATHOLOGY. REMOTE CAUSES. 417 
 
 morbid susceptibilities, but only certain parts in the vicinity >f its ap- 
 plication, and then only when those parts are preternaturally suscep- 
 tible (§ 143). It then operates, like blisters, through contiguous sym- 
 pathy (§ 497, 1088 b). And so equally of croton oil (^ 893 a, 905). 
 
 When, however, almost any article of the materia medica is taken 
 into the stomach it produces an obvious impression upon that organ, 
 or upon the intestines. Reflex nervous influences are then transmitted 
 to other parts ; and it is upon this great law in relation to the intesti- 
 nal canal especially that the curative effects of remedies depend. A 
 strong analogy is also thus supplied in proof of the primary action of 
 many of the profoundly morbific agents upon the alimentary mucous 
 tissue ; since the positive remedial agents are as truly, though more 
 transiently, morbific (§ 901). It may be one part or another of that 
 tissue, — where it traverses the nose, or the mouth, or intestines, ac' 
 cording to the special virtues of the operating cause, and the natural or 
 acquii'ed modifications of the vital states in either part (§ 150, 649 b), 
 just as one mental emotion or another will, through t?tVec< nervous ac- 
 tion, strike at this part or at that of the foregoing tissue, or again 
 descend upon other parts of the organ as it may fluctuate in its vital 
 states ; or, at other times, may aim at other organs (§ 227, 500). The 
 mucous texture of the lungs is, also, doubtless, often the seat of mor- 
 bific influences from external agents ; though here we have no great 
 range of analogies. 
 
 649, d. The reason why the skin is so little susceptible of the influ- 
 ence of morbific and remedial agents consists partly in the protection 
 which is afforded by the cuticle ; not, however, because of its sup- 
 posed impeiTious nature which is inculcated by the mechanical phi- 
 losophy, but that the cuticle is a mere shield to the very susceptible 
 properties of the true skin. When, therefore, that guard is removed, 
 numerous agents operate with great and rapid effect, and send their 
 influences abroad with great power over the system. Hence, one of 
 the obvious final causes of the cuticle. — See p. 930, § 1088 b. 
 
 650. Every distinct morbific agent (and every remedy), however 
 allied to others, has its peculiar virtues, which produce, cceteris pari- 
 bus, a general corresponding modification of the vital properties and 
 functions (§ 52). If two or more be united, chemically or mechani- 
 cally, the compound is an agent of new virtues, and produces corre- 
 sponding effects (§ 188^, d). This is the reason for combining reme- 
 dial agents. Hence arise many varieties of inflammation, and of idio- 
 pathic fever ; the differences being greater where the morbific causes 
 differ most from each other, or, as two or more may operate (§ 766). 
 This is rendered distinctly obvious by the specific character of those 
 diseases which follow the application of morbid or healthy animal 
 poisons in each of the cases, respectively. Thus, the poisons of small- 
 pox, of measles, of scarlet fever, &c., always affect the vital condition 
 in nearly one uniform way. From these distinct and strongly-mark- 
 ed affections we might safely reason to all other morbific agents ; but, 
 independently of this analogy, which rarely fails in relation to any or- 
 ganic laws, we have the same proof, though less remarkable, in respect 
 to other affections. In the great family of idiopathic fevers, among 
 which there are close resemblances, there is no rational doubt that 
 each variety depends upon specifically diflerent predisposing causes. 
 It appears, also, to be well ascertained that these causes are of vege- 
 
 Dd
 
 418 INSTITUTES OF MEDICINE. 
 
 table origin, and that the differences in their nature depend upon differ- 
 ent combinations of their elementary principles, that take place dm-ing 
 the decomposition of vegetable matter. This difference in decompo- 
 sition, and the consequent generation of each peculiar poison, accord- 
 ing to the new and exact modes in which the elements recombine, is 
 owing to various chemical influences ; such as peculiar states of the 
 atmosphere as to heat, moisture, light, &c. ; and also upon the kind 
 of vegetable matter, its simplicity or variety, the nature of the soil, 
 whether wet or dry, whether impregnated with fresh or salt water, or 
 whether the vegetable matter be superficial or mixed with earth, &c. 
 Certain climates, cities, &c., will generate varieties of fever, and of 
 other diseases, which never happen in other places (^ 1068, h, note). 
 
 All the foregoing has its exact analogies in the natural agents of 
 life (§ 136). 
 
 651, a. The predisposing causes, nevertheless, give to disease no 
 small part of its special character, while in each tissue, or part of a 
 tissue, of any given organ, the exact pathology also depends on the 
 special vital constitution of that part (§ 132-152). 
 
 651, h. Age, sex, habits, &c., exert, also, certain influences upon 
 the results of the remote causes of disease ; and it is owing to analo- 
 gous changes in the vital states that the usual effects of any morbific 
 cause in ordinary constitutions may be variously modified in constitu- 
 tions which possess natural or acquired peculiarities, &c. The influ- 
 ences left by former diseases, and whatever may have diverted the 
 properties of life from their perfectly natural character, or have in- 
 creased their susceptibility, will be conducive to the deleterious ac- 
 tion of morbific causes, and of many of the ordinary stimuli of life, 
 and may variously modify the results in the several cases, respectively. 
 Hence there is scarcely a limit to the modifications of disease, while 
 they may agree in the general outlines (§ 153-156, 163, 535-630). 
 
 652, a. By no circumstances, however, is the pathology of disease 
 so greatly determined as by the predisposing causes ; and this impor- 
 tant result, therefore, will be more or less aff'ected by the simplicity 
 or the variety, and intensity, of the causes, as well as by their naturo 
 (§722). 
 
 oo2, h. But, there is not only one predisposing cause which is gen- 
 erally most important, and which mostly rules the pathology, but there 
 are many morbific agents which are capable of so controlling all 
 other influences as to determine certain uniform morbid conditions, 
 whose symptoms may be foretold ; particularly the healthy and mor- 
 bid animal poisons. The contribution, however, which is often made 
 by other causes as to the intensity and complications of exact diseases 
 is well manifested in epidemic scarlatina, epidemic measles, and epi- 
 demic dysentery (§ 630 e, 663, 827 e, 961-970, 1002-1005). 
 
 652, c. The precise vital influences of any remote cause, their de- 
 pendence upon the exact natui-e of that cause (all other things being 
 equal), is critically displayed by the effects of slightly varied mechan- 
 ical agents. Thus, " a mere prick or scratch is usually followed by 
 cutaneous erysipelas ; but not so with a deeper wound ; and a punc- 
 tured wound is less likely to induce it than a lacerated one" (§ 722, 
 725. Also, Med. and Phys. Comm., vol. i., p. 610 ; vol. ii., p. 474-480). 
 And so in the same critical sense of the acclimated subject when a 
 new epidemic influence may pi'evail. as set forth in section 551.
 
 PATHOLOGY. REMOTE CAUSES. 419 
 
 More striking distinctions, and according to the nature of the cause, 
 are shown by such agents as opium, cantharides, mercui'y, the virus 
 of snakes, of the mad dog, of small-pox, measles, scarlatina, &c. 
 
 The importance of enforcing this fact, in a practical sense at least, 
 is shown by a common disregard of the subject, as occurs in the fol- 
 lowing example. Thus, — Pereira, in his erudite work on the Mate- 
 ria Medica, very justly says, that, " \kiQ precise pathological condition 
 of the brain and spinal cord of an animal under the influence of hy- 
 drocyanic acid is matter of conjecture." But he adds, — " Whatever 
 it may be, it is probably identical with that which occurs during an 
 epileptic paroxysm, and with that induced by loss of blood." Now, 
 loss of blood will often remove an epileptic paroxysm, at once ; and 
 is the best remedy for the cerebral congestion induced by hydrocy- 
 anic acid, after the depressing effect of the acid is over. 
 
 652, d. The physiological inquirer will not fail to apply the fore- 
 going facts in opposition to the chemical and physical hypotheses of 
 life and disease. 
 
 653, a. Animal or vegetable poisons, if natural or healthy, are the 
 product of natural organic actions ; if morbid, they are generated by 
 diseased actions ; if altered from the foregoing conditions, they are 
 more or less the product of chemical decomposition. 
 
 653, h. Since, also, every specific disease requires its exact cause, 
 and as every cause of disease which is elaborated by the living or- 
 ganism requires a certain precise state of the organic properties and 
 functions for its production, (or if more or less of a chemical nature 
 it has lost its original peculiarities,) it follows that the disease which is 
 produced by a healthy animal or vegetable poison cannot be gener- 
 ated by a morbid one, and vice versa, nor can a chemical product be- 
 come the cause of a disease which is induced by poisons that are ex- 
 clusively the product of organic action, as in small-pox, measles, 
 yellow and typhus fevers, &c. And since small-pox is produced by 
 a morbid organic product, and can never, therefore, arise from an- 
 other cause, and can be alone propagated by contagion, so, also, as 
 the foregoing fevers depend, in certain known instances, upon the 
 products of vegetable decay, they can never be of a communicable 
 nature. Nevertheless, other causes may predispose the body to the 
 operation of the more specific predisposing agents, so that small-pox, 
 measles, &c., may be unusually epidemic and malignant (§ 630 e). 
 
 653, c. Healthy animal poisons, therefore, are never generated by 
 the diseased processes which they excite ; but the morbid ones are 
 reproduced by such processes, and by no other, and mostly by indi- 
 viduals of the same species, while the same law of individuality is 
 universal as to healthy animal poisons. 
 
 653, d. For the foregoing reasons no contagious disease can ever 
 be propagated by any other cause than such as is generated by that 
 precise modification of the vital states which constitutes the essence of 
 the disease. By the same inductive process all those affections which 
 have for their causes the products of laws which govern inorganic 
 matter can neither be I'egarded as contagious by the philosopher, nor 
 shown to be so by the man who doubts every thing but his senses. 
 The laws of life and the laws of chemistry are as wide as the poles 
 from each other. No organic action can form the chemical combina- 
 tions of dead matter, nor can the forces of chemistry imitate the mor-
 
 420 INSTITUTES OF MEDICINE. 
 
 bid any more than the healthy products of life (§ 43, 44, 52, 53, 150, 
 191 a, 409 c, d, 447^ c, 630 e, 758, 773, 777-780, 1057 e-g). 
 
 Since, therefore, miasmata produce yellow fever, plague, typhus, &c., 
 it clearly follows that the living system, when affected by those diseases, ' 
 cannot generate a poison capable of producing the same affection in oth^ 
 ers, since the poison depended originally upon vegetable decomposition 
 (§ 657 b, 741 b). " Veritas Met in puteo"* 
 
 But, independently of this incontrovertible law which is predicated 
 of numerous facts in physiology and pathology, and without one to in- 
 validate its force, the whole of this question as to the contagiousness 
 of fevers is settled negatively by a great variety of direct observations. 
 (See Objections to the supj^osed Contagiousness of Yelloio Fever, &c., in 
 Med. and PIujs. Comm., vol. i., p. 445-453, note, 532-534 ; vol. ii., p. 
 511.) — Also, § 1068 b, note. [Just now, 1860, suddenly abandoned.] 
 
 654, a. Specific predisposing causes, consisting of animal, and min- 
 eral, and most of the vegetable poisons, generally produce their sen- 
 sible effects with great rapidity. Even vegetable miasmata, in a state 
 of concentration, may determine an attack of idiopathic fever as soon 
 as their operation begins (§ 648). It is upon this rapidity of effect 
 that much of the utility of the materia medica depends (§ 554). I have 
 accumulated examples of this nature in the Medical and Physiological 
 Commentaries (vol. i., p. 471-474, &c.). But as no small number 
 believe, with Louis, that "it is not true, as has been said too often, 
 that facts do not become old, and the immense majority of them have 
 become so ; and, moreover, those which we collect in these times, 
 will, in like manner, in their turn, become old" (the " numerical 
 method" to the contrary notwithstanding, ibid., vol. ii., p. 810), I 
 shall, I say, in view of this skepticism in respect to "facts" (§ [>\,a,e), 
 present an instance fresh from Bombay (1846) relative to the malig- 
 nant cholera, and as yielding " food for the mind contemplative." 
 Thus, the writer : 
 
 "Who shall depict the scene in the hospitals] I speak more of the 
 Fusiliers, because of that I saw much ; every cot was filled — delirium 
 here, death there — the fearful shrieks of pain and anguish. Men 
 whom you had seen a short time before hale and strong, were rolling 
 in at every door, crowding every space — countenances so full of mis- 
 ery — eyes sunken and glaring, shriveled and blackened cheeks. This, 
 too, the work of five short minutes or less ! So sudden was death 
 with some, that they were seized, cramped, collapsed, dead, almost 
 as fast as I have written the words. Previous health and strength 
 were no guaranties ; men attending the burials of their comrades 
 were attacked, borne to the hospital, and buried themselves the next 
 morning. Pits were dug in the church-yard morning and evening; 
 sewed up in their beddings, coffinless, they were laid side by side, one 
 service read over all." 
 
 The foregoing paragraph, as well as the facts to which I have just 
 referred, in another work, may remind the reader of what has been 
 said of the action of hydrocyanic acid, nux vomica, &c., and lead him 
 to appreciate the analogies in the modes in which morbific and reme- 
 dial agents bring about their results, and strengthen his philosophy of 
 the properties and laws of organic beings (§ 494 dd, 827 d). 
 
 654, h. The foregoing, however, is not equally true of morbid ani- 
 mal poisons, which are alike specific. I may also say, as farther il- 
 
 * A remarkable plagiarism of the foregoing argument (§ G53 a-d) was exposed b}- 
 a correspondent in American Medical Gazette (N.Y.), December. 1859. " Veritas vincit."
 
 PATHOLOGY. REMOTE CAUSES. 421 
 
 lustrativc of great vital laws, that morbid animal poisons have, com- 
 monly, the remarkable attribute of producing their sensible efl'ects at 
 more determinate periods than any olher predisposing causes, with a 
 tjiw exceptions like the liydrophobic virus. It is also another striking 
 fact, that natural small-pox occurs iu about fourteen days after expo- 
 sure, but tliat the intermediate period is only eight days where the 
 same disease is communicated by inoculation. The disease, too, is 
 violent in the former, and comparatively mild iu the latter case ; thus 
 showing that slight variations in the condition of the predisposing 
 causes will not only vary the duration of the predisposition, but mod- 
 ify all the phenomena of the ensuing disease (§ 650, G51). This is 
 more particularly seen in the relative history of natural small-pox and 
 the cow-pox, which are, essentially, one disease. It is an example, 
 also, which illustrates the specific modifications of the properties of 
 life in diflerent animals; since we know of no other than the cow 
 (certainly not the human species) that can so alter the variolous poi- 
 son (§ 545. Also, Med. and Phys. Com??!., vol. ii., p. 184, 195-200). 
 
 654, c. Again, there may be an intei'val of weeks, months, and 
 yeai's, after the application and the removal of the predisposing cause, 
 before disease ensues. This is witnessed particularly in some re- 
 markable exceptions which occur among the specific causes ; as those 
 which generate intermittent fever, while the same causes may also 
 develop an attack with great rapidity (§ 654, a). " When a cause is 
 applied which produces fever," says the philosophical Fordyce, " it 
 produces it utio ictu, although the cause be no longer applied. Nei- 
 ther is it increased, diminislied, or altered, by the farther application 
 of its cause." 
 
 654, d, AVhere the sensible eftects follow rapidly the application of 
 the causes, the predisposing is generally adequate to the full produc- 
 tion of disease ; and it may be equally so where the interval is longer, 
 as in small-pox, hydrophobia, &c., though more commonly some ex- 
 citing causes are necessary, as probably in a large proportion of idio- 
 pathic fevers. Hence, an attack of these diseases may be often pre- 
 vented by a proper regimen, but not by medicine. — Note S p. 1124. 
 
 0)55. Specific causes commonly operate with greater certainty than 
 the general (§ 646) ; and this is owing, in part, to the circumstance, 
 that the former generally act both as predisposing and exciting causes. 
 But, even the effects of these may be moderated by a proper regimen. 
 Low diet, for instance, after exposure to small-pox, measles, scarlati- 
 na, &c., or after inoculation, or exposure to the causes of fever, will 
 lessen the severity of the disease. The principle is the same as when 
 a stimulant diet, &:c., contribute to their production (§ 663). 
 
 656. The ordinary exciting causes, which, in their usual force, com- 
 monly fail of producing disease where a morbid tendency has not been 
 induced by predisposing causes, may readily become predisposing, or 
 both together, by a greater intensity of action. 
 
 657, a. It commonly happens, especially in acute diseases, that, 
 when predisposing causes are not followed immediately by a devel- 
 opment of disease, the principal morbid states take place in organs 
 distant from that on which the morbific causes exert their direct ac- 
 tion. The main predisposition, therefore, is produced by reflected 
 nervous action ; and of course it is there that the principal explo- 
 sion of disease takes place. It is subsequent to this, that the surfaces
 
 422 INSTITUTES OF MEDICINE. 
 
 on which the agents exert their direct action become sensibly involved 
 in disease ; and then it is probably quite as much a result of sympa- 
 thetic reaction from the organs where the main explosion takes place 
 (§ 148, 514 li, 524 c, 743). This is especially true of the alimentaiy 
 and pulmonary mucous tissue, and of the skin, upon the former of 
 which malaria appear to exert their direct action. The principle is 
 seen distinctly in the pulmonic inflammation, rheumatism, &c., which 
 follow the action of cold upon the skin, and in the application of mer- 
 curial ointment, and other unirritating remedial agents, to the unde- 
 nuded surface (§ 649, c). And so of other remedies addressed to the 
 stomach. They commonly exert their most sensible effects upon the 
 remote parts now rendered particularly susceptible by the presence 
 of disease (§ 137, d). But examples of remedial influences more in 
 point occur in subsequent sections (§ 902 m, 905). In respect to mor- 
 bific causes, however, there may not exist any preternatural suscep- 
 tibility of the distant parts, but the agents establish their effects in con- 
 formity with laws already indicated (§ 150, &c.). The propagation 
 of their influences in the foregoing manner is replete with problems 
 of the deepest interest in medicine, and reason is often conducted to 
 the truth by a firm hold upon a long chain of analogies. In this way, 
 for example, we arrive at a knowledge that hydrophobia follows the 
 law of propagation by nervous influence. The hydrophobic virus es- 
 tablishes certain imperceptible morbid influences upon the bitten part, 
 which are by reflex action propagated over the system ; and here, as 
 in miasmatic fever, the predisposition is sufficiently formed in various 
 other parts as not to require, for the general explosion, a full devel- 
 opment of disease in the bitten part. There are commonly present, 
 however, in hydrophobia, symptoms which denote either inflammation 
 or morbid irritation of the injured part, just antecedently to the gen- 
 eral explosion, which is precipitated by it. Hence, also, the reason 
 why the removal of the bitten jDart, many days, or even weeks, after 
 the infliction of the wound, may prevent hydrophobia; which it would 
 be absurd to explain by the humoral philosophy of this disease (Med- 
 ical and Physiological Commcntai-ics, vol. i., p. 499-505). — Note D. 
 
 657, b. It will have been seen that a peculiarity attends idiopathic 
 feyer in its universal invasion of the body (§ 148, 757, &c.) ; and this 
 leads me to indicate a certain difference in the sympathetic proj^aga- 
 tion of the predisposing influences from what may obtain in the more 
 circumscribed forms of disease. In the operation of the predisposing 
 causes of fever, the reflected nervous influence from the direct 
 seat of morbific action gives rise to coincident pathological states 
 throughout the system, where there is no interference from inflamma- 
 tion or venous congestion ; while other morbific causes are apt to re- 
 sult in various modes of disease, as the effects of sympathetic influ- 
 ences radiated from their seat of action. In the former case, there- 
 fore, the general extension of reflex nervous actions is equivalent, 
 in principle, to a specific universal action of the original predisposing 
 cause (§ 228, 653, 516 d, no. 6, 6381). 
 
 658. If disease be limited to the part on which the morbific cause 
 makes its direct impression the changes may be then instituted by the 
 direct action of the cause upon the organic properties, and without any 
 necessary intervention of the nervous power. And so of remedial agents, 
 as when caustic is applied to ulcers, unguents to the skin, &c. But,
 
 PATHOLOGY. REMOTE CAUSES. 423 
 
 it more commonly happens that the reflected nervous powci is the 
 immediate agent in the production or cure of disease, though seated 
 in the part to which the morbific or remedial agent is applied. This 
 reflection of the nervous power may come either directly through the 
 nerves supplying the part, or from organs more remote (§ 184, 188, 205 
 -216, 222-2331, 475-492, 493 cc, 500, 514 h, 6471, 8931, 902, 905 a). 
 
 659, a. Predisposing causes are often involved in much obscurity, 
 especially when of a complex nature. Their operation may have be- 
 gun at some remote period, and there may have been a long consec- 
 iitive series without much relation to each other. Neither may be 
 sufficient to lay the foundation of disease ; but each renders the 
 properties of life more and more susceptible to morbific influences 
 from other causes, but which, otherwise, might have been innoxious. 
 These new causes being applied, one after another, alter more and 
 more the natural condition of the vital properties and functions, till, 
 at last, some new, and perhaps as mild a cause, produces a sudden 
 explosion of disease. This last cause is often mistaken, and often fa- 
 tally for the patient, as the principal, or only source of a malady 
 which has been the slow consequence of a long series of causes. 
 And so of the last remedy, after a series of remedial influences. 
 
 Thus it frequently happens that the first in the chain of predispos- 
 ing causes begins in childhood, and the last does not take place till 
 adult age. The gastric and hepatic inflainmations which supervene 
 on the indigestion of adult life have often grown out of improper 
 food in childhood, and a neglect of other natural habits, which are 
 continued till habitual indigestion sets in. It then becomes difficult, 
 from the influence of habit, to accomplish a cure ; and these patients, 
 too often indisposed to exercise self-denial, go on with persevering 
 indulgence, and carry forward the morbid changes till obstinate and 
 even disorganizing inflammations ensue (§ 548). Such, too, is the 
 frequent history of intemperate drinkers, excessive tobacco chewers 
 and smokers, opium eaters, &c. ; the poison being slowly morbific in 
 all the cases, but aided in its operation by many concurring causes 
 (§ 524 c, 527 &, d, 548, 578, 630 e, 714, 902 c, m, 905 a, 970 c, 1066). 
 
 From this combined series of causes, and their gradual influences 
 upon the vital conditions, there is every variety and gradation, as to 
 number, time, activity, &c., down to those which, like a scald, or the 
 bite of a venomous snake, develop inflammation at once, or, like 
 prussic acid, extinguish on the instant, and without any other antece- 
 dent change, the entire powers of the organic being. 
 
 659, b. The foregoing gradual operation of morbific agents lays 
 the foundation of the scrofulous diathesis (§ 836), and is analogous, 
 in principle, to the philosophy of acclimation, and to the formation of 
 artificial temperaments (§ 558, 560-563, 591). The causes, indeed, 
 being perhaps not remarkably different, and only morbific under spe- 
 cial circumstances, may transform the melancholic into the sanguineo- 
 melancholic, or into the nervous temperament, instead of producing 
 chronic indigestion, or some habit of feeble health (§ 535-540, 602). 
 
 660. In the last section we have examples of what is in constant 
 progress in disease, namely, the predisposing influence which a dis- 
 eased organ exerts on others which were not diseased. These mor- 
 bific reflex actions, leading to various sympathetic diseases, then fall 
 within the category of predisposing causes ; as may also the resulting
 
 424 INSTITUTES OF MEDICINE. 
 
 diseases ; but, if they concur only in a secondary manner with other 
 causes, then they may be only exciting-, or both exciting and predis- 
 posing causes (§ 143 h, 222-232, 514 A, 647, 715). 
 
 661. Finally, all those hereditary peculiarities, in which there is a 
 natural tendency in the vital states to take on diseased conditions, 
 may be included under remote predisposing causes. But this is 
 rather for the sake of convenience, since, in the hereditary constitu- 
 tions, the tendency to disease is virtually no more than the common 
 predisposition to disease, and is equally owing to remote causes 
 which have exerted their predisposing effects upon our ancestors. It 
 is convenient, therefore, to assume these transmitted peculiarities as 
 equivalent to the remote causes themselves. And, although we can- 
 not trace out the remote influences which lay the foundation of the 
 scrofulous constitution, or of other hereditary predispositions, the 
 known characteristic peculiarities of the accidental constitutions is 
 equivalent to a knowledge of the nature of the remote predisposing 
 causes ; since in other affections we do but employ our knowledge of 
 the predisposing causes in finding out the exact pathological character 
 of disease. And so, also, of the several temperaments (§ 561, 585, &c.). 
 
 662, a. A knowledge of the remote causes of diease is often indis- 
 pensable to the successful treatment of disease. Catarrh, for in- 
 stance, arising from cold, in a sound constitution, although prolonged, 
 may be suffered to pass without much remedial care ; but, if it have 
 
 .for one of its remote causes a natural tendency to pulmonar).' phthi- 
 sis, it should awaken all our vigilance for its removal. The reason is 
 obvious. In the ordinary catari'h all the remote causes soon cease 
 their operation, exert no profound nor specific changes, and the vital 
 states soon obey their natural tendency to the standard of health. 
 In the other case remote causes had been in prolonged operation, 
 are more or less of a specific character, and the resulting predisposi- 
 tion has almost the fixedness of the tempei'aments (§ 543, 548, 561, 
 562, 585, &c.). In these cases, therefore, the tendency of nature is 
 to go the wrong way ; and in proportion to this she requires the in- 
 tervention of art. We must then make repeated impressions upon 
 the diseased conditions before we can establish the artifical changes, 
 before we may counteract the naturally morbific tendency. This be- 
 ing accomplished, a favorable inclination is given to the balance of 
 nature, and she comes in with languid efforts at restoration. — Note F. 
 662, b. Again, a fever, or inflammation, with partial remissions, 
 presents itself. The fate of the patient may now depend upon our 
 Knowledge of whether the principal remote cause consisted of marsh 
 miasmata, or of some other morbific agent, although it have long 
 ceased to operate ; since, in the former case, the Peruvian bark, arse- 
 nic, &c., may be indispensable, while in the latter they would be de- 
 structive (§ 870). It often happens, also, where the remote cause is 
 still in operation, that its removal alone, especially those of a general 
 nature, may be all that is necessary to a speedy cure (§ 648, 815). 
 
 Venous congestions, as will be seen hereafter, may be also attend- 
 ant on intermittent fever, which shall ultimately require the Peruvian 
 febrifuge, but which would be aggravated in most other cases. After 
 bloodletting, it is the great remedy for the intermitting apoplexies of 
 Italy, &c. In all these cases, the congestive affection is peculiarly 
 modified by the nature of the predisposing cause (§ 816, 817j.
 
 PATHOLOGY. REMOTE CAUSES. 425 
 
 662. c. Again, it has been always found, on dissection, that delirium 
 « potu was attended with venous congestion of the brain ; and such is 
 the modifying influence of the remote cause that one of its frequent 
 remedies is opium, and in quantities that would induce another modi- 
 fication of the same disease if administered in heakhy states of the 
 system, and for which bloodletting and coffee would be the remedies. 
 This peculiar fact impresses us forcibly as to the wonderful modifica- 
 tions which different morbific agents establish in particular forms of 
 disease, and enforces the importance of ascertaining the nature of the 
 predisposing cause. Striking examples occur in the self-limited dis- 
 eases (§ 858, 861). In delirium a potu antiphlogistics should prevail.* 
 
 663. The remote causes which readily produce disease in one man 
 may not in another. Thus, during the prevalence of an epidemic fe- 
 ver, or the malignant cholera, or influenza, a greater portion of the in- 
 habitants may escape the disease. There is, therefoi-e, something ap- 
 pertaining to that part of the multitude which escapes that enables 
 them to resist the morbific effects of the prevailing remote cause (§ 
 648, b). And here observation, as well as vital philosophy, enables 
 us to understand the reasons, and how epidemics may be baffled. 
 
 We find, for instance, in respect to yellow fever, and all other con- 
 gestive fevers, prevailing epidemically, that their subjects are apt to 
 live on, after the appearance of the distemper, without much regard 
 to their habits. They eat as freely as usual of animal food, drink 
 their wine, and perhaps more ardent spirits. Others have become in- 
 firm from irregular habits, and such are, in consequence, rendered 
 more susceptible of the epidemical influence (§ 827 c, e). 
 
 On the contrary, we observe that the class who escape are more 
 generally abstemious, eat less stimulating food, or renounce it alto- 
 gether, abandon all alcoholic liquors, avoid the night air, retire early 
 to rest, &c. (§ 615, &c., 623-625, 645 h, 630 e). 
 
 And so, where there exist constitutional or other tendencies to dis- 
 ease ; its attack may be averted by habitually avoiding many agents 
 which are inoffensive to others (§ 150). Peculiarities in respect to 
 temperament are, also, often concerned in the degrees of susceptibil- 
 ity to the influence of morbific agents ; just as they are in respect tu 
 remedial. The sanguine, for example, will be more the subjects than 
 the melancholic or the phlegmatic ; and the former require greater 
 vigilance as to exciting causes (§ 551, 597, 598). — Note Oo p. 1141. 
 
 664. Certain predisposing causes sometimes extinguish the suscep- 
 tibility to their morbific action even in concentrated degrees when 
 they have been long in operation in degrees less intense ; as in accli- 
 mation, the use of tobacco, &c. (§ 544, 545, 551). Some other causes 
 always, or nearly so, destroy the susceptibility to their action through 
 all future time after having once produced disease. These consist, 
 mostly, of a few morbid animal poisons; namely, of small-pox, mea- 
 sles, scarlatina, hooping-cough, and mumps. It is remarkable, too, 
 that all these diseases are contagious without contact, and are the only 
 ones to which this combined law applies (§ 545, 654 h). 
 
 665. Predisposition often remains after disease shall have been ap- 
 parently eradicated ; as seen particularly in intermittent fever, and in 
 chronic indigestion (§ 514 g, 560). This persistence of predisposi- 
 tion is most likely to. occur where some organic derangement may 
 have supervened, or wheie a low chronic state of disease tnay estab- 
 
 * In the Med. and Phys. Comm. (vol. 2. p. 485-491), I have shown that tart, anti- 
 mon., cathartics, and often bloodletting, are generally the best remedies for delirium 
 a potu (§ 1058 y).
 
 426 INSTITUTES OF MEDICINE. 
 
 lish itself in some comparatively circumscribed part, and which not 
 only contributes to maintain- the general predisposition, but afterward 
 increasing, becomes one of the exciting causes of another attack of fe- 
 ver (§ S06). These local conditions are generally owing to imperfect 
 treatment ; to the neglect, perhaps, in intermittent and remittent fe- 
 vers, of proper depletion, or to the use of excessive doses of quinia, &c. 
 Acquired predisposition to particular diseases, however, often apj)ears 
 to be almost as firmly ingrafted upon the constitution as those of an 
 hereditai-y nature, with intervals of apj^arent absence of all disease 
 § 535, &c.). Acclimation is also a study for the philosopher (§ 554). 
 
 666, «. Predisposition to disease consists in some indefinite change 
 which has befallen the organic properties, and corresponds, in a general 
 sense, with the peculiar virtues of the predisposing causes (§ 650, 652). 
 Where the subsequent development of disease is severe, and especially 
 if sudden, there has been, obviously, some profound antecedent impres- 
 sion upon the properties of life, instituted by the local operation of the 
 remote causes, and propagated to other parts by alterative reflex ac- 
 tions of the nervous system. In fevers, especially, obscure symptoms 
 may be seen some time before the sudden and full explosion of disease 
 (§ 143, 227, 500 cZcZ, 514^, 685, 686, 764, 777, 785, 807, 811). 
 
 A morbific impression being once made on the changeable proper- 
 ties of life it may go on increasing in intensity, although the remote 
 cause have been early withdrawn, till, having acquired a certain de- 
 gree of force, disease may either explode spontaneously, or some mild 
 exciting cause may institute a sudden and violent change in the now 
 highly-susceptible jjroperties of life (§ 506, 512-514, 516 d, no. 6, 
 518 b, 561, 618 a). At other times the predisposition appears to be 
 stationary, perhaps for months, and even for years, as seen in fevers 
 and hydrophobia ; the former having been known to exist in a dor- 
 mant state for a year or more, and the latter for seven years.* In these 
 cases, it appears ultimately to assume, of itself, a tendency toward a 
 full development (§ 148, 514 g, 559, 561, 715, 826, 657 a). 
 
 666, h. A distinct apprehension of the nature of acquired predispo- 
 sition to disease may be had by referring to the philosophy of artifi- 
 cial temperaments (§ 591, 602, 603), and to those naturally modified 
 states of the vital properties which so frequently result in hereditary 
 diseases ; as in scrofula, gout, bronchocele, &c. In some of those 
 natural conditions which predispose us to specific modes of disease 
 (§ 661) there is no apparent departure from a state of health, unless 
 disease be developed by exciting causes (§ 646, c) ; and this will be 
 true in proportion as the predisposition is limited to a few parts, and 
 especially if those few be not important to organic life. Thus, the 
 predisposition to gout is greatly limited to the small joints, though it 
 may affect other parts, especially the intestinal mucous membrane. 
 So, in bronchocele the predisposition resides in the thyroid gland. 
 In such constitutions, therefore, there is not generally any thing pres- 
 ent, under ordinary circumstances of health, to denote any modifica- 
 tion of the properties of life which approximates a condition of obvi- 
 ous disease. These cases arc so far closely allied to those conditions 
 in which the predisposition to fever, or to hydrophobia, is in a state 
 of incubation for many months, or for years (^ 238). 
 
 But, in scrofulous subjects it is generally otherwise; since in those 
 who are naturally predisposed to scrofula the tendency to the disease 
 * An apparently clear case in London Lancet, February 3, 1838.
 
 PATHOLOGY. PATHOLOGICAL CAUSE. 427 
 
 is more or less universal, and may affect almost every tissue and or- 
 gan. There is, therefore, a natural radical fault in all the organic en- 
 dowments of the system, and this fault or natural modification consti- 
 tutes the predisposition (§ 661). Hence, in such subjects, the very 
 elements of the body are diverted more or less from their perfect 
 standard, and the union of their compounds into tissues and organs 
 deviates, more or less, from that of natural subjects (§ 220). Irrita- 
 bility, especially, is not only permanently turned from its natural 
 character, but is at all times preternaturally susceptible ; and hence 
 it happens that occasional causes, innocent in health, operate nowr 
 with morbific effect (§ 143-150). These cases approximate those ac- 
 quired predispositions where incubation is of short duration, and 
 where there can be no doubt that the organic properties sustain a 
 profound lesion during the early operation of the predisposing cause, 
 or take on, at an early time, a progressive tendency toward an explo- 
 sion of disease (§ 76, 181, 638J, 645 c). 
 
 II. PROXIMATE, OR PATHOLOGICAL CAUSE. 
 
 667. The inoximatc cause, as implied by the term, is that from 
 which all the direct phenomena of disease arise. It must there- 
 fore constitute the essence of disease itself; and hence I substituted 
 in the Medical and Physiological Commentaries the term 2^<^i^iological 
 for proximate, and have since retained it as moi'e expressive than the 
 original name when used in the sense here intended. 
 
 668. The remote causes, by their action upon the properties of life, 
 lead to that change in their condition which forms the essential path- 
 ological cause, or the essence of disease (§ 644, 658, 666). As a 
 necessary result, there also follows a corresponding change in the 
 functions over which the j^roperties preside, and therefore a more or 
 less modified action of the vessels which are the instruments of disease 
 (§ 247). All the symptoms, altered secretions, lesions of structure, 
 &c., are only consequences, more or less remote, of tliose primary 
 changes. 
 
 669. Since, also, it appears that all remote causes which differ in 
 their virtues, or in their modes of influence, establish changes in the 
 properties and functions of life corresponding, in a general sense, 
 with the nature of the causes, and with the modes and intensity of 
 their operation, it follows that the pathological causes, or results of 
 the predisposing, must vary in a coiTesponding manner (§ 650, 651). 
 
 670. But there are many remote causes that are so nearly allied in 
 their morbific virtues that they must produce pathological conditions 
 of near resemblance. Such are the various remote causes of inflam- 
 mation, and that other class which gives rise to idiopathic fevers. 
 Since, however, many of the causes belonging to each class have cer- 
 tain very peculiar virtues of their own, there must necessarily arise 
 corresponding peculiarities in the pathological conditions which they 
 produce. Hence the very obvious differences which prevail among 
 inflammations and fevers ; though more or less is due to the nature 
 of the affected parts, and often to many contingent influences. In- 
 flammation of the venous tissue, for example, presents a combina- 
 tion of phenomena that distinguish it at once from inflammation of 
 any other tissue, though the remote causes be the same. Much of 
 the variety in congestive fevers is also owing to some inflammatory
 
 428 INSTITUTES OF MEDICINE. 
 
 Stale of one or more organs ; while, also, venous inflammation is va- 
 riously modified, as in all other tissues, according to the nature of the 
 remote causes (§ 132-140, 149-152, 652, 722, 765, 766. Also, Med. 
 and Phys. Comm., vol. ii., p. 427-514). 
 
 t 671. Summarily, then, the precise nature of the pathological cause 
 I will depend upon the nature and action of the remote cause, or their 
 combined nature when two or more operate efficiently, and upon the 
 natural or other antecedent modifications of the vital properties of 
 the affected parts, and the general nature and vital relations of any 
 compound organ of which an affected tissue may form a component 
 part ; subject, however, to modifications from temperament, age, hab- 
 its, &c. (§150). 
 
 672. Every disease consists of a succession of pathological causes, 
 till they end in health, or in death. These changes are the result of 
 the natural mutability of the propeities of life, especially when once 
 diverted from their healthy standard. The morbid states are rarely 
 stationary from one hour to another. They fluctuate, favorably, from 
 the inherent tendency of the properties to return to their natural con- 
 dition, or from artificial impressions from remedial agents ; or, unfa- 
 vorably, from the intensity of disease, the force of predisposition and 
 of habit, or from the continued operation of predisposing or exciting 
 causes, &c. (§ 177-184, 535, &c., 666, 733 e). The progressive 
 changes may be gradual, and require but slight modifications of treat- 
 ment, or gi'eat and abrupt ; and either condition may follow the same 
 morbific and remedial agents, according to the surrounding influences. 
 
 The absolute condition of disease, therefore, is changing not only 
 spontaneously during its progress or decline, but is variously modi- 
 fied by remedial agents, and by other contingent causes (§ 733, d). 
 
 673. It is to the actual condition of disease, and the organs involv- 
 ed, that remedies should be directed. A knowledge, indeed, of the 
 seat of disease, and of its exact pathology as far as may be attained, 
 is often indispensable to a successful treatment ; and here a knowl- 
 edge of the remote causes may contribute the greatest light (§ 650). 
 
 So, also, at every successive application of remedial agents the 
 new pathological conditions should form the ground of the new pre- 
 scriptions. 
 
 674. a. Upon the modified conditions of the properties of life, or 
 their pathological states, therefore, all the modified actions of the 
 vessels which are the instruments of disease, all the vital phenomena, 
 and all the physical products depend ; just as the healthy actions, 
 phenomena, and products depend upon the same properties in their 
 state of health (§ 177, 410). It is for this reason, the modification of 
 the vital properties in disease, or the essence of disease itself, is called 
 the proximate or pathological cause ; all the rest being merely results 
 or effects. 
 
 But, there are only certain facts that may be understood in relation 
 to the changes which the organic conditions sustain from the opera- 
 tion of morbific causes. We can see distinctly that they are exalted 
 in inflammation, and exalted or depressed in fevers. But these are 
 comparatively unimportant elements of the changes. There is also 
 the greater change which consists in some absolute modification of 
 the nature of the properties, some positive change in hind (§ 177 
 666). What that change is it is impossible to comprehend, though it
 
 PATHOLOGV. PATHOLOGICAL CAUSE. 429 
 
 be tlie essential part of the disease. We know net, indeed, the ab- 
 solute nature of the vital properties in their healthy state, and have, 
 therefore, no standard of comparison in disease. We may, neverthe- 
 less, by the phenomena, as of all other forces of nature, learn all the 
 laws of the vital properties, and the modifications to which they are 
 liable (§ 234). The physiologist, I again say, concerns himself about 
 the facts, the anatomical medium, the existence of the forces and the 
 laws which they obey. He interrogates not the intrinsic nature of 
 the powers, nor the proximate modes in which the results are pro- 
 duced. 
 
 674, h. For the purpose of having some visible or tangible condi- 
 tion before us in considering the pathology of disease, we often in- 
 clude some of the results as elements of the proximate cause, or even 
 substitute some of the results for the cause itself Thus, increased 
 action of the capillary blood-vessels is often said to be the proximate 
 or pathological cause of inflammation, though this is only a conse- 
 quence, however a necessary one, of a certain morbid alteration of 
 the vital properties of the vessels concerned in the morbid process. 
 So, the pathological cause of venous congestion is said to consist in 
 an accumulation of blood in the veins, though this is a very remote 
 consequence. As a better designation, according to my exposition of the 
 pathology, and since venous congestion is assumed as a particular dis- 
 ease, I would say, for the sake of brevity and convenience, that its 
 pathological cause is sub-inflammation of the veins ; the accumulation 
 of blood being only a remote effect. And so of active phlebitis, or of 
 any other inflammation which derives its name from the part affected. 
 Such, indeed, has become the specification of common inflammation 
 in almost every part of the body. But, in all these cases, inflamma- 
 tion is an aggregate term which stands for that chansre in the orsranic 
 properties which is the true pathology. 
 
 674, c. But what is the pathological cause, in the foregoing com- 
 prehensive sense, of other diseases, as fever, &c. ? Here we have 
 less light as to the nature of the changes, even of function ; and hence 
 there is less guide from general principles, and more abstract de- 
 pendence upon symptoms and experience. Still, as will be seen, the 
 pathology and treatment of fever are not without their important gen- 
 eral precepts. We reach a knowledge of the modifications which the 
 physiological laws undergo, and this is the most that we require for 
 the institution of medical principles. 
 
 674, d. The vital states of a part or of the whole system may be 
 vaiiously modified in their condition so as to approach nearly to actual 
 disease, and yet the modification fall short of the absolute change. 
 This has been already seen in what I have said of predisposition to 
 disease, whether accidental or hereditary. It is also constantly illus- 
 trated by the manner in which the heart sympathizes with every part 
 which may be the seat of morbid action, and upon which the variable 
 state of the pulse greatly depends. This prominent demonstration of 
 reflex nervous action may be carried to all other organs, which, in 
 like manner, are liable to sustain sympathetic disturbances short of 
 disease, but according to their owoi natural modification of the prop- 
 erties of life, especially of irritability (§ 133-136, 188). And, although 
 these conditions do not amount to absolute disease in its common ac- 
 ceptation, they may reverberate morbific influences upon parts sus»
 
 430 INSTITUTES OF MEDICINE. 
 
 taining a greater lesion, and often call for the intervention of art (§ 
 714, 848). Or, such influences may give rise to severe forms of dis- 
 ease in other parts. Thus, gastric derangements, not inflammatory, 
 may induce severe inflammation of the mucous tissue of the throat, 
 or hepatic or cerebral congestion, &c. (§ 500, 689 I). Again, certain 
 morbific causes, acting upon the stomach, make their principal demon- 
 strations in remote parts ; as the narcotics, cantharides, &c. A sim- 
 ple element of this is constantly seen in the manner in which cold on 
 striking the skin will develop catarrh, pneumonia, &c. ; though, in the 
 former cases, there may be specific relations of the morbific agents to 
 particular parts, while in the latter, other predisposing causes m'ay 
 have operated (§ 147-151, 649 c, 657, 722 b). This principle lies at 
 the foundation of all the consecutive developments which may spring 
 up in different parts as the consequences of some primary derange- 
 ment of a particular part, or of some local morbific impression which 
 may come short of apparent disease in the organ impressed. 
 
 In sections 143, 666, 847, 848, 1 have endeavored to show how the 
 whole system may be brought, by reflex nervous actions, into that 
 condition, and how, in consequence, remedial agents Avill then exert 
 a salutary effect upon all parts, when they might fail of any effect upon 
 the same parts in their state of health ; and how, also, in consequence 
 of such remedial influences, the morbidly sympathizing parts may be 
 made the sources of salutary reflex actions upon the primary dis- 
 ease ; as may, also, such as have not sustained a morbific influence 
 (§ 514 h, 638i, 657 &).— Note D p. 1114. 
 
 675. As illustrative of some of the foregoing sections, particularly 
 the last three, I shall now present an example of a therapeutical na- 
 ture, but which takes, in its comprehensive range, the causation and 
 philosophy of disease, the principle upon which morbific and reme- 
 dial agents operate, whether directly upon the vital properties or 
 tln-ough the medium of the nervous influence, the analogy between 
 the operation of morbific agents and remedies, and how the last may 
 prove, through a common pi'inciple, either remedial or morbific. 
 
 I shall assume, for the foregoing purpose, the intermittent fever, 
 in which the whole system is engaged ; and to simplify the treatment, 
 bloodletting, nauseants, and quinine, may be the agents employed. 
 Each of these agents, like all other therapeutical means, operate en- 
 tirely upon vital principles, as set forth in the appropriate places in 
 this work. "Will the chemist and humoralist give their attention 1 
 
 Now, without the aid of the philosophy which has been hitherto 
 considered we could not comprehend, in the least, any of the phenom- 
 ena of this disease, much less their consecutive relations, as they are 
 regularly presented at the several stages of the complaint ; nor could 
 we any better understand the salutary or the conflicting results of our 
 remedial agents. But, the true philosophy of life places the whole 
 subject in a consistent, intelligible, and even sublime aspect. At 
 each of the several stages of an intermittent, the properties of life 
 are in different states of modification, and the remedies must be 
 adapted to their particular modification at the diff*erent stages of the 
 disease ; or such as may be curative at one stage will either fail of 
 their effect at all other stages, or exasperate the complaint. In the 
 first, or cold stage, the properties of life are profoundly altered ; and, 
 as this is the beginning of the paroxysm, the alteration has not ac-
 
 PATHOLOGY. PATHOLOGICAL CAUSE. 431 
 
 quired that fixedness, or that influence of habit, which results from 
 its prolongation (§ 535, &c.). Powerful impressions may, therefore, 
 be made upon the morbid properties, and, if rightly made, they may 
 at once arrest the paroxysm. But no remedy can be applied with 
 safety at the cold stage which would add to the excitement if applied 
 at the hot stage. No stimulants, therefore, not even quinine, which 
 is so eminently curative during the intennission, can be employed in 
 the cold stage without proving morbific, and an aggravating cause to 
 the hot stage. But, many remedies which are appropriate to the hot 
 stage will tend, more or less, if applied during the cold stage, to pro- 
 duce a change that will mitigate the hot stage, or bring on at once 
 the sweating stage. Of the three remedies proposed, there are two 
 which will often accomplish this result, and cut short the disease at 
 this stage of the paroxysm, or at least conduct nature to an immediate 
 consummation of her cure in the sweating stage. But, the nearer 
 the beginning of the cold stage either of the two remedies are applied, 
 whether loss of blood or an emetic, the more salutary, for the reason 
 already stated, will be their effect. Numerous and striking examples 
 of this important principle might be stated ; as, for instance, an 
 emetic will often subdue, at once, pneumonia or croup, if exhibited 
 at their very invasion, when it may be perfectly powerless in a few 
 hours afterward. And so, in a more limited sense, of the abstrac- 
 tion of blood, which reaches more profoundly and more universally 
 all the organic properties, and determines upon them, when syncope 
 approaches, a greater and more universal impression of the nervous 
 power (§ 947, 948). This remedy, therefore, may often answer well 
 at any period of the cold stage, should we determine upon its use. 
 
 But, suppose that the hot stage supervene. A new condition of the 
 vital states has now sprung up, and it must be treated accordingly. 
 Whatever will lessen and otherwise favorably modify initability 
 (§ 188, &c.), and contribute to the production of the sweating pro- 
 cess, will be salutary at all periods of the hot stage, and whatever in- 
 creases irritability and mobility will, as at the cold stage, exasperate 
 the hot stage and embarrass the sweating stage. It is evident, there- 
 fore, that quinine will still prove morbific. But we have in certain 
 nauseating remedies, as tartarized antimony, and in bloodletting, ap- 
 propriate means for reducing and otherwise modifying the morbid 
 state of irritability, in the hot stage. Alterative closes of antimony, 
 even short of nauseating, may now exert a powerful tendency to 
 bring about that favorable change which ensues naturally ; while in 
 its full emetic dose, so often favorable near the invasion, or at the on- 
 set, of the cold stage, this agent is rarely useful and frequently inju 
 rious. Abstraction of blood has the same useful tendency. But, 
 this remedy, unlike its effect, and that of emetics, in the cold stage, 
 will not operate with the greatest force at the beginning of the hot 
 stage, but near the termination of this stage in the sweating process. 
 The properties of life have now assumed a radically different condi- 
 tion. They are rapidly throwing off" the influence of predisposition 
 and of morbid habit, and their tendency is toward a restoration of 
 their natural state. Nature is therefore more successfully aided in 
 this new condition as she approaches the sweating or more curative 
 process, which is the final cause of the hot stage. Hence it follows, 
 where the advantage of one impression only can be had from a remn-
 
 432 INSTITUTES OF MEDICINE. 
 
 dial agent, although it be useful, like bloodletting, at other periods of 
 this stage, it should generally be delayed, at least, till the stage of ex- 
 citement has reached its acme. If cathartics be employed at thia 
 stage, they should be delayed, at least, till the sweating process has 
 begun ; and now an emetic may be sometimes salutary. But, the 
 fonner, partly on account of their irritation, should rather be defended 
 till the sweating stage is over, while emetics are most salutary just 
 before the invasion of a paroxysm, which, as in the hot stage, is al- 
 ways an inauspicious time for cathartics. 
 
 In propoi'tion as nature is going on with a progressive march toward 
 a comparatively healthy result, as in the sweating process, there should 
 be no gi-eat interference from art. No help is wanted, for the restor- 
 ative process will be soon spontaneously completed, and, at an ad- 
 vanced stage of this process, and before it is finished, there will be 
 always danger of making some unfavorable impression, unless it be 
 from remedies of a mild character, whose uniform result is that of 
 acting as sudorifics, and coinciding in other respects with the changes 
 which are in progress during the sweating stage. Such a remedy, for 
 instance, is tartarized antimony, in doses short of nausea. 
 
 Finally comes the interval of repose, which is remarkable for its 
 specific, but various, duration ; giving to intermittent fever its quotid- 
 ian, tertian, or quarteiTi type. There is, however, notwithstanding 
 the apparent state of tranquillity, very often some morbid condition re- 
 maining; as sufficiently denoted by any subsequent return of the par- 
 oxysm. In all such cases, there is a progressive change going on in 
 the «vital properties from the time of their comparatively natural state 
 at the close of the sweating process toward that profoundly morbid 
 alteration which constitutes the cold stage. The disease is again in a 
 state of incubation, and tlierefore the tendency to change in th^ or- 
 ganic properties is exactly the reverse of what had just antecedently 
 existed during the hot stage and its termination in the sweating pro- 
 cess (§ 666). It is now the object of art to prevent a repetition of the 
 paroxysm. This may be often accomplished by mere rest in a hori- 
 zontal posture, and abstinence from all solid food ; for the tendency of 
 nature may be the right way, if she be not embarrassed by exciting 
 causes ; the slightest of which, as a shock of the mind, may throw her 
 into a state of incubation. This shows not only the great susceptibil- 
 ity of the vital properties, during the intermission, to morbid changes, 
 but, also, their frequent disposition to return, unaided, to their natural 
 state. Should they require any other intervention from ait than the 
 mere act of withholding exciting causes, it is manifest, from what 1 
 have now said, that slight influences from remedial agents will be am- 
 ply sufficient ; so only we discard pernicious causes, and there be no 
 severe local disease. The remedies for this purpose consist of a group 
 that are called specifics, and have been suggested by experience inde- 
 pendently of any general principles ; so very peculiar is the state of 
 the vital properties during the period of intermission. Of these specific 
 agents the Peruvian bark and its alkaloids is one, arsenic another, and 
 cobweb another; coming severally from each of the three great king- 
 doms, and each exerting nearly an equal control over the progress of 
 incubation, but without any other known analogies to each other ; cer- 
 tainly none of a chemical nature. The quinine, or arsenic, which would 
 have been surely morbific at any other stage of the paroxysm, may
 
 PATHOLOGY, PATHOLOGICAL CAUSE. 433 
 
 now be employed with a remarkably curative effect. But, a great er- 
 ror is often committed in exhibiting quinine, in this very tangible state 
 of the organic properties, in excessive quantities ; by which the dis- 
 ease is either prolonged, or the predisposition only temporarily sub- 
 dued, or local affections induced or aggravated. As an invariable and 
 important rule, also, just in proportion as the organic properties are 
 approaching a state of health, so should our treatment be cautiously 
 mild, or it will light up disease (§ 764. Also, Med. and Phys. Coinm., 
 voh i., p. 443, &c.).— Note K p. 1119. 
 
 676, a. In the foregoing section I have stated a problem for the spe- 
 cific object of showing the variety of changes which diseases are liable 
 to sustain in their pathological character during a short period of their 
 progress, and the importance of adapting the treatment to the changes 
 which may ensue, with no other reference to symptoms than as they 
 are indicative of the seat of disease and its true pathology (§ 762). 
 But I have also, incidentally, at the same time, demonsti'ated the ab- 
 surdity of attempting any part of the problems of disease, or the mo- 
 dus operandi of remedial agents, by any philosophy boirowed from 
 the inorganic world, or by any hypothesis in the humoral pathology. 
 The vital solidists, however, being numerically small, claim to be 
 little ceremonious with error ; and once more, therefore, I shall bring 
 into contrast the adverse doctrines (§ 350i-376j, 433-450). With 
 this intention I shall submit the philosophy as now taught in Great 
 Britain and France, and leave it to the reader to interpret by that 
 philosophy, if he can, the problems contained in the last preceding 
 section. 
 
 676, h. It is scarcely necessary to remind the reader that Liebig's 
 speculations in medicine are in general vogue in Great Britain (§ 
 349, d), and have become incorporated in medical works of every de- 
 scription (§ 433). Take the following example, relative to my pres- 
 ent topic, from the long-celebrated and able, but now completely met- 
 amorphosed, Pharmacologia of Dr. Paris {^ 339, h). 
 
 " In a recent work by Professor Liebig, to which I have frequently 
 referred," says Dr. Paris, " we are presented with views not only ap- 
 plicable to the question under discussion, but well calculated to ex- 
 tend our knowledge with regard to the modus operandi of contagious 
 matter, and its reproduction in the living body. I have already ex- 
 plained his important application of the dynamic law of La Place to 
 chemical action ; viz., that a body, the atoms of which are in a state 
 of transformation, may impart its peculiar condition to compounds with 
 which it may happen to communicate." 
 
 Dr. Paris then proceeds to say, that it " was reserved for the genius 
 of Liebig" to apply this doctrine of "fermentation," "putrefaction," 
 &c., to the living body, in explanation of " the modus operandi of con- 
 tagious matter," &c. I had occasion to set forth this philosophy of the 
 Continental Chemist in my Examination of Reviews, together with 
 the principal examples by which it was sustained (p. 55). Some of 
 them occur, also, in the present work (§ 350, nos. 29 to 46, and 78 to 
 97). Of the " sausages," by-the-way (to illustrate the extent of acqui- 
 escence), it is said by Dr. Paris that, " by entering the blood, they im- 
 part their peculiar action to the constituents of that fluid, and a,ll the 
 substances in the body are induced to undergo a modified putrefaction'^ 
 (§ 339 b, 349 d, 350, no. 44). 
 
 E E
 
 434 INSTITUTES OF MEDICINE. 
 
 I shall not pursue this subject farther, having, in the Medical and 
 Physiological Commentaries (vol. i., p. 385-716), devoted an Essay to 
 the merits of the Humoral Pathology, where all the foregoing points, 
 the " sausages," &c., are duly investigated (§ 282). 
 
 And now to complete this example of sudden and general illumina- 
 tion, and to exemplify, again and again, " the recent progress of med- 
 ical science" under the auspices of" expei'imental philosophy," let urf 
 hear Dr. Paris as he was at a former edition of his Pharmacologia, 
 and when he and others were just as much enlightened as to the con- 
 nection of chemistry with the healthy and morbid processes of man aa 
 when he put forth the ninth and last edition of that distinguished 
 work. Thus : 
 
 " Every rational physician must feel, in its full force, the ahsurdity 
 of expecting to account for the phenomena of life upon principles de- 
 duced from the analogies of inert matter ; and we therefore find that 
 the most intelligent physiologists of modern times have been anxious to 
 discourage the attempt, and to deprecate its folly T 
 
 In descanting upon the interference of the celebrated chemist, Mr. 
 Brande, with medical topics, Dr. Paris remarked, that 
 
 ^'■Whenever the chemist forsakes his laboratory for the hed-sidc, he 
 
 FORFEITS ALL HIS CLAIMS TO OUR RESPECT AND HIS TITLE TO OUR CON- 
 FIDENCE" (§ 709, 1006 a, 1034). 
 
 III. SYMPTOMS. 
 
 677. Symptomatology is the third and last division of pathology ; be- 
 ing the doctrine of symptoms. It embraces all the phenomena which 
 result either directly or indirectly from morbid states, and includes, 
 therefore, the physical as well as vital signs (§ 883). 
 
 678. During the healthy state of the vital properties all the results 
 of life progress in one uniform way, according to the nature of the 
 several parts of the organic being (§ 249). But, as soon as the prop- 
 erties of any part undergo changes there arise corresponding changes 
 in the motions of the vessels, and in all the phenomena and products 
 (§ 177). 
 
 679. Now it is owing to the insensible, recondite nature of the effi- 
 cient causes of all phenomena that we are compelled to apply our- 
 selves to the study of the phenomena to obtain a knowledge of the 
 powers or properties upon which they depend, the modifications 
 which the powers or properties may undergo, and the laws which 
 they obey. It is obvious, therefore, that the nearer the phenomena 
 are to the direct operation of the causes the more significant will 
 they be of their nature and existing condition. This undeniable fact 
 shows us the superiority of the primary effects of disease, as a guide 
 to pathological conditions, over those ultimate results which are dis- 
 closed by morbid anatomy. 
 
 680. In entering upon this inductive branch of pathology it is im- 
 portant to bear in mind, that, however complex the nature and varie- 
 ty of symptoms they have always as much an absolute cause as any 
 effect in the inorganic world; and I am led to this remark for the pui'- 
 pose of adding another, — that it is of incomparably greater importance 
 to ascertain the former than the latter. AVhen motions are disturbed 
 in the subordinate kingdom it is the first impulse of reason to trace 
 out the cause ; but that is the measure of its compass. The Power
 
 PATHOLOGY, SYiMPTOMS 435 
 
 that gave to matter its being, oi* natural influences, can alone rectify 
 the cause. But, how different with organic nature ! How expres- 
 sive of the radical distinction between the causes of motion in the 
 dead and the living world! In the latter all is fluctuating in its na- 
 ture, yet all controllable in that very nature by the hand of man. AVe 
 see in the principle of life the cause of organic results. We see 
 those results vacillating in every possible aspect ; and, as with the 
 chemist, or the astronomer, in the former case, we interrogate the 
 cause. But we do so with a far higher aim ; for we know that the 
 cause is amenable to rectifying influences. In the world of matter 
 and in the world of life the causes of erratic phenomena may be on 
 a par in principle. The disturbing influences may be alike due to a 
 common cause in each department, respectively. But, in the miner- 
 al kingdom there are numerous fundamental causes in operation, and 
 the jDhenomena, therefore, may depend upon opposing influences. In 
 the organic, from the mushroom to man, there is but one cause ; and 
 hence the obvious induction that certain changes in the natural condi- 
 tion of that one give rise to all those diversified effects which form 
 the transient phenomena of disease, or those more stable changes 
 which are seen in the progress of the being from its embryo to its 
 adult state, or in the vicissitudes of temperament, &c. 
 
 We therefore apply ourselves, I say, to the cause itself; and here 
 all analogy disappears with any known cause in the inorganic kino-- 
 dom. The former is changeable in its nature, and as the changes go 
 on, its existence comes to an end. But the same First Cause Who 
 imparted that instability for great and wise purposes ordained, also, 
 that when the principle of life should be diverted from its natural 
 condition by untoward agents, it should still possess, through the same 
 law of mutability, a capacity of receiving impressions from other 
 agents that shall awaken its inherent tendency to a state of integrity. 
 In tracing out the nature and the seat of disease through the at- 
 tendant phenomena, we are also animated with the conviction that 
 organic beings are subject to laws as precise as those which rule in 
 the inorganic world, under all their fluctuations ; and the greater com- 
 plexity in the elements of their laws than such as relate to physics 
 and chemistry should stimulate the most exact investigation of symp- 
 toms wherever nature may demand the active interference of art, sc 
 that the latter may make the best use of her laws (§ 237, 447 b). 
 
 681, a. The symptoms, or effects to be employed as guides to the 
 nature and seats of disease, are, 1st. Those which are denominated 
 vital signs, and which are independent of physical products. 2d. 
 The changes of motion and other conditions relating to the vessels 
 which are the instruments of disease, but which are independent of 
 structural changes. 3d. The physical products which are compre- 
 hended under the denominations of secretions and excretions. 4th. 
 Symptoms of the foregoing nature which are determined or modified 
 by changes of organization, and about which morbid anatomy is in- 
 terested. 5th. Signs of a physical nature which depend upon either 
 some change of structure, or on the accumulation of fluids, or the 
 presence of some unusual fluid, or other substance, within the body. 
 These last signs come to us principally through the medium of sound 
 and touch. The first three of the foregoing classes of symptoms may 
 be denominated ^r/wary, the last two secondary.
 
 436 INSTITUTES OF MEDICINE. 
 
 6S1, h. The five divisions into which I have distributed the symp- 
 toms of disease, and the remaining facts which we derive from mor- 
 bid anatomy, and what we learn from remote causes, and the effects 
 of remedial agents, supply all the knowledge we can obtain of the 
 pathology of disease, 
 
 681, c. We must, therefore, constantly concern ourselves about ef- 
 fects, whether investigating the natural world, the powers by which 
 it is governed, or spiritual existences. 
 
 Symptoms, then, are the language of disease, as effects are of all 
 other real existences. 
 
 682, a. Certain symptoms are called diagnostic. By these, in part, 
 we distinguish diseases from each other. A symptom, therefore, to 
 be diagnostic, must be peculiar to one affection. Thus, hydrophobia 
 is the diagnostic symptom of the disease which is called, like some 
 other affections, after the name of its diagnostic. But it is only pecu- 
 liar to the disease as it affects the human species. The diagnostic of 
 intermittent fever is the intermission between the paroxysms ; and so 
 of their attendant intermittent apoplexies ; and paroxysmal increase 
 of those inflammations that are relieved by bark, and the intermission 
 of periodical headaches, and of tic douloureux, are their diagnostics. 
 
 682, Z». Some diseases may have several diagnostic symptoms. Thus, 
 in pneumonia, a good diagnostic is found in the tenacity of the mucus. 
 Another diagnostic is the crepitating noise which is heard on applying 
 the ear to the chest. The first symptom, however, is often absent, 
 and the other is not always present, especially in infants. The crep- 
 itus, also, disappears when condensation of the air-cells takes place, 
 and this disappearance is diagnostic of condensation. But if the pa- 
 tient recover, the condensation generally disappears, and while the 
 process of absorption is going on the crepitus returns, and this is di- 
 agnostic of the absorption. Many diagnostics are supplied by aus- 
 cultation as to the particular parts which are affected in diseases of 
 the heart, and which are significant of the precise nature of the affec- 
 tion. And so of the lungs. Percussion has also its peculiar diagnos- 
 tic signs. We are doubtful, for instance, whether a tumid state of the 
 abdomen be owing to flatulency or to something else. A hollow 
 sound, on percussion, assures us that it depends, in part, at least, upon 
 the presence of some gaseous substance. % 
 
 682, c. Many diseases have certain symptoms which are nearly 
 always present at certain stages of their progress, but are more or 
 less attendant on some other affections. This is the case with the 
 hectic fever of consumption. In such instances the other attending 
 symptoms will determine whether the prevailing one in any particu- 
 lar affection is significant of that disease in the case before us. In- 
 compressibility of the pulse is perhaps always significant of inflamma- 
 tion ; but it often requires much skill to detect it. The attendant 
 hai-dness of the pulse may be then taken as a good diagnostic ; but 
 this also is often ascertained only by a delicacy of touch, and may not 
 be always distinguished from the pulse of pregnancy. An auxiliary 
 diagnostic will then be found in a buffiness of the blood ; but here, 
 too, that appearance is often presented by the blood of pregnant fe- 
 males. There then remains an unequivocal diagnostic of inflammation 
 in the associated cupping and fimbriated edges of the blood (§ 688,<Z,e) 
 
 On the other hand, there are many affections which have no diag-
 
 PATHOLOGY. SYMPTOMS. 437 
 
 nostic symptom ; and we must then rely upon the combined symp- 
 toms, the remote causes, &c. 
 
 682. d. Such, then, are symptoms which impart a general appre- 
 hension of the nature of disease, or of its variations, &c. They serve 
 as an aggregate of the other attending phenomena, and, in a general 
 sense, should be employed only as starting points to a critical investi- 
 gation of those numerous details which may alone conduct us to a 
 knowledge of the extent and force of disease, its complications, &c. 
 
 683. There are other symptoms which are called prognostic. It is 
 by these, in part, that we judge of the degree of danger, and of the 
 probable issue of disease. Hence arise the X.evms, favorable and Jictal, 
 and various other expressions of an intermediate import. 
 
 684. We acquire our knowledge of symptoms, or deviations from 
 the natural states of the body, by comparing the former with the phe- 
 nomena of the latter; and we distinguish diseases from each other, 
 and learn the changes which are in progress, by comparing symptoms 
 with each other. By the same system of comparison we judge, also, 
 of the effects of remedies, form our prognosis, &c. 
 
 685. It is evident, therefore, that the young practitioner, at least, 
 should acquire a habit of methodical analysis of disease, with a steady 
 view to its pathological cause, and the successive changes which may 
 arise in respect to this cause (§ 673, 675). He should begin, 
 
 1st. With an inquiry into the natural temperament of the subject, 
 his age, habits, &c. 
 
 2d. Make a general survey of the symptoms, the organs from which 
 they spring, their general aspect, number, variety, &c. 
 
 3d. In all cases of severity, the remote causes should be ascertain- 
 ed as far as possible. 
 
 4th. All the great organs should be next critically interrogated, that 
 the primary seat of disease may be ascertained and understood, and 
 how far it may have involved, by reflex nervous actions, other or- 
 gans, both in their compound nature and in their individual tissues 
 (§ 133, &c.), and how far, also, the sympathetic results may react 
 upon the primary disease, or institute morbific reflex influences among 
 themselves. 
 
 This inquiry embraces all the vital signs, the state of the secretions 
 and excretions, and the physical signs afforded by auscultation and 
 percussion. The countenance, the organs of sense, and all that re- 
 lates to the external body, the state of the tongue, pulse, &c., should 
 come under review. 
 
 5th. A careful comparison of all the symptoms should be instituted 
 with the analogous phenomena in health ; with the symptoms of the 
 same disease as it may affect other parts ; with the symptoms as they 
 may have been observed in various degrees and at different stages of 
 the same malady ; with the symptoms of convalescence ; and with 
 Buch as follow the action of medicines ; and with the symptoms of 
 other diseases. 
 
 6th. Inquire into the mode in which the symptoms occur, whether 
 suddenly or gradually, distinctly or confusedly, &c. 
 
 7th. Consider their progress, their changes, the mode of their prog- 
 ress, &c. 
 
 8th. Examine the relation of different symptoms to each other ; as^ 
 their relative duration, order of occurrence, &c.
 
 438 INSTITUTES OF MEDICINE 
 
 9th. Calculate the degree or force of the symptoms; a point of dif 
 ficult attainment, requiring a correct appreciation of the properties ot 
 life, a profound knowledge of physiology, an extensive acquaintance 
 with its modifications in disease, habits of a close analysis of symp- 
 toms, much thought, and a well-disciplined mind. To one thus quali- 
 fied the eye of the patient alone may be a luminous index to the de- 
 gree or force of the general symptoms (§ 163, 714). 
 
 686, a. And now, as a consummation, next to the direct application 
 of remedies, of all that has been hitherto submitted to my reader, as 
 immediately indispensable to the ultimate aim of all that has been said, 
 and without which the Institutes of Medicine would only serve as an 
 intellectual exercise, I shall introduce a practical example, as a gen- 
 eral standard for investigating any given form of disease with a view 
 to its treatment (§ 714). 
 
 686, b. Let us, then, suppose ourselves called to a case of idiopathic 
 fever of some three or four days' duration, in which, from the length 
 of its continuance, there have probably arisen some local inflamma- 
 tions, and, perhaps, venous congestions. 
 
 We proceed, according to the foregoing method (§ 685), to inquire, 
 
 1st. Into some general facts, and take a general survey of the case. 
 AVe inquire how long the patient has been sick, with what symptoms 
 ■he was attacked, what new ones have subsequently sprung up. wheth- 
 er they have undergone an increase in the afternoon, and a decline 
 toward morning, whether the attack was preceded by unusual sen- 
 sations, or by any signs of beginning disease, what is his age, consti- 
 tution, habits, &c. The knowledge thus acquired gives us a general 
 apprehension of the nature of the case, and we come, at once, to the 
 conclusion, that it is a case of idiopathic fever, affecting an individual 
 of a certain age, temperament, habits, &c. This leads us to inquire, 
 
 2d. Into the nature of the pi'edisposing causes (§ 662), and as they 
 are atmospheric (§ 648, b), we ascertain his place of residence for a 
 few preceding months. We find, perhaps, that he has lately come 
 from a city where yellow fever prevailed, or had resided from one to 
 six months ago where typhus was rife, or where it is known to occur, 
 or from one to twelve months since he had been in some marshy dis- 
 trict, or upon some new rich soil, where the remittent fever delights ; 
 or, there may be reason to suppose that the causes originated in the 
 place where he is attacked. A knowledge of any of these facts, 
 whichever may be true, goes far in ascertaining the particular modifi- 
 cation of fever he may suffer (§ 650-653). Let us suppose him an 
 Irish emigrant, just landed in New York. We suspect at once ty- 
 phus fever, though we have no such fever originating with us.* It is 
 a very common form of fever, however, in Ireland ; and we learn far- 
 ther from our patient that it prevailed in his neighborhood when he 
 left that country. This knowledge influences our subsequent inqui- 
 ries, when we proceed, 
 
 3d. To inquire specifically into the symptoms attendant on all the 
 organs, and to compare them with the natuial phenomena of each. 
 We begin where they are most strongly pronounced, and pass from 
 one organ to another as may be suggested by the most obvious symp- 
 toms, or as they may seem to be related by sympathetic influences 
 (§ 6G0). The disease being typhus, the brain, or its membranes, are 
 probably the seat of inflammation or venous congestion. We inquire 
 ♦ See Note S p. 1124.
 
 PATHOLOGY. SYMPTOMS. 439 
 
 as to headache, whether obtuse or acute, in what part of tlio head, 
 &c. ; whether there be drowsiness or wakefuhiess ; whether there bo 
 an unusual pulsation of the carotids, or of the temporal arteries, or 
 an exalted temperature of the head ; whether the face be suffused 
 with blood, and if so, whether the plethora be in the arteries or 
 veins, — being florid in one case and purplish in the other. We look 
 critically at the eyes, observe how their lustJ'e or other expression is 
 affected ; whether the pupil be dilated or contracted, and, if the sight 
 be dim, we inquire whether it be owing to an affection of the ictina, or 
 h )w far to actual cerebral disease or to sympathy of the eyes with any 
 gastro-intestinal derangement; whether the conjunctiva or the eye- 
 lids be red or purplish, whether moist or dry, &c. We attend to the 
 hearing, whether dull or acute ; observe how far speech may be af- 
 fected, and how much any impediment may be due to cerebral disease, 
 or to dryness of the mouth, or to inattention, &:c. These inquiries 
 relative to. the senses should be accompanied by others respecting 
 the mind, whether memory be much affected, perception and reflec- 
 tion impaired, whether there be hallucinations when awake, or talking 
 in sleep, and whether sleep be comatose, or how long continued, &c. 
 These inquiries may leave little doubt that there is both inflammation 
 and venous congestion within the head, which will be cleared up by 
 an investigation of symptoms relative to other organs (§ 803, &c.). 
 Our attention may be next attracted to the chest by cough, or some 
 embarrassment of respiration. We inquire when the cough began, 
 what its frequency and severity, how far it may be independent, in 
 its origin, of other local burdens of disease, or how far consequent 
 on abdominal affections, and whether attended by expectoration, and 
 what the nature of the matter expectorated. We count the respira- 
 tions, and observe their equality or inequality. We see, perhaps, 
 that the brain influences the respiration unfavorably, especially if 
 slow, and this adds to our conviction that mischief exists in the 
 head; or, if the breathing be hurried, it may be due to febrile excite- 
 ment, or to abdominal derangement. The cough and expectoration 
 show us that some inflammatoiy action is going on in the lungs ; but 
 we are doubtful, perhaps, on account of some thoracic pain, and as 
 the sputa is rather adhesive, whether inflammation be confined to the 
 mucous membrane of the bronchi, or have reached the air-cells and 
 cellular tissue, and thus constituting pneumonia. We therefore resort 
 to auscultation and percussion to resolve the doubt. I'^i'om the for- 
 mer we learn that there is no crepitus, that the murmur is clear and 
 free, and there is only a mucous rale ; by percussion, we find that 
 the resonance is good, and we therefore dismiss our fears as to the 
 possible existence of pneumonia, or of tubercle. But the patient 
 complains of pain in his chest. We ask him to breathe dee])ly, and 
 the pain is much increased, as it is also on coughing. From this 
 symptom, and the absence of pneumonia, we are sure of the exist- 
 ence of inflammation in the pleura, while the cough and expectora- 
 tion tell us of catarrhal inflammation in the pulmonary mucous tissue. 
 It is now time to feel of the pulse, to learn how far reflex nervous 
 actions may affect the heart and arteries, since the extent of the influ- 
 ences on tiac circulatory organs may show us considerably the sever- 
 ity of the local inflammations. But this system is also under the influ- 
 ence of the general idiopathic disease, and it is often one of the nicest
 
 440 INSTITUTES OF MEDICINE. 
 
 points to determine how much of its character is due to the febrile af- 
 fection and how much to reflex nervous actions. And the difficul- 
 ty is enhanced if influences are directly propagated abroad by cere- 
 bral disease. We find the pulse, perhaps, not so hard or full as we 
 had expected, and this leads us to infer more of venous congestion 
 than of ordinary inflammation of the brain ; or, that there may be ve- 
 nous congestion in some other organ not yet examined, since these 
 congestions are very apt to spring up in typhus, and to moderate a 
 hardness of the pulse which the coexisting inflammations of the mem- 
 branes of the brain and lungs would otherwise produce (§ 815, &c.). 
 Perhaps we discover, also, in the pulse, some intermission or other 
 irregularity in its stroke. This may be owing to some organic affec- 
 tion of the heart, and to resolve this doubt, we again resort to auscul- 
 tation. We find, however, all the sounds good, and we are now led 
 by the foregoing symptom, along with the subdued hardness of the 
 pulse, and its want of any great incompressibility, to suspect venous 
 congestion of the liver, since intermission and other irregularities of 
 the pulse, without organic disease of the heart, commonly depend 
 upon that state of hepatic disease, though, also, on cerebral inflam- 
 mation ; but in the latter the pulse is more frequent than in the former 
 case, when, also, in the absence of fever, it is often preternaturally 
 slow; or, if slowness of pulse depend on venous congestion of the 
 brain, as it sometimes does, the respiration is also apt to be slow, 
 while it is unaffected in simple hepatic congestion (§ 390, h). We 
 then take the liver next in our range of inquiry. We find, perhaps, 
 some obscure tenderness on pressing its region, and the patient may 
 have had some pain in this quarter. We then look at the skin, to see 
 whether there be any shade of yellow, and when our cathartics oper- 
 ate, we examine the discharges with various references, but partic- 
 ularly as to the state of the visceral secretions. If they are blackish, or 
 green, this strengthens our conclusion as to congestion of the liver, 
 though the congestion may be so profound that little or no bile is se- 
 creted. This condition of the liver, however, is more apt to attend 
 remittent, intermittent, and yellow fevers. We observe whether there 
 be a redundancy of intestinal mucus, as this would denote some in- 
 flammation of the mucous tissue, and has often an important bearing 
 upon the treatment of the case, as does also that irritable state of the 
 intestine which is denoted by the diarrhoea that often supervenes in 
 i\\G progress of typhus fever. We look at the urine, and find it per- 
 haps scanty, scalding, very high-colored, and depositing a sediment. 
 This, however, would imply nothing distinctly, but that the kidneys 
 suffer in their powers and functions, though great scantiness of urine 
 and a high color would denote a considerable burden of disease upon 
 one or more important remote organs, and those particularly the di- 
 gestive organs. We now turn our attention more particularly to the 
 alimentary canal, partly with a reference to its morbid state, and in 
 part to aid our judgment in the right administration of medicines. 
 Here, too, we may find a great focus of disturbing reflex nervous in- 
 fluences radiating from the gastro-intestinal mucous membrane, light- 
 ing up inflammations or congestions of other parts, or maintaining and 
 aggravating such as may have sprung from other causes, and sustain- 
 ing itself reverberated nervous influences (§ 514 h, 647, 889 g). We 
 press, for example, the region of the stomach, to learn whether it be
 
 PATHOLOGY. SYMPTOMS. 441 
 
 tender, and in like manner examine the whole, or special regions, of 
 the abdomen, if there be pain or uneasiness in the intestines, &c., and 
 we make percussion to see if there be flatulency. We inquire what 
 food the patient has recently taken, and whether the bowels have beer, 
 constipated or loose. In all this part of the inquiry we are often great- 
 ly aided by the appearances of the intestinal evacuations, which should 
 be carefully observed throughout the continuance of disease (§ 6945). 
 We also examine the tongue with a reference to several objects, but 
 especially with a view to the condition of the stomach and intestines. 
 We notice its color at its edges and in the centre ; whether coated, and 
 how extensively, and what the color of the coating in its different parts; 
 whether light and loose, smooth or rough ; whether dry or moist, 
 and the extent of each ; whether the tongue be enlarged or conti'acted, 
 pointed or obtuse, smooth or indented at its edges, what its color, &c. 
 We look at the fauces, to learn if they be red or purplish, as indica- 
 tive of inflammation or venous conpcestion, or other derano-ement in the 
 important organs below ; observe whether there be glutinous matter 
 on the teeth, and what its color, and the rapidity with which it may 
 collect. 
 
 We now turn our attention more distinctly than before to the 
 functions of the skin ; whether it be dry or moist, or each alternate- 
 ly, and the duration of each, whether hot, wann, or cold, and at what 
 times, and how long, whether the heat be distributed equally, whether 
 the feet be cold when the rest of the surface is hot, whether the skin 
 be rough or smooth, what its color, whether there be " sudamina," 
 " rose-colored spots,"* &c. 
 
 The patient may require the loss of blood, and we observe its col- 
 or, whether dark or florid, the manner in which it flows from the arm, 
 whether in a full stream or whether it trickle, whether it throw up a 
 buffy coat, be indented or cupped in its centre, or fimbriated at its 
 edges; and, that these observations maybe perfect, we take an ounce 
 in a fumiel-shaped vessel for examination (^ 682 c, 688 ee). 
 
 If, in the case of fever now under examination, there be a predom- 
 inating influence of the venous congestions over the membranous in- 
 flammations, the blood will be dark, will trickle from the arm, or flow 
 in a languid stream, at first, and will throw up a buffy coat, without 
 as much indentation as when membranous inflammation exists with- 
 out venous congestion. 
 
 686, c. The foregoing analysis of symptoms is, to the young practi- 
 tioner, necessary to a clear apprehension of many severe diseases, but 
 must be more or less varied according to the nature of the disease. 
 It may be apparently tedious, but is accomplished with rapidity by a 
 little practice. Nor have I stated all the inquiries which should have 
 been instituted, and which may be of essential moment. Thus, it may 
 be necessary to call irithe aid of smell to ascertain whether any foetor 
 we may observe come from the mouth, or stomach, or lungs, or from 
 the surface of the body. The patient may also supply a variety of 
 facts as to his sensations, — whether restless, weary, prostrated in his 
 voluntary muscles, what as to pain, or sensations of heat, chilliness, 
 &c. We vary his posture, to learn how it may affect respiration, or 
 the state of his pulse. I have also left out of my examination of the 
 
 * See Essay on tho Writings of Louis, in Medical and Physiological Commentaries 
 Tol. ii. p. 724. &c.
 
 4-12 INSTITUTES OF MEDICINE. 
 
 Toregoing case an inquiry as to the mode in which the symptoms took 
 place, — whether suddenly or gradually, distinctly or confusedly, wheth- 
 er they began with a chill, or with a paroxysm of heat, &c., about 
 which the patient should be specifically interrogated. Nor did I ex- 
 amine sufficiently the relation of the different symptoms to each other, 
 as their relative duration, their order of occurrence, &c., by which we 
 ascertain which organ was first inflamed or congested, an<^what oth- 
 ers are more or less affected by reflex nervous action. And there 
 yet remains to be considered the progress of the symptoms, their mode 
 of progress, their spontaneous changes, or such as may arise from in- 
 cidental exciting causes, or from the action of remedies, &c., and, 
 also, their comparison with those of other modifications of fever, or 
 other forms of disease. I said nothing, specifically, as to an inquiry 
 into the degree or force of the symptoms, which is always a subject 
 for accurate consideration, as it goes far in denoting the severity of 
 disease in different parts, and is one important guide to the nature 
 and extent of the remedies. But this is an attainment, as already im- 
 plied, which cannot be imparted by a description of symptoms, since 
 their force cannot be expressed in language. Their estimate must 
 come, as it were, by intuition. Chemistry contributes nothing. 
 
 686, d. In propoition as our knowledge of physiology enlarges, and 
 we apply it to the investigation of disease, the practice of a minute 
 analysis of symptoms becomes less and less necessary. But, to ac- 
 quire this professional tact or skill, we must first go through the 
 school of elementary instruction and practice. But industry will at 
 last triumph, and what seemed at first obscure in diseases may be- 
 come luminous at a comparatively superficial view. We then begin 
 to neglect, more or less, many of the minutiae. We confine ourselves 
 more to the most prominent or characteristic symptoms. The coun- 
 tenance alone may tell us of a labyrinth of disease. But, it will still 
 often happen that no prominent symptoms are present, and it may 
 then be necessary to go into the details ; or they may be so confused 
 and indistinct as to render us undecided as to the seat or the nature 
 of the disease till other symptoms are developed. This may be il- 
 lustrated by the growth of a plant. When it first emerges from the 
 ground it may have no specific characters by which we can determine 
 whether it be destined for a tree or a weed. AVe must therefore 
 await the development of its charactei's, which, if it continue to 
 grow, it will certainly put forth. There is often an obscurity of a like 
 nature in diseases, at their early invasion, and even when jDrofound. 
 The soundest judgment may be baffled in the adaptation of certain 
 remedies; and if these are to be administered internally, especially if 
 active, no risk should be taken, but farther developments awaited. 
 
 OF CERTAIN SPECIAL SYMPTOMS. 
 
 687. It had been my purpose to have limited my remarks to the 
 general principles which respect the present branch of my inquiries. 
 But, in consideration of what I shall say of the pathology and treat- 
 ment of inflammation, venous congestion, and fever, as also on the sub- 
 ject of bloodletting, I have determined to express my own views as 
 to some of the symptoms which take a prominent rank in diseases. It 
 is also my desire to associate the results of disease with the philoso- 
 phy which concerns tiiem, that these important sources of pathological
 
 PATHOLOGY. SYMPTOMS. 443 
 
 knowledge may be studied in connection with those inquiries which 
 distinguish the philosophical physician from the mere empyric (5|, a). 
 
 The Pulse. 
 
 687^. There is one system of organs, particularly, whose motions 
 .ire so constantly affected by reflex nervous actions, and whose phe- 
 nomena are universally employed in estimating the nature, force, &c., 
 of all diseases, and at all stages of their progress, and which are also 
 elementary in denoting the effects of remedies, especially of loss of 
 blood, that I shall make a general analysis of the prominent charac- 
 teristics. We generally learn the influences exerted upon this system 
 of organs by the varying states of the pulse, and the radial artery af- 
 fords the best opportunity for this purpose, though the pulse may be 
 often advantageously examined in other places. Thus, in inflamma- 
 tions and congestions of the brain it is useful to learn how far the 
 pulsation of the carotids may be specifically affected. So, in similar 
 affections of the liver we attend to any unusual pulsation of the aorta 
 in the region of the stomach. In all such cases irritations are apt to 
 be propagated by continuous sympathy along the principal communi- 
 cating arteries, by which their action is more or less increased (§ 498). 
 It may be also important, sometimes, to examine the heart itself, es- 
 pecially when it may be suspected of being the seat of absolute dis- 
 ease ; and, although the pulse be generally regulated by the action of 
 the heart, the arteries, as we have now and before seen, are liable to 
 independent influences, arising from reflex nervous action, and from 
 continuous sympathy. As to the latter, if there be inflammation 
 of the hand or arm, we shall be very likely to find the pulse on that 
 side with greater characteristics of disease than on the other; and 
 differences will arise from mere differences in the size of the arteries. 
 In inflammations and congestions of the brain, the nervous influence 
 will often exert an effect, less marked in similar affections of other 
 organs, upon the capillary vessels, and this effect is sometimes strongly 
 pronounced by an inequality in the radial arteries (§ 929-936, 973, 
 974). In various forms of disease the heart sometimes beats with 
 greater force than is denoted by the pulse at the wrist, and sometimes 
 the pulse is very voluminous without a corresponding action of the 
 heart, according to the nature of reflected nervous actions. — Note Ll. 
 
 688, a. When the radial pulse is examined, the four fingers should 
 be applied along the course of the aitery, and various degrees of 
 pressure should be made. The blood taken for examination should 
 be into a conical wine-glass, and, if possible, in a full stream. 
 
 688, J. Certain general conditions of the pulse worth noticing are 
 the followmg : — its quickness, slowness, frequency, hardness, softness, in- 
 comjyressihility, compressibility , fullness, smallness, strength, weakness, 
 obstruction, freedom, intermission, redoubling, trembling, and other ine- 
 qualities (See an extensive application of all this in § 500 m, 694f , 826 cc). 
 
 688, c. Quickness. — This term does not stand in opposition to slow- 
 ness, although it is genei'ally so considered. Frequency is the opposite 
 o^ slowness. Quickness arises from the systole of the heart occupying 
 less time than its diastole ; so that a quick may be a slow pulse. The 
 stroke is then sudden, the dilatation more prolonged, with an interval 
 somewhat distinct. A. frequent pulse, on the contrary, is always what 
 the term denotes. The systole and diastole of the heart succeed each 
 other rapidly, and in about equal times.
 
 444 INSTITUTES OF MEDICINE. 
 
 A slow pulse is, also, like 2^ frequent one, uniform as it respects the 
 systole and diastole, both of which are prolonged. It is most apt to 
 be attendant on chronic venous congestions, though, as the affection 
 advances, or undergoes any sudden increase, it may hecoxne frequent. 
 When slow in such conditions, the pulse is also often intermittent or 
 otherwise irregular, and if it subsequently become frequent, the irreg- 
 ularities are apt to disappear. Venous congestion is always to be 
 suspected, and especially in the liver, when the pulse is preternatu- 
 rally slow, without other manifest signs of disease (§ 390, b). 
 
 Quickness of pulse is not an important symptom, in a general sense. 
 
 688, d. Hardness and Softness. — These terms stand in opposition to 
 each other. Softness is a natural state, and hardness a morbid one ; 
 though a pulse may be preternaturally soft. Hardness of pulse is one 
 of its most important modifications. In nearly all cases it is indica- 
 tive of inflammation, and no considerable inflammation can exist long 
 without producing it. It appears to depend upon some direct modi- 
 fication of the action of the vessels, and not connected with that of the 
 heart ; the nervous influence being determined in a peculiar manner, 
 by inflammatory affections, upon the whole arterial system (§ 226, 233, 
 973, &c.). The term hardness may be well understood by comparing 
 the sensation to that which is produced by a solid rod rising simulta- 
 neously, and not successively, against the four fingers. 
 
 688, dd. Hardness is often confounded with strength on^ fullness ; 
 but the three symptoms ai-e very different from each other. A Jiard 
 pulse is perfectly compatible with smallness and xoeakness ; the former 
 of which is seen especially in peritoneal inflammation of the intestine, 
 and iu pulmonary consumption ; the latter in unsubdued inflamma- 
 tions after repeated abstractions of blood, and often in congestive fe- 
 vers, and in phlebitis. To distinguish the hardness fully, in these lat- 
 ter cases, requires a careful regulation of the pressure ; scarcely more 
 than a gentle touch with the four fingers. Greater pressure may 
 extinguish the symptom, and the pulse may even appear to be soft. 
 The distinction is often of great importance, especially in congestive 
 diseases, as upon it may depend the decision of those who are apt to 
 be governed by the state of the pulse in the important matter of blood- 
 letting (§ 961-965, 971).— Note Ll p. 1140. 
 
 688, e. Compressibility and Incompressibility. — Incompressibility of 
 pulse is probably peculiar to inflammatory conditions, and one of the 
 most uniform characteristics of the pulse when such conditions disturb 
 the general circulatory system by reflex nervous actions. But when 
 inflammation is fully overcome, especially if general bloodletting have 
 been freely practiced, the pulse is often more easily compressed than 
 in health. So long, however, as the disease continues to affect the 
 general circulatory system, that peculiar characteristic remains, in va- 
 rious det^rees, unless the remedies be very depressing, or the powers 
 of life vero-ino- toward a state of extinction. But, as might be ex- 
 pected fi'om what I have said of hardness of pulse in venous conges- 
 tions, incompressibility is less marked in all forms of venous inflamma- 
 tion than in equal conditions of inflammation of other tissues. Here, 
 too, as with hardness of pulse, the observer is very liable to be deceiv- 
 ed ; since the general volume of the pulse may give way under a slight 
 pressure, and yet the pulse be incompressible (§ 688, d). 
 
 The proper method of ascertaining this symptom, in doubtful cases,
 
 PATHOLOGY. SYMPTOMS. 445 
 
 is to make a hard pressure with one finger, and a moderate pressure 
 with another on the distant side, when a thread-like stream will be 
 felt by that finger. It depends upon reflected nervous influence. 
 
 Hardness and incompressibility generally demand the loss of blood ; 
 though whether local or general, and the necessary extent, must be 
 determined by other symptoms ; the extent, especially, by the effects 
 produced during the operation of general bloodletting (§ 826 cc). 
 
 688, ee. Coincident with Jiardness and incompressibilitij of pulse, 
 and almost peculiar to inflammation, is the huffrj coat, with its depress- 
 ed centre, and often fimbriated edges. The buff" which forms on the 
 blood in pregnancy is due to the increased vascular action of the ute- 
 rus, and a modification of its vital properties not very dissimilar to 
 what obtains in some varieties of inflammation, and which predis- 
 poses to those active forms of the disease which so often beset the 
 uterus and other parts in the early stages of childbed ; and should the 
 indented centre and fimbriated edge make their appearance, we shall 
 scarcely fail of deriving farther confirmation of the actual presence of 
 inflammation in an attendant hardness and incompressibility of the 
 pulse, and probably, also, in some local symptoms. And so of the 
 buff" which is sometimes apparently consequent on violent exercise ; 
 but more probably dependent upon some obscure inflammation. We 
 may not trust, in these rare instances, to the carelessness of many 
 observers, and the incapacity of others, while the fact should not be 
 neglected that this exception to a significant indication for loss of 
 blood has been raised by such as are adverse to the use of the lancet 
 in the treatment of inflammation (§ 826 cc, 952, 1020-1024). 
 
 The indentation, or cupping, is generally less strongly pronounced 
 after each abstraction of blood, and may disappear altogether, under 
 the lancet, before the inflammation is subdued (§ 952 b). 
 
 The fimbriated edge is most common where inflammation is se- 
 vere, and has established a strong reflex nervous action upon the 
 general circulatory system. In such cases, also, it will often continue 
 to occur after the cupping ceases to be formed. 
 
 Like hardness and incompressibility of the pulse, the buffing and 
 cupping of blood, for reasons already stated, are less ptrongly marked 
 in venous congestions than in membranous inflammations. 
 
 The formation of the buff", and the central depression, and the fim- 
 briated edge, ai'e remarkably aff"ected by the shape of the vessel, and 
 by the manner in which the blood flows from the veins. A shallow 
 vessel is the worst, the form of a funnel is the best. 
 
 688, yi Fullness and Smallness of pulse. — These terms are also in 
 opposition, and both may imply a preternatural state of the pulse, 
 being now employed in their morbid acceptations. Fullness is also 
 synonymous with largeness. 
 
 These morbid states of the pulse are owing to reflex nervous ac- 
 tions determined both upon the heart and arteries. The extent of 
 these influences, in that respect, is very variable, and must be judged 
 of by direct examination of the pulse at the heart and extremities. 
 
 It does not necessarily follow that an unusual quantity of blood is 
 sent out by the heart, since the volume of the arteries may depend 
 greatly upon a direct expansion of the vessels. So in a small pulse, 
 the direct morbid influences may be more upon the arteries than 
 upon the heart, by which the vessels are held in a contracted state.
 
 446 INSTITUTES OF MEDICINE. 
 
 This is especially seen in the cold, stage of fever, and in peritoneal 
 enteritis. Tt is also seen in the depressing states of venous con- 
 gestion. In all such cases an influence is propagated from the arte- 
 ries to the heart, by which, as well as by other influences, its actior 
 is accelerated ; or, if not accelerated, then the blood accumulates ir 
 the venous system, especially about the right cavities of the heart. 
 In all these cases there are profound reflex nervous actions well 
 worthy an inquiring mind (§ 222, &c., 514 d, k, I, 914-919, 929-936, 
 973, 974). 
 
 Smallness of pulse is generally a much more important symptom 
 than fullness ; commonly implying the presence of greater evil. 
 Connected with hardness, it is always bad, when it is also Jrequent. 
 
 688, g. Strength and Weakness. — I have already remarked that 
 these symptoms are often mistaken for Jiardness and softness. They 
 depend, principally, upon reflex nervous actions that are exerted 
 upon the heart by remote organs, though certainly not altogether. 
 It is doubtful, indeed, whether morbid reflex nervous actions are ever 
 exerted upon the heart without being simultaneously extended, more 
 or less, to the arteries ; especially to the capillary series (§ 481-485, 
 973, 974). But, all parts of any one division of the arterial system 
 may not be equally affected, or one part may be sensibly affected and 
 not the rest, as in blushing, when the nervous influence is direct. 
 
 688, h. Obstruction and Freedom. — Obstruction is an obscure con- 
 dition of the pulse which it is difficult to describe, but is recognized 
 in practice. It is not easy to know its cause, as it probably does not 
 actually arise from any obstacle to the passage of the blood, though 
 it may be owing to a want of harmony between the action of the 
 heart and the capillary blood-vessels (§ 386). 
 
 688, i. Frequency and Slowness. — These are two very important 
 symptoms in some of their morbid aspects, and are often replete with 
 information, especially as to the force of disease and the degree of 
 danger. 
 
 To ascertain these characters, the patient, for obvious reasons, 
 should be at rest ; and if a child, should be asleep. 
 
 No writer has so well described the conclusions to be derived from 
 ^frequent and slow pulse as Di*. Heberden, in his " Commentaries." 
 From their importance, and as I cannot improve Heberden's descrip- 
 tion, I shall quote it. 
 
 " The pulse of a healthy infant asleep," he says, " on the day of 
 its biith, is between 130 and 140 in a minute; and the mean rate of 
 the first month is 120. I have never found it beat slower than 108. 
 During the fii'st year, the limits may be fixed at 108 and 120. For 
 the second year at 90 and 108. For the third year at 80 and 100. 
 The same will very nearly serve for the fourth, fifth, and sixth years. 
 In the seventh year the pulsations will be sometimes so few as 72, 
 though generally more ; and in the twelfth year they will often be not 
 more than 70 ; and, therefore (except only that they are much more 
 easily quickened by illness, or any other cause), they will differ but 
 little from the healthy pulse of an adult, the range of which is from 
 a little below 60 to a little above 80. It must be remembered that 
 the pulse becomes more frequent, by 10 or 12 in a minute, after a full 
 meal. [Miiller, remarkably, states the same rates]. 
 
 " If the pulse either of a child, or an adult, be quickened so as to
 
 PATHOLOGY. SYMPTOMS. 447 
 
 exceed the utmost healthy Umit by 10 in a minute, it is an indication 
 of some little disorder. But a child is so irritable, that, during the 
 first year, a very slight fever will make the artery beat 140 times, and 
 it may beat even 160 times without danger [Heberden meaning either 
 idiopathic fever, or the constitutional effects of inflammation] ; and, as 
 there begins to be some difficulty in counting the pulse when the mo- 
 tion is so rapid, the thirst, quickness of breathing, aversion to food, 
 and, above all, the want of sleep, enable us, better than the pulse, to 
 judge of the degree of disease in infants. 
 
 " If the pulse of a child be 15 or 20 below the lowest limit of the 
 natural standard, and there be, at the same time, signs of a considera- 
 ole illness, it is a certain indication that the brain is affected, and con- 
 sequently such a quiet pulse, instead of giving us hope, should alarm 
 us with the probability of imminent danger. 
 
 [An important exception to the foregoing remark is frequently pre- 
 sented by venous congestions of the liver, when 'the pulse may be 
 equally diminished in frequency, but not indicative of present danger.] 
 
 " In adults ill of an inflammatory fever, the danger is generally not 
 very gr-eat where the beats are fewer than 100 ; — 120 shows the be- 
 ginning of danger ; and they seldom exceed this number unattended 
 with some deliriousness. There are two exceptions to this observa- 
 tion. The first is, that before some critical swelling or deposit of 
 matter begins to show itself in fevers, the pulse may be so rapid and 
 indistinct, as hardly to admit of being counted ; and I have known it 
 certainly not less than 130, and yet the patient has recovered. And 
 rheumatism affords a second exception ; in which the artery will often 
 beat above 120 times without any sort of danger. 
 
 [Those exceptions are relative to inflammation as limited to parts 
 unimportant to organic life. They are presented, also, in other in- 
 stances of this natui-e, and in intermittent fever.] 
 
 " In an illness where the pulse all at once becomes quiet, from be- 
 ing much accelerated, while all the other bad signs are aggravated, it 
 is a proof, not of a decrease of the disorder, but of the lessened irrita- 
 bility of the patient, and that the brain has become involved in the 
 disease. 
 
 " In low fevers, and in exhausted old men, the pulse will often con- 
 tinue below 100, or even 90, and yet the disease be attended with 
 want of sleep, deliriousness, restlessness, and a parched tongue, and 
 end in death, without any comatose or lethargic appearances. 
 
 " A pulse increased in frequency more certainly denotes danger 
 than a natural one does security, where disorders of the viscera are 
 suspected." 
 
 Finally, in countries where local congestions of the liver occur, as 
 in the regions of intermittent and remittent fever, the pulse often falls, 
 in hepatic congestions, far below its natural frequency. Considered 
 abstractedly in these cases, and often in the preceding, it affords but 
 little information as to the force of disease. There may be great dan- 
 ger, or but very little, when the pulse is slow in hepatic congestions,' 
 and all other symptoms obscurely marked ; but if the slowness be 
 supported by restlessness, sighing, thirst, wakefulness, &c., the dan- 
 ger is great. 
 
 A good pulse, excepting a moderate hardness, and incompressibil- 
 ity, as sometimes happens in pneumonia, may be attended with great
 
 448 INSTITUTES OF MEDICINE. 
 
 danger, which can only be inferred from other syraptorcs. Indeed, 1 
 may say in a universal sense, that the state of the pulse alone should 
 rarely guide our conclusions, either as to the force of disease, or its 
 treatment. The circulatory organs are so readily and variously dis- 
 turbed by the nervous influence, and that influence so constantly gen- 
 erated by physical and mental causes, that disease offers but few oppor- 
 tunities when the pulse may be safely trusted for the just application 
 of remedies without the support of other symptoms (§ 826 cc, 829).* 
 
 688, /.;. Intermission. — An intermitting pulse arises from an abrupt 
 suspension of a pulsation of the heart. It is not an alarming symptom, 
 unless it depend upon some organic affection of the heart, or some 
 disease of the brain. It is a frequent attendant upon venous conges- 
 tions of the liver, and often presents itself for the first time after the 
 patient becomes convalescent, and may continue till the flesh and 
 strength are restored. It is most apt to appear when the pulse is also 
 preternaturally slow, and frequently vanishes temporarily if the circu- 
 lation happen to be accelerated by transient causes, or a great irreg- 
 ularity of the pulse may be the temporary consequence. Its philoso- 
 phy is explained in a foregoing section (§ 390, h). 
 
 688, I. Irregularities of pulse. — These consist of iiTegularities in its 
 successive beats, redoublings, trembling, hobbling, &c., and are rarely 
 of much importance unless proceeding, as in cases of intermission, 
 from organic affections of the heart, or disease of the bi'ain. 
 
 The Tongue. 
 
 689, a. We will now turn a brief attention to the morbid appear- 
 ances of the tongue. It is by these, and the secreted products, that 
 we obtain our most direct intelligence from the internal viscera, 
 though other less sensible results may be more significant of the na- 
 ture and force of disease. 
 
 689, h. The tongue is covered by a secreting membrane, whose 
 action is liable to great and various changes, and which are attended 
 by visible results. In its healthy state this membrane is covered by 
 a thin fluid, which is partly composed of its own mucous product, 
 and, in part, of saliva. The natural color of the tongue is a light 
 florid hue, and it is studded with short minute papillae, particularly 
 at its edges. In disease these appearances are apt to undergo va- 
 rious changes ; the tongue being often covered more or less exten- 
 sively with a coat of variable hues, white, yellow, brown, or black, 
 barely attached, or closely adherent, rough or smooth, &c. At other 
 times the organ is preternaturally red or livid, dry or moist, enlarged 
 or contracted, pointed or obtuse, its natural coat thickened or appa- 
 rently scraped off", or covered with patches, vermiform marks, &c., its 
 edges jagged, the papillae enlarged and elevated, &c. These condi- 
 tions depend upon various modifications of the organic functions of 
 the tongue ; and as the organ is not much liable to independent dis- 
 ease, it is obvious that its morbid aspects are mostly sympathetic re- 
 sults ; and from its being continuous with the alimentary canal and 
 the lungs, morbific influences are readily propagated upon it from 
 either of its remote connections {%). But, the vital relations of the 
 tongue to the alimentary canal are far greater than to the lungs, 
 though not strongly pronounced in health ; and as intestinal derange- 
 ments are more common than pulmonary, a far greater proportion of 
 * Note Ll p. 1140.
 
 PATHOLOGY. SYMPTOMS. 449 
 
 the morbid and intense influences from these two sources are exerted 
 by abdominal disease (§ 129 i, 135, 142). — See Index II, Art. Tongue. 
 
 689, c. The coating which forms upon the tongue may consist 
 mostly of mucus, or of a substance resembling coagulable lymph, or 
 intermixtures of both, in various proportions, and of a morbid char- 
 acter. 
 
 689, d. All the phases which the tongue is liable to undergo may 
 be influenced by the peculiar constitution of the patient, though in a 
 general sense, where the constitution is sound, these appearances are 
 less subject to the contingencies of temperament than many other 
 symptoms, 
 
 689, €. We often observe, under various circumstances of disease, 
 that the coating has suddenly disappeared, and we may be led into 
 error in consequence, since, in many of these cases, the coating has 
 been removed by the mechanical friction of food, 
 
 689, y^ It would be in vain to attempt a definition of the vai'ious 
 changes in the aspect of the tongue which are produced by disease, 
 according to its nature and seat, accidental causes, &c. The appear- 
 ances may vary much under apparently the same conditions ; and it 
 is not one symptom alone which may attend the tongue, but the 
 whole in combination, that must guide our judgment. It is important, 
 also, to observe that the tongue may be veiy natural in profound dis- 
 eases, even of the alimentary canal and liver; but as observation 
 enlarges, and the depths of physiology are explored, we shall find 
 the morbid sims of the tonijue a luminous index of disease. 
 
 689, g. But, there is one remark more important than the rest ; 
 namely, that there are no other symptoms which borrow so much 
 light from others as those which relate to the tongue ; while, in their 
 turn, they reflect back a light upon the other symptoms. Inflamma- 
 tions of various parts, and idiopathic fevers, at their onset may pre- 
 sent nearly the same appearance of that organ, especially as it regards 
 the coating. The general symptoms now contribute largely in deter- 
 mining the import of the tongue ; though we shall generally find, on 
 close inspection, that not only each class of diseases will offer certain 
 peculiarities in the morbid aspects of the tongue, but as inflammation 
 may affect one important organ or another ; and the appearances will 
 vary in the early stages of idiopathic fever as the burden of disease 
 may happen to be distributed. In the progress of the same affections, 
 the tongue is continually fluctuating in the indications it may supply. 
 
 689, h. The disappearance of the coating in fevers and inflamma- 
 tions generally begins at the edges of the tongue, and is commonly 
 indicative of an improvement of health, though not always. When 
 these exceptions occur some other morbid appearance is apt to fol- 
 low immediately ; as preternatural redness, or nakedness, or dryness, 
 &c. If indicative of improvement the tongue commonly clears up 
 fast, along with other auspicious changes ; though it will be frequently 
 kept up, more or less, by remaining though slight visceral derange- 
 ments in the abdomen. 
 
 689, i. Absolute diseases of the digestive organs affect the tongue 
 more variously and distinctly than other parts ; according to their 
 nature, seat, intensity, duration, peculiarities of constitution, habits, 
 &c. (§ 129 i, 142). In indolent affections of the stomach, a thick, 
 dirty, yellow coat, easily scraped off" in part, appears particularly 
 
 Ff
 
 450 INSTITUTES OP MEDICINE. 
 
 toward the root of the tongue ; when, also, the tongue often becomes 
 furrowed, or covered with patches of various forms, indented at its 
 edges, or apthee arise ; the coat, too, varying according to the varying 
 states of the intestinal canal, or of the liver, &c. 
 
 689, ii. If the tongue be very red, it denotes more or less active in- 
 flammation of some part of the intestinal mucous tissue ; and if also 
 dry, and especially if at the same time denuded, it shows inflammation 
 of greater intensity in that membrane. A tongue preternatu rally 
 naked, even if moist, and of no great redness, shows moderate or sub- 
 inflammation of the mucous tract ; probably of the small intestine. A 
 livid tongue shows venous congestion of the alimentary mucous mem- 
 brane, and probably also of the liver. It is always indicative of for- 
 midable disease. — See Index IT, Art. Tongue, Heart, Kidney, Pulse. 
 
 689. I. In connection with the foregoing subject I may advert to an 
 inflammatory state of the mucous tissue of the fauces which ensuea 
 upon congestive affections of the chylopoietic viscera, and which is too 
 often regarded as an independent disease, and treated accordingly. 
 But, the condition of which I speak is so comparatively unimportant 
 with the primary affection upon which it depends, and is so often sig 
 nificant of the force of obscure, but dangerous forms of abdominal con 
 gestion, especially of the liver and intestinal mucous tissue, that 1 
 would rather place it among the symptoms than designate it, in its 
 true chaiacter, as a sympathetic form of disease. This inflammatory 
 affection is commonly of an erysipelatous nature, attended by more 
 or less tumefax;tion of the tissue, and often of the tonsils. It varies 
 greatly in intensity, and presents different hues from bright scarlet 
 to livid ; the latter being the worst, and denoting a profound and dan- 
 gerous modification of venous congestion (§ 813-816). In its worst 
 Ibrms, the throat is quite liable to ulceration, and often to sloughing. 
 In the latter case it is commonly denominated the " putrid sore throat," 
 and, most unhappily, this symptom, as it were, has been extensively 
 regarded as the main disease. These appearances of the throat are 
 also a common attendant on bad forms of scarlatina, and are due to 
 profound congestion of the liver and intestinal mucous tissue, associ- 
 ated, more or less, with a peculiarly modified form of inflammation 
 of the same tissue {§ 803, 816 b). The whole of this secondary evil 
 is, abstractedly, of little comparative moment, and is analogous in its 
 import to those forms of erysipelas which affect the surface when this 
 symptom is epidemic (§ 463 a, 523, no. 7, 630 e, 713, 961 a, 970 c).* 
 
 Secretions and Excretions. 
 
 690. The secreted and excreted products, which fall under the cog- 
 nizance of the practitioner, are messengers of intelligence either di- 
 rectly from the citadel of disease, or from organs which participate 
 sympathetically with affections of other parts, or which may scarcely 
 do more than minister to the general wants of the body. They are, 
 therefore, to be received according to their several degrees of impor- 
 tance. They consist of urine, sweat, mucus, and the alvine discharges. 
 
 691. Tlbc Urine. — No product is so variable as the urine, both in 
 health and disease. The kidneys, being designed for great and im- 
 mediate common purposes in the animal economy, in depurating the 
 blood, or in transiently fulfilling the office of the skin, &c., are render- 
 ed highly sensitive to the presence of ledundances in the blood, and 
 
 * Such, also, is equally true of the various phases of Bretonneau's Diphthkijia, and 
 which is generally considered a local or a humoral attection. — Noxic Kk p. 1140.
 
 PATHOLOGY. SYMPTOMS. 451 
 
 to the variable states of other parts, especially of the skin, whose anal- 
 ogous office is so liable to interruption. The same Great Intelligence, 
 which ordained these final causes, also endowed the kidneys with a 
 stability of function unknown to other parts (excepting the heart, for a 
 like principle), where irritability is easily impressed. Being, there- 
 fore, but little subject to actual disease, the variable product of the 
 kidneys commonly supplies only a report of the nature of the ingesta, 
 or of the influences which the skin or other parts, and even the mind, 
 may exert upon these organs in a healthy state, or of the n^utable 
 states of the body in regard to nutrition, or of any disturbing reflex 
 influences, short of disease, which may be extended to the kidneys by 
 diseases of other parts (§ 426). It is thence obvious, that but little 
 dependence, in a general sense, can be placed upon the sensible 
 changes of the urine as indicative of the nature or force of disease ; 
 and I bave endeavored to show, here and elsewhere, that we may 
 rarely trust to chemical analyses of this product (§ 417, 427). Be- 
 yond a transient inspection, occasional evaporation is about all that 
 we require, unless, also, some practicable test in calculous affections. 
 The aspects of the urine become more important in renal diseases, 
 and in those of the bladder. Albuminous urine appears in organic 
 affections of the kidneys, in dropsy, and after pastry and other indi- 
 gestible food, and is produced by mercury and cantbarides. It is evi- 
 dent, therefore, that the presence of albumen, about which so much 
 has been written, indicates nothing specifically, unless supported by 
 other symptoms (§ 421-427. Also, Medical and Physiological Com- 
 mentaries, vol. i., p. 674-682). — Vide Lehmann, p. 780. 
 
 A sensation like that of strangury is often felt when the urine is 
 high-colored and scanty. This is commonly owing to abdominal dis- 
 ease ; particularly hepatic congestion. 
 
 692, a. Sweat. — The perspirable matter is the least important of 
 any of the tangible products of disease, unless as it respects the 
 amount of sweat in its connection with the other attending symptoms, 
 or as significant of the effects of certain remedial agents. Not much 
 can be inferred from its quality, and this little is gathered from its 
 taste and odor. Dryness of the skin is oftener an important charac- 
 ter ; and it is usually one of the best signs supplied by the skin when 
 its dryness yields spontaneously. Perspiration induced by medicine 
 is of little moment, unless the remedy simultaneously impresses, di- 
 rectly or indirectly, the parts diseased ; and then the salutary results, 
 so far as the surface is concerned, depend upon special vital influen- 
 ces exerted by the remedy upon the skin, and reacting sympathies. 
 This is exemplified by the profound effects of tartarized antimony 
 and ipecacuanha, the uselessness of hot water, and the frequent per- 
 nicious results of the compound powder of ipecacuanha, when free 
 perspiration may follow the administration of either (§ 514, h). The 
 effect, therefore, upon disease depends but very little upon the evacu- 
 ation from the skin, as produced by what are called sudorifics ; but 
 upon the peculiar action which may determine the evacuation, and its 
 consequent alterative reflex nervous influences. And this, by-the- 
 way (for these opportunities may not be neglected), shows us the 
 futility of the chemical hypothesis of the formation of the secretions.* 
 
 692, b. Though sweating be generally a symptom of good omen, 
 it may be one of the worst. Thus, a person suddenly falls down, in- 
 * See Note D p. 1114.
 
 452 INSTITUTES OF MEDICINE. 
 
 sensiolo, and copious perspiration ensues. It may be death from hem- 
 orrhage, or from a sudden cessation of the action of the heart, or it 
 may be temporary syncope. Again, profuse perspiration often ap- 
 pears suddenly in protracted stages of disease. If the other symp- 
 toms are bad, the sweating is still more so. In these cases the pulse 
 is generally small and rapid. But it sometimes denotes the near ex- 
 tinction of life when the pulse gives no sign of danger, and the sweat- 
 ing may be even considered favorable if the whole circumstances of 
 the case be not carefully weighed. — A viscid state of the perspiration 
 is commonly significant of great force of disease. In some fatal cases 
 of the cholera asphyxia there was only an insensible perspiration, 
 throughout (In my "Cholera Asphyxia of New York,'" 1832). 
 
 693. Mucus. — The mucous tissue being every where more or less 
 exposed to irritating agents is naturally protected by mucus, as the 
 skin is by the cuticle ; but only in quantity sufficient to cover the sur- 
 face of the membrane. When, thei-efore, it is continuously discharged 
 from the nose, expectorated from the lungs, or voided by the intes- 
 tine, bladder, or uterus, it denotes a morbid state of the tissue ; and 
 that state is of an inflammatory nature. This is plain enough in re- 
 spect to the nose, throat, lungs, and bladder; but the analogy is neg- 
 lected in relation to the intestine, where it often supplies an impor- 
 tant indication in the absence of other prominent signs of inflamma- 
 tion. This morbid organic product is liable to great varieties in its 
 appearance and properties, each one of which depends upon a spe- 
 cial modification of inflammatory action (§ 409 h, 410, 415, 682 b). 
 Its exact condition will also conform to the natural modifications of 
 the vital properties of that portion of the tissue which may be the seat 
 of disease. Hence, in part, the varieties attending the morbid condi- 
 tions of mucus, as it may proceed from the eye, nose, throat, lungs, 
 and intestine (§ 133-135, 682 h). 
 
 Unlike the excrementitious products urine and sweat, the product of 
 the mucous tissue, like all other organic compounds, is uniformly the 
 same in health in the same parts of the tissue, nor is it liable, like the 
 former, to undergo chemical changes as soon as secreted (§ 417). Its 
 morbid changes are determined by the same precise laws as is its nat- 
 ural condition, and therefore each change depends upon some pre- 
 cise accidental modification of the vital properties and actions, and ac- 
 cording to their natural modification in the part from which the dis- 
 charge may proceed. Could we, therefore, always ascertain the pre- 
 cise character of its morbid changes we should arrive as nearly as 
 possible at the particular condition of the existing disease (§ 237, 
 682 b. Also, Med. and Physiolog. Comvi., vol. ii., p. 197, note). 
 
 694, a. Alvine Discharges. — The fasces consist of the superfluities 
 of food, and the remains of various secreted products which are pour- 
 ed into the intestine from the liver, salivary and pancreatic glands, 
 and mucous tissue. But, neither the bile, nor saliva, nor intestinal 
 mucus, nor the gastric juice, appear in the fteces in their natural 
 state. Combined, however, with the fasces, they offer a general natu- 
 ral standard for comparison with the morbid conditions. 
 
 694, b. In disease, the foregoing natural conditions as to quantity 
 and quality of the secretions, and the state of the residual food, are 
 more or less affected, according to the nature of the morbid states 
 which may attend the various parts concerned in digestion. From the
 
 PATHOLOGY. SYMPTOMS. 453 
 
 number of organs, therefore, that are liable to be simultaneously in- 
 volved in morbid processes, and which contribute their fluids to the 
 alvine dejections, as well as the imperfect changes which the food 
 undergoes in the stomach, it would seem more difiicult than it is, in 
 reality, to derive any just conclusions as to the nature of disease fron:» 
 the condition of the faeces. 
 
 The following are the most important signs to be noticed in the al- 
 vine discharges : 
 
 1st. The Residual Food. — This gives us intelligence as to the state 
 of the stomach. It is mainly important in chronic affections of that 
 organ, or during convalescence from acute disease ; since, till the subsi- 
 dence of acute diseases, the food should consist mostly of fluids, wheth- 
 er the stomach be the direct seat of the affection, or disturbed by re- 
 flex nervous actions, or liable to irritation from solid food in the absence 
 of those conditions (§ 512, 514 h, &c.). We may be thus guided, also, 
 as to the food which should be avoided. 
 
 2d. The nature a?id quantity of the matter discharged. — This, in 
 acute diseases, will consist, principally, of the secreted fluids, which, 
 so far as produced, may cease to be in any way appropriated, and ac- 
 cumulate in the intestine, though much, in respect to the apparent ac- 
 cumulation, may be due to the absence of residual food with which 
 the secreted products are habitually intermixed. Their deficiency, 
 during the operation of a cathartic, denotes severe disease in the or- 
 gans of digestion, especially the glandular, or that an unsuitable ca- 
 thartic has been applied. If the evacuation be large, watery, and col- 
 orless, the cathartic was bad. It has irritated, morbidly, the intestinal 
 mucous tissue, has not reached the glandular function of the liver, or 
 may have propagated injurious influences upon that organ. If a ju- 
 dicious cathartic have been employed, and not in excess, and mucus 
 alone follow, it shows inflammation of the intestinal mucous tissue, and 
 disordered action, probably congestion, of the liver (§ 693), which will 
 be aggravated by a repetition of cathartics till the disease be lessened 
 by other remedies ; of which general bloodletting, leeching, and blis- 
 tering, are the principal. Or delay of all remedies may be suflScient 
 (§ 856, a). Again, a redundavaj of bile may be either unfavorable or 
 favorable, and its proper interpretation may depend upon a variety of 
 considerations ; such as color, the period and past history of the dis- 
 ease, the general and local vital signs, the nature of the remedies, es- 
 pecially of the cathartic, employed, &c. 
 
 When the bile is redundant, the mucus is apt to be at least natural 
 in quantity, and when the latter is in excess the bile is commonly de- 
 ficient, since, in the latter case, the formation of bile is diminished by 
 morbific reflex nervous actions propagated upon the liver by the 
 mucous tissue. It is the same as when morbidly-irritating cathartics 
 diminish or stop the secretion of bile. And here I will say, that I am 
 far from meaning alone what are denominated the drastic cathartics ; 
 since calomel, blue pill, and even the neutral salts, may be more mor- 
 bific in a given state of disease than scammony, colocynth, aloes, and 
 especially jalap, in doses of corresponding energy (§ 889 g). 
 
 When tiie secreted products increase after having sustained a dimi- 
 nution, the sign is, perhaps, always favorable ; but how far so will de- 
 pend upon other symptoms, and upon the amount which is due to 
 nature. In some hepatic congestions cathartic? procure but small
 
 454 INSTITUTES OF MEDICINE, 
 
 evacuations till the disease is considerably overcome. The secretions 
 then start, become abundant, long continued, and a salutary bilious 
 diarrhoea sometimes sets in. The same is also true of jaundice, 
 whether arising from disease of the liver, or from obstruction by gall- 
 stones. 
 
 3d. The appearance of the fecal matter as to coIo7\ — This is a very 
 important index in many respects. We should distinguish carefully, 
 however, what may be owing to color of food, or what may be im- 
 parted by medicine, from that which is morbid. 
 
 If the discharges be light it shows a suspended secretion of bile, 
 which may be owing to the irritation of an improper cathartic, or to 
 inflammation of the intestinal mucous tissue, or to inflammation or 
 congestion of the liver, or to jaundice, &c., and the other symptoms 
 will clear up our knowledge upon the subject. In all these cases, as 
 disease gives way the bile is secreted in redundance, is apt, at first, 
 to be blackish, or of a deep gi-een, then changing to brown, or to a 
 dark yellow, till it finally becomes of a lightish yellow. 
 
 Calomel and acids ai-e very generally supposed to render the bile 
 green. This they will do when mixed with the bile out of the body; 
 but this chemical effect is counteracted by vital resistances afforded in 
 the intestinal canal, just as putrefaction is arrested in food by the 
 same agencies (§ 339, h). No quantity of calomel will impart a 
 green color to the discharges of a healthy subject, nor will any acids; 
 being an inquiry which I have sufficiently submitted to experiment. 
 When, also, the bile becomes redundant and yellow during the de- 
 cline of abdominal disease neither calomel nor acids will affect its 
 hue, unless a morbid irritation be produced. At the onset of disease 
 there may be no green appearance of the dejections till calomel or 
 blue pill be given ; but the reason is, that, till then, the secretion of 
 bile was suspended, and what was accumulated in the gall-bladder is 
 now dislodged. The mercurial agents excite the liver and it pours 
 out its morbid product; or, if they aggravate the existing hepatic de- 
 rangement the green may be increased by this vital influence of the 
 agents, or the secretion of bile may be wholly arrested. 
 
 It is important to do away with these misapprehensions ; since they 
 lead us to regard what is truly an important symptom of disease as 
 the mere result of accident. The experiments, also, oict of the body 
 show us how fallacious are all such pursuits (§ 1058 b). 
 
 The worst appearance of the bile, ^?er sc, whether vomited or de- 
 jected, is a bluish color. It shows severe and obstinate congestion 
 of the liver. Bloody mucus denotes more intense inflammation of 
 the intestinal mucous tissue than a redundancy of simple mucus (§ 
 693). It shows dysentery if attended with pain and tenesmus. Hem- 
 oiThage from the bowels or stomach denotes venous congestion and 
 inflammation of the mucous tissue in most cases ; though now and 
 then in congestive fevers the hemon-hage comes from the liver. In 
 all the cases it is an effort of nature to relieve a very formidable con- 
 dition of disease (§ 805. Also, Med. and Phys. Comm., vol. i., p. 
 371-384; vol. ii., p. 546-566). 
 
 4th. Of the sensations produced by the fecal discharges on passing 
 the anus. — These are mostly of a burning or excoriating nature and 
 denote either the presence of a morbid condition of the bile, or of 
 acids that are generated by the decomposition of food. The suff'Br-
 
 PHYSIOLOGY. SYMPTOMS. 455 
 
 ing, liowr.ver, generally arises from an acrimony of the bile. Aloes 
 will, doubtless, produce irritation of the anus in some degi'ee ; but, 
 when consequent on the use of that medicine, it arises mostly from 
 the bile which aloes is particularly instrumental in eliciting from the 
 liver ; while its sympathetic irritation of that organ will also increase 
 the morbid acridity of the bile. The fact is practically important, as 
 will be readily seen from its bearing upon our conceptions of disease, 
 and of the virtues of remedial agents (^ 1063 b). 
 
 694|. From what has been now said, it is evident that the dejec- 
 tions should be always examined in all diseases of any severity and 
 obstinacy ; and, if produced by a cathartic, they should be all exam- 
 ined, and each one in the order in which it may take place. Thia is 
 the only way of practicing medicine intelligibly. The evacuations 
 often supply more information as to the state of the abdominal viscera 
 than all other symptoms. I say, therefore, when cathartics operate, 
 it is often important to examine the dejections in the order in which 
 they may take place. The first may consist only of the faeces result- 
 ing from food, and of secretions which had not assumed a morbid as- 
 pect. With this partial inquiry, as is often the case, we may conclude 
 that all is right with the abdominal viscera, or that they are in a state 
 to bear any violent remedies we may choose to exhibit for other pur- 
 poses. But, on inspecting the second dejection, we may find it like 
 chopped grass, or of a black, pitchy aspect. This brings us to the 
 conclusion that mischief prevails at the fountain of life. What was 
 evacuated at this second discharge was perhaps nearly the whole 
 contents of the intestinal canal ; and what may be evacuated at the 
 third, or fourth, or farther dejections, will have been secreted after 
 each successive evacuation. 
 
 If any salutary changes, then, be exerted by the continued opera- 
 tion of cathartics, we shall be likely to discover them in the color and 
 other appearances of the discharges, as they come away one after an- 
 other. If they remain without change more work is to be done. 
 
 694|. It appears, therefore, that modifications of mucus, wheresoever 
 it occurs, and of the component parts of the alvine discharges, are essen- 
 tially different from the morbid phenomena attending the pulse, the 
 tongue, and the urine, as indicative of the nature and force of disease. 
 The first being the direct results of organs morbidly affected are critic- 
 ally significant of the pathological conditions (§ 741 b). The last three, 
 when the organs are not the seats of absolute disease, are indirect me- 
 dia which denote the intensity and modifications of the nervous influence 
 that may be reflected upon the organs by diseases of other parts. In 
 our ordinary investigations of symptoms, therefore, which relate to 
 the tongue, the circulatory organs, and the kidneys, we are employed, 
 however unconsciously, in estimating the relative conditions of reflected 
 nervous influence, and by which Ave judge of the nature of the patholog- 
 ical conditions in which these influences originate ; although in respect 
 to the tongue its morbid phenomena may be more or less owing to con- 
 tinuous sympathy in affections of the alimentary mucous tissue (§ 498 f, 
 500 m, 526 a, 715-719). And yet this is the great field of Humoralism. 
 
 This analysis may serve the useful purpose of drawing attention, for 
 the first time, to the philosophy of the subject, and thus contribute to- 
 ward an understanding of the same philosophy as it respects diseases 
 which grow out of each other, and the operation of morbific and reme- 
 dial agents (§ 826 cc, 961 a, 970 c).
 
 456 INSTITUTES OP MEDICINE. 
 
 PATHOLOGICAL INDICATIONS FROM MORBIE 
 ANATOMY. 
 
 695. Lesions of organization, and all deviations from natural condi- 
 tions which occur during life and are obvious to the sensos after 
 death, are embraced under the denomination of morbid anatomy. 
 
 696. All the foregoing results are owing to the pathological states 
 which essentially constitute disease, and would not, therefore, ensue, 
 could disease be removed soon after its invasion, or in its formative 
 stage (§ 639, &c.). It is a great object of art to prevent their occur- 
 rence, or, as it is termed in the treatment of inflammation, to effect a 
 resolution of disease. 
 
 697. Morbid anatomy has been pursued with various opinions as to 
 its relative value to the vital signs of disease. Those who have re- 
 garded it of paramount importance have entertained but very limited 
 views in physiology, or of the laws of disease. They have always 
 considered the organ which was most frequently altered in its condi- 
 tion as the great primary seat of disease, and the cause of all the oth- 
 er lesions and phenomena, and even the cause of death. This doc- 
 trine, and its fallacies, I have considered very extensively in an Essay 
 on the writings of Louis, and in another article devoted specifically to 
 the inquiry ; both of which appear in the Medical and Physiological 
 Commentaries. 
 
 698. Morbid anatomy is indebted to Bichat for its rank in science, 
 by whom it was cultivated in its most philosophical aspects. It was 
 this great man who first employed it, extensively, in illustrating phys- 
 iological and pathological problems; but more especially did he con- 
 vert the living phenomena of disease to the uses of physiology. 
 
 The fruits which were thus gathered from morbid anatomy ap- 
 peared to represent the field as a terra incognita, where great discov- 
 eries were to be made, and, therefore, great fame to be realized. The 
 older pathologists were either unknown, or crowded aside ; while the 
 very ground which they had gone over was brought forward as new- 
 ly-discovered land. The multitude lost sight of disease in its vital as 
 pects, and undertook a system of pathology out of the last wrecks ot 
 disease ; not unfrequently confounding the results of putrefaction with 
 those of vital actions. Such was the general state of this branch ot 
 science, upon which, also, humoralism had again reared its venerable 
 form, along with many other physical and chemical doctrines, when 1 
 undertook their systematic examination. Nor do I say this in a spirit 
 of arrogance, but as simply due to the philosophy which I have en- 
 deavored to defend. — See Rights of Authors, p. 912. 
 
 699. a. There has constantly been, however, a group of medical 
 philosophers who have remained ti'ue to nature ; and the profession, 
 therefore, split into two classes, taking the names of the Hippocratic 
 and the Necroscopic or Anatomical schools. The Hippocratists are 
 observers of Nature in all her aspects ; while the Necroscopists only 
 contemplate her ruins. 
 
 699, h. The Hippocratists maintain that Nature is most significant 
 of her existing conditions while those conditions actually exist, and
 
 PATHOLOGY. MORBID ANATOMY. 457 
 
 that we may better infer the nature of present causes by their imme- 
 diate effects, than by the effects of other causes which may happen a 
 week, or a month, or a year afterward. 
 
 699, c. The Necroscopic or Anatomical school maintain exactly the 
 reverse of the foregoing. If, for example, a case of inflammation of 
 she lungs occur, they allow no satisfactory conclusions as to the nature 
 of the disease till the patient is dead, and it can be seen whether there 
 be certain morbid changes of structure, or certain physical products, 
 which they assume as necessary to constitute inflammation. " In this 
 country," says the British and Foreign Medical Review, " few would 
 be disposed to admit that inflammation had existed, unless some of 
 its known products were brought forward as proofs." If, therefore, a 
 patient die of inflammation in its formative stage, and before any of 
 its peculiar products take place, it is contended that there was no in- 
 flammation, however violent and characteristic may have been the vi- 
 tal signs. Hence it is assumed that the cause of death, in cases of 
 that nature, is wholly unknown (§ 748), or, "they are like inflaroma- 
 tion, yet totally differe7iV (§ 1024 d). The London Lancet has a more 
 proximate philosojjhy. Thus : •' Inflammation consists in this, name- 
 ly, that the fibrin, Sec, which should pass firo??i the arterial into the 
 lymphatic system, [ ! ] passes into the venous. The true nature of 
 inflammation lies in the above few words" (April 8, 1843). 
 
 A few of the most eminent of the Necroscopic school have exploded 
 inflammation as a disease. This is extensively true of Louis, and uni- 
 versally so of Magendie and Andral ; the last of whom affirms that 
 " it is like an old worn-out coin, which ought to be discarded from 
 circulation" (§ 753). Of fever, he says, " The progress of science has 
 induced me not to devote, as in the former edition, a special volume 
 to fevers." — "Singular 'progress' that!" exclaims Cayol ; "a few 
 such steps, and medical science would be down at zero" (§ 740 b, 
 744). The distinguished Travers, in commenting upon the Anatomi- 
 cal school, especially its corruptions in France, remarks that, " out of 
 the debris of the dead subject, however accurately inspected, examin- 
 ed, and arranged, to attempt a solution of the great problem of living 
 actions, and to build upon such a foundation an edifice of pathology of 
 self-support, is as injurious a fallacy, and scarcely less arrogant and 
 absurd, than that of the Cartesian Philosophers, who undertook, out of 
 the depth of their anatomical sagacity, to make a man." — Note F. 
 
 699, d. Again, in another case where there may have been a suc- 
 cession of inflammations in different organs, and, although one or more 
 in the series shall have entirely subsided, but the real cause of all that 
 followed,' it is assumed by the Necroscopic school that the last in the 
 series had been the cause of all the phenomena from the beginning 
 of the complaint. Such, indeed, as well as the preceding doctrines 
 (§ 699, c), is the natural result of that large school of materialism 
 which pretends to discover in the structure of organs, even in their 
 molecules, the various conditions of hfe, and all its diversified phe- 
 nomena (§ 131). 
 
 700, a. Take any case, in the wide range of diseases, and ere its 
 termination, it may present many new problems for the pathologist. 
 It may have lost its original character, or its variations may consist of 
 such modifications of a common pathological cause, that the cure shall 
 require alternations of opposite remedies. Every pathological change
 
 458 INSTITUTES OF MEDICINE. 
 
 IS ascertained through the direct phenomena, and is a far more diffi- 
 cult effort than the primary conditions. Morbid anatomy contributes 
 nothing through all the intermediate changes ; and what, tnerefore, is 
 its positive benefit in any given case of disease at its invasion or ter- 
 mination if it supply us nothing throughout its progress ] The whole 
 matter is settled before morbid anatomy can yield its light ; and Na- 
 ture would have been untrue to herself had she left her dependence 
 upon art to her own ruins. 
 
 700. 1). The physical products of disease can, at best, only denote 
 the nature of an antecedent functional action in which the essence of 
 the disease consists, and which has more or less terminated in the 
 particular part when the lesions of structure and morbid depositions 
 have taken place (§ 732 J, 863). On the contrai-y, if disease consist 
 in structural lesions, or other physical products, to what practical re- 
 sult does morbid anatomy conduct us, if it inculcate such a doctrine? 
 Organic lesions, and often preternatural formations, are to the physi- 
 cian what they are to nature, — ulterior results ; and they are equally 
 unacceptable to both. If the positive symptoms of inflammation are 
 to be set aside from want of some of its terminations, or even of vas- 
 cularity, the foundation of practical medicine will be swept away, and 
 clinical lectures should be confined to the dissecting-room (§ 730 
 732 I). 
 
 701. Morbid anatomy, as taught by the materialist school, has pre- 
 cluded all regard for those pathological conditions upon which the 
 lesions of structure and physical products truly depend, and about 
 which the art of medicine is mainly interested. In its indiscriminate 
 career, indeed, it cuts off all diseases except such as are known to the 
 vitalist under the name of inflammation, and to which he refers those 
 lesions of organic action and those new formations which alone en- 
 gage the school of materialism. But the vitalist believes that " it is a 
 rule of no small moment, in acute diseases," as expressed by Senac, 
 " that there may be great disorder in the functions of the body without 
 real inflammation, or any Jixed disease in the solid parts. Yet these 
 parts, which have experienced such deep and distressing affections, 
 may, in a short time, be entirely relieved." " At the termination of 
 a paroxysm of malignant fever, the terrible symptoms abate, and often- 
 times disappear." 
 
 702. Morbid anatomy has not, in an original sense, ever given us a 
 solitaiy clew to the pathology of disease, any more than healthy anat- 
 omy to the natural organic functions. We revert, at last, to the vital 
 indications, or other immediate results, for this knowledge. The local 
 symptoms are often an unerring guide, and many which spring from 
 reflex nervous actions, where morbid anatomy professes nothing, yield 
 also their flood of light. We analyze the whole group of phenome- 
 na, and, by the aid of experience and principles, we go to the work 
 of cure without a doubt or hesitation. There is no other mode of 
 practicing medicine. Or, suppose the anatomist to attempt a thera- 
 peutical application of his own materialism, physiological and patho- 
 loo-ical ; could he even begin to consider the condition of disease, or 
 the nature of its treatment (^ 500 m, 5Uf-m, 6471, 694^, 904 «, 990^ a)l 
 
 703. The legitimate objects of morbid anatomy are to expound the 
 sensible changes which may take place in the instruments of morbid 
 action, the lesions of structure, and other new formations, which may
 
 PATHOLOGY. MORBID ANATOMY. 459 
 
 supervene upon disease. These it associates with what had been de- 
 termined by the phenomena during life as to the essential patho- 
 logical conditions; and, when doubtful cases may arise, from the ab- 
 sence of symptoms, should the physical results occur which have been 
 found to be the regular sequelee of certain known pathological states, 
 it is then that morbid anatomy reflects its posthumous light with vari- 
 ous degrees of importance. Yet certain it is that morbid anatomy 
 can be of no advantage, so long as the symptoms, the true indices of 
 disease, may be absent in any subsequent cases of the same nature, 
 till the patient is again subjected to the scrutiny of the scalpel. 
 
 All physical results stand as the ultimate signs that a certain mode 
 of action had existed, since these aj*e the consequences of that action, 
 of which the vital signs had been the attendants, and which had form- 
 ed the sole ground of that pathological induction, which, after a seiies 
 of observations, the physical products illustrate, and are taken merely 
 as an indication that these vital signs, the basis of pathological induc- 
 tions, had been present. 
 
 704. It is manifest, therefore, that the materialism inculcated by 
 morbid anatomy destroys all rational attempts at pathological induc- 
 tions during the treatment of disease; since, if the true import of the 
 vital signs depend upon the ultimate contingency supposed, no jusl 
 conclusions can be formed, either as to the nature of disease, or tho 
 mode of treatment, till the patient is dead. This, it will be allowed, 
 is repugnant to reason ; from which it will follow that the premises 
 are wrong, and that true pathology reposes upon the vital emanations 
 of disease (§ 756, i).— Note F p. 1114. 
 
 705, a. It is, then, upon the symptoms of disease, its remote causes, 
 and the effects of remedies, that we are to depend in reaching all 
 practical knowledge of any individual case, and, therefore, all cases 
 of disease. But, since the physical products of disease which are 
 comprised under morbid anatomy are the results of the same prop- 
 erties and actions upon which the vital phenomena depend, they 
 form an ultimate and subordinate source of information ; and since 
 they concur, more or less, with the primary remote causes of disease 
 in ultimately modifying the phenomena, it is important to know, as far 
 as may be, the extent of their influence in this respect. 
 
 705, h. I may say, therefore, that the greatest practical use of mor- 
 bid anatomy is the knowledge it supplies of the tendency of certain 
 pathological conditions to result in the formation of physical products, 
 or in disorganization ; thus giving that direction and energy to prac- 
 tice that may be necessary to counteract the supervention of these 
 deplorable consequences of disease. A second important practical 
 advantage is the discrimination which morbid anatomy enables us 
 to make between those phenomena which are the result of simple 
 morbid conditions, and such as depend upon, or are modified by, the 
 supervention of physical products. 
 
 706. Morbid anatomy can never alter the general principles which 
 it may have assisted in forming. When, for example, the nature of 
 common inflammation is ascertained in one part, principles are estab- 
 lished which are applicable to this disease in all other pai'ts, and at 
 all times, and under all circumstances. The varieties must be ascer. 
 tained by interrogating the particular phenomena in each individual 
 case, and the treatment adapted accordingly. The great principles
 
 460 INSTITUTES OF MEDICINE. 
 
 will, of course, be always under the modifying influence of the phe- 
 nomena from which they have been deduced, according as the princi- 
 pal phenomena may fluctuate. 
 
 707. When the structure of parts becomes deranged, or the proper- 
 ties of life are verging toward an extinction, we have totally a new 
 order of things. Pathological principles are then upon the decline, 
 and thei'apeutics is more or less afloat, and without compass, on the 
 broad ocean of experiment. The organic being is fundamentally 
 changed in his structure, and the laws by which he is naturally gov- 
 erned are more or less broken up. And I may also add, without in- 
 tending to discourage its legitimate pursuit, that here it is that mor- 
 bid anatomy begins, and has reared its pathological fabric on the ru- 
 ins of organization. 
 
 708. Whenever morbid anatomy has been in the ascendant, the 
 practice of medicine has been either experimental and empyrical, or 
 lias run into a mere system of " watching," or what was anciently 
 denominated " a meditation upon death." We need only turn to the 
 present state of medicine in the Capital of France for a melancholy 
 exemplification of what I now state, and which I have set forth ex- 
 tensively in my Essay on the Writings of Louis. 
 
 709. The foregoing section leads me to a review of the past, and 
 to inquire how far events have justified jny former conclusions as to 
 the superiority of American practice, and of American medical edu- 
 cation, over European, as expressed in my Essay on the Comparative 
 Merils of the Hippocratic and Anatomical Schools. I had deprecated 
 more especially the corruptions of French medical philosophy, and 
 was led to remark, that, " already our young men are crowding the 
 schools of the French Metropolis in pursuit of a more thorough 
 knowledge of morbid anatomy; and immuring themselves within the 
 walls of Parisian hospitals, to contemplate the worst ravages of dis- 
 ease upon subjects of broken-down constitutions, and who have pass- 
 ed the ordeal, of French hospital practice. They return home with 
 Gallic pathology, and the results of Gallic therapeutics, which they 
 could not realize in their own country, and will never witness again 
 but by carrying out the principles which have supplied them with their 
 means of information." — Note W p. 1127. 
 
 It is true that a few have been not a little employed in dissemina- 
 ting these corruptions in this stable land of sound medical philoso- 
 phy ; but, nevertheless, I am still able to repeat, that, " What Amer- 
 icans have received from the devotees of Morbid Anatomy, or from 
 such as would make Chemistry the basis of organic science, has only 
 tended to show them more distinctly, that the phenomena of life, in 
 their various relations, are the true foundation of principles in med- 
 icine" (§ 350-350f, 744, 821, 830). 
 
 And now, having obtained the requisite permission from one ven- 
 erable in years, profound in science, and long eminent as an ex- 
 pounder and teacher of medicine, and practically familiar with Euro- 
 pean habits, I shall here subjoin an extract from a letter which he 
 did me the honor of addressing to myself, from Louisville, Ky.. 
 April 5th, 1846.* I am immediately prompted to this step by the 
 
 * In alluding to my Defense of the Medical Profession of the United States, 
 Professor Caldwell goes on to remark that, 
 
 " On perhaps every part of your unsparing career throughout your task, from begin
 
 PATHOLOGY. MORBID ANATOMY. 461 
 
 manner in which the Medical Profession of the United States has 
 been lately presented to the World by the Medical Society of the 
 State of New York, in the hope that I may be thus instrumental in 
 
 ning to end, my sentiments accompany you, and probably on one, at least, leave j'ou a 
 little in the rear. I allude to the practical superiority -which the physicians of our own 
 country hold, in general, over those of Europe, and I presume also, of course, of every 
 other portion of the globe. 
 
 " Respecting the treatment of chronic complaints I forbear to speak ; because my knowl- 
 ede:e on that point is less full and thorough, and therefore my opinion less positive. But, 
 in their rational, skillful, bold, and successful treatment of acute diseases, particularly of 
 the classes _/efrres and phlegmasia;, the physicians of the United States are incomparably 
 superior to any Europeans whose practice I have either witnessed in person, or read of 
 in books. That this is true in relation to American complaints cannot be denied. Nor, 
 in my opinion, is it less true in respect to those of transatlantic counti-ies. 
 
 " Of all the physicians in Europe of whom I have any knowledge to be relied upon, I 
 am most partial to the practice of certain Dublin gentlemen, and of those in some parts of 
 Italy. In their treatment of disease they have often reminded me of home. And of all 
 the practice I have ever witnessed, that of Paris is the most inefficient and miserable. 
 Yet is it this Parisian school in which American pupils are most anxious and proud to be 
 educated, and to which they are advised to repair ; and most unwisely and inconsiderate- 
 ly advised. As far as the practice of medicine is concerned, if they do not there learn how 
 to kill the sick themselves, they learn, or may learn, to perfection, the art of allowing 
 their complaints to kill them. Never have I witnessed in Paris a single well-directed 
 Herculean blow attempted in a case of fever. The battle was always fought in a Lillipu- 
 tian manner. Nor, were I to say the same in relation to Enghsh and Scotch practice, 
 would it be easy to refute the assertion. It is a well-known ti-uth, that European phy- 
 sicians of every nation, who migrate to America, are, on their first removal, incompetent 
 to the successful treatment of the complaints of the country ; nor can any thing but expe- 
 lience render them competent to it. 
 
 " It is undeniable, that the physicians of Europe are, in the mass, very far from being 
 an able and elevated body of men. Strike off the few, I might say the comparatively 
 very few, who alone give lustre and standing to the profession, and the remaining ' mill- 
 ion' will be found to be positively and strikingly the reverse ; a very ordinary body, pos- 
 sessing not an element of distinction on the ground of either talent or attainments. And 
 the same is true in relation to the pupils whom I have seen in attendance on the Euro- 
 pean schools. A majority of them, which may be called vast, are, in appearance, far infe- 
 rior to the pupils of our own schools. Nor have I the least reason to believe them much 
 if any less, inferior in mind than they are in person. In proof of this, the American pu- 
 pils, whom I have seen in attendance on foreign schools of medicine, were, in no ordinary 
 degree, the finest young men belonging to the classes ; the foremost, I mean, in everj' es- 
 sential attribute of standing. Of this they were themselves confident and proud ; and so 
 was I. 
 
 " It is not true, then, that the mass of physicians in Europe are, in any respect, superior 
 to the mass in the United States. In their treatment of disease, I fearlessly repeat that 
 they are decidedly inferior. On each side of the Atlantic, the icest not less than the east, 
 there exist in the Faculty the eminent feio, who, in talents and knowledge, are nearly on 
 a par; the Americans, however, being at once the most efficient, most rational, and most 
 successful practitioners. 
 
 " Wliile I yield to no one, tlierefore, in the estimate I place on the leading physicians 
 of Europe, I cannot admit that those of the United States are in any respect their inferi- 
 ors. And I should deem myself unworthy my birth-right, were I not to discountenance 
 the wordy tirade poured out so superabundantly in certain quarters, in disparagement of 
 the education and standing of the great body of American physicians. 
 
 "For the inferiority of the mass of European physicians a plain and substantial reason 
 may be assigned : they are enslaved by precedent and trammeled in mind, and are not, 
 therefore, independent thinkers. And I need hardly add, where independecce of thought 
 is wanting, so are vigor and efficacy of thought." 
 
 " An overwhelming majoritj' of the physicians of Europe reside and practice in country 
 places, villages, and small towns. And, as already alleged, they ai-e, ab origine, more or 
 less of an interior caste. Their education is also mferior. Hence, conscious of their inferior- 
 \ty, they look upward for fight and direction, sni follow those whom they acknowledge as 
 their superiors. In tliis they but conform to the European /as/iion, according to which the 
 lower orders of society do a sort of homage to the higher, and walk in their footsteps. So 
 ti-ue is all this that there are few, if any, medical commoners in the Old "World, who venture 
 to think in any other way than by authority of some writer or teacher; whom they obey 
 and adhere to as retainers do to their feudal lords. I need hardly subjoin, that in a con- 
 dition so humiliating, it is impossible for physicians to rise to eminence. 
 
 " Much of this, however, you have yourself stated in your ' Defense of the Profession,' or 
 elsewhere. But I am not apprized of your having stated that the American youth caa be 
 much better educated in their own countjy than in any foreign one. Yet is the fact un- 
 questionably true. I mean that it is a jact, and not a nan-ow-minded, selfish assertion, 
 l^e real proximate elements of medicine are more thoroughly taught in some American
 
 462 INSTITUTES OF MEDICINE. 
 
 obliterating unmerited reproach, and in inspiring ray medical couii 
 rxymen with that consciousness of worth, and self-respect, and self- 
 dependence, which they are so eminently entitled to enjoy. 
 
 schools, than in any European ones I have ever visited. This is especially true in rela- 
 tion to the Principles or Philosophy of medicine ; without an acquaintance with which 
 the practice of the profession is rank quackery." 
 
 I have no disposition to pursue the foregoing subject beyond what may seem expedient 
 for the defensive purposes which common justice urges upon an injured right. The scope 
 of rsmark is therefore designed to extend far beyond those domestic relations which might 
 be adjusted without foreign aid. But our own self-reproach was not the offspring of con- 
 scious degradation. It was but the sequel of disdain which prospective greatness never 
 fails to encounter on its triumphant march. The aspersions of the mother-country had 
 been received in the dignity of silence, and they who midertook the game at home calcu- 
 lated to win through an imaginary acquiescence in foreign diplomacy and an accustomed 
 non-resistance. All that was noble in our land had been the subject of unmitigated scorn ; 
 and so it progressed under the blandishments of diplomatic skill. I will not point, in tes- 
 timony of this, to the " London Q,uarterly," or political, or other journals of inferior note ; 
 but that which has reigned supreme in the world of letters unfolds an amount of proof at 
 which Honor and Humanity hang their heads in shame. The blows have not fallen upon 
 the imbecile and weak. That is the coward's work, and would have yielded nothing to 
 the final cause. A nation has been the intended victim, and therefore a nation's pride 
 has been the target. The critique upon Channing in that National work, the Edinburgh 
 Review, for April, 1839, is alone enough to dishonor any country, at any age. 
 
 I shall, therefore, briefly sustain the foregoing comparative estimate of the Medical Pro- 
 fession, in a limited application to "the Mother-Country." I complain not of any other; 
 and revere the ancestor as a fading luminary, of the largest macrnitude, whose resplen- 
 dent light has only passed into other regions to advance the welfare of other worlds. I 
 shall sustain the comparison, I say, by a quotation of one of many analogous comments 
 that have lately appeared in a medical work which may be regarded as the oracle of the 
 British Profession, — the London Lancet. — Note W p. 1127. 
 
 In speaking of the existing state of medicine in Great Britain, and after representing 
 British '• works on pathology and the practice of medicine as deficient in originality and 
 richness of materials," the veteran editor aims his Lancet at the very foundation. "Look," 
 he saj-s, " at the state of British pathology ! Of what does the great majority of our books 
 en this subject consist ? Of compilations ; of old views cooked up as new discoveries ; of 
 annotated translations; or, at best, of able and comprehensive digests of materials that were 
 already before the public in other forms." — London Lancet, May 6, 1843. And may I not 
 adduce, in support of the Lancet, what I have said in former sections of the reference 
 and suirender of British medicine to the laboratory of a German chemist (§ 349, d, 376j, 
 676, 878)?' 
 
 ShaU Americans, therefore, go on to decry the efforts of their own medical scholars, 
 degrade the whole profession of their own country, and sacrifice their own medical litera- 
 tiu-e for what is conceded to be the present medical literature of Great Britain? It is 
 not mine to complain of British critics for promulgating what could not be concealed ; and, 
 doubtless, it is the only remedy for professional apathy, the only stimulus to " medical re- 
 form," the only motive for " Parliamentary action," and the only means of extending edu- 
 cation and of rescuing the practice of medicine from the hands of " apothecaries." 
 
 There has been no occasion for vindictive motive ; which never fails to tarnish truth or 
 poUsh error. The common ends of life are known to all, and each in his place, in the scale 
 of conscience, weighs, to the weight of a thought, the right and the wrong. What was 
 once true is true forever ; and nothing has stood the test of truth hke the great elements 
 of national decline. In vain do we point to our former greatness, and call for help upon 
 the past. The very power of example is gone. What was noble, was virtuous, was 
 intellectual has passed to other regions, is cherished and honored in other chmes. It is 
 lost only to the land of its birth. 
 
 While, therefore, we adopt whatever is valuable from abroad, let us have a literature 
 of our own, based upon American observation, American industry, and American genius. 
 But, as I formerly said, let us remember the admonitions of history, that, when nations 
 have begim to trample upon the past, to reject its experience, and to stiike out new sys- 
 tems of observing Nature, it has been the most certain presage of approaching imbecility, 
 and of that ultimate fall to which all are destined. When the great revolution shall have 
 reached the Genius of Philosophy — " to Kpariarov r?;f (JtAoffo^iCf" — the last vial of wrath is 
 emptied, and that nation is irretrievably gone. This is humiliating to pride, and may have 
 been designed as one of its correctives. But since it is so in the great plan of Providence, 
 it must be sufficiently obvious, tiiat, as a nation approaches its chaotic state, those who 
 may be in the ascendant are bound neither to counteract the order of nature, nor to suf- 
 fer their own prosperity to be blighted by the mildew. Ambition must follow the beaten 
 path of philosophy. 'The denunciation of past experience is the ambition of egotism, which 
 erects its innovations upon error, and imbues them with superstition and absurdities. 
 
 I say, therefore, let us have, at least, a medical hterature of our own. There is noth- 
 ing that will contribute like it to the nationality of Americans, nothing that will inspire so 
 extensively the culture of other sciences, promote the advancement and refinement of tiie 
 
 1 T/ie Lo.NDON Lancet will concede that alt thins) remain in statu quo, I860.— Firft Note, p. 617.
 
 PATHOLOGY. MOllBID ANATOMY. 463 
 
 Other, and perhaps I should say more important objects, are con- 
 templated by this note, and which form no small part of the interests 
 of medicine. They are the same which I have had uninterruptedly 
 in view. They are those which are intended to designate the conse- 
 quences of spurious systems. Those systems and their results must be 
 displayed; and that, too, in connection with what may be designed as 
 substitutes. Nor is there any inquiry in which this method is so in- 
 dispensable as in the philosophy of medicine. Truth would never 
 obtain, till the " lion shall lay down with the lamb," unless the In-, 
 stitutes of Organic Nature are presented in forcible contrast with the 
 devices of art. It has been tried from the day when Hippocrates 
 evolved the philosophy of medicine from Nature herself, and dragged 
 it from the midst of error and superstition. It has been tried, I say, 
 in vain. The present times bear me witness of the fact. The mind 
 must enjoy ready means of comparison. Nay, more, the compar- 
 isons must be planned, matured, logical, and irresistible. Such, only, 
 can give stability to medicine ; can, only, illustrate and enforce the 
 truth. I have made the attempt : I do but say a humble attempt. 
 I design it as an example for more able pens ; and ever consistent 
 and firm in the views which I have now expressed, I would cheer- 
 fully become, upon my own method, the victim of a better philosophy. 
 I would have corruptions, speculations of all kind, swept with an un- 
 sparing hand from the tablet of organic nature ; and while, therefore, 
 whatever I may have attempted shall remain unrefuted, uninvalidated, 
 or however it may receive approval, or be condemned without " the 
 ordinary prerogative of being presumed to be true until the contrary 
 is clearly shown" (§ 376f , a), I shall suffer the method of inquiry to 
 remain undisturbed, the exposures of error to hold firm their places, 
 in any future editions of this work ; that they may unceasingly con- 
 tribute to their original objects, and admonish the pretender, that some 
 one more competent to the task may fasten upon him a universal 
 verdict of guilt. They will therefore remain, as a safeguard to med- 
 icine, till the corruptions be shown to bear on their front the broad 
 seal of Nature.* 
 
 useful and ornamental arts, nothing that will so effectually confirm and cany forward that 
 elevated rank which the Medical Profession of the United States have already won for 
 themselves in the hearts of their countrymen. We have, indeed, already the foundation 
 of such a literature in the multifarious writin2:s of the hard-thinking men of America ; and 
 it is this very literature, and the general dissemination of knowledge in the American 
 Medical Profession, their indomitable industry, their well-directed skill, and their discreet 
 and dignified bearing, which give them higher rank, greater influence in society, than any 
 other class. Look where we may, we shall be likely to find the medical man foremost in 
 enterprise, turning night into day, leading in measures for the public health and for its 
 general prosperity, curbing the impetuosity of error and superstition, rearing and conse- 
 crating temples to the Divinities of Health wherever a dozen worshipers can be found, 
 and stretching out an influence which awakens all the elements of learning and industry. 
 It is the Profession alone which is not true to itself 
 
 In all tliat I have now said, I may not be suspected of undue partialit'.es, for I am un- 
 der no obligation to any portion of my profession in America, or of the American Repub- 
 lic ; while I am actuated by the deepest sense of gratitude to some foreign countries that 
 can be inspired in a man of literary habits. To those countries I am the more indebted 
 as they are always just to my native land, do honor to her scholars, and are the great' 
 abodes of leanimg and philosophj'. Nevertheless, in all the instances I have endeavored 
 to speak according to my convictions of the truth, and the demands of my subjects ; ever 
 sacrificing self to those pi-imary objects. If there may seem to have been asperity, I 
 trust it will be found in the facts themselves, and in the unavoidable nature of the coa- 
 clusions at which I have arrived. 
 
 * The subject of Mkuical Educatiox, and the great superiority of the sj-stem pur- 
 sued in the United States over that of Great Britain, was resumed in a series of seven- 
 teen numbers, which I contributed (but which appeared editorially) to the New York 
 Medical Press (from Jan. 29th to June 4th, 1859), founded upou Parliamentary doc'ls.
 
 464 INSTITUTES OF MEDICINE. 
 
 INFLAMMATION AND FEVER. 
 
 710, a. I PROCEED to illustrate the most important principles in med- 
 icine by considering those which are especially relative to inflarmna- 
 tion audi fever ; the two orders of disease, indeed, which make up the 
 .great amount of human maladies, and form the great outlets of life. 
 The few diseases which do not fall under one or the other of the fore- 
 going denominations are least important in a practical sense, and least 
 understood in their pathology. Nevertheless, a knowledge of the 
 principles which apply to the pathology of inflammation and fever 
 will greatly aid our interpretation of the essential changes which con- 
 stitute the pathological conditions of other affections. 
 
 710. b. Inflammation and fever have been generally regarded as 
 one disease, and they who have considered them distinct affections 
 have offered no analysis by which their individuality may be estab- 
 lished, and by which each complaint may be readily distinguished in 
 practice. Important evils to the sick are therefore in constant prog- 
 ress from this source alone ; and when there is added to it the entire 
 darkness in which venous congestion has been shrouded, both in its 
 absolute pathology and as it modifies fever and the recognized forms 
 of inflammation, it may be safely said that a vast opening is here pre- 
 sented for the improvement of medical philosophy, and for the com- 
 mon welfare of man (§ 787, Rights of Authors, p. 919, nos. 27, 28). 
 
 INFLAMMATION. 
 
 711. I shall first state the outlines of inflammation, and its essential 
 pathological characters ; from which it will be seen that it takes its 
 rise in purely physiological conditions, and holds its progress and de- 
 cline under the same great natural laws of the constitution (§ 137, 
 149-152, 638). 
 
 712. Unlike idiopathic fever, which is a universal disease of the 
 body, inflammation is always local (§ 143, 148). Fever, however, is 
 often complicated with inflammation of one or more organs at or near 
 its commencement, and the local disease may precede the constitu- 
 tional one, and even become the exciting, though not \\~\e predisposing, 
 cause of it (§ 645, 650, 651, 653). More frequently, however, inflam- 
 mations spi'ing up during the progress of idiopathic fever, and often 
 attack and disoi-ganize many important parts in rapid succession. 
 Indeed, it is rare that fever exists long without this greater foe 
 making its appearance, and adding seriously to the difficulties and 
 dangers of the case (§ 779). 
 
 713. Owing to the foregoing complications the capital mistake is 
 often made of regarding the local affection as the essential or predis- 
 posing cause of the constitutional fever. Such pathologists assume, 
 of course, that there is no distinction between fever and inflammation, 
 and that both, therefore, are equally and always local diseases. But 
 this is not the doctrine of those who depend less on morbid anatomy, 
 and study Nature in her living aspects (§ 699). The single symptom 
 which has given to fever its name has been a main cause of the con- 
 fusion which prevails upon this subject {§ 657 h, 764, &c.).
 
 PATHOLOGY. INFLAMMATION DESCraPTION. 465 
 
 714. Inflammations of much activity generally disturb, but very va- 
 riously, the functions of many distant organs ; but the results from 
 their reflected nervous actions have mostly a different pathological 
 condition from the primary disease, and such as are truly inflamma- 
 tory are limited to a few parts ; while all parts are affected in fever, 
 and with pathological conditions more or less alike. 
 
 In chronic inflammations sympathies are more slowly and less ex- 
 tensively produced, or not at all where more acute fonns would occa- 
 sion great constitutional disturbance; even when the brain or other 
 impor);ant organs may be the seat of the chronic variety (§ 140). 
 
 Acute inflammation, on the other hand, is prone to give rise, at its 
 early stage, to what is called Jebrile action, or Jever (§ 134, 139, 140, 
 150). But this kind of " fever" is purely sympathetic, never pre- 
 cedes the local affection, and is mostly remarkable for a simple ex 
 citement of the heart and arteries ; while in idiopathic fever, the 
 most violent excitement often takes place without any appreciable 
 antecedent local complaint, but simultaneously with the general ex- 
 citement all the oi'gans appear to have become involved in a morbid 
 process ; and now, also, inflammation may as suddenly supervene (§ 
 143 h, 148). The febrile condition proves an exciting cause of the 
 other mode of disease in some part predisposed to the inflammatory 
 process (§ 4751-488^ 500 m, 514/, 674 d, 903, 904 a, 990^). 
 
 It appears, therefore, that great confusion has prevailed upon this 
 all-impoitant subject, and that causes have been mistaken for effects, 
 and effects for causes. The excitement of the heart and arteries at- 
 tendant on inffamraation appears to have engrossed attention, inquiry 
 to have stopped short as to all other organs, and a comparison to have 
 been alone made between the general arterial excitement of inffam- 
 mation and that which is attendant on fever. In one affection the 
 general excitement may be almost the only element of disease beyond 
 the local cause ; in the other it is only one of a great number of 
 elements distributed throughout the body (§ 487 h, 500 ?/?, 686, 694f). 
 
 Again, it is fundamental with inflammation that the sympathetic 
 development of general arterial excitement will subside as soon as the 
 local inflammation, or primary cause, is removed ; but, in fever the 
 whole disease continues after the original cause is removed. The or- 
 gans of circulation may be long subject to very high degrees of ex- 
 citement, as often witnessed in the intermittent fever, without a shade 
 of inflammation presenting itself during the progress of the disease. 
 And how clear the characteristic distinction, that in intermittent fever 
 the excitement disappears not only periodically, but according, also, 
 to the type of the fever, while in inflammation it remains till the local 
 cause is removed ; when, also, the whole disease is at an end. But 
 violent inflammations which coexist with intermittent fever may be 
 entirely subdued, and yet the fever proceed uninterruptedly. Again, 
 it is a common circumstance that all idiopathic fevers are introduced 
 by a chill ; while such is rarely the case with inflammations. The 
 chill, too, and of great severity, may attend every paroxysm of a long- 
 continued intermittent. Other distinctions in § 720, 757, 759, 764 a, e, 770. 
 
 715. When inflammation gives rise to general arterial excitement it 
 is in part by continuous, and in part by remote sympathy (§ 498-500). 
 The latter is mostly concerned in developing the general results, 
 The nervous power being excited in the brain and spinal cord is re- 
 
 Gg
 
 466 INSTITUTES OF MEDICINE. 
 
 fleeted upon the heart and capillaiy blood-vessels of the whole system, 
 That power, thus reflected, proves a stimulant to these organs, by 
 which their action is increased, and otherwise modified (§ 188, 205 
 22G, 480-485). Again, the same primary inflammation which thug 
 calls up a general excitement of the circulatory system .may be si- 
 multaneously producing inflammation of some other and distant part, 
 through the same process of reflex nervous action. That second pari 
 may have been predisposed to inflammation by some external remote 
 cause, and the nervous power determined upon it may then operate 
 only as an exciting cause. If the part be not antecedently predispos- 
 ed, then the nervous power may prove the predisposing as well as ex- 
 citing cause, or there may be other predisposing causes co-operating 
 with it (§ 143-150, 226, 484 h, no. 6, 645, 652). This second part, 
 thus sympathetically influenced, then becomes the source of other 
 reflex nervous actions ; co-operating, in this way, with the primary 
 inflammation, and increasing more and more the action of the heart 
 and arteries at large, and developing inflammation in other parts, 
 while, also, the general arterial excitement is a supplementary me- 
 chanical cause. The circles of sympathy now become very complex, 
 and interwoven with each other (§ 148) ; and yet, through the same 
 laws of reflex nervous action a blow may be simultaneously struck 
 at the whole by one decisive impression from a single remedy. 
 Bloodletting, for instance, will do it ; but the operation of this remedy, 
 although involving the agency of the nervous power, is different, in 
 some respects, from that of any other agent. But, suppose it may be 
 done by an active cathartic, combined with a nauseating dose of tar- 
 tarized amtimony. The pathological states of the various inflamed 
 organs are every where nearly or considerably alike. A single rem- 
 edy inay, therefore, overthrow at once the whole complex condition 
 of disease (§ 137 d, 143 c, d, 476^ h, 479, 481 g, 484 b, no. 5, 514. 
 557 a, 929-934, 944 b, 970 c).— Note D p. 1114. 
 
 715^. So also the foregoing modus operandi of the nervous influ- 
 ence ininfl.ammation is applicable to the predisposing influences of the 
 remote causes of fever (§ 148), of hydrophobia, of the constitutional 
 effects of mercury, antimony, &c., and of all agents, indeed, which 
 transmit their influences to parts remote from the direct seat of their 
 operation (§ 500, 535, &c., 657). It is all by reflex nervous action. 
 
 716. The general sympathetic excitement is supposed to often con- 
 stitute a state o^ general inflammation. But this is an error; since 
 inflammation is always confined to some limited part, the minute ves- 
 sels of which, and not the larger arteries and heart, are the instru- 
 ments of the disease (§ 407 b, 410, 411). The term inflammatory fe- 
 ver '\s> also objectionable, as being significant of what has no existence. 
 The term constitutional derangement is commonly employed to denote 
 the sympathetic disturbances which inflammation may inflict upon 
 parts remote from its own location. It is the same condition that goes 
 under the denomination o? fever when owing to the reflex nervous ac- 
 tions of inflammation. But, unlike idiopathic fever, per se, it embra- 
 ces a variety of morbid conditions in different parts (694f ). 
 
 717. Inflammation occurring in one part may induce the same dis- 
 ease in another, and this last in a third, &c., independently of the fore- 
 going affection of the heart and arteries. It often happens, also, that 
 Bome sympathetic derangement will disturb the system far more ex
 
 PATHOLOGY. INFLAMMATION DESCRIPTION. 467 
 
 tensively than the primary afFection. The heart may be the only or- 
 gan that may be disposed to sympathize with an inflammation of the 
 skin ; but, when the action of the former important organ becomes 
 disturbed, though only its irritability be increased along with that of 
 the general arterial system, it may develop sympathetically, and by a 
 mechanical impulse of blood, extensive derangements, perhaps inflam- 
 mations, in other parts. And so, in the same vital sense, of the stom- 
 ach, brain, &c., when one of those organs may sympathize with some 
 distant inflammation (§ 139, 140, 525 c), by reflex nervous action. 
 
 718. The more active and extensive the inflammation, the more 
 important the part affected, and the more irritable and disposed to 
 sympathy the individual, the more readily, in a general sense, will con- 
 stitutional effects ensue, and vice versa (§ 139, 140, 597 d, 600 b). Ex- 
 ceptions are seen in the pleura and the mucous tissue of the fauces. 
 But only, in the latter case, under special circumstances ; probably of 
 primary abdominal disease, when the secondary affection, which is 
 commonly erysipelatous, reacts, in its turn, sympathetically (§ 689, I). 
 Th'e special sympathies of tissues and compound organs have been 
 already considered in a general sense (§ 525-529). As it respects 
 inflammation, a predominance is seen among certain organs, as the 
 skin and mucous tissue of the alimentary canal. But the principle is 
 more readily comprehended by observing its operation among parts 
 whose natural physiological connections are strongly pronounced, as 
 in the principal organs subservient to the process of digestion (§ 
 129, i). The sympathetic results may not be inflammatory, or of the 
 same nature as the primary disease ; but the organs which thus co- 
 operate in a special function are readily disturbed when any one part 
 of the system is invaded by disease, and readily excite reflex nerv- 
 ous actions among each other, and throughout the body (§514 h, &c.). 
 The general constitutional affection is, therefore, often more or less 
 dependent on the habitual association of the action of different organs 
 while in health, as well as upon the nature of their vital constitution 
 and their special relations to other parts of the body (§ 129). Owing, 
 also, to the special modifications of the vital states of associated or- 
 gans, some of them sympathize more readily than others with each 
 other, and extend their influences more readily and powerfully abroad 
 (§ 133, &c.). Thus, the small intestine occasions sympathies more 
 readily and forcibly than the large, and the stomach more readily than 
 the liver, with each other. But these morbid sympathies are not mu- 
 tual among the parts where they occur most readily, and the same is 
 true of tlieir natural sympathies. Thus, inflammation, or any aflbc- 
 tion, of the small intestine commonly produces more or less derange- 
 ment of the stomach ; but the same affection happening to the stom- 
 ach will not equally disturb the small intestine. Gastric disease read- 
 ily deranges the liver ; but hepatic affections do not as readily affect 
 the stomach. Such are plain cases of reflex nervous action. 
 
 It may be also well to remark, that were it not that one part nat- 
 urally sympathizes with others, it would never sympathize with them 
 under circumstances of disease ; no more than in plants (§ 113- 
 117, 129, 183-185, 224, 226, 349, 456-461^, 475^, 493 cc, 578 d). 
 
 719. Violent sympathetic disturbances which are especially relative 
 .to the nervous system often spring up from simple irritation of the 
 
 nerves of a comparatively unimportant part, as convulsions from
 
 468 INSTITUTES OF MEDICINE. 
 
 teethino;, &c. These conditions have been confounded with absolute 
 
 * 
 
 inflammation of the nerves (§526 d). 
 
 720. We may, perhaps, reckon as the first among my radical dis- 
 tinctions between inflammation and fever the fact that the constitution- 
 al disturbances of the former grow out of direct or reflex nervous influ- 
 ences instituted and kept up by local disease, while in pure fever they 
 are independent of local diseases, though equally brought about by al- 
 terative reflex nervous influences (§ 233|, 475|, 647-0-, 715^). 
 
 721, a. Inflammation is a very comprehensive genus ; or, perhaps, 
 it should be rather said, it is a species of disease which embraces a mul- 
 titude of varieties, forming a truly protean malady. 
 
 721, b. According to the varieties, it is divided into common and spe- 
 cific, whose details distinguish it very broadly from fever. 
 
 In its most simple form, as arising from mechanical injuries, or as 
 manifested in pneumonia, pleurisy, catarrh, &c., it is distinguished as 
 common inflammation (§ 652, c). 
 
 When the disease presents certain peculiarities that are not attend- 
 ant on the common form, it is called specific ; as in small-pox, scrof- 
 ula, lues, gout, rheumatism, &c., and in all cases of animal and veg- 
 etable poisons (§ 650). 
 
 722, a. Between the foregoing characteristic examples of common 
 and specific inflammation there is a vast range of gradations, which 
 meet, as it were, together; so that it is evident no definite line exists, 
 and that all the individuals belong to a common family. The very 
 extremes are so much alike that they may be compared to twins, 
 which we may mistake, one for the other, at a superficial glance, or 
 may only know them apart by some ^peculiarities of mind or manner; 
 but which peculiarities, again, have so many points of resemblance 
 that the same general system of moral and physical discipline is 
 adapted to each of the twins, with only some special modifications to 
 suit the peculiarities of each. 
 
 722, b. In a general sense, when inflammation is produced by a 
 single cause it appears under the same modification or variety (§ 
 652). But when two or more predisposing causes concur in estab- 
 lishino^ the morbid chans^e the modification thus induced will be de- 
 termined more or less according to their combined virtues (§ 652). 
 Thus, cold applied to the sui-face generally produces what is called 
 common inflammation. But it will also act as a predisposing cause 
 of acute rheumatism, which is a specific form of inflammation, and 
 therefore possesses peculiarities which distinguish it from all other 
 forms. Hence, in this affection other predisposing causes are con- 
 cerned, the principal of which may be ingrafted upon the constitu- 
 tion, or if transitory, may have begun the foundation of disease in 
 the organs of digestion (§ 659, 661). 
 
 722, c. Inflammation is also modified by the natural peculiarities 
 of the vital properties in the different tissues, and the sympathetic 
 influences it may exert will often depend, both as to kind and inten- 
 sity, upon the nature of the tissue inflamed, and the general nature 
 of the compound organ of which the tissue may form a component 
 part. As to the modifications of the disease and the reflex nervous 
 actions as affected by the nature of the tissue, good examples of dif- 
 ference occur in the comparative phenomena and sympathetic effects 
 of pleurisy and phlebitis (§ 150, 160-162, 807, 809, &c.).
 
 PATHOLOGY. INFLAMMATION DESCRIPTION. 469 
 
 As to the modifications of common or specific inflammation which 
 grow out of the combined peculiarities of the vital properties of par- 
 ticular tissues and of the compound organ of which the inflamed tis- 
 sue is a component part, we have numerous and striking examples ; 
 as in inflammations of the brain, stomach, liver, intestines, &c. 
 
 Again, the phenomena will be varied as inflammation may affect 
 different parts of one and the same continuous tissue, according to 
 the nature of the compound organs into which the different parts 
 may enter. Examples of this occur in the pulmonary and intestinal 
 mucous tissue wherever it contributes to variations of the general 
 structure (§ 135-140). 
 
 722, d. From all that has been now said, it is evident that those 
 lesions which have been rejected fi'om the general denomination of in- 
 flammation by Louis, Andral, Marshall Hall, &c., and airanged un- 
 der the designations of hyperEemia, hypertrophy, lesions of nutrition, 
 iriitation from loss of blood, contra-inflammatory action, &c., but at- 
 tended by many of the characteristic marks of inflammation, fall nat- 
 urally within the range of this variable affection, (§ 725. Also, Med. 
 and Phys. Comm., vol. ii., p. 317-331, 712-715, 760, &c.). 
 
 723, a. Inflammation is also divided into acute or active and chronic ; 
 the former being more violent than the latter, comparatively of short 
 duration, and commonly distinguished by a greater variety of local 
 results, and far greater constitutional derangements. 
 
 723, h. The foregoing pathological states, being essentially alike, 
 run into each other; so much so, indeed, that what has been chronic 
 may suddenly become acute, and pass with great rapidity through the 
 different stages. There is, therefore, no other foundation for this di- 
 vision than such as is here indicated. 
 
 724, I am now conducted to an analysis of this disease, and shall 
 consider it, 
 
 1. In its most simple condition, as affecting different tissues. 
 
 2. As affecting different parts of different structures. 
 
 3. The varieties of inflammation in respect to its general attributes. 
 
 4. The sympathies to which it may give rise. 
 
 5. The remote and pathological causes of inflammation. 
 The first four problems will be considered connectedly. 
 
 725, a. In a general sense, inflammation is attended by redness, tw- 
 mor, heat, and ^;aw. They were once supposed to be essential phe- 
 nomena ; but either may be absent, particularly exalted heat and 
 pain. Their presence or absence, intensity or mildness, may depend 
 upon the nature of the morbific cause, the nature of the tissue, &c. 
 (§ 651, 722). Thus, there is no redness from the bite of a musketoe, 
 and there is intense itching instead of the exquisite pain occasioned 
 by the sting of a bee. None will deny that the affection resulting 
 from the latter cause is exquisitely inflammatory, and all must allow 
 the near coincidence between the two affections. By this analogy we 
 bring, also, the white nettle rash, the white gangrene, scirrous tu- 
 mors, &c., under one general pathological condition (§ 722, d). 
 
 725, b. Again, for example, in respect to pain, much will depend 
 upon the nature of the tissue affected, and upon the force and kind 
 of inflammation. Inflammation of the serous membranes is attended 
 with far greater pain than the mucous ; in which last it is often ab- 
 sent. Simple pneumonia may exist to an alarming extent with littla
 
 470 INSTITUTES OF MEDICINE. 
 
 or no paiij. The serous tissue, also, possesses only colorless blood- 
 vessels in its healthy state, but is apt to become more florid in its in- 
 flammations than the mucous. On the other hand, parts which have 
 only a dormant state of sensibility, as the tendons, bones, ligaments, 
 may become exquisitely painful when inflamed, and more so when 
 inflammation is produced in the fibrous tissues by a lacerated than 
 an incised wound. There are also peculiarities as to the skin (§ 
 652, c). It is also worth observing, as contributing to a knowledge 
 of the properties and laws of life, that while common sensibility is 
 liable to be exalted in inflammations, specific sensibility, as seeing 
 tasting, feeling, is apt to be diminished, or impaired in a different way 
 from common sensibihty {^ 133-137, 193-204). 
 
 725, c. It would appear, therefore, that increase of sensibility is 
 only a contingent result of inflammation. This property, too, is not 
 directly concerned in the organic functions; and a part is quite liable 
 to become inflamed when all its principal nervous connections with the 
 brain and spinal cord are separated (§ 188,193,205,489,500 J, 746c). 
 
 726. There is generally more or less pulsation in the inflamed part, 
 and in the larger arteries leading to it (§ 498, 516 d, 803). In all 
 such cases the extreme capillary arteries, which are the immediate 
 instruments of the disease, and which naturally carry little red blood, 
 have become enlarged, and admit the red globules. This transmis- 
 sion, however, of ^;he red globules is less due to the enlargement than 
 to a change in the relation of the vital properties of the vessels to 
 these globules (§ 192, 384, 394, 396, 398, 399). 
 
 728. Like the arteries, the veins of an inflamed part are increased 
 in size ; at least when the former are enlarged. This is owing to 
 active dilatation of the veins, and to the increased volume of blood 
 transmitted to them (^ 387, 786, &c.). 
 
 729, a. Common inflammation, when it goes on to a natural ter- 
 mination, and in its greatest latitude of simple results, may be distin- 
 guished into four stages; namely, the formative, suppurative, ulcera- 
 tive, and restorative or granulating. There may be present, there- 
 fore, from what has already been said, only the formative stage (§ 700, 
 &c.). When the disease does not advance beyond that stage, it is 
 said to terminate by resolution. The suppurative and restorative 
 stages form the most simple natural process of cure. They are also 
 subject to great irregularities. 
 
 Pathologists have generally reckoned the adhesive process as a dis- 
 tinct stage of inflammation. It will be seen, however, that it is not 
 founded on principle. 
 
 729, b. The curative stages of inflammation, whether regular or ir- 
 regular, are also called terminations of inflammation. The term is sig- 
 nificant of what has not truly happened ; and, as words have often 
 more force than facts, it should be abolished. There is gi-eat practi- 
 cal philosophy concerned about the mutations of disease at the sev- 
 eral regular stages of inflammation, and in all the modifications to 
 which those stages are liable. There is but one termination of dis- 
 ease, excepting death. Disease remains, however altered from the 
 formative stage of inflammation, till nature is completely restored 
 (§ 672, 733 c). 
 
 730. The formative stage is distinguished more or less by the char- 
 acteristics alx'eady described.
 
 PATHOLOGY. INFLAMMATION DESCRIPTION. 471 
 
 The suppurative stage is introduced by a decline of all the symp- 
 toms of the formative stage, and when most regular there is a pro- 
 duction of purulent matter, which constantly tends to a more com- 
 plete removal of the formative stage. 
 
 The ulcerative stage is more or less attendant on the suppurative ; 
 generally attends the formation of pus excepting on exposed sur- 
 faces, when it may be present or absent (^ 733, b). Whenever pres- 
 ent it is immediately antecedent to the restorative or granulating 
 stage, although a destructive process. 
 
 The restorative or granulating stage is promoted by the suppura- 
 tive, and is marked by a continued decline and ultimate disappear- 
 ance of all the symptoms. 
 
 731. The foregoing stages are generally more distinctly marked in 
 the cellular than in other tissues. With the exception of the ulcera- 
 tive, they may be often well observed upon the mucous tissue of the 
 eye. The ulcerative is seen in the intestinal mucous membrane. 
 
 732, a. Deviations occur in the suppurative stage in the production 
 of coagulable lymph, or of serum, or redundant mucus, or effusions of 
 blood, instead of purulent matter. But these results, or however 
 they may deviate from their proper standard, are all analogous to the 
 formation of pus, being exactly equivalent in principle, constitute 
 equally the second stage, and, in the same way, contribute to the 
 restorative stage, or that of perfect cure (§ 12,2 f, 740 h, 764 e, 863 a). 
 
 732, h. The fluids effused operate as depleting means ; and it is 
 especially for this reason that morbid anatomists, not finding the vas- 
 cularity they had anticipated, declare that its absence in many drop- 
 gical affections denotes an exactly opposite pathology from that where 
 the same affections are attended by a preternatural fullness of the ves- 
 sels (§ 699 c, 700 li). Nature, however, has no such inconsistencies 
 {Med. and, Phys. Covim., vol. i., p. 180-182; vol. ii., p. 187, 199, 556, 
 557, note). At the first reference here made I have quoted the vic- 
 chanical rationale as propounded by Andral, and have endeavored to 
 prove, by his own showing, that what are denominated " passive 
 dropsies" depend on a vital, inflammatory action (§ 740 J, 805, 863 a). 
 
 732, c. When the second stage of inflammation is attended by an 
 effusion of coagulable lymph it is called the adhesive, instead of the 
 suppurative stage. This variety appears mostly in the serous and 
 cellular tissues, though it is often presented by particular parts of the 
 mucous system, as that of the trachea in croup, and of the intestines 
 (§ 133-135). 
 
 732, d. When wounds heal from the effusion of coagulable lymph, 
 it is by the " first intention ;" though the process is the same as when 
 the pleurae unite, or the lungs become hepatized in pneumonia. In 
 either case the new formations are a part of the natural process of 
 cure (§ 732 a, i, 863 a). However momentous the evil in pneumo- 
 nia, or other disorganizations, it is still the result of the great recu- 
 perative law; just as effusions of blood within the head in cases of 
 cerebral congestion are on a par with haemoptysis, haematamesis, &c., 
 or all dropsical effusions with each other, and with the preceding re- 
 sults. Nature makes no digression from great principles for minor 
 purposes. But, in the apparent contradictions now stated Nature 
 has duly provided for the removal of extraneous matter from shut cav- 
 ities, and from the recesses of organization by the function of ab-
 
 •172 INSTITUTES OF MEDICINE. 
 
 sorption (Med. and Phys. Comm., vol. i., p. 371-384 ; vol. ii., p. 546- 
 666, 733). 
 
 732, e. It is also a peculiarity of lymph not appertaining to pus that 
 it is readily susceptible of organization, whereby Nature accomplishes 
 other purposes ; though such ox-ganization occurring in pneumonia is, 
 as in § 732, d, an apparent though not a real departure from the great 
 law cf recuperation. Being a law of Nature for reparation in other 
 parts, it must, under equal circumstances, prevail in all parts. 
 
 732, y. It appears, therefore, that the adhesive process consists of 
 two stages ; that by which lymph is effused, and the strictly adhesive. 
 And, although the effusion of lymph be equivalent'to the suppurative 
 process, there is superadded to the former a distinct final cause, since 
 Nature contemplates in this modification not only the curative effect, 
 but, also, the reparation of injured parts (§ 732, a). 
 
 733, a. When suppuration occurs upon surfaces, as on the mucous 
 tissue, the process happens in its most simple form. But, in other in- 
 stances, as when pus is generated by the cellular or serous tissue, the 
 matter cannot escape as when it is produced by the mucous tissue. 
 In these cases, therefore, an obstacle intervenes between Nature and 
 the cure, as when the formation of lymph or of serum takes the place 
 of purulent matter (§ 732, d). But here, as there, Nature has provi- 
 ded for the removal of the secondary evil, through a principle com- 
 mon to all the cases, and which appertains to the absorbent vessels, 
 This happens after the following manner, wliich must be briefly sta- 
 ted as characterizing an important law, and the third stage of inflam- 
 mation. 
 
 733, b. The process is called ulceration (§ 730). It consists in the 
 absorption of all the tissues intervening between the accumulated 
 matter and some external surface. It is so significant of a sc^eat final 
 cause, so replete with evidences of Design, especially in connection 
 with the other attendant processes, that some authors, even Hunter, 
 have metaphorically ascribed it to something like intelligence. It is 
 to be observed, also, that in this complex condition there is in simul- 
 taneous progress both the formation of pus and of lymph. The pus 
 occupies the central parts of the abscess, while the lymph is effusea 
 at the circumference, agglutinates the cellular tissue, and thus, by 
 forming a sac, prevents the spread of the purulent matter. It is yet 
 another part of the complex law under consideration, that while the 
 substance between the abscess and external surface is constantly yield- 
 ing to the ulcerative process, rej^aration or the graiiulatijig process is 
 going on posteriorly to the abscess, and the redundant lymph under- 
 going absorption, or what is equivalent to the ulcerative process in 
 the anterior part of the abscess. There is, however, a certain differ- 
 ence between the processes ; but it is less than between the absorption 
 of lymph in the present example and the function which is in univer- 
 sal operation in health. In the case before us, like ulceration, the ab- 
 sorption of lymph is an emanation from inflammation, though more 
 remote than ulceration. Both, therefore, may be regarded, though 
 not equally, as pathological conditions of absorption (§ 672). 
 
 733, c. When the surface is reached, and the matter discharged^ 
 the cavity is no longer circumscribed. Nature now puts an end to 
 the destructive process, and completes the work of reparation which 
 had been in progress in the posterior part of the abscess. This is ac-
 
 PATHOLOGY. INFLAMMATION DESCRIPTION. 473 
 
 complished by the formation of a substance analogous to that which 
 had been removed. Coagulable lymph, along with more or less pu- 
 rulent matter, is secreted by the surface of the ulcer, upon which it is 
 arranged in little fleshy heaps, or knobs, of a florid color, and forms 
 the granulations. These knobs contract and spring from the top of 
 each other till the cavity is filled. 
 
 Among the various and striking results which are involved in this 
 process of reparation none is more remarkable, or more strongly ex- 
 emplifies its dependence on laws that are unknown in the inorganic 
 world, than one which is least appreciated, the substitution for the 
 granulations of an organized substance similar to that which had been 
 removed. The granulations have, originally, the same apparent phys- 
 ical characteristics, from whatever part of the body they may spring. 
 But they are so endowed with the special vital characteristics of the 
 parts by which they are generated that in each part they secrete a 
 substance which is similar to the part removed, while the granulations 
 themselves are progressively absorbed (^ 135, b). Doubtless, also, 
 the granulations are specifically different, in a physical sense, in all the 
 cases, differently organized, and therefore, as in all other cases of or- 
 ganized lymph, derive their vessels from the parts by which they are 
 generated (Med. and Physiolog. Comm.^ vol. ii., p. 354-362).* 
 
 The cavity being filled, the granulating process ceases, as if inetinct- 
 ively, and a new one sets in, by which the granulations are covered 
 with a substance analogous to skin, and which is called the cicatrix. 
 This completes the series of Designs attendant on the different stages 
 of an abscess, and which exemplifies all the regular stages of inflam- 
 mation (§ 729, h). 
 
 733, d. Who shall resolve the foi'egoing wonderful processes and 
 results, their exact concurrence, their obvious design, their great final 
 cause, by any process or laws of the inorganic world % Yet is even 
 this now almost universally attempted ! Such is ever materialism ! 
 But, when it will not listen to the voice of Nature as it proclaims her 
 Author, we may hope in vain for any interpretation of her phenome- 
 na that may recognize dignity or design in her minor aspect^*, and 
 least of all as it may conflict with the fundamental principle of mate- 
 rialism. When error is bold in its demonstrations it is reckless of 
 consistency, and therefore regardless of facts (§ 5i, 5|, 40, 80, 117, 
 137, 143, 155, 156, 169/, 172 h, 226, 303i a, 306, 310, 311, 350^ g-o, 
 376i, 384, 385, 387, 399, 409/, 422, 500 n, 514 h, 524 d, 525, 526 d, 
 528 c, 638, 649 d, 733 h, 764 h, 811, 847 c, 848, 902/ 905, 943 c, 980, 
 1019/ 1085). 
 
 733, e. As we have now and before seen. Nature often contem- 
 plates a variety of useful purposes in the individual processes she 
 adopts for the benefit of organic beings. The healthy state of the 
 body is full of examples. Every action of every part has commonly 
 more than one definite object; often many. So is it, also, with those 
 morbid processes which are instituted for the restoration of health. 
 As soon as the tendency in diseased actions is set up toward the nat- 
 ural condition, the subsequent changes have a specific reference to 
 the ultimate cure ; the completion of which, however, may be very 
 remote from the initiatory step. The vital properties and actions may 
 pass through a variety of changes before they attain the natural phys- 
 iological condition (§ 672, 676). But each change, each step in the 
 
 * OUier's production of bone by tlie transplantation of periosteum is a good illustration of thi 
 
 subject.— 1800
 
 474 INSTITUTES OF MEDICINE. 
 
 process, may be necessary to the next succeeding, till Nature attains 
 her normal condition. This, however, is only one part of Nature's 
 plan in her salutary efforts to escape from disease. She renders vari- 
 ous results, as she goes along, instrumental in bringing about the sub- 
 sequent steps in the process of cure, and even associates with these 
 other useful objects. In the case but just before us, while ulceration 
 is making its way to the surface for the discharge of matter, the puru- 
 lent formation is constantly subduing the inflammation, and the secre- 
 tion of lymph, which is designed for agglutination and granulation, has 
 the same salutary influence upon the morbid process on which its pro- 
 duction depends (§ 764, e). 
 
 The properties of life are thus constituted in such a manner as not 
 only enables them to undergo changes from their diseased to healthy 
 states, but, through their instruments of action, to result in the forma- 
 tion of products which shall contribute to this great ultimate end (§ 
 672, 733 d, 761). This is the philosophy of the vis medicatrix natures. 
 733, y. The foregoing law of reparation prevails universally in or- 
 ganic beings ; extending, therefore, to the vegetable kingdom. It ap- 
 pears, however, under various modifications, even among the animal 
 tribes. It is presented in its most simple form in the growth of divi- 
 ded polypi, the reproduction of the claws of lobsters, of the lizard's 
 tail, &c., when it takes the name of regeneration. But, it is equally 
 an act of regeneration when ulcerated parts are restored in their for- 
 mer organization by the granulating process. The difference consists 
 alone in partial modifications of a common action (§ 733, Z»). In the 
 regenerative and reparative processes of plants the difference is still 
 greater ; and such as reject analogy, or cannot discern its light, have 
 argued that the differences depend upon essentially different laws. A 
 previous inflammatory action, it is true, is necessary to reparation in 
 the higher order of animals, but is not necessary to the fundamental 
 law as it is concerned in the regenei'ation of entire parts in the lower 
 animals, nor in the reparative process of plants. The properties of 
 life are differently modified in each, and consequently the processes 
 differ, though as intimately connected by analogies as the modifica- 
 tions of the simple physiological states (§ 185, 672, 688 ee, 733 e). 
 Nor is the granulating process an inflammatory one, but only conse- 
 quent on that pathological condition ; while the simple production of 
 lymph may be a direct emanation from inflammation, or only conse- 
 quent on its decline, or on a near approximation to that mode of ac- 
 tion. All the modifications, however, give rise to con-esponding va- 
 rieties in* the nature of the lymph, just as they do in that of purulent 
 matter. They may offer to our inadequate vision the sameness of ap- 
 pearance that is presented by the pus of an abscess, or of a chancre, 
 or of small-pox, or appear as identical as the granulations of every 
 part. The last, indeed, are the things in question ; and although their 
 ultimate results supply an unening test, it is only coincident with all 
 the others, and even with that which is offered by the natural states 
 of the different tissues (§ 22, 42, 48, 53 h, 133, 135 a, 409 e, 411, 739, 
 740). 
 
 By thus pursuing the inquiry, the various results will be found con- 
 nected by close analogies, though the extremes may be stumbling 
 blocks to the careless. The periodical regeneration of the stag's 
 horn, where some of the most characteristic marks of inflammation
 
 PATHOLOGY. INFLAMMATION DESCEIPTION. 475 
 
 are present, forms an intermediate example. But the deer, in other 
 respects, is as limited as man, or other animals of the same complex 
 organization, as to the principle of reparation. In all such animals, 
 the amputation of a limb, or the removal of any important organ, is 
 never followed by a regeneration of the part. Such parts do not em- 
 brace, like the parts of a polypus, or of a plant, the organization that 
 is necessary to constitute a whole. Nevertheless, the law obtains, 
 even here, to a remarkable extent. If the middle of a bone be re- 
 moved,* it is regenerated. But there must be opposite surfaces, and 
 the right action must be instituted in each surface, as when the oppo- 
 site pleurae unite. In the same way central portions of the muscles 
 and nerves may be removed and regenerated ; and the process by 
 which this is accomplished is the granulating. — See p. 473, note. 
 
 733, g. This leads me to notice a fallacy of the physical philoso- 
 phers, who have been led into the error, as in most other cases, from 
 neglecting, if not altogether the vital properties, at least their natural 
 modifications as they exist in vegetables, and in the different races of 
 animals (§ 133-163, 185). With this neglect of fundamental princi- 
 ples, and a substitution of chemical and physical laws (§ 5\, h), they 
 have endeavored to array an argument against the Hunterian doctrine 
 of the dependence of the union of wounds, by \hejirst inf.e?ition, mpoji 
 inflammatory action, by identifying the process of reparation in veg- 
 etables with the union of incised wounds. Reparation in plants, say 
 they, is not an inflammatory process, and, therefore, the eff'usion of 
 lymph in the incised wounds of animals is not connected with inflam- 
 matory action ; and they endeavor to fortify this reasoning by an ap- 
 peal to the regenerating power of the polypus, the lobster, &c. As 
 well might we argue that vegetables, and polypi, should be subject to 
 the same diseases as man or quadrupeds, or that all animals should live 
 alike upon the same kinds of food [Med. and P/ii/sioIog. Comm., vol. 
 1., p. 696-698). 
 
 733, li. The same objectors, however, set aside, on other occasions, 
 some of the plainest and most important analogies of nature. They 
 maintain, for example, that the functions of nutrition, secretion, &c., 
 are carried on in all animals mostly through the nervous system, but 
 are compelled to take a very different ground for the same functions 
 in plants (§ 350, no. 18-20, 62, 63, &c.). 
 
 The nervous system, however, being superadded to animals, modi- 
 fies greatly their common properties and functions of life, expounds, 
 in part, the differences and special analogies in the foregoing pro- 
 cesses of reparation, regeneration, &c. ; and being a superaddition to 
 animals, and a large, however unintelligible element in the doctrines of 
 the physical philosophers of life, I formerly employed it as the ground 
 of an analogical argument that the principle of life was originally su- 
 peradded to animals after the creation of their structure. 
 
 733, i. Consider, also, the parallel which holds between the mor- 
 bid growths that are induced by special injuries of the animal and veg- 
 etable organization. Take an example of the latter in the nest of 
 the Cynips quercus folii ; and how evident is it, from this simple fact 
 alone, that both departments of the organic kingdom are endowed 
 with the same organic properties and functions, alike liable to dis- 
 ease, and governed by analogous laws (§ 185, 191 a, 409). 
 
 All the foregoing may be farther illustrated by what I have said in
 
 476 INSTITUTES OF MEDICINE. 
 
 a former section of inflammation in its connection with child-bed 
 women, &c. (§ 688, ee). 
 
 733, k. It is certainly remarkable that such obvious analogies should 
 strike different minds under such different aspects, and doubtless many 
 will think it superfluous that misapprehensions of the foregoing nature 
 should receive a formal refutation. But they are sustained by minds 
 that have a powerful influence, and must be respected. It is so, in- 
 deed, with the delusions of imagination itself; and were not a cer- 
 tain degree of resistance opposed to animal magnetism, its votaries 
 would trespass far upon the domain of physiology, and trample with- 
 out remorse upon universal knowledge. 
 
 Irregularities of Inflammation. 
 
 734, The regular stages and results of common inflammation which 
 have been now described are subject to various irregularities, which 
 spring from innumerable causes, but especially from morbific influ- 
 ences propagated from the organs of digestion. A great variety of 
 modifications are also attendant on the specific forms of the disease ; 
 when the special results are apt to be mostly due to the nature of the 
 predisposing cause. At other times, and in numerous cases of com- 
 mon inflammation, certain effusions, such as coagulable lymph and 
 serum, which are equivalent in principle to the suppurative stage, ap« 
 pear to be regular stages. But they so often run into each other, that 
 it is more philosophical to regard suppuration as the elementary pro- 
 cess. 
 
 735, a. Instead of the progressive stages of inflammation, the dis- 
 ease may terminate in resolution. This result is generally intended 
 to embrace one of the common products, coagulable lymph ; the name 
 and mode of termination coming to us from the humoral pathology. 
 But, according to the philosophy which I have endeavored to set 
 forth, I reject both the " concoction of humors" and the eftusion of 
 lymph, and mean by the term resolution a simple restoration of the 
 morbid properties and functions of an inflamed part to their natural 
 state, without any other supervening result beyond the formative 
 stage (§ 729, h). 
 
 it is a primary object of art to anticipate nature in her depletive 
 course, and thus prevent inflammation from passing beyond its incip- 
 ient stage. It is here that the advantages of art are strikingly illus- 
 trated ; since unaided nature proceeds to the cure by effusions of 
 lymph, pus, serum, &c. (§ 732 d, 863). 
 
 735, b. Inflammation frequently advances in its fonnative stage 
 without being circumscribed either by effusions of lymph, or by other 
 causes, and it is then diffuse. This irregularity is apt to attend upon 
 some tissues more than others, especially the venous, lymphatic, cu- 
 taneous, and serous. There are also certain striking facts relative to 
 diffuse inflammation which go to illustrate important physiological 
 laws. Thus, in erysipelas, it is apt to be symmetrical upon both sides 
 of the face. In phlebitis, the inflammation is often limited to the di- 
 vero-ence of a vein (§ 741, c). In small-pox and kine-pox, the inflam- 
 mation extends only a certain distance around the pustules, though 
 not limited by the adhesive process. And here we may notice one of 
 ihe various demonstrations of a law expressed in § 149, in the manner 
 in which the sinapis, cochlearia, rhus vernix, &c., produce diffuse in«
 
 PATHOLOGY. INFLAMMATION DESCRIPTION. 477 
 
 flammation of the skin (§ 649, c). Each of all the cases, and thousands 
 of parallel examples, each as a whole, or in its details, supply so 
 many problems for the pi'ofound inquirer, reveal the apparent myste- 
 ries of life, and stamp their seal upon the doctrines I have taught (§ 
 133-163, 177-184, 188-192, 651-657, &c.).— Note T p. 1125. 
 
 736, a. Opposed to the termination of inflammation in resolution 
 is that of mortification^ which is the greatest irx'egularity of the dis- 
 ease. Mortification, also, like resolution, commonly happens in the 
 formative stage. This result also takes place, in most instances, 
 when that stage has reached a very high intensity. Exceptions, how- 
 ever, as to tlie force of the disease, occur in dry gangrene, in the gan- 
 grene of old men, and in white gangrene [Med. and Physiolog. Comm., 
 vol. ii., p. 319, &c.). Irregular eftusions are more or less attendant 
 on this mode of termination. 
 
 736, h. What is the cause of mortification % It can be only said of 
 it, that there happens a profound alteration of the properties and ac- 
 tions of life which results in their extinction, and that this change is 
 of a vital nature and not dependent on mechanical causes, as supposed 
 by the physical theorists, unless the circulation be artificially inter- 
 rupted, and as practiced by these theorists with a view to an interpre- 
 tation of a natural process. But this mode of death is as easily com- 
 prehended as that from fever, or hydrocyanic acid, &c. (§ 54-56. Also,. 
 Med. and Physiolog. Comm., vol. ii., p. 171-173). 
 
 736. c. By what process is the dead removed from the living parts] 
 Here, again, we have, from most physiologists, a mechanical rationale 
 which shall be consistent with the more important steps in their phi- 
 losophy of inflammation. The dead parts, say they, ai'e removed by 
 the impulse of the vis a tergo. But I apprehend the process to be ex- 
 actly the same as that by which a thorn is removed from a living mus- 
 cle, or a scab from an ulcer. Each is, in the same relative sense, a 
 foreign body, and each brings into operation, for its own removal, the 
 laws which are represented in section 733. The dead part, like the 
 thorn, excites inflammation in the surrounding tissues, suppuration and 
 ulceration set in, the absorbents carry off the portion of the living 
 matter contiguous to the foreign bodies, and thus is their separation 
 effected. The process of granulation completes the cure {Med. and 
 PJiysiolog. Comm., vol. ii., p. 167-172). Or, turning to the analogy 
 supplied by the vegetable kingdom, will it be surmised that the re- 
 moval of the dead parts of plants depends upon the mechanical action 
 of di vis a tergo 1 
 
 737. Another irregularity of inflammation respects the period of its 
 different stages, one or more of which may be accelerated or protract- 
 ed beyond the ordinary time. This is often true of \hQ formative and 
 restorative ; and since the formative may be long continued, and then 
 result in resolution, we see the importance of holding morbid anatomy 
 subordinate to the vital signs of disease. 
 
 The restorative process varies, also, as to its course. Granulations 
 sometimes fail of approximating a level with the skin, when the true 
 cicatrix may fail of being formed, and in the place of it appears a 
 scabby substance, or some other imperfect formation, and often read- 
 ily liable to absorption. At other times the true cicatrix is suddenly 
 removed, the granulations absorbed, and the ulcer reproduced. 
 
 738. Scirrus is another distinct irregularity of inflammation. Here
 
 478 INSTITUTES OF MEDICINE. 
 
 the action is modified in a very remarkable manner, and is obstinate- 
 ly retentive of that peculiar modification. It is so far analogous, how- 
 ever, to common inflammation, that some of its worst results are an 
 effusion of coagulable lymph, and destructive ulceration. It has been 
 lately denied by the physical theorists that scirrus is an imflamma- 
 tory affection [3Ied. and Physiolog. Comm., vol. ii., p. 321-330). 
 
 739. The products of the second stage of inflammation, pus, lymph, 
 or serum, are liable to deviations; denoting special modifications of 
 the pathological conditions upon which they depend (§ 733, y). Be- 
 sides the obvious and well-known variations from the proper pus of 
 common inflammation, there are other varieties which neither sense 
 nor chemical analysis can detect ; as in small-pox, and lues. It pre- 
 sents, also, certain obscure peculiarities according to the nature of the 
 tissue by which it is generated (§ 133-137) ; and this is also true of 
 the morbid production of serum [Med. and Physiolog. Comm., vol. ii., 
 p. 197, 198). 
 
 740, a. Every variety of product has its special pathological cause, 
 which it is the great end of art to comprehend. It is the best obser- 
 vation ever made by Andral, that, 
 
 " We are not to suppose that the qualities of the purulent secretion 
 are affected by causes which operate locally. The qualities are like- 
 wise modified by every alteration, whether physiological or patholog- 
 ical, which takes place in any other organ, no matter how far removed 
 from the seat of the suppuration, even though it have no particular con- 
 nection either of function or tissue. Thus, we have all seen instances 
 of the pus secreted by the surface of a sore becoming suddenly altered 
 in quantity and quality, under the influence of a simple moral emotion, 
 of the process of digestion, of the diminution or increase, whether 
 natural or artificial, of any of the secretions, or, in short, of any super- 
 vening disease. Nay, farther, there are certain constitutions, certain 
 idiosyncrasies, which modify the qualities of pus, and in which it con- 
 stantly assumes a peculiar and determinate character. There are 
 some persons, for example, whose organs, when irritated, never fur- 
 nish any other than a thin serous fluid ; in others it is always blood 
 more or less pure which is secreted ; while in a third class of persons 
 the place of pus is supplied by a grumous fluid," &c. (§ 134, 135, 222- 
 232, 500, 585, &c., 593, 732, 733/, 830, 847 d). 
 
 Thus have I quoted from Andral a luminous confirmation of my 
 doctrines of vital action, of alterative nervous influence, direct and 
 reflex ; and I have adopted it on account of the force which it de- 
 rives from emanating from a physical theorist of disease, and the dis- 
 tinguished restorer of the humoral pathology. 
 
 740, b. Nor have I yet quoted all from Andral that is expedient, 
 in this place, on a subject where vitalism and solidism may establish 
 their firm foundation ; and this, too, by the most absolute, unguarded 
 concessions from the opposite school. 
 
 Let us hear, then, once more, the great modern humoralist. Thus : 
 
 " All attempts to modify the qualities of the suppuration by local 
 treatment, in scorbutic and scrofulous subjects, are utterly ineffectual ; 
 for it is the system at large, and not merely the suppurating surface, 
 which is deranged in nutrition and secretion. We must commence 
 the treatment by endeavoring to modify the whole process of nutrition, 
 innervation, and haematosis." — And again: ''We do not know what
 
 PATHOLOGY. I\FLA.MMATIO\ DESCRIPTION. 479 
 
 the peculiar modification is which the texture of an organ undergoes, 
 60 that in one case it allows the blood determined toward it to escape 
 from its vessels ; in another it fonns pus, or exhales only a thin se- 
 rum ; while in a thii-d, it becomes indurated, softened, and ulcerated ; 
 but there is a common link which unites these different alterations ; and 
 hence it is, under the influence of apparently the same cause, we often 
 see them produced indifferently, and not unfrequcntly replaced one by 
 the other (§ 732, a). But, in all this series of phenomena, we can per- 
 ceive, throughout the whole course of the disease, one constant lesion^ 
 namely, the hyperemia, and a succession of morbid alterations in the 
 organic action of the tissue affected, producing, alternately, the results 
 already mentioned" (§ 672, 733 e,f). 
 
 Here, then, are pure vitalism and solidism, because the writer was 
 specifically concerned about matters of fact. The same principles, 
 exactly, ajjply to all other actions and results which deviate from the 
 natural condition of the body (§ 64, 345-350, 350f «, 699 c). 
 
 741, a. Again, here is another important practical and philosophi- 
 cal fact, which distinctly evinces the dependence of all the foregoing 
 conditions, changes, &c., upon purely vital actions. A suppurating 
 surface may be so affected by constitutional influences, by disordered 
 digestion, that the same results may follow as when the change is pro- 
 duced by some local imtant. This proves that the modifications of 
 pus, and therefore pus itself, are not owing, as commonly maintained, 
 either to a degeneration of the blood, or of the tissues, or even to 
 changes of organization, but to certain modifications of the vital prop- 
 erties by which organization is animated ; since it would be absurd 
 to suppose that indigestion, and some caustic or other imtant applied 
 to the ulcer, would determine the same physical changes. 
 
 741, h. From what has been now and before seen, we may insist 
 upon one of the most important conclusions in medical philosophy, 
 which strikes at the whole foundation of humoralism, and is unsur- 
 passed in its practical bearings. We may conclude, I say, that when 
 serum, or lymph, or mucus, are diverted from their natural condition 
 by disease, that the modification depends, in each instance, as much 
 upon certain special physiological changes as do their natural states 
 upon the natural condition of the solids. This analogy prevails 
 throughout all other natural products of an organic nature, when 
 turned from their common standard ; and were .there no other facts, 
 the analogy would establish the same principle in relation to all new 
 formations, as pus, &c. But, such facts I have multiplied abundantly 
 in another work. All the varieties, every shade of difference, arise 
 from modifications of action which are always necessary to the sev- 
 eral varieties, respectively. The vital properties must be so modi- 
 fied in the several cases that the capillaries, acting in obedience 
 to these properties, shall decompound, and recombine, the particular 
 elements and constituents of each product, and in their proper ratio, 
 and modes ; rejecting all the rest. Otherwise, indeed, there could be 
 no resemblances among the natural or morbid products, no gradations 
 from one to the other, no obvious coincidence between certain mor- 
 bid lesions of the solids and the resulting products. Every thing 
 would be confused ; there would be nothing but the riot of the chem- 
 ical forces ; and even empyricism would look on in dismay. The 
 physical theorists, therefore, are forever involved in inconsistencies
 
 480 INSTITUTES OF MEDICINE. 
 
 excepting their universal collision with facts, and suiting hypotheses 
 to each particular occasion (§ 42-52, 409 d, 694f ). 
 
 But the properties of life can never undergo any change of their 
 essential nature till they are verging toward a state of extinction. 
 Hence the analogies among diseases, according to the nature of the 
 remote causes. It is a great foundation of the healing art ; and were 
 it otherwise, medicine would be utterly fruitless, a mere creature of 
 circumstance, one perpetual experiment (§ 638, 780j. 
 
 The considerations which I have now made enforce, particularly, a 
 critical reference to the pathological conditions in all our prescrip- 
 tions, their seat, the influences which surround them, the precise 
 adaptation of remedies as to their nature, dose, time and order of 
 their exhibition, &c. They demonstrate, also, the distinction among 
 remote causes of disease, especially such as have their origin in mor- 
 bid or healthy processes of living beings, and establish the fact that 
 the same disease cannot be produced by the products of organization 
 and of chemical decomposition (§ 653). 
 
 741. c. We may now glance at one or two important facts connect- 
 ed with the foregoing subjects. Thus, it is important to bear in 
 mind that it is the tendency of inflammation to confine itself to that 
 tissue in which it springs up, along which it is propagated especially 
 by continuous sympathy; though exceptions often occur (§ 133, 141, 
 &c., 498, 500). What is true of inflammation in this respect is prob- 
 ably, also, of other morbid states. The reason is to be found in the 
 natural modifications of the vital properties of the different tissues. 
 This modification existing in different parts of one and the same con- 
 tinuous tissue commonly limits the continuity of inflammation to a 
 particular part of the tissue, though it often spring up in other parts 
 of the tissue by reflected nervous actions (§ 134, &c., 500, 674 d). 
 
 The foregoing general limitation of any given foiTn of disease to 
 the tissue first invaded (excepting as other tissues of the same com- 
 pound organ are more or less disturbed in function) is especially re- 
 markable of the common form of inflammation, and of diseases that 
 are not distinguished by obstinate conditions, such as specific inflam- 
 mations with strongly-marked characteristics ; as scrofulous, venereal, 
 carcinomatous, &c. (§ 149-151, 525-531). 
 
 REMOTE CAUSES OF INFLAMMATION. 
 
 742. The remote causes of inflammation fall under the general 
 considerations already made (§ 644-606). As all the agents which 
 contribute to its production must be included in the category, such as 
 are naturally salubrious, or necessary to the purposes of life, as food, 
 &c., sometimes fall within the comprehensive class. It is mostly, 
 however, the abuse of such agents which renders them predisposing 
 causes ; but they may readily prove exciting when other causes have 
 laid the foundation of predisposition. 
 
 743. It only remains to be added ujion this subject, that I cannot 
 agree with distinguished vitalists that stimuli are alone the predis- 
 posing causes of inflammation and fever ; but there can be no doubt 
 that a right decision of the question is of practical importance. 
 Upon it may depend, for example, the proper treatment of cerebral 
 aflfections arising from excessive doses of opium. In excessive doses, 
 it is generally conceded to be directly sedative ; and yet is profound
 
 PATHOLOGY. INFLAMMATION REMOTE CAUSES. 481 
 
 cerebral congestion one of its morbific effects, for which bloodletting is 
 the most efficient remedy. Hydrocyanic acid will do the same thing, 
 which, in like manner, is best relieved by loss of blood (§ 483, 484, 
 494 dd, 827 d, 828). And so of extreme cold, the philosophy of 
 which is set forth in the Commentaries (vol. ii., p. 478-493.) Tartar- 
 ized antimony is powerfully sedative in all its doses, and the larger 
 the more so. Yet in its over-doses it j)roduce3 a serious form of in- 
 flammation. Even excessive bloodletting may lead to inflammation, 
 for which the farther abstraction of blood by means of leeches may 
 be useful, or at least so it is said (^ 1024 a, 1057). 
 
 Concentrated miasmata, when followed immediately by an attack of 
 fever, evidently depress the powers of life, as one of the first changes 
 which they establish [Commentaries, vol. i., p. 471-474). We must 
 take the facts as we find them, and build our theories accordingly. 
 And here we see the importance of looking well to the characteristics 
 of the properties of life, at their wonderful mutability, observe how 
 they may be profoundly altered at the moment when certain morbific 
 causes begin to operate, how they may go down in an instant to a 
 state of extinction ; and how, on the other hand, every restoration 
 from disease is the result of their own constitutional tendency to return, 
 through a series of changes, suddenly or gradually, to their natural 
 state (§ 175, 177-185, 672, 733 e). 
 
 These considerations enable us to understand how the properties 
 of life may be as readily aflected by depressing agents or sedatives 
 as by stimulants, and how, when affected by the former, they may 
 speedily react and constitute the absolute conditions of inflammation 
 and fever (§ 666), or return at once to their natural state (§ 150, 151, 
 227). When either of these morbid conditions actually ensues, there 
 can be no doubt that the organic properties have undergone an exal- 
 tation as well as another modification in kind. The physical philoso- 
 phers will allow nothing but absolute prostration, and a passive relax- 
 ation of the vessels, when high arterial action sets in ; but they look 
 upon the cold stage of fever as being best explained by something 
 like the " glacier theory." And yet, if we go to the simple facts at- 
 tendant on the very invasion of fever, we shall find in the universal 
 contraction of the capillary vessels, during the cold stage of fever, 
 abundant proof of the exaltation of mobility and irritability ; and this 
 is farther confirmed by the salutary effects of two most depressing 
 agents, bloodletting and emetics. See, too, how local inflammations 
 are becoming generated duiing this stage ; and when the hot stage 
 supervenes, and when, also, in progi'essive order, the secretions break 
 forth, we have the most unequivocal demonstrations of exalted pow- 
 ers ; though here, as in inflammations, this change is only an incon- 
 siderable part of the alteration which the properties of life sustain (§ 
 188i, 487 h, 569, 675, 764, 964). 
 
 Still, however, in respect to inflammation, its most common causes 
 are directly stimulant, and exalt the vital properties and actions by 
 their direct operation; but this appears not to be equally true of idio- 
 pathic fever {Med. and Fhys. Comm., vol. ii., p. 213, 241-248, 277- 
 280,^ 288, &c.). 
 
 Finally, we may not lose sight of the fact that the nervous influence, 
 either reflex or direct, is the immediate remote cause of effects beyond 
 the seat of the direct action of the primary causes (§ 647|^, G66). 
 
 H H
 
 482 INSTITUTES OF MEDICINE. 
 
 PATHOLOGICAL OR PROXIMATE CAUSE OF INFLAMMATION. 
 
 744. "The act of inflammation," says Hunter, "appears to be an 
 increased action of the small vessels. It is commonly supposed to ha 
 contraction of the vessels ; but I have show^n that their elastic power 
 also dilates them, and I have also reason to believe that their muscu- 
 lar power has a similar effect." — Hunter, on the Blood, &c. 
 
 "The blood," says Magendie, "traverses with ease the infinitely 
 more minute tubes that abound in our tissues. There must be soma 
 particular conditions to facilitate its passage. What proves their ex- 
 istence is, that if certain alterations are effected in the composition of 
 the blood, it stops, undergoes morbid changes, becomes extravasated 
 and decomposed, and produces the various disorders which patholo- 
 gists have vainly attempted to explain by the words inflammation 
 and irritation. What sense, in truth, is there in applying the word 
 inflammation to our organs ] Do our tissues actually takeJireV' [So 
 says Vacca, and Magendie is of his school.] — Magendie, in London 
 Medico- Chirurgical Review, January, 1839, p. 208. 
 
 " For my part, I declare boldly, that I look upon these ideas about 
 VITALITY and the rest of it, as nothing more than a cloak for ignorance 
 and laziness." " All the physician can do is to order remedies, which, 
 if necessary, the nurse could prescribe equally well." "You saw me 
 give rise, at my pleasure, to pneumonia, scurvy, yellow fever, typhoid 
 fever, &c., not to mention a number of other affections lohich I called 
 into being before you." — Magendie's Lectures. — And that, too, upon 
 animals. 
 
 " Pythagoras," says an ancient philosopher, " looks at the sun verj 
 differently from Anaxagoras. The former carries his eyes into it like 
 a god, while the latter looks up to it as unfeelingly as a stone" (§ 699, 
 709, 810, 838. — Also, Medical and Physiological Commentaries, vol. 
 i., p. 510-515, text and notes, 518, note, 526, 539, 567, note, 584, 611, 
 650, notes, 697, 698, as to Magendie. Also, Lehmann, ^ 1034). 
 
 745. No subject has excited more discussion, or more deservedly, 
 than the pathological cause of inflammation, since this affection and 
 idiopathic fever comprise most of the diseases of man, and since, also, 
 the treatment of disease turns mainly upon our conceptions of its path- 
 ological character (§ 4, 667-677). 
 
 The example of inflammation involves the whole philosophy of all 
 other diseases ; and, if our views be right in respect to this affection, 
 we shall have little difliculty with any other. This I shall endeavor 
 to show by a special consideration of fever and venous congestion. 
 The general laws are the same in all the cases ; though the results 
 are variously modified. There may be, for instance, in one form of 
 disease increased action of the extreme vessels, an exaltation of the 
 vital properties, &c., while in another foim an opposite condition may 
 obtain. Yet these opposite states shall depend upon the same great 
 general laws. In either case, for instance, it is a general law that an 
 altered condition of the organic properties constitutes the essential 
 pathology ; and, it is another general truth that this altered condition 
 has been instituted by deleterious agents. The changes in function 
 will also correspond with the particular changes of the organic prop- 
 erties. But, coming to the details in respect to the exact nature of 
 the changes, we find them different in the diflerent cases ; and they
 
 PATHOLOGY. INFLAMMATION PATHOLOGICAL CAUSE. 483 
 
 depend mainly upon the specific nature of the remote causes, which 
 have altered the properties of life in one series of cases in a different 
 manner from the other series (§ 652). These, therefore, are only con- 
 tingent results, and do not affect the great laws which are concerned 
 about the essential pathology of disease. 
 
 746, a. The extreme terminating series of the arterial system of 
 vessels are the immediate instruments of inflammation. They are en- 
 dowed with muscular fibres, and perform, naturally, the function of 
 active contraction and dilatation (§ 384-387, 397-399). That such 
 are the essential instruments is evident from a variety of facts, of 
 which, however, it is only necessary to state one, namely, the analogy 
 which subsists between the process of nutrition and the reparative 
 process of inferior animals and the formative and adhesive stages of 
 inflammation; while the true suppurative, and all its modifications, 
 are analogous to the general function of secretion (§ 729, 732 a). 
 The effect of cantharides, &c., applied to the skin, is an example in 
 illustration. All this, too, corresponds exactly with what is kno^vn 
 of the greater development of the properties of life in the exlremo 
 vessels ; which, it may be now said, supplies an important proof of 
 their increased action in inflammation (§ 407 h, 410, 411). 
 
 Such, too, are some of the numerous instances in which we reason 
 with certainty from analogy, especially in relation to organic life; 
 while the conclusions are corroborated by all the relative facts. 
 
 I have thus thought it impoitant to indicate with precision the in- 
 struments of inflammatory action, that they may not be confounded 
 with that series of capillary vessels which serve mainly as reservoirs 
 to the extreme vessels, and between which there is also a broad dis- 
 tinction in their vital states. We shall have accomplished much in 
 establishing the vital character of inflammation, and in exposing the 
 errors of the physical hypothesis, by the plain fact whose statement is 
 made as a point of departure and for the government of the whole in- 
 quiry. Those vessels, as I have endeavored to prove, are eminently 
 characterized by the attributes of life, and I hold it to be fundamen- 
 tal, and cannot be denied, that what is physiologically true is true, 
 also, of those morbid states which coincide in their genei'al results 
 with the physiological (§ 41-44, 48, 52, 134, 135, 136, 409 c-411, &c., 
 516 d, no. 6, 524 a, no. 1, 526 a, 1039, 1040, 1056). 
 
 If such, therefore, be founded in nature, the essential philosophy of 
 inflammation is to be found in modified states of the natural proper- 
 ties and functions of the extreme series of the arterial system. 
 
 746, h. The absorbents, also, are interested in the ulcerative pro- 
 cess, and are, therefore, modified in their action. 
 
 746, c. The nerves, from constituting a part of all the tissues, and 
 from the liability of every part to be affected by preternatural deter- 
 minations of the nervous power upon them, and being, also, the organs 
 of sensibility, are so far liable to a participation in the pathological 
 states of inflammation, and in affecting the secreted products (§ 456 a). 
 
 From all that has been said, it is evident that the nervous power 
 can act only as a remote cause of morbid changes, and that the con- 
 clusion is unavoidable that all the remote causes of inflammation, as 
 of every other disease, produce their morbific effects upon the oi'ganic 
 properties, that the morbid processes are carried on by these proper- 
 ties, as in the vegetable kingdom, and that the nervous system is not
 
 464 INSTITUTES OF MEDICfN E 
 
 necessary to the disease, however it may exert a profound influence 
 both upon the actions and products (§ 227, 233|, 475^, 507, 647^). 
 
 The nervous power, it is true, is the immediate remote cause of all 
 inflammations which spring up sympatheticafly, but it forms no part 
 of the essential pathological cause ; nor are the nerves in any other 
 way the medium through which inflammations are excited (§ 201-204, 
 226, 233,405, 446 a, 500, 647^, 715, 725 c, 902-905, 1039, 1040). 
 
 On the other hand, the physical philosophers, with singular incon- 
 sistency, maintain that the "nervous influence" has an important 
 agency in the inflammatory process, though they do not say in what 
 that agency consists, or how it co-operates either with mechani- 
 cal or chemical agencies (^638j). 
 
 747. Hunter laid the foundation of the true theory of inflammation. 
 He supposes that the vessels are in a state of increased action, both as 
 to contraction and dilatation, and that, in a general sense, they carry 
 an increased quantity of blood. 
 
 Irritability and mobility, the two great properties upon which oi 
 ganic actions mostly depend, are probably always increased and 
 otherwise variously modified in all inflammations. In consequence, 
 also, of the increase of irritability all inflamed parts are more than 
 naturally susceptible of the action of stimuli, though not according to 
 their ordinary effects in health. It is a general law, indeed, in re- 
 spect to all diseases, that the natural relations of the affected parts to 
 physical and mental agents are more or less altered ; and upon this 
 turns, mostly, the curative action of medicine, (Sec. (§ 143, 149-152). 
 It was a radical defect in Hunter's doctrine that he did not consider 
 the altered condition, in their very nature, of the vital properties, but 
 imputed the essence of inflammation to a simply " increased action 
 of the powers of the part." If the hand be plunged into warm water, 
 there ensues an increased action of the vessels, but there is no inflam- 
 mation. 
 
 748. A theory opposed to the foregoing, and now universally adopt- 
 ed by the physical school of medicine, supposes, 
 
 1. That the vessels concerned in the process of inflammation are 
 passively relaxed. 
 
 2. A progressive accumulation, stagnation, and coagulation of blood 
 within the vessels (§ 789). 
 
 3. An enlargement of the collateral vessels proportioned to the re- 
 dundancy of blood transmitted to the part, occasioned by the force of 
 the vis a tergo. 
 
 4. That the blood is propelled through the collateral vessels by the 
 action of the heart (§ 392). 
 
 5. That the vessels, being paralyzed, relaxed, and mechanically ob- 
 etructed, can perform no part in generating the products, or in those 
 processes already described as the results or " terminations" of in- 
 flammation ; but, on the contrary, that all the fluids are mechanically 
 strained off" from morbid blood, notwithstanding the mechanical ob- 
 struction occasioned by the coagulation, and that ulceration is only a 
 mechanical softening of the living solids. (See "Report of the recent 
 State of Knowledge of tlie Nature of Inflammation,''' by Mr. Wharton 
 Jones, in British and Foreign Medical Review, April, 1844.) 
 
 749. Such is the prevailing mechanical doctrine of inflammation, 
 vvhich, in conformity with the plan of this work, I have here intro-
 
 PATHOLOGY. INFLAMMATION PATHOLOGICAL CAUSE. 485 
 
 duced as appearing to me the most adverse to facts and philosophy, 
 but sustained by a powerful school. I shall not enter upon its farther 
 refutation, nor upon the proof of the vital theory, beyond the state- 
 ment of a few prominent facts. Both of these objects I have endeav- 
 ored to accomplish in the Medical and Physiological Commentaries, 
 nor have I seen any fact whose import is not there considered (vol. ii., 
 p. 141-214, 224-397. Also, my " Introductory Discourse," p. 22, &c., 
 1842, in vol. iii.). 
 
 The mechanical doctrine of inflammation has grown out of experi- 
 ments by which Nature is misrepresented. I mean that such is my 
 opinion ; but not without its attendant reasons. One experimental 
 fallacy, however, lies mainly at the foundation of all the foregoing 
 conclusions, which consists in the means by which inflammations are 
 artificially produced for the purpose of amving at a knowledge of 
 their pathology. Irritants of a chemical nature have been applied to 
 delicate membranes, by which their organization is impaired or de- 
 stroyed, and the blood also coagulated by direct chemical influences. 
 The part has been then subjected to the microscope, under the direct 
 rays of the sun, whose heat has the effect of drying the disorganized 
 tissues, and consolidating the blood. Let rubefacients be a test. 
 
 From such most unnatural results the whole organic process of in- 
 flammation, its formative stage, the stages of suppuration, ulceration, 
 and the secretion of lymph, of serum, &c., are interpreted upon 
 purely mechanical principles (§ 396, 410). 
 
 But, if this were true of inflammation, it should be, equally so of 
 the analogous results in the healthy state of the body ; and growth 
 itself, and all the secreted products, should be equally determined by 
 mechanical laws. Were the doctrine, therefore, founded in nature, it 
 'would completely overthrow the whole science of physiology, and re- 
 duce the living being to a mere automaton (§ 639 a, 746 a). 
 
 750, a. We have already variously seen what analogy prompts. 
 We have seen, too, that it has been demonstrated that the blood is ac- 
 celerated in the capillary and larger vessels when stimulants are ap- 
 plied to them, or to the brain or spinal cord, and that they give rise 
 to alternate actions of contraction and dilatation, even in the veins 
 (§ 384, 387, 392, 399, 408-411, 480-485, 498 e). We have seen 
 how the extreme vessels become enlarged and admit the red globules 
 (§ 192). We have seen, physiologically, that all the vessels must 
 have an independent vital action (§ 382, &c., 407, 410, &c.). And 
 now I ask the physical philosopher, upon his own ground, how the 
 extreme vessels in dense structures, such as ligament, cartilage, and 
 bone, acquire their great enlargements in their inflammations 1 It is 
 evident that the physical philosopher has limited his views, as he has 
 his experiments, to soft, delicate membranes. He has reasoned from 
 an isolated fact, and that fact evidently of a spurious nature (^ 5^,6, c). 
 
 That there is generally, though not invariably, an increased volume 
 of blood circulating in the instruments of inflammation, is shown by 
 the increased quantity of blood which flows from the veins of an in- 
 flamed part ; by the high florid color of the part, and of the blood ; 
 by the profusion of blood which follows scarifications and leech-bites ; 
 by the rapidity with which the blood returns when expelled, by rub- 
 bing, from an inflamed surface ; by the actually increased fluidity of 
 the blood proceeding directly from the seat of inflammation, as show»
 
 486 INSTITUTES OF MEDICINE. 
 
 by its slower coagulation than in health ; by the preternatural gener- 
 ation of heat, which even no chemical theory can explain without 
 admitting an increased circulation of the blood ; by the profuse se- 
 cretion of certain fluids, and their specific nature ; by the frequently 
 increased pulsation of an artery leading to an inflamed part, and es- 
 pecially as the pulsation is often strongest when the general circula- 
 tion is prostrate, and' again, on the other hand, as the throbbing of the 
 vessel often subsides when the force of the general circulation rises 
 under the influence of the lancet ; while the local inflammation may 
 go on increasing, &c. (§ 1056). 
 
 750. h. Coincident with the numerous physical and pathological 
 facts which lie at the foundation of the vital doctrine of inflammation 
 are the effects of remedial agents ; since bloodletting, cathartics, an- 
 timonials, and other depressing agents, should increase the supposed 
 relaxation of the vessels, and stagnation of blood, both by their direct 
 action and by diminishing the force of the vis a tergo ; while, on the 
 other hand, tonics and stimulants should be the prevailing means of 
 cure. Nor can the curative effect of the former agents, nor the mor- 
 bific of the latter, be interpreted on any other than physiological prin- 
 ciples. How, again, will the physical philosopher explain the instan- 
 taneousness with which moderate bloodletting, nay, even syncope 
 without the loss of blood, will sometimes overcome pneumonia, in- 
 flammation of the brain, &c. (§ 951) ? How explain the rapidity 
 with which croup will yield to the prostrating effect of antimonials ; 
 or how deep-seated inflammations take their departure as soon as the 
 same condition is produced in the skin by cantharides, or yield more 
 gradually to the silent influences of antimony, ipecacuanha, mercu- 
 rials, iodine, colchicum, guaiacura, veratria, quinia, &c., according to 
 the special modifications of the disease by its various remote causes 
 (§ 150, 650-653, 662 h, 668, 669, 672, 674, 742, 935 d, e) ? 
 
 751. I have just intimated that, if vital action do not exist, there 
 should be no varieties of inflammation. It should be all small-pox, 
 or lues, or rheumatism, or, at least, all of the common variety. The 
 vital phenomena and physical products should be always the same; 
 the same in all tissues and in all constitutions (§ 409, c-i). Nor 
 should we have any remarkable and diversified sympathetic influences 
 of inflamed parts upon the system at large (§ 500, 512-530). The 
 vitalist supplies the only intelligible solution of the facts which are 
 presented in real life. He points to the various modifications of the 
 organic properties, according to the peculiarities of every tissue, the 
 diversities of the remote causes, constitution, age, sex, &c., which he 
 believes, also, to be the foundation of all rational pathology ; and upon 
 the same principles he interprets the curative effects of remedies. 
 
 Active and Passive Inflammation. 
 
 752. I endeavored, originally, in the Medical and Physiological Coni' 
 mentaries, to show the fallacy of the distinction of inflammation into 
 active and passive, and to prove the dependence of all forms of the 
 disease upon one general pathological cause ; and I shall now briefly 
 advert to the manner in which the principles set forth in the present 
 work establish that conclusion. 
 
 753. In the active fosm of inflammation there appears to be a vague 
 recognition, so far as the verbal distinction gcos, of the morbidly-in-
 
 PATHOJ,OGY. INFLAMMATION PATHOLOGICAL CAUSE. 487 
 
 creased action of the part, while in the passive form all is " relaxa- 
 tion" and " stagnation" (§ 748). These exactly opposite states of 
 verbal pathology are especially characteristic of the school who main- 
 tain that inflammation is always constituted by a passive relaxation of 
 the vessels and coagulation of blood. With the same consistency they 
 also affirm that the two nominal conditions require opposite modes of 
 treatment ; though, in justice to the real hypothesis, it should be said 
 that the stimulant plan is apt to prevail. There are many authors 
 
 who speak of an active and passive state of inflammation as things in 
 absolute opposition, but they attempt no explanation of the supposed 
 distinction. 
 
 Andral perceived that the term active is not in harmony with the 
 mechanical philosophy of the disease, nor with his own views as to the 
 abolition of the general term ; and he therefore substitutes sthenic and 
 asthenic to express the opposite conditions, and hypercemia in the place 
 of inflammation. But the epithets are as much in direct opposition 
 as active ■axidi passive (§ 699, c). 
 
 754. But it requires only a right exercise of judgment to under- 
 stand that the same disease cannot be constituted by opposite patho- 
 logical conditions (§ 741, h). The supposition contradicts itself. The 
 varieties depend simply upon partial modifications of a common path- 
 ological cause ; and this conclusion, as abundantly exemplified, is of no 
 little practical importance (§ 766). The term passive can only be in- 
 tended, by those who use it, to inculcate a stimlant treatment, and that 
 mechanical condition of the blood-vessels whose refutation I have at- 
 tempted extensively in the Commentaries. 
 
 755. Again, in the supposed opposite conditions, the vital signs, and 
 the morbid products, are nearly identical ; which evinces, sufficiently, 
 a close affinity in the pathological states, while the analogy between 
 those products and such as depend on the natural processes places 
 both modifications of the disease on a common physiological founda- 
 tion (§ 137 e, 150-153, 639, 746 a, 694f ). 
 
 756. a. The occasional success of tonics and stimulants in the treat- 
 ment of inflammation, whether applied internally or externally, or 
 with or without antiphlogistic remedies, is no evidence, as supposed, 
 of a pathological state manifestly different from that which is most 
 readily surmounted by loss of blood, cathartics, &c., alone. This will 
 be obvious when the true modus operandi of remedial agents is duly 
 considered (§ 150-152, 638, 893, &c.). It is also well known that a 
 sudden and powerful impression even from alcoholic stimulants will 
 sometimes subvert an inflammation or a fever of great activity, which, 
 under apparently the same circumstances, would be aggravated by 
 such treatment in the hundred next following cases, but where loss of 
 blood, &c., would be speedily curative in nearly all (§ 900, 904 d'). 
 The disciples of Brown have been thus enabled to sustain themselves 
 in the midst of general failure. — Note Ee p. 1133. 
 
 Take a clear example, which illustrates the only distinction, so far 
 as principle is concerned, between the supposed opposite conditions 
 of inflammation. Such a one occurs in this disease when modified by 
 the predisposing cause of intermittent fever. Here the Peruvian bark 
 may be as necessary to its cure as the loss of blood, though the latter 
 is commonly, also, more important. And there occurs to me a proof 
 from analogy which demonstrates the vital doctrine of inflammation ;
 
 488 INSTITUTES OF MEDICINE. 
 
 which consists in the fact that the Peruvian bark is also a specific for 
 intermittent fever, w^hile, as with inflammations, it wiJl aggravate other 
 forms of fever. If, therefore, it be admitted that there is no " stagna- 
 tion of blood" in the intermittent and other fevers, it clearly follows 
 from this analogy that there is none in inflammations. 
 
 The intense inflammations attendant on scurvy often yield only to 
 such remedies alone as improve the digestive organs, of which tonics 
 may be one ; and here we witness impressive demonstrations of the 
 laws of sympathy (§ 500, 512, &c.). And yet in the same conditions 
 bloodletting may be simultaneously appropriate or necessary. Op- 
 posite modes of local treatment succeed in burns and scalds ; catarrh 
 is often cured by " gin sling;" erysipelas has apparently yielded to the 
 tonic and stimulant practice, though at the hazard of life ; and typhus 
 fever, with its train of local inflammations and congestions, divides the 
 medical world into the two opposite systems of treatment. 
 
 Again, the most feeble subjects are quite as likely to require the 
 depletive treatment, in grave inflammations, as the robust ; and long- 
 continued chronic inflammations have often yielded to a repeated loss 
 of blood where tonics had been employed under the illusive doctrine 
 of passive inflammation (§ 1007 h-d, 1008, 1019).— Note Ii p. 1139. 
 
 The differences in small-pox, varioloid, and cow-pox, which are 
 essentially one disease, illustrate the principles before us. So, too, 
 do all the varieties attendant on specific forms of inflammation, as 
 measles, scarlatina, lues, rheumatism, &c. Lues yields especially to 
 mercury ; rheumatism to colchicum and guaiacum ; scrofula to io- 
 dine, &c. ; and yet the simultaneous loss of blood may be more or 
 less useful or indispensable. The example of tuberculous phthisis is 
 illustrative of our whole subject. A mixed, or even a stimulant, treat- 
 ment is slow in its destructive effects ; and its evils have been, there- 
 fore, overlooked in the speculative views which morbid anatomy has 
 suggested as to the nature of the pathological change in which tuber- 
 cle originates (§ 695, &c.), and in the brown chicken-meat which 
 chemistry has contradistinguished from the white. This morbid con- 
 dition has been recently and extensively considered non-inflammatory, 
 and as supposed by Louis when the most extensive inflammatory le- 
 sions and products have supervened : and it supplies us with another 
 exemplification of the irresistible tendency of theory, true or false, to 
 determine the treatment of disease (§ 4). The antiphlogistic prac- 
 tice has been abandoned. But what are its results % Has the mor- 
 tality from phthisis diminished ] On the contrary, it has most fear- 
 fully increased [Medical and Physiological Commentaries, vol. ii., p. 
 622-633, 743-752).— Notes F p. 1114, Mm p. 1141. 
 
 756, b. However varied may be some of the remedies in the differ- 
 ent modifications of inflammation, the general principles of treatment 
 are substantially the same. The incidentally favorable effect of local 
 or constitutional stimulants is no proof that the pathological conditions 
 of inflammation are not closely allied. It only proves their effect in 
 altering the vital properties in such a way as will enable Nature to 
 take on the restorative process. Least of all can opposite principles 
 prevail at different times and in different climates. It has been so 
 from the earliest records of disease. Otherwise, medicine would 
 consist only of an unconnected series of observations. There would 
 bo no principles, and of course no science. Medical learning would
 
 PATHOLOGY. FEVER DESCRIPTION. 489 
 
 be useless, and experience would suit only the present occasion. A 
 new system of treatment would have to be devised for every climate, 
 every constitution, and every reappearance of the same disease. 
 
 But Nature is not thus the creature of accident. It is not Nature 
 who is inconsistent, or who operates by conflicting laws. Art may 
 give her this appearance ; but still I say, that " Nature can never 
 deceive." It is owing to this consistency of Nature that medicine 
 had long since become a noble science; difficult and concerned about 
 all other sciences, and therefore taking the lead of all others. A 
 6cience of principles deduced from the phenomena of Nature, and 
 which, with the facts that are known, conduct us with remarkable 
 certainty to facts that are unknown. It is here that well-founded 
 principles enable us to see farther than the senses, and to learn from 
 a single vital phenomenon, from the expression of the eye, the ex- 
 istence and nature of those latent changes which too many can see 
 only when seeing is useless, and bring upon art and philosophy the 
 derision of the crowd (§ 704, 1005^, 1006/-1007 d, 1068 a-d). 
 
 A sound pi'inciple in medicine is like the calculus in mathematics ; 
 and what are falsely called "exceptions to general principles" are 
 nothing more than variations in phenomena, which arise from the in- 
 stability of the properties of life, and the vast variety of influences to 
 which they are exposed (§ 177-179, 237). These variations may de- 
 note only partial modifications of a common morbid action, arising 
 especially from differences in the remote causes (§ 644, &c.) ; or, 
 they may depend upon the same action affecting different tissues ; or 
 upon the morbid condition of particular organs affecting certain other 
 organs, or all others (§ 117, 129, 134, 137, 529, &c.) ; or, upon age, 
 sex, constitutional peculiarities, and other accidents (§ 335, &c., 570, 
 &c.). And, although there be one leading principle in the treatment 
 of such cases, there are other subordinate ones founded u^Don the 
 modifications. These are to be nicely balanced, that the governing 
 principle may be properly directed (§ 675). But, it is only men of 
 correct thinking and close observation that can apply these principles. 
 All others will look upon the variations of symptoms from their usual 
 state in any one disease, or upon the differences in the results of an 
 exact methodical practice, as denoting very different pathological con- 
 ditions, or as constituting " exceptions to general principles ;" and 
 *' bark and wine" will therefore obtain in numerous cases where 
 bloodletting is the only efficient remedy. 
 
 FEVER. 
 
 757, a. Important distinctions between the two great classes of dis- 
 ease. Inflammation and Fever, have been already sufiiciently indica- 
 ted. The former, as we have seen, is limited to certain parts, while 
 the latter invades the body universally from its beginning. I have 
 reserved for this place, however, a fundamental distinction, which, as 
 a characteristic of inflammation, has been described. This consists 
 of the morbid products, new formations, and lesions of structure, to 
 which inflammation gives rise. It is otherwise with fever, whose dis- 
 tinguishing phenomena are mostly of a vital nature, and whose mor- 
 bid physical products consist only of modifications of the natural se- 
 creted fluids (§ 764, e). Morbid anatomy, therefore, reflects no light 
 whatever upon the pathology of fever. And yet is its treatment, all
 
 490 INSTITUTES OF MEDICINE. 
 
 its varieties, as well ascertained as that of inflammation and its vari- 
 eties. Indeed, of most of the varieties of inflammation morbid anato- 
 my does not afford the least information ; and yet is the specific treat- 
 ment of the most common and important, such as rheumatism, gout, 
 intermittent, scrofulous, &c., as well known as the general remedies 
 for inflammation. And so with the varieties of fever. I say ao^ain, 
 therefore, that the morbid anatomist may not appropriate what- so em- 
 inently belongs to the acumen of genius in its philosophical observa- 
 tion of the phenomena of nature (§ 695, &c.). 
 
 It is plain, therefore, that all those who would render morbid anat- 
 omy the principal basis of pathology can have no definite views of 
 disease. The effects are mistaken for the cause ; and if the former 
 be not present, the case is regarded as inscrutable in respect to its 
 pathology. Every disease is, of course, to the morbid anatomist cir- 
 cumscribed to the organs which tell upon his senses ; the varieties in 
 inflammation are overlooked from their want of tangible distinctions ; 
 and as ulceration, and some other lesions of inflammation, may happen 
 to appear red or white, they ai'e denominated, as by Louis, inflam- 
 matory or contra-inflammatory. 
 
 757, b. Many of the ordinary and most characteristic symptoms of 
 inflamrft«.tion are wanting in fever ; such as hardness and incompress- 
 ibility of pulse, buffing and cupping of the blood, local pain, &c. This 
 is very obvious in intermittent fever. Exalted heat probably takes 
 place in all inflamed parts ; but a sunken temperature is common in 
 fever (§ 712-722). Reflex nervous actions supply a test (§ 720, 893). 
 
 758* Fever, like inflammation, has numerous modifications, as a ne- 
 cessary result of the constitution of the vital properties, the variety of 
 morbific causes, the unequal distribution of the disease, &c. These 
 modifications have given rise to the distinctions of continued, intermit- 
 tent, remittent, typhus, nervous, hilious, yellow fever, plague, &c. But 
 strong analogies prevail among the whole; the general pathological 
 cause, as in inflammations, being essentially the same. Most of the 
 varieties in fever depend, indeed, more or less, upon the modifying 
 influences of coexisting inflammations and venous congestions, though 
 more so upon the predisposing causes, while, also, the modifications 
 which grow out of these local affections will depend much upon their 
 particular seat. Some organs, also, sustain a greater burden of the 
 febrile disease than others ; and this, of course, will give to every 
 case certain peculiar modifications (§ 134, &c., 644, &c.). 
 
 759. Fever, in its most simple form, is of short duration, never con- 
 tinues three days, rarely longer than twenty-four hours, and some- 
 times terminates within four hours. This is the ephemera, which may 
 be taken as the type of the complex forms that consist of a series or 
 repetition of paroxysms. 
 
 The foregoing may be also noticed as a broad fundamental distinc- 
 tion between fever and inflammation ; since the ephemera, a perfect 
 representation of fever, may sweep through its course, and terminate 
 as suddenly as it invades the body, and in less than twelve hours, and 
 leave scarce a vestige of its former presence behind. 
 
 760. If fever, therefore, be continued beyond a single paroxysm it 
 is made up of a succession of paroxysms. Many have supposed that 
 every compound case consists of as many fevers following each other 
 as there are paroxysms. This, however, is not pathologically true;
 
 PATHOLOGY. FEVER DESCRIPTION. 491 
 
 Bince the same moi~bid predisposition in which the first paroxysm 
 originated remains, and is the cause of each succeeding paroxysm, 
 and, therefore, a connecting hnk among the whole. The supposed 
 distinction consists only of periodical abatements of one continuous 
 disease (§ 514 g, 516 d, no. 6, 665, 666). 
 
 761, a. The foregoing abatements of fever are the results of salu- 
 tary efforts of nature, and are variously pronounced as to their degree 
 and duration (§ 733). They are most perfect in intermittent fever, 
 in which they vary from a few hours' duration to one or more days (§ 
 675). 
 
 761, b. These abatements of fever, often amounting to an apparent 
 termination of the disease, supply a fine illustration of the recupera- 
 tive nature of the properties of life, and of their inherent tendency to 
 maintain themselves in a state of integrity. We see, too, the modus 
 operandi of art in its use of physiological Iravs, when, by the interposi- 
 tion of remedies the natural abatement of fever is confirmed by new 
 influences that are different from the original morbific ones (§ 675, 
 897, 898, 901, 237, 239, 447 h. 639, 839, 854, 856, 900, 905). 
 
 762, a. Each paroxysm of fever consists, in a general sense, of a 
 certain succession of symptoms, which, however, are liable to great 
 variations ; and new ones that may spring up in the progress of dis- 
 ease, from accidental influences, may present a general aspect more 
 widely different from the preceding than the near identity of the path- 
 ological cause would lead us to suppose. These differences spring 
 from the very susceptible nature of the properties of life, especially in 
 their morbid state, and the various new influences which may operate 
 upon them ; and the manifestations are liable to exceed the ratio of 
 any change that may be wrought in the vital conditions. A slight 
 change only, some error in diet, by instituting morbific reflex nerv- 
 ous actions, may give rise to new and striking phenomena, or they 
 may be forcibly presented by the transient effect alone of some mo- 
 mentary cause, as an emotion of the mind {^ 740, 1067). 
 
 762, b. In presenting a summary analysis of fever, I shall first con- 
 sider the Ephemera. Secondly, fever as constituted by a repetition 
 of the "same paroxysm, and in different modes. Thirdly, the remote 
 causes of fever, the coexisting inflammations, &c. Fourthly, the path- 
 ological cause. 
 
 763, The ephemera, as I have said, may be taken as the general 
 type of the entire family of fevers. It generally commences between 
 six or seven o'clock in the morning, or five or six in the evening; a 
 coincidence of difficult explanation, but manifestly connected with 
 some natural periodical mutations in the vital states' of the system 
 (§ 768). It has three distinct stages, which are commonly present; 
 namely, the cold stage or cold Jit, the hot stage, and the crisis. 
 
 764, a. The first, or cold stage, is the period of the most intense 
 morbid action. Its invasion is marked by a sudden contraction .of all 
 the capillary blood-vessels, and consequent determination of blood 
 about the right cavities of the heart, by a diminution of the fluid prod- 
 ucts, by reduction of temperature, and by a loss, in various degrees, 
 of the voluntary control over the muscles. These are the most obvi- 
 ous changes ; and such as relate to organic life evince a universality 
 of the disease at its invasion. Here we may stop to observe another 
 Droad distinction between fever and inflammation ; since the latter
 
 492 INSTITUTES OF MEDICINE. 
 
 does not begin in the foregoing manner, but with an enlargement of 
 the capillary blood-vessels (§ 712, &c., 757, 759, 770). 
 
 In idiopathic fever, many of the prominent, but less important, vital 
 symptoms, so far, at least, as sensation is concerned, appertain to the 
 organs of animal life. Those of the organic system are less remark- 
 able at first, as natural sensibility is here inferior to its condition in 
 animal life. The eye, for instance, is naturally more sensible than 
 the intestines, and hence an affection of the former is more conspicu- 
 ous than of the latter, till disease, at least, may develop the property 
 in the intestine. The same rule, in a general sense, will hold as to 
 the individual organs in either division of life, at this early stage of fe- 
 ver, and is applicable to all other diseases. There may be more dis- 
 ease in one organ than in another, yet the symptoms of that which is 
 most affected may be less strongly pronounced on account of its nat- 
 ural inferiority in sensibility^ and often, also, oi irritahility (§ 133-139, 
 188, 194). 
 
 A preliminary condition, subsequent to the formation of the predis- 
 position, and immediately antecedent to the cold stage, may be rec- 
 ognized under the denomination of access ; a term which has been 
 employed to denote the cold stage, or the most intense degree of mor- 
 bid action, and which, being already formed, cannot be regarded as 
 the access of disease. Prior to the absolute seizure, however, there is 
 commonly a more or less obvious failure of the living powers to per- 
 form any of their functions in their perfect manner ; and that consti- 
 tutes the true access of the complaint. The distinction and the term 
 are practically useful as leading to sound pathological views, and to 
 correct treatment. 
 
 The development, or attack of fever, is always sudden, whatever 
 the duration of the pi'edisposition ; and this is one of distinguishing 
 marks between fever and inflammation. 
 
 764, b. After the cold stage has continued for an indefinite time, 
 the diseased conditions begin to assume a tendency toward their natural 
 state, or to obey the great restorative law, the vis medicatrix naturce. 
 This recuperative effort introduces the hot stage, which is the first 
 part of the natural cure. The prominent characteristics of this stage 
 are an expansion of the capillaries, an increased volume of blood at 
 the circumference, greater force of the general circulation, and an ex- 
 altation of temperature above its natural standard. 
 
 A spontaneous change has happened in the vital conditions of the 
 whole body. The small vessels expand in consequence. Irritability 
 has become more susceptible, but less profoundly altered, and the 
 blood accumulated about the heart in the cold stage now rouses that 
 organ to greater action, while it receives concurrent reflex nervous 
 influences from the changes which are going forward in all parts of 
 the capillary system. An increased volume of blood is thus sent out, 
 and this is harmoniously met by the active expansion which is taking 
 place in all the small vessels {§ 384-387). But this is only a part of 
 the involutions of reflex nervous actions which are now in progress. 
 
 Notwithstanding, however, the hot stage is the beginning of the 
 natural cure, the symptoms would often denote an increase of the 
 morbid condition, and frequently call for the intervention of art. 
 Nature may be excessive in her aims at reparation. She may over- 
 step her ordinary limit, and push the organs of circulation with a ve-
 
 PATHOLOGY. FEVER DESCRIPTION. 493 
 
 hemence that shall light up inflammations, and call for an outlet of 
 blood as an indispensable means of prevention (§ 674, d). But we 
 know, from the general progress of symptoms, and the final result, 
 that a succession of favorable changes has been instituted from the 
 beginning of the hot stage. 
 
 764, c. The crisis follows next. This constitutes the greatest de- 
 cline of the disease. The phenomena of health are now more or less 
 pronounced. The secretions break forth, morbid at first, but rapidly 
 assuming their natural character. Among these perspiration is the 
 most obvious ; and hence this stage of the disease is universally 
 known as the sweating. The designation is too partial and hypothet- 
 ical, since the volume of bile, or of urine, may be quite as redundant, 
 or more so. Crisis is more comprehensive, and implies exactly the 
 things which are in progress. The hot stage is better named ; for 
 exalted temperature is the beginning of the elaboration of redundant 
 products, and, for a while, it stands alone. And here I may refer to 
 this connected series of physical products, during the curative stage, 
 as showing analogically the dependence of sweat, bile, urine, and the 
 elevated temperature, upon common physiological principles, and 
 in which. alteratiA'^e reflex nervous actions take an important part (^ 
 224, 226, 446-447, 461; 475-491, 503, 512, 902 g). 
 
 764, d. The secreted products, although the result of improving 
 pathological changes, contribute, as in inflammations, to the ultimate 
 design of nature as depletory remedies (§ 732, 733 e, 151 a). 
 
 764, e. In consequence of the foregoing remarks it may occur to 
 some that there is a greater affinity between fever and inflammation 
 than I have admitted (§ 712, &c.). But that conclusion does not fol- 
 low from the course of nature in her restorative movements. The 
 cold stage of fever may be the period of the most profound disease, 
 and nature may be emerging toward her healthy standard during 
 the stage of reaction, and yet the apparently analogous excitement 
 of the general organs of circulation, and of the immediate instru- 
 ments of the morbid process in inflammation, may be the stage of 
 most profound disease; and this is known by the various attendant 
 facts.* The pathological conditions, indeed, are so widely different, 
 that the general arterial excitement attendant on inflammation is not, 
 as in fever, followed by augmented perspiration, bile, &c. The in- 
 creased products are relative to some particular part, and are not of 
 the nature of those which attend the restorative process of fever. In 
 one disease they proceed from a tissue, in the other from compound 
 organs. One affection besets the tissues in their individual sense, the 
 other in their compounded sense. These are, therefore, other broad 
 fundamental distinctions between fever and inflammation (§ 141 b, 
 148, 675, 712-722, 757, 759, 764 a, 110). 
 
 765. If a repetition of the paroxysm take place, the crisis is al- 
 ways imperfect. Their repeated occurrence is said to form a com- 
 pound fever ; but, as we have seen, the disease is as much an entire 
 whole as the ephemera (§ 759, 760). 
 
 When the paroxysms apparently go off entirely the fever is called 
 an intermittent. When the interval is less perfect, or a new pai'oxysm 
 takes place in the middle of a crisis, the disease is called a remittent. 
 Wlien the disease continues without much abatement of symptoms, 
 or, rather, if a new paroxysm set in during the hot stage of a prece- 
 
 * Inflammation, as a general fact, is not introduced by a chill, but chills often precede 
 suppuration, when disease is subsiding.
 
 494 INSTITUTES OF MEDICINE. 
 
 ding paroxysm, it receives the name of continued fever. Between the 
 remittent and continued fevers, however, there is no well-defined line 
 of distinction, as it respects the succession of paroxysms. Again, the 
 remittent and intermittent interchange with each other ; and it is even 
 common for one attacked with a remittent to have the intermittent 
 form before his recovery. When, also, intermittents are badly treat- 
 ed, they are often converted into a remittent ; which is commonly a 
 more intractable form (§ 557). 
 
 766. We have thus a series of analogies which connect the contin- 
 ued fever with the intermittent ; and when we regard the distinct na- 
 ture of the paroxysms of an intermittent, we see that the ephemera is 
 a representation of each one. The symptoms also confirm these con- 
 clusions ; from which we learn, more and more, that the essential ele- 
 ments are the same in all the preceding forms, and other minor varie- 
 ties of the disease (§ 557, 650, 652, 670, 741 b, 754, 756 b). The ex- 
 istence of this coincidence corresponds with the like attribute of in- 
 flammations ; the varieties of which, respectively, are not more re- 
 markable in their vital manifestations and results than are the natural 
 modifications of the vital properties in different tissues (§ 133-137). 
 
 767, a. Notwithstanding, however, the foregoing analogies (§ 765, 
 766), the causes of continued fever are so far different from those of 
 the remittent and intermittent, that the first of these varieties does not 
 interchange with the last, as do the last two with each other, although 
 the quotidian and tertian types are sometimes manifested with consid- 
 erable distinctness during the pi'ogress of continued fever. Remit- 
 tents and intermittents are, also, rare in climates where the continued 
 fever occurs, while the former go togethei', and have close affinities 
 in their predisposing causes (§ 652, &c.). 
 
 767, b. We see, therefore, more and more, the fallacy of the doc 
 trine which regards disease as a unit, and especially as propounded 
 by one to whom medicine is under the deepest obligations. Thei'e 
 are, indeed, no two cases precisely alike in their pathological condi- 
 tions ; and there is scarcely a principle of greater importance (§ 673, 
 S57). It is true of diseases which are most allied, and even true of 
 the same case during its advances or its decline ; and coming to the 
 specific forms of inflammation, and paesing from those to idiopathic 
 fever and the various modifications of this disease, and regarding in 
 connection, also, the more obscure pathology of the various conditions 
 of the stomach which are grouped under the general denomination of 
 indigestion, and all those states which go to make up the " nervous 
 disorders," we can scarcely fail of escaping from the illusions which 
 have grown out of the physical views of disease, or of turning our- 
 selves to that philosophy which concerns the mutability of the prop- 
 erties of life (§ 177-184, &c., 780). 
 
 768, a. In a vast proportion of all the cases of fever the paroxysms 
 take place in the afternoon ; generally beginning about five or six 
 o'clock, and going off about five o'clock in the morning. This is com- 
 mon to all constitutions ; nor is it much regulated by the force of mor- 
 bid habit, but rather by its association with a natural evening parox- 
 ysm, to which all individuals in health are liable, and which happens 
 and subsides about the foregoing hours, even when traveling to the 
 eastward or westward (§ 772, b). This natural paroxysm is marked 
 clearly by its phenomena ; and the foregoing coincidence shows,
 
 PATHOLOGY. FEVER DESCRIPTION. 495 
 
 again, how the physiological laws hold their control in disease (§ 133- 
 152, 638). A coincidence is farther seen in a diminution of the se- 
 cretions attendant on the natural and morbid paroxysm. A purgative 
 given now, whether in health or disease, irritates the system more 
 than at any other time, and produces smaller evacuations than in the 
 morning, especially if rapid in its operation. On the contrary, in ei- 
 ther case, if the cathartic do not operate till morning, the discharge 
 will be far more abundant. Toward morning the natural paroxysm 
 subsides, sweating often comes on, and all the functions of the body 
 and mind are then manifestly improved. And so, more or less, with 
 the morbid paroxysm. The former is not connected with the fatigue 
 of the day, since it is common to mankind under every condition of 
 repose, employment, and habits. 
 
 Again, the first paroxysm of a fever may take place at any period 
 of the day ; the time of the invasion often depending upon some im- 
 mediate exciting cause. But, the succeeding ones generally coincide 
 with the natural evening paroxysm ; especially in continued and re- 
 mittent forms of fever. I speak, however, of the disease as manifest- 
 ed by unembarrassed Nature, or when she may be duly assisted by 
 art. Misapplied remedies, and various other exciting causes, will be 
 apt to affect the periodical law, especially where Nature is least re- 
 cuperative, as in continued and remittent fevers. The regularity of 
 the paroxysm is also influenced by local congestions and inflamma- 
 tions, and this, particulai'ly, when exciting causes are in operation (§ 
 773). These considerations, independent of their practical bearing, 
 refer to important problems in the philosophy of life and of disease. 
 
 The paroxysms of fever, therefore, observe a diurnal period ; rare- 
 ly taking place in the night. 
 
 768. b. The foregoing natural paroxysm extends its influences to 
 all diseases, and influences, also, the operation of remedial agents. 
 
 769. If a paroxysm return two or three times, or two or three re- 
 lapses take place at short intervals (as a few days, or perhaps weeks), 
 the force of morbid habit is manifested ; since in one case the parox- 
 ysms continue to return with greater obstinacy, and in the other re- 
 lapses are more likely to follow, and this, often, for a threat length of 
 time (§ 535, &c., 768 a). Much, howevei", may be frequently due to 
 supervening local congestions, which keep up the predisposition to fe- 
 ver, and operate, also, as exciting causes (§ 645, 665, 666, 870). Where 
 the intervals are long, the return of the fever is not a relapse, but a 
 new attack ; though this is truer of continued than of intermittent or 
 remittent fever. And this leads me to say, that any remote cause of 
 fever is less apt to produce a relapse than to excite the disease in one 
 who has not been before affected (§ 544, 550, 560, &c.). 
 
 770. It would be difficult to say why the paroxysms of fever are 
 separated by definite intervals, and these intervals, too, remarkable 
 for their variety as well as precision in the same form of fever. They 
 show us at least, however, the absurdity of expounding disease by 
 any of the laws or agencies that are known in the inorganic world. 
 These definite intervals have given rise to several designations of the 
 same form of fever; and according to the interval so is the ty2)e. We 
 have nothing like this in inflammations (§ 712-722, 764 e). 
 
 771. In the continued form of fever, and in remittents, the parox- 
 ysms (or exacerbations, as they are then called) recur about once in
 
 496 INSTITUTES OF MEDICINE. 
 
 twenty-four hours ; but the interval is more indefinite than with inter- 
 raittents. In a majority of the cases of intermittent fever the parox- 
 ysms are repeated at the end of forty-eight hours, and hence the name 
 oi tertian, or tertian type. The next most common are quotidians, or 
 fever with daily paroxysms ; each one taking place at the end of twen- 
 ty-four hours. A third, and most fixed variety, is called the quartan, 
 having a return of its paroxysms in seventy-two hours. 
 
 772, a. Sometimes there is a periodical difference in all the varie- 
 ties, or types, of the intermittent, of four hours ; and if, as now and 
 then happens, the difference be greater, the fever is said to be irregu- 
 lar. These irregularities are commonly owing to local congestions, 
 or other accidental influences, the removal of which will generally es- 
 tablish the more definite interval. 
 
 772, b. When the foregoing deviations occur, the paroxysms may 
 either anticipate the usual hour, or be delayed beyond it ; and it is a 
 remarkable fact, and strikingly illustrates the law of vital habit (since 
 it is inobedient to the influence of the natural paroxysm of health), 
 that in such cases the paroxysms are apt to go on with the particular 
 irregularity with which they began (§ 544, &c., 768 a). 
 
 772. c. Another remarkable fact connected with the intrinsic nature 
 of the vital properties, and illustrative of the special institutions of 
 organic life, relates also to the inequality of the foregoing intervals. 
 That is to say, if the interval of tertian paroxysms, for example, de- 
 viate from forty-eight to forty-six hours, or, on the other hand, from 
 forty-eight to fifty hours, the occurrence of the paroxysms will be 
 growing earlier in the former case, and later in the latter. But this 
 is not the most striking phenomenon attending these cases ; for when 
 the paroxysms, by their regular anticipation of the period of each last 
 preceding paroxysm, approach the night, one paroxysm is often lost. 
 This phenomenon, however, has its more obvious foundation, as the 
 others have more obscurely, in the natural law of the body already 
 mentioned (§ 768, o), since there is no inherent tendency in the sys- 
 tem to induce a paroxysm during the night (§ 137 b, 149-152, 638). 
 
 773. The intermittent and remittent fever are often so nearly allied 
 in pathology, that it is sometimes difficult to decide upon the type. 
 Here the deviation from the regular form of the intermittent is clearly 
 owing to the presence of venous congestions, or to inflammation ; 
 since the intermissions will become well defined as soon as those com- 
 plications are removed (§ 758, 762, 768 a). 
 
 774. The natural duration of continued fever is about three weeks, 
 rarely six. It varies with intermittents according to the particular 
 type. Such is the power of vital habit (§ 544, &c.), that a tertian nat- 
 urally occupies from three to four months ; and this is one of the nu- 
 merous instances in which the advantages of medicine are illustrated, 
 and the philosophy of solidism established ; since, as it respects the 
 pathology, an emetic, or a dose of quinine (of no analogous virtues), 
 may so alter the morbid properties as to place them at once in a con- 
 dition to recover their natural state (§ 557 a, 904 d). 
 
 Much, however, of the prolongation of fever is often due to the lo- 
 cal forms of disease which supervene on its progress, to errors in diet, 
 fatigue, &c. 
 
 775. Opposed, also, to the humoral pathology, and all the physical 
 hypotheses, is the occasional sudden termination of continued and in-
 
 PATHOLOGY. FEVER REMOTE CAUSES. 497 
 
 termittent fevers, in a state of health. This is generally preceded by 
 a severe paroxysm, and the disease is ended at once (§ 557, a). The 
 very violence of morbid action is attended by an alteration of the or- 
 ganic properties vi^hich enables them to take on the recuperative pro- 
 cess; just as w^e sometimes see alcoholic stimulants overthrow acute 
 inflammation, or the same conditions of fever (§ 756). Will the 
 chemist or humoralist explain 1 Fothergill, Falconer, and others, sup- 
 posed that the full and tense pulse which often supervenes on apo- 
 plexy depends upon a struggle which arises from an action of the 
 vires vitce. to restore health. " I believe," says Fothergill, " it hap- 
 pens in most cases where there has been a temporary, or even mo- 
 mentary cessation of the animal powers." 
 
 Remote Causes of Fever. 
 
 776. I come next to the remote causes of fever, and to consider, 
 also, yet farther, how the general pathological condition, as in inflam- 
 mation, is liable to modifications by differences in the nature of the re- 
 mote causes, and how, also, fever is influenced by coexisting inflam- 
 mations and venous congestions ; with a view to farther illustration 
 of principles of various import. 
 
 777. The predisposing causes of idiopathic fever probably consist, 
 in all cases, of the results of vegetable decay (§ 652, 653). The spe- 
 cial type and modification of the fever are determined very greatly 
 by the nature of the new combinations ; though other influences may 
 contribute (§ 650, 651, 758, 762, 773). The essential causes make 
 their impression so profoundly, that the incubation goes on althouo-h 
 the causes may have long ceased to operate ; which is commonly dif- 
 ferent with inflammations (§ 711, &c.). The causes of fever are also 
 distinguished by the peculiarity of so modifying the organic properties 
 of certain parts by their direct action, that the entire system is sympa- 
 thetically brought into a corresponding morbid state (§ 148, 657 h). 
 
 778. The predisposing causes of fever have been considered in all 
 their other relations to the disease under that general division of pa- 
 thology ; their modus operandi, the nature of predisposition, the in- 
 tervening periods, &c. (^ 148, 644, &c.). 
 
 779. The predisposing causes of fever are also causes of inflamma- 
 tion and venous congestion ; and hence it is, in part, that fever rarely 
 continues long without the appearance of one, or the other, or both 
 conjointly, of these local affections. Or, the local may precede the 
 constitutional disease, and become its exciting cause ; or the former 
 may exist without developing an attack of the latter, although the 
 system be predisposed to the constitutional affection. Or, again, the 
 explosion of the general malady is very apt to occasion a full develop- 
 ment of the local conditions of disease in organs so predisposed. But, 
 independently of this predisposition to local disease, it is the great 
 tendency of febrile action to lay its foundation. The occurrence of 
 these local affections modifies very variously the constitutional disease, 
 and increases its force and obstinacy. The treatment, therefore, must 
 turn greatly upon the local complications, and remain strictly anti- 
 phlogistic till they are removed or greatly subdued. 
 
 780. It may seem remarkable that diseases which are so consider- 
 ably diverse in theii- pathological conditions as fever and inflammation 
 should be produced by the same predisposing causes. But this only 
 
 I r
 
 498 INSTITUTES OF MEDICINE. * 
 
 shows that there are analogies among all diseases. All depend upon 
 certain states of the properties of lite ; and as these propeities can 
 never be greatly diverted from their natural conditions till life is at its 
 ebb, there must be affinities among all morbid states. By consider- 
 ing, also, that the vital properties have various natural modifications 
 in different parts we come to understand how the predisposing causes 
 of fever may simultaneously predispose particular organs to inflamma- 
 tion, or venous congestions (§ 133-152, 741 h, 767 a, 786, &c.). What 
 I have said, also, in former sections (§ 662, 670, 675) as to the fluctu- 
 ating state of the vital properties and functions during the progress 
 of a febrile paroxysm may reflect light upon this subject of analogies. 
 
 Pathological Cause of Fever. 
 
 781. Coming to the pathology of fever, morbid anatomy yields nu 
 assistance, and proves that our conclusions as to the essential nature 
 of disease must be mainly derived from its phenomena during life 
 (§ 695, &c.). It is therefore not remarkable that they who look for 
 the philosophy of disease to its direct manifestations should alone dis- 
 tinguish idiopathic fever from inflammation (§ 695, &c., 712-722, 757, 
 759, 764, 770). 
 
 782. Next to the proximate cause of inflammation no question in 
 medicine has occasioned more speculation than that of fever. The 
 humoral pathology has been at the foundation of many hypotheses, 
 and others have risen upon some supposed change in the organiza- 
 tion of the solids. These were the ancient and are now the prevail- 
 ing doctrines. 
 
 783. In no form of fever do the symptoms denote an absolute un- 
 varying affection of any organ ; but, on the contrary, the greatest va- 
 riety occurs as to the force of the disease in different parts. These 
 contingencies have suggested the minor designations as stated in sec- 
 tion 758 (§ 134, 138, 142, 143, &c.). 
 
 784. a. Fever being a disease of the whole body, and constantly 
 liable to complications with local inflammations and venous conges- 
 tions, it is particularly important that all the attendant symptoms 
 should become elements in forming our conclusions as to the nature 
 and force of the disease, both in a general and local sense, and that 
 our prescriptions should be determined by the aggregate weight of the 
 phenomena (§ 675). Vicissitudes may be also hourly occurring in 
 different parts, embarrassing to the judgment of the practitioner, and 
 demanding its highest exercise (§ 675, 685, 686, 857), 
 
 784, b. Owing to the universality of the disease, and the general 
 coincidence in its pathological character, remedial agents, when ap- 
 plied before morbid habit has taken possession, or local inflammations 
 have supervened, will stretch their influence over the universal body, 
 and may institute every where those pathological changes which are 
 capable of a progressive march to their ultimate termination in health 
 (§ 148-152, 487, 535, &c., 557, 672, 854, 893, &c.). 
 
 785. It is the triumph of morbid anatomy that it lays open to the 
 senses the tangible products of inflammation ; while it seizes upon 
 what an observation of Nature had already determined as to the pa- 
 thology of the disease. The great family of fevers shall sustain this 
 position of the vitalist, since here nothing is seen, in numerous cases, 
 after life has become extinct. The knife of the anatomist goes down
 
 PATHOLOGY. FEVER PATHOLOGICAL CAUSE. 499 
 
 to tne smallest fibre, and the aid of the eye-glass is summoned in vain. 
 And yet do we know about as much of the pathology of fever, for 
 pi'actical purposes, as of inflammation, and the treatment of one is as 
 well determined as of the other (§ 705). This has been inferred from 
 the vital phenomena of both diseases, and from an observation of the 
 effects of remedies. These phenomena are not less multifarious in 
 fever than in inflammation ; and so far as sensible changes attend the 
 immediate instruments of disease there is more to be seen in febrile 
 than in inflammatory diseases. In both there is commonly an in- 
 creased volume of blood circulating in the capillaries ; but there is 
 also, as a common element of fever, a primary contraction of those 
 vessels. What I have now said is the test between organic philoso- 
 phy and morbid anatomy (^ 1056). 
 
 And how is it with the signs which denote the essential pathology 1 
 We have seen that the facts are equally clear in both diseases, that 
 there is an exaltation of irritability and mobility from the time of their 
 invasion (§ 743, 744, &c.). But that is all we can leaiTi of the partic- 
 ular changes which they undergo in either affection, and that is only 
 a minor part of the disease. The organic properties and functions 
 have also sustained a change in kind, which is likewise known by the 
 phenomena. It is that change which constitutes, essentially, the dis- 
 eases, respectively, and which distinguishes one from the other (§ 177- 
 181). The phenomena, however, do not indicate the nature of this 
 essential*change ; but what they disclose as to the exaltation of irrita- 
 bility and mobility, in connection with their more indefinite sugges- 
 tions, and with experimental obsen^ation, enables us to institute all the 
 pathological and therapeutical principles that are necessary or useful 
 in practice. The rest is concealed, because it would be useless for 
 man to know it.* 
 
 The cold stage, or invasion of fever, when morbid action is most 
 profound, is marked, it is true, by an apparent debility of the living 
 powers ; so much so, indeed, that it may be difficult to show that this 
 universal opinion is erroneous. In a former section, however, I have 
 attemj:)ted it (§ 743). Its practical importance cannot be too highly 
 appreciated, since it deters the practitioner from the use of the lan- 
 cet, or leads him to that of stimulants ; especially in congestive fevers 
 (§ 961, &c.). The error has proceeded, in part, from the very fact 
 which evinces an exalted state of irritability and mobility, — the tonic 
 contraction of the capillary vessels during the cold stage. The em- 
 barrassed action of the heart, diminished circulation, sympathetic in- 
 fluences of venous congestions, the partial loss of control over the vol- 
 untary muscles, or indisposition of the will to act, and the want of a 
 proper estimate of the j^roperties of life, and of the morbid changes 
 to which they are liable, have contributed their share to this mistaken 
 view of the pathology of fever. Nothing, however, has done so much 
 toward the doctrine of " debility," and the stimulant treatment, as the 
 impaired energy of the will over the voluntary muscles, which arises 
 from the venous congestions that are associated with fever (§ 569, 487, 
 488^). I shall therefore proceed next to the subject of Congestion. 
 
 * I had a patient whose head of dense black hair changed in the course of one night 
 to a bright bluish turkey-ffreen, as the result of remittent fever. He recovered, and his 
 hair returned gradually to its former black. I had been before skeptical as to the re- 
 puted effect of the nervous influence when excited bj- fear in changing the hair sud- 
 denly from dark to white.
 
 500 /NSTITUTES OF MEDICINE. 
 
 VENOUS CONGESTION. 
 
 78G. The pathology of venous congestion, its treatment, &c., form 
 an extensive Essay in the Medical and Physiological Commentaries. 
 
 For all that relates to the pathology of that disease, as well as ol 
 varix, and for an exposure of the errors of former doctrines, and, in- 
 deed, for most that is essentially important in that Essay, I claim the 
 merit of an exclusive originality (Rights of Authors, p. 919, no. 28.) 
 
 787. The conclusions at which I have arrived, if founded in nature, 
 are among the most important in practical and theoretical medicine ; 
 since the conditions which obtain in venous congestion often demand 
 an energetic practice, reveal the true cause of the extensive mortality 
 v/hich has resulted from the stimulant treatment of fevers, and enforce 
 the admission of some of the most important doctrines in physiology 
 (§ 710, b). The relation, for example, of the pathology of venous 
 congestion to the philosophy of the circulation of the blood, &c., illus- 
 trates the vital character, and establishes the elements of that com 
 plex function (§ 384-391). 
 
 788. During the last century, the enlarged state of the veins, which 
 forms the prominent characteristic of venous congestion, attracted the 
 attention of several writers, who ascribed a malign influence to the 
 enlargement, though they regarded it merely as a mechanical phe- 
 nomenon. From that time, till a recent period, this state of the veina 
 was lost sight of entirely, notwithstanding it contributes, more than 
 the recognized forms of inflammation, to the mortality of the human 
 race. The neglect of this disease in our own times probably arises 
 from the prevailing disposition to interpret organic phenomena, wheth- 
 er healthy or morbid, upon chemical and mechanical principles. 
 
 789. The foregoing enlargement of the veins is an essential condi- 
 tion of the disease, though of minor importance. This enlargement 
 has been universally referred to an obstruction of the current of ve- 
 nous blood, or to a partial relaxation of the coats of the veins and a 
 stagnation of blood within them. It has been also as universally sup- 
 posed that all the evil results of this disease are owing to the accu 
 mulated or stagnated blood, while it is in the highest degree probable 
 that neither the enlargement of the veins, nor the increased volume 
 of blood within them, is productive of a single morbid phenomenon 
 (§ 748). 
 
 790. a. The enlargements of veins which are produced by ligatures, 
 hanging, reflux of blood, and as presented in the " circuitous circula- 
 tion" occasioned by the pressure of tumors or obliteration of the trunk 
 of a vein, are in no respect instances of venous congestion, although 
 they are generally adduced as the most palpable examples of that dis- 
 ease. Nevertheless, the stimulus of distension arising from pressure 
 on a vein may give rise to the sub-acute disease which constitutes es- 
 sentially congestion, varix, and venous hypertrophy ; as set forth in 
 my former Essay. 
 
 Four mechanical hypotheses have been surmised, to meet the exi- 
 gencies of all cases. One of them supposes, that, during the cold 
 stage of fever, the blood being determined from the centre to the
 
 PATHOLOGY. VENOUS CONGESTION. 501 
 
 circumference, accumulates about the heart, and then regurgitates 
 throughout the venous system of the internal organs. A second is 
 similar in pi-inciple. It supposes that, at other times, the accumula- 
 tion results from a simply diminished energy of the vis a tergo, which 
 is inadequate to the maintenance of a free circulation, and that an ac- 
 cumulation of blood takes place in the veins as a consequence. A 
 third hypothesis assumes that an embarrassed circulation takes place 
 in the lungs, by which an obstruction is constituted to a return of 
 blood to the heart, when, also, as a farther consequence, the blood 
 accumulates in the veins of other parts, particularly the head. The 
 fourth hypothesis has a similar mechanical cause. It imagines that 
 venous congestions in all parts are owing to obstructions occasioned 
 by hepatic disease. 
 
 I have shown that the objections to all the foregoing suppositions 
 are numerous and conclusive. In respect to those of a general na- 
 ture, which are mostly applicable, I may now say that it is obvious 
 that the blood would accumulate principally about the right cavities 
 of the heart alone, and not in the veins of distant organs. Or, should 
 a reflux happen, it should be coextensive and equal in the veins of 
 all parts at equal distances from the heart. On the contrary, how- 
 ever, venous congestion is limited to particular parts, often to one or- 
 gan, which may be, also, distant from the heart or supposed centre of 
 obstruction. It is often, for example, the brain only that is congested ; 
 where, too, accumulations of blood, unless from disease of the ve- 
 nous parietes, would be prevented by gravitation alone. Again, also, 
 were there any foundation for these hypotheses, the liver, stomach, 
 kidneys, lungs, &c., should always be congested whenever the brain 
 is the seat of the supposed reflux of blood. It is also obvious that, 
 the moment an equilibrium is restored to the general circulation, as 
 in bloodletting, the volume of blood should be equally reduced in the 
 veins of all parts. Contrary to this, however, the veins of some par- 
 ticular organ or organs often continue in a state of great enlargement, 
 as in the brain, &c. ; while the central accumulation of blood, the 
 supposed cause, is now completely removed. 
 
 790. b. So indefinite has been the pathology of venous congestion, 
 that injuries attendant on falls, and those prostrated states that are in- 
 duced by the shock of surgical operations, have been regarded as 
 identical with profound congestion ; and this even by so distinguished 
 and able an observer as Dr. Armstrong. This great error in theory 
 may explain his commendation of stimulants in aggravated forms of 
 congestive fever, and is probably one of the causes which have led to 
 their more indiscriminate use in less prostrating conditions of the dis- 
 ease (§ 970). 
 
 791. To aiTive at the true pathology of venous congestion, as well 
 as to ascertain the powers which circulate the blood, it was one of 
 my primary objects to show that the state of the circulation in con- 
 gested veins is exactly the reverse of the foregoing supposition (§ 
 790) ; that is to say, that the veins are in a state of active dilatation, 
 and that the blood circulates freely within them. (See Comm., vol. ii. 
 Also, § 382-394.) 
 
 792. I have shown, also, that the veins are susceptible of active di- 
 latation in their natural state from the local irritation of stimulants; 
 and that it is owing, primarily, to this action of the veins that the^
 
 502 INSTITUTES OF MEDICINE. 
 
 swell when the hand is immersed in warm water or exposed to a fire 
 From these premises, I passed on to a demonstration that the veins 
 possess an exquisite relation to the communicating arteries, of a sym- 
 pathetic nature, and by which they dilate actively in obedience to the 
 action which exists in the communicating arteries, and the quantities 
 of blood which may be transmitted. — See, also, ^ 387. 
 
 I endeavored to show, also, that when the veins become inflamed, 
 as in acute phlebitis, or in the sub-acute state of venous congestion, 
 the inflammation of their coats acts as a stimulant, and thus occasions 
 an active dilatation. 
 
 793. Whatever, therefore, will produce any degi'ee of inflammation 
 in the venous parietes, will be a remote cause of dilatation ; and, al- 
 though the phenomenon depend upon that physiological constitution 
 of the veins which occasions their active dilatation when increased 
 quantities of blood are transmitted from the arteries, or when they 
 are irritated by simple stimuli (§ 387), there is a wide difference in 
 the proximate cause of the morbid and the natural phenomenon. In 
 the latter case there is simply an obedience to natural influences, 
 and the phenomenon is therefore transient ; in the former, the influ- 
 ences are morbid, and the organic properties altei'ed from their healthy 
 standard, and the dilatation, therefore, is also cotemporaneous with 
 the disease, or until the vein becomes disorganized, as in acute phle- 
 bitis. In the natural state there is also an increased volume of blood 
 constantly transmitted to the veins ; in the morbid the increased vol- 
 ume depends upon the enlargement of the veins. And yet the mor- 
 bid dilatation has the physiological constitution for its foundation. 
 
 The following example shows the operation of the natural princi- 
 ple. " Cooks," says Sir B. Brodie, " are subject to varicose veins. 
 Wiiy 1 If you put one hand into warm water, and the other into 
 cold, you know that the veins of the former become dilated, and that 
 those of the latter will contract." 
 
 This is a clear illustration of the physiological constitution of the 
 veins, both as to active dilatation and contraction. But it goes no far- 
 ther. The dilatation is the result of the operation of a healthy vital 
 stimulus, and depends, in part, upon a constantly-increased volume 
 of blood which is transmitted from the arteries, as set forth in section 
 387. In varix there is no such increased volume transmitted, nor in 
 phlebitis, nor in venous congestion. The dilatation is also permanent 
 in the latter cases, while in that of the cook it subsides as soon as the 
 stimulus of heat is withdrawn. The illustration is, indeed, a con- 
 tradiction of the intended philosophy, since cooks are not subject to 
 varicose affections in their arms, which are alone, though constantly, 
 exposed to hot water. And so of the glass-blower. It is nothing 
 more than the phenomenon which proceeds from exercise, or febrile 
 action, or even from the common forms of inflammation ; though 
 slightly modified in these morbid states of action. The example 
 serves to confirm, also, what I have taught as to the physiological re- 
 lations between the arteries and veins, and the instrumentality of a 
 great principle in the circulation of the blood (§ 387). 
 
 The assumed analogy to varix in the foregoing example is a part 
 of the common mistake of confounding the physical with the vital 
 laws, and shows the untenable nature of all such positions. We re- 
 lax dry, dead matter by soaking it in warm water. The water pen-
 
 PATIIOLOiiY. VENOUS CONGESTION. 503 
 
 etrales the substance ; and this whether wai'm or cold. But what 
 would be the effect upon the cook if she take the hand from the 
 warm water and place it with the other in the cold water ] 
 
 794. The venous tissue is composed of three coats ; the inner, 
 which resembles considerably a serous membi'ane, the middle, which 
 possesses longitudinal fibres, and the external or cellular coat. 
 
 The inflammation is seated mostly in the inner coat. Contraction 
 and dilatation are effected by the fibres of the middle coat ; which, be- 
 ing longitudinal, are capable of producing contraction or dilatation 
 with rapidity and uniformity over a great extent. This natural pro- 
 vision was necessary to the purposes of venous circulation, and to ac- 
 commodate the diameters or capacity of the veins to the suddenly 
 and constantly varying proportions of blood transmitted to them from 
 the arteries. Circulation could not be performed without it ; since, 
 if the dilatation of the veins were effected by the supposed mechan- 
 ical distension of the blood when increased volumes are deteiTnined 
 upon them by the arteries, the physical resistance of the veins would 
 impede the transmission, and the subsequent progress of the blood. 
 There would then be a want of harmony between the arteries and 
 veins, which would constitute a fundamental defect in organization. 
 Nay, more ; this harmony reaches, also, to special modifications of the 
 organic properties of the venous tissue, by which the veins are ren- 
 dered sensitive to the varying states of the capillary arteries, and to 
 impressions arising from the varying quantities of transmitted blood 
 (§ 133, &c., 385). 
 
 795, a. Now, it is in the foregoing peculiar organization of the 
 veins, and the special modifications of their vital properties, that all 
 the remarkable phenomena of acute phlebitis and venous congestion 
 have their foundation. The veins dilate actively when inflamed, be- 
 cause such is their natural function when impressed by stimuli, espe- 
 cially their natural stimulus, the blood. Their dilatation is permanent 
 in inflammation, as that affection operates as a permanent stimulus ; 
 and irritability is permanently increased, by Avhich the blood has. 
 also, a preternatural effect (§ 143, &c.). 
 
 795, h. From the exquisite development of their organic properties, 
 the veins are extremely liable to inflammation ; especially that sub- 
 acute form which constitutes venous congestion. And whether their 
 inflammations exist in the form of acute phlebitis, varix, or venous 
 congestion, it is always diffuse, extending rapidly over the venous tis 
 sue, and liable, in all its forms, especially of phlebitis and congestion, 
 to give rise to great constitutional disturbances. The diffuse nature of 
 inflammation is partly owing to the natural principle by which the 
 venous tissue has an associated action over an extensive surface ; and 
 all the local and constitutional phenomena may be traced to the pecu- 
 liar vital constitution of the veins (§ 151, &c.). 
 
 Turning, however, to the arterial system, we find all things quite 
 the reverse, and referable to the natural vital constitution of those 
 vessels (§ 149, &c.). The arterial tissue is very little liable to inflam- 
 mation, the disease is always very circumscribed, and produces but 
 little, or no constitutional effect (§ 140, 526 a). 
 
 796. It was an important object in my Essay on Venous Conges- 
 tion to establish satisfactory analogies between acute phlebitis and ve- 
 nous congestion, and I extended the analogies to varix and venous
 
 504 INSTITUTES OF MEDICINE. 
 
 hypertrophy ; and in so doing, as well as by the specific facts, demon- 
 strated the inflammatory nature of these last affections. The several 
 conditions were thus brought to illustrate and confirm the common 
 nature of their pathological cause. Nor was the necessity overlooked 
 of showing the fallacy of the universal doctrine of the dependence of 
 varix upon local obstructions to the venous circulation and stagnation 
 of blood, nor of applying to practical uses the true pathology of varix 
 (§ 350|). It was thus shown how it happens that tying, or dividing, 
 varicose veins, is so often followed by active phlebitis. 
 
 Besides its never having been shown that any obstructing cause ex- 
 ists either in venous congestion, or in the early stages of varix, if any 
 stagnation of blood arose from other causes, the valves of the veins 
 should be closed, and a knotted appearance presented at the several 
 points. Such, indeed, had always been the supposition in relation to 
 the valves, till I proved it otherwise. While the blood circulates, the 
 valves are necessarily open (§ 391). — Rights of Authors, p. 919. 
 
 797. Taking the most simple and subdued form of venous inflam- 
 mation, and in its most local sense, we have a type of the whole by 
 which we may ascend progressively upward till we reach the strong- 
 ly-marked conditions of phlebitis, without losing a hold upon many 
 striking analogies which assure us that the common feature is imparted 
 by venous inflammation. When constitutional influences may not ob- 
 tain, as in the ordinary conditions of varix, there are still present the 
 dilatation of the veins, their long-continued, unembai-rassed circulation, 
 their ultimate disorganization, pain, soi-eness, liability to active phle- 
 bitis, &c., to establish the intimate relationship of varix to the high- 
 est grades of venous inflammation, and to throw a broad light over the 
 common family, however they may be removed in degrees of con- 
 sanguinity. 
 
 798. It is also an important practical fact, as well as proof of the 
 physiological doctrine of venous congestion, that this affection often 
 springs up in quick succession in different organs, and often manifest- 
 ly as sympathetic results of each other (§ 525, a). The same is also 
 partially true of active phlebitis. Apoplexies are often remotely 
 owing either to irritation of the stomach, or to venous congestions of 
 the liver. On dissection, we find in most of the cases a state of ve- 
 nous engorgement in the brain, which has been excited sympatheti- 
 cally by one of the foregoing causes. It is especially to hepatic con- 
 gestion, connected with peculiar influences of external predisposing 
 causes, and the law of sympathy which predominates in the venous 
 tissue (§ 387), that we must ascribe the epidemic apoplexies which 
 have been described by numerous writers from Hippocrates to our 
 own times. And how absurd would be the conjecture that in such 
 apoplexies there happens an epidemic mechanical obstruction to the 
 venous circulation of the brain, and where, too, gravitation would pre- 
 vent all accumulations of venous blood, were it not for the active, mor- 
 bid dilatation of the veins! 
 
 799. My demonstration, also, of the essential contribution of the 
 derivative or suction power of the heart to venous circulation brings 
 into view another principle which must tend powerfully to prevent all 
 accumulations of blood in the veins. — {Essay in Comm. Also, § 388- 
 390.) 
 
 800. Passing over a multitude of facts which I formerly embra
 
 PATHOLOGY. VKNOUS CONGESTION. 505 
 
 ced in the foregoing illustrative proof of the inflammatory nature 
 of venous congestion, and varix, I may now appeal to morbid anato- 
 my for a tangible demonstration of my conclusions. But this ground 
 is too extensive and circumstantial for the objects of the present work ; 
 and it has been most amply explored in my former Essay. It is wor- 
 thy of remark, however, that the blood often gravitates from congest- 
 ed veins of the liver after death (p. 725, note). 
 
 801, a. Let us, therefore, attend next to a more practical demon- 
 stration, which will be again resumed under the Philosophy of the 
 operation of loss of blood ; namely, the appropriate treatment of ve- 
 nous congestion, in its simple forms, and as complicated with idio- 
 pathic fever. There is no practical question of greater moment, none 
 more likely to be decided by theoi'etical principles, and none where 
 the therapeutical facts settle more conclusively the nature of the dis- 
 ease, and the piinciples which should guide the treatment. 
 
 801, b. The method of cui'e had been either empyrical, or Avithout 
 a sound principle to guide it, till my Essay was published. So far as 
 the mechanical hypothesis has had its sway, it has led to nothing but 
 error, suffering, and death ; since, upon that ground, stimulants have 
 been the remedies. — Notes F p. 1114, S p. 1124. 
 
 Nevertheless, experience has led some of the soundest minds, as it 
 has many in regard to the humoral pathology in its broad application, 
 to disregard the dictates of hypothesis, and to depend upon bloodlet- 
 ting and other antiphlogistic means ; and the result has proved that 
 they are the only successful means. But there was little of this prac- 
 tice till the time of Armstrong, and even this philosopher yielded to 
 the mechanical doctrine in those intense fOrms of the disease where 
 loss of blood was most imperatively demanded (§ 4, 960, 961, 964 
 1005). Bloodletting was inculcated by the ancient masters. 
 
 Now, therefore, antiphlogistic means being the remedies for inflam- 
 mation of other tissues, and stimulants, as in such inflammations, be- 
 ing pernicious in venous congestions, they concur with all other facts 
 in establishing the inflammatory nature of this disease. 
 
 801, c. By the guide of the pathology and principles which I have 
 indicated, and as shown by the results of the best and the worst expe- 
 rience, we apply ourselves to the work of cure with an intelligible 
 object before us ; nor are we harassed by doubts, nor fluctuate from 
 experiment to experiment (§ 960, 1005). There is a specific object 
 in contemplation, the only principal one to which our treatment should 
 ever refer (§ 667, &c.), and we pursue it with steadiness of purpose, 
 and without the alarm or those imputations of imbecility to a noble 
 art which flow from the mechanical doctrine, with its associated 
 visions of debiliti/. We regard the sluggish mood of the will as 
 constituting much of what otherwise seems a state of universal weak- 
 ness (§ 487 h, 569, 743), and look, as in all other cases, with the calm- 
 ness of an enlightened understanding, upon an insidious and powerful 
 foe, since we know his ambush and his strength, and our own means 
 of circumvention and defeat. 
 
 802. As to the incipient seat of venous congestion, I shall only now 
 say, that farther observation has sustained the opinion which I ex- 
 pressed, and endeavored to enforce, in the Co?)imeniaries, that there is 
 " much ground for believing that the inflammatory action begins in the 
 capillary veins, and that it is subsequently propagated to their trunks."
 
 506 INSTITUTES OF MEDICINE. 
 
 Many grounds are set forth for the conclusion, some of which were 
 of the nature of principles ; such as the extent in which the venous 
 system of organs is generally and simultaneously involved, &c. This 
 also corresponds with what I have said of the natural function of these 
 vessels in relation to the varying proportion of transmitted blood. 
 
 When the larger veins are the seat alone of accumulated blood, 
 they are commonly isolated, as in varix. Nor does venous conges- 
 tion affect the largest series; but it is commonly limited to some com- 
 plex vital organ, where we are certain that the capillary veins are 
 more highly endowed with the properties of life than in parts which 
 are less instrumental in the great organic piocesses, and where re- 
 mote causes, external and internal, may therefore operate with great- 
 er intensity, or any general derangement of the organ may develop in 
 the venous capillaries the supposed morbid condition. The termina- 
 ting series of the arterial system are the instruments of all the great 
 vital actions, and of all diseases, — of venous congestion itself. Anal- 
 ogy, therefore, as well as the general office of the veins, and their an- 
 atomical and functional alliance to the terminating series of arterial 
 vessels, show us that the organic properties of veins are more strong- 
 ly pronounced in the venous capillaries than in the venous trunks. 
 And yet they may be so modified that inflammation may run higher 
 In the trunks than in the capillaries (§ 134, 387, 526 a). 
 
 803. Venous congestion often passes rapidly into inflammation of 
 other tissues with which the congested veins may be associated ; and 
 both forms of the disease frequently exist together in the same organ. 
 This remarkable fact of the ready passage of venous congestion into 
 inflammation of other associate tissues grows out of the vital relations 
 between the veins and arteries (§ 387). The mode of propagation, 
 therefore, is by continuous sympathy* or by reflex nervous action. The 
 presence of inflammation in the coats of the veins operates either di- 
 rectly or indirectly as a stimulus upon the communicating arteries, 
 through the foregoing natural relations (§ 802), and thus becomes a 
 sympathetic cause of inflammation in some other associate tissue. 
 The nature of the irritation is strongly manifested in the violent pul- 
 sations of the abdominal aorta, and of the coeliac and carotid arteries, 
 in hepatic and cerebral congestion ; and, I may add, that this phenom- 
 enon alone would establish the vital nature of the whole assemblage 
 of movements and results. It is the result of continuous sympathy.* 
 
 804. But, while the foregoing morbid action is taking place in tis- 
 sues associated with the congested veins, an abatement of the conges- 
 tion or venous inflammation is simultaneously going forward. This 
 harmonious process involves, also, another beautiful exemplification 
 of reflex nervous action. As soon as the supposed influence is estab- 
 lished upon the capillary arteries of the surrounding tissues, a reaction 
 of sympathy takes place in the veins, by which the morbid state is 
 overcome (§ 143 c, 152, 524 c, 528, 657, 660, 905). Their contraction 
 then follows, as a consequence, and " the balance of the circulation," 
 as it is called by the mechanical theorists, is more or less restored. 
 This salutary reacting sympathy which arises from the supervening 
 diseases is a common phenomenon. Pulmonary affections, for exam- 
 ple, will supervene by reflex action upon gastric disease, and simul- 
 taneously operate as a relief to the stomach. A part of this great and 
 universal law is manifested by the operation of blisters, and sometimes, 
 
 • Contimcovs injluence of these Institutes (5 129 c, /, 498 a).
 
 PATHOLOGY. VENOUS CONGESTION. 507 
 
 when the artificial disease subsides, its abatement accelerates the decline 
 of the natural affection, and thus exemplifies the law of reflex nervous 
 influence in its compound aspect (§ 733 e, 893, 90<5). 
 
 Inflammation of other tissues is also an exciting cause of venous 
 congestion, and here, too, the primary affection is apt to subside when 
 the sympathetic one has taken place; the philosophy being the same 
 as in the preceding case (§ 638 J). 
 
 Again, active phlebitis of the liver is not infrequent, preceded by 
 symptoms of venous congestion, which has simply passed into the more 
 active state, just as irritation of varicose veins will excite acute phlebitis. 
 
 805. With the farther object of illustrating the pathology of venous 
 congestion, as, also, to ascertain the pathology of spontaneous hemor- 
 rhage, I have gone into a critical inquiry relative to the latter subject 
 in two Essays embraced in the Commentaries, one of which is devoted, 
 to that investigation (vol. i., p. 371-384 ; vol. ii., p. 546-566). The 
 subject involves some physiological and therapeutical principles of 
 great moment ; and so far as I have shown the general dependence of 
 hemorrhage upon venous congestion, it goes with my other facts in 
 establishing the inflammatory nature of the disease. As a prelimina- 
 ry step, I demonstrated by the observations of mechanical theorists, 
 that the prevailing physical rationale is contradicted by their owr. 
 facts ; that it is very rare that ruptured vessels have been detected by 
 the microscope, and tliat no vessels admit the transudation of their 
 fluids till putrefaction has opened the way. I shall now only add, that 
 I have variously sho\vu that capillary hemorrhage is not only the re- 
 sult of a vital process, but is analogous, as had been supposed by 
 Hunter, to that of secretion. Prominent examples occur in purpura 
 hemorrhagica, in petechial fevers, in sanguineous apoplexy, haemop- 
 tysis, &c. (§ 1002).— Note Bbb p. 1148. 
 
 The effusion of blood is the result of a salutary effort of nature to 
 relieve the venous inflammation (§ 732). The quantities of blood 
 which are often poured out in this condition of disease, not only with 
 safety but with relief, are perfectly astonishing, and such as would be 
 fatal if imitated by art. We may, however, well take a lesson from 
 nature as to this her antiphlogistic treatment of venous congestions, 
 and pause over the administration of stimulants to revive the energies 
 of powers when prostrated by an overwhelming load of venous inflam- 
 mation, for the relief of which nature often snatches the cure from the 
 hand of art, and astonishes the stimulant practitioner by a stupendous 
 and successful discharge of blood (§ 812, 1018, 1019).* 
 
 806. The influences of venous inflammation, in all its degrees, are 
 very different from inflammation of other tissues (§ 140). The gen- 
 eral circulation, for instance, is apt to be much excited in common in- 
 flammations ; but in acute phlebitis, and in venous congestion, the 
 influences are quite liable to be of a depressing nature, especially upon 
 the general circulation. This is generally true when either form of 
 the disease exists in its greatest intensity ; and the phenomena of ex- 
 citement obtain, more or less, when these forms of venous inflamma- 
 tion are less violent, or when on the decline. 
 
 Its morbific reflected nervous influences, whether it be acute or sub- 
 acute, are of a compound nature ; partly the exciting influences of 
 inflammation when affecting other tissues, and partly the depressing 
 effects which are peculiar to morbid changes in the venous tissue. 
 * See Notes F p. 1114, Ff p. 1135, Gg p. 1138, Ii p. 1139.
 
 508 INSTITUTES OF MEDICINE. 
 
 These are the most visible results, though more profound changes tako 
 place. The predominance of these two manifest influences is gener- 
 ally on the side of the depressing effect, in the stages of full develop- 
 ment ; but, in what may be called the chronic state of venous conges- 
 tion, the exciting and depressing tendencies seem more nearly bal- 
 anced. An exception, however, should be made in respect to venous 
 congestion of the brain, where the usual exciting influences of inflam- 
 mation are commonly in the ascendant (§ 686 h, 974 c, 975). It fre- 
 quently happens that a very decided hardness, incompressibility, and 
 considerable fullness of pulse attend the chronic forms of hepatic con- 
 gestion, and that there will be little other apparent constitutional dis- 
 turbance, excepting as the stomach performs its ofiice imperfectly, the 
 bowels more or less torpid, &;c., and that these cases may suddenly 
 eventuate in a very aggravated form ; especially if miasmatic fever 
 happen to supervene. The character of the pulse then undergoes a 
 very striking change ; becomes small, accelerated, loses much of its 
 hardness and incompressibility (§ 686 I, 688 d, e). A chronic state 
 of hepatic congestion is often the forerunner of miasmatic fever, and 
 one of its exciting causes ; the local predisposition having been form- 
 ed by the predisposing cause of the general malady (§ 665, 813). 
 
 807. The local phenomena, also, are apt to be obscure in all grada- 
 tions of venous inflammation ; and it is no unusual event for uterine 
 phlebitis to terminate fatally without its presence having been sus- 
 pected ; till a post-mortem examination has revealed a disorganized 
 state of the uterine and iliac veins, attended with purulent matter 
 within the vessels. And, although it is not my purpose to enter into 
 a detail of symptoms beyond what may be necessary to illustrate the 
 patholoo-y of venous congestion, and the general principles which 1 
 have in view (§ 800, b), it is still worthy of the practical remark, and 
 as showing, also, the special constitution of the venous tissue, that it3 
 inflammations of every degree are apt to be unattended with much pain, 
 or tenderness on pressure ; excepting when in the form of varix, which 
 is sometimes very painful, and often tender (§ 725, b). An absence of 
 those common phenomena of inflammation of other tissues, and per- 
 haps only a subdued state of some other of its striking symptoms, iiot 
 unfrequently betray the unwary into a false security, or beguile him 
 into the fatal belief that " debihty" is the worst attendant. 
 
 808. Upon my theory, therefore, of the pathology of venous conges- 
 tion, we see more and more an admirable concurrence between the 
 morbid phenomena of that aflectiou and the natural physiological 
 manifestations of the venous system ; and we arrive through the phys- 
 iological data at a ready interpretation of the most difficult problems 
 in venous congestion. By these data we are enabled to discover, also, 
 why the veins of the external parts of the body are not, like those of 
 the internal organs, subject to congestion, but rather to varix; and 
 why, again, an acute inflammation of a large internal vein is often lim- 
 ited to a point of divergence (§ 133-152, 526, 576 d, 578 d, 579 b, 
 721, 722, 794, 795). 
 
 809. It is owing especially to the foregoing peculiarities of venous 
 inflammation, that when complicated, either in its form of acute phle- 
 bitis or venous congestion, with idiopathic fever, it greatly modifies 
 the phenomena of that disease ; rendering it insidious, obstinate, and 
 fatal (§ 651, 652, 722 c). It is always an attendant of the plague
 
 PATHOLOGY. VENOUS CONGESTION. 509 
 
 yellow fever, typhus, cholera asphyxia, " black death," &c., and im- 
 parts to them much of their peculiarities, severity, and danger. 
 
 810. Venous congestion and acute phlebitis not only steal their 
 march in ambush (§ 807), but often throw a mask over constitutional 
 fever, or present their own characteristics as the prominent phenome 
 na. Hence it is that when venous inflammation is artificially excited 
 by mechanical injuries of the veins, or by irritating injections, the re- 
 sults are said to resemble those of typhus, or yellow fever. It was 
 this illusion, as well as a radical defect in his physiological views, and 
 practical obsers'ations, which betrayed Magendie into the experiment- 
 al fallacies recorded in a foregoing section (§ 744). — Note S p. 1124. 
 
 It will be also observed that the experiments go to prove the de- 
 pendence of many of the phenomena of typhus and yellow fever upon 
 the attending venous congestions. 
 
 811. The foregoing modifying influence of venous congestion upon 
 idiopathic fever (§ 688 dd, 806, 810, 961, &c.) is one of the many 
 clear demonstrations of the modifying effects of local disease upon the 
 vital states of the whole system, illustrative of the manner in which 
 it may bring all parts into harmonious relation with any changes which 
 such local disease may effect in the blood, and which would other- 
 wise prove morbific (§ 847, g). It shows, also, how the entire body 
 may be rendered susceptible, through morbific influences, to the ac- 
 tion of remedial agents which might be otherwise inert, and how, when 
 those agents exert salutaiy effects upon the various parts that may be 
 partially influenced by some local malady, the morbidly sympathizing 
 parts may then become reacting sources of salutary impressions upon 
 the more absolute seat of disease (§ 143, 149-152, 514 h, 638, 804. 
 Also, Med. and Phys. Comm., vol. i., p. 649, 653-655, &c.). 
 
 The reflex nervous influences of venous inflammation being of a 
 mixed character (§ 806), are extended, also, over the phenomena of 
 any coexisting membranous inflammation, as well as of idiopathic fe- 
 ver ; thus presenting still farther, in their delicate shades as well as 
 prominent characteristics, the complex results of diff'erent forms of 
 disease, whether existing independently or in connection with each 
 other, or offering a striking illustration of the natural modification of 
 the properties of life in the different tissues and organs, of the man- 
 ner in which morbid changes in any common disease correspond in 
 peculiarities with the natural peculiarities of the vital properties of 
 the tissue, and showing how reflex nervous influences exerted on 
 remote parts correspond with the peculiar conditions now stated (§ 
 133-151, 191, 577, 578). It is also worthy of remark, that where ve- 
 nous congestion is complicated with inflammation of other tissues, it 
 is apt to lessen the hardness and force of the pulse, and to modify the 
 other symptoms which are usually attendant on the recognized foiTn 
 of inflammation. In congestive pneumonia, and epidemic erysipelas, 
 for example, it so far disguises the usual phenomena of the associated 
 inflammation, that practitioners are constantly betrayed into the fatal 
 use of tonics and stimulants. These associated conditions supply, 
 also, a good exemplification of the tendency of venous inflammation 
 to maintain the pulse within a limited degree of that hardness and in- 
 compressibility which are often very strongly pronounced in inflam- 
 mations of other tissues (§ 638i, 814, 1005 h). 
 
 812. Examples of independent, isolated forms of venous conges-
 
 510 INSTITUTES OF MEDICINE. 
 
 tion are constantly seen in the brain, especially of children and ap* 
 oplectic subjects, in the liver, &c. (§ 790, a). But the most prom- 
 inent instance occurs in purpura hemorrhagica, where all its phe- 
 nomena may be studied, and where its inflammatory nature may be 
 fully ascertained, particularly if not complicated with fever, or with 
 inflammation of other tissues, but depending, immediately, upon ex- 
 tensive congestion of the veins (805, 1002 d). 
 
 813, a. Venous inflammation in the form of congestion is occa- 
 sioned more frequently than inflammation of other tissues by the 
 predisposing causes of .idiopathic fever (§ 644, &c., 742, &c., 776, 
 &c.). Congestive fevers and local congestions pi'evail, therefore, at 
 the same time and places. Both may also prove exciting causes of 
 each other (§ 712, 777, &c.). The local affection may exist many 
 weeks, grow into a state of intensity without being suspected (§ 807), 
 and finally give rise to an explosion of fever, which, from the mild 
 ness of the predisposition, may not have happened but for the exci- 
 ting influences of the local disease. The fever which ensues, though 
 not a sympathetic, but an independent disease, aggravates the local 
 congestion, and gives greater intensity to its symptoms ; though both 
 conditions may coexist for some time in great force and obstinacy 
 without any prominent or alarming symptom. These Cases are not 
 uncommon, nor is it a rare circumstance, in such instances, for prac- 
 titioners in good repute to stand appalled over a lifeless body where 
 they had only a few hours before predicted an early convalescence ; 
 and if the morbid anatomist be summoned to the scene of disappoint- 
 ment, chagrin, and distress, he seeks in vain for his post-mortem pa- 
 thology, and pronounces a malediction upon Nature, or upon the im- 
 perfections of science, or upon the imbecilities of art (§ 695, &c.). 
 " Medical philosophy is a metaphysical subtlety, and it were a thousand 
 times better to confess our ignorance than to give up our senses." 
 
 813, h. Since, therefore, miasmata are so extensively the cause of 
 venous congestion, it is important to consider that its exact patholog- 
 ical character will depend, caeteris paribus, like that of fever, upon 
 the exact nature of the miasma (§ 653). Hence, also, the constitu- 
 tional modifications of fever by venous congestions will be more or 
 less determined by the exact pathology of the venous disease, as well 
 as by the general effect upon the system of the miasmatic agent (§ 644, 
 &c., 722 c). 
 
 814. The considerations which have been now made enable us to 
 understand the sources of those numerous modifications which distin- 
 guish the different species of fever, and aid, especially, our compre- 
 hension of their connections with venous congestion, and the various 
 modifying influences of this disease upon the constitutional affection. 
 Depending greatly on the specific nature of their predisposing causes, 
 the local, as well as the constitutional changes, being imbued in the 
 several cases with the specific influence of these causes, and the 
 general characteristics being determined, for the most part, by the 
 constitutional affection, the incidental venous congestions impart yet 
 another general resemblance among the congestive fevers ; varying 
 the whole from their simple type, and often more or less confounding 
 the specific phenomena under a common aspect (§ 638^, 811). 
 
 It is upon principles which I have now, and at other times stated, 
 that we may understand why the typhus of one country, or of one
 
 PATHOLOGY. VENOUS CONGESTION. 511 
 
 season, lias been, under equal circumstances of treatment, varied in 
 its phenomena from that of another ; why epidemic scarlatina and 
 measles are more fatal than the simply contagious ; epidemic erysip- 
 elas more so than sporadic; why the inttjrmittents of Africa are more 
 pernicious than those of other countries (§ 630 e). — Note Oo. 
 
 815. When venous congestion so far disguises the attributes of idio- 
 pathic fever as to present the constitutional phenomena of venous in- 
 flammation, there is no condition of disease which demands more im- 
 peratively enlarged views in pathology, a deeper scrutiny of symptoms, 
 or greater moral firmness for its appropriate treatment. If danger be 
 seen, it appals the timid, and prostrated voluntary power urges him 
 to the fatal use of stimulants (§ 487, 488^, 569). Under these fearful, 
 but common conditions, the presence of well-marked inflammation of 
 other tissues contributes to the safety of the patient. Such inflamma- 
 tions, however undesirable in other aspects, tend to counteract, for 
 awhile, the depressing influence of venous inflammation, to lull the 
 imagination, which sees nothing but " debility," or " putrefaction," in 
 the prostrated state of the circulation and of voluntary motion, and in 
 itself sustains the powers of life under the influence of depletive rem- 
 edies, which alone can cure ; and gives the last remaining hope which 
 may be inspired by the unaided vis medicatrix, but which may be 
 speedily extinguished by tonics and stimulants (§ 662 h, 675, 686).* 
 
 816, a. Venous congestion, being mostly occasioned by miasmata, 
 prevails in its local form simultaneously with congestive fevers, and 
 independently of any apparent predisposition to the latter. In this 
 simple condition the disease is most apt to affect the abdominal or- 
 gans. Nevertheless, it is evident in many of these cases, that the sys- 
 tem is also imbued with a predisposition to fever (§ 666). In a still 
 more simple form it is common in cities ; particulai'ly south of the lat- 
 itude of forty degrees. It seems then dependent, also, upon malari- 
 ous causes. And when it is considered that the liver is especially the 
 seat of venous congestion in the different forms of congestive fever, and 
 that the veins of this oi'gan are quite liable to acute phlebitis, and that 
 the phenomena of each are often analogous, a very special proof is thus 
 supplied of the correspondence of the pathological states (§ 390 b, 526 b, 
 803, 809). 
 
 816, h. Other causes of malign influence may be transiently no- 
 ticed. The disease, for example, is generally an accompaniment of 
 severe forms of scarlet fever, appearing then mostly in the liver and 
 intestinal canal ; when it is also badly modified by the predisjDoshig 
 cause of the more specific affection. Again, it often springs up as a 
 sequel of scarlet fever; when it is also imbued with the lingering in- 
 fluences of that complaint, and presents obstinate and difficult prob- 
 lems for the practitioner. It is still the digestive organs that suffer 
 its invasion ; and now it not unfrequently leads to inflammatory afl^ec- 
 tions of the peritoneum, or of the cellular tissue of the surface, which 
 ends in dropsical eff"usions ; or, as when coexisting with scarlatina, 
 glandular swellings may suddenly supervene about the neck. This 
 is especially true if the intestinal canal be often subjected to the irri- 
 tation of mercurials, which are apt to be of a peculiarly morbific na- 
 ture in scarlatina (§ 689, I), Gastric irritations in childhood are com- 
 mon causes of hepatic and cerebral congestions ; and in many adults 
 there is a constitutional predisposition to cerebral congestion which is 
 * See Note S p. 1124.
 
 512 INSTITUTES OF MEDICINE. 
 
 apt to terminate in sanguineous apoplexy. Various kinds of poisons, 
 animal and vegetable, healthy and morbid, give rise to venous con- 
 gestions ; each one imparting some peculiar shade of difference to the 
 affection (§ 721, 722). Such is the case with the narcotic poisons, 
 alcohol (in delirium tremens), hydrocyanic acid, the poison of dissec- 
 tion wounds, the wourari, &c. {§ 662, c). 
 
 All the foregoing causes, excepting miasmata, produce the local 
 forms of venous congestion; which is therefore never complicated 
 with idiopathic fever when proceeding from those causes (§ 653). 
 
 817. Looking back upon the attributes, the causes, the constitu- 
 tional effects, and the morbid anatomy, of venous congestion, and con- 
 sidering what is yet to be said of its treatment (§ 961, &c.), we find 
 a great amount of proof in favor of the vital doctrine which I have 
 propounded as to the pathology of this disease. As in inflammations 
 of other tissues, the causes are such as make their impressions upon 
 the properties of life. We see, also, in like manner, even a greater 
 variety of modifications of the phenomena, corresponding, also, with 
 the special nature of the predisposing causes. We see the disease 
 influenced by peculiarities of climate, habits, constitution, age, &c., 
 and constantly arising with or without fever in some places, while it 
 is rare in others. It affects the robust far more frequently than the 
 weak ; high livers, the sanguine, and especially tipplers, more than 
 the temperate and other constitutions. We see it slaying the morbid 
 anatomist, while its remote cause has been concealed in a wound 
 which no microscope can discover. We see it springing up in the 
 brain in obedience to the specific relations of many agents to that or- 
 gan ; narcotic poisons, alcohol, prussic acid, carbonic acid gas, &c. 
 We see it coexisting with affections of a distinctly inflammatory char- 
 acter, as measles, small-jDox, scarlatina, &c., always increasing their 
 violence, and adding, according to the nature of the principal disease, 
 to their fatality, as when complicated with idiopathic fever. Or, if it 
 supervene on common derangements of other parts, those maladies 
 are such as predispose to inflammation of other tissues. Nor has 
 morbid anatomy detected a cause of obstruction, nor can reason sur- 
 mise a cause for a single instance in the midst of the variety ; but' 
 where, on the contrary, the variety alone of predisposing causes de- 
 molishes the whole fabric of the mechanical pathologists. 
 
 If we turn to active phlebitis, or admitted inflammation of the veins, 
 we find it equally depending upon the predisposing causes of venous 
 congestion, and both diseases often associated in the same organ, or 
 presenting themselves together as complications of idiopathic fever, 
 and often making demonstrations of the same phenomena. Shall we, 
 therefore, in one case, impute the phenomena to a simple mechanical 
 fullness of a limited portion of the veins, while in the other, we refer 
 the analogous symptoms, and the venous enlargement, to a local dis- 
 ease whose pathology is settled upon the broad basis of organic ac- 
 tion 1 
 
 The treatment is yet in resen^e as contributing largely to the com- 
 prehensive philrsophy of bloodletting, and as demanding, more than 
 any other disease, that summary remedy. Let us, therefore, study 
 the pathology of venous congestion, as of inflammation, through the 
 philosophy of the operation of loss of blood, and the analogies which 
 are supplied by its effects upon all other inflammatory conditions ;
 
 PATHOLOGY. VENOUS CONGESTION. 513 
 
 nor, when deliberating upon these profound and important topics, let us 
 neglect the coincidences in the adverse effects of tonics and stimulant?. 
 818. I now dismiss the great subject of venous congestion ; than which 
 none greater can undergo the attention of the philanthropist or the med- 
 ical philosopher. But he may not bring to its investigation any fancied 
 analogies, nor any of the laws, or other conditions of the inorganic world. 
 He must start with all the philosophy of organic life, carry it all into the 
 depths of the subject, and finally try the grand result by the test of thera- 
 peutical principles. He will then have found that he has accomplished 
 a study of the most elaborate character, and where medical philosophy 
 is presented in its most difficult but elevated aspects. He will have 
 cleared up the way to all other obscurities in medicine, and have obtained 
 a key by which he will acquire a ready access to most of the arcana of 
 organic beings. 
 
 REVIEW OP THE PHILOSOPHY INVOLVED IN THE FOREGOING DISCUSSION 
 OP THE REMOTE AND PATHOLOGICAL CAUSES OF DISEASE, AND OF THE 
 SPECIAL CONDITIONS KNOWN AS INFLAMMATION, FEVER, AND VENOUS 
 CONGESTION, AS IT RESPECTS^THE NERVOUS SYSTEM. 
 
 818 1. Throughout the foregoing field I have endeavored to expound 
 the operation of the remote causes of disease, whether of an external or 
 internal nature, and of all remedial agents, which, in either case, exert 
 their effects upon parts remote from the seat of their direct action, through 
 the natural laws of reflex actions of the nervous system, and have endeav- 
 ored to demonstrate variously modifying influences of those causes, and 
 according to their special characteiistics, upon the nervous power which 
 is thus brought into a preternatural and alterative condition (§ 222-233|, 
 498-514, 894-905, etc). Every distinct external cause we have seen 
 to possess certain peculiarities, or as two or more may operate, and ac- 
 cording to their individual or combined properties the nervous power 
 will be modified and thus governed in its production or removal of dis- 
 ease, so far as this agent is concerned ; and the same philosophy applies 
 to those internal remote causes which consist of the various forms of 
 local disease, or any other internal cause, such as the passions, when 
 they exert morbific effects. In the former cases the effects depend upon 
 reflex actions of the nervous system, by which the modified nervous 
 power is brought into alterative action ; in the other series of cases, or 
 that of the passions, and diseases of the nervous centres, the development 
 of the modified nervous power is not reflex but direct. The philoso- 
 phy is, however, as I have sho^^^l, precisely the same in both cases, the 
 only difference being that in the one, or that o^ reflex action, the sensi- 
 tive nerves participate, while they do not in the other. The latter, 
 therefore, I designate as direct action, or direct sympathy, the former as 
 remote and contiguous sympathy, or, simply, sympathy. These terms, and 
 sympathetic influences also, are wanted to express the functional influences 
 of the foregoing processes, especially their morbific and therapeutical, 
 and as being brief and comprehensive. The terms remote and contiguous 
 sympathy were introduced by John Hunter, and predicated of the phe- 
 nomena, and their import is perfectly understood, even by the communi- 
 ty, and sympathy as far back as Hippocrates, and are exactly adapted to 
 all that has been recently ascertained as to the nervous mechanism through 
 which the function is performed, whether reflex or direct (§ 222-233f, 
 495-500 I, 500 o-514 m, 6381, 894-905, etc.). 
 
 K K
 
 514 
 
 INSTITUTES OF MEDICINE. 
 
 THE HUMORAL PATHOLOGY. 
 
 819, a. " To what errors have not mankind been led in the employment and denominar 
 tion of medicines ? They created deobstruents when the theory of obstruction was in 
 fasliion ; and incisives when that of the thickenings of the humors prevailed (§ 748, 7S9). 
 The expressions of diluents and attemiants were common before this period. When it 
 was necessary to blunt the acrid particles, they created inviscants, i7icrassants, &c. 
 Those who saw in diseases only a relaxation and tension of the fibres, the laxum and* 
 slrictwn as they called it, employed astringents and relaxants (§ 569, b). Refrigerants 
 and heating remedies were brotight into use by those who had a special regard in dis- 
 eases to an excess or deficiency of caloric (§ 433, &c.). The same identical remedies have 
 been employed under different names, according to the manner in which they were sup- 
 posed to act. Deobstruent in one case, relaxant in another, refrigerant in another, the 
 same medicines have been employed with all these opposite views ; so true is it that the 
 mind of man gropes in the dark, when it is guided only by the wildness of opinion" (§ 4) 
 — BiCHAT's General Anatomy applied to Physiology and Medicine, vol. i., p. 17. 
 
 " Among physical people,'' says Hunter, " we find such expressions in common use as, 
 the humors are affected in the blood ; sharp humors in the blood ; the whole humors being 
 ill a bad state ; the whole blood 7iiust be alteredi or corrected ; and a vaiiety of such expres- 
 sions without meaning. They ev(!n go so far as to have hereditary humors, as gout, scrof- 
 ula, &c. ; and make us the parents of our own humors, saying that we breed bad humors. 
 Humors are even supposed to gravitate to the legs slowly ; and, in short, the whole theory 
 of disease has been built upon tlie supposition of humors in the blood, or the blood itself be- 
 ing changed. I cannot conceive what is meant, unless it be that a strong susceptibility 
 to a specific disease exists; as small-pox may bring on scrofula, or a strain the gout."— 
 Hunter's Lectures on the Principles of Surgery, 11th. 
 
 Affirmative. 
 
 1. " Various animal poisons, such as those 
 of the snake tribe, and different mineral poi- 
 sons, as mercuiy, for instance, act upon the 
 blood. Those derangements of functions and 
 organs produced by the experimenter, when 
 he introduces different deleterious substan- 
 ces directly into the blood, are likewise those 
 that are produced by the sting or bite of cer- 
 tain animals ; they are also those that take 
 place in small-pox, measles, and scarlatina, 
 of a malignant nature, as it is called. They 
 are the same derangements that appear in 
 persons exposed to putrid emanations, vege- 
 table or animal, and to miasmata from the 
 bodies of other persons that are themselves 
 diseased and crowded in confined places, 
 iVc. Lastly, they show themselves, also, in 
 individuals whose blood is only imperfectly 
 or badly repaired by insufficient or unwhole- 
 some diet." 
 
 2. "There takes place a vitiation o{ the 
 blood by the commixture of deleterious sub- 
 stances ; next, in consequence of such vitia- 
 tion, an alteration of the functions of the 
 nervous system ; and, lastly, the blood that 
 supports the organs, and the nei-vous sys- 
 tem that animates them, having suffered a 
 geneial injury, a constant, though not al- 
 ways appreciable, modification of these or- 
 gans in their functions, or in their texture." 
 
 3. " Diseases, resembling many of the 
 preceding (no. 1) in their s3Tnptoms, or in 
 the appearances discovered after death, are 
 not unfrequently occurring where no delete- 
 rious substance has been introduced into the 
 blood, and in which there is no direct proof 
 that any alteration of that fluid has been the 
 primary cause of the morbid phenomena. 
 Here, as in the preceding case (no. 1), it ap- 
 pears tliat the primary cause of the disease 
 thould be referred to the blood, whicli. in this 
 
 Negative. 
 
 A. " The VITAL FORCES appear to be af- 
 fected primarily by a gi'eat many poisons, 
 by the vegetable or animal emanations, 
 known by the name of miasmata, and by 
 various modifications of the external agents 
 which are incessantly acting upon us, such 
 as a want of due exposure to the sun, too 
 damp an atmosphere, and an unwholesome 
 diet." 
 
 5. " In every disease not immediately pro- 
 duced by external violence, the symptoms 
 that occur depend either on a lesion of the 
 forces that animate every living part, or on 
 a lesion of organization (§ 177, 189 b). The 
 former is primary and constant ; the latter 
 is secondary, variable in its nature, and in- 
 constant in its existence." 
 
 6. " No one solid can undergo the slight- 
 est modification without producing some de- 
 rangement in the nature or quantity of the 
 materials destined to fonn the blood, or to 
 be secreted from it." 
 
 7. " Until it is proved that the forces 
 which, in a living body, interrupt the play 
 of the natural chemical affinities, main- 
 tain a proper temperature, and preside 
 OVER the various actions of organic and ani- 
 mal life, are analogous to those admitted by 
 natm-al philosophy, we shall act consist- 
 ently with the principles of that science, 
 by giving distinct names to those two kinds 
 OF FORCES, and employing ourselves in cal- 
 culating the DIFFERENT LAWS they obey." 
 
 " The qualities of pus are modified by 
 every alteration, whether physiological or 
 pathological, which takes place in any other 
 organ, even though it have no particular con- 
 nection either of function or tissue. Thus 
 we have all seen instances of the pus se- 
 creted by the surface of a sore becoming 
 suddenly altered in quantity and quality
 
 PATHOLOGY. HUMORALISM. . 515 
 
 Affirmative. Negative. 
 
 case, lias altered its nature under the influ- under the inflaence of a simple moral emo- 
 ence of unknown catisen, as it has in the otli- tion, of the process of digestion, or, in short, 
 ers, in consequence of the commixture of of any supei-veuing disease. Nay, farther, 
 various substances." — Andral's Pathologi- there are certain constitutions, certain idio 
 cal Anatomy. syncrasies, which modify the qualities of 
 
 pus, and in which it constantly assumes a 
 peculiar aud detenninate character." — An- 
 deal's Pathological Anatomy. 
 
 yi9, h. I HAVE thus brought into contrast the prominent doctrines 
 of the distinguished individual w^ho enjoys the honor of having re- 
 stored the humoral pathology, with the same intentions that led me to 
 a similar display of the chemical philosophy in its applications to 
 physiology, pathology, and therapeutics, according to the exact quan- 
 titive method of the laboratory (§ 350, 350i, 350^, 350|, 350f a-gg, 
 438-442, 447y^448y). I have done this, I say, because of the gen- 
 eral alliance of the whole philosophy, and its almost universal sway 
 in Great Britain and France, urged on by the powerful influence of 
 the Parisian School, of the British Association for the Advancement 
 of Science, of the British and Foreign Medical Review, the Med- 
 ico-Chirurgical Review, the London Lancet, and other periodicals of 
 less importance (§ 5| a, 349 d, 350;^ k, JcJc, 709, note). In consider- 
 ing the causes which have led to the subversion of medical philos- 
 ophy, we should steadily distinguish the projectors from those who 
 give the impulse and who govern public sentiment. It will be read- 
 ily seen by every discerning mind, from my analysis of doctrines, 
 and from what I have shown of the absence of all method, of all 
 consistency, and the manifest want of any definite conceptions, in the 
 chemical and physical doctrines, from the intermixture of vitalism, 
 solidism, chemistry, humoralism, mechanical philosophy, &c., as the 
 basis, individually and collectively, of exactly the same laws, that if 
 the systems which are thus projected had been permitted to address 
 themselves to the reason of mankind truth would have enjoyed, at 
 least, an equal chance with error. But, the opposing school decided 
 that it should be otherwise ; and nothing remains, therefore, to the 
 few who have been thus overlooked in the haste, but to disarm, if 
 possible, the adversary, and turn his own weapons against him. These 
 weapons, in the phraseology of science, are facts, and upon his own 
 " facts" the great questions at issue might be safely rested. The 
 whole matter, indeed, must ultimately turn upon this species of ev- 
 idence. The theories naturally follow. As the mind becomes en- 
 lightened about the nature of the premises, there will be no diflSculty 
 in distinguishing between the fair and the false in theory. In all 
 medical philosophy, where so much is controverted, truth cannot be 
 attained without a simultaneous survey of the ground-work of error 
 as well as of truth ; or if the latter take its chance upon its Heaven- 
 born rights, it is sufficiently known that it cannot remain long in the 
 ascendant (§ 1 h, 5\ c). 
 
 820, a. I thought it an object of importance to examine the whole 
 ground of the humoral pathology in the former work, which I had 
 devoted to the high branches of medicine, according to the best of 
 my humble efforts. I shall now rather invite an attention to what 
 I have there presented, than enter again upon any circumstantial 
 view of the subject. But, independently of the important objects 
 set forth in the preceding section, the present work would be defec-
 
 516 • INSTITUTES OF MEDICINE. 
 
 live in its plan, should all regard be neglected for a doctrine sc 
 widely embraced by the educated physician in common with the ig- 
 norant pretender, and so broadly opposed to the solidism which lies 
 at the foundation of these Institutes (§ 1 h, 3501). 
 
 Moreover, there was not extant, till the appearance of the Com- 
 mentaries^ any representation of the doctrines of Humoralism, ex- 
 cepting such as might be gathered from the writings of its masters, 
 or from disquisitions of a desultory nature by its opponents. 
 
 820, h. The restoration of humoralism is an impi'essive exemplifi- 
 cation of the popularity of simple views when brought into contrast 
 with systems of philosophy that concern profound institutions of Na- 
 ture, since it unavoidably associates itself with that identical ratioci- 
 nation which is the pai'ent of empyricism, but which the more enlight 
 ened party can only recognize as the offspring of ignorance. 
 
 The essential facts, however, which are relative to the great foun- 
 dations of Nature, especially in her organic department, have been 
 too familiarly known, and their laws too well comprehended, to ad- 
 mit of any important innovations in medicine that shall long retard 
 its progress, or rescue the projector from a certain oblivion. The 
 beaten path is the only road to usefulness and enduring fame ; but to 
 achieve the latter requires the patient toil of the botanist who looks 
 for eclat in the discovery of an unknown plant within the environs of 
 London. Enlightened genius attempts no other route. It is alone 
 the ambition of narrow mind, or the conceit of genius in its limited 
 observation, that aspires at revolutions in philosophy. Hence the de- 
 sertion, by the former, of that path for the old by-ways which lie 
 obscured in the mists of antiquity ; while the latter strikes out sys- 
 tems of such eccentricity as command, for awhile, universal admira- 
 tion (§ 350, 3501, 350i). 
 
 820, c. Without, however, attempting now, as on a former occasion, 
 to assign more extensively the ground of the foregoing conclusions, I 
 si.all briefly add that I know of no recent attempted innovation upon 
 the philosophy of organic nature, whether under its healthy or moi'- 
 bid aspects, and as that philosophy recognizes the principles of vital- 
 ism and solidism, but has prevailed more or less at former eras, and 
 has been so abandoned and eradicated that it now comes up again 
 with the interest and power of novelty. And it comes to us again 
 without having changed in one essential aspect its old thread-bare 
 livery. That this should be so is owing to the absence of all efforts 
 to refute the erroi's, excepting as transiently made in the form of 
 opinions, and imbodied in the perishable journals of the day, 
 
 821, a. The humoral pathology having higher pretensions, from its 
 dignified relations to the past, than its kindred hypotheses, should al- 
 ways secure for itself a patient hearing, and a full refutation (§ 1 h. 
 3501, and Rights of Authors, p. 919, no. 21). 
 
 821, h. In the brief review which I now propose the question 
 should be first settled as to the main doctrine of the present humor- 
 al ists. This was so accurately done in my Essay on the Humoral 
 Pathology that the Medico-Chirurgical Review, which was addicted 
 to that Pathology, quoted my exposition of the main principle, and 
 allowed that it was " fairly stated." The following is the passage : 
 
 " The question at issue is not, whether the blood becomes diseased 
 by a morbid action of the solids ; and the solidist is sui-prised that the
 
 PATHOLOGY. HUMORALISM. 517 
 
 defense of humoralism should often turn upon labored attempts to 
 prove what every body admits. Nor is it, whether vitiated blood, or 
 putrid matter, will excite disease when injected into the veins. The 
 question at issue is, whether foreign viorhijic causes, and remedial 
 agents, in their ordinary modes of operation, produce their primary ef- 
 fect upon the solids or upon the blood, and the latter become the cause 
 of disease in the former ; whether we ' have hereditary humors, as gout, 
 scrofula,^ Sfc, and whether we are ' the parents of our own humors, and 
 that we breed bad humors,^ " &c. — M.ed. and Physiolog. Comm., vol. 
 i., p. 636. 
 
 In the same Essay I have quoted many recent authors, as setting 
 forth the doctrine in exact conformity with its ancient impurities, and 
 as promulgated in the newspapers of the day. A paragraph em- 
 braces all that is essential in the science of medicine ; or, should the 
 facts, the basis of the science, form an accompanying part, the whole 
 is comprised within a moderate pamphlet entitled " Organic Chemis- 
 try in its Application to Physiology, Pathology, and Therapeutics^ 
 
 821, c. It may be interesting to some should I annex the precise 
 tnodus operandi of morbific agents, as expressed in almost every work, 
 ancient and recent, which recognizes the humoral pathology. The 
 learned and distinguished Dr. Hosack shall speak for the school and 
 its imitators. Thus : 
 
 " That ' a little leaven leaveneth the whole lump' is as true in fevers 
 as in making bread, or in the conversion of acescent fluids into acetic 
 acid ; and that upon the same principle of assimilation. That one 
 spoiled herring will taint the whole cask, is well known to every 
 housewife or fish-monger. Hence the gi-eat care of the Dutch in theii 
 herring fisheries to salt down their fish as soon as they are taken. 
 They never permit the sun to rise upon them" (§ 830, b). And so, 
 also, the chemists (§ 350, nos. 44, 45). 
 
 Although, as will be seen by the references, the exact chemical 
 school differ from the foregoing in respect to the modus operandi of 
 the mind and passions, they agree as to the physical agents ; even to 
 the Dutch herring (§ 349 e, 350, no. 44, &c.). So far as these illus- 
 trations go, it must be in justice admitted that they are peculiar to the 
 walks of science, and are the rightful trophies of " experimental phi- 
 losophy." " Qui meruit palmam" &c. 
 
 In connection with what I have now said should be taken the details 
 of the philosophy as expounded by its late restorer, which may be 
 seen in the introductory matter, and in subsequent sections. 
 
 Such, then, by universal admission, is the philosophy of humoralism; 
 and that it has no better foundation I have endeavored to demonstrate 
 in my former Essay (§ 4, Z»).* 
 
 822. On the other hand, what says the solidist? He tells us that, 
 however simple the foundation (§ 638), disease and its cure depend 
 upon the most intricate system of laws ; far beyond any thing in the 
 inorganic world : That these laws are associated with properties 
 which are peculiar to organic beings, and determine all their natu- 
 ral processes : That all morbid conditions consist essentially in alter- 
 ations of the properties and functions of the solid parts : That altera- 
 tions of the blood are only consequences of these essential changes ; 
 That all practical medicine consists in restoring these solids to their nat- 
 
 * The philosophy and illustrations (including "the stimulating plan") remain un- 
 changed, 1860. — Vide the late and standard British works of F. W. Headland, R. B. 
 Todd, and J. H. Bennett. Also, notes p. 462, 872.
 
 518 INSTITUTES OF MEDICINE. 
 
 ural state, witliout leference to the existing condition of the blood, ex- 
 cepting in the aspect of symptoms : That it is only through the agency 
 of the renovated solids, whose morbid state had affected the condition 
 of the blood, that this fluid can be in any respect diverted from its 
 modified conditions, or restored to its integrity. 
 
 Finally, we are told by the solidist that medicine, in any one of ita 
 branches, cannot be taught in the compass of a pamphlet. 
 
 823. There are some eight or nine principal positions taken by the 
 present humoralists in the way of tangible proof. With the exception 
 of the second following, they are the same as are disseminated in the 
 books of the older writers. They are now, for the first time, con- 
 densed into a methodical order from extended disquisitions in the 
 Commentaries ; namely : 
 
 1. That substances deleterious to life have been known to be taken 
 into the circulation through the lacteals (§ 826). 
 
 2. That gaseous and fluid substances, having an affinity for each 
 other, permeate and unite through a dead animal membrane (^ 827).* 
 
 3. That morbific agents, when inserted in wounds, give rise to dis- 
 eases in various parts (§ 828). 
 
 4. That injections of various substances, and morbid blood, into the 
 circulation, produce disease in the solids, and occasion death (§ 830). 
 
 5. That when many substances, as salt and acids, are mixed with 
 the blood out of the body, they affect its sensible character apparently 
 like the changes which happen to the blood when circulating in the 
 living organism (§ 832). 
 
 6. That when certain substances, such as yeast, are added to dead 
 organic compounds, like vegetable infusions and dough, they create 
 an intestine commotion. The example of a putrid fish, which is of 
 the same nature as the preceding, contaminating a barrel of sound 
 ones, has been lately, as formerly, adduced in high quarters to prove 
 the soundness of humoralism (§ 833). 
 
 7. That the blood, in certain conditions of disease, undergoes changes 
 in its appearance ; especially in refusing to coagulate, and in being of 
 a dark color ; and that chemists, also, have sometimes detected a va- 
 riable composition (§ 834, p. 780, ^ 1029). 
 
 8. That morbid changes occur in the secreted and excreted prod- 
 ucts (§ 835). 
 
 9. That diseases are transmitted from parent to child (§ 836). 
 
 10. That remedial agents, when injected into the circulation, some- 
 times produce the same effects upon particular organs as when ad- 
 ministered by the stomach (§ 837). 
 
 11. That certain vegetable tonics, containing an astringent princi- 
 ple, will increase the physical strength of dead muscles, vessels, mem- 
 branes, &c. (§ 842). 
 
 824, a. So far as my knowledge extends, the foregoing admitted 
 facts constitute the entire foundation of humoralism ; and it will be 
 seen that not a single one of them has any sound relation to physiol 
 ogy ! But what do they prove 1 Nothing whatever beyond the sim 
 pie fact affirmed by each proposition (§ 5\). No one of them has the 
 least bearing upon the questions relative to the natural operation of 
 morbific causes, nor of remedial agents when employed according to 
 the only methods that are sanctioned by nature or by art. We have 
 also before us a remarkable display of the general habits of mankind 
 
 * By a violent process it may be done throu-ili - living one.
 
 PATHOLOGY. HUMORALISM. 519 
 
 in respect to the value of evidence in that sense which Nature has or- 
 dained as the basis of her institutions. Here we see nothing but a 
 factitious assemblage of analogies for the foundation of great princi- 
 ples in medicine, devised by those very philosophers who condemn all 
 conclusions in this science that are predicated, in other systems of phi- 
 losophy, of those analogies which are impressed upon the face of Na- 
 ture. Nor is it less worthy of remark, that the school in chemistry, 
 who aspire at more exact applications of analogy to the healthy and 
 morbid processes of the living being, borrow the whole from the in- 
 organic world, and, for its better success, condemn this method of in- 
 duction as employed by the vitalists in their study of organic phe- 
 nomena. 
 
 824, b. Most of the foregoing premises in humoralism are brought 
 into view in various parts of this work in their appropriate relations to 
 special principles in physiology, pathology, and therapeutics ; and 
 the subjects are too extensive for elaborate consideration. In the Es- 
 say embraced in the Commentaries they have been subjected to all 
 the examination which farther experience and reflection would enable 
 me to bestow. 
 
 825, Humoralism, however, has now become so generally preva- 
 lent, and. is sustained by so powerful an array of " authorities," and 
 as my own writings afford the only systematic view of the subject, I 
 shall, for the advantage of the young inquirer, present such a condens- 
 ed and. connected statement of my grounds of objection as will enable 
 him to comprehend the misapplication of facts, and to apply them in 
 the manner which appears to have been ordained by nature (§ 5^). 
 I shall, however, introduce other facts and arguments, that they may 
 be taken in connection with the former, and shall simplify the subject 
 by adopting a method in conformity with the foregoing propositions 
 (§ 823). But it will be my object to bring into view the great jmn- 
 ciples which bear upon the several specific statements, either directly, 
 or by reference to other sections. These references, therefore, will 
 form an important part of the investigation, as they connect it with 
 various principles and facts in physiology (§ 639, a). 
 
 826, a. As to the first proposition, that substances deleterious to 
 life have been taken into the circulation through the lacteals, I ob- 
 ject, that the phenomenon is rare, that it has been mainly ascertained 
 of certain mineral substances, and that these, as allowed by the chem- 
 ists, are eliminated by the kidneys in from five to fifteen minutes after 
 their absorption (§ 280). The lacteals, on the contrary, elect, with 
 astonishing precision, the nutritive chyle, and. reject the rest. This is 
 due to the exquisitely-modified irritability of these vessels ; just as 
 has been seen of a like provision in the glottis, the pyloric orifice, and 
 vessels which exclude the red globules of blood (§ 191, 192). Nor 
 can we too much admire the Wisdom which embraced in one univer- 
 sal Design the general good of the organism by so endowing the lac- 
 teals that they shall exclude all things which are not in harmonious 
 relation to the special vital states of every other part (§ 274-295). 
 
 When such substances effect their entrance through absorbing ves- 
 sels, it is, as we have seen, by modifying their irritability, and thus 
 establishing relations with them ; just as undigested food escapes a 
 morbid pylorus, or the red globules of blood enter the serous vessels 
 in inffammations. Bile, &c., are incapable of producing such modifi-
 
 520 INSTITUTES OF MEDICINE. 
 
 cations of the lacteals, and are, therefore, forever excluded. Here, 
 too, morbific or remedial agents act in their concentrated state, and 
 supply a ground for interpretation, through reflex nervous action, of 
 the remote phenomena ; while the little that may gain the general cir- 
 culation is so diluted, and so soon excreted, as to be worthless in our 
 estimate of causes (§ 1089). 
 
 826, h. It should be also considered, that, notwithstanding the ra- 
 pidity with which foreign matter at all offensive to the organism is 
 eliminated by the excretory organs (§ 280), the blood and entire body 
 may have undergone many renewals between the application of the 
 predisposing cause and the explosion of disease ; that hydrophobia 
 may not supervene for months or for years, fever for a year or more, 
 and may then return at annual periods ; that salivation may follow a 
 very minute quantity of mercury, and may be continued long after the 
 saliva and other secretions have flowed in great redundancy, &c. ; 
 while, on the other hand, the interpretation of their modus operandi, 
 accoi'ding to the philosophy which I have propounded, is in perfect 
 harmony with every principle advanced in these Institutes, and in- 
 vites the severest scrutiny. In connection, also, with these topics 
 should be considered all that I have expounded of the laws of sympa- 
 thy, vital habit, constitution, acclimation, temperament, &c. As to the 
 oft-alleged smell of garlic in the excretions, of the coloring matter of 
 madder in the bones, or of the bile in all parts of the body, they are 
 among the most attenuated of material substances, and are inoffensive 
 to the lacteals and the general organism. (See, also, il^e<i. «wcZ PA?/5- 
 iolog. Comm., vol. i., p. 523-557, 576-581, 589-594, 599-608, &c.) 
 
 826, c. Nor should it be neglected, that there is no agreement among 
 chemists as to some of the most important morbific and remedial agenta 
 which have been said to gain a ready admittance to the circulation. 
 
 826, cc. Why is the pulse always consulted in all forms of disease 
 and after all remedies % Is it to find out how far the blood is affected, 
 or whether the remedies be duly absorbed, or whether the heart or ar- 
 teries be the seats of disease ? Consider the unceasing modifications 
 of the heart's action, and of the arteries too, as brought about by dis- 
 eases of all parts, and by medicines, and by mental emotions, and mark 
 the coincidences, and you will allow that you " feel the pulse" simply 
 to learn the nature of the reflex nervous influences which remote dis- 
 eases inflict upon the circulatory organs, and to thus find out the na- 
 ture and force of those diseases, or equally in the case of medicine what 
 reflex nervous influences they institute either mediately or immediately. 
 If such, then, be our objects in feeling the pulse, why is not the same 
 philosophy applicable when diseases spring up consecutively, or when 
 morbific causes, acting upon surfaces, light up diseases in the internal 
 organs? In the former cases you "feel the pulse" for the purpose 
 alone of ascertaining the nature and extent of the disturbing or mod- 
 erated reflex nervous actions, whether you know it or not, and in the 
 latter cases the analogy is supported by all the pathological and thera- 
 peutical facts, and especially so by the staring fact that powerful irri- 
 tants, like tartarized antimony, which occasion violent disturbances 
 when conveyed into the circulation, break down inflammations and 
 high arterial excitements Avhen applied to the intestinal mucous mem- 
 brane (§ 829, 902 g, 904 hh)* Why is the tongue, like the pulse, always 
 expected to supply information as to the diseases of other parts and the 
 
 * The universal custona of " feeling the pulse" is a remarkable example of an equall 
 universal unconsciousness of the philosophy which relates to the subject.
 
 PATHOLOGY. HUMORALISM. 521 
 
 salutary or injurious effects of remedies ? Can any other rational solu- 
 tion be offered than that which I have presented in relation to the heart 
 and arteries (§ 500 m, 687^-688, G94f, 840, 891^-, 892|, 893)?* 
 
 826, d. We should not be led into the error of confounding the re- 
 sults of agents applied to the trunks of a nerve and to its extremities. 
 The physical philosophers have taken advantage of the comparative 
 failure of the former to show that morbific and remedial agents do not 
 produce their remote effects through the medium of the nervous sys- 
 tem, and have adopted this view from Miiller's misapprehension of 
 the subject. " The narcotic action of opium," says Miiller, " does not 
 react from a particular point of a nerve on the brain." Therefore, 
 argue the materialists, when applied to the surface of tissues, its nar- 
 cotic effect is due to absorption. But the great Physiologist has 
 shown, himself, the error, while, at the same time, he proves the un- 
 tenable nature of humoralism. Thus : 
 
 " The spirituous extract of nux vomica, introduced in a small quan 
 tity into the mouth of a young rabbit, produces immediate death (in a 
 second of time) ; whereas, when applied to a nerve at some distance 
 from the brain, for instance, to the ischiadic nerve, it produces no 
 general symptoms" (§ 494 dd, 498 c, 514 d). 
 
 There is the broadest distinction between the trunk of a nerve and 
 its expanded extremities in connection with organic tissues ; while, 
 also, the organic properties of the terminal fibres, and especially sym- 
 pathetic sensibility (§ 201, 451 d), are incomparably more strongly 
 pronounced than in the nervous trunks. The important consideration 
 has been also neglected that two orders of nerves are concerned in 
 .the function of remote sympathy as it occurs naturally, and that the 
 points of departure and of incidence are the expanded portions of the 
 nervous system. This is also undoubtedly true even of the sympa- 
 thies of the nervous system itself, which embraces all the elementary 
 parts of other organs (§ 472, no. 4, 514 d, 516 d, 526 d. Also, Med. 
 and Phys. Comm., vol. i., p. 507, 563-566). 
 
 Moreover, when irritating, or other agents, produce strong im- 
 pressions upon the surfaces of organs, it is not, as supposed by Miil- 
 ler and others, mainly upon the ramifications of the nerves, but may 
 be equally, at least, upon the organic properties of the other tissues 
 of the part (§ 184, 188). Hence, particularly, the wide difference in 
 the effects of irritants, &c., when applied to the trunk of a nerve and 
 to an organ of a different vital constitution ; as shown, for example, in 
 the action of vesicants (§ 133, &c.). The insusceptibility of nervous 
 trunks is also farther shown by their remarkable exemption from the 
 action of morbific causes (§ 526, d). 
 
 827, a. The second fundamental proposition of humoralism is in 
 part that gaseous and fluid substances, having an affinity for each oth- 
 er, permeate and unite through a dead animal membrane. 
 
 That fact is undeniable. But what is its physiological aspect 1 Is 
 it worthy, in any other than its naked relations to chemistry, of grave 
 consideration ] And so of the entire amplitude of endosmosis and 
 exosinosis. There must first be shown a correspondence between a 
 dead, permeable tissue, and a living, impermeable one, before we 
 can proceed to apply the foregoing fact in any physiological bearing. 
 But its utmost latitude would only show that foreign substances unite 
 chemically with the blood through the living tissues. It is true that, 
 * See Notes I p. 1118, Ll p. 1140.
 
 522 INSTITUTES OF MEDICINE. 
 
 more recently, active chemical agents have been brought to bear in a 
 corresponding manner upon living tissues ; but the violent influences 
 which have been thus set in operation render these experiments as worth- 
 less as the original ones. It is equally a perversion of nature. 
 
 827, h. Of all the agents which surround us oxygen gas is the only 
 one which has been shown, with any degree of plausibility, to pene- 
 trate a living animal tissue, or to unite chemically with the blood, or 
 with any supposed constituent of that fluid. If it be allowed, also, 
 that this has been demonstrated, nothing can be predicated of it ana- 
 logically in respect to other extraneous matters, since it is an ordain- 
 ed function of organic life, under the c-ontrol of specific laws in the 
 animal and vegetable kingdoms, and conducted through special parts 
 of the organism. The philosophy is the same as we recognize in all 
 other parts. It is the office, for example, of the chylopoietic and 
 sanguiferous organs to rearrange the elements of food, and endow the 
 new compounds with the properties of life ; while it is that of the 
 glandular organs, the membranes, &c., to select certain constituents 
 from the common homogeneous mass by virtue of these vital proper 
 ties, and to impress upon them various peculiarities, according to the 
 mechanism of each tissue, and as the vital constitution of each part 
 may happen to be modified (§ 18, 42-44, 133, &c.). 
 
 Coming again to the specific uses of oxygen in the organic king- 
 dom, the relative laws, the organs, the final causes, &c., are also dif- 
 ferent in the two organic departments, and even varied as to oi'gani- 
 zation in animals ; yet in all according to other variations in the gen- 
 eral physiological constitution (§ 133-151, 185, 259-295, 409, 410). 
 
 But, I think it must be conceded that I have shown that there is no • 
 physical penetration of the pulmonary mucous tissue even by oxygen 
 gas, and that the formation of carbonic acid within the lungs is pri- 
 marily due to a strictly physiological process (§ 135, 419, 433, &c., 
 447i a^).— Notes N p. 1121, R p. 1123. 
 
 I am now conducted to a fact which illustrates the principle on 
 which miasmatic poisons operate. 
 
 It is well known that adult dogs, &c., will bear without injury a 
 suspension of respiration for the space, at least, of five minutes. But 
 they perish immediately if plunged into carbonic acid gas. There- 
 fore, say the humoralists, the gas is absorbed in the latter case, which 
 makes the difference in results. This, however, is contradicted, in 
 the first place, by the ordination of nature that carbon shall be evolv- 
 ed from the lungs, and by an organization of the mucous tissue of the 
 lungs coiTesponding to that fundamental law ; whether the process 
 be the result of chemical or vital actions, or both united (§ 447|,jr). 
 Organization is thus specifically opposed to the absorption of carbon- 
 ic acid. As well might it be assumed that gastric juice is resorbed 
 by the mucous tissue of the stomach. Carbonic acid, therefore, does 
 not destroy by absorption and union with the blood (§ 419, 420). 
 
 But this incontrovertible philosophy is sustained by direct experi- 
 ment ; since it was found by Nysten that " carbonic acid gas may be 
 injected into the venous system in large quantities, without stopping 
 the circulation, and without acting primitively on the brain ; but when 
 more is injected than the blood will absorb, it produces death by dis- 
 tending the heart, as when air is injected into the veins." — Nysten, 
 RecJterchcs, &c., p. 88. This, however, is not the modus operandi.
 
 PATHOLOGY. HUMORALISM. 523 
 
 Here, then, we have the pnnciple demonstrated, which is of uni- 
 versal appHcation to mephitic gases, upon whatever surface their ac- 
 tion may be exerted. The poisonous action of carbonic acid is ex- 
 erted upon the pulmonary mucous tissue, and then only upon the 
 brain, as a consequence of that primary effect, and through the phys- 
 iological relations of the mucous tissue of the lungs to the great ner- 
 vous centre (§ 129, 137, 222, &c., 666. Also, Med. and Physiolog. 
 Gomm., vol. i., p. 443, &c.). This lets us into the secret why certain 
 poisons, as that of the viper, of the mad dog, and some others, have 
 no action upon the stomach, or when applied to the surface of the 
 brain, but operate with violence when inserted within the organiza- 
 tion of the skin, and why that of the rhus vemix, &c., will affect the 
 skin when applied only superficially (§ 135-137, 140, 150, 904 h). 
 
 Again, in connection with the foregoing illustration, it is an im- 
 portant fact that animals may be destroyed by the application, for a 
 considerable time, of carbonic acid to the skin, although free respira- 
 tion of atmospheric air be permitted. This shows that it may also ex- 
 ert a deleterious action upon the organic constitution of the skin; and 
 by analogy, therefore, such may be more or less the case with mala- 
 ria. And it should be farther stated, that the action of carbonic acid 
 agrees, also, with that of concentrated forms of malaria in the instan- 
 taneousness of its effects (§ 654, a). 
 
 827, c. An almost endless series of examples of clear, definite char- 
 acter illustrate the philosophy of more obscure but analogous problems. 
 Another, for instance, may be found in the effects of the nitrous oxide 
 gas, when respired. Here, the immediate production of the phenome- 
 na, and more especially the abruptness with which they subside, prove 
 that the whole action of the gas is upon the pulmonary mucous tissue, 
 and that the general phenomena can be in no respect owing to a mod- 
 ified state of the blood, however the gas may be absorbed. And just 
 so with the respiration of ammonia, which brings on coughing, rouses 
 the circulation, &c., instantly, and which cease as instantly on remov- 
 ing the exciting cause. The example of cold in producing pneumonia, 
 or rheumatism, &c. (§ 649 c, d, 657, 666), the fatal action of hydrocy- 
 anic acid, aconitina, strychnia, «fec., the remedial influences of tartarized 
 antimony, of the mercurials, and of numerous other alterative agents, 
 concur in one general illustration of this subject (§ 494 cZd, 550-563). 
 The philosophy relative to reflex nervous action conducts us through 
 all the labyrinth of the wide-spi'ead influences that radiate from a given 
 point which may seem almost alone exempt from the general invasion 
 of disease (§ 222, &c., 500, 904 h, 1066 a).— Note M p. 1120. 
 
 827, d. The present place supplies a good opportunity for intro- 
 ducing a case of death from hydrocyanic acid ; partly with a view to 
 our present subject, and to serve, in part, as a reference to illustrate 
 other topics. Thus : 
 
 A medical gentleman had swallowed a fatal dose of Scheele's hydro- 
 cyanic acid, from which he died in about ten minutes. " On cutting 
 into the right lung, a frothy, dirty-brown semi-mucous fluid exuded, 
 tinged with blood. There was no odor of prussic acid fi'om it. In 
 the cavity of the right pleura were about eight ounces of thin serum. 
 The left lung was firmly adherent in its whole extent to the costal 
 pleura. Heart firmly contracted. It exhaled no smell of prussic acid 
 Liver healthy. Spleen soft and easily broken down, resembling mul-
 
 524 INSTITUTES OP MEDICINE. 
 
 berry jam. Kidneys natural. The stomach contained about fifteen 
 ounces of half-digested food, that gave out the well-known odor of bit- 
 ter almonds. The mucous coat of the stomach healthy, and smelled 
 strongly ofprussic acid after the stomach had been emptied of its con- 
 tents (§ 657). Intestines healthy. Vessels and sinuses of the hrain 
 filled with a dark-colored fluid hlood. No smell of prussic acid. 
 Blood every where fluid" (§ 494, 904 h). — Mr. PooLEy, in London 
 Medical Gazette, 1845.— See notes, p. 172, 863.-§ 1066, 1088 a, h. 
 
 827, e. The foregoing philosophy enables us to understand why the 
 morbific action of miasmata is promoted by various causes which in- 
 crease the susceptibility of the system (§ 663), and which has its par- 
 allel in numerous examples of daily occurrence ; as the greater liability 
 of mercurial agents to produce salivation if we increase irritability by 
 cathartics, blood-letting, &c. (§ 556 c, 030 e) ; while, on the contrary, 
 had humoralism-any foundation, cathartics and blood-letting should di- 
 minish the chances of mercurial action, nor should that action increase 
 long after profuse ptyalism has been established. The warm bath pro- 
 motes the constitutional action of mercurial ointment by increasing the 
 susceptibility of the skin and system at large (§ 1088 b, c). 
 
 It should be observed, also, that upon the hypothesis of humoralism 
 there should be no exemption of individuals from epidemic diseases, 
 since the blood of all should be equally liable to contamination. Hu- 
 moralism may not, consistently, assign as the ground of exemption a 
 difference in the susceptibilities of the solids which have been in- 
 duced by other causes (§ 651 b, 657 a, 837 Z») ; and since, therefore, 
 the blood is the 2^(ibulum vitce, and convertible into the solids, it 
 should, upon the humoral doctrine, when itself diseased, occasion 
 universal disease of the solids (§ 663). The same is also true of the 
 poisons, of the prick of a pin, &c. ; but always affecting some severe- 
 ly, and others slightly, — the former sometimes striking at one organ, 
 and again at another, while the latter induces in one man erysipela- 
 tous inflammation, in another always phlegmonous, and in a third 
 none at all (§ 652 c, 828 c, 494, 740, 741).— Note Oo p. 1141. 
 
 827, f. If, however, it be admitted that offensive substances when 
 absorbed operate through the medium of the circulation, solidism and 
 vitalism can alone interpret the phenomena. There is abundant proof 
 that the results are not due to any affection of the blood, but must be 
 referred to the direct action of the agents themselves upon the vital 
 constitution of the solids to which they are distributed. This con- 
 struction of the subject, therefore, is directly within the pale of solid- 
 ism ; though it be foreign from the truth (§ 284, 904 c). 
 
 827, g. Again, however, most of the substances whose presence in 
 the blood or secretions can be detected (a) are either innoxious, or 
 undei'go chemical decomposition as soon as they come in contact with 
 the cii'culating mass, and would therefore either be rendered inert, 
 or would certainly give rise to different phenomena from those of the 
 agents in their original shape (§ 52, 149, 650). 
 
 827, h. But this part of the doctrine of absorption does not end 
 with gaseous substances; since there are some distinguished philoso- 
 phers who maintain that seeing is produced by the penetration of light 
 to the recesses of the brain, where it gives rise to certain cerebral 
 changes that result in vision ; just as Liebig and his school suppose 
 that all the operations of the mind are determined by chemical chan-
 
 PATHOLOGY. HUMORALISM. 525 
 
 ges of the brain (§ 349 e, 350| 'n-g)- By the analogies of Nature, 
 therefore, we must conclude that, whatever gives rise to other sensa- 
 tions must be equally absorbed and conveyed to the sensorium com- 
 mune, — the odor of plants, the undulations of air, the prick of a pin, 
 &c. (§ 837, b). If this be frivolous it is not the fault of the logic. 
 
 828, a. The third proposition of humoralism sets forth, that when 
 morbific agents are inserted in wounds they give rise to diseases in 
 various parts. 
 
 Here, then, we have something besides ordinary surfaces. The 
 ■' facts" which I have considered in the preceding propositions were 
 evidently unsatisfactory to " experimental philosophy," and, therefore, 
 a start has been given to absorption by inserting the noxious agents 
 within the vascular systems. But, I have gone extensively, in the 
 Commentaries, into the proof that in all the cases of this nature the 
 agents have been either violently forced into the torrent of blood, or 
 that their direct effect is exclusively upon the injured part, and thence 
 by reflected nervous actions over the system. It will be also observed 
 that in these experiments the agents are brought into dii'ect contact 
 with parts where the organic properties are most exquisitely develop- 
 ed and susceptible. The time of incubation (§ 666) may be from an 
 instant, as with hydrocyanic acid and strychnia (§ SSO^^, 494, 743, 
 826 h-d, 827 d, 904 Z>), to a year or more, as with the cause of inter- 
 mittent fever (§ 561, 657), or even to years, as with the hydrophobic 
 virus (§ 547, 559, 560, 654-659, 500 o, 503, 506, &c. Also, Comm., 
 vol. i., p. 496-506). As to the last, the virus can neither remain in 
 the wound, nor circulate in the changeable body for months, or for 
 weeks. It is either washed away from the former, or carried off by 
 the latter. — Note Aaa p. 1146. 
 
 Now all these cases are exactly upon a par so far as principle is 
 concerned. The same influences obtain in respect to the hydropho- 
 bic virus as with those agents which destroy life as soon as they como 
 in contact with the body. This is the work of the nervous power ; 
 just as it is when joy, or anger, or a surgical operation, or blows on 
 the stomach, &c., kill in an instant of time (§ 227, 230, 234 e, 476 /*, 
 509-511). The principle is the same as when the division of a nerve 
 excites inflammation in the part to which it is distributed. And all 
 this conducts us, at once, to a knowledge of the modus operandi of 
 the poison of venomous animals in the following comprehensive case. 
 
 828, h. " I have seen," says Dr. Johnson, the late distinguished ed- 
 itor of the Medico-Chirurgical* Review, " the ear of a rabbit exposed 
 to the bite of a cobro de capella, with a pair of scissors kept across 
 the ear, ready to cut it off the moment the bite was inflicted ; yet the 
 animal died quickly in convulsions" (§ 234 e, 507, 827 d). 
 
 The foregoing fact corresponds exactly with experiments of a very 
 different nature by Van Deen, Stilling, Budge, &c. (§ 494), and forms, 
 with those, substantial grounds for analogical inductions. They may 
 be safely considered of universal application, whatever the morbific 
 cause, whatever the interval of predisposition. 
 
 828, c. It is astonishing, too, with what rapidity certain morbific 
 causes will establish inflammation, and thus lead to an almost instan- 
 taneous disorganization. Take another example from the venomous 
 serpent, as related by Sir E. Home. He caused a rat to be bitten 
 by a snake. It died in one viinute. The cellular membrane beneath
 
 526 INSTITUTES OF MEDICINE. 
 
 the wound was wholly destroyed, the muscles separated from the ribs 
 and from a small extent of the scapula. The bitten part was greatly 
 inflamed. — Note Aaa p. 1146. 
 
 Here the inflammation must have commenced in the region of the 
 thorax at the moment the bite was inflicted. Absorption and distribu- 
 tion were, of coui'se, impossible, and there is nothing but the philoso- 
 phy which I have propounded of the nervous power that will in the 
 least explain the phenomena in this and all analogous cases (§ 222, 
 &c., 234 e, 503, 509). By the foregoing case we are also prepared 
 to understand that hydrocyanic acid may light up venous congestion 
 in the brain, although it destroy with equal rapidity (§ 827, d). 
 
 828, d. Finally, an elementary example of universal application to 
 morbific agents, and illustrative of the nature of life, will supei'sede 
 the necessity of farther comment upon the three fundamental proposi- 
 tions of humoralism as it respects absorption (§ 823). This example 
 is of the same nature as that of the seton, farther on ; but more open 
 to the understanding of all (§ 905). 
 
 It will be admitted that when inflammation is excited by the punc- 
 ture of a lancet, it is not by irritating, or otherwise affecting the blood ; 
 but that all the attendant phenomena are due to an impression made 
 upon the solids, and to their consequent morbid action. The inflam- 
 mation, thus excited, may be extensively and violently propagated 
 along the part, as in phlebitis, &c. (I specify a vein, as it is here the 
 acrid injections are made, § 830) ; and it is but reasonable to suppose 
 that the same condition is owing to a similar cause at one or six inches 
 from the Avound, as at the eighth of an inch.* No sooner, also, does 
 the inflammation begin than reflex nervous actions may ensue ; 
 but as we have no morbific blood in these cases, we must look for 
 some principle, analogous to that in which the local changes began, to 
 explain the general derangement (§ 500, 711, &c.). All this will 
 help us to the philosophy of analogous developments in diseases of re- 
 putedly humoral origin. But, besides the common effects of inflam- 
 mation the prick of the lancet may convulse the whole nervous and 
 muscular systems (§ 222, &c.). Nay, more, and greatly to our pur- 
 pose, the inflammation arising from a wound will be variously modifi- 
 ed in its character by the exact nature of the wound itself, and the 
 kind of instrument or violence with which it is inflicted (§ 652, c). 
 
 If there be now added to the point of the lancet sulphuric acid, or 
 the virus of putrid animal matter, of the small, or cow-pox, or the 
 poison of the viper, of the wourari, &c.', there will be many diversities 
 in the general results of the several causes thus superadded to the 
 mechanical, but strong resemblances in the local phenomena, and in 
 the progress of symptoms. The specific products, also, as well as 
 other circumstances, denote specific modifications of a common path- 
 ological state (§ 722, &c.). If, then, the mechanical irritation in one 
 instance have acted directly upon the solids, is it not a proper conclu- 
 sion from the progress and analogy of symptoms, that the several va- 
 rieties of poison have done so in the others ] It cannot be said that 
 certain differences in the results imply a difference in the principle, 
 since all these results, where life is sufficiently prolonged, are purely 
 secondary, and will be admitted to be consequent on the morbid affec- 
 tion of the solids. But all the primary phenomena in such instances 
 coincide with each other, and have the same order of development. 
 
 * By continuous sympatliy, or continuous influence of these Institutes (sec. 129 c, / 498 a).
 
 PATHOLOGY. HUMORALISM. 527 
 
 • 
 
 If the poison of the viper destroy life with great instantaneousness, 
 this is conclusive against absorption, and is exactly allied in principle 
 to the fatal operation of a blow upon the region of the stomach, or of 
 surgical operations which produce instant death, or of the prick of a 
 pin which is followed by tetanus (§ 494 h, 509, &c.). 
 
 828, e. There is an endless variety of analogies where disease is 
 excited by agents of a mechanical, or even of a more negative nature; 
 such as cold, heat, wakefulness, fatigue, &c., which, like the opera- 
 tions of the mind or its passions, in producing or removing disease, 
 killing or curing, according to the exact nature of the intellectual pro- 
 cess, that are applicable with all the force of the strongest analogies 
 to show that in all other cases the same laws prevail (§ 188^ d, 527 h, 
 902 m, 905). The laws of reflex nervous action explain the whole. 
 
 829. " When we consider," says Pei-eira, " the peculiarities attend- 
 ing the hepatic circulation, and that all the remedial agents, whose 
 particles are absorbed, have to pass through the portal vein, — the vein 
 by whose branches the bile is secreted, — our astonishment is great that 
 this secretion is not more frequently affected hy the various medicinal 
 agents put into the stomach^ — Pereira's Mat. Med., p. 92. 
 
 May we not, however, rather be astonished that the frequent exemp- 
 tion of the liver itself from all morbid effects, as well as the condition 
 of the bile, did not satisfy our able author that the doctrine of reme- 
 dial and morbific action by absorption is contradicted by the plainest 
 facts (§ 889, a) 1 
 
 Our author, however, has been led into an important physiological 
 error by Magendie's assumption that the veins, and not the lymphat- 
 ics, perform the office of absorption ; while in respect to any ingress 
 of deleterious agents, it is mostly by way of the lacteals (§ 277). Ad- 
 mitting, therefore, that the violent agents of the Materia Medica oper- 
 ate by absorption, they are first conveyed directly to the heart through 
 the thoracic duct; and if "astonishment" be great in the mistaken 
 case of the liver, how much greater should it be when we consider the 
 realities of nature, and observe how often the exquisitely irritable 
 heart remains unaffected when the niost powerful irritants would be 
 emptied into its cavities. Or taking the construction of our author, 
 the effect upon the heart would be equally the same, since a large 
 proportion of the portal blood is delivered at the same cavities. In 
 either case, the irritants would exist in a state of concentration in tho 
 most in-itable organ of the body compared with their dilution in other 
 parts, except the lungs, as 1 to 50, or more. And yet the henrt often 
 remains undisturbed in its regular action after the administration of 
 violent agents, while they are simultaneously healing, or inflicting 
 disease on other parts. I present, therefore, this isolated fact as ade- 
 quate in itself to a full refutation not only of the doctrine of morbific 
 and remedial action by absorption, but, by the force of analogy, to 
 that of the entire system of the humoral pathology. If embarrassing 
 to the humoralists in the case of the inirritable liver, it is conclusive 
 in that of the heart (^ 500 m, 638J, 826 cc, 840, 1089, 487 a, 904 c).* 
 
 8.30, a. Tho fourth grand assumption of humoralism, as a, part of its 
 basis, is the production of disease and death by the injection of va- 
 rious substances into the circulation (§ 823). These injections are 
 made upon ani?nals, and their effects carried up to the natural morbific 
 causes which operate on man. 
 
 * Diseases have their predisposing and exciting causes (§ 645), and no one supposes 
 thai the latter are absorbed. Why, then, the former?
 
 528 INSTITUTES or MEDICINE. 
 
 Strange as is this analogical ground of induction, it is, neverthelesg, 
 the great bulwark of humoralism. The doctrine is thus set forth by 
 its restorer, M. Andral : 
 
 "Various animal poisons, such as those of the snake tribe, and dif- 
 ferent mineral poisons, as mercury, for instance, act upon the blood 
 in the same manner as deleterious substances injected into the circu- 
 lation." " Those derangements of functions and organs produced by 
 the experimenter, when he introduces different deleterious substances 
 directly into the blood, are likewise those that are produced by the 
 sting or bite of certain animals ; they are also those that take place in 
 small-pox, measles, and scarlatina of a malignant nature, as it is call- 
 ed. They are the sai7ie derangements that appear in persons exposed 
 to putrid emanations, vegetable or animal, and to miasmata from the 
 bodies of other persons that are themselves diseased and crowded in 
 confined places, &c. (§ 653). Lastly, they sJioio themselves, also, in 
 individuals whose blood is only imperfectly or badly repaired by in- 
 sufficient or tmwliolesome dief" (§ 744, 819 b). 
 
 830. Z». The order of results as stated by Andral, and as adopted by 
 all humoralists, is the following : 
 
 " A vitiation of the blood by the commixture of deleterious sub- 
 stances. Next, in consequence of such vitiation, an alteration of the 
 functions of the nervous system. Lastly, the blood that supports the 
 organs, and the nervous system that animates them, having suffered a 
 general injury, there takes place a constant, though not always appre- 
 ciable, modification of these organs in their functions, or in their tex- 
 ture" (§ 709, 740, 744, 821, 847 d). ^ 
 
 831. Injections of noxious agents into the circulation of animals 
 were made to an almost incredible extent centuries ago ; and millions, 
 I may safely say, have been repeated in later times. But they prove 
 only two things, — their short-sightedness and inhumanity. They cer- 
 tainly do not show, in the least, that the ordinary causes of disease are 
 taken into the circulation, nor do they produce those constitutional 
 affections which are generated by the natural operation of morbific 
 causes, especially on the human species. Their action is commonly 
 upon the venous system ; and if the reader will refer to my remarks 
 upon phlebitis, he will perceive the reason for the conclusion of many 
 experimenters that they have given rise to yellow fevei-, typhus, &c., in 
 the brute race (§ 744, 810, &c., 1088 d). 
 
 These devices of art are very extensively considered in my Essay 
 on the Humoral Pathology, where 1 have endeavored to show that they 
 all go to the proof of solidism (§ 827,/"). — In Med. and Phys. Comm. 
 
 832. For an examination of what I have designated as the Jifik prop- 
 osition in humoralism (§ 823), I must refer the curious reader to the 
 Co?nmentarics, vol. i., p. 401-408, 431-451). 
 
 833. The sixtJi foundation is relative to the yeast and herrings ; and 
 the reader will probably be satisfied with the references to this sub- 
 ject which occur in § 821, c ; otherwise, he may consult section 350, 
 nos. 44, 45 ; and the Comfnentaries, vol. i., p. 417, &c. 
 
 834. The seventh fundamental assumption goes with ihejifth, and 
 the I'eader, by the references there, may satisfy himself of their degree 
 of importance. 
 
 835. The eighth bulwark of the doctrine is the important fact, — im- 
 portant to the solidist, — that morbid changes occur in the secreted
 
 PATHOLOGY. HUMORALISM. 520 
 
 and excreted products. Nor is it less important in its philosophical 
 and practical bearings upon the humoral pathology ; since it is unde- 
 niable that it places the learned and the unlearned practitioner on 
 common ground. Their pathology is the same ; and what is affirmed 
 in the following extract of the educated, in respect to their practical 
 habits, every newspaper in the land assures us is equally true of the 
 pretender in medicine. Thus the extract : 
 
 " The humoral pathologist neglects the study of visceral lesions , 
 and when he turns his attention to the digestive system, he only con- 
 siders its secretions, and not its actual condition, or the state of its 
 sympathies. His sole purpose is to evacuate sordes, or to produce a 
 flow of healthy bile, and to eliminate depraved secretions ; and this he 
 attempts without possessing any knowledge of the effects of disease 
 of the digestive system on other organs" (Stokes' Theor. Prac. Med.). 
 
 Professional humoralism assumes that these " vitiated secretions" 
 are due to a morbid state of the blood, and not to perverted actions 
 of the solids, which, in their ordinary state, give rise to the various 
 natural products. And so the newspapers. Perhaps, however, the 
 student may obtain some ideas to the contrary by consulting the fol- 
 lowing references (§ 42, 44, 53, 135, 220, 222-233f, 284-292, 307, 
 314, 322-326, 327-331, 407-432, 452, &c., 500, &c., 512, &c., 674, 
 675, 686, 8911 ^^ 893 a, c, e, 896, 900, 902 g, 904 bh, 905, 905|, 1088. 
 
 836. The ninth ground of induction goes back to ancestral dis- 
 eases ; and assumes their transmission, by hereditary impurities of the 
 blood, to succeeding generations. I have referred sufficiently to the 
 philosophy of this subject in the present work (§ 75-80, 143-147, 
 220, 327-331, 559, 561-563, 591, 659, 666 b, 674), and more exten- 
 sively, and in other aspects, in the Commentaries (vol. i., p. 464, &c.). 
 I shall not, therefore, again encounter this part of the foundation ; but 
 cannot refrain from adverting to its pernicious eff"ects in practice. 
 One of its vague attendants is the doctrine of " poverty of the blood," 
 and this, as practically applied to active conditions of scrofula, is a 
 fearful scourge to the human family. The " enriching black meats," 
 and the " sustaining cordials," which are every where commended to 
 the subjects of phthisis, in its early stages, are the occasion of a great- 
 er mortality in one day than ever proceeded from the abstraction of 
 blood in all diseases since medicine became an art (§ 620, note. Also, 
 Comm., vol. ii., p. 608-634, " PatJiology of Tuhercle and Scrofula").'^ 
 
 837, a. Humoralism assumes, as its tenth fundamental basis which 
 I have indicated, that remedial agents when injected into the circu- 
 lation sometimes produce the same effects upon particular organs as 
 when administered by the stomach (§ 823). 
 
 Rarely has this experiment been tried on man, in recent times ; 
 probably in consequence of the mere transfusion of blood having been 
 fatal, and interdicted by law, in former times. It is almost entirely 
 limited to animals ; when, as might be expected, the agents exert 
 their effects mostly upon the venous system ; " giving rise to scurvy, 
 yelloiv fever, typhoid fever, &c., not to mention a number o^ other affec- 
 tions which I called into being before you'^ (§ 744, 709, 810). 
 
 The case in which Dr. Hale, of Boston, injected castor oil into his 
 
 own circulation is a standing reference ; but loses force from want 
 
 of confirmation. What though, however, it rewarded the gentleman 
 
 \vith a few moderate evacuations, I have never yet seen it affirmed by 
 
 * See Notes F p. 1114, Mm p. 1141. 
 
 L L
 
 530 INSTITUTES OF MEDICINIC. 
 
 the advocates of operation by absorption that castor oil has been 
 detected within the organism after its exhibition by the stomach ; and 
 we need not doubt that the experiment has been satisfactorily tried. 
 
 837, h. That certain articles of the materia medica which manifest 
 specific relations to particular parts when administered by the stom- 
 ach will exert specific effects according to those relations when in- 
 jected into the circulation is clearly inferable from the first princi- 
 ples in physiology. If vomiting result from the mere action of tar- 
 tarized antimony upon the mucous surface of the stomach, and purg- 
 ing from that of castor oil on the intestine, it should probably follow 
 that the same results will happen when either of these, or analogous 
 agents, are injected into the veins, and are circulating within the very 
 organization of parts possessing superficially those relations to the 
 same agents (§ 150). Each series of observations, however, stands 
 independently by itself. The injections prove nothing beyond their 
 own results. They can have no bearing upon the question of super- 
 ficial action ; and we may as well deny that croton oil, hellebore, ela- 
 terium, &c., act upon the skin when they produce inflammation of that 
 organ as to deny the same local action upon the intestines when they 
 increase their motion, augment their secretion, or inflict inflammation 
 upon them ; we may as well deny, I say, that we feel with the ends 
 of our fingers, or assume that offensive odors, tickling the throat, warm 
 water, and mental emotions, produce vomiting through the medium of 
 the circulation. Humoralism must group the whole under one cate- 
 gory, and must include all those varying susceptibilities which arise 
 from habits and analogous causes as exerting their morbific effects upon 
 the blood ; for the moment it regards the solids as taking an initiatory 
 step it opens a door for its own expulsion (§ 651 h, 827 e, 1088 c?). 
 
 837, c. A great variety of examples might be adduced in proof of 
 the repugnance of nature to the doctrine of humoral absorption as 
 commended to our confidence by the experimentalist, and which 
 equally confirm the vital theories of morbific and remedial action, 
 whether the agents be applied to the raucous tissue or to the skin. 
 What, for example, would bg*the condition of the acetate of lead, or 
 the nitrate of silver, or sulphuric acid, were they absorbed from the 
 stomach % Utterly changed, perfectly inert, on their contact with the 
 blood. How, then, does sulphuric acid, or the acetate of lead, ar- 
 rest the night-sweats of phthisical subjects 1 What disposition, I say, 
 will you make of the universal effects of certain familiar substances 
 applied to the skin; as the numerous preparations of mercury ? How 
 will you account for the well-known action of nitric acid upon the 
 liver, when applied in the form of pediluvium ? Interrogate the 
 chemist as to the condition of all these things, and many other analo 
 gous Bemedial agents, when he mingles them with the blood (^ 1088) 
 
 The experiments, therefore, have no tendency to prove the doc 
 trine of absorption. On the contrary, they go to substantiate what 1 
 have said of the nervous power as the immediate cause of the remote 
 effects, and the importance of duly considering the special modifica- 
 tion of the properties of life in the different tissues and organs {§ 133- 
 152, 227, &c.).— Note R p. 1123. 
 
 837, cc. But, after all, the foregoing experiments are worthless in a 
 practical sense, since they have been made (unless in rare and unsuc- 
 cfiKsful instances) upon a very few individuals in health; and there-
 
 PATHOLOCy. HUMORALISM. 531 
 
 fore prove nothing as to their action upon diseased conditions (§ 137, 
 143, 149, 150, 152 h, 156, 163, &c.). And, coming to the multifari- 
 ous examples in which animals have been the subjects, they serve only 
 to raise our astonishment that educated men can have imagined their 
 applicability, in any sense whatever, to the profound problems of hu- 
 man maladies. The difference in constitution alone is conclusive 
 against the supposed analogies. It is conclusive, indeed, against all 
 such reasoning from one species of animal to another species, how- 
 ever apparently allied ; since, in respect to the critical relations even 
 of food, there is scarcely any certainty attending this inductive process, 
 while the distinction in respect to the influences of morbific and reme- 
 dial agents upon different animals is marked by every agent which is 
 capable of making any positive demonstration. Some vegetable poi- 
 sons, indeed, which are most destructive to man, and to many species 
 of animals, are to others of the brute tribe wholesome articles of food 
 (§ IS, 150, 191, 366, 447, 854 bb). 
 
 838. The natural adaptation of the various fluids of the body to the 
 several parts with which they come in contact, and the certainty with 
 which most of them produce disease in parts to which they are not 
 naturally related, is conclusive that the blood cannot be medicated by 
 any agents of sufficient power to act upon parts that are morbidly ir- 
 ritable, without often endangering every part of the body. The prin- 
 ciple is of course the same as with the truly morbific agents ; and, to 
 be fully comprehended, the following references should be consulted 
 (§ 133, 136, 137, 2333, 277, 494, 526, 826 cc, 829, 847 a, 889). 
 
 839. As with morbific, so with remedial agents. The philosophy 
 is essentially the same (§ 151). May we not, therefore, take from 
 Nature an important hint as to the mode in which remedies operate, 
 and apply it analogically to the modus operandi of morbific causes 1 
 Does unaided Nature medicate the blood ] Does she ever effect a 
 change in that fluid without an antecedent change in the solids? 
 Never. Does she not always restore the blood from its morbid 
 states through the agency of the solids alone % How is it with small- 
 pox, and measles, and other self-limited diseases % Art can do noth- 
 ing to shorten their established time, or affect their regular progress. 
 Nature accomplishes the whole. But I say, again, does she first ren- 
 ovate the blood (§ 858, 861)? We may imagine primary changes in 
 this fluid as the cause of the morbid changes which befall the solids ; 
 but if this were true, then, ex necessitate rei, the restorative powers 
 must commence and advance with the blood. In the natural cure, 
 however, there is no agent excepting the solids to exert the slightest 
 impression upon that substance; by which I thus demonstrate the de- 
 pendence of the morbid changes of the blood upon those solids by 
 which their subsequent removal is brought about. 
 
 840. Try the question by an infallible experiment. Apply the 
 medicine to the organ affected ; tartarized antimony, for example, to 
 the brain in phrenitis, to the lungs in pneumonia. How absurd the 
 proposition ! Even in the primary action of remedies upon the stom- 
 ach, and when disease of that organ yields to their operation, it is 
 not alone from the direct action of the agents, but greatly so from in- 
 fluences of the nervous power reflected upon the mucous tissue of the 
 organ (§ 514 b, 516 d, nos. 6, 12, 657, 658). 
 
 Circulating within the organization, remedial agents of an imtating
 
 532 INSTITUTES OF MEDICINE. 
 
 nature exasperate disease far more certainly and violently than do 
 cathartics when acting upon a highly-inflamed intestinal mucous 
 membrane. This will be readily appreciated by all who have wit- 
 nessed the stimulant effects of muriate of soda when injected into the 
 veins of the dying subject of the cholera asphyxia. Simple as the 
 substance, the scarce audible heart bounded under its influence be- 
 yond its natural vigor, and the whole vascular system instantly emer- 
 ged from its sunken state into one of preternatural excitement, and 
 long after the most powerful stimulants administered by the stomach 
 would not awaken, in the least, the expiring sympathies of the heart, 
 nor violent irritants applied to the skin rouse its circulation (§ 829). 
 
 Can it be entertained that pneumonia, or ophthalmia, or erysipelas, 
 or fuininculus, &c., are relieved by the transmission of the various 
 substances, which may yield relief, to the very organization of the 
 parts affected 1 And when vesication, and bloodletting, and mental 
 emotions, are added to those, a medley is presented which defies as- 
 sumption, but which is interpreted with consistency through the agen- 
 cy of the nervous power (§ 222-233|, 686 b, 872, 904 bb, 905). 
 
 841. In former sections I had occasion to illustrate the law of vi- 
 tal habit by certain effects of morbific and remedial agents ; and 
 what is there considered would appear to cover the whole ground of 
 solidism and vitalism. Among the many illustrations is the complex 
 example of the influences of tartarized antimony (§ 549-554, 556), 
 which may now be continued with a more specific reference to the 
 humoral pathology, as it will be in a future section to that of its mo- 
 dus operandi (§ 902, 904 bb). But now, as hereafter, I shall show its 
 operation through reflex action of the nervous system (^ 904 bb). 
 
 I may say, then, that it is especially to my present purpose that the 
 humoralist, as well as the solidist, is guided, in his repeated adminis- 
 tration of the antimonial alterative, by its effects upon the stomach ; 
 since nothing can be more obvious to either than that all the remote 
 effects depend upon the amount of impression which the remedy pro- 
 duces upon the stomach. It is not, therefore, quantity, but effect, 
 gastric effect, which is regarded in the administration of this distin- 
 guished humoral agent (§ 826, c). The intense excitement of fever, 
 or the violence of pneumonia, yields to the first nauseating dose of 
 the antimonial, or if it only approximate that point of gastric irritation. 
 The next, and the next, in unaltered doses, may fail of an equal as- 
 cendancy, while the fourth makes no resistance to the returning phe- 
 nomena. But, if there be now added to the original twentieth or 
 eighth of a grain only a fiftieth or thirtieth part, the phenomena are 
 again subdued the moment that gastric influence begins. And in 
 this way may we proceed, experimentally, by continuing the same, or 
 increasing the dose, and find at each repetition that the general re- 
 sults will conform to the impression which is made upon the stomach, 
 at its nearest approximation to a state of nausea ; whatever the re- 
 quisite dose, — however small, or however large (§ 556, 873, 904 bb). 
 
 Again, antimonials are more salutary when they can be borne in 
 gradually-increased doses than where it is necessary to lessen a small 
 dose from the beginning. The reason is this. In the first, or most 
 advantageous case, the irritability of the stomach is not morbidly sus- 
 ceptible to the action of the remedy, but, on the contrary, obeys 
 the law of vital habit in its diminishing influences upon the suscepti
 
 PATHOLOGY. HUMOR ALISM. 533 
 
 bility of the vital states (§ 551, &c.), so that the stomach is not inju- 
 riously irritated ; while, in the opposite case, the law of habit has its 
 exactly opposite effect (§ 556), and the susceptibility of the stomach 
 being morbidly great, and farther aggravated by the antimony, dis- 
 ease of this organ is more or less liable to set in as a consequence, and 
 the object of the remedy to be thus defeated. In the mean time, it 
 may be shedding abroad pernicious reflex nervous influences in 
 doses of extreme minuteness. In a general sense, the best dose is just 
 short of that which produces nausea; but, at other times, occasional 
 nausea may be very salutary, and again, at others, a full emetic dose 
 may overthrow, at once, a formidable condition of disease (§ 476|^ h). 
 The principle, though not the details, is universal. Its practical 
 application is of the highest importance, and, unlike the hypothesis of 
 absorption, may be in the hands of all (§ 481, 494, 828 h, 1088). 
 
 842. The eleventh foundation of humoralism, and the last in the or- 
 der of arrangement (§ 823), is derived from the tan-yard. Thus, — 
 animal tissues have their strength increased by immersion in astrin- 
 gent vegetable infusions ; therefore, as many tonics are also astrin- 
 gent, they are taken into the circulation and give strength to the stom- 
 ach and the system at large by the same process (§ 569 h, 904 d). 
 
 So much has been said upon the foregoing philosophy in the course 
 of this work, that I should have avoided the present subject but for 
 its incorporation into the basis of humoralism, and as I was desirous 
 of presenting the whole system in a methodical manner. 
 
 My own construction of the modus operandi of astringents is briefly 
 set forth in ray Arrangement of the Materia Medica, and will be ex- 
 tended in subsequent sections of the present work. But I would now 
 propound for the consideration of the humoralist the modus operandi 
 oicoM, of ipecacuanha, of muriate nf soda, and analogous agents devoid 
 of true astringency, in arresting hemorrhage ; or how vesicants and 
 ipecacuanha often relieve redundant effusions from the pulmonary 
 and intestinal raucous membrane, or how opium restrains all secre- 
 tions (§ 890 V) ? The force of necessity which applies to the an- 
 swers will be very likely to extend its sway throughout the classes 
 of astringents and tonics, and yield to the laws of reflex nervous 
 action. — Note Bbb p. 1148. 
 
 843. That nothing may be omitted which may serve to complete 
 my analysis of humoralism, I may state what may be regarded by 
 many as a twelfth fundamental ground ; though it is only an induction 
 from the general assumption that the blood is radically vitiated, &c., 
 and the efficient cause of the morbid state of the solids. Its " black" 
 color, as it is called, which appears in congestive fevers, scurvy, &c., 
 is taken as one of the important evidences of its corrupted state ; and 
 when it refuses to coagulate, humoralism assumes that " putridity" 
 has taken place. It will be thus seen that " putrescency" is only a 
 corollary of the seventh proposition in my analysis, and sustained by 
 the fifth (§ 823, 834). Liebig has gone scientifically into the subject 
 (§ 350) ; and in the Commentaries I have endeavored to do justice to 
 its merits (vol. i., p. 403-410, 418, 430-440, 442-460, 663-673). But, 
 what is more remarkable than the rest, it is argued, that, because the 
 blood ultimately becomes "black" or "putrid," it therefore takes the 
 initiatory step in the morbid processes. It is also an important " fact" 
 in the " experimental philosophy" of humoralism, that the color of this 
 elood is changed to a vermilion hue by adding saline cathartics to
 
 534 INSTITUTES OF MEDICINE. 
 
 that whicli is abstracted ; from which the conclusion, is drawn that vhe 
 same substances are taken into the circulation when administered by 
 the stomach, and that they then and there change the color of the 
 blood in like manner ; which proves that the remedial effect is exert- 
 ed upon that fluid. There is no doctrine in humoralism more sti-enu- 
 ously maintained, and none in which the conclusions are considered 
 more logical. It goes with the rest in representing the nature of the 
 " experimental philosophy" which now lies at the basis of theoretical 
 and practical medicine. Next to this are ancBmia, chlorosis and iron.'''' 
 844, Finally, an author of the olden times, writing in the palmi- 
 est days of humoralism, but not of the professional corps, in one of 
 his sallies upon the vagaries of philosophy, let slip a bolt which de- 
 molishes every material fabric in medicine. 
 
 " All the world knows," he says, " there is no virtue in charms ; but 
 a strong conceit and opinion alone, which forceth the humors {moral 
 ones), spirits, and blood, which takes away the cause of the malady 
 from the parts affected. The like we may say of our magical effects, 
 superstitious cures, such as are done by mountebanks and wizzards 
 (§ 167y, note). An empiric oftentimes, and a silly chirurgeon, doeth 
 more strange cures than a rational physician. Nymannus gives' a 
 reason : because the patient puts his confidence in him, which Avi- 
 cenna prefers before art, and all remedies whatsoever. 'Tis opinion 
 alone, saith Cardan, that makes or mars physicians ; and he doeth the 
 best cures, according to Hippocrates, in whom most trust. So di- 
 versely doth this phantasie of ours affect, turn, and wind, so imperi- 
 ously command our bodies, which, as another Proteus, or a chame- 
 leon, can take all shapes, and is of such force, as Facius adds, that it 
 can work upon others as well as ourselves. How can otherwise blear- 
 eyes in one man cause tlie like affection in another ] How does one 
 man's yawning make another yawn 1 — one man's p — ing provoke a 
 second many times to p ] Why does scraping of trenchers offend a 
 third, or hacking of files 1 Why do witches and old women fascinate 
 and bewitch children, but, as AVierus, Paracelsus, Cardan, Mizaldus, 
 Valleriola, Vannius, Campanella, and many philosophers think, the 
 forcible imagination of the one party nerves and alters the spirits of 
 the other % Nay, more, they can cause and cure not only diseases, 
 maladies, and several infirmities, by this means, as Avicenna suppo- 
 seth, in parties remote, but move bodies from their places, cause 
 thunder, lightning, tempests ; which opinion Alkiadus, Paracelsus, 
 and some others approve of; so that I may certainly conclude, this 
 strong conceit or imagination is astrum Jiominis, and the rudder of 
 this our ship, which reason should steer, but overborne by phantasie, 
 cannot manage, and so suffers itself and this whole vessel of ours to 
 be overruled, and often overturned" (§ 167/, note, 227, 234 e, 500/, o, 
 509,892|, 1072). What a display is here of our direct nervous action ! 
 845. Having now considered the grounds upon which the humoral 
 pathology reposes, and how estranged from the institutions of organic 
 nature, I shall proceed to offer the reader a condensed view of my ar- 
 gument predicated alone of the fundamental laws of physiology. 
 
 I propose showing by this argument, that the blood is neither a^;n- 
 ynuftj cause of disease in the solids, in virtue of its own morbid con- 
 dition, nor an aggravating cause of disease when altered in its char 
 acter l)y the morbid action of the solids. 
 
 * See NoTK. R p. 1123.
 
 PATHOLOGY. HUMORALISM 535 
 
 b46. No one will deny what is affirmed by Andral, tliAt every mor- 
 bid change in the action of the solids is probably followed by some 
 change in the blood. The influences from bloodletting often give rise 
 to very remarkable and instantaneous changes in the circulating mass 
 (§ 952, a-h). — See Kriemer's expriments ^ 485. 
 
 I also agree with Andral, that ^xiy primary alteration of ihe blood, 
 of a morbid nature, must, with greater certainty, produce disease of 
 the solids (§ 827, e). 
 
 The latter proposition is the basis of humoralism, and it is this 
 which I now address. 
 
 847, a. There is a specious parallelism about the two foregoing 
 propositions, of which humoralism has taken no little advantage. Both 
 are conceded by the solidists, and humoralism draws its conclusions 
 from both, just as has been seen of its principal data (§ 823, &c.). Its 
 inferences involve the assumption that the blood and the solids sus- 
 tain, reciprocally, the same relations to each other; when, in truth, 
 the distinction is nearly as great as between an agent and the object 
 acted upon. There is this difference, however. In the present case, 
 in their natural state, the blood is the object, while it contributes to 
 the support of the agent, and to maintain its action. 
 
 Were the blood, therefore, to become primarily diseased, it would 
 then assume the same relation to the solids as any other morbific 
 cause, and this the more so on account of its incorporation with them. 
 
 Now, observe the humoral premises, as laid down by Andral, and 
 considered impregnable by all humoralists. It will be seen that the 
 first is the very thing which is most denied in humoralism, — the ground 
 of solidism itself; yet is it put forth for an unreflecting world. Thus : 
 
 Ist. Every morbid change in the action of the solids is followed by 
 some change in the blood. 
 
 2d. 'EiV ery pri7nary alteration of the blood, of a morbid nature, pro- 
 duces disease of the solids (§ 846). 
 
 Therefore, say Andral, and other humoralists, every morbid change 
 in the action of the solids is occasioned by a primary change in the 
 blood. That is the logic (§ 843). But, we have seen that the two 
 propositions are not convertible in a physiological sense, while they 
 stand as independent statements, and in exact opposition to each other. 
 
 But let us reverse the logic, and then see how the case will stand. 
 By the first of the premises, the solidist argues that all morbid lesions 
 of the blood are dependent on primary changes of the solids. And 
 this conclusion is justified by the strongest force of analogy. From 
 the germ to the adult, all the results of organic life have their origin 
 in organic actions. The nutritive fluid itself, from the time that or- 
 ganic actions begin, is universally conceded to be either directly or 
 indirectly the product of these actions ; and the only sense in which 
 the blood can be regarded as an agent, is that of stimulating the solids 
 so that they shall carry on the work of life and appropriate the blood 
 to their own uses (§ 1087). 
 
 Here, then, we must steadily regard the true relation of one to the 
 other, in the farther progress of this inquiry. 
 
 Now, it is said that the solids, which give being and vitality to the 
 blood, become, in their noi*mal state, the subject of its morbific ac- 
 tion ; and, according to the premises of humoralists and solidists, whec 
 the solids are diseased, the blood undergoes disease in consequence.
 
 536 INSTITUTES OF MEDICINE. 
 
 If, therefore, diseased blood be originally the cause of disease in the 
 solids, it must certainly maintain an ascendency over them. Moreover, 
 the solids, in their turn, react upon the blood and increase the dis- 
 eased state of that fluid, or the primary morbific cause ; and, accord- 
 ing to the admitted premises, every increasing degree of disease in the 
 hlood must he a cause of increasing disease in the solids. Thus would 
 the blood and solids perpetually act and react upon each other; and 
 since a morbid state of the blood, according to humoralism, is the pri- 
 mary cause of disease in the solids, and constantly becomes more and 
 more diseased and morbific in virtue of the morbid state which it sets 
 up in the solids, it is plain, if the doctrine of humoralism were true, 
 there could never he a recovery from disease. — Note Aaa p. 1146. 
 
 It follows, therefore, I say, that the solids having been brought int » 
 a morbid condition by their own natural stimulus, and their own 
 means of sustenance, and the morbific state of the blood continually 
 advancing, according to the admitted pi-emises, every disease so be- 
 ginning must necessarily terminate in death. For, again, in the first 
 place, I have shown the absurdity of attempting the restoration of the 
 blood to its natural state by any direct action upon it by foreign agents; 
 and secondly, what I have thus shown an absurdity is a matter of uni- 
 versal admission, since it is conceded by all that the natural state of 
 the blood is entirely dependent on a natural or healthy state of the 
 solids. Nor can Nature, in her spontaneous cures, begin to restore 
 the blood but through a primary recuperative act on the part of the 
 solids. Nothing, therefore, can make healthy blood but the 
 HEALTHY ACTION OF THE SOLIDS. It is exactly with morbid blood as 
 with morbid bile, mucus, &c. The restoration of one depends as 
 much as the other upon an antecedent improvement of the solids. No 
 humoralist medicates the blood to change the bile or mucus, per se. 
 
 847, b. As the foregoing doctrine is based upon fundamental laws 
 in physiology, which admit of no " exception" (§ 284-288), it is man- 
 ifest that, when the constitution of the blood is altered, or becomes dis- 
 eased, in virtue of a diseased state of the solids, the blood thus alter- 
 ed is not an aggravating cause of disease in the solids. Indeed, 
 should it become, under these circumstances, a direct morbific agent 
 to the solids, the same philosophy would hold, the same effect obtain, 
 as were the blood primarily diseased ; since, as the blood is entirely 
 dependent upon the solids for its healthy constitution, the moment it 
 becomes a morbific agent to the solids, the latter will have lost a con- 
 trol which they can never regain. 
 
 847, c. The fundamental principles now stated might have been in- 
 ferred from the final cause of the blood ; since it would have been a 
 radical defect in the animal economy, that a fluid which pervades so 
 universally every part, which is intended for the growth and nutrition 
 (ff the whole, which depends upon those parts for its being, and those, 
 in their turn, upon the blood for their nutrition, and is at all times in 
 subordination to the state of the solids in the natural condition, should 
 receive a morbid impress fiom a part or the whole, which would not 
 only defeat its great final purpose, but give to it an ascendency over 
 those poweys and actions to which it is entirely submissive, for the 
 great end of life, in their natural state (§ 43, 277, 27S, 3031, 303^, 
 322-326, 385, i09 f-i, 411, 422, 424, 449 a, 464, 638, 733 d). 
 
 There is an ever-varying adaptation of the state of the blood •'C
 
 PATHOLOGY. HUMORALISM. 537 
 
 the vaiying condition of the solids, and this is brought about by the 
 Bolids themselves. It proceeds, in equal pace, with the changes of 
 the latter ; as clearly and forcibly exemplified dui-ing the operation of 
 general bloodletting (§ 136, 970 c). The properties and universal 
 condition of the blood, therefore, undergo changes corresponding with 
 any alterations of the vital condition of the solids. What is phys- 
 iologically true in this respect must be equally so in a pathological 
 sense (§ 639, a). A morbid state of the blood is an exact product of 
 an antecedent change in the solids, by which they move on in harmo- 
 ny (§ 653, 733 d, 740, 741). 
 
 847, d. Just so is it with the morbid product of an ulcerated sur- 
 face. The exact condition of the product will depend upon the exact 
 state of the solids by which it is generated (§ 653), nor does the prod- 
 uct, however morbid, increase the diseased state of the solids, unless 
 it undergo some chemical change after its elaboration. "Were it oth- 
 erwise, the natural and immediate result would be a perpetual in- 
 crease of the morbid condition of the ulcer and of its secreted product. 
 The same, again, is exactly true of the blood and the organs upon 
 which it depends (§ 133 c, 136, 137, 150-152, 740, 741). 
 
 The analogy of which I am now speaking is still more forcible in 
 its connections with the humoral philosophy of morbid blood, when 
 it is considered that, with whatever violence morbid secretions may 
 act upon sound parts, they bear a common relation to all other mor- 
 bific causes, and that, therefore, as soon as the parts are brought into 
 a morbid state and generate other or the same morbid products them- 
 selves, they cease to be offended by either. The surface upon which 
 the syphilitic virus, or that of small-pox, excites suppurative inflamma- 
 tion, ceases to be offended by the virus as soon as it becomes the 
 product of the part. Now it is, indeed, that not only is this resistance 
 made, but Nature may set in with her recuperative process. 
 
 It is hai-dly necessary to add, that there is no physiological coinci- 
 dence between the foregoing morbific causes and morbific blood in 
 the humoral acceptation. The blood, in the humoral pathology, is 
 converted into a morbific cause by agents foreign to the organic prop- 
 erties and actions. These properties and actions, I say, therefore, will 
 have lost their control over the blood thus affected, since the blood is 
 their natural stimulus, the pabulum vitce, and depends upon a healthy 
 state of the solids for its integrity. 
 
 847, e. The correspondence of which I have now spoken between 
 the modified vital properties of a part and its morbid products, and 
 between a diseased state of the solids and blood rendered morbid 
 thereby, has its deep foundation in physiological laws. The princi- 
 ple is seen, naturally, in the adaptation of the veins to venous blood, 
 the ureters and bladder to the urine, of the gall-bladder and mucous 
 tract of the bowels to the bile, while venous blood is fatal in the arte- 
 rial system, and these natural products excite inflammation in other 
 parts (§ 133, &c., 385, 733 d). Mark, however, that such inflamma- 
 tion cannot be overcome while a fresh supply of urine or bile is 
 brought into contact with the parts which they had thus offended. 
 It is not now, as was just seen of the syphihtic and small-pox virus 
 (§ 847, d), since no part is ca|lb.ble of having its constitution so alter- 
 ed as to generate urine or bile, and therefore there can be no preter- 
 natural adaptation of the vital state of any part to the morbific proper 
 ties of those natural secretions.
 
 53S INSTITUTES OF MEDICINE. 
 
 And just so with the ordinary forms of disease, if excited in the sol« 
 ids by a primary diseased state of the blood. There will be nothing, 
 then, to make healthy blood, and disease must go on to the death. 
 The humoralist seems to have had some vague conception of this, 
 since he applies himself to drugging the blood. 
 
 847/". Again, as to the morbid secretions and the blood, in the for- 
 mer case the general powers of the body may contribute their restora- 
 tive influence (§ 848), but not in the latter, according to humoralism. 
 l>ut, in the sense of solidism, if the alterations of the blood depend on 
 un antecedent morbid state of the solids the changes of the blood will 
 be always suited to the existing condition of the organic properties and 
 actions, of which the morbid state of the blood has been only a conse- 
 quence, as in the foregoing analogous cases (§ 847 e). And since the 
 changes are thus exerted, the same organic properties and actions, 
 whatever their condition, can, either unassisted or by the aid of reme- 
 dies, replace, by their own improvement, the morbid changes of the 
 blood by others of any degree of approximation to the healthy standard ; 
 as was seen of a part in relation to the syphilitic or small-pox virus. 
 
 847, g. Is it asked why the blood, when essentially altered by any 
 local inflammation, is not, according to my principles, detrimental to 
 the system at large % The solidist can reply upon sound physiological 
 laws, while the humoralist can make no answer. 
 
 I say, then, that all other parts are now modified in their powers 
 and functions by reflex nervous influences of the local disease (§222, 
 '&c., 452, &c., 500, &c., 512, &c., 733 d, 811). In proportion as that 
 affection is capable of modifying the blood, so does it exert a reflex 
 nervous action upon all parts of the organization (§ 674, d). The mod- 
 ifications of the blood and the constitutional derangement being pro- 
 duced by a common cause, the blood and the solids are universally 
 adapted to each other ; the blood being thus inoffensive to the gener- 
 al organization, just as the virus of the small-pox is harmless to the 
 skin by which it is generated (^ 858). 
 
 This law of adaptation meets us every where, both in the natural 
 and morbid states of the animal kingdom. It is the same great work 
 of Design under all the circumstances of life. In disease it is coin- 
 cident with what is seen in health of the modified irritability of the 
 larynx, adapting it to atmospheric air, of the pylorus to chyme, &c. 
 The same as the adaptation of natural bile to the natural state of the 
 intestine, or of morbid, acrid bile to the diseased or disordered intes- 
 tine. It is analogous to the expedient by which a deep-seated ab- 
 scess reaches the surface, and, finally, to all the pi'ocesses of recu- 
 peration (§ 156 b, 733 d, references). Through the same law of 
 adaptation, also, the solids are brought into such relationship with 
 each other by the reciprocal influences of disease as it may affect va- 
 lious parts, and whatever the variety in the coexisting conditions, that 
 a single remedy, as bloodletting, a cathartic, an emetic, &c., may be 
 universally suited to the several pathological states. These cases are 
 perpetually before us ; and were not my philosophy true, all our effi- 
 cient remedies would forever aggravate some part of a compound dis- 
 ease. The principle is the same in both the cases, and our experi- 
 mental knowledge of its truth in the latter confirms what I have stated 
 as to the blood in the former (§ 143, c). 
 
 847, 7i. Were not the foregoing all-wise provisions established in
 
 PATHOLOGY. HUMORALISM. 539 
 
 the constitution jf animals, all the diseases which it may now throw 
 off would require for their removal the interposition of Supernatural 
 Power (§ 133 c, 151, 152). The morbific blood would not develop 
 disease in one part alone, as overlooked by the humoralists, but through- 
 out the universal organism; and the blood itself, becoming progress- 
 ively diseased in the ratio of its morbific influence upon the solids, 
 would hasten the general catastrophe in an increasing ratio. The 
 blood of the victim of small-pox would poison more and more pro- 
 foundly, while the purulent matter would erode the body and lend its 
 powerful aid in the universal work of destruction. Nature, however, 
 comes out triumphantly, and in an allotted time. We must look U) 
 the philosophy which I have taught for the only possible interpreta- 
 tion ; while it opens a door to a stupendous, harmonious system of 
 fundamental laws (^ 233f, 500 k, m, 841, 893 a, n, 904 bb, 905). 
 
 848. It will now be apparent from what has been said in the pre- 
 ceding section, how it is that remedial agents will call into salutary 
 reflex nervous actions various parts of the body not affected by disease, 
 but whose susceptibilities are increased by morbific reflex nervouB 
 actions excited by absolute desease, and upon which parts the 
 remedial agents might otherwise be inoperative. In this way, there- 
 fore, various parts may be rendered instrumental in establishing those 
 influences upon the seat of disease which enables Nature to take 
 on the recuperative process (§ 137 d, e, 143 c, 149-151, 152 b, 163, 
 514 7i, 674 d). Wh.irever, too, may be the complexities of disease, 
 the right remedy will be at least compatible with the whole condition 
 (§ 870 aa, 891 g, 891^ e,f, 892 c, d, 892i c, d). 
 
 849. Upon the foregoing fundamental ground (§ 847), it appears, a 
 fortiori, that if perfectly healthy human blood be allowed to flow into 
 the veins of a subject affected with fever, or scurvy, or inflammation 
 of any important organ, in quantities sufficient to produce an eflfect, 
 while, also, a corresponding quantity of morbid blood flows out of the 
 veins, such healthy blood would aggravate the disease (§ 136, 137 h, 
 c, e, 149, 152). This induction from principles has been practically 
 demonstrated, even to the death of human subjects, although the quan- 
 tity of healthy blood transmitted was small. There was no natural 
 relation between the healthy blood and the diseased solids, and the 
 former, therefore, became morbific (§ 152, b). 
 
 850. It follows, also, from the foregoing physiological principles, 
 that morbid blood may excite disease in a healthy subject, if trans- 
 ferred in certain quantities into the circulation. It may be necessary, 
 however, that the quantity should be large ; when, as soon as morbid 
 action follows, the whole mass of blood will become affected, and thus 
 brought into harmonious relation with the diseased state of the solids 
 (§ 847, e-g). Hence, the great mass of blood is altered from its natu- 
 ral state by the solids, and convalescence may, therefore, begin spon- 
 taneously, or through the intervention of art. 
 
 It is scarcely necessary to add, that the pi-esent case is entirely dif- 
 ferent from those in which it is assumed by the humoralists that the 
 whole mass of blood is primarily morbific. The injected portion is 
 like any other morbific agent circulating with the blood ; nor does it 
 assimilate to itself, any more than wine, or bile, when so injected, the 
 circulating mass. The general mass remains under the control of the 
 solids, and receives from them its deterioration should disease ensue.
 
 540 INSTITUTES OF MEDICINE. 
 
 Nor doss it follow that the injected blood will produce the same con- 
 dition of disease as that by which it was altered (§ 350, nos. 44, 45, 
 97, 744, 810), or be fatal either in this or the other case (§ 849). 
 
 851, a. Finally, the humoral pathology chains the mind in igno- 
 rance, and. whether with the learned man, or the bolder empyric, leads 
 equally, in its application, to the most unhappy practical errors. The 
 violent assumption is equally made by either, that the blood must be 
 purified or otherwise changed by the direct action of remedial agents ; 
 that its impurities must be purged away ; that the means are taken 
 into the circulation, even calomel, blue pill, and other less soluble sub- 
 stances ; that they are then conveyed into the torrent of the circula- 
 tion, cleanse, neutralize, purify the blood, and reinstate its natural 
 condition, as necessary to the subsidence of disease in the solids. It 
 is all the work of the hlood-mdking faculty of calomel, opium, and nux 
 vomica. The treatment, therefore, is ajDt to be governed by this in- 
 dication (^ 1087). 
 
 Or, does the humoralist resort to bloodletting; he professes to 
 carry off the poison, the " peccant humors," &c., by abstracting some 
 dozen ounces of blood from the circulating mass. But this is neither 
 conformable with fact, nor with the hypothesis ; since the great bulk 
 of the poison remains behind, and since, also, at the beginning of the 
 disease, the infected mass must be greatly less morbific than when 
 remedies are applied at its advanced stages. The humoralist affirms, 
 indeed, that an inappreciable quantity of miasma, or of the virus of the 
 dissection wound, &c., enters the circulation and throws the whole 
 mass into a ferment, and that this goes on progressively increasing ; 
 nay, that one drop of blood thus affected is sufficient to contaminate 
 the whole mass, " as a little leaven leaveneth the whole lump," or 
 " as one spoiled herring will taint the whole cask" (§ 350, nos. 44, 45, 
 821 c). And yet may a severe grade of disease be suddenly overcome 
 by a single bloodletting, or by a cathartic, or by an emetic, or by a 
 full dose of quinine (^ 284, 330, 892 I, 900, 902, 905 c, 970 c). 
 
 But the humoralist, learned or unlearned, is little prone to abstrac- 
 tions of blood in recent times, and. now, more than ever, proceeds 
 upon the broad basis of his pathology. Cathartics are his special fa- 
 vorites, for they purge off the humors, and cleanse the blood ; or if it 
 be quinia for an intermittent, it is administered with a view to neu- 
 tralize a poison. To him the vis mcdicatrix NaturcB is like the mid- 
 night darkness to a blind man (§ 240, 839, 853). 
 
 851, h. How different the practice of the solidist ; how enlarged his 
 philosophy ; how various his remedies ; how consistent his doctrines ; 
 how important to humanity ! Let a single example illustrate and con- 
 firm his theories. According to-the nature of the predisposing causes, 
 and the exact pathological conditions, he cures ophthalmia by an emet- 
 ic, or cathartic, or by bark, or arsenic, or iodine, or mercury, or blood- 
 letting, or leeches, or blisters, or electricity, or local sedatives or stim- 
 ulants, and by light or darkness (§ 675, 686, 904 a). 
 
 851, c. I reoret the necessity of the parallel and the contrast. But 
 r speak of facts and philosophy ; nor should I be true to my duty did 
 [ not speak with honesty and frankness. If wrong, refutation will be 
 easy and gladly accepted (^ 1 a}
 
 THERAPEUTICS. 541 
 
 THERAPEUTICS. 
 
 852, a. Therapeutics is the great ultimate object of all medical 
 inquiries. It refers back to the natural physiological states of the 
 body, and to the laws which govern organic beings in their healthy 
 condition. It takes in the whole range of pathology, since there could 
 be no rational treatment of disease without a previous investigation 
 of its causes and nature, and a proper knowledge of their relative laws 
 and principles. Having, also, for its specific objects the means of 
 cure, and their just application to disease, therapeutics comprehends 
 all the vital relations of the Materia Medica. 
 
 Notwithstanding, however, the vast range of principles which it em- 
 braces, and the immensity and complexity of its details, it has, essen- 
 tially, but one fundamental object ; namely, that of inducing such 
 changes in the morbid organic properties and functions as will enable 
 them to return spontaneously to their natural state (§ 177). 
 
 852, h. We thus find that all parts of our inquiry are intimately 
 bound together ; that together they form a perfectly consistent whole ; 
 and that as a whole each part is necessary to all the rest (§ 137 a, 
 639 a). 
 
 Wonderful, indeed, that so vast a subject should be so simple in its 
 elementary principle ; but more wonderful still that a principle so 
 simple should be more complex in its attributes than all other princi- 
 ples in nature (§ 133-153, 177-182, 222-233). 
 
 853, It is an attribute of the properties of the Vital Principle that 
 they possess an inherent tendency to return from their morbid to their 
 natural states. This endowment has given rise to Thei'apeutics, and is 
 indispensable to the perpetuation of organic beings. It belongs, 
 therefore, to plants as well as to animals (§ 133 c, 185). The object 
 of art, in the treatment of disease, is to place those properties in a 
 condition which will enable them most readily to obey this natural 
 tendency (§ 189). This is what I mean by Nature, and the vis rncdicatrix. 
 
 854, a. Remedial agents operate upon the same principle as the 
 remote causes of disease (§ 150-152). They can never transmute the 
 morbid into healthy conditions. That is alone the work of Nature 
 (§ 524, d, 862). Art can only make the best use of her laws (§ 237). 
 
 854, h. The most violent poisons are among our best remedies. 
 " Ubi virus, ihi virtus." In a medical sense, however, we do not know 
 them as poisons, but as among the choicest blessings bestowed upon 
 man. Poisons, however, they may all become when not employed in 
 their proper relations to disease (§ 150, 673, 674). That it may be 
 properly known in what respects they are remedial, they should be 
 studied in their morbific aspects ; studied in their morbific effects upon 
 diseased, not upon healthy, conditions (§ 137, d, &c.). Thus, also, 
 shall we employ them with a more solemn reference to their morbific 
 capabilities, and under the deep conviction that when injudiciously 
 administered they cannot fail to exasperate disease. 
 
 854, hh. The foregoing consideration demonstrates an important 
 fallacy at the very foundation of homoeopathy. It affects very seri- 
 ously its main principle as founded upon experiments with remedial
 
 542 INSTITUTES OP MEDICINE. 
 
 agents upon the healthy subject. But the fact that this objection has 
 not been advanced is an evidence of the little consideration which is 
 bestowed upon the vast differences between the operation of reme- 
 dies upon healthy and diseased organs ; and if such palpable distinc- 
 tions be not observed, what must be the amount of knowledge in re- 
 spect to the immense variety in the degrees and kinds of susceptibility 
 in different forms of disease and in the variable pathological states of 
 a common form (§ 137 d, 150, 191, &c., S92i h, 855, 856) ] There 
 is nothing, however, more important in medicine than the principle 
 which I am now considering. But, there can be little hope of its gen- 
 eral recognition till experiments upon animals with a view to elicit 
 the causes and the philosophy of disease as manifested in the human 
 race shall have been abandoned. Not till all indications as to the 
 curative virtues of remedial agents shall become limited to observa- 
 tions upon man alone, and man in a state of disease. Not till all 
 others shall have ceased. Not till principles in medicine are wrested 
 from the hands of the chemical and mechanical philosophers (^ 676, h). 
 Not till a proper decision can be obtained between the two methods 
 of considering disease as propounded in sections 5^ a, 675, 6S6 h. 
 Should the last of these references prevail, then must fall, as an indis- 
 pensable prerequisite, all the principles and suggestions which have 
 been derived from the philosophy which concerns the external world, 
 and yield to that system which I have set forth as the foundation of 
 the method of interrogating disease according to that section to which 
 this special reference is made (§ 686, h, 1058 b, note, 1059). 
 
 854, c. In respect to the absolute influences of all remedial agents 
 of positive virtues, they are essentially morbific in their remedial 
 action ; as will have been duly explained (§ 893, 902). They are 
 alterative in disease, as in health, in respect to the vital properties 
 and actions. There is no difference in principle as to their absolute 
 action. In certain remedial quantities many may induce, in the 
 healthy organism, various degrees of disease with as much certainty 
 as those agents which are called morbific. It is upon this alterative 
 nature of remedial agents that I have founded, in part, my Therapeu- 
 tical Arra?igement of the Materia Medica (§ 893, 897-901, 1059). 
 
 854, d. The difference, in effects, between the truly morbific and 
 remedial agents is two-fold. Morbific causes make their deleterious 
 impression, in a general sense, more profoundly and more perma- 
 nently. Positive remedial agents, in certain quantities, exert such 
 morbid changes as are not profound, and from which the properties 
 of life may recover, by their inherent tendency, their normal state. 
 But, there is also another difference which is fundamental. The two 
 classes of agents not only affect the vital states in different modes, ac- 
 cording- to the special virtues of each, but each establishes changes ac- 
 cordino- to the existing condition of the vital states (§ 137^^,149, 150, 
 S54 hb). The Materia Medica is necessarily founded upon the fore- 
 goincr principles, however it may have been hitherto unexplained, or 
 however it may not be now admitted (^ 2 b, 143c, 895, 902/). 
 
 854, e. In the treatment of disease, therefore, we do but substitute 
 one morbid action for another. Physiological processes do the rest. 
 
 854, y. In consequence of the laws of organization, the approxima- 
 tions of morbid conditions are such as to enable us to estaljlish upon 
 a conain combination of phenomena certain general priaciplep of
 
 THERAPEUTICS. 643 
 
 treatment, corresponding harmoniously with the principles through 
 which the morbific agents have induced the adverse changes. The 
 curative principles, therefore, will be liable, in all cdses which are not 
 exactly alike, to certain modifications according to the modifications 
 of disease ; and these are to be learned, especially, from the vital 
 manifestations (§ 150-152, 177-179, 182 b, 638, 650, 670, 672, 676, 
 677, 680, 733 e-i, 741 b, 745, 756 b, 758, 766, 854 bb). 
 
 855. Many of the remedies for disease, especially when Nature is 
 engaged in the recuperative process, consist of the ordinary means 
 of maintaining health, such as the various modes of exercise, change 
 of climate, &c. These means now operate with greater power than 
 under ciixumstances of health, and must therefore be carefully adapt- 
 ed to the existing state of the patient, since, when unduly applied, 
 they aggravate or reproduce disease like agents of absolute virtues 
 (§ 137 b, 143, 147, 149, 150, 854 bb, 872 a, 902 m). When produc- 
 tive of useful eifects they co-operate in a direct manner with the ten- 
 dency to restoration which had already begun (§ 672, 733 e-i). 
 
 Of the same nature, also, are the agreeable excitements of imagi- 
 nation, of society, of rural scenery, of joy, hope, amulets, charms, &c. 
 While, also, some of these means may be powerfully morbific they 
 may be equally curative of disease (§ 226, 227, &c., 844, 1067). 
 
 856, a. There are yet other remedial means which may be called 
 negative, or such as merely allow Nature the fullest opportunity to go 
 on with her recuperative "efforts. They make no impression upon 
 the vital conditions ; and all the changes to which they administer 
 grow exclusively out of the constitutional tendency of the properties 
 and actions of life to return to a state of health ; which is the import 
 I give to the convenient term Nature when employed therapeutically. 
 
 856, h. Now the means of cure embraced in this and the preceding 
 sections are of the highest moment in every case of disease ; and yet 
 are they the most neglected except by those who depend on Nature 
 alone.(§ 854, bb). In a large proportion of chronic forms of disease, and 
 whei'e they are acute but not profound, little else is needed than a 
 modified system of hygiene adapted to the individual cases. Com- 
 ing to graver modes of disease, and where active remedial agents are 
 required, the negative means are more important than in the former 
 cases, and nothing more so than a rigorously low diet. 
 
 Here, then, is opened a wide door for the contemplative and prac- 
 tical inquirer. Here recuperative nature is displayed according to 
 the Ordination of Providence throughout brute creation. The animal 
 sickens, " starves," and thus nature works the cure. Man alone vio- 
 lates her law (§239, 240). 
 
 857. It has been seen that morbific and remedial agents, even the 
 natural agents of life, acting with certain intensities, and under given 
 circumstances, may be entirely on a par ; each leading with certainty 
 to morbid changes which may transcend the restorative disposition of 
 the organic functions. 
 
 This fact involves a principle which is fundamental in the Materia 
 Medica ; that of limiting the quantity of remedial agents, and the 
 duration through which they operate, so that they shall only establish 
 such changes in the vital conditions as will enable them to exert their 
 fullest tendency to return to a state of health. Beyond that point pos- 
 it We remedies determine morbid changes that are emban'assing to
 
 o44 INSTITUTES OF MEDICINE. 
 
 Nature, and may be far more so than the conditions which had been 
 instituted by the primary cause of disease. This is a matter of constant 
 demonstration ; and if we connect with it the more general abuse of 
 food, their common mode of action becomes so obvious, that he who 
 may pause in his excessive medication should take the hint and unite 
 the advantages of the negative treatment (§ 856). 
 
 I am now upon ground of the first importance in practical medi- 
 cine. I have endeavored to enforce and to illustrate that importance 
 by calling up, in a variety of shapes, those fundamental physiological 
 laws which give the greatest determination to the effects of remedial 
 agents, in respect to their amount, and the frequency of their repeti- 
 tion (§ 889, 1). I leave out of consideration, for the moment, the vast 
 questions which relate to the right adaptation of remedies as concerns 
 their nature, and the order of their application (§ 150). I would dwell 
 abstractedly upon the dose and the frequency of its repetition. Too 
 little reference to the natural constitution of the pi'operties of life and 
 the laws which they obey in their natural states, and too little depend- 
 ence upon recuperative nature — ay, I may safely affirm, too general 
 an abandonment of that foundation, and even a universal ignorance of 
 the practical bearings of some of its most important elements (§ 516 d, 
 no. 6, 524 d), have mainly led to an abuse of remedies in respect to 
 doses and their repetition which has been more pernicious than er- 
 rors in their appropriate nature, and their order of application. That 
 abuse, indeed, in connection with the stimulant and feeding practice, 
 is the whole secret of the origin of homoeopathy, and of its extensive 
 prevalence (^ 621, a, 1068). 
 
 It must be conceded, however, that there is no attainment in medi- 
 cine so difficult as that which relates to quantity or dose, or which re- 
 quires so much critical observation of disease ; and next to that is the 
 time when the dose should be repeated, or varied, or some substitute 
 made. The most delicate points are relative to dose and repetition, 
 and these can never be attained with any accuracy without a full ap- 
 preciation of certain physiological laws which I have endeavored to 
 expound as far as my own apprehension of their nature will admit (§ 
 5J a, 516 d, no. 6, &c., 686). It should be kept steadily in view that 
 all efficient remedies are morbific in excessive doses, that what would 
 be pei-fectly inert in one condition of the same disease may be fatal in 
 another modification, and that the impressions produced are continued 
 beyond the time of their direct operation, according to the nature of 
 the remedy, its dose, the precise pathological conditions, &c. (§ 149, 
 150, 163, 191, 514 g, 516 c, 516 J, no. 6, 550, 552, 556 h, 558 a, 
 673). A repetition of the means before the influences already estab- 
 lished shall have ceased, or have duly lessened, or have fallen short of 
 the intended amount, either prolongs the cure, or exasperates and 
 multiplies disease (§ 872). 
 
 858. The foregoing principle is strikingly shown, and a large reli- 
 ance upon Natui'e as strongly enforced, by the impracticability of art 
 in arresting the progress of the self-limited diseases, and by their 
 spontaneous termination in health. We cannot, by any active treat- 
 ment of small-pox, &c., place the morbid properties and functions in 
 a more advantageous slate to exert their recuperative principle than 
 had been already done by the very causes of the disease. On the con- 
 trary, all active treatment embarrasses Nature, and is generally mor-
 
 THERAPEUTICS. 545 
 
 bific. Accidental conditions, such as inflammation of important or- 
 gans, may spring up in the truly self-limited diseases, which may re- 
 quire a decisive impression from remedial agents ; and it is an ad- 
 mirable law of nature that, in proportion as these special exigencies 
 may arise, the influences of their pathological conditions will enable 
 the more general affection to bear the treatment that may be demand- 
 ed by the contingent derangements (§ 150, 156 b). But we must be 
 careful to avoid such agents as may interfere with the established ten- 
 dency of the general affection to subside spontaneously (^ 847 g). 
 
 Nowhere, however, is the recuperative tendency of nature, the vis 
 medicatrix natures, so forcibly displayed as in the brute creation, where 
 instinct alone obtains, and where organic life moves on unshackled by 
 artificial habits (§ 856, V). All is the work of physiological processes. 
 
 859, a. We see, therefore, more and more, that, in therapeutics, we 
 should cautiously avoid those fallacious inductions which have been 
 drawn from the actiun of remedial agents upon man in health, and 
 even upon animals and plants, and which constitute a part of the " ex- 
 perimental philosophy" of the age (§ 854). It is, however, one of the 
 worst corruptions that has crept into medicine. I have variously in- 
 dicated its want of philosophy, and the evils of its practical applica- 
 tion. They are summarily comprehended in principles set forth in 
 sections 149-152. These principles I regard as among the foremost 
 in therapeutics ; and here, but for other reasons, they would have 
 been first announced. 
 
 859, h. To arrive at any just knowledge of the physiological rela- 
 tions of any remedy to a given form of disease, it must be considered 
 in the opportuneness of its application, its appropriate degrees, and 
 according to the varieties of constitution, age, habits, sex, &c., and 
 according, also, to the nature of the affected organ, to the variations 
 of any given disease, its reflex nervous influences, and as those influ- 
 ences may be modified by the remedy, and the connection of the par- 
 ticular remedy with other agents that may precede, or follow, or be 
 simultaneously employed, and all other circumstances that may favor 
 or embarrass its most salutary effects (§ 133-163, 535, &c., 574, &c., 
 585, &c., 622, 650, 651, 659-662, 671-673, 675, 685, 686, &c.). 
 
 859. c. Nevertheless, the salutary action of remedies, or rather the 
 aid which they may contribute to the recuperative process, is common- 
 ly in the ratio of the intensity of disease. This grows out of the con- 
 stitutional nature of the organic properties, as already variously con- 
 sidered, and Medicine simply administers their laws (^ 235, 237). 
 
 860. All remedial agents of positive virtues, like all morbific ones, 
 alter the properties and actions of life, ctxteris paribus, according to 
 the nature of each agent (§ 652). Each one affects them in Tiind, and 
 in a way more or less peculiar to itself. Hence, mainly, the varieties 
 in any common genus of disease, as in inflammation and fever ; hence, 
 also, the modifications of a common mode of treatment, and hence the 
 importance of selecting the cathartic, the emetic, &c., whose virtues 
 may be most appropriate to the precise pathological condition of tlie 
 case before us, and introduce the right pathological change. 
 
 861. There are but a few diseases which have a determinate ten- 
 dency to a state of health, and these are, in consequence, denominated 
 self-limited. Sooner or later, however, there is apt to arise in a large 
 proportion of diseases a spontaneous subsidence This may not be 
 
 M M
 
 546 INSTITUTES OF MEDICINE. 
 
 true of a great proportion of cases ; but the restorative disposition is 
 often manifested in a gi'eat number of instances of any given disease, 
 vsrhile a gi-eater number of the same disease may run on to a fatal ter- 
 mination. Their morbific causes are not such, as in small-pox, &c., 
 as to establish modifications of the vital states which go on through 
 regular changes till they terminate in health (§ 858) ; though there 
 may be a strong tendency of this nature existing, as seen in intermit- 
 tent fevers. Nevv^ agents (called remedial, but in reality morbific 
 (§ 901)) may, therefore, be made to operate so as to develop the 
 restorative principle where it might otherwise fail, or introduce it 
 sooner than it would occur spontaneously ; and thus place the disease 
 on a par with the self-limited, whose predisposing causes surpass all 
 remedies, in a fundamental sense, in developing a tendency to the re- 
 storative process. 
 
 It is also important to consider that the restorative process, in a 
 general sense, is most readily established near the invasion of disease, 
 whatever its violence (§ 557 a, 868, 869, &c.). 
 
 862. Nature resorts to a variety of expedients in caiTying out her 
 process of cure. The principle is the same in all the cases, and its 
 details illustrate what has been hitherto so obscurely meant by the vis 
 medicatrix. It is the same, through all the intermediate conditions and 
 complications, from those diseases which are marked by a definite or- 
 der of results, as in the self-limited, to the most intractable maladies. 
 A clear and impressive example of the nature of the principle is seen 
 in the progress of an abscess toward the surface, to its termination in 
 health (§ 733). Whenever inflammation passes its formative stage, 
 there is always some sensible demonstration of the modus operandi of 
 the vis medicatrix. These visible results are of a depletory nature, 
 like redundancies of bile, and consist of lymph, serum, pus, &c. ; and, 
 although the results of salutary changes in the morbid states, and con- 
 ducive to the farther subsidence of disease, they are apt to constitute 
 as great or greater evils than the disease whose decline had led to 
 their formation (§ 732 d, 733 a). It is the business of art to prevent 
 these intangible consequences, although they grow out of a law by 
 which Nature aims at preservation and cui-e (§ 733, c). 
 
 863, a. In the treatment of disease we endeavor to imitate Nature 
 in her spontaneous efforts at relief, so far as principle is concerned. 
 If these efforts result in the formation of new products, or an increase 
 of the natural ones, in certain modes of disease, our remedies should 
 be such, in the same, or analogous affections, as will be likely to de- 
 termine an increase of the natural secretions (§ 732 a, h, 756 h, 785, 
 801, 805). And, although these effusions do not relate directly to the 
 parts that may be mainly diseased (as is generally, though not always, 
 true of Nature), they are significant that favorable impressions are 
 made upon these parts. In the natural cure, also, it is these vital 
 changes, far more than the physical products to which they give rise, 
 that determine the cure. This is artificially exemplified in the influ- 
 ence of vesicants, rubefacients, issues, moxa, &c., upon deep-seated 
 inflammations, and proving my doctrine of reflex nervous action. 
 
 863, b. Nevertheless, these redundant products, whether of Na- 
 ture or of art, contribute more or less, as means of depletion, to the 
 restorative process. The part, however, which they perform will de 
 pend upon a variety of circumstances, upon the nature and seat of the
 
 THERAPEUTICS. 547 
 
 disease, upon the means employed by art, upon the organ from which 
 the effusion takes place, and whether from that which is diseased or 
 from another which may only sustain a moderate sympathetic derange- 
 ment, upon the nature of the product, and whether it be the conse- 
 quence of disease or induced artificially. 
 
 S63, c. If Nature institute the effusion, it is commonly far more 
 curative than when flowing from remedial agents. The latter operate 
 mostly by changing the morbid states ; and although they are design- 
 ed to imitate nature in their general results, they may be yet intend- 
 ed to prevent many of the consequences of spontaneous cure, such as 
 effusions of lymph, serum, and blood, and the formation of pus. But, 
 in accomplishing this, they institute an increase of those natural prod- 
 ucts which issue upon open surfaces (§ 862). 
 
 863, d. The increased product is most curative when it proceeds 
 directly from the affected organ. This is true both of Nature and of 
 art. If produced artificially from other organs, the curative effect will 
 be generally the greatest in proportion to the importance of the organ ; 
 and will so far depend upon reflex nervous actions set up by the vi- 
 tal changes which give rise to the increased product ; as when cathar- 
 tics augment the bile, the intestinal mucus, &c., or antimonials the 
 perspirable matter. Hence, it will be seen that the vital changes in- 
 duced will depend, in any given form of disease, upon the nature of 
 the cathartic by which the bile or intestinal mucus is augmented. Calo- 
 mel, or jalap, or castor oil, &c., may be speedily curative, when aloes, 
 or elaterium, or croton oil, &c., may be as speedily fatal. So, again, 
 as to " sudorifics," as they are called. Antimonials or ipecacuanha, 
 for example, though they but soften the skin, may overthrow the most 
 profound inflammations, when hot water, or herb teas, would be per- 
 fectly ineflicient, though they bathe the skin in perspiration. " Sialo- 
 gogues" fall under the same philosophy. Horseradish is one of them; 
 but though its mastication may keep up a flow of saliva, it will only 
 aggravate an inflammation which mercury, without salivation, may 
 soon subdue. We come thus to understand how all remedial and 
 morbific agents affect the vital states in conformity with the exact vir- 
 tues of each agent and the existing condition of parts upon which their 
 effects may be exerted (§ 150). We are thus enabled to understand 
 why the vomiting which is produced by an offensive odor, or by tick- 
 ling the fauces, or by disgusting objects, or any other mental emotion, 
 or by warm water, is less effective in breaking up disease than when 
 produced by an infusion of mustard seed ; and less from the last than 
 from the sulphate of zinc, and less from this than from ipecacuanha, 
 and often, perhaps, still less from ipecacuanha than from tartarized an- 
 timony, and perhaps often still less from either than from ipecacuanha 
 and tartarized antimony combined. One agent impresses the organic 
 properties of the stomach more profoundly and in a different way from 
 another, and therefore excites and modifies the nervous power in a 
 way peculiar to itself, which, when reflected upon the diseased parts, 
 will affect their condition in modes corresponding with the peculiar 
 impression that had been made by the nauseating influence exerted 
 on the mucous tissue of the stomach (§ 226, &c.). And so of every 
 other remedial agent which produces its effects upon reinote parts 
 by primary impressions upon the gastro-intestinal mucous membrane, 
 or the skin, or any other organ. The same is also equally true of mor-
 
 649 INSTITUTES OF flIEDICINE. 
 
 bific agents (§ 650, 653). And here, through the foregoing philoso- 
 phy, we may understand the reason for the differences in results be- 
 tween the action of cathartics and the analogous effects of emetics 
 upon the intestine. We may regard it, for example, as manifested by 
 tartarized antimony in the double aspect of a curative and morbific 
 agent as it may happen to prove emetic or cathartic. If it fail of the 
 former effect, it will, nevertheless, have produced more or less of that 
 profound impression upon the stomach which is peculiar to its own 
 virtues in their relation to the gastric mucous tissue, and when it passes 
 on to the intestine it exerts not only a more depressing effect upon the 
 whole organism, but may act upon the intestine as a profoundly mor- 
 bific cause, and develop reflex nervous influences that light up inflam- 
 mation in the lungs, or extinguish life, as is often the case, ere its 
 purgative effect has ceased (§ 150, 226, 228). The fundamental prin- 
 ciples are the same thx-oughout, and rest mainly on reflex action of the 
 nervous system. No chemical, physical, or humoral hypothesis can 
 withstand its force, for a single moment, with the enlightened prac- 
 titioner. In a practical sense, it should be the perpetual study of phy- 
 sicians ; the touch-stone, as it were, by which all remedies are selected 
 (§ 149-154, 222-2334, 475^, 500 k-nn, 514/ 647^, 891^ k, 893 a, c). 
 A great variety of other practical conclusions follow in the train of 
 the foregoing principles. We see, for example, from what is known 
 of the rapidity with which emetics produce vomiting, and the reaction 
 which speedily follows, that they exert their alterative effects upon 
 diseased parts with great suddenness, and that the influence of mere- 
 ly nauseating doses of the same agents may be exerted more 
 gradually, and may therefore, according to the nature of their virtues, 
 be more profoundly alterative. The depressing nausea which pre- 
 cedes the emetic effect of tartarized antimony may be remarkably pro- 
 ductive of an alterative influence upon all the organs of the body (§ 
 514, h-m) ; prostrating the circulation, and, when prolonged, removing 
 croup, or pneumonia, more effectually, perhaps, than by the speedy 
 operation of an emetic. Hence, also, it is obvious that emetics are 
 mostly useful, in their therapeutical aspect, soon after the invasion of 
 disease, when unembarrassed by the force of vital habit (§ 535, &c.), 
 or during the intermission-s of fever when nature is inclined to the 
 restorative process, and when, as in either case, she may require only 
 a sudden and temporary shock to place her permanently in the right 
 way.* The philosophy of their success in these cases appears to be per- 
 fectly simple. The morbid change, in one case, having but just be- 
 gun, and Nature, in the othei', being inclined to restoration, reflex 
 nervous influences which radiate from the stomach during the action 
 of an emetic easily establish new changes in the diseased conditions, 
 when the properties of life are enabled to obey, at once, their natural 
 tendency to return to a state of health. This simple principle, there- 
 fore, leads us to understand that the most auspicious time for admin- 
 istering an emetic in intermittent fever is when the stage of intermis- 
 sion is fully formed. There is now the greatest suspension of morbid 
 action, and the organic states are going the right way. We critically 
 seize this moment to prevent Nature passing again into a state of in- 
 cubation ; or, perhaps, a better time is not long before the expected 
 access of a paroxysm, since the artificial change being made about the 
 time of the access, the predisposition is so crippled at this partic ila. 
 
 * See p. 298, d 470J h.
 
 THERAPEUTICS. 549 
 
 juncture that the artificial change breaks up, most effectually, the suc- 
 cession. This interruption of the access of" a paroxysm destroys the 
 paroxysmal habit, and. the disease is at an end.* The same philosophy 
 is here concerned as that which respects the influences of bloodlet- 
 ting just before the access of the cold stage, and goes to illustrate the 
 modus operandi of that remedy (§ 986, &c.). But the most advanta- 
 geous time for bleeding, if not demanded by some inflammation, or 
 by high arterial action during the rise of the hot stage, is soon after 
 that stage begins to subside ; and this, next to the time just antece- 
 dently to the expected access of the cold stage, is the best period for 
 administering an emetic ; and this, also, is the best period for the ex- 
 hibition of a cathartic, unless given along w^ith the emetic before the 
 access of the cold stage. The same philosoj^hy applies whether Na- 
 ture be engaged in a restorative movement or be about to enter upon 
 a state of incubation. The expediency as to time depends upon the 
 kind of remedy. In either case Nature may be readily turned into 
 her favorite course. Conditions are instituted which correspond with 
 those through which the morbid properties take on spontaneously the 
 progressive changes that result in health ; as shown by the coincidence 
 in the immediate results of the remedies, and those which ensue at 
 more distant times when no remedies have been applied. In either 
 case, whether the artificial or the natural, sweating breaks forth, the 
 secretions of the liver, of the intestinal mucous tissue, of the kidneys, 
 &c., are poured out. By anticipating nature we aid her in consum- 
 mating her efforts at relief; while the artificial change so far tran- 
 scends the spontaneous improvement that Nature is gi'eatly started 
 along in her recuperative process, and often obtains an impulse by 
 which she passes on triumphantly through an uninterrupted series ot 
 salutary changes till the properties and actions of life become restored 
 to their natural state (§ 672, 675).* And here we may look at one of 
 the reasons why cathartics are more remedial than emetics after dis- 
 ease becomes established ; for, although very profound reflex ner- 
 vous actions may be determined by emetics through the mucous tis- 
 sue of the stomach, the impression upon that organ, as exerted by the 
 most curative, is much more transient than that upon the intestine 
 by the best of the cathartics (§ 514 g, 516 d, no. 6). This, however, 
 is only a principal one among other reasons, of which the difference 
 in, virtue is the greatest. Hence, an important corollary, that the 
 therapeutical effects of cathartics and emetics, and, indeed, of all other 
 remedies, will depend, other things being equal, upon the particular 
 virtues of the agent, and the time, within certain limits, during which 
 it may act upon the gastro-intestinal mucous tissue (^ 516 d, no. 6). 
 
 We may remark, also, as intimately related to the principles and 
 practice now under consideration, and as farther illustrative of the 
 importance of adapting our remedies to the precise pathological con- 
 dition of any given form of disease (§ 675, 870 aa), that cathartics, un- 
 less united with an emetic, are apt to be detrimental if exhibited just 
 before the access of a paroxysm of intermittent fever^ and to bring on 
 the attack. But this is less the case with an appropriate cathartic, 
 such as calomel and jalap, if associated with an emetic ; since the op- 
 eration of the cathartic is then more immediate, less prolonged, and 
 its general irritation more or less counteracted by the prostrating ef- 
 fect of the emetic It is the same principle which is concerned wher 
 * See Notes K L pp. 1119, 1120.
 
 J50 INSTITUTES OF MEDICINE. 
 
 antecedent loss of blood lessens the constitutional irritation of cathar- 
 tics, or when the prostrating effect of an emetic prevents the abstrac- 
 tion of blood, however apparently different in the two cases. The 
 principle reaches very far into the philosophy of medicine, and con- 
 cerns, especially, the order in which remedies should be applied. As 
 one of its more obscure details, I may say that the union of opium with 
 a cathartic, for the purpose of moderating the irritation of the latter, is 
 exactly equivalent to either of the immediately preceding examples. 
 
 From what has been just said, we readily see one of the princi- 
 pal distinctions between cathartics and emetics. The non-stimulant 
 emetics reflect a nervous influence which depresses the circulation 
 throughout their widest range but excites perspiration as a conse- 
 quence of salutary changes, while, on the contrary, cathartics are more 
 or less apt to stimulate and excite the circulation at first, and do not 
 often affect, in a sensible manner, the functions of the skin. A knowl- 
 edge of these differences, as well as of the analogies which prevail 
 among the influences and results of different remedies, and also of their 
 modus operandi, is indispensable to a successful application of those 
 suggestions which are afforded by Nature in her unaided efforts at 
 restoration. — Note Ee p. 1133. 
 
 863, e. In respect to the curative influence of increased effusions, 
 much will depend upon the intrinsic nature of the product which arti- 
 ficial or natural changes may bring about {b). By the natural process, 
 in local inflammations, lymph, and serum, and pus are a good deal alike 
 in the amount of effect (§ 732, ti), and redundancies of bile are next in 
 the relief of hepatic derangements. Least of all, in respect to organic 
 products, is increased mucus. But this will depend much upon the 
 nature of the part. It is most cui-ative in inflammations of the lungs, 
 far less in intestinal inflammation, and still less so in inflammation of the 
 bladder (§ 133, &c.). The inorganic products contribute very little, 
 by their augmentation, to the curative process, whether naturally or 
 artificially induced. Perspiration is more so than urine. When these 
 products, however, flow abundantly, the salutary effects depend most- 
 ly upon the vital changes from which the redundancies emanate. Hu- 
 moralism, on the other hand, imputes all to the augmented product (§ 
 514, h). That is the difference between solidism and philosophical 
 humoralism. The former detects the cause and renders it his polar 
 star in his philosophical and practical movements ; the latter mistakes 
 the effect for the cause, analyzes the blood, or the saliva, or the urine, 
 and according to the real, or artificial, or imaginary developments of 
 the test glass and crucible, he neutralizes an acid or an alkali, purges 
 off" ozmazome, or picromel, or cholesterine, and taps the abdomen to 
 cure the dropsy ; while the charlatan " holds up the mirror," and all 
 the world believes the shadow reflected " Nature" (§ 5 j, 349 d, 851). 
 
 863, y. But Natui'e has one means of depletion which stands for all 
 the rest. And so it does in the hands of art. This, I need not add, 
 is loss of blood. Here Nature and art meet upon common ground. 
 Both interpose the remedy for the direct subversion of disease, and 
 Doth equally prevent thereby the formation of other products (§ 805, 
 890 d-g, 1019). Indeed, such is the magnitude of this remedy, and 
 such its direct effect in changing pathological conditions, that I shall 
 enter largely upon the philosophy of its operation, and its applicabil- 
 ity to disease.— Notes Fj'. 11 14, Ff p. 1135, Go p. 1138, Ii, p. 1139.
 
 THERAPEUTICS. 5&1 
 
 863, g. What we have now seen of Nature and of art, in respect to 
 inflammatory diseases, is equally true of fever. The eff"usions, how- 
 ever, which Nature institutes in fever are less various than in inflam- 
 mation, and proceed from organs connected with the external world. 
 But here they are more universal, and it is here as fever is complicated 
 with venous congestions that Nature makes the same demonstration 
 with the remedium principale as she does in obstinate affections of the 
 lungs, or the stomach (§ 805). 
 
 863. 7i. It is a common event for disease to persist until great ema- 
 ciation, and other signs, denote approaching death, but, notwithstand- 
 ing, for the restorative process to set in, and where no secreted prod- 
 ucts had apparently contributed to the change. In these cases, how- 
 ever, the emaciation has been moi'e or less an equivalent. And here, 
 again, a lesson may be taken from Nature, on the subject of diet, by 
 those who will not listen to her law as proclaimed by the instinct of 
 animals. But even where disease is maintained by eiTors in food, there 
 may be yet remaining hope from emaciation (^ 1007 K). 
 
 864. It appears, therefore, that the salutary changes which occur 
 spontaneously in all inflammatory and febrile affections lead to a va- 
 riety of evacuations from the secretory and excretory apparatus, and 
 within the organization, of which eff"usions of blood are the most effi- 
 cient. Art, in its imitation of Nature, has proved that she is the only 
 guide ; and since fever and inflammation comprise all the severe forms 
 of disease, and as there is nothing in the results of spontaneous chan- 
 ges which correspond with those induced by tonics and stimulants, we 
 may safely conclude that those practitioners who often resort to that 
 class of agents have but very imperfect views in physiology and pathol- 
 ogy, and are astray from the path of Nature. — Note Ee p. 1133. 
 
 865. No remedial agents are truly specifics ; though, for conven- 
 tional purposes, the designation is useful. Mercurials will often fail 
 of curing syphilis, where a non-stimulant diet may succeed alone. 
 Cinchona may exasperate an intermittent, when arsenic or cobweb 
 would readily succeed. There is no remedy, indeed, however adapt- 
 ed to the cure of any given disease, which will not sometimes fail, and 
 admit of a substitute apparently quite different. Bloodletting, cathar- 
 tics, &c., will generally remove intermittent inflammation ; but cases 
 occur in which the s^peci^X febrifuge virtue of cinchona is necessary. 
 
 866. All remedies, therefore, are only so in relation to diseases upon 
 which they may exert salutary effects (§ 149, 150). Cinchona, for 
 example, is a remedy for intermittent fever if no local diseases of se- 
 verity exist ; but if so, it will commonly exasperate the fever, and is 
 then a morbific agent (§ 854, 857). Its tonic virtues then transcend 
 iisfehrfuge, of the first of which arsenic and cobweb are destitute. 
 
 The former of this remarkable combination of virtues may be the 
 best for enfeebled states of the system, or of the stomach, if no inflam- 
 mation be present ; otherwise, it is morbific It should be constantly 
 before us, that a tonic, an antiphlogistic, &c., are only such when ap- 
 propriate to the case before us. With this understanding, we are led 
 to investigate the exact pathology of the case, and its various attend- 
 ing circumstances (§ 673, 675, 685, 686). 
 
 867. The curative effect of remedies is more or less progi'essive. 
 When the primary state begins to give way, a new pathological con- 
 dition is introduced, and so on in regular progress where there is an
 
 552 INSTITUTES OF MEDICINE. 
 
 uninten-upted decline of disease (§ 672). But it rarely happens that 
 diseases are diverted from the essential pathological character with 
 which they begin. 
 
 The curative effect commences at the first moment a favorable im- 
 pression is made upon the seat of disease or upon any part capable of 
 participating sympathetically in the restorative process, and terminates 
 when that exact change is made in the diseased properties and func- 
 tions which is most conducive to their spontaneous recovery. When 
 remedies are carried beyond that point, they are apt to become mor- 
 bific. Hence it is one of the most important, but difficult acquisitions, 
 to determine when our remedies should be discontinued, or moderated. 
 
 868, a. It should be a great object of art to render the associated 
 train of pathological states as short, and make it consist of as few 
 changes, as possible. In a general sense, therefore, where disease is 
 intense, the first remedial impressions should be strongly made ; but, 
 in doing this, the right agents should be selected. It would answer, 
 for instance, to exhibit a decisive dose of calomel and jalap, at the on- 
 set of pneumonia ; but it would be sad practice in inflammation of the 
 intestine. Bloodletting, however, is adapted to either case, and is 
 the right initiatory remedy for both. 
 
 As the favorable changes advance, our remedies should become 
 milder and milder, till that critical point is attained where Nature re- 
 quires only the occasional interposition of art to accomplish the remo- 
 val of some slight obstacles that are more or less liable to spring up 
 during convalescence ; such as constipation, deficient secretion of 
 bile, &c. 
 
 868, h. Our remedies may be perfectly right, and yet disease shall 
 increase by the force of its intensity (§ 685, no. 9). In such a case, 
 however, we may have fallen short of the due amount of the remedial 
 agent ; and this we shall see to be often true of bloodletting. But it 
 is rarely so of any internal agent ; there being a prevailing disposition 
 to medicate largely. We have thus a positive abuse of drugs and a 
 nesrative abuse of bloodlettino:. Beino; sure of the riofht, we should 
 steadily pursue it ; repeating the remedy, or associating, or substitu- 
 ting, others of analogous virtues in relation to the case before us, till 
 their effects are pronounced by a manifest decline of the symptoms. 
 
 869, The rapidity with which the full salutary changes will be ef- 
 fected will depend upon a vai"iety of circumstances ; but mainly upon 
 the period of the disease. All diseases being most easily and speedily 
 arrested near the time of their beginning (§ 557, a), the difficulties in- 
 crease in proportion to their unmitigated duration, or any increase 
 they may sustain. They soon begin to acquire the obstinacy of a mor- 
 bid habit (§ 535, &c.), to involve sympathetically other organs, and to 
 result. in disorganization, effusions of serum, &c. (§ 660, 712-718. 
 732 d). 
 
 870, a. Some remedies, in their greatest proper latitude, make a 
 decisive impression much sooner and more effectually than others, un- 
 der the same circumstances of disease, and where either may be ap- 
 propriate. Bloodletting, in inflammations and fevers, operates far 
 more immediately and decisively than any other remedy, and cathar- 
 tics are generally next. And so of many individual cathartics which 
 may be appropriate to a given condition of disease. The saline may 
 be slowly and moderately useful, and some of them better than olh-
 
 THERAPEUTICS. 553 
 
 ere / castor oil more speedy and effectual ; jalap more so; calomel far 
 more so ; and the united force of calomel and jalap may greatly tran- 
 scend either. Sometimes, however, as we have seen, a fever at its 
 onset may be completely subdued by the alterative action of an appro- 
 priate emetic. Tartarized antimony will do it with the gi'eatest certain- 
 ty ; ipecacuanha comes next ; but most of the other emetics would be 
 perfectly useless or detrimental. The union, however, of antimony 
 and ijjecacuanha improves the useful alterative virtue of each, and 
 lessens the chance of morbific action from the antimonial (§ 150). 
 
 870, aa. Remedies sometimes operate with gi-eat and rapid effect 
 upon one part of a compound disease, but may fail in respect to other 
 parts ; or, if not justly applied, they may assuage a part of the disease, 
 but, from theirtiwant of proper relation to other parts, they may prove 
 morbific to these conditions, and thus indirectly reproduce that part of 
 the malady which they had been instrumental in subduing. But this 
 will not happen with the right remedy (§ 150, 552 b, 665, 848). Blood- 
 letting, for example, may quickly subvert pneumonia when complicated 
 with small-pox, but will not shorten the natural progress of the more 
 general malady (§ 858). But the remedy will now be perfectly com- 
 patible with the whole condition of disease ; since the local inflamma- 
 tion has brought the specific form under its influence, and bloodletting 
 now operates in conformity with the law of adaptation (§ 137 c, 143 c, 
 847, &c.). Through the same law quinine may be peculiarly salutary 
 in some cases where pleurisy is complicated with small-pox, if the for- 
 mer affection be owing to the remote causes which generate intermit- 
 tent fever ; but will exasperate the whole condition of disease if the 
 pleuritic affection be owing to any other cause. Much, also, may de- 
 pend upon a coexistence of different virtues in a remedial agent, espe- 
 cially in connection with the amount of its doses. Thus, quinia, in the 
 dose of five or ten gi-ains, may speedily arrest an intermittent fever by its 
 febrifuge virtue. But that is bad practice ; since, by its associate tonic 
 virtue, it is likely to increase or to induce local congestions ; thus leav- 
 ing the patient imperfectly cured and subject to relapses (§ 769). But, 
 in these cases, the local inflammation and venous congestion are so apt 
 to be modified by the predisposing cause of the febrile affection, that 
 repetitions of a small dose of quinine may be curative as to the whole 
 condition of disease. I have twice seen, in my own family, the most 
 formidable grade of remittent fever, of long duration and attended by 
 the foregoing complications, ardent heat, thread-like pulse, loss of 
 raind, &c., and where hope of recovery had been abandoned, yield to 
 less than a grain of quinine, divided into sixteen doses (§ 137 d, 662 b, 
 756, 811, 813 b, 857). There had been repeated bloodlettings &c* 
 
 870, b. This leads me to say, that the best experience sustains what 
 is enforced by my interpretation of the modus operandi of remedial 
 agents, that simplicity of treatment should distinguish the course ol 
 the practitioner. Where diseases are circumscribed, he will have 
 little need of variety ; while, on the other hand, the more compound- 
 ed the affection the more likely will it be necessary to bring several 
 agents into operation. In simple pleurisy an appropriate loss of 
 blood may be the only requisite means, and an emetic at the invasion 
 of croup. But if pleurisy be complicated with congestion of the liv- 
 er, or with idiopathic fever, &c., several other agents may be neces- 
 sary to meet these complications. Much, however, will depend upon 
 * See Notes K L pp. 1110, 1120.
 
 554 INSTITUTES OF MEDICINE 
 
 the stao-e of the disease when the treatment is begun. There must 
 be harmony, however, among the virtues of the several agents, con- 
 forming- to the general modifications of disease, and the existing sus- 
 ceptibilities to their influence (§ 150, 870 aa, 871, 888 b). 
 
 871. We have variously seen how the susceptibility of organs to 
 the influence of remedial, as well as morbific, agents may be increas- 
 ed by antecedent impressions from other causes (143, 145, 149, 150, 
 556, &c.). This is fundamental in therapeutics, and carries us back 
 to preceding statements (§ 672, 867, 868). The administration of 
 remedies proceeds greatly upon this principle. One prepares the 
 way for the favorable operation of another, or which last might be 
 otherwise injurious. A remedy which is curative under one combi- 
 nation of circumstances may aggravate disease when ^at combination 
 is a little varied. The cathartic which would not irritate intestinal 
 inflammation immediately after bloodletting might gi-eatly exasperate 
 the disease if exhibited without the antecedent loss of blood. And 
 so of vesicants, &c. Indeed, so profoundly and rapidly curative is 
 bloodletting of inflammatory affections, and so greatly does it promote 
 the useful effects of other remedies, or prevent their morbific action, 
 that, whenever it is indicated, it should precede all others ; and then 
 it will be often found that it has taken the place of all others. 
 
 Hence a great doctrine in therapeutics, that the order in which 
 remedial agents are applied should be in their best individual rela- 
 tions to the existing pathological state, whether that state may depend 
 exclusively upon the primary causes, or as modified by the subsequent 
 treatment (§ 137, d, &c.). 
 
 This principle, however manifest, enforces a thorough knowledge, 
 not only of physiology and pathology, but of the exact capabilities of 
 remedial agents, of their various doses, and of their modus operandi, 
 in any given pathological state. Its highest practical attainment is the 
 highest consummation of medical skill and science. It is the ne plus 
 ultra of medicine (§ 857). 
 
 872, a. The last section involves the principle which is concerned 
 in the combination of medicines. By the union of two or more, and 
 according to the exact virtues of each substance, and according, also, 
 to the proportion of each, we create, as it were, a new remedy, — add 
 a new one to the Materia Medica. It is thus seen that art may mul- 
 tiply remedial agents to an almost endless extent ; and this explains 
 the reason, in part, why the most enlightened practitioners do not oft- 
 en seek for desirable virtues in the inferior medicines. By variously 
 combining two or more of a limited number new virtues are evolved, 
 however analogous, in almost every prescription for disease. 
 
 By this process, what might be otherwise highly morbific may bo 
 rendered curative. The cathartic, which given alone might aggra- 
 vate intestinal inflammation, may be often rendered safe and useful 
 by the addition of a little opium or hyoscyamus ; and thus, too, the ne- 
 cessity of antecedent bloodletting may be sometimes avoided. The 
 narcotic so lessens irritability that the cathartic is innoxious, and is 
 thus enabled to establish a favorable pathological change. How ad- 
 verse to humoralism this single example, how confirmatory of the doc- 
 trine which I have taught of the action of remedies upon the proper- 
 ties of life (^ 188 a, 189, &c.) ! Add to the cathartic, guarded by the 
 narcotic, a grain, or more or less, of ipecacuanha, and new alterative
 
 THERAPEUTICS. 555 
 
 hiflueiices may spring up, of great power and extent ; each ingredi- 
 ent, and according to the proportion of each, modifying, increasing, 
 and extending the reflex nervous actions, hut in such a combined 
 manner that the compound acts as a whole, and not by its individual 
 parts (§ 188i d, 224, 500 k-nn, 514 A, 889 k, 8911 k, 896, 902). 
 
 Take another example ; for these examples not only illustrate im- 
 portant principles, but are, in themselves, practically important. In 
 a case of common remittent fever, near its invasion, we may proceed 
 with decision, employ bloodletting, calomel and jalap, and speedily 
 pretty well overcome the disease. The most that the patient will im- 
 mediately afterward require will be rest, low diet, and mild influences 
 by certain cathartics. The best of these, till the bile begins to assume 
 a good yellow color, will be small doses of castor oil ; for this cathar- 
 tic exerts a peculiarly alterative influence upon the livei'. When the 
 dejections shall have put on a natural aspect, castor oil begins to irri- 
 tate the intestine rather injuriously, and this effect increases as its rep- 
 etition goes on ; although given, perhaps, in the dose of a tea-spoonful, 
 or a half tea-spoonful only, to an adult. It is also then apt to nauseate 
 the stomach and prostrate the strength. Convalescence has now ad- 
 vanced too far for this active agent, and some other should be substi- 
 tuted to maintain a free secretion of bile, and to procure one evac- 
 uation, at least, daily. But I know of no mild cathartic which is 
 exactly suited to this state of things. If we employ moderate doses 
 of Rochelle salts, they operate too superficially ; mainly upon the mu- 
 cous tract of the intestine, and ai'e also apt, in this condition, to irritate 
 that membrane injuriously. Magnesia is liable to the same objection 
 as it respects the superficial effect ; and rhubarb alone is too stimula- 
 ting to the whole system, and to the mucous tract. But it has the ad- 
 vantage of extending its influences to the liver, and of promoting the 
 tone of the stomach and of the whole system, when this part of its 
 tonic and stimulating effect can be properly restrained. 
 
 Now, the foregoing three agents in combination, and in proportions 
 adapted to the state of the case, are exactly suited to the convalescent 
 from fever who has passed the stage when castor oil ceases to be use- 
 ful. The magnesia corrects the irritating effects of the Rochelle salts, 
 and neutralizes any acid that may exist in the primee viae, while each 
 counteracts any injurious stimulant action of the rhubarb, so only the 
 proportion of rhubarb be not too large. The rhubarb, also, in its turn, 
 gives tone to the digestive organs, counteracts the prostrating effect 
 of the saline substance, and imparts to the whole compound a reflex 
 nervous action over the liver, by which a free secretion of bile is 
 maintained till health is established. — See Note Ee p. 1133. 
 
 Nature has carried out this principle of combination very extensively, 
 and has thus supplied, in numerous substances, a variety of virtues 
 in each one, which are exactly adapted to the varying exigencies of 
 disease. We see it strongly pronounced in the cathartic, tonic, and 
 astringent properties of rhubarb ; in the febrifuge and tonic virtues of 
 cinchona; in the soporific, anodyne, and relatively astringent proper- 
 ties of opium ; in the narcotic and laxative virtues of hyoscyamus, &c. 
 Indeed, so manifold is this union of virtues, that art has availed it- 
 self of the opportunity, and elaborated many in the form of the alka- 
 loids, &c., by which greater simplicity is obtained. 
 
 It is not unusual to meet with prescriptions in systematic, labor-
 
 556 INSTITUTES OF MEDICINE. 
 
 savino- works, embracing several articles, with definite proportions of 
 each, which are said to be adapted to certain forms of disease. This 
 practice is not only wanting in philosophy, but is clearly empyrical; 
 since the adaptation of remedies, both as to the ingredients of the 
 compound, and their relative proportions, should be adjusted by the 
 united circumstances of every case, as they may exist at the moment ; 
 especially in all the forms of acute disease. It is manifest, therefore, 
 that this great object of medical science can be fulfilled only by a 
 careful investigation of every case whenever a prescription is made. 
 It implies a great range of inquiry, an accurate discrimination of the 
 pathological conditions, and an intimate knowledge of the virtues of 
 each remedial agent (§ 686, d). Hence, also, the voluminous reports 
 of cases, with or without the " numerical method," are only useful for 
 the institution of principles in medicine (§ 672, 867). It is so with 
 every thing, with food itself in every case of disease. The principle 
 extends even to light in the treatment of ophthalmia ; which also sup- 
 plies another proof of the coincidence in the philosophy that relates 
 to the operation of light and other vital agents (§ 74, ISSh.d). And 
 so with the agreeable emotions of the mind (§ 500, 539 c, 855, 1067). 
 If the reader will now attend, in connection with the foregoing 
 principle, to what has been said of the nervous power (§ 222, &c.), 
 of its laws of reflex action (§ 500, 512, &c.), and to other special cir- 
 cumstances which favor the operation of remedies (§ 143 c, &;c., &c.), 
 he will readily perceive the extent of his power in tlie judicious com- 
 bination of a few only of the best remedies. But, to accomplish this 
 art of combining remedies, in connection with the requirements in the 
 preceding section (§ 871), demands an acquaintance with the whole 
 ground which forms the basis of therapeutics.' — Note Ee p. 1133. 
 
 872, b. And yet I would not abandon any part of the materia med- 
 ica. I would hold it all, and all in connection ; that what is good may 
 be compared with what is indifferent or bad, and our knowledge of 
 remedial virtues and remedial action be thus extended. There is 
 also scarcely a recognized means of cure but is hallowed by the ser- 
 vice it has done, and which it may do again, in enlightened hands, 
 where the better means are wanting. It was with such intentions, 
 and to promote the habit of a critical investigation of each member 
 ^f the materia medica, that I was prompted to an attempt of arrang- 
 ing the whole according to their physiological aspects and therapeu- 
 tical capabilities. 
 
 873, a. It is an important circumstance to be recollected, that many 
 remedies are cumulative in their effects when employed in small 
 doses ; while the effects of others, on the contrary, lessen by use (§ 
 549-559). The action of the former, therefore, should be carefully 
 observed during their progressive administration, that they may be 
 promptly diminished or discontinued. The latter are not obnoxious 
 to the equal objection of becoming morbific, as they must be often 
 increased to obtain progressively their original effects; but much may 
 be lost by neglecting the ascendency of habit in its aspect of dimin- 
 ished susceptibility (§ 535, &c., 841, 889 b). 
 
 These two important gi'oups, however, are liable to some essential 
 modifications. Mercurials, for example, in their constitutional altera- 
 tive sense, are cumulative in respect to most adults, but very little si 
 in regard to children, who are generally insusceptible of salivatioo
 
 THERAPEUTICS. 557 
 
 Again, in respect to agents which become inoperative from habit, this 
 is often true of them only in certain small doses, and when frequent- 
 ly repeated. Tartarized antimony, in its minimum doses, generally 
 diminishes the irritability of the stomach. But, if carried to the point 
 of nausea, its effects will then be often cumulative, and the dose must 
 be diminished, or incessant and aggravated vomiting may follow (§ 
 556, 841). Opium, hyoscyamus, &c., lose their, effects, more or less, 
 from habit, when continued at certain intervals, as twelve hours, and 
 the dose, if expedient, may be increased ; but if repeated as fre- 
 quently, perhaps, as once in six hours, or less, they are cumulative, 
 and the dose must often be diminished. By-and-by, however, under 
 this frequency of exhibition, irritability becomes obtuse in relation 
 to the agent employed, the opposite influence of habit obtains, and the 
 dose must be increased to procure the original effect. 
 
 Many agents continue to produce about the same effects in the same 
 doses, administered at certain intervals, however long continued. Such 
 is true of ipecacuanha, and those vegetable substances which are alli- 
 ed to it. So, generally, of iodine, and many of its combinations. 
 Much, however, depends upon the intervals between the doses. Un- 
 like tartarized antimony, which it resembles in so many respects, ipe- 
 cacuanha is cumulative as the intervals shorten below four hours, 
 when the dose is a grain. The ipecacuanha will then often produce 
 nausea and vomiting, while the antimonial, though repeated at far 
 shorter intervals, is apt to lose its effect unless progressively increased 
 to an extent which would prove emetic at the first dose. 
 
 873. h. In larger doses, or in their greatest admissible extent, all 
 the foregoing agents are apt to be cumulative. This is true of the fre- 
 quent exhibition of cathartics and emetics, though more so of some 
 than of others. The dose of aloes which purges from the beginning 
 must be often greatly lessened at the subsequent doses ; or what was 
 originally only a mild effect may soon become a violent one. This is 
 also remarkably true of castor oil. All the cathartics, also, when ad- 
 ministered daily in small doses, commonly raise the irritability of the 
 intestine, and operate with increasing energy, though in some of the 
 cases a part of the result may be due to an increased production of 
 bile (§ 516 d, no. 6, 556 h, 841, 889 m, mm, 902-904, 1057 T). 
 
 874. It is an important circumstance, philosophical and practical, 
 that the operation of narcotics is remarkably influenced by pain, and 
 by certain states of the great centre of sympathies, as in delirium a 
 2)otu. It is fatally opposed to the physical hypotheses, and to thera- 
 peutical conclusions from experiments on animals or on man in a state 
 of health. 
 
 It is also interesting to the medical philosopher that pain has no 
 remarkable modifying influence upon any remedial agents excepting 
 the narcotics ; and of those, such only as have a special relation to 
 sensibility (§ 194, &c., 891). 
 
 875. We have now seen, in a general manner, that the susceptibili- 
 ty of the vital properties to salutary impressions, and their inherent 
 tendency to a state of restoration when driven by disease from their 
 natural standard, has given rise to two general modes of treatment, 
 which are familiarly known as the active and the ^catching or expect- 
 ant (§ 853). 
 
 876. The active method consist? in the application of such remedies
 
 558 INSTITUTES OF MEDICINE. 
 
 as produce artificial impressions. It comprises all that is attempted 
 by art, in a direct manner, to promote the natural curative process. 
 By this method, therefore, we forcibly institute those new patholofj- 
 ical conditions which are most conducive to a return of the natural 
 physiological states (^ 150, 854 h, 855, 856, 901, &c.). 
 
 877. The system of watching, or the expectant plan, leaves Nature 
 mostly to herself; only keeping obstacles out of her way. In its 
 greatest latitude its advantages are exemplified in the self-limited dis- 
 eases ; but there is a period in all dieases, terminating favorably, when 
 art should surrender the case to Nature (§ 858, 861, 867, 868 a). 
 
 878. So many evils have resulted from abuses of the active method, 
 that great numbers, not considering that Nature is embarrassed in 
 these cases by ignorance or carelessness, and, withal, having errone- 
 ous views in physiology themselves, do little else than loatch. This 
 is remarkably true of the homoeopath, whose lessons from Nature 
 have taught physicians that all the virtue does not lie in the amount of 
 doses, and that a foe has arisen who can be exterminated only by con- 
 sulting the philosophy of disease, and the modus operandi of remedies. 
 
 Nevertheless, although medical philosophy and a knowledge of the 
 mode in which remedies operate be indispensable to the right treat- 
 ment of disease, the community look only at the results ; and while 
 the homoeopath cultivates his mind, there will be no inquiries, no in- 
 terest, as to his theories. In America these innovations cannot pre- 
 vail extensively, since the contrast will be vastly on the side of our 
 Hippocratic practice (§ 709). But, in every section of the country 
 there are some who are prone to a large and indiscriminate medica- 
 tion ; and while this evil exists, homoeopathy, in its original practical 
 sense, will make its more successful demonstrations. Nor can it be 
 doubtful that the tonic and stimulant practice which has risen in our 
 cities, and which still sways the British profession (§ 621, a), would 
 yield a harvest to those who suffer Nature to take an unmolested, how- 
 ever unaided way.* 
 
 It is due, however, to truth {Jlat justitia mat ccelum), that the physiol- 
 ogist concede to the homoeopath that his hypothetical views may be di- 
 rected by an enlightened understanding of the properties and laws of 
 healthy beings. Upon that ground, indeed, his hopes can alone re- 
 pose ; and even his doctrines in pathology and therapeutics are a thou- 
 sand-fold better, more rational, more consistent, more conducive to 
 liealth and to life, than any or all the tenets of the chemical and phys- 
 ical schools. With the one there may be a great deal of misapplied 
 philosophy ; with the other there is certainly none at all (§ 892, i). 
 
 879. It appears, therefore, that the active and expectant modes of 
 treatment should be more or less associated ; either taking the lead ac- 
 cording to the general character of the disease, and the particular cir- 
 cumstances of individual cases. Having made the requisite impression 
 by the active method, we should watch till another remedial change 
 may be advantageously produced. When all is steadily in the right 
 way, we should do nothing but watch. Another impression by an ac- 
 tive agent would disturb the restorative process, and might so derange 
 the vital states as to establish a condition of disease which art and na- 
 ture together might not be able to surmount (§ 137 d, 150, 151, 854). 
 
 * See Dr. Torbes's "Young Physic.;" also, Prof. Lawsos's, and Medico Chirurg* 
 oal's Reviews of tlie same, 1846.
 
 THERAPEUTICS. 55'J 
 
 880. Having, I say, placed the morbid conditions in the right way 
 for their subsidence into health, but little else remains than to with- 
 draw, in good time, the active interference of art. Much, however, 
 as I have said, may remain to be accomplished by what may be call- 
 ed restorative means ; such as a well-regulated diet, exercise, expos- 
 ure to the air, &c. (§ 855). In protracted diseases Nature may also 
 require the aid of tonics and stimulants ; and this is mainly the ad- 
 vantage which they bestow. They are rather, therefore, adjuncts to 
 medicines that are curative, than positively curative themselves. The 
 same is also true of those narcotics which address themselves to exalt- 
 ed sensibility or irritability. — See Note Ee p. 1133. Also Note F. 
 
 881. Though by the system of watching we intrust Nature with 
 the cure, the active interference of art may be demanded by super- 
 vening obstacles. Such is the case, as we have seen, when visceral 
 inflammations spring up in the self-limited diseases (§ 858). In these 
 affections, also, in their simple states, general arterial excitement may 
 become so excessive as to require the loss of blood, or alterative do- 
 ses of tartarized antimony, &c. The remedies are designed for these 
 specific objects, and not with any expectation of arresting diseases 
 which have a strictly natural course and termination. The same prin- 
 ciple is applicable to all other forms of disease ; according to the na 
 ture of the contingencies that may arise after the restorative process 
 shall have been introduced. It is alike employing constitutional laws 
 
 882. It is no uncommon prejudice that certain local, and even con 
 stitutional forms of disease should be allowed to continue for the pre- 
 vention of some apprehended greater evil. This practice is founded 
 upon the humoral hypothesis, and is one of the strong exemplifications 
 of the fallacy of that doctrine. The intermittent fever is thus allowed 
 to persist, that some peccant matter may be concocted and expelled ; 
 ulcers are cherished as outlets to vicious humors, &c. But, we are 
 never benefited by the continuance of natural diseases. The sooner 
 we get rid of them, the more shall we insure the chances of pi'o- 
 longed life, enjoy an exemption from corporeal and mental suffering, 
 and manifest our common sense. 
 
 883. a. In considering what is to be done in the treatment of dis- 
 ease, we speak of the Indications. These consist of the suggestions 
 that may be afforded by all that relates to the state of the patient. 
 They refer to the symptoms, the seat of the disease, its remote and 
 pathological causes, its duration, the habits, occupation, temperament, 
 constitution, age, and sex (§ 686, b). 
 
 883, b. And here we may go back to the origin of our Science for 
 one of those summary statements which can flow only from an en- 
 lightened and comprehensive view of organic philosophy, and which 
 no subsequent observation has improved. 
 
 " Consider well," says Hippocrates, " the nature of causes, the na- 
 ture and seat of the disease, what is most suitable to-day, and what 
 to-morrow, what the vigor and what the mildness of treatment. A 
 neglect of either may be fatal to the sick. Reason as a practitioner, 
 and practice with reason." " Again, an important thing to be done is 
 to consider the seasons of the year, the various changes, and the dif- 
 ferences of their effects. Next, the winds, particularly such as are 
 common to all nations, and such as are peculiar to certain countries." 
 " The knowledge of disease is to be obtained from the common na-
 
 560 INSTITUTES OP MEDICINE. 
 
 lure of all things, and from the nature of every individual ; from the 
 disease, the patient, the things that are administered, and the peison 
 that administers them, for the case becomes easier or more difficult 
 accordingly. We are, also, to consider the whole season in general, 
 and the particular state of the weather, and of every country ; the 
 customs, the diet, the employment, the age, of every one, the conver- 
 sations, the manners, the taciturnity, the imaginings, the sleep, the 
 watchings, and the dreams ; and how far vellications, itchings, and 
 tears, are concerned ; and what the paroxysms are ; what the evacu- 
 ations by stool, or spitting, or vomiting may be ; and what changes 
 may happen from one disease to another, and their various conse- 
 quences. Sweat, cold, shivering, cough, sneezings, sighing, breath- 
 ing, belchings, flatus (secret and audible), hemorrhages, and hemor- 
 rhoids, are also to be considered, together with the consequences of 
 each" (§ 5i a, 350f, 821 c-823).— Note Oo p. 1141. 
 
 884. When the foi'egoing indications are subjects of attention we 
 pursue the rational system, which is so called in contradistinction to 
 the e)7ipirical. 
 
 The rational treatment looks, also, at the physiological states of the 
 body, and considers disease in its relations to those states. It is 
 constantly concerned about the laws of vital actions, and regards dis- 
 ease as consisting in their modifications. In short, it proceeds upon 
 the broad ground of inductive philosophy, and, therefore, takes in its 
 scope all the principles of medicine (§ 639, a). 
 
 The empirical practice, on the contrary, discards evei'y thing but a 
 few prominent symptoms, and would as soon relieve the pain of pleu- 
 risy by opium as that which attends a spasm of the stomach. Such, 
 rather, is the common acceptation of empiricism. But, it is more a 
 prevailing usage with the ignorant, and with those who discard the 
 rational treatment, to be regardless even of abstract symptoms, and to 
 be mostly swayed by the humoral hypotheses (§ 4 h, 744, 821, 824, 
 830, 835). 
 
 885. Symptoms, however, are the most essential, in their relative 
 beai'ing, in the series of indications. They inform us of the organs 
 affected, conduct us to a knowledge of the pathological cause, and fre- 
 quently conti'ibute their aid in detecting the nature of the remote 
 causes, by which the pathological is determined (§ 644, 667, 678). 
 
 A few diseases have a particular symptom which is pathognomonic ; 
 as the eruption in small-pox, measles, &c. But signs of this nature 
 are very rare, and still rarer the strictly vital phenomena (§ 682, h). 
 
 In the great class of inflammations there are certain symptoms com- 
 mon to the whole, which, being more or less present, denote the pres- 
 ence of this disease, and thus become a general guide to the treat- 
 ment through the light which they shed upon the general pathology. 
 That treatment is the antiphlogistic ; but whether it shall consist of 
 bloodletting, cathartics, alteratives, blisters, &c., individually or col- 
 lectively, and to what extent, will depend not only upon the amount 
 and severity of the general symptoms, but often, also, upon many 
 others less uniform that may relate to each individual case, and which 
 frequently mark some special modification of the common form of in- 
 flammation (§ 721, 722), 
 
 886. Next in importance to the immediate symptoms, and as often 
 indispensable to a correct apprehension of the pathological cause, is
 
 THERAPEUTICS. 561 
 
 a knowledge of the predisposing causes. This, also, has been amply 
 shown in its appropriate places (§ 644, 742, 776, 813, &c.). To these 
 causes, besides the more immediate, belong the innate tendencies to 
 particular forms of disease, and, more or less, all the natural and ac- 
 quired temperaments, and all the habitual deviations from the natural 
 standard of a sound constitution (§ 143—147, 561, 661, &c.). It is evi- 
 dent, therefore, vi^here there are many remote causes concerned in the 
 production of any given case of disease, that a few only, perhaps but 
 one, have an important agency. Those few, or this one, are most im- 
 portant to be known ; and so of the others in proportion to their mod- 
 ifying influence. In the great families of fever and inflammation 
 there is generally but one principal cause for each modification, which 
 is generally transient, or may appertain to the constitution. In the 
 latter case, as where phthisis pulmonalis arises from the combined 
 influences of cold, moisture, errors in food, &c., I regard these appa- 
 rently predisposing causes as simply exciting, and assume the natural 
 predisposition as the predisposing cause (§ 661). ^ 
 
 887. The great value, then, of a knowledge of symptoms and of the 
 •"emote causes of disease is that of conducting us to a right under- 
 standing of the pathological cause. In forming our indications of 
 treatment from the symptoms alone we may effect the removal of 
 many, but in so doing we may aggravate the disease, and perhaps 
 destroy the patient. This is conspicuously seen in the bark and wine 
 treatment of those congestive fevers which destroy so many of the 
 human family ; one symptom only being the guide of practice in such 
 cases. " Debility," indeed, is practically rendered the disease itself 
 by philosophers of the tonic and stimulant school (§ 476 c, 487 h, 488^, 
 569, 621 a), though it be a mere failure of voluntary power. 
 
 888, a. It is commonly a simple problem for the enlightened and 
 observing practitioner to resolve the general character of any patho- 
 logical condition. With this knowledge we are ready to act in a cer- 
 tain general manner, or, as it is called, upon general principles. But, 
 there is something far more diflScult, though often scarcely less im- 
 portant to be known, in many cases of disease; namely, the particu- 
 lar species, or rather variety, of inflammation, of fever, &c., which 
 any given case may present. Having found this last important point 
 in the cases supposed, and settled the modifying influences of contin- 
 gent causes, we are fully prepared for all the details of treatment. 
 
 888, h. Owing to variations in the pathological state of many cases 
 of a common form of disease, but where no fundamental change in 
 the general character of the affection has happened, it may be neces- 
 sary to employ remedies in apparent opposition to each other. But, 
 in these cases, there is no violation of principle, no inconsistency of 
 Nature. A different conclusion only proves that we do not interpret 
 Nature correctly. To reconcile the seeming inconsistency it is only 
 necessary to recollect the explanation which I have, given, that our 
 remedies cure by instituting new pathological states, and that a cer- 
 tain variation of disease from that condition to which loss of blood is 
 generally most appropriate may render stimulants, along with anti- 
 phlogistics, the best means for instituting the pathological change that 
 shall be most r.oy^y'.ive to the restorative process (§ 752-756, 870- 
 872). W^ 
 
 888, c. There are a few fundamental points to be carefully consid- 
 
 N N
 
 6B2 INSTITUTES OF MEDICINE. 
 
 ered in all cases in relation to the effects of lemedies. They refer to 
 the j)rinciples and details already propounded. 
 
 1. The direct local effect of remedies upon the part to which they 
 may be applied. 
 
 2. Their effects upon remote parts through reflex nervous action. 
 
 3. Their ultimate effects after their direct action i« over. 
 
 4. The general influence each remedy may exert upon the course 
 and termination of disease. 
 
 888, d. It is one of the most remarkable facts connected with con- 
 stitutional principles, that those organs which are most important to 
 life ai'e either within the direct reach of medicine, or they sympathize 
 with such more powerfully and more readily than do the less impor- 
 tant (§ 129, cScc.) 
 
 It is also to be observed that the parts through which we operate 
 artificially, and with which those vast and important sympathetic rela- 
 tions subsist, are of an external nature, and admit the application of 
 powerful remedies to their surfaces. 
 
 And yet, again, observe that whenever no useful results would fol- 
 low the direct application of remedies to other organs, such organs 
 will not admit their application without injury to themselves and to 
 others remotely situated. Nature has therefore kindly given to us 
 two surfaces through which we may act upon all diseases ; while she 
 has placed a barrier against the entrance of all morbific agents into 
 those parts where the direct action of remedies would be useless or 
 detrimental (^ 278 and references there). 
 
 888, e. I now leave the subject of therapeutics in its general as- 
 pects, to illustrate the doctrines which I have propounded, and to ad- 
 vance the rational treatment of disease, by investigating still farther 
 the modus operandi of remedial agents, and as that philosophy is mod- 
 ified in its connection with the operation of loss of blood. At a future 
 time it will be my purpose to carry the same philosophy through all 
 the details of the Materia Medica. 
 
 Before proceeding, however, to the summary consideration of the 
 modus opei'andi of remedies, I shall make a more practical analysis 
 of the therapeutical, effects of certain agents which are capable of a 
 wide range of influences, but between which the resemblances are so 
 obscure as to have contributed not a little to the errors which prevail 
 in respect to the impressions they produce, or discourage others from 
 all expectation of ever attaining any knowledge of their operation be- 
 yond their direct manifestations. I shall select such agents for this 
 purpose as will be most conducive to a ready apprehension of the mo- 
 dus operandi of all others, especially the most impoitant and most 
 neglected of all — neglected practically as well as philosophically — loss 
 of blood. Those agents may consist of catliartics, astringents, tonics, 
 Thircotics, antispasmodics, arsenic, Peruvian hark, or, rather, the alkaloid 
 q^iinia, iodine, and ergot. The last four will illustrate what is known 
 as specific action. In the Peruvian bark I shall also bring into view an 
 agent possessing two prominent and rather opposite virtues, and thus at- 
 tempt the just application of a compound agent to important problems 
 in disease. So, also, with rhubarb, &c., when speaking of astringents. 
 
 While considering the therapeutical uses of the foregoing agents, I 
 shall also indicate their morbific capabilities ; and, as an important 
 means of engaging attention, I shall dwell upon their abuses.
 
 THERAPEUTICS. CATHARTICS. 563 
 
 The advantages of irritants, applied externally, especially vesicants, 
 will follow in the train ; and bloodletting, the first in importance, will 
 be reserved for the last, that it may have the united testimony in its 
 behalf of all that precedes. 
 
 I am also prompted to these inquiries by a desire to introduce the 
 treatment of inflammation, fever, and venous congestion, along with 
 my investigation of their pathology, &c. 
 
 CATHARTICS. 
 
 889, a. What I may now say of cathartics is a continuation of what 
 has been set forth in section 863, d. Their definition as founded upon 
 their most sensible and uniform effect is — agents which increase intes- 
 tinal evacuations. But this acceptation scarcely refers to any of their 
 important physiological and therapeutical influences; which are just 
 as intelligible, through the various resulting phenomena, and the laws 
 of reflected nervous actions, as the evacuations they produce. 
 
 The increase of peristaltic motion, and the augmented product of 
 the intestinal mucous tissue, spring from the irritation which is exerted 
 upon that tissue by the action of cathartics ; and the whole group of 
 these agents are more or less capable of producing those results. It 
 is through this irritation, which is variable in its kind according to the 
 nature of the cathartic, that all the remote influences which they exert 
 arise ; and as these remote effects depend upon modifications of the 
 nervous power corresponding with the nature of the primary impres- 
 sion, it is obvious that one cathartic may be speedily curative, while 
 others may be profoundly morbific, in certain given conditions of dis- 
 ease (§ 52, 150, 227, 228, 500, 638^, 1088 d). 
 
 But cathartics exert, also, important effects upon remote organs by 
 continuous sympathy ;* as upon the stomach, and especially upon the 
 liver (§ 498). It is extremely common, for instance, when a cathai'tic 
 is about operating, for nausea or vomiting to take place ; which, how- 
 ever, may result from remote as well as from continuous sympathy. 
 And here I bring the analogous influences of leeching into connection 
 with the illustration to which I formerly adverted (§ 498, y, g). By 
 the foregoing manifest irritation of the stomach we see, also, how the 
 vital condition of that organ may be at the same time profoundly af- 
 fected, either for better or for worse, by the mere action of cathartics 
 upon the intestine. And that this is truly so is evident from the man- 
 ner in which we often see gastric disease subside, or produced, or in- 
 creased, immediately after the nauseating effect of a cathartic. But, 
 should the same results happen without nausea, we know from the 
 connection of phenomena now stated, that they have pi'oceeded in the 
 more obscure instance from exactly the same influence, though the 
 prominent symptom of nausea happen to be absent. We thus arrive 
 at the farther knowledge not only that cathartics throw their powerful 
 influence, by reflex nervous action, upon distant organs, in virtue of their 
 intestinal action, and in the same manner as the stomach is affected 
 by the remote process, but how, also, this organ is simultaneously ren- 
 dered the point of departure of other profound influences upon distant 
 organs ; — their main efi^ects depending on reflex nervous actions. 
 
 If we now look at what is going forward in the liver, at the same 
 time, we shall see that here, also, are phenomena which denote the 
 same principles, and the same chain of causation. Take, in the first 
 
 * Continuous inf.wcnce of these Institutes (§ 129 c,f, 498 a).
 
 564 INSTITUTES OF MEDICINE. 
 
 place, what is most obvious to the senses, the bile ; and we find it 
 often greatly increased during the operation of cathartics. Now it 
 would be clearly wrong to explain this phenomenon upon any other 
 principle than that which I have assigned for the nausea and vomiting; 
 that is to say, by remote and continuous sympathy,* just as muco-in- 
 testinal inflammation is extended by reflex and continuous sympathy 
 into the ducts of the liver (see § 829). Here, also, as in the case of 
 the stomach, we find that disease simultaneously subsides, or is produ- 
 ced, in the liver, and we know that it depends upon the same causes that 
 had given rise to the production of bile. But this is not all. The 
 liver, from its important connections with other parts, now occasions, as 
 in the case of the stomach, reflex nervous influences upon distant 
 parts, while, moreover, it may yield important relief to the brain, or 
 the stomach, or intestine, &c., through an increased secretion of bile 
 (§ 863). The irritation of the intestinal mucous tissue which determines 
 the nervous action upon the muscular coat (§ 514/) is the occasion of 
 extensive alterative reflex actions upon other structures, and the former 
 phenomenon is a key to the latter, and of the modifications which result 
 in increased secretions, the abatement or increase of disease, etc. Organic 
 actions alone manifest change under such influences, never the muscular, 
 and hence the difficulty of reasoning from the latter to the former (§ 893 J). 
 
 889, b. But, cathartics often produce their full curative effects upon 
 remote organs without determining any alvine evacuation ; and this 
 proves to us that the great curative operation of cathartics is of a phys- 
 iological nature. Nothing, indeed, is more common than to exhibit 
 cathartics when the intestine is empty ; and all the good we then ob- 
 tain from them (and it is often great) arises from those vital influences 
 of which I have been speaking. If much bile, mucus, &c., happen to 
 be discharged in these cases, they are mainly generated during the 
 action of the cathartic (§ 694^-). In almost every acute disease of 
 much importance cathartics are administered, and if not with the in- 
 tention of which I am speaking, they are employed empyrically. 
 When no such specific object is contemjolated, they are given mere- 
 ly because it is customary to do so ; always excepting the humoral 
 interpretation (§ 456 a, 46U, 473 c, 478 b, 483 c, 1058 d). 
 
 889, c. In my Arrangement of the Materia Medica, I have placed 
 the chloride of mercury and blue pill as the first in importance among 
 cathartics ; and yet their purgative effect is comparatively very little 
 with many of those which I have arranged as the most infeiior. This 
 was plainly done for the reason that the curative influences of these 
 mercurial preparations are far greater, in a general sense, than those 
 of any other cathartic. Experience assures us that the arrangement 
 is right ; while philosophy, as also founded on observation, enforces 
 the truth that the most drastic cathartics inflict their injuries through 
 exactly the same principles that the less purgative exert their good 
 effects, differing only in the irritations and reflex nervous actions. 
 
 We thus see how liable definitions are to lead us astray ; and this 
 is true of most of the designations which I have retained in my Phys- 
 iological Arrangement, and more })articularly so of those general de- 
 nominations, such as demulcents, revulsives, deobstruents, &c., which 
 I have excluded (§ 729 h, 819 a). 
 
 889, d. We mny make up our minds, therefore, that the mere pur- 
 gative effect, or the evacuation of the fecal matter, abstractedly con- 
 
 * The case is the same here as when stimulants or mechanical irritants applied to 
 the conjunctiva instantlj' excite the lachrymal gland to the production of tears.
 
 THERAPEUTICS. CATHARTICS. 565 
 
 sidered, is one of the least that is exerted by cathartics ; and nothing 
 can be said in behalf of their supposed action upon the blood. 
 
 889, e. Nevertheless, it should be steadily considered that fecal 
 accumulations are a source of mechanical imtation, at least ; or, if 
 they consist more or less of fermented food they also irritate in virtue 
 of their specific properties, and, in both the cases, exasperate remote 
 diseases through the same physiological laws that are relative to the 
 good or bad effects of cathartics. It is then an object to remove these 
 exciting causes. But, if none of the important vital influences of ca- 
 thartics be then contemplated, we should employ such only as are 
 mild, and whose action does not extend much beyond the intestinal 
 canal. Precisely the same rule should also obtain in the administra* 
 tion of emetics. Tartarized antimony and ipecacuanha are all we 
 want for profound curative virtues ; and sulphate of zinc for superficial 
 action, or, at most, associated with one of the others where gastric ir- 
 ritability is rendered obtuse by narcotic poisons. 
 
 889, y! Does the reader now inquire why it so frequently happens 
 that the best effects of cathartics, in diseases remote from the intes- 
 tines, are obtained only when they operate decisively, and perhaps 
 powerfully 1 The answer is important ; for it goes far to illustrate the 
 modus operandi not only of cathartics, but of all remedial agents. It 
 is, then, because this strong impression upon the vital condition of the 
 intestinal mucous tissue is necessary to establish those reflex nerv 
 ous actions on remote parts that may be the seat of disease which re- 
 sult in such a change as brings about their own natural curative ten- 
 dency. The repeated evacuations are a necessary consequence of 
 that requisite impression upon the intestinal mucous tissue, and serve 
 as an evidence that such necessary impression has been produced.* 
 
 889, g. It appears, therefore, that the results which follow the ac- 
 tion of cathartics may affect powerfully all organs, however remote 
 they may be from the intestine, without resorting to the common as- 
 sumption of absorption, or to any doctrine in the humoral pathology. 
 In al] this, too, we are aided not only by our knowledge of the phys- 
 iological relations of the intestinal mucous tissue to all other parts 
 through the sympathetic nerve, but by its anatomical connections with 
 the liver and skin, and by its vast extent. It is also the seat of some 
 of the most important vital functions, and it is here that the whole lac- 
 teal system takes its rise, and here is the great concentration of the 
 sympathetic nerve in the semi-lunar ganglion and solar plexus, with 
 the contributions from the pneumogastric nerve and spinal cord. 
 
 It is owing to these vast and important anatomical and physiolog- 
 ical connections, that, when disease springs up in the intestinal mu- 
 cous membrane, it sheds its morbific influence abroad over the whole 
 system; now developing, by reflex actions, cerebral inflammation or 
 congestion; now of the liver; again, inflammation of the skin; at an- 
 other time, of the bladder; in this subject rheumatism; in that, scrof- 
 ula ; in another, croup ; in others, inflammation of the fauces ; here, 
 of the eyes ; there, of the nose ; here, an attack of the gout ; there, 
 abortion ; and so on, through every part of the organization. 
 
 Considering, therefore, I say, the foregoing anatomical and phys- 
 iological characteristics of the mucous tissue of the alimentary canal, 
 and how diseases of this membrane may give rise to disease in every 
 other part, we may readily comprehend how it is that cathartics exeil 
 * See Note G p. 1116.
 
 566 INSTITUTES OF MEDICINE. 
 
 powerful sympathetic eifects upon distant organs when rendered un- 
 usually susceptible by disease. And so of all other remedial agents, 
 internally applied, according to the nature of their virtues, their 
 doses, &c. The philosophy lies mostly in reflex nervous actions. 
 
 889, h. From all which it follows, that three principal advantages 
 are contemplated from the operation of cathartics ; namely, 
 1st. Their sympathetic influences, remote and continuous. 
 2d. The increased secretions to which they give rise ; especially 
 from the intestinal mucous tissue, and from the liver. 
 
 3d. The evacuation of the fecal matter, which, in a general sense, 
 is the least of all. 
 
 889, i. Certain cathartics affect certain portions of the intestinal mu- 
 cous tissue more than other portions ; and this is owing to the pecu- 
 liar modifications of the organic properties in different parts of that 
 tissue, and the peculiar vital relations of particular cathartics to one 
 or another of those different parts (§ 134-137, 150.) These special 
 relationships should become the subjects of critical investigation, since 
 it often happens that cathartics may be advantageously selected with 
 a view to these exact physiological conditions. The fact is more or 
 less understood, but not so the philosophy. Thei'e are some great 
 errors, howevei-, as to the facts. Aloes, for example, is supposed, 
 universally, to exert its effect especially upon the large intestine, while, 
 in truth, its influence is vastly more upon the jejunum and ilium, as 
 abundantly manifested in irritable states of the small intestine, and by 
 the manner in which it aggravates the general arterial excitement of 
 fever and inflammation. The irritation of the highly-sensitive anus 
 which has given rise to the prejudice depends mostly upon the sudden 
 provluction of morbid bile which aloes elicits by its special influence 
 up )n the liver; and this, also, is a proof of its direct and main effect 
 upon the superior portion of the alimentary canal (§ 718). But again, 
 we have an opposite demonstration of the same philosophy in the 
 failure of aloes to be attended by this irritation of the anus in the ab- 
 sence of hepatic derangements ; and then, also, there is comparatively 
 little bile evacuated (^1063 h). 
 
 The gi"eat governing principle, however, in the selection of cathar- 
 tics, should be their known effect upon disease, according to its seat 
 and pathology. If applied with a view to their special action upon 
 one part or another of the intestinal canal, they will be often liable to 
 the worst practical consequences unless the philosophy which I have 
 Bet forth upon this subject be considered accurately along with exper- 
 imental observation of the relative virtues of the different cathartics ; 
 and, I may add, that the more these relations are studied, the more 
 apparent will that philosophy become in its truth and importance (§ 
 52, 134-137, 150, 1058 h, and references there, 1063 i, 1065 h). 
 
 889, li. From what has been hitherto said of the philosophy of life, 
 and as modified by disease, we readily understand how cathartics 
 may be greatly varied in their action by associating two or more to- 
 gether, or by uniting with them agents from other groups. Each com- 
 bination is a new remedy, and a new one, too, according to the exact 
 proportions of each ingredient. How important, therefore, a critical 
 regard to all the details involved in these suggestions ! But, there is 
 no problem, I say again, more difficult in practical medicine ; and 
 next to that is the right dose of the whole, or of any single agent, and
 
 THERAPEUTICS. CATHARTICS, 567 
 
 next in order the time for its repetition, or for the substitution of some 
 other remedy. Such combinations act as a ivhole, and not only upon 
 the intestinal mucous tissue according to their collective virtues, but 
 develop and reflect upon other parts an alterative nervous influence in 
 a corresponding manner. Thus the nervous influence is on common 
 ground with those agents as an exciting and modifying cause, since the 
 latter increase and modify the raucous product by their direct action, 
 while the increase of bile, urine, sweat, &g., depends upon reflected 
 nervous action as the exciting cause (§ 222-233|, 461, 512, 647^). 
 
 If we now take an example, familiar as it may be in practice, it may 
 help our philosophy as to all other combinations of remedies, and 
 guide the practical hand in regulating the proportion of ingredients, 
 the doses, &c. Thus, cathartics may become completely inoperative, 
 as such, by the addition of opium. This is done by rendering the ir- 
 ritability of the intestinal mucous tissue so obtuse that it cannot be 
 roused by the irritating virtue of the cathartic. Diminish the propor- 
 tion of opium, and the cathartic irritates moderately and purges 
 slightly. Reduce the narcotic still more, and the cathartic irritates 
 more and purges more. Omit the opium, and the purgative effect 
 may be violent and attended by great pain. And, in doing all this, we 
 also variously modify the reflected nervous influences of all the 
 agents which are thus employed (§ 227» 228, 500, &c., 872 a)* 
 
 This is an example for all other combinations of remedies ; for the 
 same philosophy is concerned throughout. We see, too, in this ex- 
 ample, how the combination acts as a whole. The cathaitic and nar- 
 cotic simultaneously impress irritability and sensibility ; each exerting 
 its force upon those properties of life in the ratio of their proportions, 
 and according, also, to the existing state of the properties (§ 137 d, 
 150, 189, 191, 872 a), and so will be the modified reflex nervous actions. 
 
 889, I. Cathartics are often cumulative in their effects ; but this will 
 depend much, as with numerous other remedies to which this princi- 
 ple applies, upon the frequency with which they are administered 
 (§ 556-558). If the interval be short, as about four or six hours, and 
 the same dose be continued, the last may operate with violence, al- 
 thouo'h the preceding had manifested no effect. But this is far from 
 being always true. Indeed, it is often necessary to increase the dose, 
 even when exhibited at these short intervals ; and we arrive at a 
 knowledge of all this, and sufficient for the exigencies of the case, 
 whether as to dose, the nature of the cathartic, or time for repetition, by 
 considering the existing condition of the intestinal canal, or other con- 
 tingent influences, such as jaundice, &'c. But here, embarrassments 
 frequently grow out of constitutional peculiarities of patients. These 
 natural peculiarities, in relation to cathartics especially, are often re- 
 markably great ; one patient bearing far larger doses, and more ac- 
 tive cathartics, than another under apparently the same circumstances 
 of disease ; just as in the case of bloodletting (§ 912). I am therefore 
 always in the habit of interrogating patients with whose susceptibili- 
 ties in this respect I am unacquainted, as to the quantity of salts, or 
 of castor oil, they may be in the habit of using, with a view to their 
 action upon the bowels. This enlightens us greatly as to their pTob- 
 able susceptibility to the action of other cathartics ; and, with the ob- 
 ject of extending the philosophy which concerns this subject, I will 
 add that this knowledge, as to cathartics will not help us with any oth- 
 er agent. Every other must be subjected to the same analysis. 
 * See NoiK Ek p. 1133.
 
 568 INSTITUTES OF MEDIC [NE. 
 
 There is another and important modification of the cumulative effect 
 of cathartics, according to the frequency of their repetition, and which 
 may be said to apply, more or less, to most other remedies whose ef- 
 fects are cumulative {^ 555-558). We have just seen, that if cathar- 
 tics be administered once in four or six hours, that effect is variously 
 manifested. But, if the interval be much shorter, the cumulative in- 
 fluence will be more strongly pronounced. This is owing to the per- 
 sistence of the modified state of intestinal irritability after each suc- 
 cessive dose. Each dose, if soon repeated, raises irritability more 
 and more, so that each, in succession, operates more and more. But, 
 if the intervals be long, irritability returns to its natural state, and a 
 larger dose will be necessary to make an impression (§ 137 d, 514^, 
 516 d, no. 6, 549-558, 857). The principle now concerned explains 
 the reason why tartarized antimony or ipecacuanha when united with 
 the sulphate of zinc will take effect as soon as the latter. It is the 
 same, too, which brings the permanent tonics into speedy operation 
 when associated with the analogous diffusible stimulants (§ 890|-, g). 
 
 Now, therefore, if the interval be quite short between the doses of 
 a cathartic, their cumulative effect will be more and more strongly 
 pronounced. Thus : if an infusion of senna, or a solution of salts, 
 forming, respectively, one full dose, be taken in divided quantities ev- 
 ery half hour, the entire quanxity of either will often purge more act- 
 ively than if the whole of either were taken at once. So, if a grain 
 of ipecacuanha be administered once in four hours, it will generally 
 fail of producing nausea; but if half a grain be exhibited once in two 
 hours, it will be more apt to nauseate. There are peculiarities about 
 tartarized antimony and other agents, in this respect, which have been 
 considered under the designation of vital habit (§ 535, &c., 873). 
 
 A common principle applies to all the foregoing cases, is extensive- 
 ly ingrafted upon morbific and remedial agents, and of vast import- 
 ance to the hand of art. In the cases recited, by the frequent repeti- 
 tion of the remedies we increase progressively the susceptibility of one 
 part or another to their peculiar influences, either directly or by reflex 
 nervous action. We bring the virtues of the different agents more 
 and more into relation with the organic properties ; and, when that 
 relation is fully established, the last dose appears to exert, and may 
 exert, a greater power than all that had preceded it. 
 
 889, m. We may now, perhaps, more readily comprehend a part 
 of the philosophy which should govern us where it is mainly an ob- 
 ject to remove habitual constipation, and to which a brief reference 
 was made in a former section (§ 556, b). In cases of this nature, there 
 are two primary objects to be kept in view : 1st. To avail ourselves 
 of the cumulative effect of cathartic remedies ; 2d. To establish a free 
 secretion of bile, through alterative reflex nervous actions. To ob- 
 tain these objects, it is obvious that the cathartic should be adminis- 
 tered with, a certain frequency, and that it should be of a certain kind. 
 The cathartic should be of the best alterative nature, that it may reach 
 the liver, and establish the most favorable change in the intestinal ca- 
 nal ; the last of which has been already stated (§ 556, h). Castor oil 
 is also valuable for this purpose (Paine's Materia Medica, p. 37). It 
 is plain, also, that the doses should be so small as not to produce irri- 
 tation ; for this would soon result in positive disease. The most vio- 
 lent agent may be rendered mild by a proper regulation of the dose
 
 THERAPEUTICS. CATHARTICS. 569 
 
 It is therefore less the energy of the remedy, than its salutary altera- 
 tive virtues, that is to be considered. In pursuing the treatment, our 
 object should be to imitate Nature as nearly as possible : that is to 
 say, to produce one free movement, daily, in the adult, and one or two 
 in infants. The remedy, therefore, should be administered at least 
 once in a day; or, if it can be rightly adjusted, evening and morning 
 would be still better, at the beginning of the treatment. By this pro- 
 cess we gradually alter the irritability of the intestine and bring it fully 
 into relation with the virtues of the agent ; and, as the bile possesses, 
 also, cathartic endowments, we shall have thus adapted intestinal 
 irritability to the action of that natural and now augmented stimulus. 
 The case is parallel, in its philosophy, with that of the emetics and 
 tonics, as stated in the preceding section 889, /. Also, § 516 d, no. 6. 
 
 It hence becomes manifest, that, by pursuing this course we shall 
 soon be under the necessity of diminishing the dose with which the 
 treatment was commenced ; till, at last, the quantity dwindles away 
 to such minute doses that the stimulus of the bile and the mechanical 
 irritation of the alimentary matter supersede the faither use of the 
 medicine ; or, the minute doses may now become morbific. 
 
 It not unfrequently happens, that, at the beginning of the foregoing 
 treatment the doses fail of their intended effect ; when some other 
 cathartic, as a little castor oil, or Rochelle salt, should be exhibited, but 
 not enough to operate actively. Their active effect would interfere 
 with the process of bringing the organic properties into a fixed rela- 
 tion with the small doses of the more alterative remedy, and subse- 
 quently to their natural stimulus, the bile. 
 
 In all this series of influences it is clear enouarh that a change is 
 established in the condition of the liver ; but a not less important one 
 occurs in the vital state of the intestine (^ 1057 c). 
 
 889, m7n. If we now regard, for a moment, the universal system 
 which is pursued of administering active doses of cathartics, in the 
 foregoing cases (§ 889, m), at intervals of two, three, or more days, 
 we shall readily see that different results must follow; while experi- 
 ence teaches that constipation is not often surmounted in this manner. 
 Too much violence is thus inflicted, nature is embarrassed, and is in- 
 capable of instituting those salutary changes which we have seen to 
 arise in the former case. — See ^ 516 d, no. 6, 857. 
 
 Nor is it alone the intestine which fails of being diveited from its 
 torpid state. A shock is propagated to the stomach ; the liver vio- 
 lently impressed, and natural changes are not instituted in its action, 
 and a continuous flow of increased bile is not established (§ 889, a). 
 
 It is readily seen that rhubarb, for the sake of its tonic virtue, may 
 be often substituted for the aloetic and mercurial compound (§556,Z>), 
 or associated with them, or ipecacuanha sometimes intermingled. Or, 
 at other times, it may be greatly best to substitute mild enemas, whose 
 action is explained in section 498, or again to depend upon diet, ex- 
 ercise, running especially, &c. But, a very common error is commit- 
 ted in these cases, as it respects food. It is not considered that the 
 stomach often suffers as well as the intestine ; and all the laxative food, 
 as it is called, which is employed with a view of increasing the residuary 
 matter, is apt to inflict a greater injury upon the stomach than any 
 advantage that may arise from its mechanical irritation of the intes- 
 tine. These are cases, therefore, for a very limited diet of those
 
 570 INSTITUTES OF MEDICINE. 
 
 things which are easy of digestion, and for the alterative treatment 
 by medicine, exercise, &c. 
 
 889, n. And now as to the time, in a general sense, most appropri- 
 ate for the exhibition of cathartics, and the philosophy which concerns 
 it (§ 863, (Z). There is a certain attendant of the human constitution, 
 as already seen (§ 768), which disposes the system to daily periodical 
 excitement. This natural phenomenon takes place late in the after 
 noon, in all parts of the globe. I have considered its application in 
 a pathological sense, and it is of great importance in that double ac- 
 ceptation as it regards the operation of cathartics. 
 
 It is obvious, I say, that the system is in its most irritable and sus- 
 ceptible state toward the decline of the day, and that this period must be 
 the worst for the operation of so powerful an irritant as cathartics, and 
 more especially so if fever or inflammation be present (§ 137, d) ; 
 though there is a great difference, in this respect, among different ca- 
 thartics. The most appropriate time for their administration, in a gen- 
 eral sense, is toward the decline of the natui-al evening paroxysm, or 
 between ten o'clock at night, and eight o'clock in the morning. This 
 will also generally bring their exhibition in febrile affections at an 
 early stage of the remission of fever, so that their operation may be 
 over before the access of another paroxysm. The same principle ap- 
 plies to inflammation ; for, although there be no manifest exacerba- 
 tion in the afternoon, the disease is under the natural tendency of the 
 system to a sate of excitement at this period of the day. 
 
 At a late hour in the evening, the natural paroxysm is fast on the 
 decline, and this is the most suitable hour for those cathartics whose 
 operation is slow ; as calomel, blue pill, aloes, &c. ; and if other pur- 
 gatives be afterward necessary, they may follow in the morning with 
 a speedy effect. In this manner, the repose of the patient is not dis- 
 turbed, and is conducive to the salutary influence of the highly-al- 
 terative cathartics. These cathartics exert powerful influences upon 
 organs that may not be the seat of disease ; which is particularly true 
 of the skin. Now this action which is thus instituted in the surface 
 transmits a curative reflex nervous influence to parts that are diseased, 
 and both the impression upon the skin and its salutary reflex nerv- 
 ous actions will be much promoted by the warmth of the bed, by the 
 horizontal posture, and by sleep. For the same reason, if cold should 
 arrest the action in the skin which the cathartic institutes, that organ, 
 suffering this violence, may reflect morbific sympathies upon other 
 parts, and may thus, more or less, defeat the useful effects of the ca- 
 thartic (§ 514, li)* It is the work, throughout, of reflex nervous action. 
 
 But, all cathartics whose operation is speedy should be exhibited 
 at an early hour in the morning, when the irritability of the system ia 
 least, and sleep has had its balmy influences. 
 
 ASTRINGENTS. 
 
 890, a. Astringents are commonly supposed to act upon physical 
 principles more than any other remedial agents, and that their special 
 operation is analogous to the tanning process (§ 569, h). I shall en- 
 deavor, however, to show that Nature is so far consistent with herself, 
 and that all the facts in the case enforce the conclusion, that astrin- 
 gents operate like all other remedial agents upon vital principles, 
 whether thoy be administered internally, or applied to the external 
 * See Note D p. 1114
 
 THj!,ivAPEUTICS. ASTRINGENTS. 571 
 
 siuiace ; that they operate by so modifying the living properties and 
 actions of the secerning vessels, that redundant secretions of blood, or 
 of other fluids, are arrested in virtue of that change of vital action. 
 
 890, h. Let us wow look for an illustration of the foregoing to some 
 agent which embraces other virtues in connection with that which is 
 reputedly astringent. There are many of these ; such as the sul- 
 phate of zinc, the sulphate of copper, rhubarb, &c. We will take 
 the last mentioned, for the sake of indicating, also, its uses in prac- 
 tice. This substance is positively cathartic in certain therapeutical 
 doses, but so stimulating to the system in such doses as to render 
 great caution necessary in its administration in acute inflammatory 
 diseases ; while, on the other hand, in much smaller doses it is adapt- 
 ed to many chronic inflammations. Again, in certain other small do- 
 ses it is a valuable tonic, but still contra-indicated by active inflamma- 
 tion. Lastly, it may act as an astringent in various doses, from its 
 smallest alterative, to its full cathartic dose ; operating under partic- 
 ular circumstances of disease as a direct astringent in its small doses, 
 as in diarrhcea, yet, in an opposite state of the bowels, as in constipa- 
 tion, proving an admirable laxative in the same small and repeated 
 doses (§ 889, m, min) ; while its wonders cease not even in its full ca- 
 thartic dose — for now in diarrhoea it first operates as a cathartic, and 
 then shuts up the bowels as an astringent. 
 
 Now, to what causes are all these diversified and apparently con 
 tradictoi'y effects owing? They depend upon the natural susceptibil- 
 ity of the organic properties to changes according to the virtues of the 
 agents which may act upon them, and their existing state when the 
 agents are brought into operation ; and, secondly, as well, also, upon 
 the doses in which they are administered. When the vital conditions 
 are affected in a peculiar way, and under a given combination of cir 
 cumstances, if a vital agent possessing particular virtues be applied, it 
 will so modify or alter the existing morbid state, that new and definite 
 results will follow. Thus, when the intestinal mucous tissue is affect- 
 ed with that condition of disease which results in a preternatural wa- 
 tery secretion, and consequent evacuations, which is called diarrhoea, 
 and rhubarb is administered in a certain dose, this substance first im- 
 presses the membrane in such a way as to determine an increase of 
 the peristaltic movement ; but it simultaneously alters the morbid 
 state of the intestinal mucous tissue in such manner that the unnatural 
 secretion is arrested ; while the change which is thus established in 
 the tissue removes the morbid reflex nervous action from the muscu- 
 lar tissue of the intestine, upon which the diarrhoeal evacuation in 
 part depended. The diarrhoea thus ceases after the rhubarb has act- 
 ed moderately as a cathartic. The same causation which determined 
 the action of the rhubarb as a cathartic changed the morbid state in 
 such wise as to arrest the farther production of the intestinal fluid, 
 and the preternatural determination of the nervous power upon the 
 muscular coat of the bowels (^ 1062). — See Note Ee p. 1133. 
 
 Whether, therefore, the rhubarb purge, or prove astringent, or 
 tonic, a common principle and common laws are concerned through- 
 out; and all the sensible results depend upon certain alterations 
 which the agent effects in the vital properties and actions of the ves- 
 sels, or tissues, which are the seat of the morbid conditions, or in 
 which the various phenomena may take place.
 
 572 INSTITUTES OP MEDICINE. 
 
 Just SO it is, also, with the sulphate of zinc, or of copper, or ipe- 
 cacuanha, when they restrain haemoptysis by their emetic effect, or 
 when in smaller doses they arrest other hemorrhages, or diarrhoea, or 
 at other times bring about the results of ordinary tonics. Consider, 
 too, the special, but analogous, effects of opium ; which, in arresting 
 intestinal secretions, or those of the liver and kidneys, surpasses ev- 
 ery astringent. And yet opium has no astringent principle, nor has 
 it ever been supposed that this remedy checks those products by as- 
 tringing the vessels or condensing the tissues. It arrests them, espe- 
 cially, by so modifying irritability and sensibility that the natural and 
 other stimuli become less operative. And what lets us particularly into 
 the philosophy of this subject is the coincidence in the effects of opium 
 as it respects the simultaneous diminution of the various other products 
 of the abdominal organs ; the cause of the diminution of the bile, and 
 of the urine, being the same as that of the diminution of the diarrhoeal 
 product of the intestine (§ 889 k, 891 (/, 891^ k). 
 
 890, bb. What I have now explained comprehends the whole philos- 
 ophy of the operation of astringents. When they arrest the discharge 
 of ulcers, or of blood from the stomach, or of any part with which 
 they come in direct contact, it is mostly by their direct action upon 
 the vital condition of the parts. In other cases it is through reflex ac- 
 tion of the nervous system. And here we may look at the coinci- 
 dence in results between the application of an astringent to a suppu- 
 rating surface and as the same discharge is arrested by a tonic, or by 
 exercise, or change of air, &c. (§ 227, 740, 902 m). It is the change 
 of action upon which the cessation of the various products depends, and 
 this change may or may not be attended by a vital contraction of the 
 secerning vessels, or of the vessels of any tissues upon which the agents 
 may exert their direct effects. 
 
 Other remedies, such as loss of blood, and that one of a negative na- 
 ture, cold, which often surpass the pure astringents in arresting effusions 
 of blood, &c., may be brought to the same interpretation of the modus 
 operandi of those astringents. And so the mind itself (§ 740 a). 
 
 890, c. When astringents are applied to outward surfaces, as to 
 leech-bites, wounds, &c., they are called styptics ; and in relation to 
 those agents which are designed for the purpose of arresting external 
 hemorrhages only, there are many which act mostly upon mechanical 
 principles ; either by pressure upon the bleeding vessels, as with lint, 
 agaric, cobweb, &c., or by coagulating the blood which exudes from 
 the part; while they also stimulate the bleeding vessels to contract. 
 
 890, d. Astringents are one of the classes of remedies which have 
 been greatly abused, as well as applied with little reference to the 
 pathological states they are designed to correct. Hemorrhage from 
 every part, frequent discharges from the intestine, whether watery, 
 bilious, or mucous, the discharge in gonorrhoea, leucorrhoea, &c., are 
 treated by vast numbers according, alone, to the physical conceptions 
 of the action of astringents ; and those agents, thei-efore, are indiscrim- 
 inately applied to all the foregoing conditions. Beyond this consid- 
 eration, the discharge alone is an object of attention ; the disease ap 
 pearing to consist in this particular symptom. Many of the preter- 
 natural effusions depend upon inflammation or congestion, which as- 
 tringents rarely fail to aggravate. And yet nothing is more common 
 than the exhibition of those agents in these pathological conditions
 
 THERAPEUTICS. — ^ASTKINGEKTS. 573 
 
 without any antecedent treatment by other remedies. It is a common 
 practice, for example, to exhibit the acetate of lead, or some other 
 pm"e astringent, for a moderate hsemoptysis. The effusion, being in- 
 stituted by nature for the relief of the congestive state of the lungs 
 in which it originates (805, 1019), and violently arrested by the astrin- 
 gent, is counteracted in its great final cause. But astringents not only 
 inflict that evil, but are also apt to increase the pulmonary affec- 
 tion by a direct morbific action ; just as they increase dysenteric in- 
 flammation when they establish the change by which the redundant 
 secretion of mucus is arrested. A very frequent ultimate consequence 
 of the former untoward treatment is tuberculous phthisis. This prac- 
 tice has received a great impulse in recent times from morbid anato- 
 my, especially as promulgated by Louis and Andral, and carried for- 
 ward by British pathologists ; who deny the dependence of tubercle 
 upon inflammation. Nor can we desii'e a better proof of the import- 
 ance of i-endering all such pursuits entirely subservient to the demon- 
 strations of living Nature (§ 756. Also, Med. and Physiolog. Comm., 
 vol. ii., p. 608-634, 743, 744, 748, 780-782, 799).— Note F p. 1114. 
 
 Instead,therefore,of the foregoing mal-practice, along with the simul- 
 taneous use of a stimulating diet, these patients, if the hemorrhage be 
 small, should be treated by bloodletting, or small doses of tartarized 
 antimony or ipecacuanha, blisters, &c. These agents an-est the effu- 
 sion, and so far they exert the effect of astringents. But they do more. 
 They alter the morbid states in a mode which Nature was attempt- 
 ing; while the real astringents alter them for the worse; though a 
 cessation of the hemorrhage may be equally the result of either meth- 
 od of treatment (§ 150, 151, 732 h, 733 e, 862-864, 892| d, g) * 
 
 There can be no sound practice till hemorrhagic effusions are rec- 
 ognized as the result of a secreting process, instituted by morbid 
 states. The proof is abundant; but it is enough that we witness the 
 consequent relief of disease, and apply ourselves to the analogy in 
 this respect with what is known of redundant effusions of bile, of se- 
 rum, &c., and which none can fail to recognize as salutary means em- 
 ployed by Nature. These hemorrhages, too, are analogous to men- 
 struation, and here, as there, a great final cause lies at the foundation 
 There is, therefore, no more propriety in arresting hemorrhage, unless 
 excessive, than in attempting to interfere with the natural function. 
 
 890, e. In the advanced stages of fever, and of other severe forms 
 of disease, hemorrhages have been often followed by death. And 
 here it is that hemorrhages have raised the greatest apprehension of 
 their fatal tendency. But, it is very rare that it is the hemorrhage 
 which destroys (§ 1019). It is only a symptom, at this advanced 
 stage of the malady, significant of a fearful condition of disease, 
 which, in itself, in a vast proportion of cases, is the true cause of 
 death (§ 805,863). The cause, therefore, is too apt to be mistaken, 
 the blame too often attributed to a kind effort of Nature to throw off 
 the deadly weight; and Nature would much oftener succeed by this 
 depletory process were it not for the interference of art with its mis- 
 chievous astringents. It is, however, always a fearful symptom in 
 the advanced stages of acute disease. But, bad as it is, it should be 
 hailed as the best possible event that can happen. The effusion 
 comes directly from the congested parts, and if any thing can relieve 
 them, it must be this spontaneous effort. Art cannot now interfere 
 * The record should be made that tonics and stimulants are now generally applied to 
 this as to most other maladies. — Notes F, Ee, Ff, Gg, Ii, Mm. — lb65.
 
 574 INSTITUTES OP MEDICINE. 
 
 with bloodletting. The golden opportunity may have been allowed 
 to pass, either from ignorance, or fear, or from the difficulties of the 
 case (§ 569, 960, 964 c). Nature, alone, can now institute the great 
 remedy; and hei'e it is that we so often witness the safety with which 
 she makes her wonderful demonstrations of cure, and rebukes the 
 timid practitioner. But she has now her own way of operating. She 
 has taken the business of rational treatment upon herself, and out of 
 the hand of art ; for now it is that quarts of blood may flow away 
 from the intestine, and triumph over disease, when bloodletting would 
 be perfectly useless, and the abstraction of a dozen ounces of blood 
 would probably be fatal. These are lessons from Nature of every- 
 day occurrence, and should not be lost even to such as are incapable 
 of appreciating disease, or who may be imbued with prejudice, or 
 haunted by fear, in respect to the great remedy whose timely appli- 
 cation would save them from the consternation of witnessing a natural 
 (jutpouring of blood, and from the mortification of discovering that 
 there may have been an important error in treatment. 
 
 These are cases which require, in all respects, a great precision of 
 treatment. Where Nature may have laid the foundation of cure by 
 hemorrhagic eff'usions, a slight error in practice may be fatal. And 
 here, again, the fault is apt to be laid at the door of Nature, and thus 
 the disposition to interfere with astringents is more and more increas- 
 ed. Nevertheless, we should watch these effusions with vigilance ; 
 and, whenever they appear to be transcending the exigencies of the 
 case, or the ability of the system to bear them, we should endeavor 
 to restrain them by appropriate astringents (§ 805).* 
 
 890, ee. Those philosophers who justly refer capillary hemorrhage 
 to a secretory process have distinguished the condition into active and 
 passive ; of which haemoptysis is an example of the former, and that 
 which was considered in the last preceding section, of the latter. 
 But, this distinction is as clearly unfounded as that of active and 
 passive inflammation (§ 752, &c.). Here, as there, the varieties are 
 nearly on a par in respect to the pathological cause. Tlie differences 
 which exist among them are owing to only slight modifications of that 
 essential cause. The modifications, however, are such as may require 
 variations of treatment ; one of them the antiphlogistic, another the 
 antiphlogistic and astringent combined, and another the astringent 
 alone. They are thus seen to run into each other, and they offer 
 problems where it is the nicest point to determine whether we shall 
 bleed and purge, or administer an astringent. 
 
 890, y! When hemorrhage supervenes upon chronic forms of dis- 
 ease, it commonly happens that it must be great to overthrow the ob- 
 stinacy of habit ; and the triumph of Nature is often thus displayed 
 in the haematamesis which is set up by aggravated indigestion. 
 
 The hemorrhage attendant on tuberculous phthisis is a relief to the 
 sufferer ; but not often more than temporary. Nor can we now hope 
 to do much by co-operating with Nature, any farther than to moder- 
 ate the activity of disease by a non-stimulant diet, and blisters to the 
 chest, or by general or local abstractions of blood where the quantity 
 expectorated may be small. Astringents are always pernicious in 
 these cases, unless the hemorrhage be excessive ; and even then we 
 shall generally fail to arrest the eff'usion on account of its connection 
 with a serious lesion of organization. These, therefore, are case/» 
 * Notes Ff p. 1135, Go r- H-'^S. I' F>- 1139. Also, § 1019.
 
 THERAPEUTICS. ASTRINGENTS. 575 
 
 which sometimes prove suddenly fatal by the quantity of blood ef- 
 fused, or by its choking up the air-cells. — Note F p. 1114. 
 
 890, g. Cases of the foregoing nature (§ 890, y) appear now and 
 then as consequences of badly-treated pneumonias, especially the con- 
 gestive variety, or what is called typhoid pneumonia. But, we rarely 
 witness any thing more than an expectoration of bloody mucus in the 
 common form of the disease, or even in the congestive, if the treat- 
 ment have been of the proper antiphlogistic nature. 
 
 890, h. Again, nothing is more extensively employed in the treat- 
 ment of dysentery than rhubarb, and nothing more injuriously (§ 150). 
 Its administration proceeds upon the erroneous views of the modus 
 operandi of astringents and the want of a proper reference to the pa- 
 thology of the disease. As that pathology consists in active inflam- 
 mation, it should be manifest that rhubarb is one of the worst agents 
 that can be devised ; since it possesses not only the virtue of a true 
 astringent, but is stimulant to the whole circulation, irritant to the 
 whole mucous tract of the intestine, now morbidly susceptible through- 
 out its length from the severe and specific inflammation of its inferior 
 portion (§ 137 d, 398), and if the agent arrest the discharge, it is com- 
 monly by increasing and otherwise unfavorably modifying the inflam- 
 matory condition (^ 1062). — Note Bbb p. 1148. 
 
 As in the foregoing case of haemoptysis, therefore, we should have 
 recourse to dii-ect antiphlogistic means ; and the cathartics employed 
 should be of the least irritating nature, and then, only in cautious 
 doses. But, they should be also of an alterative nature, and such as 
 will reach the liver as well as the intestine. In a general sense, cas 
 tor oil is the best (Paine's Materia Medica, p. 45). Also, ^ 1057 I. 
 
 If we now consider that ipecacuanha is the best internal remedy 
 for dysentery, and the best for haemoptysis, and that common table 
 salt is one of the best for the latter affection, it will help us greatly 
 to the knowledge we are seeking as to astringents, and lead to many 
 practical advantages. — See Ergot § 892f o ; Note Gg p. 1138. 
 
 890, i. Rhubarb, opium, and other agents which arrest redundant 
 secretions, are often highly useful in some forms of diarrhoea, and some- 
 times in chronic discharges of mucus ; but these products depend upon 
 various pathological states, and whether astringent remedies will be 
 useful or injurious will depend upon the precise nature of the disease 
 (§ 150, 670-674, 733y). In the simplest forms of diarrhoea they are 
 more or less useful ; particularly rhubarb, and that agent, chalk, which 
 possesses no astringent virtue, but brings about the prominent result 
 of an astringent merely by neutralizing some irritating acid. But 
 soda or potass would not answer, since these irritate by their own vir- 
 tues, and still more so by forming purgative salts within the alimenta- 
 ry canal. Saline cathartics are, therefore, also improper, and, more- 
 over, scarcely extend their salutary permanent effects beyond the in- 
 testinal canal in cases where they are admissible (^ 1061). 
 
 390, k. But, even in the simple forms of diarrhoea, there is variety 
 as to the exact nature of the morbid condition, which demands, in dif- 
 ferent cases, a choice of astringent remedies (§ 150, 672-674, 733/, 
 863 d). One variety will be greatly benefited by rhubarb and chalk, 
 but aggravated by opium. To another opium is exactly suited, as in 
 pulmonary phthisis ; and in such rhubarb may be detrimental, and 
 pure astringents useless. To another variety, as in some old chronic
 
 576 INSTITUTES OP MEDICINE. 
 
 cases, the acetate of lead may be best adapted ; and to others the pure 
 astringents, such as kino, catechu, geranium, &c., when all other means 
 which I have indicated would be either useless or injurious. 
 
 890, I. The foregoing examples illustrate variously the general prin- 
 ciples which are propounded in this work. But, the variety of illus- 
 tration may be greatly extended in respect to the remedies now be- 
 fore us. It often happens, for example, that frequent watery dis- 
 charges are owing either to inflammation of the intestinal mucous tis- 
 sue, or to a state approaching inflammation ; as in cholera infantum. 
 Here, all astringents are inadmissible ; and, if the case be cholera in- 
 fantum, such is the peculiar nature of its predisposing causes (§ 650- 
 653), that there is nothing comparable with the mild chloride of mer- 
 cury in doses varying from the twentieth to the eighth of a grain, once 
 in four to twelve hours ; perhaps, also, with a little chalk and the 
 camphorated tincture of opium along, to neutralize an acid and to al- 
 lay intestinal irritability. But it is the mercurial agent which does 
 the work, by breaking up the morbid condition. Calomel, therefore, 
 in such cases, is just as much an astringent as alum, or the acetate of 
 lead, or catechu, in other cases of a modified pathology (§ 150, 151, 
 863 d). Will Chemistry explain (^ 892 h) 1 
 
 890, m. Gonorrhoea is another example, and another form of in- 
 flammatory disease, where great suffering, and prolonged sickness, are 
 induced by the want of a proper knowledge of the operation of as- 
 tringents, and a proper discrimination as to the particular state of the 
 pathological condition when the remedies are applied (§ 672). The 
 preternatural discharge is apt, indeed, to be regarded as the disease ; 
 or whether so or not, it is a common practice to resort, at once, to as- 
 tringent remedies, internally and by injections. Such, however, is 
 the force of inflammation, and morbid iiTitability so strongly pro- 
 nounced, that a direct antiphlogistic treatment should be at least pre- 
 mised ; when, also, it will be commonly found that it has superseded 
 the necessity of astringents. And here, again, we may remark how 
 the coincidence in effects between the internal use of copaiba, or cu- 
 bebs, and injections of an astringent nature, denotes a common mode 
 of action, and places the whole upon vital ground. The frequent sal- 
 utary effect of the nitrate of silver when employed as an injection in 
 the early stage of gonorrhoea, and its pre-eminent advantages in leucor- 
 rhoea, go to confirm the same philosophy (§ 150, 151). This sub- 
 stance lias no astringency, in the proper acceptation, but operates in 
 its own wonderful way in breaking up the inflammatory state upon 
 which the discharge depends. 
 
 890, 71. And then as to leucorrhoea. How badly is this affection 
 often treated by astringents, internally and externally, and also by 
 tonics! And all this, mainly, because the disease happens to have, 
 for one of its symptoms, a discharge from the vagina, and is supposed 
 to depend upon debility of the general system, and relaxation of the 
 mucous tissue ; a sort of mechanical exudation from a flabby mem- 
 brane that tonics and astringents may condense and sti-engthen (§ 409 i, 
 410, 509). But, if we look at the inflammatory nature of this afl'ec- 
 tion, there will be no difficulty in understanding how these agents, 
 and the usual stimulating diet, inflict their injuries. And now, if we 
 consider that cantharides is the best internal remedy for leucorrhoea, 
 another luminous guide will be obtained to a right appi'ehension of
 
 THERAPEUTICS. ASTRINGENTS. 577 
 
 the mode in which astringents may check, for awhile, those discharges 
 which they may ultimately increase, or others, in other cases, success- 
 fully and permanently. 
 
 890, 0. Let us now consider the remarkable manner in which cer- 
 tain agents will arrest a copious excretion of sweat, and we shall 
 learn still more distinctly that astringents operate through reflex nerv- 
 ous actions ; and thus be guided to the only intelligible purposes fiu 
 which they should be employed, and carry this knowledge throughout 
 the breadth of the Materia Medica. 
 
 Thus, then ; here is a patient affected with pulmonary phthisis, who 
 rises in the night to shift his wet for dry linen. But this inconveni- 
 ence may be stopped at once by a few drops of sulphuric acid ; and 
 opium will often do the same. The acid and the opium, however, 
 produce very different impressions ; though each arrests the sweating 
 by certain vital influences. One may be beneficial, while the other is 
 injurious, and vice versa, according to the exact combination of path- 
 ological circumstances when the agents are administered. In other 
 diseases, and where the skin is dry, opium will induce perspiration ; 
 and it accomplishes this through the same laws as when it arrests the 
 excretion. And, if we now observe the apparently contradictory phi- 
 losophy when opium simultaneously checks the products of the liver 
 and kidneys and increases that of the skin, we gain yet farther light 
 as to astringents, penetrate to the common laws which are distinguish- 
 ed by opposite results, and go to the work of cure as the mechanic 
 when he elicits countervailing movements from a common principle, 
 or a common power, whose attributes are known (§ 863, d). 
 
 The vegetable kingdom supplies many astringents from which a 
 substance is derived under the name of tannin; and hence, in part, 
 the physical rationale of their modus operandi upon living beings. It 
 is supposed that their astringent virtue resides in this tannin ; and this 
 may be so where the principle may be elaborated. But, there are 
 numerous substances of active astringent virtues from which nothing 
 analogous to tannin can be derived ; such as the acetate of lead, and, 
 indeed, all the mineral substances belonging to the group of astrin- 
 gents. We see, therefore, that the effect of the astringents them- 
 selves is not due to any coincidence in the constitution of these sub- 
 stances ; and yet, notwithstanding the great differences among them, 
 they may all bring about a common result (§ 150, 892 h, 892^ v). 
 
 It is not alone to certain pathological states that result in redundant 
 effusion that astringents are applicable. Certain conditions of inflam- 
 mation, especially of external surfaces, are often greatly relieved by 
 their local action. Acetate of lead is one of the best remedies, exter- 
 nally applied, for inflammation of the skin, of the eyes, &c. Sulphate 
 of zinc, also, for conjunctivitis, the mineral acids or vegetable astrin- 
 gents for inflammation of the tonsils. These are active astringents, 
 and the variety in their effects, according to the nature of the patho- 
 logical conditions, whether employed internally or externally, declare 
 their physiological action, and call upon the practitioner to study well 
 the capabilities of each one. Nay, more ; their variety of action when 
 applied externally is not less than what we have seen from their inter- 
 nal administration. The acetate of lead, for example, may speedily 
 relieve certain conjunctival inflammations, when such modifications of 
 inflammation would be greatly aggravated by the sulphate of zinc ; 
 
 Go
 
 578 INSTITUTES OP MEDICINE, 
 
 but, in another case apparently alike, the sulphate of zinc will answen 
 a better purpose. The nitrate of silver, however, or blisters, or leech- 
 es, may be well adapted to all the modifications. But hei'e is a case, ap- 
 parently the same, in which all the foregoing means have failed en- 
 tirely. On pushing inquiry, however, we learn that in the generation 
 preceding the last there prevailed the scrofulous diathesis. We ac- 
 cordingly resort to iodine, and the inflammation yields as under the 
 influence of some magic power (§ 137 e, 150, 151, 851 b, 863 d). 
 
 Now, it is of vast practical importance to consider that the forego 
 ing differences in results depend mostly upon slight shades of differ- 
 ence in the inflammatory states in the several cases (§ 150, 662, 673). 
 And who can mistake the common nature of the modus operandi of 
 all the agents employed (§ 137, e) 1 
 
 890,^:?. It is important, therefore, to understand that no two astrin- 
 gents are exactly alike in their effects, and that the property which is 
 recognized as such may be associated with other active virtues in the 
 same substance, by which the astringent is variously modified ; while, 
 as in compound medicines, the several virtues act as a whole, that 
 which is most predominant giving the gi-eatest determination to the na- 
 ture of the impressions that may be produced (§ lS8i d, 889 k, 892). 
 This variety, it appears, adapts thdse agents very variously to differ- 
 ent forms of disease. When, therefore, a pure astringent is only re 
 quired, sucli as may possess tonic or stimulant virtues should, obviously, 
 be avoided. Remarkable examples of this nature, associated also with 
 other virtues, occur in rhubarb, cinchona, the muriated tincture of iron, 
 &c. Hence there is a great range of choice among remedies which 
 may be selected to answer the intention of an astringent, in its strict 
 acceptation. This has been already variously illustrated, as in the ex- 
 ample of rhubarb. But we will have an exemplification in the Peru- 
 vian bark, an infusion of which, on account of its specific febrifuge 
 virtue, would be exactly adapted to diarrhoea attendant on intermit- 
 tent fever ; or quinine, perhaps, would be preferable if the disease 
 be recent. In such cases a pure astringent would be useless ; which 
 farther illustrates the operation of astringents, as it does, also, the dis- 
 tinctions between tonic, astringent, and febrifuge virtues. 
 
 But, the foregoing are broad shades of difference in pathological 
 conditions. In very many cases where there is a great approximation 
 in the pathological states, in many modifications of inflammation, it is 
 often important to apply a certain remedy of astringent virtue in pref- 
 erence to others. 
 
 890, q. We may now see that certain astringents may be best suited 
 to certain organs to which they are addressed than to other parts (§ 
 133, &c., 140, 150). 
 
 But these agents are so much circumscribed in their uses, that it is 
 no longer an object to pursue the inquiry. What has been said is 
 more with a reference to bring these remedies within the pale of med- 
 ical philosophy, and to illustrate that philosophy ; and, in so doing, to 
 prevent their misapplication. Those which are associated with other 
 virtues are mostly wanted ; such as rhubarb, cinchona, the sulphates 
 of zinc and copper, &c., and these, mainly, for the sake of those vir- 
 tues.
 
 THERAPEUTICS. TONICS STIMULANTS. 579 
 
 PERMANENT TONICS, AND DIFFUSIBLE STIMULANTS. 
 
 890^, a. Tonics raay be regarded as a counterpart of the antiphlo- 
 gistics. Froin the circumstance, therefore, of the latter occupying the 
 high places in the materia medica we may come, at once, to the con- 
 clusion that the former are comparatively of very limited importance. 
 Indeed, it is only in the advanced, or in the declining stages, of acute 
 diseases, or in certain states of chronic affections, that tonics can ren- 
 der much service. — Note Ee p. 1133. 
 
 No remedial agents, however, have been more extensively employed, 
 and therefore none which have been so extensively injurious (§ 569, e). 
 This misapplication of the Materia Medica has arisen, as in other ca 
 ses, from erroneous theoretical views of disease, and mistaken notions 
 of the modus operandi of remedies (§ 854 hh, 863 d, 892 b, 904 d). 
 
 8901, b. In considering the uses of tonics it should be borne in 
 mind that they have but a very limited range of curative influences ; 
 and that, in a general sense, they do but invigorate organic actions 
 which have been reduced by prolonged disease, and where there is 
 either no great amount of absolute disease, or where nature is already 
 in the way of the restorative process, or where that process may only 
 require an invigorating impulse to start it into existence. Such are 
 the uses of tonics. — Note F p. 1114. 
 
 By now regarding the true mode in which these intentions are ac 
 complished, and the absolute influences which are exerted by tonics, 
 we shall come to a just apprehension of their relations to morbid states, 
 and be better qualified to avoid them where they may be injurious. 
 
 890^^, c. Tonics are commonly supposed to act upon mechanical prin- 
 ciples, by bringing into close apposition the molecules of which the 
 living tissues are composed, and attempts have been lately made, as 
 at former times, to demonstrate the truth of this conjecture by exper- 
 iments upon dead tissues (§ 569, b). This has led many to con- 
 found the virtues of tonics with those of astringents. But, we shall 
 find that here, as in all other cases. Nature is consistent, and that ton- 
 ics bring about their results like other remedial agents ; that here, as 
 in all analogous instances, there is no departure from Unity of De- 
 sign (§ 137, e). A few plain illustrations will place the opei'ation of 
 tonics in its proper aspect. 
 
 8901, d. Thus : on leferring to an example already stated for anoth- 
 er purpose, we cannot fail to observe that the increased warmth of 
 the skin, and muscular vigor produced by animal food as soon as it 
 enters the stomach, are due to the same causation as the analogous ef- 
 fect of alcoholic stimulants, and that both must be expounded upon vital 
 principles (§ 512, b). Those speedy effects manifestly depend upon 
 vital impressions exerted upon the mucous tissue of the stomach, and 
 their transmission by reflex nervous action to other parts. They are va- 
 riously pronounced according to the exact combination of circumstan- 
 ces. The food will display itself most distinctly in such as have .suf- 
 fered its privation, and where the surface is chilled ; the wine where 
 it is least employed (§ 535, &c.). By varying these incidental influ- 
 ences a corresponding variety will obtain in the results. Employ the 
 food or the wine in febrile and inflammatory states and the same man- 
 ifestations take their rank among the violent phenomena of diseasa 
 Now, here is the whole principle which is relative to the action of
 
 580 INSTITUTES OF MEDICINE. 
 
 tonic*. These agents produce the same effects as the foregoing causes, 
 They are the same, or sufficiently so for my present purpose, in the 
 natural state of the body, and are modified in the same manner when 
 employed in fever and inflammation. The fatigue incident to hard 
 labor is instantly relieved by nourishment or by wine. The influence3 
 here are exactly analogous to the vigor which is imparted to the vol- 
 untary muscles by tonics in cases of indigestion. In the former case 
 the powers of the stomach and the animal frame have sunk under fa- 
 tigue (§ 855) ; in the latter from disease. The food and the wine in 
 one case exalt those conditions ; and, from the analogy in the influen- 
 ces which are established by tonics in the other, we know that a com- 
 mon mode of action has obtained throughout (§ 137 e, 151). But, the 
 tonic goes yet farther, and brings about a change in the organic state 
 of the stomach, since food will not remove the condition upon which 
 its indigestion depends. The tonic, therefore, is an alterative stimu- 
 lant. In all the cases the voluntary muscles are suddenly or grad- 
 ually invigorated by reflex nervous actions propagated from the stom- 
 ach. It is the same with the tonic as with the food or the wine. No 
 sooner has the dyspeptic swallowed the first dose of bark than he tells 
 us that his strength is coming as by enchantment. The tonic, also, 
 like the wine, increases the desire for food ; and if this effect can be 
 no more interpreted by the physical doctrine than the former results, 
 it may be safely concluded that every other problem oflTered by tonics 
 falls within the philosophy of vitalism (§ 500, 516 d, no. 6, 350, no. 94). 
 
 It is now an easy matter to institute analogical demonstrations of 
 the physiological operation of tonics, as in former cases, that of astrin- 
 gents, for example (§ 890). For this pui'pose ipecacuanha and the 
 nitrate of silver may be taken ; neither of which has any tonic virtue, 
 while the former is contra- stimulant. But these agents are appropri- 
 ate to the same states of indigestion as the tonics, and bring about the 
 same results (§ 904, d). Or, take a mental cause for an exactly simi- 
 lar parallel, which may be seen in the effects of some agreeable intel- 
 ligence, which, no one can mistake, has imparted, on the instant, a 
 keenness of appetite, a vigor of digestion, and an exaltation of mus- 
 cular strength, which had not been enjoyed for a month or a year (§ 
 137 e, 227, 512, 514 k). Or, place the same individual on board a 
 vessel, or give him an airing by land, and the first hour, perhaps, will 
 have brought with it far greater improvement of digestion and of mus- 
 cular strength, than would have been imparted by cinchona, or any 
 other tonic, in a month (§ 150, 657 a, 847 g, 856 a). 
 
 890j, e. As to the extent in which tonics may act as alteratives 
 that, as in respect to all other remedial agents, will depend upon the 
 departure of the organic properties and actions from their natural 
 type. As in all other cases, also, the useful effects will depend upon 
 the nature of the morbid changes. But these conditions, in their re- 
 lation to tonics, are not often constituted by any great deviations from 
 the-natural states. In most other instances tonics are morbific (§ 137, e). 
 If they happen to be useful in active foi-ms of disease, it is a random 
 hit (§ 756). Their operation, however, even then, comes under the 
 same principle as when they produce favorable results upon chronic 
 derangements (§ 901). Sometimes, therefore, when active disease 
 becomes prolonged, and the susceptibilities of the parts affected turn- 
 ed a little from the incipient pathological state and under the influ-
 
 THERAPEUTICS. TONICS STIMULANTS. 581 
 
 ence of vital habit, tonics will prove less frequently detrimental, or 
 may be so far curative that w^e venture to associate them now and 
 then with the direct antiphlogistics, to obtain their mixed influence. 
 It is often useful to combine them, especially the vegetable, in the 
 form of infusion, or, perhaps, of tincture, with the mild cathartics that 
 are adapted to the advanced stages of disease, just as we have seen 
 of the union of rhubarb with saline purgatives (§ 872, a). In such 
 cases, they not only prevent any prostrating effects of the cathartic, but 
 are positively remedial by going to the vital condition of organs (§ 
 137 d, 150, 569 c). And here, as in the case of rhubarb (§ 872, a), 
 we may reverse the order of indications, and suppose that a tonic may 
 be useful if it can be prevented from stimulating injuriously. This 
 object may be often attained by uniting a mild, saline cathartic, or, 
 administering small alterative doses of tartarized antimiony. This 
 practice, in respect to antimony, is often highly useful in the treat- 
 ment of intermittent fever, where the tonic virtue of cinchona, or quin- 
 ia, interferes with the febrifuge virtue ; while, at the same time, the 
 antimony does its important work as an antiphlogistic alterative. 
 Both of the agents, in these cases, are principal remedies. But it is 
 the febrifuge, not the tonic virtue, which makes the salutary impres- 
 sion. The former is positively morbific, and may not only defeat the 
 febrifuge action without the counteracting influence of antimony, but 
 aggravate greatly the whole condition of disease. And this, by the 
 way, is a distinct exemplification of the existence of those two oppo- 
 sing virtues in cinchona ; while in the other forms of disease it shows 
 itself in the aspect only of one of the best tonics (§ 137 d, 150, 535, 
 &c., 672, 673, 675, 756, 847 g, 848, 854, 863 d, 867, 889 k, 890 i). 
 
 890 J, y! But I say, again, that these agents are never wanted, in 
 their relation to diseased states as tonics, in the early stages of any 
 disease whatever ; and, however they may now and then succeed (§ 
 756), they are generally prejudicial. If employed in certain forms 
 of fever or inflammation in which tonics possessing febrifuge virtues, 
 like cinchona, are not indicated, they endanger life (§ 150, 569 e, 621 a, 
 652 c, 662, 847 g, 848, 863 d). I think I shall have justified this as- 
 sertion throughout the extent of these Institutes. But, in failure of 
 this I have only to point out the results of the Brunonian doctrine 
 of disease, which prompted the tonic and stimulant treatment to so 
 oreat an extent that it has been computed to have destroyed a great- 
 er number of the inhabitants of Europe, in the first forty years of its 
 prevalence, than all the wars of that sanguinary period (§ 621, a, 1068). 
 
 890^, g. There are great resemblances between the virtues of ton- 
 ics and diffusible stimulants, in their common acceptation ; but there 
 are also important distinctions. In instituting comparisons, therefore, 
 between them, or of all other remedies, they should be regarded in 
 their just relations to morbid states ; for in this adaptation alone can 
 they be remedial. We shall thus find that both classes of remedies 
 are more or less applicable to the same conditions of disease, and that, 
 on account of the differences that exist in their remedial virtues, it 
 will be often useful to combine them together (§ 863 d, 889 k, I). In 
 their proper therapeutical acceptation, tonics make their impression 
 much more gradually, and more permanently, than diff'usible stimu- 
 lants ; observing, in this respect, the same distinction that subsists be- 
 tween animal and vegetable food (§ 441 c, 890 J d). When, also,
 
 582 INSTITUTES OF MEDICINE. 
 
 tonics are useful, their effects are far more profound than those of dif- 
 fusible stimulants. But this is not true of their morbific effects under 
 circumstances of existing disease ; since wine, and especially more 
 ardent spirits, taken in any acute inflammation or fever, not only pro- 
 duce their usual more rapid impressions, but exasperate the morbid 
 states to far greater degrees of intensity than any of the permanent 
 tonics. The principle holds, also, in chi'onic diseases when tonics or 
 stimulants prove moi'bific (§ 137, d). 
 
 The foregoing peculiarity of tonics fits them admirably to certain 
 chrouic forms of disease where the strong influence of a long-pro- 
 tracted morbid habit is to be surmounted (§ 535, &c.). Stimulants 
 will not reach these conditions with sufficient alterative effect, or they 
 may act with too much rapidity where a diseased habit is obstinately 
 established, and where long-continued organic actions of a morbid na- 
 ture can be surmounted only by the slow operation of favorable 
 causes. But, in these obstinate conditions the permanent tonics may 
 not act with all the rapidity that may be useful ; and then we associ- 
 ate some of the transient stimulants with them, by which the morbid 
 states are rendered more susceptible of the effect of the tonic remedy, 
 just as by uniting the sulphate of zinc with ipecacuanha the latter will 
 exert its emetic effect simultaneously with the former ; all of which 
 contradicts the doctrine of absorption (§ 137 d, 889 k, I, 904 bl). 
 
 Again, however, some of the tonics possess, also, the virtues of 
 ti'ansient stimulants, such as the cinchonas; and these compound at- 
 tributes suit them well for those conditions of which I was last speak- 
 ing, or for irritable states of the stomach when tonics are wanted, but 
 are apt^to nauseate (§ 150, 889 k, 890 b). In these conditions, a cold 
 infusion of cinchona, whether as a febrifuge or as a tonic, surpasses 
 its alkaloids on account of the presence of a volatile oil by which the 
 stomach is promptly and gently stimulated, and thus enabled to bear 
 the tonic influence of the bark. 
 
 890|, Ji. The suggestions which have been now made let us at 
 once into the reason why all the tonics and stimulants may be con- 
 verted to useful purposes in disease, and why it is greatly otherwise 
 with cathartics and emetics. In the last instances there are far great- 
 er diversities in their curative and morbific virtues, and they ai'e far 
 more of an alterative nature than such as appertain to tonics and 
 stimulants. There exist, indeed, among cathartics and emetics many 
 agents that can rarely be applied to any morbid conditions without 
 increasing the existing evil or engendering new ones. In this re- 
 spect, all the tonics and stimulants, when employed in active febrile 
 or inflammatory states, are on a par with the most irritating cathartics 
 and emetics. Their effect then goes deep ; which admonishes us, 
 more and more, to study well the relations of remedies to diseased 
 conditions, and to discard all the conclusions which have been drawn 
 from an observation of their effects upon man in health (§ 137 d, 150, 
 662 a, 675, 854 bh). 
 
 Nevertheless, the same principle of diversity applies to the sevei-al 
 members of the classes of tonics and stimulants ; but it reaches them 
 in a vei-y inferior degree (§ 52, 650). Since, therefore, there are nc 
 groups of remedies so closely allied in their virtues throughout as 
 tonics and stimulants, there are none which, throughout, bring about 
 results in the treatment of disease that so closelv resemble each othpr 
 (§ 863, r^).— Is^oTK Ee p. 113?. ■
 
 THERAPEUTICS. NARCOTICS. bHii 
 
 We thus come to understand why all the substances which compose 
 the classes of tonics and stimulants may be more or less useful, and 
 that no one of them is an excrescence upon the Materia Medica ; 
 notwithstanding the vast abuses to which they have been subjected, 
 and the immense mortality of which they have been the conspicuous 
 causes (§ 569 e, 621 a). We are also thus led to the knowledge that 
 one tonic, or stimulant, will often answer a better purpose than an- 
 other; and we find, on applying ourselves to an observation of Na 
 ture, that experience confirms all the other premises. We have just 
 seen an example of this in cinchona, and it is a striking general dis- 
 tinction, that the vegetable tonics are best adapted to the prostrate 
 conditions which follow long-protracted acute diseases, while the min- 
 eral, especially the preparations of iron, are suited to chronic mala- 
 dies, such as indigestion. Here, however, the vegetable tonics may 
 be equally appropriate, while the mineral ones are not so to the direct 
 sequelae of acute maladies. 
 
 NARCOTICS. 
 
 891, a. Narcotics are agents which affect, especially, the nen'ous 
 centres, and are, therefore, also denominated cerehro-spinants.* 
 
 In my Arrangement of the ^lateria Medica I have divided them 
 into six groups or orders, according to their special influences upon 
 the nervous system. Narcotics stand in a group by themselves ; and 
 the remaining five consist of antispasmodics, tetanies or cerebro-spino- 
 excitants, moto-paralysants, senso-paralysants, and cerehro-spino-de- 
 pressants. These distinctions are more or less observed by others. 
 
 Some of the narcotics, however, possess also the vii-tues of other 
 groups, and vice versa ; and, therefore, in conformity with this com- 
 pound endowment, the same agents appear under the several appro- 
 priate denominations. — Note Nn p. 1141. 
 
 891, b. The most useful of the narcotics are the great agents by 
 which pain is immediately assuaged, restlessness subdued into tran- 
 quillity, and wakefulness converted into refreshing sleep. Such, 
 therefore, may be taken as the definition which I apply to narcotics, 
 and without special reference to the profound influences which they 
 may exert upon organic functions, or to other useful effects. 
 
 But, all narcotics do not equally produce their several effects. 
 Some of them are more remarkable for diminishing and relieving 
 pain, and are called anodynes (§ 194, &c.). Others produce sleep 
 more particularly, and are known as soporifics. Others allay irrita- 
 bility and diminish vascular action, local and general, in a more deci- 
 ded manner than the rest, and are called sedatives (§ IBS, &c.). 
 
 Such are the denominations in common use ; but they are some- 
 what defective. All the soporifics, for instance, are also anodynes, 
 and most, though not all of the anodynes, are more or less soporific. 
 There are, also, many sedatives which do not rank at all among the 
 narcotics ; to which, indeed, the most powerful do not belong, such as 
 bloodletting, hydrocyanic acid, tobacco, &c., and of which bloodletting 
 is the only one of much value in the treatment of disease, but that one 
 emphatically and justly denominated the reviedium pn'incijmle. The 
 sedatives, therefore, which fall under the denomination of narcotics, 
 possess, also, anodyne or soporific virtues. 
 
 891, c. We have seen how extensively large classes of remedies 
 
 * This term is deficient in not embracing tlie sympathetic nerve, which is mainly 
 interested in the nervous influences upon organic functions and products (§ 113, 46H).
 
 584 INSTITUTES OF MEDICINii. 
 
 have been perverted in their uses, and have yet to consider the no less 
 common neglect or misapplication of bloodletting. There is no other 
 way of enforcing their claims to a just consideration. In respect to 
 the agents now before us, there is a yet smaller class who are equally 
 unhappy in their estimate of their virtues ; and, while the stimulating 
 school exhaust the energies of Nature by adding to the intensity of 
 disease in their peculiar way, the narcotizing school do the same 
 mischief by a similar neglect of the pathology of disease ; and what in 
 either case should be attacked by the lancet, cathartics, antiphlogistic 
 alteratives, &c., is roused into greater immediate violence by tonics 
 and stimulants, or indirectly by other morbific influences which apper- 
 tain to the narcotics (§ 150, 151). Take, for example, the opinion of 
 the able and distinguished London physician. Dr. Sigmond, who says 
 that, 
 
 " Of all the different classes of ?nedicine we possess, we may fairly 
 consider the narcotics, slcillfully, judiciously, and watchfully adminis- 
 tered, the most important.'"' — Sigmond's Lectures in hondon Lancet, 
 183G-7, p. 216.— And so, also, Pereira, ^ 960, a, p. 718. 
 
 The foregoing affirmation shuts out, of course, bloodletting, cathar- 
 tics, all the important and numerous agents which I have grouped un- 
 der the denomination of alteratives, as inferior, in therapeutics, to opi- 
 um, hyoscyamus, &c. {§ 854 hb, S57). — Note H p. 1117. 
 
 On the contrary, I shall have endeavored to show, in various parts 
 of this work, that narcotics are but little more than humble auxiliaries 
 to more important remedies, and then only in a comparatively small 
 number of the cases of disease ; or, that they are mere palliatives, giv- 
 ing a temporary ease by blunting sensibility, where death is probably 
 inevitable, and thus easing the sufferer out of existence. 
 
 891, d. That narcotics are extremely deficient in curative virtues 
 should be sufficiently apparent from what has been already said of the 
 uses to which they are constantly applied. But, even these inten- 
 tions can be rarely well fulfilled by narcotics where much disease is 
 present. We must then resort to the class of antiphlogistics for our 
 great curative means ; and, if the narcotics be summoned to their aid, 
 it should be done with the greatest caution, or they may prove fatally 
 morbific. We may exhibit opium, &c., for the relief of mere spasm 
 of the stomach, to procure rest, &c., where no important acute dis- 
 ease is present. But he who should employ them to assuage the pain 
 of pleuritis, enteritis, or any other active form of inflammation, and, 
 in a general sense, of chronic forms, would either most seriously ag- 
 gravate the disease, or destroy the patient (§ 150, 151).* Whenever, 
 also, there is any affection of the head, or any tendency to cerebral 
 disease, so great is the liability of narcotics to induce congestion of 
 the brain, that they are totally inadmissible where that organ is in- 
 creased in its susceptibilities (§ 137, d). And then let us consider 
 their never-failing effect, in their ordinaiy doses of so injuriously 
 modifying the action of the glandular organs, that the secretions of the 
 whole, especially of that most important organ the liver, are more or 
 less diminished ; whereby Nature is obstructed in one of her greatest 
 processes, natural and curative, and morbific nervous actions reflected 
 upon all diseased parts, and upon the whole organism (§ 862, 863). 
 Should this nervous influence excite in the skin a perspirable action, 
 it is not of a salubrious nature; and here, again, we see demon- 
 
 * There would be as much propriety in treating pleuritis as peritonitis by the enor- 
 mous doses of morphia now in vogue for the latter affection. — 1860. — Note H p. 1117.
 
 THERAPEUTICS. NARCOTICS. 585 
 
 strated the evils that arise from regarding the product and not the na- 
 ture of the action upon which it depends (§ 512 b, 863 d, 902 g). 
 Hence has arisen the pernicious custom of depending upon the com 
 pound powder of ipecacuanha as a principal curative means in the 
 treatment of fever. The opium determines morhific nervous actions upon 
 the glandular organs and nervous system; being scarcely modified 
 for the better through its union with ipecacuanha, even in its greater 
 diaphoretic influence upon the nervous power. 
 
 891, e. In respect to the modus operandi of narcotics, I shall now 
 only lay down the proposition that these agents produce their saluta- 
 ry or their morbific effects like all other remedies, or all other causes 
 of disease, and set forth the proof in other appropriate places (§ 891^ k, 
 904, &c.). The principle involved is so perfectly in harmony with 
 all physiological facts relative to the healthy state of the body, and 
 supported by all the well-ascertained facts in medicine, that it ena- 
 bles us to comprehend how it is that ten drops of the tincture of opi- 
 um administered by the stomach will afford more relief to one man 
 than fifty drops will to another, or how the ten. drops of laudanum may 
 do more injury in the former case, than fifty will in the latter, where 
 the conditions of disease are exactly alike, but where the doctrine 
 which I have advanced expounds the difference in effects upon natu- 
 ral physiological differences and other attendant peculiarities, and, as 
 for the rest, by the production of a sedative reflex nervous action corre- 
 sponding with the existing susceptibiHties (§ 227, 447, 891^ ^, k, 904). 
 The failure of narcotics to produce the same effects when applied 
 to the trunk of a nerve as upon its expanded extremities is a promi- 
 nent fact in humoi'alism, and has contributed largely to the doctrine 
 of remedial effect by absorption. The fallacy of the whole philoso- 
 phy is indicated in other places (§ 826, d, &c.). 
 
 891, yi The effects of narcotics generally decrease, respectively, 
 when frequently repeated, or when habitually employed at more dis- 
 tant intervals (§ 558, a). But the organic properties, as in their rela- 
 tion to all vital stimuli, whether remedial or morbific, maintain about 
 their usual susceptibility to all narcotics except the one in use ; and 
 it is therefore often advantageous to change from one to another, or 
 to employ two or more in combination (§ 150, 151, 650, 889 k). And 
 here I may remark how a single fact proves that remedies operate 
 upon the system at large by reflex actions of the nervous system. 
 
 We have hitherto seen that an admirable variety of virtues apper- 
 tains to many of the different members of each group of remedies, by 
 which they are extensively adapted to various pathological conditions 
 that approximate each other, but which are marked by such differen- 
 ces that, were each group composed of only one or two agents, we 
 should be constantly baffled in the treatment of disease (§ 889, k). 
 And, how vastly, in this respect, has the Materia Medica been im- 
 proved in recent times by simplifying certain substances of compound 
 virtues, attended, also, with much excrementitious matter ; as in the 
 examples of many alkaloids, iodine, &c. ! Opium, for instance, is gen- 
 erally inadmissible in inflammations, unless to moderate irritability 
 of the intestine in muco-enteritis, or of the lungs in pneumonia, oi 
 after the disease as affecting some other parts shall have been subdu 
 ed by bloodletting, cathartics, &c. But morphia may be very appro- 
 priate when opium itself would be detrimental (§ 863, d). If nei
 
 586 INSTITUTES OF MEDICINE. 
 
 ther, however, be admissible, we possess in hyoscyaraus, or coniunij 
 or lactucariura, or lupulin, or cliurrus, &c., substitutes which may be 
 often employed with advantage. So, again, belladonna, aconite, stra- 
 monium, render, each one, their peculiar services in certain painful 
 affections, or other conditions of disease, or subserve some purpose 
 in surgery. As these last three, however, possess no soporific virtue, 
 but lead to sleep by assuaging pain and irritability, they are included 
 in my arrangement under the denomination oi se^iso-paralysants. 
 
 891, g. The most extensively useful effect of narcotics is that of 
 procuring sleep ; so great is the tendency to wakefulness in diseases, 
 and so pei"nicious is its presence. This, too, depends greatly upon 
 age ; children requiring a great amount of sleep, while four or six 
 hours will commonly answer for manhood and more advanced age. 
 This is for disease. Rather more than the maximum is wanted in 
 health. The law of adaptation comes, here, into operation, in morbid 
 states, as with all things else (§ 137, 847 g, 848, 859, 863 d, 870 aa). 
 
 But, before the administration of narcotics for the purpose of pro- 
 curing sleep, we should look well to the cause of the wakefulness; 
 for the loss of blood, or a cathartic, or an emetic, or greater abstinence 
 from food, &c., may be the appropriate means. When, however, nar- 
 cotics are adapted their effect is peculiarly happy, not only in reliev- 
 ing and aiding Nature, but in promoting the operation of other reme- 
 dies (§ 137 d, 150). 
 
 891, h. We are often required to witness an obstinate wakefulness 
 arising more from anxiety, or other affections of the mind, than from 
 the disease itself; and when the day comes, the first glance of the eye 
 upon the sunken or ghastly features of the patient may awaken ap- 
 prehensions for which there is no just foundation. Now let the win- 
 dow-shutters be closed, exclude all unnecessary attendants, let the 
 nurse be seated quietly in a chair, lay aside medicine and even food, 
 take down the bed-curtains, ventilate the room, but not from a win- 
 dow that may throw a blast upon the patient, graduate the bed-clothes 
 to his sensations, moderate or put out the fire, and if the patient have 
 not rested when night comes on again, give him a suitable narcotic, 
 keep all things quiet, and, at our morning call, we shall be likely to 
 understand the reason why narcotics are so improperly administered 
 when wakefulness arises from profound disease, perhaps of the brain, 
 or when sleep is ample, but pain and suffering call for a relief that 
 narcotics may not yield. It is the delightful effect of these agents, in 
 the case which I have just supposed, and where pi'eliminary means 
 for tranquilizing the system have been adopted, that often leads the 
 inattentive observer of the pathology of disease to their indiscriminate 
 use ; and his blindness is frequently such, and so great may be the 
 quiet and insensibility which the narcotics produce, that the patient 
 may drop into the grave without raising the suspicion that he was 
 doomed by the treacherous remedy. 
 
 What 1 have just said of quiet, darkness, &c., are exceedingly im- 
 portant auxiliaries to soporifics, and should be carefully directed. 
 They are causes, too, which should awaken attention to the modus 
 operandi of active remedies, whereby the necessity of the latter will 
 be greatly diminished. Choose, also, the night, when possible, for 
 the exhibition of soporifics ; not only on account of its greater stillness 
 than the day, but because this is the natural time for sleep (§ 137, e).
 
 THERAPEUTICS. NARCOTICS. SS"? 
 
 891, i. The next great use of narcotics, in an absolute remedial 
 Bense, relates to their power of diminishing the irritahility of disease ; 
 whether local or general, and thus aiding nature (^ 188, 905 b). 
 
 Ii'ritability is augmented in inflammations, and it may be important 
 to allay it by narcotics ; not only to enable Natui'e to take on the cure, 
 but to prevent the undue action of exciting causes (§ 137 d, 150, 
 645 c, 855). Thus, it may be very useful to exhibit morphia in pneu- 
 monia, after bloodletting ; by which the cough may be more immedi- 
 ately assuaged than by the loss of blood. But narcotic means arc 
 more admissible, and far more useful in inflammations of the intesti- 
 nal mucous tissue than of any other organ. Here, too, in various states 
 of the alimentary canal, narcotics may often precede advantageously 
 the administration of cathartics, or be associated with them ; and, in 
 a general sense, hyoscyamus is by far the best. In this case we lessen 
 the irritability of the intestinal mucous tissue, and thus prevent the 
 cathartic from doing mischief to the part (§ 889, h). So, also, in dys- 
 entery opiates are often given to allay the irritability of the part in- 
 flamed ; even when no other internal remedy may be employed. Or, 
 it may be to prevent any irritation from small doses of ipecacuanha, 
 or calomel, &c. But when opiates are employed in such affections, 
 the doses should be small, and repeated if necessary. Larger ones 
 prove morbific. In serous inflammation of the bowels, on the other 
 hand, they are entirely inadmissible (§ 137, b, &c.). But, it not un- 
 frequently happens, that active inflammation seated in some circum- 
 scribed part of the intestinal mucous tissue induces spasmodic action 
 in the contiguous muscular portion, which cathartics never fail to ag- 
 e:ravate. In these cases a moderate dose of opium may relieve the 
 spasm, and result in free dejections, by imparting a sedative influence 
 to that reflex nervous action which occasions the spasm (§ 89 ^ k). 
 
 Nevertheless, opium should be always cautiously exhibited in all 
 cases of the foregoing nature ; but, with this reservation, they are like- 
 ly to prove highly salutary in very many instances. But it is in all 
 such instances only a subordinate agent ; and it will be often far bet- 
 ter to accomplish our purpose of obviating the apprehended bad ef- 
 fects of a cathartic, or any other remedy that may be likely to irritate 
 the intestinal mucous tissue, by the general or local abstraction of 
 blood, or by vesicating the abdomen (^ 890 b, 1058/). — Note Gg. 
 
 It should be now said that puerperal peritonitis is sometimes treated 
 successfully by opium given to full narcotization, though recovery is 
 then as slow as seldom. The same has been more doubtfully aflarmed 
 of intestinal peritonitis. Irritability is so thoroughly subdued in the 
 successful cases that it ceases to be morbidly excited by the blood, and 
 the inflammation yields in consequence. Gi'eater exceptions may be 
 seen in § 756. The practice is empyrical (§ 1005 a-g). — Notes E H. 
 891, Ti. Next in order come?, pain, depending on exalted or moibid 
 sensibility. This might appear to call more frequently and imperious- 
 ly for narcotics than wakefulness or the irritability of disease. But it 
 is otherwise ; though it is for the relief of pain that narcotics are most 
 abused, and where they do their greatest injury. Whether they will 
 be now beneficial will depend upon the cause of the pain, its seat, and 
 other circumstances. If owing to active inflammation, they will be 
 likely to aggravate the disease in most parts, but not in all. And here 
 we learn the vast importance of a critical knowledge of the special 
 vital endowments of the different tissues, and of a studious reference
 
 588 INSTITUTES OF MEDICINE. 
 
 to the seat of disease, as well as a critical examination of the attend 
 ant symptoms, since the pain of mucous and serous inflammation of 
 the intestine may be exactly the same, and opiates curative in the 
 former, but certainly fatal in the latter (§ 133, &c., 150, 685, 686). 
 Here, too, in the mucous tissue, they accomplish the double purpose 
 of reducing irritability as well as sensibility (§ 150, 188, 194). In the 
 other case, or that of serous inflammation of all parts, if they render 
 sensibility obtuse, they do not often fail to injuriously modify the 
 irritability of the part, and thus aggravate the disease. In the same 
 general sense, also, opiates are more or less suited to inflammatory 
 states of the whole mucous system. 
 
 891, I. But, the great agent for the relief of pain attendant on active 
 inflammation of any tissue is bloodletting ; and this, particularly, when 
 the disease affects any gieat vital organ. In a general sense, also, the 
 less important the part the safer will narcotics be in inflammatory af- 
 fections, whether acute or chronic ; though, in these cases, care should 
 be taken that they are not contra-indicated by obscure conditions of 
 disease in the complex and great organs of life (§ 150, 689 I, 863 d). 
 And here it is well to remark, that the organs most important to life 
 are far from being most liable to pain. This is true of the lungs in 
 pneumonia; and the liver, also, is but little subject to pain in any of 
 its diseases, while the pleura, or peritoneum, or thecal membranes, 
 the ligaments, &c., are never much inflamed without great attendant 
 suffering. The urinary and generative organs are liable to very pain- 
 ful affections ; and here, most happily, narcotics are very often admis- 
 sible in their acute inflammatory diseases. So, also, they afford im- 
 mense temporary relief in pain of the stone. They operate like a 
 charm in cramp of the stomach, and in the suffering attendant on the 
 passage of a gall-stone along the ductus choledocus. In these last 
 cases the narcotic is directly curative by relieving spasm. 
 
 When pain attends chronic affections narcotics may be adminis- 
 tered with less hesitation ; but still with a careful reference to the seat 
 and nature of the disease. They are of the greatest value, as pallia- 
 tives, in the pain of cancerous affections, and genei-ally for the suffer- 
 ing attendant on the chronic maladies of most parts that have not strong 
 sympathetic relations to important organs (§ 725, 859 h). 
 
 891, m. It may be said, in connection with the foregoing subject, 
 that pain is very rarely a cause of disease, but may increase the force 
 of such as may be present. But, even in these cases the aggravation 
 of disease is owing more to the general disturbance inflicted, and to 
 privation of sleep, than to any direct influences upon the part affected. 
 Great suffering may exist without disturbing even the action of the 
 heart, if the subject be firm of endurance. If the general circulation 
 be disturbed as the apparent consequence of pain, it is mental emotion, 
 not the pain, which produces the phenomenon (§ 167y, note). Indeed, 
 the true philosophy of life conducts us to the above conclusion, since 
 the property upon which pain depends is not interested in the organ- 
 ic functions (§ 194, &c.). In the foregoing manner, or through the 
 medium of the vai'ious mental emotions it produces, pain may aggra- 
 vate or develop an attack of disease ; and it is through the medium of 
 the cerebro-spinal axis that it increases disease without the interven- 
 tion of the passions, that is, by alterative reflex nervous action. 
 
 The power of endurance, and, therefore, the degi'ees of injury which
 
 THERAPEUTICS. NARCOTICS. 589 
 
 pain may inflict, depend greatly upon temperament, and the general 
 condition of the constitution as arising from disease, habits, culture of 
 mind, &c., and these contingencies affect, also, the susceptibility of the 
 vital states. Much, too, will depend upon the kind of pain ; and the 
 kind, also, has its important influence in dii'ecting the treatment. 
 
 891, 71. Owing to the prevalence of sympathies, the patient is often 
 liable to be deceived as to the true seat of pain ; and an inattentive or 
 ignorant physician may be thus led into the greatest mistakes (§ 526 d, 
 891^ b). Diseases of the liver, for example, give rise to pain in the 
 right shoulder, which opium may relieve, while it would aggravate the 
 hepatic affection. Or, if he apply a blister, or other agents, to the shoul- 
 der, they will be useless. But, if placed over the seat of the liver, 
 they will be moi"e or less likely to relieve the remote sympathetic af- 
 fection. This, also, enlightens us as to the importance of addressing 
 our remedies, in all cases, mainly to the organs upon which sympa- 
 thetic developments depend, and where they may remain under the in 
 fluence of the primary affection (§ 689 I, 905). 
 
 891, o. We see, therefore, that blisters are among the great means 
 of assuaging pain ; but, like bloodletting, they operate in a very diffei'- 
 ent manner from narcotics, though by reflex nervous actions. 
 
 There are, also, other agents not of the class of narcotics, which are 
 remarkable for their control over the pain of particular modifications 
 of inflammation, such as colchicum, guaiacum, &c. (^ 892 b, c,). 
 
 Hence we see, more and more, the uncertainty of pain as a guide 
 to treatment, and that our remedies should be mainly determined by 
 other considerations. Nor will I neglect the opportunity of saying 
 how deeply all this subject relative to pain, wakefulness, &c., and the 
 counteracting influences of the narcotics, should impress us with the 
 futility of the chemical and physical philosophy of natural and morbid 
 processes. From what we have seen, too, of the great variety of 
 means by which pain may be assuaged, we come to an unhesitating 
 conclusion as to the modus operandi of narcotics. 
 
 891, p. There is one agent not yet mentioned, which is often very 
 remarkable for the relief which it affords in tranquilizing restlessness, 
 allaying pain, and in procuring sleep ; while it has also the great ad- 
 vantage of being generally free from objection. This is the warm 
 bath ; or analogous means in the form of warm fomentations and poul- 
 tices. By these means intestinal pains, strangury, the intense suffering 
 from sprains, painful menstruation, &c., are frequently dissipated at 
 once. Again, refreshing sleep may be often induced by the warm 
 bath when narcotics fail, or would be injurious (§ 150, 863 d). These 
 agents are also curative in a direct manner ; but variously so, accord- 
 ing to the nature of the affection and the degree of heat employed. 
 The bath at 105° or 110° F. frequently, perhaps daily applied, es- 
 tablishes such impressions upon the skin that highly salutary influen- 
 ces are often reflected upon some chronic forms of hepatic and intes- 
 tinal disease, through the communicating sensitive and motor nerves. 
 
 As farther illustrative of the remedial nature of narcotics in reliev- 
 ing pain, and as contributing to many general objects in the philos- 
 ophy of life, I may advert to the manner in which certain affections 
 of the mind aiTest intense suffering, remove wakefulness, &c. This 
 is strikingly shown in the sudden subsidence of toothache when the 
 dentist is expected, and in the relief which follows the exercise of
 
 590 INSTITUTES OF MEDICINE. 
 
 charms, &c. Certain sounds, also, by awakening agreeable emo« 
 tions, produce similar results ; as variously observed, in the effects of 
 music, the monotonous bubbling of the brook, &c. ; and here the di- 
 rect nervous influence illustrates the reflex of narcotics {^ 844). 
 
 891, q. Narcotics are generally directly sedative, though there is 
 sometimes a temporary excitement of the general circulation. But, 
 their great effect, and which is positively conclusive of their sedative 
 action, consists in lessening irritability and sensibility in a direct man- 
 ner. Nevertheless, opium is considered by many as the most power- 
 ful stimulant ; which shows the importance of correct views in the 
 philosophy of life (§ 1057). 
 
 891, r. Narcotics generally produce their effects with rapidity, so 
 that when their repetition is indicated for immediate purposes, the 
 inteiTening time need not be long. And this leads me to advert to 
 the remarkable manner in which pain often counteracts the sedative 
 effect of narcotics, and enables the patient to bear a quantity that 
 would be fatal in health. The solution of this problem is even be- 
 yond the compass of the physiologist ; nearly as much so as that of 
 sleep (§ 137 e, 150, 151, 175 c, 500 n). 
 
 Certain special affections of the nervous system also counteract the 
 usual effects of narcotics in an astonishing manner ; as seen in deliri- 
 um of drunkenness, which excites an irritating nervous action. 
 
 891, s. Finally, habit, in respect to the use of narcotics, is very re- 
 markable. Instances are authenticated, in which the habitual use of 
 opium has enabled individuals to carry it to the extent, daily, of more 
 than three hundred grains. Solidism and vitalism point to coito- 
 epondence between the general results and the amount of impression 
 upon the stomach for an interpretation of the jDhilosophy (^ 841).* 
 
 ANTISPASMODICS. 
 
 891^, a. Two principal objects are contemplated in rendering the 
 antispasmodics a subject of consideration. First, to aid in illustrating 
 the philosophy which concerns the nervous power ; and, secondly, to 
 indicate their misapplication in many conditions of disease. 
 
 891|, b. The group of antispasmodics embraces all the narcotics, 
 and regards them in the special acceptation which it is my present 
 purpose to consider. As the term implies, they are employed for the 
 relief of spasm, and, mostly, of the voluntary muscles. Now these 
 agents are very commonly applied for the relief of the symptom, and 
 with too little reference to the fundamental cause. Thus, Dr. Paris 
 says that " Spasin may arise from excessive irritability, as from teeth- 
 ing, wounds, ivorms, &fc., in which case a narcotic would prove benefciaV* 
 (§ 526 d, 676 b, 891 n). I have taken this illustration because it is 
 quoted by others as a good example of spasm where the narcotic anti- 
 spasmodics maybe properly employed. But, to my mind, all the con- 
 ditions which ai'e here stated very rarely admit of relief from narcot- 
 ics, and are often aggravated by them. The spasm imputed to teeth- 
 ing may depend upon a variety of pathological causes, however the 
 irritation of the gums be a concumng cause. If it be due alone to 
 dentition, lancing the gums is the remedy. If to intestinal disease 
 which is maintained by teething, the remedies are then the foregoing 
 and others of greater importance relative to the abdominal affection, 
 such as calomel, castor oil, warm fomentations to the abdomen, &c. 
 * See Note H p. 1117.
 
 THERAPEUTICS. ANTISPASMODICS. 591 
 
 If narcotics be now employed, it is for the purpose of allaying intes- 
 tinal irritability, and not at all with a view to their direct action on 
 the cerebro-spinal system. As to spasm from wounds, the narcotics 
 have been most extensively tried and abandoned as useless, excepting 
 where they are slight ; and then, more relief may be procured by a 
 warm poultice applied to the wound. If worms be the cause, we 
 ought surely to look for the remedies among the anthelmintics (§ 150, 
 526 d, 891 n, 859 b, 863 d). 
 
 89 1|^, c. Antispasmodics have been largely employed in hysteria. 
 But here they have been almost as fruitless as in the spasms of chil- 
 dren ; though, perhaps, not so detrimental. Hysteria, in numerous in- 
 stances, is so dependent on some uterine derangement, and this con- 
 dition so often consequent on visceral disease of the abdomen, that the 
 treatment should be, in such cases, of quite a compound nature, but in 
 which antispasmodics can take no useful part. An emetic, however, 
 in a general sense, will afford temporary relief, which it accomplishes 
 in part by modifying the several conditions of disease, and in part 
 through influences which are called into operation in suspending a 
 paroxysm of spasmodic asthma, and hiccough, as explained in section 
 514, c, where the philosophy rests upon reflex nervous action.* 
 
 891|, d. Chorea is another complaint in which antispasmodics have 
 been extensively employed, and with as little reference to the cause 
 of the symptom. They have, therefore, failed, or have left the patient 
 for the worse. Abdominal disease being at the foundation, the rem- 
 edies should consist of cathartics, a well-regulated diet, exercise, and 
 change of air (§ 150, 863 d). 
 
 891^, c. But, worse than all, antispasmodics have been in high re- 
 pute for epilepsy ; notwithstanding their universal failure to afford 
 any relief. The disease, however, is attended by spasm, and the 
 symptom, as in the other aff*ections, has been taken for the disease, 
 and no small amount of suffering and death have been accordingly in- 
 flicted by antispasmodics. In many cases this affection depends, im- 
 mediately, upon cerebral congestion ; and then bloodletting, mostly, 
 is the proper remedy. At other times it is owing to a transient sym- 
 pathy of the brain with an overloaded stomach; when a mild emetic 
 is the sure antispasmodic. In other cases the sympathetic disturb- 
 ance of the brain depends upon profound disease of the liver and oth- 
 er abdominal organs ; and here, cathartics of calomel, &c., and doubt- 
 less bloodletting also, are the appropriate means. Again, it depends 
 upon organic disease of the brain, or on a spicula of bone projecting 
 from the dura mater, or on depression of some part of the cranium. 
 
 The foregoing are almost all the causes of epilepsy ; from which it 
 results that antispasmodics should have no place among the remedies 
 for this affection (§ 150, 847 g 848, 859, 863 d, 870 aa, 1058 v). 
 
 891|,y! Congestive asthma, the usual form of the disease, has had 
 its full share of the antispasmodics, and, of course, with as little bene 
 fit as they have yielded to the preceding affections. They are more 
 or less appropriate, however, to the rare form of spasmodic asthma; 
 but here an emetic is often better, or a pipe of stramonium leaves 
 may answer (§ 514, c). But congestive asthma depends upon some- 
 thing more than simple irritation of the nervous centres, There is a 
 highly-injected state of the venous system of the lungs, consequent on 
 disease of the abdominal viscera, involves many important organs, and 
 * See Note Cc p. 1132.
 
 592 INSTITUTES OF MEDICINE. 
 
 calls imperatively for blood-letting, and cathartics (§ 150, 786, &c., 
 847^, 848, 859 b, 863 d, 870 aa). 
 
 891^, g. We have thus seen various examples in vi^hich reflex actions 
 originate either in sensitive fibres of cerebro-spinal nerves and terminate 
 in motor sympathetic fibres or vice versa, and direct nervous action orig- 
 inating in the brain or spinal cord and terminating in motor fibres of 
 the sympathetic system (§ 111-113, and references there, 488 J, 893 a). 
 
 891^, A. It appears, also, that the true narcotics must be commonly 
 injurious in most of the affections w^hich give rise to spasms. 
 
 89 li, i. But there are some agents which are mostly antispasmodic, 
 in their relation to the nervous system, such as asafoetida, musk, valeri- 
 an, &c. These agents are know^n as the true antispasmodics, although 
 opium greatly transcends the whole in its virtue of arresting spasm. 
 But those of simpler virtues are very circumscribed in their morbific 
 relations to the brain and to other organs, and exert but little effect 
 as therapeutical agents (§ 150). This leads me to consider the re- 
 maining object of the present inquiry (§ 891i, a). 
 
 89 li, k. No one can mistake the immediate bearing of the whole 
 of this subject upon the general philosophy which concerns the modus 
 operandi of remedial and morbific agents, while the function of res- 
 piration, and other natural processes, display the physiological laws 
 under which the former are directed (§ 462-475, 495-534, 639 a). 
 Although, therefore, the phenomena of spasm form so luminous a guide 
 through the whole labyrinth of sympathy, and impart a peculiar in- 
 terest to the discovery of Sir C. Bell in relation to the different orders 
 of nerves (§ 462-470, 476 b), we need not be long detained in making 
 the contemplated exposition. 
 
 In the first place, then, we observe that the irritation of the nervous 
 centres may be either direct, as in severe forms of epilepsy (§ 891^, e), 
 or indirect, as in the more compound and ordinary reflex nervous in- 
 fluences (§ 227, 230, 500). In the former case the nervous power 
 is developed, in a direct manner, either in virtue of some disease af- 
 fecting the nervous centres, or by some direct mechanical irritation, 
 as in depressions of the skull-bone, projecting spiculae of bone, and 
 extravasated blood (§ 476-494). In the latter case the primary irri- 
 tation is in a remote part, as in the gums, or intestinal canal, &c 
 (§ 8911, a). In this instance the impression is transmitted through 
 sensitive nerves to the nervous centres, where it operates as an ex- 
 citing cause of the nervous power, and is exactly equivalent to the di- 
 rect irritation of those centres ; as observed in the former case. The 
 residue of the process then becomes alike in both the cases. That ia 
 to say, the nervous power is reflected through motor nerves, or motor 
 fibres of compound nerves, upon the affected muscles, and thus ai*e they 
 thrown into spasmodic action (§ 230, 233, 500, 893^.) 
 
 Such, again, are all the elements ; and since they are now in oper- 
 ation in their morbid aspect, we have the plainest demonstration that 
 the whole process depends upon natural physiological laws. 
 
 And now, briefly, for the opposing or curative influences. We 
 have seen that when the simple antispasmodics arrest the movements, 
 they institute only mild impressions upon the nervous centres ; but 
 they must necessarily modify the nervous power in its very nature, 
 or they could not arrest the movements of the muscles ; since it is the 
 nervous power which now operates, and upon exactly the same mua-
 
 THERAPEUTICS. CINCHONA. r>U3 
 
 des ill wbicli it liad developed tlie spasmodic action.* In one case, 
 therefore, it acts as a stimulant, in the other as a sedative. Moi'e or 
 less, however, is due to a mere suppression of the exciting nervous 
 iuliuence. The same results obtain, also, when the narcotics operate 
 ill simply removing spasm. But these are agents which embrace oth- 
 er virtues that are very apt to prove moi-bific (§ 891, d), and their mor- 
 bific impression may be transmitted from the stomach to the nervous 
 centres, especially on account of their specific relation to the nervous 
 system (§ 137, c), without first engendering or increasing disease in 
 the stomach or other parts (§ 502, c), or, there may happen along with 
 this a direct morbid change in the condition of the stomach (§ 502, c), 
 or indirectly, through the increased morbid change in the nervous 
 power, in other parts. These new conditions of disease may aggra- 
 vate the spasmodic affection ; since the nervous power is not render- 
 ed sedative to the affected muscles (§ 150, 228 b-2o2, 233|) ; or, on 
 the other hand, the morbid change may be of such a nature as to break 
 up the special condition of the nervous power which gives rise to the 
 spasm, and thus put an end to that part of the malady, although there 
 ensue a very aggravated state of disease (§ 890, 900, 901, &c.). Thus 
 we see presented the compound aspect of a remedial agent bringing 
 about relief to one part of disease, or removing one symptom, and 
 simultaneously aggravating or inducing disease in other parts, and in- 
 creasing all other symptoms. The principle is distinctly the same, 
 throughout, as when the narcotics, or simple antispasmodics, establish 
 that change which results only in the removal of spasm. There is, 
 therefore, presented in the examples before us, as a general gi'ound 
 for the interpretation of morbific and remedial agents, the union of 
 the physiological, morbific, and remedial processes (^ 903, 984 b). 
 
 From the foregoing facts and philosophy we might reason safely to 
 the modus operandi of all other remedial and morbific agents, espe- 
 cially in connection with the natural processes of sympathy (§ 500), 
 had we not about the same amount of concurring proof in the mani 
 festations of every other cause, 
 
 CINCHONA, AND ITS ALKALOIDS. 
 
 T7(to, cito, et jucunde. 
 892, a. As an interesting incident in the history of this extraordi- 
 nary agent, it may be said that the Peruvian bark was not introduced 
 into Europe till the year 1640, or more than one hundred years after 
 the full conquest of Peru ; which is abundantly conclusive that all the 
 alleged connections of the savages, lions, and vultures, which continue 
 to appear in works on the Materia Medica, are wholly fabulous. It 
 was not, however, till a century afterward, or in 1738, that the plant 
 became known to naturalists, through Condamine, the French savant. 
 His account of the tree appeared in the Memoirs of the French Acad- 
 emy, along with the story about the lions. Condamine says that the 
 Countess del Cinchon, wife of the Viceroy of Peru, earned the bark 
 to Europe in 1640 ; from which circumstance, and from her previous 
 connection with the introduction of the bark into use, as stated by 
 Condamine, Linnaeus immortalized her name. The countess brought 
 the bark into use in Peru by a first experiment upon herself, at the 
 suggestion of the Corregidor of Loxa. She then transferred its patron- 
 age to the Jesuits; when the bark dropped the name of the " Count- 
 
 * Shown also b}' certain external applications, as when camphor or ice applied to 
 the skin relieves instantly the spasms in malignant cholera (p. 838, § 1057^). 
 
 P V
 
 594 INSTITUTES OF MEDICINE. 
 
 ess' powder," and became known as the "Jesuits' bark." It would 
 be an entertaining inquiry to follow the history of cinchona after its 
 introduction into Europe. No article of the Materia Medica has em- 
 ployed so extensively the pens of medical philosophers, and under ev- 
 ery aspect of praise and condemnation, and of angry controversy ; 
 and next to this, that now universal luxury of man, the nicotiana ta- 
 bacum. Before the time of the alkaloids, Von Bergen published the 
 names of more than six hundred authors whose writings he had con- 
 sulted on the subject of the Peruvian bark, and refers to eight hun- 
 dred distinct treatises upon this remedy. Subsequently to that peri- 
 od, the discovery of the cinchona alkaloids, and their application as 
 therapeutical agents, have given rise to so vast an accumulation of 
 books, pamphlets, and memoirs, that the writings upon this single ar- 
 ticle of the Materia Medica would, alone, form a library of very impos- 
 ing dimensions. And yet do I find myself at the threshold of another 
 paragraph upon what should seem so completely exhausted. I shall 
 therefore endeavor to turn myself upon that track which has been 
 least pursued, and which, as in many other cases, is too often aban- 
 doned, — the path of Nature. 
 
 The bark, having been early carried from Spain into Italy, it may 
 be well supposed that a country so liable to intermittents, and those, 
 too, of the most formidable character, would soon illustrate the virtues 
 of this extraordinary febrifuge, and enlist in its favor the most power- 
 ful patronage. About this time, however, it was called to encounter 
 one of those checks which it repeatedly afterward underwent with 
 less disaster, and which will remind us of what has befallen the phi- 
 losophy of medicine in the laboratory of a German chemist. I shall 
 therefore state it, in the hope, at least, that it may go with the rest in 
 promoting independent habits of observation (§ 349 d, 350, 350^-). 
 
 The commendations which the bark received from the priesthood, 
 and the popular appellation of the " Jesuits' bark," were not suffi- 
 cient to establish its success in countries less scourged by malaria 
 than the Peninsula ; for even in Spain the physicians were either dis- 
 posed to reject the remedy, or to meet it with opposition. But, its 
 demonstrations were such in the Italian climate, that Pope Innocent 
 the Tenth made it the subject of a papal communication to the Church, 
 and co-operated with the Italian physicians by directing the publica- 
 tion of their report ; in which the curative virtues of the bark were 
 set forth with all the confidence that has been wairanted by subse- 
 quent experience. 
 
 The medical document which was thus promulgated was called the 
 " Schedula Romana," and contained directions for administering the 
 bark as to time, quantity, &c. ; the established dose being two drachms 
 of the powder. 
 
 This Schedula soon became a target for those who had been hos- 
 tile to the bark ; and the warfare was begun by one who had profess- 
 ed to have entertained prepossessions in its favor. This individual, 
 whose name was Chifletus, was prompted in his opposition to the 
 bark by its partial failure in a case where it was important for the 
 physician to have obtained moi'e complete success. A relapse, how- 
 ever, ensuing at the end of a month, the chagrin of the physician led 
 him to denounce the remedy in such violent terms, that it lost, at once, 
 many of its firm friends, and rekindled the animosity of its opponent.«
 
 THERAPEUTICS. CINCHONA. • 595 
 
 Chifletus boldly assumed that all the Roman and other encomiums 
 were mere pretense, and that the bark was not only useless as a rem- 
 edy for fever, but absolutely pernicious, and should be utterly pro- 
 ecribed by the profession. He challenged any well-authenticated 
 cases of cure ; and by this arrogant style he attracted the attention 
 of no small part of Europe. The credulous came to believe his as- 
 sertions, and the evil-disposed united in a crusade against the tenant 
 of the Andes. Chifletus was hailed as a great public benefactor, as 
 " the Reformer" of the day, in having relieved the world of a scourge. 
 His publication w^as reprinted in the languages of different European 
 countries ; and, for awhile, the whole profession appeared to acqui- 
 esce in the justice of the decision. 
 
 Nor was this condemned article ultimately rescued from the tram- 
 mels of ignorance and prejudice by its proper guardians ; but by a 
 learned Jesuit, who once more bore it aloft by unequivocal proof of 
 its extraordinary control over the great bane of Italy. From that 
 time, opposition became more and more feeble, and the merits of the 
 remedy gradually established. 
 
 But, this is only a passage in the early history of the Peruvian bark. 
 It was not, like the tobacco, required to encounter the edicts of des- 
 pots, though it equally underwent the ordeal of a fierce disputation ; 
 and it is scarcely possible for us, who now contemplate these two re- 
 markable members of the vegetable kingdom with the calm indiffer- 
 ence of long and universal experience, to appreciate the uncertainty 
 in which their virtues were held, or the angry and vindictive reproach 
 to which that uncertainty gave rise. 
 
 We see, also, in the nature of the hostility v.'hich was for awhile 
 waged by a great part of the profession against this invaluable reme- 
 dial agent, and in the very face of its triumphant success, a disposition 
 to trample upon the best interests of society, where it may seem ex- 
 pedient to bow to the dictates of a despotic writer, or where profes- 
 sional pride, or cunning jealousy, or malevolent envy, may hope fox 
 gain. Nor can we fail to observe in this extraordinary and almost 
 universal denunciation of the Peruvian bark, as a curse which was 
 scarcely exceeded by pestilence, a striking parallel with the furious 
 opposition which bloodletting has been required to encounter. 
 
 It is also an interesting, as well as instructive, coincidence, that 
 while Sydenham was storming the prejudices against the remedium 
 princ.ipale in the treatment of inflammations and fevers, he was also 
 emploj^ed in combating the opposition to the bark, which had become 
 very general in England. He triumphantly set forth the advantages 
 of the former, and compelled his obstinate cotemporaries to acknowl- 
 edge the healing virtues of the Peruvian febrifuge. But, to the Pon- 
 tine marshes of Italy we may refer the stability which was first be- 
 stowed upon the bark. Here were perpetually emitted the seeds of 
 intermittents, which were now, for the first time, controlled exten- 
 sively by the all-potent drug. — Notes F H K pp. 1114, 1117, 1119. 
 
 892, aa. In my Arrangement of the Materia Medica, I have group- 
 ed together, in the order of their therapeutical value, many agents 
 which are peculiarly appropriate to intermitting forms of disease, and, 
 into this group no other remedies are admitted. They possess, there- 
 fore, what are commonly denominated specific virtues in relation to 
 the diseases to which the group refers. This, indeed, may be more
 
 596 INSTITUTES OF MEDICINE. 
 
 or less affirmed of all the other groups, excepting those of a common 
 antiphlogistic nature. It is not, therefore, to be inferred, when the 
 remedies for any given character of disease are specifically indicated, 
 that there may not be others that are more or less appropriate, but 
 which are not included in the gi'oup before us (§ 137 d, 150). Cathar- 
 tics, even, are liable to this qualification ; since, without previous blood- 
 letting they will often aggravate disease. But, after applying the for- 
 mer remedy the cathartic may cease to be necessary. The loss of 
 blood has accomplished all that Avas contemplated from the internal 
 agent ; but blood-letting cannot be arranged among the cathartics. In 
 certain conditions of amenorrhoea it may be evident that guaiacum will 
 establish menstruation after blood-letting or a purgative, but would be 
 injurious without, or either of the last may be sufficient. Now, the? 
 same remarks are precisely applicable to the group of anti-periodics, un- 
 less it be that the virtues of these remedies have a remarkable beai-ing 
 upon the remote causes of intermittents (§ 650, 652 c, 653, 662, 675). 
 892, b. It is the prevailing doctrine that cinchona, arsenic, and oth- 
 er anti-periodics operate by either neutralizing some imaginary poison, 
 or by forming chemical combinations with the tissues of the body, and 
 thus transmuting them into their normal conditions ; Avhile there are a 
 remaining few who ascribe the results to molecular changes induced by" 
 a tonic or astringent pi'inciple, as in tanning (§ 350, nos. 41, 42, 487 /i, 
 569, 851 a, 890 a, 892^ ^). On the contrary, I endeavor to show that 
 these remedies in subduing special forms of inflammation and fever op- 
 erate upon the same principle as loss of blood, cathartics, and antimo- 
 nials, in the common forms, and therefore as antiphlogistics (§ 756 a, b). 
 Excepting loss of blood and the antimonials, the remedies which are ap- 
 propriate in a general sense to inflammations and fevers will often prove 
 morbific in some of the pathological phases of the common forms of those 
 diseases. Cathartics are comparatively of little use, and often injurious, 
 in pneumonia, plcuritis, enteritis, phrenitis, &c., without antecedent 
 loss of blood ; and this is still truer of vesicants, which may ultimately 
 render important service in those diseases. But there is a large class 
 of inflammations which deviate from the common form, known as spe- 
 cific (§ 648, 653, 721-722). Here, howevei', the same principle ob- 
 tains, and is corroborated by a greater variety in the means that may 
 be suitable to the special pathological conditions. Intermitting inflam- 
 mation and intermitting fever are specific forms of inflammation and 
 fever, and are so far bent from the common forms as to be benefited, 
 in connection with tlie general antiphlogistics, by many heterogene- 
 ous remedies of special virtues, but whicli will aggravate the common 
 forms of those diseases. And just so of chronic rheumatism, for which 
 colchicum, and guaiacum, and veratria, and other acrid and miscella- 
 neous substances are special remedies, but which will aggravate not 
 only the common form of inflammation but even acute rheumatism. 
 Blood-letting, however, and tartarized antimony, are the main remedies 
 for intermitting inflammation and acute rheumatism, and generally the 
 best for the chronic forms. It would be, therefore, equally necessary 
 to deny that loss of blood and antimonials act as antiphlogistics, in the 
 vital acceptation, as the foregoing specific remedies, and to assume that 
 the entire medley, indiscriminately employed, lead to a common result 
 in the cases supposed by some common neutralizing or chemical process 
 (§ 350, nos. 41, 42)! As well might it be assumed that any of the
 
 THERAPEUTICS. — CINCHONA, 597 
 
 remedies for intermittents will unite and form an identical compound. 
 The mercurials will oftener overcome syphilitic inflammation .than any 
 other form, and oftener than any thing else. But iodine, and sarsapa- 
 rilla, and a non-stimulating diet, and frequently loss of blood, are very 
 good remedies. And so of scrofula, in which the general antiphlogistics 
 are often necessary, but mainly sudsidiary to iodine and bromine, while 
 the latter never fail to aggravate the common form of inflammation (§ 
 851 a, 863 d, 892^ v, 892|^, 896-900, 904 c, 905|, 951 c, 1065). 
 
 Having thus divested this plain affair of the mystery which has been 
 thrown around it, and seeing clearly the simple principles through 
 which all remedial effects are produced, we may bi-ing the philosophy 
 with no little aid to our experience in the treatment not only of inter- 
 mittents, but of all other diseases. — Notes K L pp. 1119, 1120.* 
 
 892, c. The considerations to which 1 have now referred, along 
 with what is known of the peculiarities that appertain to the virtues 
 of every remedy, and how those viitues may prove morbific as well 
 as salutary, enable us to understand the favorable and unfavorable re- 
 lations which cinchona, or arsenic, may bear to the different stages of 
 a paroxysm of intermittent fever, when to apply the remedies and 
 when to withhold them, how they may aggravate any coexisting local 
 congestion or inflammation, or how, from our knowledge also of the 
 modifying effects of the remote causes, these agents may, at other 
 times, arrest the local as well as the general disease, or how other 
 agents, like bloodletting, will place the unfavorable states in a favora- 
 ble way for the action of the tonic febrifuge (§ 150, 675, 847 g, 848, 
 857, 859, 863 d, 870 aa). We learn, also, from the same considera- 
 tions, and from what is set forth in section 904, d, that no remedies 
 can be properly regarded as specifics, neither cinchona, arsenic, &c. ; 
 since, from the vast variety and contradictory nature of the means by 
 which intermittents may be arrested, we may clearly perceive that no 
 one of these causes exerts what is understood by specific effect. The 
 several means, however, arrest the disease ; and they do it by insti- 
 tuting such changes in the diseased conditions as place them in the 
 way of restorative changes (§ 672). Each one, however, determines 
 changes according to its own special virtues, and in no other sense 
 are they specifics. So far, then, they are exactly on a par with any 
 other remedy, and with every cause of disease (§ 52, 150, 151, 650, 
 892| d). But, this peculiarity of virtues is more strongly pronounced 
 in some things than in others, and is seen remarkably in cinchona ; as 
 in its profoundly morbific effect during the hot stage of the febrile 
 paroxysm, and its equally curative demonstration during the period of 
 intermission. Here, too, I may again say that its mode of operating 
 at these successive stages of one and the same disease is distinctly 
 seen to be of a common nature (§ 675, 891^ k). Here we have not 
 only a consistent philosophy throughout, but, also, in that philosophy 
 and the attendant facts a fountain for many practical conclusions; 
 such, for instance, as the importance of bringing about, in a general 
 sense, distinct intermissions before resorting to what are emphatically 
 denominated remedies for intermittents ; and that it would be improp- 
 er, in a general sense, to employ the agents now under consideration, 
 in remittent fever, or, at most, not till the febrile action has been mod- 
 ified by direct antiphlogistic means (§ 150, 847 g, 848, 857, 859 L 
 870 aa, 1059. — See Modus operandi of Cinchona, p. 677, § 904 d) 
 =:- Also, N-Tic Ek r- 1133
 
 598 INSTITUTES OF MEDICINE 
 
 Nor may we begin, precipitately, the treatment of intei'mittents by 
 cinchona, nor by any agents of the present group, simply because it is 
 an intermittent, and there happens to exist that suspension of febrile 
 action which is known as the period of intermission (§ 675, 890, d, 
 891 k, I). There may be present some local congestion or inflamma- 
 tion that may demand the abstraction of blood ; and the general con- 
 dition of things will rarely fail of requiring a cathartic, at least. But, 
 it often happens before any preliminary treatment may have been 
 adopted, that an intermission is pretty strongly pronounced, and yet 
 that the intensity of the febrile condition is such as to raise apprehen- 
 sions that the patient may be destroyed by the violence of the next 
 paroxysm. These are frequently cases for grave deliberation, whethei 
 we shall abstract blood, or administer a purgative, or an emetic, or pro- 
 ceed at once to the employment of bark. If no important local dis- 
 ease be present, some eight to fifteen grains of calomel should be giv 
 en, followed soon by an appropriate dose of castor oil, and, in the 
 mean time, the sulphate of quinia should be exhibited till the next 
 paroxysm takes place. It will not do to prostrate the system in these 
 cases by an emetic. In the way now suggested, however, we may 
 stay the violence of the approaching shock. Will chemistry explain ? 
 
 On the other hand, if there be any serious amount of congestion in 
 the liver, or inflammation of the intestinal mucous tissue, as commonly 
 happens with the liver especially, we shall accomplish nothing by this 
 early use of the bark, in these concentrated forms of fever. Either 
 trust alone to the cathartic till after the next paroxysm, or bleed the 
 patient also. There is no " debility" in the case. Keep the eye on 
 the pathology. Nature may rise up at once under the lancet, when 
 she would sink under an emetic, or the tonic virtue of the febrifuge 
 (§ ].50, 569 c, 576 e, 847 g, 8US, 857, 859 b, 863 d, 870 aa, 961, 962). 
 
 892, d. Having brought the system into a condition for the admin- 
 istration of cinchona, or some of its preparations, we are next to ascer- 
 tain which of the two methods should be adopted ; for there are two 
 modes of treatment having essential differences. 
 
 One of these methods consists in making a very strong impression, 
 at once, by a single blow, as it were, upon the diseased conditions, 
 during the intermission, by the administration of a large dose of bark, 
 or of quinia (as five or ten grains of the latter), and thus endeavoring 
 to arrest the fever at once. 
 
 The other method is one of greater moderation ; the remedy being 
 exhibited in small quantities (as that of a gitiin of quinia), at intervals 
 of two to four hours throughout the intermission. 
 
 By the latter process the alterative action is more gradually exert- 
 ed ; so that the pai'oxysms may continue to recur an imcertain num- 
 ber of times, but with diminished intensity, till, at last, they disappear. 
 
 And now as to the relative advantages of the two methods. In the 
 first place, we can readily understand, theoretically, that the precipi- 
 tate course, by large doses, may exasperate any coexisting inflam- 
 mation or venous congestion ; and yet, from the difference in the 
 pathology of fever and inflammation, the former condition may be 
 overthrown. 
 
 We know, also, that it will not answer to arrest the fever suddenly 
 by arsenious acid ; because a large dose of that remedy may inflict a 
 far greater evil than is constituted by the fever. Such, in fact, is tha
 
 THERAPEUTICS CINCHONA. 599 
 
 ntjgative reason ; for an excessive dose of arsenic may arrest the com- 
 plaint at once. It is only, therefore, its liability in large doses to in- 
 flict other mischief that prompts its administration in small doses. 
 And just so it may be with cinchona, or its alkaloids, and their salts. 
 In the former case the morbific effects are strongly pronounced, and 
 the agent is not prescribed at random. But, it is quite otherwise with 
 the large doses of quinia. The attending venous congestions, which 
 are very apt to be present (and far less frequently other forms of in- 
 flammation), may be increased and established without manifesting 
 any striking phenomena to admonish a hasty practitioner of the mis- 
 takes he may have made (§ 790, 795 b, 798, 801, 806, 807, 811, 815, 
 816, 961-964, 967). 
 
 Now, experience shows exactly what theory, suggested by the true 
 operation of remedies, rendered moi'e or less probable. Experience, 
 I say, shows that, though bark, and its alkaloids, in large doses, will 
 often arrest intermittent fever suddenly, such doses are liable either 
 to induce some congestion, especially of the liver or of the mucous 
 tissue of the stomach, or will aggravate and establish some coexisting 
 congestion ; and thus, while the patient is, for the present, relieved of 
 the fever (§ 904, d), he is dismissed with an insidious local complaint 
 that not only renders him a permanent invalid (resulting often in in- 
 durated enlargements, § 803), but which local malady may, and often 
 does, become, in a process of time, the exciting cause of another at- 
 tack of fever ; thus showing, also, that the predisposition to the con- 
 stitutional disease remains, although the paroxysms, and therefore its 
 absolute condition, were interrupted (§ 150, 560, 665, 666, 779, 904 d). 
 In other words, while we thus inflict a useful and sudden blow upon 
 the fever, or general malady, through one virtue of the bark, we lay 
 the foundation of a local disease, through the tonic virtue, in itself per- 
 petually harassing, undermining the constitution, and not unfrequent- 
 ly so establishing the predisposition to fever, that the patient will con- 
 tinue to suffer returns of it from time to time during the residue of 
 the brief period of life which an indiscreet practice not unfrequently 
 allots to him. He is but " imperfectly cured," as Celsus has it ; and 
 these imperfect cures become the slow cause of those chronic enlarge-^ 
 ments of the liver and spleen for which iodine is especially beneficial. 
 In respect to relapses, it is not infrequent that, when intermittents are 
 suddenly stopped by a large dose of quinine the paroxysms return as 
 soon as the patient begins to exercise much, or to take his ordinary 
 food, — certainly with far greater frequency than when the case has 
 been treated upon the moderate system (§ 847 g, 848, 857, 859 b, 
 870 aa, 878).— Notes K p. 1119, L p. 1120. 
 
 It is now interesting to remark that the plan of large medication is 
 apt to be adopted by those practitioners who are least inclined to rec- 
 ognize bloodletting as of much importance among remedial agents, or 
 do not see in the philosophy of disease any other elements than de- 
 bility and something in the blood to be expelled or neutralized (§ 569, 
 960), and suppose that medicines do the whole work of cure (§ 853, 856). 
 On the other hand, when the gradually alterative process is pursu- 
 ed, the patient is not only about as expeditiously relieved of the fever, 
 but, also, of his local congestions; for, Nature has now a chance to 
 throw off" these more obstinate affections (§ 904, d), which she is great- 
 ly disposed to do wiile undergoing the gradual removal of the febrile
 
 600 INSTITUTES OF MEDICINE. 
 
 action ; so only we do nothing to interfere with these local salutary 
 efforts (§ 662). But, there is also the more important advantage re- 
 sulting from the negative fact of not directly increasing, or actually 
 producing, congestions by the milder system of treatment. 
 
 According to this plan, certain other objects of the highest import- 
 ance are not as likely to be overlooked as when its antagonist is 
 brought into action. It presupposes a tolerable regard for the exist- 
 ing state of the pathological conditions before the treatment is begun, 
 that care is taken that all congestions or inflammations of important 
 organs are so far mitigated by bloodletting or cathartics, or by anti- 
 monial alteratives, and the intensity of the fever so far subdued by 
 some one or more of those direct antiphlogistics, as shall render the 
 tonic febrifuge not only safe, but speedily curative (§ 150, 151, 847^, 
 848, 857, 859 b, 863 d, 870 aa) ; for speedy it will almost always be 
 when its administration is proper, and the case continues to be judi- 
 ciously treated. If the intermissions be not well marked, there proba- 
 bly remains some special burden of disease upon the stomach, or liver 
 or other important organ, which should be yet farther mitigated be 
 fore the use of the tonic febrifuge is begun ; although, as already 
 seen, it may be sometimes employed in cautious doses where the local 
 inflammations and venous congestions have refused to yield to blood- 
 letting, cathartics, antimonials, &c., and even now and then at rather 
 advanced stages of the disease where the paroxysms run into each 
 other (§ 662). In all such cases, however, we should move on with 
 great circumspection ; never employing the agent of tonic virtues till 
 it become apparent that this form of fevei", and its local complications, 
 are not likely to surrender to the direct antiphlogistic means (§ 870 aa). 
 
 Among what may be considered the subordinate remedies, but 
 which are truly among the most important, are perfect rest in bed, 
 and a total privation of stimulating and solid food during the exist- 
 ence of the fever, whatever may be its prolongation. It is astonish- 
 ing, I say, what an important agency these two negative remedies ex- 
 ert. Animal food, although it be fluid, will stimulate injuriously, or, 
 if the food be in a solid form, it will irritate the stomach mechanic- 
 ally; while the erect posture, if long continued at least, proves in oth- 
 er ways an exciting cause. And then, as to all those things which so 
 falsely pass under the denomination of refrigerants, such as the acid 
 of lemons, oranges, &c., they never fail of so irritating the intestinal 
 raucous tissue as to aggravate the symptoms which they are intended 
 to assuage. A cathartic, or bloodletting, are the only things that de- 
 serve such a name, unless it be ice ; and even in regard to ice itself, 
 either of the first means may prove far more refrigerant to the organic 
 being (§ 150, 151, 440 e, no. 14, 441 c, 442 b-e, 443 c, 447 c, d, 447 h, 
 447i/, 863 d). 
 
 A proper want of attention to food, and fatigue from exercise, du- 
 ring convalescence, are the great causes of the relapses which take 
 place after well-treated cases of intermittent fever. Almost any thing 
 will arrest the paroxysms when applied under favorable circumstan- 
 ces. And just so it is on the other hand ; almost any thing unduly ap- 
 plied will reproduce them while the predisposition is strong, as it com- 
 monly is for some time after their subsidence. Will chemistry explain ? 
 
 892, e. In the quotidian form I commonly exhibit one grain, in so- 
 Vution, of the sulphate of quinia every two or three hours during the
 
 THERAPEUTICS. CINCHONA GOl 
 
 intermission. In many of the cases the patient does not suffer anoth- 
 er paroxysm after the preliminary treatment and beginning the use of 
 qiiinia; but, in a majority of instances he has another paroxysm, but 
 of great comparative mildness. This, however, is almost invariably 
 the last of the fever. 
 
 In the treatment of tertians, the intermission being longer, more 
 time is allowed for producing the requisite impression by the quinia, 
 and I therefore take no unnecessary risk of aggravating, or of produ 
 cing any local forms of disease, but administer the sulphate of quinia 
 in doses of one grain once in three or four hours ; and ] continue this 
 regular exhibition of the remedy throughout the night. In a vast ma- 
 jority of these cases there has been no return of the paroxysm after 
 beginning the use of the quinia — so only the fever have been a reg- 
 ular tertian, and the intermission well marked. But absolute rest, 
 and a fluid, farinaceous diet, till there is a failure of the periodical re- 
 turn, are a sine qua non. 
 
 892, y! The various means which I have now stated as to the treat- 
 ment of regular intermittents, with -the exception of cinchona, are still 
 more important in remittent and continued fevers ; and their im- 
 portance increases in the ratio of the intensity of any local inflam- 
 mations and congestions of important organs. The former affection 
 is here far more apt to spring up than in intermittent fever, espe- 
 cially in the continued form ; while venous congestion is the predom- 
 inating condition in intermittents and remittents. 
 
 892, g. When the hot stage of an intermittent is unusually pro- 
 longed I have found it most useful to employ not more than iialf a 
 grain of quinine at a dose; and, in remittents, of the most formidable 
 nature, after repeated abstractions of blood, and the exhibition of ca- 
 thartics, especially of calomel, and alterative doses of tartarized anti- 
 mony, 1 have in the end resorted to the sulphate of quinia in the minute 
 doses set forth in section 870 aa, and patients have been thus rescued 
 from otherwise inevitable death. 
 
 Here, too, as in numerous other gradations of febrile action, espe- 
 cially where the constitutional affection is not subdued into a distinctly 
 intermitting form, or where it remains complicated with declining in- 
 flammations, quinine may be brought to bear advantageously in small 
 doses, by associating with it the minimum doses of tartarized antimo- 
 ny, when the former agent would be otherwise morbific. The anti- 
 mony lessens irritability, subdues arterial action, and thus counteracts 
 the stimulant virtue of the tonic febrifuge, while it also reaches more 
 profoundly by its alterative virtue. For an opposite rectifying in- 
 fluence tonics may be sometimes brought usefully to the aid of anti- 
 mony; especially where unsubdued chronic inflammations are kept up 
 by prolonged indigestion. So, again, cathartics, especially the neu- 
 tral salts, may be added to tonics with the same double intention ; or, 
 on the other hand, tonics may be combined with cathartics to coun- 
 teract the prostrating influence of the latter. 
 
 892, h. On the Continent of Europe, and in many parts of the Uni- 
 ted States, ten grains of the sulphate of quinia at a dose is common ; 
 ani this explains the reason why an impression has obtained that this 
 compound is apt to irritate the stomach, or to produce purging. If its 
 full effects in such quantities were farther analyzed and better appre- 
 tiated we should also hear of them much more unfavorable reports.
 
 602 INSTITUTES OF MEDICINE. 
 
 892, i. The celebrated French writer, and admirable practitioner 
 Tissot, more than a century and a half ago, complained that the bark 
 had suffered much in reputation from being employed in too small 
 a quantity. The subject, in consequence, was submitted to the test of 
 critical observation. The dose employed by himself, and which was 
 about the same as sanctioned by the distinguished men of that age, 
 was one drachm of the powdered bark. If the fever were of the ter- 
 tian type he administered eight of these doses during the intermission, 
 or a dose every three hours. For a quartan he prescribed the same 
 dose, and at the same interval, so that, instead of an ounce, as in the 
 tertian form, an ounce and a half would be taken during the period 
 of intermission. " These doses," he says, " frequently prevent a rep- 
 etition of the paroxysm." And this it would have done with greater 
 success had it not been the usage of those days to enjoin exercise 
 upon these patients, and even to allow them solid food during the in- 
 termission. 
 
 As to the quantity of bark, Tissot gave the maximum doso that was 
 mostly employed. This was considered abundantly large. Tissot, 
 indeed, observes that, " The frequent failures of the bark are owing to 
 small doses. On such occasions the medicine is cried down and con- 
 demned as useless, when the disappointment is solely the fault of those 
 who do not employ it properly." 
 
 If we allow, therefore, the large pi'oportion of one grain and a half 
 of the alkaloids to one drachm of good bark, and that the febrifuge 
 virtue of cinchona depends mostly upon these principles, we shall not 
 have more than one grain at a dose in actual operation, on account of 
 the nature of the compound. But, in a great proportion of the bai'ks 
 in common use there is not the quantity of one grain of the alkaloids 
 in a drachm of the bark. The crown bark of Loxa (C. Condaminea), 
 an excellent species, and mostly in use in Tissot's day, has less than 
 half a grain of the alkaloids to each drachm. These facts are of gi-eat 
 practical moment as it respects the important question now before us ; 
 as they come from some of the very best observers, men who would 
 venture upon bloodletting whenever necessary, and who had the same 
 question under consideration. — Notes K L pp. 1119, 1120. 
 
 In Tissot's time, however, there were many who employed exces- 
 sive doses of the bark, and thus injured or destroyed their patients. 
 And this, of course, was another reason why the bark was often in dis- 
 repute. The alkaloids, it is true, are rather less morbific ; but not at 
 all so in the ratio of the moderate and immoderate practice. The 
 consequences, therefore, are the same now as represented by Tissot, 
 Morton, Torti, Sydenham, and others, in their times. 
 
 Be it also remembered, that they who are thus fearless of the cin- 
 chona alkaloids, and others who administer calomel by the table-spoon- 
 ful in congestive fever, and tartar emetic in five to ten grain doses, 
 repeated at short intervals, in the treatment of pneumonia, &c., are 
 the very ones who most condemn the greatest, safest, and most spee- 
 dy of all means for the cure of such affections. And just so, too, as 
 in former times, the public, seeing the failure of their efforts with 
 quinia, and other powerful internal agents, as is very natural with a 
 class so entirely uninformed of the true merits of the case, run to an 
 opposite extreme, and imbibe a belief that medicines are hazardous 
 unless in such small doses as shall exert no effect whatever. The
 
 THERAf t^UTlCS. CINCHONA. COS 
 
 confidence of the public being thus more or less impaired in the whole 
 profession, there will not, of course, be wanting those who, as in Tis- 
 sot's day, will take advantage of this false conclusion, and will, as in 
 former times, employ cinchona, and other remedies, in such minute 
 doses as will render no aid to Nature (§ 854 bb, 878, 894, mottoes). 
 
 892, /.;. The large medication by quinia may be traced up, in part, 
 to the analogous use of tartarized antimony in Europe. But, while 
 the treatment of intermittents by doses of five and ten grains of quinia 
 has extended from Europe to America, we have not kept pace with 
 its progress there. How far this practice has had its origin in physi- 
 ological or pathological facts may appear from some of the results 
 which have been affirmed by its advocates. Thus, the distinguished 
 M. Piorry, having embraced the opinion of M. Louis that the enlarged 
 and indurated spleen, a condition which often supervenes on neglected 
 or badly-treated intermittents, is the cause of the fever, applied the 
 treatment upon that hypothesis. Accordingly, we learn from M. Pi- 
 orry the following results. In a patient, for example, affected with a 
 quotidian, we ai"e gravely told that, 
 
 " All the oi'gans were healthy, except the spleen, the length of 
 which was seven inches and ten lines, breadth five inches and five 
 lines." 
 
 To this patient thirty grains of quinia were given at a dose, and in 
 twenty minutes afterward the hypertrophied spleen was reduced more 
 than one inch in its length and breadth, as asceitained by percussion ; 
 but which we may regard as physiologically impossible. Four days 
 afterward, as the paroxysms still continued, M. Piorry gave this pa- 
 tient forty grains of the sulphate of quinia at a dose ; and measured the 
 spleen by percussion in twenty minutes afterward, and found it more 
 than four inches shorter than when the first dose was exhibited ! 
 Other cases uf the same nature are related, in which he administered 
 sixty grains of the sulphate at a dose ; with the never-failing effect of 
 reducing the spleen at least an inch in all its dimensions within the 
 regular time (twenty minutes) after the exhibition of the remedy (§ 
 854 bb, 857, 878). 
 
 These reports of cases have been extensively circulated, and in-, 
 corporated into the "experimental philosophy" of the day. Sigmond 
 has a salutary remark upon this subject, which may not be without its 
 advantages in this place. Thus : 
 
 " He who has in eauly youth sedulously watched the practice of 
 hospital physicians, and has heard from them the mode of manage- 
 ment which was formerly pursued ; he who has compared what he 
 himself saw at that period, with what he gathers from the most emi- 
 nent writers, and has then enjoyed opportunities of drawing his con- 
 clusions from the bed-side of patients, both in public establishments 
 and at their own houses, will be able to appreciate tlie difficulties 
 which occur in the application to practice of the rules that are laid 
 down by some individuals with such dogmatic precision ; he can also 
 judge of the inutility of those theories which appear based upon 
 plausible foundations, arid which are often promulgated by individu- 
 als who hastily draw conclusions from few facts, and who commence 
 explanations of their own views, ignorant of what has been thought, 
 said, and practiced by some of the able men who have preceded 
 them ; who are again reviving doctrines which time and experience
 
 G04 INSTITUTES OF MEDICINE. 
 
 have already demonstrated to be erroneous. The disregard ofjjJtysl- 
 ology and pathology has been one of the great fallacies of the age in 
 ichicli we live. The devotion to morbid anatomy, however praisewor- 
 thy is its investigation, has absorbed too much of the consideration of 
 some of our most eminent medical philosophers. They have rather 
 reasoned from the ravages which disease has committed, than from 
 the signs and symptoms, and from the gradual development of the 
 morbid functions of organs. Hence fever has been imagined to be 
 a local disease, and hence the various theories have led not only to 
 unsound, but, in my opinion, to dangerous practice." " The enlarge- 
 ment and induration of the spleen, which attend upon mismanaged 
 intermittent fever, are not uncommonly produced by the neglect of 
 the proper means previous to the use of cinchona, and by its admin- 
 istration in the wrong stage." — Sigmond's Lectures, hondon, 1837. 
 
 892, kJc. In what has now been said of the employment of cinchona 
 with a special reference to chronic enlargements of the spleen (§ 
 892, h), it is not intended to be implied that the agent is not more or 
 less adapted to such cases; as it is, also, to analogous affections of the 
 liver, &c., which supervene upon intermittent and remittent fevers. 
 But, in all such cases there are other means not less important ; such 
 as a well-regulated diet of mild vegetable food, leeching and vesica- 
 ting the affected region, the local or internal use of iodine, &c. In 
 all such cases, however, the doses of quinia should not exceed one 
 grain ; and the practitioner and his patient must yield to the necessi- 
 ties of the case, and be content with advances toward a state of cure 
 that shall correspond, in some degree, with the gradual progi-ess of 
 the disease from its incipient to its aggravated form (§ 150, 548 a, 
 557 a, 855, 856, 926). 
 
 892, I. Pereira has presented a good summary of the effects of 
 quinia in the exclusive practice, as inferred from general experience. 
 Thus: 
 
 " In doses of ten grains, sulphate of quinia has produced on man 
 three classes of effects : 
 
 " 1. Gastro-enteritic irritation, marked by pain and heat of the gas- 
 tric region, nausea, griping, and purging. 
 
 " 2. Excitement of the vascular system, manifested by increased 
 fullness of pulse and augmented respiration. Fm-red tongue, and 
 other symptoms of a febrile state, are observed. 
 
 " 3. Disorder of the cerebi-o-spinal functions, indicated by head- 
 ache, giddiness, contracted, and in some cases dilated, pupils, disor- 
 der of the external senses, agitation, difficulty of performing various 
 voluntary acts, somnolency, in some cases delirium, in others stupor." 
 — Pereira's Materia Medica. 
 
 Here, then, are a great vai'iety of symptoms which denote the per- 
 nicious effects of quinia as having followed immediately its exhibition 
 in doses of ten grains, and I have witnessed many of them fromj»?i'« 
 grains only. But, it is these strong demonstrations only which are 
 likely to engage the attention of a large class of practitioners, while 
 the more obscure, but analogous effects of wliich I have spoken, pass 
 unheeded, or are imputed to other causes. 
 
 892, m. Let us, then, look well to the px-eparatory treatment. Let 
 us scrutinize the varied and exact pathology of the individual cases 
 of intermittent fever; and clear up, at least, any local congestions
 
 THERAPEUTICS. CINCHONA. 605 
 
 tlut are so apt to stand in the way of" the tonic febrifuge. But, let us 
 not neglect the important consideration that these local states aie im- 
 bued with the special influences of the remote causes of the constitu- 
 tional affection, and that they are more or less amenable to the Peru- 
 vian bark, and would, doubtless, be far more so but for the tonic vir- 
 tue of the febrifuge (§ 650, 652 c, 662, 670, 814-816, 847 g, 848, 
 857). Where they are marked by periodical exacerbations they may 
 refuse to yield in their specific nature to all things else than some 
 agent of very peculiar virtues ; and here it is that cinchona, or arse- 
 nic, manifest their effects as specifics. But it is far from being cer- 
 tain that such agents are indicated because the local conditions of dis- 
 ease do not give way to a direct antiphlogistic treatment. It may be 
 that this treatment has been imperfectly applied, that too little blood, 
 pei'haps, may have been abstracted, that leeching or blistering have 
 been improperly neglected, or out of their relative order to general 
 bloodletting and cathartics, or, that some untoward exciting causes, 
 such as eiTors in food, or fatigue, &c., have been in operation to de- 
 feat the right influence of the principal remedies for inflammation 
 These are considerations of great moment, and should duly pass un- 
 der review in all cases, before we summon to our aid the power in 
 reserve; especially if the local symptoms do not fluctuate like the 
 paroxysms of fever (§ 151, 675, 686, 847 g, 848, 870 aa). 
 
 Again, however, cases arise where the local affections put on a dis- 
 tinctly intermitting character. The symptoms of cerebral congestion 
 rise and fall with the febrile paroxysms and the intermissions, or those 
 of pleurisy undergo the same fluctuations. Here, therefore, there is 
 little or no room for doubt, after a full impression has been made by 
 bloodletting, cathartics, &c., upon the general pathological condition. 
 This preparatory treatment adopted, the first modei'ate dose of qui- 
 nine will often tell us that it has reached deeply the peculiar modifi- 
 cation which had been impressed upon the congested or inflammato- 
 ry states by the miasmatic cause ; while, on the other haiid, had the 
 remedies for common inflammation been neglected, and no impression 
 had been thus made upon the universal pathological condition, that 
 grain, or less, of quinia would have exasperated the whole condition 
 of disease (§ 137 d, 150, 151, 650, 672, 673, 801, 814, 857, 870 aa). 
 
 892, n. The foregoing peculiarly modified states of congestion and 
 inflammation, in their supposed intensity (§ 892, m), are not, however, 
 common in America ; but, it is more common to find that remittent 
 fevers, notwithstanding any remaining congestions with which they 
 may have been complicated, will be ultimately benefited by vei-y small 
 and cautious doses of the cinchona alkaloids (§ 150, 870 aa). 
 
 892, o. It should be added that it has occasionally happened within 
 the experience of the best observers, that acute and violent inflamma- 
 tions have occuiTed independently of intermittent fever, where the in- 
 flammation has refused to yield to bloodletting, &c., but has subse- 
 quently surrendered speedily to the bark. It can scarcely be doubt- 
 ed, however, that these rare conditions are under the modifying influ- 
 ence of the remote causes of intermitteots (§ 150, 151, 813 a, 816). 
 
 892, p. Besides the aflfections which I have considered in the fore- 
 going sections, there are others of an intermitting character to which 
 the cinchonas, and their allies, are especially adapted. These are the 
 well-known intermittent head-aches, intermittent neuralgia, intermit-
 
 606 INSTITUTES OP MEDICINE. 
 
 tent amaurosis, intermittent ophthalmia, &c. ; all of which probably de- 
 pend, for their specific character, upon the vegetable miasmata that 
 lay the foundation of intermittent and remittent fever (§ 150, 650, &c.). 
 Such has been the opinion of those who have lived and written in the 
 midst of such affections. " The same cause," says Tissot, " which 
 produces the intermittent fever, frequently occasions also disorders 
 that return periodically at the same hour, without shivering, without 
 heat, and often without any quickness of the pulse. Such disorders 
 generally observe the intermissions of the quotidian or tertian fevers, 
 but much more seldom those of quartans. I have seen violent vomit- 
 ings, and retchings to vomit, with inexpressible anxiety, the severest 
 oppressions, the most racking colics, dreadful palpitation and tooth- 
 aches, pains in the head, and very often unaccountable pain over one 
 eye, the eyelid, eyebrow, and temple, on the same side of the face, 
 with a redness of that eye, and a continual trickling of tears. I have 
 also seen such a prodigious swelling of the affected part, that the eye 
 projected, or stood out, above an inch from the head, covered by the 
 eyelid, which was also extremely inflated or puffed up. All these 
 maladies begin precisely at a certain hour, last about the usual time 
 of a fit, and terminate without any sensible evacuation, return exactly 
 at the same hour the next day, or the next but one." 
 
 This reminds us of Hippocrates ; and the practitioner in the mala- 
 rious districts of the United States will not fail to recognize in the 
 graphic portrait the same things in his almost daily walks, as he does 
 in the "epidemics" of the venerated father of medicine. 
 
 The treatment of the foregoing cases is very embaiTassing, unless 
 we are prepared by a knowledge of their peculiar pathological chai'- 
 acter ; and, having quoted the experience of Tissot as to their occur- 
 rence, I cannot do better than to state the treatment which was pur- 
 sued by one who is so eminently entitled to our confidence ; especial- 
 ly as that treatment has not been impi'oved. 
 
 If the affection was decidedly inflammatory, as in the case of the 
 eye, he abstracted blood. Then he goes on to remark tiiat, " Thei"e 
 is but one medicine that can effectually oppose these periodical mal- 
 adies, which is the bark. Nothing affords relief in the fit, and no other 
 medicine ever suspends or puts it off. But, I have cured some of these 
 disorders with the bark, and especially those affecting the eyes, which 
 happen oftener than the other conditions, after their duration for many 
 weeks, and after the ineffectual use of bleeding, purging, baths, blis- 
 ters, and a great number of other remedies. If a proper quantity of 
 it be given, the next fit is very mild ; the second is prevented, and 1 
 never saw a relapse in these cases, as often happens with intermittent 
 fevers." But Tissot had, also, a preliminary treatment. 
 
 Tissot wrote before arsenic had come into use as a remedy for in- 
 termittent fever, and which has been subsequently employed with 
 great success for the intermitting headache, &c. 
 
 892, g'. There is one form of continued fever to which the bark is 
 adapted in its advanced stages, and, what is remarkable, the tincture 
 is often the best, and that, too, where stupor has come on, along with 
 subsultus tendinum, black tongue, sordes, &c. This form of the con- 
 tinued fever is the typhus, and belongs to climates where the inter- 
 mitting diseases are scarcely known to occur.* In these cases, the 
 
 * I have shown in the 31ed. and Phys. Comm. (vol. 2, pp. 449, 690) that typhus or 
 typhoid fever does not originate in the U. S. south of Lat. 41°. The '■'■fatal typhoid^^ 
 of our civil war is the congestive remittent fever. — August. — 1862. — Note S p. 1124.
 
 THERAPEUTICS. ARSENIC. 607 
 
 bark appears to act both as a tonic and febrifuge. But, it is suited 
 only to advanced stages of the disease. 
 
 892, r. Whenever cinchona, or its alkaloids, prove beneficial under 
 other circumstances than such as have been stated in the foregoing 
 sections they operate in virtue of their tonic property. But, like all 
 other tonics their range of usefulness, in this acceptation, is very lim- 
 ited ; being suited only to advanced stages of acute disease, or to 
 some chronic maladies in which digestion is peculiarly impaired, or 
 to others attended by profuse mucous discharges, as in old and ex 
 cessive bronchial secretion, old diarrhoeas, &c. Their best effects as 
 tonics are probably manifested in feeble scrofulous habits, when di- 
 gestion is impaired ; and along, perhaps, with iodine. They exert, 
 also, a kindly influence upon the shattered constitutions of old vene- 
 real subjects, especially when mercury fails of its usual office, and 
 then, also, iodine should often go with it. They are among the pres- 
 ent helps to broken-down debauchees. 
 
 Notwithstanding, however, the inconsiderable advantages that arise 
 from cinchona as a tonic, it stands at the head of that group of reme- 
 dies, as it does in its rank among the special alteratives for intermit- 
 tent diseases. The contrast in effects separates very widely from 
 each other these coexistinsr virtues, while the limited advantages of 
 one or its more frequent peraicious effects tell us, forcibly, to beware 
 of the whole group of tonics. 
 
 ARSEMOUS ACID. 
 
 892|, a. Arsenious acid, in the ti-eatment of intermittent diseases, 
 has been rapidly passing into the great reservoir of forgotten things ; 
 whither it has been driven by the power of novelty, and the superior 
 excellencies of the cinchona alkaloids. But, it remains as ever a sure 
 friend of man whenever his necessities may oblige him to call it from 
 obscurity. It is partly from these considerations, and in part to look 
 at its peculiar attributes as a curative agent, and thus to elicit new 
 rays of light upon organic life and the philosophy of medicine, that I 
 shall venture to disturb the repose of this once busy member of the 
 mineral kingdom. 
 
 But, these objects need not detain us long, as I contemplate a ref- 
 erence mostly to its relations to intermittent diseases ; and much of 
 what was said of cinchona is applicable to arsenic. This agent, how- 
 ever, is not complicated by any tonic virtue, as otherwise supposed 
 by many, which divests it of objections that are relative to that char- 
 acteristic of cinchona.* Yet, it has the attribute of a violent poison, 
 and may, therefore, be liable to disastrous effects from its incautious 
 use. But, with this contingent objection the amount of evil which it 
 has inflicted is insignificant with that which is constantly in progress 
 from the untimely application of the Peruvian bark, or from its ex- 
 cessive administration. In one case the immediate evils are less 
 striking, or creep slowly on ; in the other it is death itself who stands 
 before us. 
 
 8921, h. Arsenious acid appears to be more or less poisonous to all 
 animals. In its therapeutical dose it produces no apparent effect 
 upon man in health ; which is only one of the numerous facts that 
 admonish us against all conclusions as to remedial agents from what 
 may be witnessed of their effects upon the healthy system, and to give 
 
 * The supposed tonic virtue of arsenic is predicated mostly of Voght's experiments on broken 
 down horses, whi'-h have been incorporated into medical philosophy (§ S54 66, 892i j, A).
 
 608 INSTITUTES OF MEDICINE. 
 
 our a.,teT)tIon to the properties of life as their susceptibilities may be 
 affected in disease (§ 150, 854, 870 aa, 892^ a). 
 
 In respect to the manifestations of arsenic in morbid states of the 
 body, independently of its curative effects, they may be sufficiently 
 learned from a statement by Dr. Fowler, that, "in 320 cases, some- 
 what more than one third was attended with nausea; nearly one third 
 with an open body ; and about one third with griping. Vomiting, 
 purgings, swellings, and loss of appetite were but rare in comparison 
 with the preceding effects, and their less frequent occurrence was gen- 
 erally found in the order in which they are here enumerated. About 
 one fifth of the cases attended with nausea, and one fourth of those 
 attended by an open body, were unconnected with any other effects. 
 Griping did not often occur alone. Purging and loss of appetite sel- 
 dom or never alone, and vomiting was always accompanied with 
 more or less nausea." 
 
 The foregoing observations unfold the nature of the general influ- 
 ences which may be more or less expected from the therapeutical 
 dose of arsenic, and illustrate the fluctuating nature of the organic 
 properties. Such effects, however, may he generally avoided (§ 857). 
 
 892^, c. Fowler's Report upon the effects of arsenic appeared in 
 1786, and subsequent experience has amply established its febrifuge 
 virtue. It appears, indeed, to have succeeded not only occasionally 
 in the hands of most practitioners of experience where the bark and 
 its alkaloids have failed, but even upon an extensive scale in certain 
 epidemical intermittents. It owes, in fact, its early reputation con- 
 siderably to its success in an intermittent fever which infested Great 
 Britain about the year 1780, and which prevailed for more than two 
 years. But, it was the obstinacy, more than the great prevalence of 
 this epidemic, which renders it memorable ; and this the more so 
 from its resistance of the bark, and its submission to arsenic. This 
 was one of the occasions in which the bark fell into considerable dis- 
 repute ; and we now comprehend the reason of its frequent failui'e 
 during the epidemic of which I am speaking. Bloodletting was not 
 then the fashion in Great Britain, and this fever was attended by 
 those local congestions and inflammations which either demand the 
 loss of blood, or, at least, render it necessary to any safety in the eai'ly 
 administration of bark. But this tonic febrifuge was administered 
 without the requisite advantages of a preliminary treatment, and tlie 
 local conditions of disease were accordingly exasperated, the fever 
 aggravated and prolonged, and often rendered fatal by the very rem- 
 edy upon which there was the sole reliance (§ 847 g, 848, 854 hb, 
 857, 863 d, 870 aa). 
 
 However, therefore, the bark may have been thus baflled in its ef- 
 fects as a febrifuge, and inflicted the evils of a tonic, it was no fault of # 
 the I'emedy, but of the practitioners, who neglected the true pathology 
 of the disease, overlooked the local developments, and permitted their 
 prejudices against bloodletting and cathartics to deprive them of the 
 benefits which might have accrued from the Peruvian febrifuge. Be- 
 ing thus baffled in their attempts with an agent of tonic virtues, a few 
 practitioners availed themselves of the reputation which arsenic had 
 obtained in Poland as a febrifuge ; and this substance being destitute 
 of the tonic and stimulant virtues of cinchona, it was more compatible 
 with the local condition of disease, and therefore succeeded in the
 
 THERAPEUTICS. ARSENIC. 609 
 
 hands of those few better than the bark. It was apt, however, to oc- 
 casion vomiting and purging ; but these effects were mostly the con- 
 sequence of a neglect of the appropriate means for subduing the force 
 of the local burdens of disease. 
 
 Parallel with the foregoing is an opinion which is thus stated by 
 Dr. Sigmond. 
 
 " The effects of arsenic are much more striking in the intermittent 
 fever occurring during the autumnal months, than during that which 
 is prevalent in the spring ; and the more intensely the miasm has act- 
 ed upon the system, the more decided are its good effects, while cin- 
 chona, and the barks of certain trees, produce their characteristic ef- 
 fects during the spring." — Sigmond's Lectures, 1837. 
 
 I have quoted this remark for the purpose of carrying out the views 
 which I have expressed as to the failure of the bark in the English 
 epidemics, and as it is its tendency, also, to encourage the use of 
 arsenic in the autumnal intermittents, without any just ground for the 
 conclusion as to its superiority over the bark in the fevers of that sea- 
 son. The greater success of arsenic as here stated has been observed 
 only in the hands of those who administer the bark indiscreetly, and 
 without properly subduing the local congestions and inflammations 
 which are every where more common and severe in the autumnal than 
 in the vernal intermittents. And, as one of the evidences that the 
 greater success of arsenic, under the circumstances now stated, is 
 due to the absence of the tonic and stimulant virtues of cinchona I 
 may quote the remark from Pereira that, " It is not necessary to in- 
 termit the use of arsenic during the febrile paroxysm. In agues, ac- 
 companied with inflammatory conditions, where cinchona and quinia 
 disagree, arsenic may, according to Dr. Brown, be sometimes admin 
 istered with the best effects." It has, he says, no tonic virtue. 
 
 Immediately after the events of the British epidemic of which I had 
 been speaking. Dr. Fowler appeared with his " arsenical solution," 
 or the liquor potassae arsenitis ; which has been supposed by many 
 to surpass the arsenious acid in its remedial virtues. This preparation 
 became the means of establishing, rapidly, the character of the new 
 agent all over Europe. 
 
 892^, d. The question arises, next, as to what conditions of inter- 
 mittent fever arsenic is applicable in preference to cinchona. Wc 
 have seen that the bark and its alkaloids are capable of surmounting 
 the disease with great certainty and rapidity under its ordinary con- 
 ditions when properly administered ; and this qualification supposes 
 that other remedies, such as bloodletting, and especially cathartics 
 and antimonials, shall be brought into operation whenever demanded 
 by the general or local symptoms. The disease, being thus treated 
 according to its variable pathological conditions, and the Peruvian 
 febrifuge withheld till its application is compatible with the patholog- 
 ical states as meliorated by the direct antiphlogistics, we may, un 
 doubtedly, in almost all cases which are seen in their early stages, 
 succeed completely with the alkaloids, and thus avoid a remedy, which, 
 like arsenic, is liable to the objections of being fatal in the dose of a 
 single grain, or of inducing violent symptoms, or of laying the founda- 
 tion of other serious and even fatal affections, in its usual therapeu- 
 tical doses, if administered in inauspicious conditions of the system, 
 or when continued, under favorable circumstances, beyor.d a certain 
 
 Q a
 
 GIO INSTITUTES OF MEDICINE. 
 
 period. These considerations leave no doubt, therefore, that the al- 
 kaloids should be first employed in every case of intermittents, whether 
 they be of fever, or of those other local diseases having periodical par- 
 oxysms, as considered in sections relative to the bai'k. Such, indeed, 
 were the conclusions of the soundest medical experience before the 
 introduction of the cinchona alkaloids ; and, while balancing the mer- 
 its of these remedies we cannot too well consider the safety of one 
 when employed with a proper reference to pathological conditions, 
 and the dangers of the other, under all conditions, that are liable to 
 accrue from over-doses. But this objection applies only to the care- 
 less, and may be predicated of many other remedies in common use. 
 We must take the world, however, as it is, and not as it should be ; 
 and when, therefore, as in the case before us, a choice exists, let us 
 banish the evil as far as the choice extends. It should still, however, 
 be recollected that, in the case of the bark, a morbific virtue may be 
 in operation in the therapeutical doses of that agent, while the same 
 special virtue does not appertain to arsenic (§ 150, 847 g, 848, 859, 
 863 d). 
 
 It appears, therefore, that arsenic will be wanted mostly in neg- 
 lected or badly-treated cases of intermittent fever ; and the former 
 will be more likely to yield to other means than the latter. In the 
 neglected cases, disease can, at most, have been aggravated only by 
 errors on the part of the patient, while art, with its powerful morbific 
 ao-ents, may lay the foundation of very intractable local maladies that 
 shall impart great obstinacy to the constitutional disease, as uninter- 
 mitting exciting causes (§ 659, b). Cases undoubtedly arise, also, at 
 certain seasons of the year, such as the autumnal (§ 892^ c), to which 
 arsenic is better adapted than quinine, or where the latter may fail on 
 account of its tonic virtue. Again, other cases sometimes present 
 themselves at all seasons where the vegetable remedy fails under the 
 most judicious treatment. This may be owing to very peculiar modi- 
 fications of the pathological states, or to unusual affections of certain 
 parts, or to some idiosyncrasy. In short, arsenic is the next remedy, 
 appertaining to the group before us, which should be tried after the 
 failure of cinchona. But, it by no means follows that agents from other 
 groups may not be equally or more appropriate. It happens, fre- 
 quently, in prolonged or badly-treated cases of intermittent fever 
 where the liver or spleen becomes the seat of enlargements and indu- 
 rations, that iodine maybe employed very successfully in conjunction 
 with quinine. The accession of these two agents to the Materia Med- 
 ica has contributed, largely, in this as in other respects, to the facili 
 ties of art. 
 
 It has placed, indeed, the foregoing affections greatly under the 
 control of either; and, what is vei'y important, where the bark was 
 inadmissible during the coexistence of fever with the chronic derange- 
 ments, quinine is often adapted to both conditions ; so only, the treat- 
 ment be properly conducted in its other details. Iodine, however, is 
 only appropriate after an ascendency is obtained by other remedies 
 over the febrile state, and where the force of the local affections has 
 so yielded that they inflict no exciting reflex nervous 'influences upon 
 the oigans of circulation. Otherwise, that intensity should be first 
 moderated by leeching, blistering, low diet, &c. With this qualifica- 
 tion, and in the absence of fever, iodine has contributed not a little 
 toward the exclusion of arsenic froin the tieatment of agues.
 
 THERAPEUTICS. ARSENIC. 611 
 
 In some of the conditions of which I have just spoken, arsenic in 
 advantageously associated with quinia, or administered in the associ- 
 ated form of a salt. 
 
 892i, e. We finally come to the conclusion that arsenic ranks next 
 to cinchona in the certainty with which it overcomes intermittent 
 fever. But, it is less certain, and less rapid in effect ; and the objec- 
 tion which applies to it as an energetic poison in over-doses should 
 hold it in reserve, to be employed only where cinchona, or quinine, 
 properly administered, may fail. Such as may study disease in its 
 philosophical aspects, taking a comprehensive survey of its varied 
 pathological conditions, firmly resisting the prejudices which timidity 
 or ignorance have heaped upon bloodletting, and who prescribe for 
 the absolute conditions rather than for the name of a disease, will 
 rarely find it necessary to have recourse to arsenic in the ordinary 
 forms of intermittent fever. 
 
 892^, J". It is not improbable, however, that this agent may be found 
 more useful in the distinctly intermitting inflammations which accom- 
 pany marsh fever. It is always difficult to adapt even a cinchona alka- 
 loid to these inflammatory states, while it never fails to exasperate the 
 inflammation if administered before a strong impression has been 
 made by bloodletting and other antiphlogistics. 
 
 892^, g. Intermitting headache is a more common form of period- 
 ical disease than inflammation, in which arsenic proves often useful, 
 and frequently where cinchona has failed. And so, also, of periodic 
 tic douloureux. 
 
 892i, h. Besides the intermitting affections, there are others to 
 which arsenic is well adapted, and which strikingly illustrate the pro- 
 foundly alterative and comprehensive remedial virtues of this agent. 
 These remaining conditions of disease are so evidently different from 
 the intermitting, that I have reproduced the arsenical preparations in 
 two other groups of remedies, in my Materia Medica. It is impor- 
 tant, in the first place, to regard each remedial agent of two or more 
 virtues as a whole, and to consider its operation under its compound 
 aspect. But, in this state of complexity they cannot be brought into 
 that practical use which is promoted by the method which I have 
 projected of considering the various properties of remedies in an in- 
 dividual sense, and according to the prominent conditions of disease 
 to which they are suited, and by associating under the several denom- 
 inations of disease the various remedies adapted to them, and in the 
 relative order of their therapeutical value, and, therefore, presenting 
 under each denomination groups of remedies having certain remedial 
 virtues analogous to each other, however they differ in other proper- 
 ties, or however different may be the s'pecial influences by which the 
 various agents under any given denomination of disease establish 
 those changes which give to Nature the recuperative start. In this 
 manner a single compound remedy comes to be distributed into what 
 is equivalent to several agents ; each remedial adaptation to possess 
 an individuality which distinguishes it from other remedial virtues that 
 qualify the agent as a remedy for other morbid conditions. In this 
 way, I say, we avoid a confusion which has prevailed so extensively 
 from considering a remedy of compound virtues in its general aspect 
 alone. We are led to an attentive examination of its several virtues, 
 of their critical relations to different uathological conditions and thus
 
 612 INSTITUTES OF MEDICINE. 
 
 to acquire a more distinct apprehension of the propcities of life, of the 
 modus operandi of remedial agents, and of the laws which govern the 
 organic being under all his conditions of health and disease. 
 
 8921, i. The diseases which fall, more or less, under the power of 
 arsenic, and which illustrate the extent of its remedial virtues beyond 
 those which have been hitherto considered, consist of certain chronic 
 eruptive affections of the skin, cancel", noli-me-tangere, chronic rheu- 
 matism, diseases of the bones, chorea, elephantiasis, iScc. In some 
 of these conditions, especially in cancer, it is applied externally as 
 well as iuternally. Iodine has been also advantageously associated 
 with arsenic in the treatment of some of these affections. 
 
 8925, h. The variety of diseases to which arsenic is adapted, and its 
 inertness upon the healthy body in its therapeutical doses, illustrate my 
 doctrines of operation through alterative reflex nervous actions, and of 
 the increased susceptibility of morbid states (§ 143 c, 222-233^, 500 m, 
 892 h, 892^ V, 900, 902, 1059).— Note L p. 1120. 
 
 IODINE. 
 
 892^, a. Considering the extensive and powerful nature of the al- 
 terative action of iodine, it is remarkable that in its small therapeuti- 
 cal doses it produces no well-marked effects upon the function of any 
 organ in its healthy state. In this respect, therefore, it goes with 
 arsenic, and the rest, in illustrating the nature of life, and in enforcing 
 a limitation of inquiries into the therapeutical capabilities of remedial 
 agents to morbid states of the body (§ 137 d, 150, 854 hh, 870 aa, 
 892i b). When its use is long continued, emaciation is said to have 
 sometimes followed, and now and then a low state of gastro-enteritis 
 has been supposed to have supervened when iodine has been employ- 
 ed in large doses. This, however, is considered a rare effect, and to 
 depend upon the incautious use of the medicine. It has doubtless 
 happened in morbidly irritable states of the alimentary canal (§ 137 
 d, 150). Lugol, who had great experience with iodine, says, that so 
 far from even occasioning a wasting of the body it promotes growth, 
 and increases the size of organs, in their healthy state. The nervous 
 system is said, also, to have been occasionally disturbed, in natural 
 states of the body, by therapeutical doses of iodine ; attended by 
 headache, giddiness, &c. But here, too, there had probably been an 
 antecedent derangement of the alimentary canal, &c. It has been also 
 laid to iodine, that it has occasioned a state of the system which merits 
 a name significant of one of its morbific tendencies ; and hence that 
 of iodism has been associated with the remedy. This condition is 
 marked by vomiting, purging, cramps, emaciation, fever, &c. But, I 
 am apt to think that the fault, in these cases, is chargeable to malad- 
 ministration. Others have affirmed that iodine has occasioned saliva- 
 tion ; but this, also, is denied by others. In any event, such a result 
 is exti-emely rare. Twelve grains, on an average, have been given 
 daily for eighty days, making 960 grains, without any manifest effect. 
 In excessive doses, however, iodine is capable of acting as an irritant 
 poison ; or, should disease be present, the whole aspect of the subject 
 is changed. I have never witnessed any of these alleged eflTects. 
 
 A remedy, therefore, so exempt from all untoward action upon 
 the healthy body, and, withal, as inoffensive when skilfully used in 
 morbid states, yet capable of a vast range of the most important reme-
 
 THERAPEUTICS. IODINE. iJlH 
 
 dial effects, must be regarded as an accession to the Materia Medica 
 of great value. 
 
 892^, b. I have been thus led to consider the failures of iodine upon 
 the body in a state of health, in its ordinary doses, for the purpose of 
 contrasting them vv^ith some of the remarkaljle therapeutical influences 
 of which iodine is capable, and to show how the vital states are chan- 
 ged hi their relation to remedial agents by morbid states. This, how- 
 ever, may be equally instituted with many other very powerful reme- 
 dies, even those which are liable to act upon morbid states, in their 
 therapeutical doses, with the intensity of energetic poisons, or strike 
 at other alarming maladies, yet manifest no sensible effects upon the 
 healthy organism (§ 137 d, 150, 870 aa, 8921 5^ ^^ jv^q^e L p. 1120). 
 
 892|^, c. Perhaps the most remarkable demonstration of which io- 
 dine is capable is in those latent forms of disease where nothing is 
 present to denote the morbid state but some gradual change of organ- 
 ization. This is seen especially in bronchocele, for which affection it 
 surpasses, greatly, any other remedy. And here it may be said, as 
 indicative, in every aspect of the subject, of the vital philosophy of the 
 operation of iodine, that it is often as efficient in most of the local 
 forms of disease for which it is employed whether it be administered 
 internally, or applied externally. It is also an important fact, of the 
 same import, that the»external application must be made over the re- 
 gion of the affected part, when disease is seated internally ; in which 
 respect its mode of action through a reflex nervous process borrows 
 light from the modus operandi of counter-irritants. Its control over the 
 ordinary form of bronchocele is thoroughly established, and where it 
 has failed I have no doubt it has been generally owing to some defect 
 in the treatment (§ 893 a, c, e, m, 905f, 1059, 1088 b). 
 
 I say, the common form of bronchocele ; for there are some condi- 
 tions of the thyroid gland which nothing will reach ; which is one of 
 the endless exemplifications of the importance of addressing our rem- 
 edies to the exact pathological condition. Now the true bronchocele 
 is constituted by a low indolent action of an inflammatory nature, that 
 which results in hypertrophy ; better known at present as a " lesion 
 of nutrition." To these lesions iodine is adapted; and, although 
 it seek out the obstinate forms of disorganization, there are some 
 morbid changes of the thyroid gland which have been mistaken for 
 bronchocele where this agent has disappointed expectation, and has 
 suffered the blame of another's fault. Among these intractable con- 
 ditions are formations in the gland of o'ther substances than deposits 
 of lymph, such as stony and other concretions. Or, again, the organ 
 takes on a scirrous condition. Or, at other times, it enlarges sudden- 
 ly, and shows high vascular action, which ends in an effusion of serum ; 
 the gland becoming enlarged in consequence. But this condition is 
 not apt to remain long ; and, although it subside spontaneously, it is 
 not amenable to iodine. The remedies consist of leeches, vesicants, 
 &c. ; and, if such treatment be applied to the indurated states of 
 bronchocele, preliminary to the use of iodine, this remedy will not 
 often fail of accomplishing the residue of the cure. It is also indis- 
 pensable to subdue, in the first place, any attendant excitement of the 
 general circulation, or functional derangement of the chylopoetic vis- 
 cera. These, indeed, are important objects of attention, whatever be 
 tne nature of the disease for which iodine may be prescribed. Th^
 
 614 INSTITUTES OF MEDICINE, 
 
 external use of iodine, in the treatment of goitre, is net less efficient 
 than the internal ; so that both methods may be associated. Or, where 
 objections apply to the more constitutional mode, the local application 
 is often admissible. But iodine will not, like the mercurials, extend 
 its influence over the system through the medium of the skin. Its 
 effect is then by local reflex nervous actions {^ 497, 893 e, 1059, 1088 b). 
 
 892^, d. Soon after the discovery of iodine Dr. Coindet applied it 
 successfully to the cure of scrofula. His observations were soon fol- 
 lowed up by others; so that the claims of the remedy became early 
 established in respect to this most intractable disease. Numerous 
 cases and memoins were published, all tending to advance inquiry 
 into the new and extraordinary agent ; extraordinary as well in its 
 relations to the inorganic as the organic world. It was early and suc- 
 cessfully tried upon an extensive scale by Dr. Manson in various con- 
 ditions of sci'ofula, scrofulous ophthalmia, &:c. ; employed both inter- 
 nally and externally. Then followed Lugol, attached to the hospital 
 of St. Louis, who published three memoirs confirming the favorable 
 report of his predecessors. This naiTative seems to be due to the early 
 founders of a remedy which has already bestowed incalculable bless- 
 ings upon man ; approaching even cinchona, since we had in arsenic, 
 and numerous other means, pretty good substitutes for that. And 
 now, when we pause for a moment over the ciluntless numbers who 
 have been already rescued from the grave by iodine alone, and when we 
 attempt to think of the labyrinth of medical philosophy through which 
 the enlightened physician directs, with so much relief to the whole 
 race of man, the most potent, as well as the milder agents, of the Ma- 
 teria Medica, — ay, the rcmedium j^^i'ncipale itself, what shall be said 
 of that credulity of the public which reposes its confidence in the 
 charlatan, or yields the Paean triumph to an Apollo in surgery 1 
 
 Lugol's authority is valuable. His experience has scarcely been 
 improved. He employed the remedy internally and externally, and 
 treated the various conditions to which scrofula is liable, from the 
 simple glandular swelling, ulceration, abscess, &c., to its destructive 
 effects upon the cartilages and bones. An exception, however, must, 
 and probably always will, be made in respect to tuberculous phthisis. 
 He prefers a solution of iodine with the iodide of potassium, in water. 
 This he administered either in the form of drops, or largely diluted 
 with water under the denomination of ioduretted mineral water. It 
 has become, indeed, a standing formula ; but to which there is the 
 same objection as applies to all other analogous prescriptions. They 
 all require variations in the relative proportions of their constituent 
 parts, and lead to a neglect of the varying pathological states of a 
 common form of disease (§ 150, 672, 673, 857, &c.). It is doubtful, 
 however, whether the union of the iodide of potassium often increas- 
 es the efficacy of the simple iodine ; although the salt, being less 
 enei'getic, is often better adapted to irritable states of the alimentary 
 canal, or where the circulatory organs are liable to excitement. It is 
 readily seen, therefore, that for this reason the iodide of potassium 
 may be often united in variable proportions to the more active and 
 irritating form of the remedy. 
 
 892^, e. It should be considered, however, in reviewing the favora- 
 ble reports which have been made of a new remedy, that here, as in 
 most other cases, other observers have been less successful with iodine;
 
 THERAPEUTICS. IODINE. 615 
 
 though a general admission obtains that it is more useful in scrofulous 
 affections, with the exception of phthisis, than any other agent. This, 
 therefore, is sufficient to place it upon very high ground as it respects 
 the most Protaean disease. There is much reason to think, however, 
 that those who have been least successful have often failed fi-om not 
 having bestowed the same attention upon those general means of im- 
 proving health, such as diet, warm clothing, exercise, &c., which are, 
 of themselves, not unfrequently curative of scrofulous affections ; as 
 they are of syphilitic. When remedies are employed in any given 
 disease for the cure of which they have acquired the reputation of 
 specifics, we are often apt to rely too exclusively upon the supposed 
 specific, and the remedy, in consequence, frequently fails when it 
 would have succeeded under a proper regard for the subordinate 
 means. Failure in this respect may turn the " specific" into a form- 
 idable foe, especially in active forms of disease (§ 137 d, 150, &c.). 
 
 Again, since the early day, recent to be sure, of the wonder-work- 
 ing power of iodine, the reputed pathology of scrofula has undergone 
 a revolution ; and where abstraction of blood, general or local, a non- 
 stimulating diet, &c., were often considered necessary, especially in 
 the primary .stages of phthisis pulmonalis, a tonic and stimulant treat- 
 ment has been erected upon the new doctrine (§ 4, 5i. Also, Med. 
 and Phys. Comm., vol. ii., p. 608-634, 743-746, 780-782). From my 
 own observation, I can entertain no doubt that iodine is yet destined 
 to yield a subordinate aid in the treatment of tuberculous phthisis ; 
 while it will rarely fail to aggravate the disease if employed before 
 inflammation is brought under the discipline of the lancet, low diet, 
 &;c., or where the alimentary canal, or the system at large, is in an ir- 
 ritable state. — Note F p. 1114, Mm p. 1141. 
 
 S92i, y. Thirdly. The power of iodine, and of its combinations, 
 reaches yet farther, and more remarkably, perhaps, than as respects 
 its control over bronchocele. It has often accomplished the removal 
 of certain chronic affections which appeared to have been excluded 
 from the reach of every other medical agent. This has been especially 
 true of many cases of those affections which have run on to induration. 
 Here it is that iodine illustrates its remarkable virtues as an alterative, 
 in breaking up the most obstinate conditions of disease, changing en- 
 tirely the long-established morbid action of those capillaries from 
 which the deposition of a peculiarly modified condition of lymph 
 arises, and which forms some of the worst enlargements and indura- 
 tions short of carcinoma (§ 733y', 738, 740 a, b) ; while, also, its san- 
 itive effect must extend to the absorbent system of the part, increas- 
 ng its energy, and thus reducing the volume of the organ and restor- 
 mg it to its natural state. Mercury, it is true, will accomplish this in 
 some instances, but is comparatively inoperative, and they are beyond 
 the reach of quinine. 
 
 So also in those chi-onic enlargements and indurations of the liv- 
 er and spleen which form the sequelae of intermittent and remittent 
 fevers the Peruvian alterative finds a competitor in iodine, though 
 they will now harmonize together (§ 892, kk). Mercury, too, in some 
 of its forms, is also more or less applicable to these conditions. But, 
 to iodine we look with greater confidence in the intractable shapes ; 
 and here we may not calculate much upon the cinchona alkaloids. 
 Nevertheless, even here mercury may be often advantageously asso-
 
 616 INSTITUTES OF MEDICINE. 
 
 ciated with iodine ; and this is particularly true of bad forms of he- 
 patic induration. Iodine, however, is more apt to take in its thera- 
 peutical scope those enlargements of the spleen which are known as 
 ague cakes. They have often yielded to its influence in this and ir 
 other countries ; and sometimes, indeed, where the splenic induration 
 has been independent of fever, and where quinia is powerless (§ 662 a, 
 813 h, 814, 816 h, 892 hk). Leeching often promotes their effect. 
 
 The uterus, in its former intractable indurations and enlargements, 
 has frequently yielded of late to the alterative action of iodine. Even 
 when of a bony hardness, and filling nearly the cavity of the pelvis, 
 this condition of the uterus has given way to iodine in the space of 
 six weeks, the volume of the organ reduced to the natural size, and 
 the catamenia restored. Here the dependence was upon iodine alone; 
 and justly so, since there was no local or constitutional inflammatory 
 symptom to require the co-operation of a depletory treatment. But, 
 in other examples, where more or less active inflammation has at- 
 tended the uterine enlargements, local and general bloodletting, rest, 
 low diet, &c., have been brought advantageously to the successful use 
 of iodine (§ 855, 856). It is astonishing, too, with what rapidity these 
 conditions of the uterus have given way ; yielding entirely, in the most 
 successful cases, within periods varying from six weeks to four months. 
 
 These uterine cases, like the ophthalmic, illustrate the safety and 
 advantage of applying iodine directly to the affected part, wherever 
 accessible ; it being rubbed, in the fonn of an ointment, in the case of 
 the uterus, upon the neck of that organ. This practice has succeed- 
 ed especially where the neck of the uterus has been the special seat 
 of induration, and of those hard tumors which are liable to run into 
 ulceration. 
 
 Iodine has even made salutary impressions upon ovarian tumors; 
 and here, also, it is mainly useful in the indurated enlargements of the 
 ovaries, and probably little, if at all, in ovarian dropsy. 
 
 Leaving the uterine system for its associate mammary gland, we 
 have many accounts of its partial success, at least, in those scin-ous 
 affections which put on some of the aspects of cancer, but without its 
 malignancy ; relieving the distress, and holding the disease in check ; 
 while even cancer itself, and in its ulcerated state, is said to have de- 
 rived mitigation from the external use of iodine. 
 
 Few affections are more sad than enlargements and indurations of 
 the prostate gland ; and here, too, the sufferer has sometimes obtained 
 relief from this remarkable agent, both from its internal and external use. 
 
 The parotid glands swell up and remain permanently enlarged and 
 indurated after scarlatina, and from other transient causes ; and the 
 lymphatic glands become involved in the same way from sympathy 
 with diseased states of the stomach, or from other causes not connect- 
 ed with the scrofulous diathesis. In all these cases, iodine is the most 
 efficient agent ; at least, in a general sense. But these are cases, also, 
 for leeching ; which not only greatly heips the restorative change, but 
 imparts, also, greater efficacy to the iodine. Indeed, it is not unusual 
 that repeated applications of leeches to these glandular tumors, al- 
 though of an extremely indolent nature, will alone overthrow their 
 morbid states, and disperse the whole affection. It is a common mode 
 of treatment in my practice, and has often revealed an alteiative influ- 
 ence of the remedy of which cupping -= rncapable (^ 893 c, c, q, 926).
 
 THERAPEUTICS. lODINK. 617 
 
 892 1, g. Iodine has been employed internally and externally, with 
 various degrees of advantage, in chronic affections of the skin, such as 
 lepra, ichthyosis, psoriasis, &c., audit has been applied in the same vfa.y 
 to arrest the progress of phagedenic and other destructive ulcers, 
 which often put on favorable changes under the local as well as con- 
 stitutional effects of this agent ; which is also equally true of bromine. 
 
 8921^, 7i. Nor has secondary syphilis refused to yield to the power 
 of iodine ; and this, too, in cases where mercury has either failed, or 
 has aggravated the affection. But, these cases are not .common, and 
 we should not be led away from the better remedy by i-are exam- 
 ples of greater success from an agent which will commonly fail. 
 Where iodine has succeeded in cases of this nature, without the co- 
 operation of mercury, the syphilitic affection may have been under the 
 influence of the scrofulous diathesis (§ 659, 662 a). Besides the in- 
 ternal proof concerned in these cases, the foregoing conclusion is 
 strengthened by the emaciation, ulcerations of the skin and throat, 
 and the inflammation of the bones and periosteum, which often attend 
 cases where iodine has exerted an independent sway. 
 
 But iodine has succeeded most happily in syphilitic cases when 
 combined with mercury ; especially where syphilis has affected scrof- 
 ulous subjects. But simple iodine, true to its great prerogative of 
 overthrowing deep-seated mischief of chronic glandular inflammations, 
 has been successfully applied to old venereal affections of the testicles, 
 and to indolent buboes. 
 
 892^, i. Gonorrhoea and leucorrhoea, in their indolent states, have 
 been successfully treated by iodine ; especially so in scrofulous habits, 
 when the relief it yields is more uniform than in other cases. 
 
 892^, Ic. I stated just now, that iodine has been more successful in 
 real ovarian tumors than in simple ovarian dropsy ; but other drop- 
 sical affections have not escaped the far-reaching virtues of this new 
 agent; though I have not much to say in commendation of its efficacy 
 on this score. As in many other affections, it is evident that iodine 
 delights in the worst forms of dropsy, and is little disposed to grapple 
 with those simple conditions which depend upon mere inflammation 
 of the serous or cellular tissues. It makes its attack, rather, upon 
 those dropsies which nothing else will reach ; such as are symptom- 
 atic of organic affections of the liver, or kidneys, or spleen, or heart, 
 &c., and where a low inflammation is instituted, sympathetically, in 
 the serous tissue of the abdomen or thorax, as the immediate proxi- 
 mate cause, and kept up by the organic disease. And now we under- 
 stand how it is that iodine will sometimes reach these most formidable 
 dropsies, since it is the pecuhar province of this agent to break up old 
 organic lesions ; and, in exerting this astonishing office in regard to 
 the liver, &c., the cause which maintains the serous inflammation is 
 removed, and the dropsical affection disappears as a consequence. 
 Hence, again and again, the importance of looking well not only to 
 the nature of the pathological cause, but to all the complications with 
 which it may be attended, and their sympathetic relations to each oth- 
 er (§ 905). 
 
 8921, I. Iodine has been successfully employed as an emmenagogue 
 by most of the physicians who have illustrated its uses. My ovra ob- 
 servation leads me to believe that it is mostly useful in restoring men- 
 struation in subjects of a scrofulous diathesis ; and here it will be sal-
 
 G18 INSTITUTES OF MEDICINE. 
 
 utary, if not contra-indicated by irritable states of the btomach and in- 
 testines. But, even in such cases the iodide of starch, or the milder 
 sponge, may be admissible ; and this remark, it will be readily seen, is 
 more or less applicable to other affections attended by morbid irrita- 
 bility of the gastro-intestinal mucous tissue. 
 
 The same agent is also entitled to much consideration as an indirect 
 emmenagogue in all cases where suspended menstruation is complica- 
 ted with chronic enlargements or indurations of any of the great in- 
 ternal viscera. In these instances the uterine affection is only symp- 
 tomatic of graver disease, as, indeed, it may be said, in a majority of 
 other cases, to depend upon a primary though only simple derange- 
 ment of some other part, especially of the alimentary canal (§ 689 /, 
 905), the uterus being disturbed by reflected nervous actions. 
 
 892^, VI. Chronic rheumatism has proved itself amenable, in some 
 cases, to iodine. We shall find, however, much better remedies for 
 rheumatism, in all its aspects. But, it is not remarkable that a power 
 so sovereign in many other intractable maladies should sometimes 
 succeed in whatever less difficult and somewhat analogous instances 
 it may be brought to bear. It must be considered, also, that the 
 scrofulous diathesis is common, and that here iodine is at home. 
 
 892 '2, n. In the form of iodine vapor the novelty is even held up as 
 a remedy for pulmonary consumption by Sir C. Scudamore, Sir James 
 Murray, and others. But, it is scarcely probable that this condition 
 can be affected in any other way than through the constitutional 
 method, and it may be expected that the vapor will share the fate of 
 boiling tar, and the steam of the horse-stable. 
 
 8921, o. Gout has yielded to this potent but quiet remedy. The 
 swellings of the joints have given way not only in chronic, but in 
 some acute forms of the disease. Those practitioners who have em- 
 ployed it in the latter case are probably of them who cure the same 
 disease with bark and wine, and it has been overrated in the former. 
 With the same experimental views iodine has been administered in 
 diabetes mellltus ; but, whether it may be useful or detrimental in this 
 disease will depend, clearly, upon the circumstances of each individual 
 case ; especially upon the state of the digestive organs, which take an 
 important part in the pathology of diabetes (^ 1007 c). 
 
 8921, 2^- Iodine is employed by the surgeon for various local pur- 
 poses, among which many forms of ill-conditioned ulcers are the most 
 common. Here it often manifests its sanative influence, but more so 
 when the cases justify its internal use. It were well, too, if these 
 cases were oftener treated according to the precepts of medical phi 
 losophy and the experience of sound physicians. 
 
 8921, q. The ioduretted bath has been overrated, and the proof is 
 against the supposed absorption by the skin (^ 892^ c, 1088 h, c). 
 
 The details as to dose, &c., must be sought by the young inquirer 
 in the appropriate books. There, too, he will find some useful com- 
 binations of this with other substances, which have been brought to- 
 gether by the chemist, who is always laying the profession under these 
 high obligations. We shall not often want, however, more than the 
 simple substance, the iodide of potassium, the iodide of mercury, and 
 the iodide of starch. It is not improbable, also, that we may some- 
 times find in bromine, or some of its combinations, useful substitutes 
 for iodine.
 
 THERAPEUTICS. IDDINE. 619 
 
 892i, r. I have spoken of the iodide of starch as suitable in many 
 cases where the intestinal canal, or the system at large, is too irritable 
 for the more active forms of iodine. But, I am apt to think that, in 
 such cases, we may also fall back advantageously upon the vegetable 
 a'thiops, or upon the burnt sponge. They have done us service in 
 former times, and may do it again. 
 
 It is certainly a curious fact, in the history of the Materia Medica, 
 that the fucus vesiculosus and the sponge, one an unseemly weed of the 
 ocean, and. the other an anomalous organic being from the bottom of 
 the Mediterranean, should have been applied to the relief of broncho- 
 cele and scrofula, and have led to the important supplement which 
 the Materia Medica has enjoyed in the iodides and bromides. Nor 
 is it less curious that a remedy for the same affections had been de- 
 tected in the liver of the cod. 
 
 Although the day of these mysterious agents has passed away, — 
 passed in their uses and their mystery, — it may be that exigencies . 
 may now and then commend to our notice their quiet influences ; 
 when we may depend upon it we shall find organic nature as unde- 
 viating in these low conditions of life as in all other objects within its 
 comprehensive range. We shall always find iodine and bromine 
 among these humble tenants of the deep ; and, in doses of one drachm 
 to four of the calcined preparations, we may depend upon i-esults, it 
 not as certain and speedy as those of iodine or bromine, at least such 
 as will evince an efficient remedial power (§ 290, 350, nos. 25, 26. 
 26^,28). 
 
 892|, s. It sometimes happens when iodine, or its compounds, ins- 
 tate the intestinal canal, or the system at large, they may be rendered 
 compatible by small quantities of morphia, or the extract of hyoscya 
 mus, or of lettiice, &c. This interposition of narcotics, however, tc 
 promote the tolerance of iodine, demands great care; and the narcotic 
 must not be detrimental if the iodine were not employed. But, it 
 commonly happens, when iodine produces its salutary effects, that it 
 improves the appetite, if it have been deficient ; or, at least, does not 
 impair it. In a general sense, also, if the subject have been thin ho 
 gains in flesh under its influence. These affirmations can be made 
 of no other remedy, excepting bromine, of equal curative power. It 
 is often, indeed, upon the digestive organs that the fii'st salutary effects 
 of iodine are manifested ; as seen not only in the improvement of ap- 
 petite and digestion, but in the more abundant elaboration of bile, and 
 m a healthier aspect of the fecal discharges. Simultaneously, also, 
 the bowels act more freely ; and, when purging takes place during 
 the use of iodine, it is probably often more from the redundant flow 
 of bile which it has promoted than from the direct action of the rem- 
 edy upon the intestinal canal. 
 
 892^, t. Here, then, through these effects upon the organs of diges- 
 tion, we arrive at an interpretation of those salutary changes which 
 are exerted upon parts remotely situated. It is either a direct sympa- 
 thetic result, or the sympathetic consequence of the removal of disease 
 fi-om the abdominal viscera, by which the remote affections had been 
 maintained, as expounded in § 226, 503, 524 c, 893 a, c, 905. 
 
 892|, u. In a o-eneral sense, it has been found that a non-stimulant 
 diet promotes the salutary effects of iodine. This agent is, in itself, a 
 stimulant to the circulation in most of the morbid states to which it ia
 
 G20 INSTITUTES OP MEDICINE. 
 
 applicable ; and, while it heals by other virtues, its stimulant proper- 
 ties disqualify it for all active conditions of inflammation (§ 137 d^ 
 143 c, 150, 151). It is therefore an object in the lower forms of in- 
 flammation which come within the range of iodine to avoid increas- 
 ing the susceptibility to its stimulant virtues by stimulating food (§ 
 143 c, 55(i c, 872 a). In such conditions, indeed, abstemiousness, in 
 respect to food, is in itself directly curative (§ 150, 856, 863, 1007 h-d, 
 1008). 
 
 But, there are some conditions to which iodine is peculiarly suited, 
 [)articularly bronchocele, when the general health is often sound, and 
 when the ordinary diet may be pursued (§ 143 c, 150, 151, 8921^ a). 
 In most other affections to which iodine is adapted the general health 
 is apt to be unsound, and the local affections of a distinctly inflamma- 
 tory nature. 
 
 892^^, V. When speaking of cinchona and other special remedies for 
 specific forms of disease (§ 892 b), I endeavored to demonstrate not only 
 their therapeutical eff*ects through alterative reflex actions of the nerv- 
 ous system, but, by the variety of means leading to a common result, 
 the absurdity of the humoral and chemical hypotheses, and I would now 
 reproduce that section in connection with iodine ; nor would it be less 
 appropriate to the article upon arsenious acid (§ 892;^). The great va- 
 riety of special forms of disease which iodine and arsenic will remove 
 contributes to the demonstration (§ 892^ i, 892|^, 900, 902, 951 c). 
 
 892|, a. The origin and special character of ergot have been only 
 recently well determined. Many have supposed it to be a morbid 
 conversion of the seed, produced by some insect. Others regard it 
 as a parasitical fungus ; and it is incorporated by them as a true 
 plant in the genus selerotium. It has been shown, however, by Tes- 
 sier, and others, that a part only of the grain sometimes becomes er- 
 gotized ; which proves sufficiently that it is not a fungus. The stig- 
 ma, too, often remains at the top, and the ergot, like the rye, is inti- 
 mately connected with the receptacle. Other observations, more re- 
 cently made, prove conclusively that the microscope has been at fault, 
 even in this very visible and hard substance, in its report of parasiti- 
 cal fungi as constituting the ergotized rye {§ 83 b, 131). The ergot 
 is now sufficiently shown to be a morbid degeneration of the rye. 
 
 892 ry, b. Ergot was introduced into regular practice, as a powerful 
 agent for exciting uterine contractions during the process of labor, by 
 the venerable John Stearns, M.D., of the city of New York, in a 
 letter to Dr. Ackerly, in 1808 ; though it had been a popular means 
 of expediting labor a century and a half ago, in Germany, Italy, and 
 France. 
 
 This letter of Dr. Stearns has not often met the public eye, nor has 
 that reward attended the service which it was the delight of darker 
 ages to bestow upon the great benefactors of man. The letter, too, ia 
 interesting from the brevity with which it announces a most impor- 
 tant discovery (new at least to the profession), for the perfect accuracy 
 with which the effects are described, and for the precautions which 
 Dr. Stearns had the sagacity to suggest as to the circumstances under 
 fvhich this aerent should be administered, but which have been most 
 strangely violated by others.
 
 THERAPEUTICS. ERGOT. 621 
 
 The brief statement, which has now gi'own into volumes, of the 
 wonderful properties of ergot, and of the only known substance which 
 is capable of exciting uterine contractions, contrasts in its brevity and 
 modesty not less remarkably with the never-ending and inflated ac- 
 counts which are often coming to us of worthless specifics, and more 
 worthless speculations, than does the decisive power of ergot form an 
 imposing contrast with the whole host of those pretended remedies 
 which have fallen into oblivion, one after another, when their ineih- 
 ciency has been proved by an adequate sacrifice of human life. 
 
 But let us once more call into light the original announcement. 
 Thus the letter : 
 
 " In compliance with your request, I herewith transmit to you a 
 sample of the pulvis parturicns, which I have been in the habit of 
 using for several years with the most complete success. It expedites 
 lingering parturition, and saves to the accoucheur a considerable por- 
 tion of time, without producing any bad effect on the patient. 
 
 " The cases in which I have generally found this powder to be useful, 
 are when the pains are lingering, or have wholly subsided, or are in any 
 way incompetent to exclude the foetus. Previous to its exhibition, it 
 is of the utmost consequence to ascertain the presentation, and wheth- 
 er any preternatural obstruction prevent the delivery ; as the violent 
 and almost incessant action which it induces in the uterus precludes 
 the possibility of turning. The pains induced by it are peculiarly 
 forcing, though not accompanied by that distress and agony of which 
 the patients frequently complain when the action is much less. My 
 method of administering it is either in decoction or powder. Boil 
 half a drachm of the powder in half a pint of water ; and give one 
 third every twenty minutes till the pains commence. In powder 1 
 give from five to ten grains. Some patients require larger doses, 
 though I have generally found these sufficient. 
 
 " If the dose be larger, it will generally produce nausea and vomit- 
 ino-. In most cases you will be surprised with the suddenness of its 
 operation. 'It is, therefore, necessary to be completely ready before 
 you begin the medicine, as the urgency of the pains will allow you 
 but a short time afterward. Other physicians who have administered 
 it concur with me in the success of its operation. 
 
 " The modus operandi I feel incompetent to explain. At the same 
 time that it augments the action of the uterus, it appears to relax the 
 rigidity of the contracted muscular fibres. 
 
 " It is a vegetable, and appears to be a spurious growth of rye. On 
 examining a granary where rye is stored, you will be able to procure 
 a sufficient quantity among the grain. Rye which grows in low, wet, 
 ground yields it in greatest abundance. I have no objection to youi 
 giving this any publicity you may think proper." — John Stearns, in 
 Neiu "York Medical Repository, vol. xi., p. 308, 1808. 
 
 That is the whole ; correct in every aspect, and without a practical 
 improvement from that day to the present; unless it be an extension 
 of some of the minor points which are embraced in the comprehen- 
 sive statement of the discoverer. It may, therefore, stand as an admi- 
 rable concentration of all the leading details relative to this great ac- 
 cession to the universal cause of humanity and medical science. It is 
 the best general guide for the practitioner that can be devised, and 
 had it been duly posted in medical journals and obstetrical works, in-
 
 622 INSTITUTES OF MEDICINE. 
 
 Stead of some of its violations which have appeared from time to time 
 it w^ill be conceded, I catmot doubt, that I am not astray from the ob 
 jects of the present work in bestowing an ample notice of the origin 
 of an important remedy which stands alone in the natural world. 
 
 No sooner was this discovery announced than its value was pro- 
 claimed in different quarters, not only by a confirmation of the impu- 
 ted virtues of ergot, but by an opposition to its use on account of those 
 very attributes of the remedy. It was said to be dangerously violent 
 in its uterine influences. And so it is, like all things else in their 
 various relations to disease unless employed with a proper reference 
 to "precaution" (§ 137 d, 143 c, 150, 151). 
 
 With others there was not a ready disposition to concede the merit 
 of originality, and records were hunted up for the purpose of showing 
 that ergot had been long before in the hands of the common people, 
 about in the same way as had been the cow-pox before Jenner confirm- 
 ed its protective power. But, whether the former was of any greater 
 use than motherwort the profession had not troubled themselves to 
 inquire. 
 
 Frightful accounts were also quoted of wide-spread and fatal epi- 
 demics, which had been commonly charged upon rye, of which ergot 
 was supposed to be the insidious cause (§ S92|, I). A more feebla 
 conjecture was never assigned for epidemics ; unless the hypothesis 
 be excepted, that damaged rice was the cause of the malignant chol- 
 era in Asia and Europe, because the patients had " rice-water evac- 
 uations :" and, also, that the milk of cows in some of our Western 
 States is the cause of a malignant form of miasmatic fever [Med. and 
 Physiolog. Cojnm., vol. i., p. 537-539). 
 
 Other writers entered the field against the new agent in other 
 shapes ; some of them denouncing the remedy as invariably fatal to 
 mother and child, while others affirmed that it was as inert as rye itself. 
 
 But time puts all things right, though it may come too late for him 
 who should reap the reward. Hai'vey lost all his practice because of 
 the envy which was excited by his discovery of the ciPculation of 
 the blood ; and nothing but demonsti'ation upon demonstration to the 
 eyes of the multitude rescued Jenner from the execration which he 
 received because he had been so unfortunate as to render a great ser- 
 vice to his cotemporaries. Newton, too, was so annoyed by opposi- 
 tion that he regretted his pursuits, and has left, in consequence, his 
 stamp upon the very front of Philosophy, that she is " a capricious 
 maid." But there is this consolation, as Bacon has it — "The sweetest 
 canticle is, ' Nunc dimittis,^ when a man hath obtained worthy ends and 
 expectations. Death has this also, that it openeth the gate to good 
 fame and extinguisheth envy : ' Extinctus amahitur idem.'' " 
 
 It was not so in the early ages of our art ; and had Har\'ey, or Jen- 
 ner, or Stearns, have lived at that remote period, temples would 
 have overspread the land for the perpetuation of their names, and aa 
 grateful memorials for their services to the universal family of man- 
 kind. 
 
 892?-, c. Ergot is poisonous to flies, leeches, and some other small 
 animals. In very large quantities it is said to be destructive to dogs, 
 cats, pigs, sheep, rabbits, fowls, &c. But this effect has been evident- 
 ly overrated, since it appears that some ounces were necessary to 
 affect rabbits and pigeons. Sheep are put down by Pereira, in his
 
 THERAPEUTICS. ERGOT. 623 
 
 Materia Medica, among the animals that are liable to be poisoned by 
 ergot. But a little farther on he says that, "In 1811, twenty sheep 
 ate together nine pounds of it daily for four weeks, without any ill ef- 
 fects. In another instance, twenty sheep consumed thirteen pounds 
 and a half daily, for two months, without injury." And then as to 
 other animals : " Thirty cows took together twenty-seven pounds dai- 
 ly, for three months, with impunity ; and two fat cows took in addition 
 nine pounds of ergot daily," with no ill effect whatever. 
 
 The same conflicting statements are made as to the effects of ergot 
 on man in health ; some affirming that in doses of half a drachm to two 
 drachms it excites nausea, occasions pain in the head, dilated pupils, 
 &c.; while other experimenters declare that it produces no effects what- 
 ever. This is probably the fact; since we have heard of only some very 
 rare cases in which it has had any other effect upon the susceptible preg- 
 nant, or parturient female, than that of exciting uterine contractions. 
 We may, therefore, conclude that the fractional number of some fire 
 or six cases in which delirium or stupor is said to have resulted from 
 doses of half a drachm to two drachms was due to other causes ; 
 especially when it is considered that such affections of the head are 
 not unusual with parturient women where no ergot has been exhibited. 
 
 Universal and large experience has settled the fact that ergot has 
 no special influence on the nervous system, and that, in its therapeu- 
 tical doses, at least, it is perfectly inoffensive when administered with 
 the proper " precautions" that are relative to the uterine system. This 
 consideration, therefore, imparts an inestimable value to the uterme 
 agent; and the other attending circumstances go with iodine, arsenic, 
 &c., in reprobating all conclusions as to the therapeutical virtues of 
 any agent which are associated, as inductions, with its manifestations 
 upon man in health, and especially upon the modified constitution of 
 animals, or the yet greater modifications that are presented by vege- 
 table life. There is no other agent known to possess virtues anal- 
 ogous to those of ergot, while, also, its only manifest influences are 
 pronounced under special modified states of the uterus. But, perhaps 
 you say, and truly, too, that other things will excite abortion, or some- 
 times hasten natural labor. But, in all such cases, the results depend 
 on very different influences ; on some violence inflicted on other parts, 
 or some uterine or other malady which may be thus removed. Can- 
 tharides may have sometimes excited abortion ; but, if this be true, it 
 is practically useless, rare in the effect, and obnoxious to other palpa- 
 ble objections. The highest practical as well as philosophical consid- 
 erations r>re every where involved in the principles now, again, under 
 investigation (§ 137 d, 143 c, 150, 151, 650, 831, 836, 854 bb, 857. 
 859 b, 892 c, 892i b, &c.). 
 
 892^, d. The next question which comes up relates to the circum- 
 stances under which the uterus is susceptible of the influences of this 
 specific agent ; for this one may be so regarded till others may appear 
 which will accomplish the same results. 
 
 Such is the remarkable action of ergot after labor has been institu- 
 ted, especially after the usual period of gestation, that it was natural, 
 perhaps, to suppose that the agent can bring on the process by its own 
 specific virtues (§ 143 c, 150, 151, 652 c, 863). Experiments have 
 been accordingly made upon animals to ascertain whether abortion 
 would be thus brought about; but Villeneuve. Warner, ChatU'd, and
 
 624 INSTITUTES OF MEDICINE. 
 
 others, have failed in all their attempts, whether the ergot be injected 
 into the circulation, or administered by the stomach (§ 150, 151), 
 But this would not prove that abortion may not be thus instituted in 
 the human subject (§ 892|, c). And to show how deeply founded in 
 nature are some of the important laws embraced in a former section 
 (§ 150), it is worthy of remark that ergot commonly promotes the ute- 
 rine contractions in dogs, cats, sheep, cows, deer, and, indeed, of all 
 other animals, so far as tried, after natural labor has been for some 
 time in progi'ess ; even where the uterus has become exhausted by 
 its long-continued efforts. 
 
 As to the human female, there is probably not much doubt that er- 
 got is capable of exciting abortion. The vital relations, in the preg- 
 nant state, are more or less in correspondence with the virtues of the 
 agent (§ 143 c, 150, 189 b, 892| c). The question is stated in the 
 following manner by an adequate observer, and who believes in this 
 remarkable virtue of the great uterine agent : 
 
 " Given," he says, " to excite abortion, or premature labor, ergot 
 has sometimes failed to produce the desired effect. Hence many ex- 
 perienced accoucheurs have concluded that for this medicine to have 
 any effect on the uterus it was necessaiy that the process of labor 
 should have actually commenced. But, while we admit that it some- 
 times fails, Ave have abundant evidence to prove that it frequently 
 succeeds." Other able observers testify to this fact; Miiller, Rams- 
 botham, and other familiar names. 
 
 It is evident, too, that ergot is capable of acting upon the uterus, 
 and of exciting contractions of the organ, in its unimpregnated state, 
 when its susceptibilities are increased by disease (§ 143 c, 150, 151, 
 177, 189 h). Uterine polypi have been thus expelled, and menor 
 rhagia arrested. 
 
 But, this ceases to be remarkable when it is considered how great- 
 ly changed is uterine irritability in a state of pregnancy ; when the 
 most trifling causes, such as lifting a chair, putting up window-cur- 
 tains, sudden joy, sudden surprise, or grief, will rouse the muscular 
 action of the impregnated uterus, and bring on abortion (§ 150, 151, 
 189 b, 227, 233, 233f , 904 d). If we now add to the foregoing con- 
 siderations the increasing tendency to abortion in proportion to the 
 frequency of its occurrence, it may aid our philosophy of life in its 
 general aspects, and concur with other facts in a specific illustration 
 of what I have propounded as to the laws of vital habit (§ 535-567). 
 
 Our experimental knowledge, however, as to the ability of ergot to 
 institute labor must be always limited ; for opportunities must be 
 rare in which a physician of any moral sense, and therefore of any 
 reliable truth, would administer this, or any other agent, with a view 
 to producing abortion. Even in the very limited number of cases 
 where art is called upon for this solemn duty it rather seeks the me- 
 chanical method. 
 
 Connected with the difficulty of attaining an adequate knawledge 
 of the power of ergot of inducing abortion (especially the extent of 
 its power), are the numerous mistakes that have been made in respect 
 to other supposed effects of this substance ; particularly those which 
 are relative to the epidemics, and which continue to be more or less 
 ascribed to its malign influence. But, what is more to the present 
 pu rpose is the important fact, that, although now as in the " epidemic "
 
 TIIERAPKUTICS. ERGOT. 625 
 
 times (p, 622), doubtless, rye largely compounded with ergot is ha- 
 bitually and very extensively consumed, we have never heard, as one 
 of its evil consequences, that it has given rise to abortion. This un- 
 deniable truth, therefore, must settle the question, at least, as to any 
 uniformity in this imputed effect of ergot, and turn our attention to 
 the mechanical means when the interposition of art is required, and 
 our scrutiny to other expedients in detecting the criminality of oth- 
 ers. A right decision of the question is one of great interest, not only 
 in a philosophical aspect, but on account of its practical bearings, 
 and, also, in a medico-legal aspect. — Note A p. 1111. 
 
 892|, c. It may now be said to the young practitioner, that he 
 should bear in mind that the expulsive efforts are made by the uterus, 
 that all the devices of the lying-in chamber, such as straining, pulling, 
 &c., are worse than useless , that the uterine contractions are in- 
 creased in violence and frequency soon after the administration of er- 
 got, and that they generally go on increasing till the birth is effected. 
 Indeed, the parturient process sometimes continues, under the influ- 
 ence of the agent, for several minutes after the expulsion of the pla- 
 centa ; but it commonly ceases, so far as the ergot is concerned, after 
 delivery is consummated (§ 150, 151, 652 c). 
 
 892|, f. The rapid and energetic action of the uterus led Dr, 
 Stearns to say, that, among other things, it is " of the utmost conse- 
 quence to ascertain whether any preternatural obstruction prevent 
 the delivery;" and, from what is also said of the circumstances which 
 justify the use of ergot, it is evident that the discoverer considered a 
 full dilatation of the os uteri of indispensable importance to any thing 
 like a safe i"esult. He foresaw that the uterus might otherwise be 
 ruptured, or the external parts lacerated, or the child destroyed by 
 the rapidity with which its head would be forced along the yet rigid 
 parts. He foresaw, I say, a violation of nature if the foregoing con- 
 dition were not awaited. And how fearfully has this been verified in 
 pi-actice ; especially as it regards the foetus ! Why the vast differ- 
 ence in results in the hands of different accoucheurs 1 Why the nu- 
 merous cases of cerebral hemorrhage in still-born ehildren, that have 
 come up, of late, for the good of science 1 The question is readily 
 expounded when we turn to those Essays in which it is affirmed that 
 ergot may be administered when the mouth of the uterus has attained 
 the diameter of half an inch ! This has been recommended princi- 
 pally with a view to saving the time of the practitioner ; and it opens 
 to us the ground of the prejudices, which have sprung up in enlight- 
 ened and more honest quarters, against the use of ergot when it can 
 be possibly avoided. Where the safety of the mother does not re- 
 quire earlier interference, it is, doubtless, a good rule not to adminis- 
 ter ergot till the head of the child has passed the brim of the pelvis, 
 and the labor has become lingering. 
 
 If the remedy be delayed till the os uteri is well dilated, then, by 
 an admirable concert of sympathy, the external parts will have either 
 undergone a corresponding dilatation, or a tendency to an easy dila- 
 tation (§ 150, 151, 385, and references). 
 
 892|, g. " Previous to the exhibition of ergot," says the discoverei, 
 " it is of the utmost consequence to ascertain the presentation ;" and 
 now the only question that arises is relative to the admissible presenta- 
 tions. The OS uteri is, of course, supposed to be fully dilated ; and it 
 
 R B
 
 626 INSTITUTES OF MEDICINE. 
 
 appears to be conceded that ergot may be employed when tne head is 
 turned from its usual position. But, this is not auspicious. Breach 
 presentations admit of its use where labor has become prolonged, and 
 the pains suspended ; though here manual aid may be safely applied 
 without the forceps. These instruments are always difficult but in 
 the hand of experience, and are otherwise more or less liable to ob- 
 jection. 
 
 S92|, h. It is not alone in protracted labors, where the uterine ef- 
 forts have ceased to be efficient, that ergot is applicable with a view 
 to promoting delivery. Serious hemorrhages sometimes spring up, 
 where it becomes important to hasten delivery by every possible means 
 that may be less hazardous than the impending evil. In cases of this 
 nature, especially when alarming hemorrhage comes on during natural 
 labor, and the attachment of the placenta is right, we enjoy no means 
 so likely to insure safety and immediate success as offered by ergot ; 
 so only the pelvis be not deformed, and the presentation suitable, 
 
 892|, i. So, also, in ordinary cases of abortion, where hemorrhage 
 may become alarming, ergot may be employed to hasten the expul- 
 sion of the ovum, and arrest the flow of blood. In these instances, 
 howevei", the tampon is probably preferable, since it is always sure, 
 and it is not certain that abortion will happen. 
 
 892|, h. Some females are remarkably liable to profuse uterine 
 hemorrhage after natural labor ; and these are cases for the adminis- 
 tration of ergot a few minutes before the expulsion of the child ; what- 
 ever may be the activity of the uterine contractions. In such instan- 
 ces it is not unusual for the pains to be quite energetic throughout the 
 labor, but to cease abruptly as soon as the child is born. The advan- 
 tage of ergot, therefore, administered some fifteen or twenty minutes 
 before birth takes place, consists in its disposition to maintain the ute- 
 rine contractions till the organ is so reduced in volume that hemor- 
 rhage is prevented or arrested. 
 
 892|, /. Again, where the forceps cannot be used in puerperal con- 
 vulsions, ergot may be rendered a valuable substitute. The objec- 
 tions which have been made to its use in this condition, on the ground 
 of its tendency to affect the head, appear to be hypothetical. In any 
 thing like its therapeutical doses, the common experience of mankind 
 has fully settled the fact that it has no tendency to induce or to increase 
 cerebral or any other condition of disease, excepting as it may increase 
 convulsions sympathetically through its uterine influences. 
 
 The erudite Pereira, in his Materia Medica, pauses over the exhibi- 
 tion of ergot in puerperal convulsions, because, as he says, " The nar- 
 cotic operation of ergot presents a serious objection to its use in cere- 
 bral affections" (§ 960, a). 
 
 There existed a remarkable prejudice against ergot throughout 
 Great Britain, for many years after it had come into extensive use in 
 other countries, on account of the stories about its having produced 
 wide-spread epidemics at former periods. Indeed, it was not em- 
 ployed, I think, in England, till the year 1824, or about sixteen 
 years after it was in successful use in America. Some of the old prej- 
 udices remain in Great Britain, and where they exist the risk of that 
 formidable affection, puerperal convulsions, will be taken sooner than 
 one of its most efficient means of relief will be employed. We uee^ 
 "not inquire, in the foregoing cases, whether the os uteri be dilated, so
 
 THERAPEUTICS. ERGOT. 627 
 
 only labor have fairly begun. But, we may not precipitate ourseU'es 
 at once upon ergot. There is something else to be done first. The 
 patient, I say, should be first thoroughly bled, as a preliminary requi- 
 site, not only on account of the cerebral affection, but to place the 
 whole genital organism in a most favorable state for a ready expulsion 
 rf the child. Let each remedy come in its appropriate place. A vi- 
 olation of their proper order of sequence may be fatal, and doubtless 
 has been (§ 960, a). The specific, as it is called, is, or should be, oft- 
 en the last in the consecutive series. If cerebral disease be not first 
 moderated by loss of blood, the increased uterine irritation occasion- 
 ed by ergot cannot fail to increase the evil in the head of which it had 
 been the sympathetic cause. But, loss of blood strikes both at cere- 
 bral and uterine disorder. Nor have I any doubt that, where any cere- 
 bral symptoms have sprung up after the employment of ergot in its 
 therapeutical doses, they have been due either to entirely different 
 causes, or to the use of the agent at so early a stage of labor that an in-" 
 jurious violence has been inflicted on the uterus, and thus sympathet- 
 ically upon the nervous centres (§ 230). There has been great rash- 
 ness in the use of ergot, from an unnatural haste of some practitioners 
 to get rid of their patients in one way or another. It is this haste 
 which I would reprobate, as, also, a careless administration of ergot 
 without a due reference to a proper state of the local requisites, and 
 its employment in such excessive doses as render uterine action inju- 
 riously violent (§ 878). In such instances, we need not be surprised 
 at any untoward result; and, if the uterus be ruptured, or the child 
 destroyed, or the nervous system shaken at its centre, we may not 
 blame the remedy. 
 
 892|, 7rt. In cases where the placenta is retained from want of prop- 
 er uterine contractions, ergot, if employed soon after the birth of the 
 child, rarely fails of its purpose. The longer, howevei', its adminis- 
 tration is delayed, the less likely will it be to reproduce the uterine 
 contractions. Nature has accomplished her great purpose after the 
 expulsion of the child ; and if, from artificial influences upon the hu- 
 man constitution, she pause at her remaining office, it may often be 
 that she is prematurely started upon her recuperative process, in 
 which she now makes all haste to her wonted station. But, whether 
 so or not, experience assures us that uterine imtability undergoes 
 changes very rapidly after the expulsion of the foetus, and that, in the 
 same ratio, the reflected nervous influences induced by ergot fail of 
 acting upon the muscular tissue of the organ (§ 150, 151). 
 
 892|, n. Where retention of the placenta depends upon spasmodic 
 action of the uterus, or is owing to morbid adhesions, ergot yields no 
 benefit, and may be injurious. The former condition certainly consti- 
 tutes a serious objection to its use. The reason is, that one part of 
 the organ is now in a more irritable state than the rest, and ergot, 
 therefore, will act with unequal effect and increase the spasm; just 
 as a cathartic will increase spasm of the intestine which depends upon 
 some inflamed portion of the mucous tissue of that organ (§ 150, 151). 
 
 892|, 0. Our parturient agent has shown itself capable of arresting 
 uteiine hemonhage in the unimpregnated state, and that it is a use- 
 ful agent in monorrhagia. Here it displays another attribute, and 
 yet another differing from the astringent virtue. It does not now act 
 as in the foregoing cases, as is evident from its failure of inducing any
 
 628 iNSTirorEs of medicine. 
 
 of the phenomena of uterine contraction, while, moreover, the uterus 
 is ah-eady in its contracted state. Its effect, in these cases, is like 
 that of common salt, or of ipecacuanha, in restraining hsemoptysis. 
 That is to say, of the individual substances, each one exerts some 
 change in the action of the part peculiar to itself, but differing more 
 or less from that of astringents, by which the secretion of blood is ar- 
 rested (§ 904 d, 890, a). 
 
 Again, it is said that ergot has been successfully employed in hem- 
 orrhages from the stomach, intestine, lungs, nose, and gums ; all of 
 which concurs in farther illustrating the modus operandi of the pure 
 astringents, and of ergot in restraining monorrhagia. It should be 
 added, however, that the anti-hemorrhagic effect of ergot, except as 
 it respects the uterus, has been overrated. 
 
 892§ p. All the foregoing effects of ergot, from its excitement of 
 uterine contractions to its restraint over hemorrhage, are demonstrative 
 of its operation through reflex action of the nervous system, and, with 
 a multitude of other things which I have brought to the attention of 
 the reader, supply a ground of analogical induction as to the modus oper- 
 andi of all other remedies (§ 893^). — Note A, on the cattle of Labor. 
 
 EMMENAGOGUES. 
 
 892|^, q. In the foregoing sections I have been so near upon em- 
 menagogues, and as the right treatment of amenorrhoea concerns so 
 nearly a vast number of important cases, I shall briefly state the re- 
 sults of my own observation in connection with this subject, and with 
 a view, also, of multiplying illustrations of the principles which form 
 the ground-work of these Institutes. 
 
 Emmenagogues are arranged in my Materia Medica under the gen- 
 eral denomination of Uterine Agents, of which ergot is the first, can- 
 tharides the second, and guaiacum the third in importance. I drop- 
 ped the usual denomination which appears in this section, partly with 
 a view of moderating a common belief that suspended menstruation 
 is to be always ti-eated by some agent bearing the name of an em- 
 menagogue, as the name chlorosis leads to medication of the blood. 
 
 All the agents comprised in this group possess virtues that exercise, 
 more or less, extensive though various influences upon the uterine 
 system. In consideration of this known relation, such of them as 
 have received, the appellation of emmenagogues (of which cantharides 
 and guaiacum are the principal) are apt to be employed, with a ref- 
 erence alone to the prominent symptoms attending amenorrhoea. 
 But, when the failure of the uterine function stands by itself, all the 
 emmenagogues may be inapplicable on account of some special mor 
 bid state of the uterus upon which the cessation of the discharge de- 
 pends. They are always contra-indicated, cantharides and guaiacum 
 especially, in all inflammatory and irritable states of the uterus ; at 
 least, till these conditions are overcome by antiphlogistic means 
 They are also inadmissible where menstruation is only suspended, by 
 some direct influences, as from exposure to cold, &c. ; and they are 
 positively injurious where the suspension depends upon sympathetic 
 influences propagated by some active form of disease in other organs. 
 
 892|, r. In a large proportion of cases amenorrhoea is consequent 
 on chronic maladies of the chylopoietic viscera, when uterine remedies 
 are often administered with reference to the remote consequence;
 
 THEHAPEUTICS. EMMENAGOGUES. b29 
 
 and the condition of the important organs in which the uterine em- 
 barrassment had its origin, and by which it is commonly maintained, 
 is apt to be overlooked or neglected. Where, however, the abdom- 
 inal derangements are sufficiently pronounced to attract attention, it 
 is not less common to look upon these primary causes as the results of 
 a mere failure of the uterus to excrete its natural product. This inter- 
 pretation comes of the humoral pathology, and is one of the every-day 
 practical illustrations of the amount of its philosophy. 
 
 But, menstruation has a totally different final cause than humoral- 
 ism imagines (§ 428-432). The evils which are imputed to a fail- 
 ure of the evacuation depend but little upon this circumstance. They 
 are due, on the contrary, to the morbid state of the organ throuo-h 
 which the excretion fails ; and this condition is various in its patho- 
 logical nature. According, also, to the pathological state of the ute- 
 rus, other things being equal, will be the nature and amount of its 
 disturbing reflex nervous influences. In a large proportion of cases, 
 however, the uterus suffers but little, and its function returns as soon 
 as the remote influences are overcome. 
 
 Hence, it is obvious that the main treatment should be addressed 
 to the organs of the abdomen in all the cases included in this sec- 
 tion. The state of the uterus, it is ti-ue, reacts upon the prim.ary and 
 leading seats of disease ; but generally feebly (§ 905, a). Local means 
 should, therefore, go along with the more constitutional ones ; such as 
 leeching the perineum, exercise on horseback, the hip-bath, &c., ac- 
 cording to the general nature of the case. 
 
 892|, s. The foregoing view of our subject inculcates a variety 
 of treatment in the multifai'ious aspects of amenorrhoea, and regards 
 all things as emmenagogue, in principle, which will restore the ute- 
 rine function ; though that be commonly one of the least important 
 effects. A cathartic may be best when menstruation is suddenly ar- 
 rested by exposure to the cold, or a hot bowl of motherwort may do 
 as well. Bloodletting is the main remedy when amenorrhoea is ow- 
 ing to inflammation or congestion of the uterus, whether it be prima- 
 ry or secondary. Exercise in the open air, especially on horseback, 
 chalybeate tonics, mercurial and aloetic laxatives, a well-regulated 
 diet, &c., are the means when it is dependent on indigestion (^ 892 J v). 
 
 892|, t. Having accomplished the leading intentions in the chronic 
 forms of amenorrhoea, if the uterus still fail of excreting the menses, 
 those agents which are known as emmenagogues may then be called 
 into use ; and of these, cantharides, administered till slight strangury 
 takes place, is not only the most efficient, but far the safest. Guai- 
 acum is liable to irritate the stomach injuriously, and to stimulate, un- 
 favorably, the whole system, and especially the uterus. There are 
 many cases, however, in which the uterus may ultimately require this 
 peculiar irritation, or where certain states of constipation will yield, 
 happily, to the action of guaiacum ; but they require a sounder refer- 
 ence to the exact condition of the organ than when cantharides is em- 
 ployed. The uterus, indeed, is so liable to an interruption of its men- 
 strual function that slight degrees of indigestion will occasion its fail- 
 ure ; and in these cases cantharides will generally be entirely compati- 
 ble with the abdominal affection, and sufficient in itself to re-establish 
 menstruation. This variety of things leading to a specific result can be 
 expounded only through alterative reflex actions of the nervous systerr» 
 (See Genito-Urinary Agents, p. 683-689).
 
 630 INSTITUTES OF MEDICINE. 
 
 DIURETICS. 
 
 892f , a. Diuretics are agents which increase the urinary discharge, 
 and are employed either for that purpose specifically, or more com- 
 monly with an indirect reference to dropsical affections, upon which 
 they are supposed to operate by promoting the absorption of the fluid 
 and its excretion by way of the kidneys. 
 
 8925, J, On looking over this group of remedies, it will be at once 
 seen that it is obnoxious to objections which I have made to other 
 groups, and that, as in the former cases, the denomination of diuret- 
 ics must be received with special qualifications. Many remedies, also, 
 are not embraced in the group which are capable of producing, under 
 particular circumstances of disease, the most powerful diuretic effect. 
 This is especially true of cathartics, and of some of them to so great 
 an extent as to have procured for them the appellation of hydrogogue 
 cathartics, or such as are capable of expelling dropsical effusions. In- 
 deed, I may say that cathartics are better entitled to the name of diu- 
 retics than any other group of remedies ; since no one of them oper- 
 ates upon the intestine without very generally increasing the excre- 
 tion of urine ; and, as to their relative effect in subduing dropsical 
 affections, they greatly surpass the diuretics proper. The latter agents 
 scarcely extend their influences beyond the kidneys ; while cathartics 
 accomplish their work as diuretics by overcoming the diseases upon 
 which dropsical effusions depend, and by thus, also, withdrawing mor- 
 bific reflex nervous actions which those or other diseases inflict upon 
 the kidneys, and, thirdly, by exciting the kidneys to a freer production 
 of urine (^ 227, 422 h, 423, 516 d, no. 6, 524 c, 889 a, 891| l, 892^ k, t). 
 
 These remarks relative to cathartics lead me to advert to their con- 
 trol over dropsical affections as one of the demonstrations that dropsy 
 depends upon inflammatory conditions. That pathological cause be- 
 ing removed by the antiphlogistic virtues of cathartics, the redundant 
 effusions cease. The modus operandi is shown in the last references. 
 
 Bloodletting, which is not among diuretic remedies, has often as 
 gieat an effect as cathartics, often greater, in establishing a copious 
 production of urine, where it has been greatly diminished or suspend- 
 ed. And, from what was just said of the pathology of dropsy, it should 
 be the best remedy, as it certainly is, in the early stages of hydrotho- 
 rax and ascites. 
 
 To exemplify yet farther the nature of diuretics, and whether one 
 thing or another will determine an increased flow of urine, and to 
 show that this is an insignificant result of all the agents that may be 
 employed, and that it is to the seat and pathology of disease that all 
 our prescriptions should refer, — keeping the attention there and away 
 from the kidneys, — I may refer to what was said of the diuretic effect 
 of iodine in a former section, and of its modus operandi in subduing 
 dropsy (§ 892 j, Tt, t. Also, last references). 
 
 Again, there is nothing more uniformly and powerfully diuretic 
 than fear, which, in all its degrees and modifications, rarely fails to 
 increase the urinary product ; being, also, in its excessive operation, a 
 most powerful sudorific, while it simultaneously determines the blood 
 from the circumference to the centre. The boldest warrior is not 
 without the universal instinctive principle which impels all animals to 
 flee from danger. On the eve of battle, when most stimulated by
 
 THERAPEUTICS. DIURETICS. 631 
 
 pride and the hope of victory, he shows that another principle is in 
 powerful operation by the frequency with which he dismounts, or 
 turns aside from the ranks, to let off troublesome accumulations of 
 urine. And just so with man whenever dangers impend ; whether 
 they threaten his life, his limb, or his reputation. And so with any 
 event in the success of which he has an immediate interest. All this, 
 too, is equally true of animals ; and it all conspires in showing that 
 humoralisni, and " dynamic" and " quantitive" chemistry, are upon the 
 wrong track, and that as mental emotions can excite diuresis and per- 
 spiration only through direct nervous influence, so do physical causes by 
 reflex nervous action upon the secerning vessels (§ 422 b, 1067). 
 
 But, there is a vast variety remaining of the foregoing nature. Take 
 a modification of fear, as showing the delicate shades of difference 
 among the passions, and how they correspond in their effects, and in 
 their organic influences, with material agents. Thus, anxiety, which 
 has fear for one of its elements, exerts, also, a like but modified effect 
 upon man. So, again, jealousy, which results from the united opera- 
 tion of fear and love (§ 188J, d). Thus Sappho : 
 
 # " la dewy drops my limbs were chilled, 
 
 My blood with gentle horrors thrilled, 
 My feeble pulse forgot to play, 
 I fainted, sunk, and died away." 
 
 And, coming to the pure element, love itself, we observe other coin- 
 cidences with fear ; especially as it respects perspiration. In exces- 
 sive joy, also, we meet with another powerful diuretic, as, likewise, in 
 the sympathy between man and man. But it is manifest, in all these 
 cases, that each agent, each passion, produces influences peculiar to 
 itself, each one in its individual or its compound aspect. It is vari- 
 ously illustrated in the following sections : 227, 228 b, 233f , 234 e, 
 500 c, g, k, n, 512, 652 c, 827 c, 828 a, 844, 902 g, 904 d, and in 
 other places ; while it may be said, in respect to the passions, that we 
 may discern in the different conditions of the perspirable matter, and 
 in the different states of the skin, indications of different organic influ- 
 ences that are exerted by the nervous power, and carry the same con- 
 clusions to other parts which may be impressed in their organic states 
 (§ 227, 228 a, &c.). The same is true, also, of those emotions which 
 are awakened by physical influences. Certain odors prove diuretic to 
 some and cathartic to others ; and, as affirmed by Shakspeare, 
 
 • others, when the bag-pipe sings i' th' nose, 
 
 Cannot contain their urine for affection. 
 Masterless passion sways it in tlie mood, 
 Of what it likes or loathes." 
 
 The last is analogous in its philosophy to what is said of light in 
 section 514, l. And as to offensive sounds, which fall under the 
 same category, it is related by Dr. Fairfax that, " Mistress Raymond, 
 whenever she hears it thunder, even afar off, begins to have a bodily 
 distemper seize her. She grows faint, sick in her stomach, and ready 
 to vomit. At the very coming over of the thunder, she falls into a 
 downright cholera, and continues under a violent vomiting and purg- 
 ing as long as the tempest lasts. And thus hath it been with this gen- 
 tlewoman from a girl." Beddoes speaks of analogous results. " At 
 any moment," he says, " inflammation may be kindled in any part by 
 some causes which we cannot distinguish ; by others too subtle for
 
 632 INSTITUTES OF MEDICINE. 
 
 our senses, as, perhaps, by a thunder cloud passing over head" (^ 230, 
 828 c). Until the nature of lightning was understood, it was sup- 
 posed that it corrupted the blood in such cases. But, later "experi- 
 mental philosophy" has enabled the chemist to expound it in another 
 way, and to the easy comprehension of most people (§ 349, d, e), 
 while the few take a more circuitous method (§ 222-233|, 500, 893- 
 905), although at no little peril (§ 5^, a). Again, cold, apphed sud- 
 denly to the surface of the body, is often a powerful diuretic (§ 422, 
 423). But, although neither this nor the preceding causes are raTiked 
 as diuretics, they are probably about as much entitled to this designa- 
 tion as those agents to which it is specifically appropriated (^ 844). 
 
 8923, c. The agents and causes of which I have now spoken dis- 
 close the whole philosophy of the operation of such as are especially 
 denominated diuretics, and place it mainly upon the ground of direct 
 and reflex actions of the nervous system. — Note D p. 1114. 
 
 Whether, therefore, it be loss of blood, or cathartics, or cold ap- 
 plied to the surface, or the operation of fear, or other mental emotions, 
 which increase the excretion of urine, they all do it by acting directly 
 or indirectly upon the secreting vessels of the kidneys, and mostly 
 by means of direct or reflex nervous action. Loss of blood may be 
 directly exerted upon the organs, or it may be, as is generally true, 
 through the instrumentality of the nervous system, by removing dis- 
 ease from some other part, as the liver (which is a common example), 
 and which had sympathetically diminished the excretion of urine. 
 The principles, as it respects the nervous power, and the change of 
 organic actions, are the same with cold, fear, &c. Coming, lastly, to 
 the diuretics proper", such as are truly remedial produce their effects, 
 also, upon exactly the same principles (§ 277). Nevertheless, it is 
 undoubted that certain substances of mild remedial virtues, especially 
 such as are not offensive to the lacteals, or to the general organism, 
 gain admittance more or less readily into the circulation ; and, com- 
 ing in contact with the kidneys, may stimulate, and increase the action 
 of, these organs. Such, for example, are certain neutral salts. Prob- 
 ably the acetates of potass and soda may produce their effects upon 
 the kidneys more or less in this way ; though certainly, also, through 
 the nervous influence when they prove cathartic. In respect to these 
 two agents, however, the chemical and humoral theorists are not all 
 satisfied with their general hypothesis (§ 278). — Note Z p. 1130. 
 
 Nor is it at all surprising that the functions of the skin and kidneys 
 should be so readily affected by the nervous influence, as developed 
 by the foregoing causes, mental and physical, when we consider the 
 final causes of each of the organs, and that Nature has ordained for 
 their fulfillment a great versatility of action, and that, therefore, mor- 
 bific and remedial agents will operate variously, according to their 
 several virtues, through that natural constitution of the organs (§ 423 
 513, 902 y, ^). This consideration also lets us into the reason why 
 the urine flows so abundantly after some fluids, such as gin (which 
 contains the diuretic juniper), and in some cases before there can 
 have been time for their incorporation with the blood; a fact, indeed^ 
 so often observed, that many physiologists have supposed that there 
 must be some more direct communication between the stomach and 
 bladder than by the ordinary route of the absorbents (^ 350, no 94). 
 
 892^, d. The " diuretics proper" are the least useful of all the an-
 
 THERAPEUTICS. EXPECTORANTS. 633 
 
 tiphlogistics ; having but little effect upon inflammations or fevers. 
 Yet are they often prescribed in high grades of those affections (where 
 the urine is greatly deficient), in the vain expectation of reaching 
 those profound lesions by the removal of one of their least important 
 sympathetic consequences. Their use, however, with the more en- 
 lightened, is now mainly limited to dropsical effusions in the great 
 cavities and the extremities ; however defective may be the patholo- 
 gy, or however inefficient these agents are compared with bloodlet- 
 ting, cathartics, blisters, mercury, iodine, &c. They are always 
 most useful in cases that are benefited by loss of blood and by ca- 
 thartics (See as to heart in § 500 m, 685^, QS1\, 694f , 826 cc). 
 
 892y, e. Some of the diuretics which possess compound virtues, 
 such as squill, and Indian hemp {apocynum canndbinum\ ™ay prove 
 very detrimental in many cases of dropsy ; the former, for example, 
 by its acrid, stimulating virtue, the latter by its severe action upon the 
 intestinal canal. Where mercurial agents are employed, they should 
 be well chosen, and according to the existing pathological states. In 
 the simple form of dropsy, or if inflammation exist in any degree of 
 activity, as in the serous tissue, or in the liver, then some one of the 
 simple mercurials should be selected, as calomel, or blue pill ; prece- 
 ded, however, by loss of blood, &c. If, on the other hand, the drop- 
 sical effusion have existed a good while, or be attended by chronic 
 enlargement of the liver, or of some other viscus, the mercurial should 
 be chosen with reference to such organic affections ; though calomel 
 or blue pill may answer well. But, in these cases, the iodides and 
 bromides of mercury are the most appropriate ; and now we may, 
 sooner or later, employ squill with or without other diuretics, though 
 it is commonly most useful to combine two or more together. If the 
 subject be of a scrofulous habit, iodine should be used freely. 
 
 W2,\,f. Much has been said of the connection of renal disease with 
 dropsy, and many physicians have, in consequence, gone into a chem- 
 ical analysis of the urine, instead of the signs to be observed in the 
 body, for an exposition of the nature of disease. But, so many coin- 
 cidences have sprung up from other causes, that it may be expected 
 that this " experimental philosophy" will not endure. 
 
 892|,^. The greatest of all the errors in relation to dropsical affec- 
 tions is that which divides them into active and passive. This erroi 
 appears to have grown out of another — that which makes the same 
 distinction of inflammations (§ 752, &c.) ; though, in the former case, 
 the relative states of pathology are supposed to be in even greater op- 
 position. The practice proceeds upon the same hypothesis as that 
 which concerns the distinctions in inflammation. 
 
 EXPECTORANTS. 
 
 892|, a. This group of agents has had too large a connection with 
 disease to be neglected; or, at least, not to be held responsible for 
 any mischief it may have done. Like many other denominations, 
 the term is significant of their most visible effect, although, like many 
 others, it is one of the least important in a large proportion of the dis- 
 eases where they are employed, while the most important can be ob- 
 tained only by remedies that do not fall within the group. 
 
 The tendency of the name, and the definition which is given of ex- 
 pectorants, have turned a great amount of attention upon the quantity
 
 634 INSTITUTES OF MEDICINE. 
 
 of matter expectorated, and away from those pathological conditions 
 upon which the physical product depends (§ 889 c, 891 d, o). 
 
 It is greatly, therefore, with expectorants as with sudorifics, diuret- 
 ics, &c. The secreted product is only a secondary result ; complica- 
 ted and various in respect to the conditions and influences by which 
 it is brought about, and capable of being increased or produced, under 
 different vital states of the body, by agents of entirely opposite vir- 
 tues, — by the most direct sedatives, and by the most active stimulants. 
 Every thing, therefore, which will, under any contingencies of disease, 
 increase or produce expectoration, is more or less entitled to be con- 
 sidered an expectorant. Hence, it is apparent that, whenever reme- 
 dies are applied with a view to the supposed objects of expectorants 
 they are quite likely to aggravate formidable grades of disease, or to 
 leave the subject, at least, to an unresisted fate which might have been 
 averted by appropriate means. 
 
 892|, h. In my Arrangement of the Materia Medico, I have placed 
 some agents, under the denomination of expectorants, as first in im- 
 portance, which others, who consider mostly the result upon which 
 the group has been founded, would rank lower down. But, as the 
 foundation of my arrangement relates to the therapeutical capabilities 
 of the various substances, I have designated tartarized antimony as 
 the first, and ipecacuanha the second in importance. These agents, 
 in a general sense, are most useful under the condition in which ex- 
 pectoration is desirable, if relief be not obtained without ; though it 
 may or may not be a result of their action. It is now, as when sweat- 
 ing may take place profusely, moderately, or not at all, from what are 
 denominated sudorifics. But, I should say that the parallel does not 
 hold strictly in these cases ; since the sympathies between the stom- 
 ach and skin are so far different from those which prevail between the 
 stomach and the lungs, that mild impressions made upon the stomach, 
 as by hot water, will determine profuse perspiration, or, as in other 
 cases, irritating food will occasion, speedily, eruptions of the skin ; 
 while none but agents of considerable power will institute reflex 
 nervous actions in the lungs, or give rise to that expectoration which 
 grows out of such actions. All the expectorants, therefore, of any im- 
 portance ai'e capable of exerting powerful effects, either for good or 
 for evil ; while, of all the sudorifics, tartarized antimony and ipecacu- 
 anha are the only ones that are entitled to consideration on account 
 of the alterative reflex nervous actions instituted by expectorants. 
 
 Reflex nervous actions, as excited by the operation of agents upon 
 the stomach, depend not only upon the nature of the agents, the nat- 
 ural function of the sympathizing part, and the particular mode in 
 which it may be affected by disease, but upon the analogies that may 
 subsist in the structure and vital constitution of the mucous tissue of 
 the stomach and the part remotely influenced (§ 133-152, 525-529). 
 The group of remedies now before us refer to a tissue of the same 
 species as that of the stomach upon which the remedial agents exert 
 their direct effect ; and reflex nervous actions upon the pulmonary 
 mucous tissue, when induced by remedial agents applied to the 
 stomach, are, for this reason in part, different from such as are ex- 
 erted by the stomach upon the skin, and are generally much more 
 profound, and of a more alterative nature. 
 
 892|^, c. The effect of remedies, therefore, in their acceptation of
 
 1 IlERAPEUTlCrf. EXPECTORANTS. 6^b 
 
 expectorants, being determined by the existing condition of disease, 
 and more or less by the state of the system at large, and conditions 
 'not much allied admitting the agency of remedies that operate as ex- 
 pectorants, it is clear that we must have a classification of these rem- 
 edies according to their general virtues. I have, therefore, more or 
 less after the manner of othei'S, distributed them into five subdivisions. 
 These I shall now state, along with the several agents erabi'aced un- 
 der each subdivision ; and, for the purpose of illusti'ating my concep- 
 tions of their relative bearing upon disease, and with only a secondary 
 view to the expectoration which they may be, respectively, capable 
 of producing, I shall designate each one by numbers that denote their 
 order of arrangement, and their relative therapeutical uses where ex- 
 pectoration is a desirable consequence if the remedy do not succeed 
 without. 
 
 Non-sti?nulating. — 1. Potassae antimonio-tartras. 2. CepliEelis ipe- 
 cacuanha. 4. Gillenia trifoliata. 6. Asclepias tuberosa. 
 
 Stimulating. — 3. Scilla maritima. 7. Polygala senega. 8. Dore- 
 ma ammoniacum. 10. Opoponax chironium. 13. Eryngium aqua- 
 ticum. 14. Myrospermum toluiferum. 15. Myrospermum peruife- 
 rum. 16. Naphthaline. 17. Styrax benzoin. 18. Styrax officinale. 
 19. Liquidambar styraciflua. 20. Amyris gileadensis. 21. Allium 
 sativum. 22. Erysimum alliaria. 23. Sisymbrium officinale. 
 
 Sti7nulating and Narcotic. — 5. Sanguinaria canadensis. 
 
 Sedative aiid Narcotic. — 11. Lobelia inflata. 
 
 Stimulating and Antispasmodic. — 9. Ferula asafoetida. Ferula 
 persica. 12. Galbanum officinale. 
 
 It will be seen, therefore, from the foregoing general distribution 
 of expectorants, that four of them only are adapted to any thing like 
 acute inflammation of any tissue of the lungs ; and that the first two 
 onlj'^ are wanted. Moreover, none of the expectorants are employed 
 as such excepting in some inflammatory state of those organs ; or, at 
 least, according to my views of all the pathological conditions for the 
 relief of which the expectorants are intended. And when it is con- 
 sidered, also, how very irritable and susceptible the lungs are when 
 affected in their parenchymatous structure, and even those parts of the 
 mucous tissue which line the bronchi, larynx, and trachea ; how lia- 
 ble, too, inflammation is to be propagated from the upper portions 
 into the air-cells ; how many there are in whom pulmonary phthisis is 
 readily awakened by inflammatory states of this membrane ; how they 
 constantly throw morbific influences over the stomach, the intestine, 
 the general organs of circulation, &c. ; and how often inflammation of 
 the tracheal portion of the membrane eventuates in ulceration ; besides 
 other sequelce of inferior moment ; it becomes apparent that this group 
 of remedies, with the exception of the two leading members, has 
 numbered its victims next after those agents which form the groups 
 of tonics and stimulants. 
 
 Why, then, it is asked, perhaps, does the squill rank, in the arrange- 
 ment, as the third in therapeutical value, and before the non-stimulant. 
 American ipecacuanha, bloodroot as the fifth, seneka the seventh, gum 
 ammoniac the eighth, and these last three before asafetida, &c. ? 
 The answer is important, although the order of arrangement assumed 
 that the reader was sufficiently conversant with the principles upon 
 ivhich it is founded. It assumed, in the first place, that he was famil-
 
 6H6 INSTITUTES^ OF MEDICINE. 
 
 lar with the general structure of the lungs, that he had some ideaa 
 about a " chemical" difference, at least, in the relations of different 
 portions of the pulmonary mucous tissue to this group of remedies ' 
 (§ 134-143) ; that he was aware of the inflammatory nature of the dis- 
 ease for which he was prescribing, as well as its exact seat ; that he 
 distinguished between acute and chronic forms of inflammation ; that 
 he understood, that, as one portion or another of the pulmonary mu- 
 cous tissue might be the seat of disease, and according to the special 
 modification of disease, it might be relieved or inci'eased by different 
 expectorants, and according, also, as the premises might be, he fore- 
 saw that this or that expectorant might develop tubei'culous phthisis, 
 or become the indirect cause of disease in other parts, &c. 
 
 Proceeding, therefore, upon these principles, and as chronic in- 
 flammation of the mucous tissue of the trachea and bronchi is a very 
 common form of disease, and is often benefited, in constitutions that 
 are otherwise sound, by a stimulating expectorant, it was important 
 that some one, at least, should occupy a high place in the Arrangement. 
 But, it should be also one whose virtues are most of an alterative 
 nature, but most exempt from morbific tendencies ; whence it be- 
 comes plain that the scilla maritima should stand immediately after 
 the cephaelis ipecacuanha. It should also precede the gillenia, since 
 the virtues of this last, as, also, of the asclepias, are analogous to those 
 of the great product of Brazil, yet much inferior. But, comparatively 
 unimportant as the gillenia and asclepias may be, they are yet so anal- 
 ogous to ipecacuanha, that they may stand by its side, and being ofeasy 
 access to the American practitioner, they should follow near upon the 
 other two non-stimulant expectorants ; gillenia taking the precedence 
 of the asclepias on account of its greater alterative virtues. 
 
 Asafetida, I am aware, is a favorite expectorant with many ; hnl it 
 is less alterative than seneka, and the preceding gums, and is much 
 more liable to offend the stomach. 
 
 As to bloodroot, that substance stands, like castor oil, alone in the 
 Materia Medica. It is capable of peculiar influences ; but, as they 
 are oftener injurious than beneficial I have given to it a higher rank 
 than was warranted by my own experience or by that of some others. 
 It has been, howevei% highly commended; and in deference, there- 
 fore, to that more favorable experience, it appeared to me that it 
 should occupy a place in the Arrangement that might yield to the 
 remedy a fair opportunity for more ample observation of its effects^ 
 so far as my Arrangement might have any influence. 
 
 The foregoing analysis will serve, also, for the disposition which 
 I have made of the members of all other groups. The arrangement 
 bears upon its face the author's conceptions of their special relations 
 either to pathological conditions that are most allied, or to such as are 
 diverted from the common forms, or to others which are distinguish- 
 ed by greater peculiarities ; while, also, the order of each one, under 
 the various assemblages, denotes its therapeutical capabilities. If 
 the author, therefore, be right in his premises upon which the arrange- 
 ment is founded, each article is thus rendered more or less descriptive 
 of its own uses, &c. (§ 892, aa, c). 
 
 S92|, d. There should be no difficulty with correct observers in 
 reaching a knowledge of the conditions of disease to which remedial 
 agents of such various and even opposite virtues as the expectoranta
 
 THERAPEUTICS. EXPECTORANTS. 637 
 
 are adapted. The general principles of pathology and therapeutics 
 go far in indicating, at once, which of the groups are properly suited to 
 certain pathological states, which of its members is best adapted to 
 any modified condition of the general pathology, or which of the 
 groups, or which members of the proper gioup, should be avoided. 
 But, a nice discrimination of the variously-modified forms of inflam- 
 mation, whether as to its nature, intensity, duration, complications, 
 &c., and a precise acquaintance with the peculiarities of each reme- 
 dial agent, will be often necessary to guide us to the just regulation 
 of influences which any given combination of symptoms may demand ; 
 or, proceeding blindly to execute the results of an expectorant, in its 
 ordinary acceptation, and under the belief that each substance so de- 
 nominated will alike fulfill the intention, we may as readily destroy 
 the patient, in the end, by this indiscriminate practice, as we might, 
 with certainty, i>elieve him by a choice of other means bearing the 
 same general name of expectorants. It is not, therefore, I say, the 
 abstract fact of expectoration that we are to regard, but this is to be 
 considered as a result of a favorable action which certain remedial 
 agents are capable of instituting, but which very often fail of that re- 
 sult when their action is in the highest degree salubrious. On the 
 contrary, also, we shall see that expectoration may be increased by 
 increasing the morbid conditions; just as the discharge of mucus, in 
 intestinal inflammation, is increased by an irritating cathartic. The 
 only difference consists in the direct action of the morbific irritant 
 upon the affected part, in one case, and by reflex action through the 
 nervous power, in the other (§ 150, 151, 226, 228, 229). It is, there- 
 fore, far from being true that the remedy is appropriate when the dis- 
 charge from the lungs is promoted and increased, even though an ex- 
 pectorant be especially indicated, and the proper one may also tend 
 to lessen the quantity of mucus through such alterative influences as 
 lessen the morbid action upon which it depends. 
 
 892^, e. We see, therefore, more and more, how indispensable it is to 
 look upon results as indicative only of certain complex vital conditions 
 which should be ascertained, and, as far as possible, to regard the 
 proximate causes in all our prescriptions (§ 673, 674, 699, 741). Here 
 we have a patient with a cough. A favorable or a fatal issue of his 
 case may depend entirely upon the exhibition of the right expectorant. 
 He may be cured by tartarized antimony, or may be killed by squill, 
 seneka, or bloodroot. It is evident, therefore, that " coughs" depend 
 upon impoi'tant varieties of pathological conditions ; though, when the 
 direct result of pulmonary disease those conditions are generally of 
 an inflammatory nature. There may be numerous gradations of the 
 form of common inflammation from that which constitutes pneumo- 
 nia, and speedily runs its course, to that indolent state which persists 
 for years, and makes little or no impression upon the general health. 
 
 All this, however, is doubtless obvious to enlightened practitioners ; 
 but, when it is considered what morbid anatomy is about, even with 
 common inflammation (§ 699), and, how deplorable the evils which 
 have sprung from the pathology of scrofula and tuberculous phthisis 
 that has issued from the purlieus of Paris, I am moved by the convic- 
 tion that I cannot attempt a more useful service to humanity than by 
 exploring the subject now under consideration. 
 
 It has been no uncommon and fatal error to have exhibited stimu-
 
 638 INSTITUTES OF MEDICINE. 
 
 laring expectorants (which, indeed, commonly form the " cough mix- 
 tures"), in active forms of pneumonia, under the belief that these stim- 
 ulating agents possess the power of at all times producing expectora- 
 tion, and that this result is the main object to be contemplated. Some- 
 times, however, these agents produce vomiting, and their effects are 
 then less disastrous ; or, in subdued forms of acute inflammation this 
 sedative influence may barely counteract the stimulant virtue, or it 
 may be useful. It is like employing snuff for nasal catarrh (^ 228 a). 
 
 892^, y. Coming to special modifications of inflammation, the expec- 
 torants in common use perform their morbific work according to the 
 variety of the disease, and the part of the pulmonary mucous tissue, 
 or other tissue of the lungs, in which it may hold its seat. 
 
 Readily as that modification which constitutes croup may be re- 
 moved in its early stages, a pernicious custom exists of prescribing 
 stimulating expectorants. It is true, they are oftea united with tar- 
 tarized antimony in the treatment of this disease ; and a formula of 
 this kind exists in the United States Pharmacopoeia, bearing the name 
 of the Co7npound Honey of Squill. That may be well enough, un- 
 accompanied with directions for its use, with the exception of the 
 honey, which is of no use whatever, never fails to injure the stomach, 
 and often produces colic in healthy people. But, the compound is 
 there, however, with the obvious design of supplying a convenient re- 
 source to the practitioner in cases of " cough," and especially that 
 which attends the croup. In Wood and Bache's Dispensatory, of 
 which the United States Pharmacopoeia forms an important basis, it is 
 said by the editors, that it " requires an explanatory commentary, in 
 order that its precepts may be fully appreciated, and advantageously 
 put into practice." Now, after stating that formula, the editors re- 
 mark, that " this is the preparation commonly known by the name of 
 Coxe's Hive Syrupy Indeed, such is the translation of the original 
 name. Thus : 
 
 "Mel Scill^ Compositum. U. S. Compound Syrup of Squill. 
 Hive Syrup.'" 
 
 In this are four ounces, each, of squill and seneka, and two pounds 
 of clarified honey, along with four pints of water and forty-eight grains 
 of tartarized antimony, boiled down to three pints, or about three 
 pounds. 
 
 Such, then, is a standing formula for croup, with the very name of 
 the disease associated with it ; and a more dangerous weapon was 
 never put into the hands of the profession. Compared with the lan- 
 cet, which is so often represented in a similar manner, the ratio is 
 about the same as computed by Smith between the " hero and the 
 murderer" (§ 569, e). In all the cases, however, the questions at is- 
 sue are to be decided by the force of facts. — Notes F p. 1114, Mm p. 1141. 
 
 If the mischief attendant on the " Hive Syrup" were limited to 
 croup alone, these remarks, perhaps, had never been written. But, 
 " cough" upon " cough," reaching even to all the stages of pulmo- 
 nary phthisis, make their frequent demands upon " Hive Syrup." 
 The antimony which it embraces atones but little for the offenses of 
 Its associates in most of the cases where they are called into action. 
 
 892*-, g. It is resolution, not expectoration, which is wanted, when 
 It can be obtained, in all the cases of active inflammation, — ay, in all 
 of pulmonary phthisis before suppuration supervenes (§ 700 h. 705,
 
 THERAPEUTICS. EXPECTORANTS. 039 
 
 732 d, 862-864, 890 e). If the disease be of such intensity that res- 
 olution may not be effected by tartarized antimony or ipecacuanha, 
 no time should be lost in calling upon general or local bloodletting, 
 cathartics, blisters, &c. "And when we consider how these accomplish 
 the intention to which the expectorants are inadequate only from the 
 force of disease, it will go with the many other analogous considera- 
 tions disseminated in this work toward clearing up the philosophy 
 which interprets the operation of expectorants, whether in their cura- 
 tive or morbific relations to disease. Or, again, if bloodletting fail of 
 ai'resting pneumonia, for example, we may pursue the philosophy in 
 another aspect ; since, while it has relieved the violence of the mala- 
 dy, it has brought on expectoration. It has so modihed the inflamma- 
 tory condition that mucus is generated in preternatural quantities ; 
 and therefore we see that bloodletting itself may operate as an expec- 
 torant. We now exhibit tartarized antimony, and it may either in 
 crease or diminish the expectoration ; and, in doing either, it contrib- 
 utes to the decline of the disease. The expectoration, therefore, is a 
 mere result, a mere symptom, of a certain change in the action of the 
 organs by which the mucus is secreted ; and it may be the result of a 
 favorable or an unfavorable change. It appears, therefore, that wheth- 
 er the agent will or will not increase the mucous product, or, on the 
 other hand, diminish it, depends upon the exact influence it may ex- 
 ert upon the pathological condition. All this clearly brings the oper- 
 ation of the several agents upon a par, and admonishes us to study 
 their virtues, their mode of operating, and the precise conditions of 
 disease to which one or the other may be applicable (^ 694f , 741 b). 
 
 But, let us pursue yet farther the case of pneumonia. Let us sup- 
 pose a slow termination of disease. Antimonials finally cease to be- 
 stow any farther benefit, and the cough has subsided into one of a low 
 chronic nature, without much expectoration. Here it is, if there be 
 no strong tendency to scrofula, that squill, seneka, and other stimula- 
 ting expectorants, may become highly useful ; and if the cough be 
 frequent and short, denoting an irritable state of the lungs, we asso- 
 ciate an opiate, which not only allays the cough and moderates the 
 Btimulant effect of the expectorants, but increases the expectoration ; 
 and thus the opiate becomes an expectorant, though neither this nor 
 bloodletting are ranked in that group of remedies (^ 872 a, 891 i). 
 
 A blister is also applied to the affected chest, and now, again, ex- 
 pectoration either increases or declines ; though, in either case, there 
 is a manifest abatement of disease as a consequence of the counter- 
 irritation (^ 111-117, 233f, 647^, 891^ k, 893 a, c, e, 905 a, 227). 
 
 But, perhaps the cough has ultimately become complicated with 
 disordered digestion, or, it may be chiefly maintained by some gastric 
 derangement. It is dry, and the usual expectorants render it still 
 more irritating and husky. The remedy, therefore, is wrong, and 
 has not been addressed to the essential pathological condition; which 
 consists of some derangement of the stomach, while that of the lungs 
 has become mostly sympathetic. Whatever will now relieve the for- 
 mer affection may remove the pulmonic. For this purpose tonics 
 may be useful, and, as relief follows in the lungs, expectoration may 
 be one of the results (§ 905). Tonics, therefore, in cases of this na- 
 ture, become expectorants, and equally so as any of the agents which 
 are confined to this denomination of remedies. It is obvious, too, that
 
 G40 INSTITUTES OF MEDICINE. 
 
 they all operate upon common principles when they promote expec- 
 toration ; and whether the result will follow one or the other, will de- 
 pend upon the existing state of the system, in a general sense, and 
 more particularly upon the precise pathological condition of the lungs. 
 It is apparent, therefore, that remedies from almost any group may 
 be expectorant ; bloodletting, cathartics, emetics, narcotics, tonics, 
 counter-irritants, and even alcohol. The last, indeed, in the form of 
 hot toddy, is a popular remedy for colds. It may or may not increase; 
 expectoration. It may relieve, but more generally aggravates the 
 disease (§ 756). Will Chemistry explain (^ 892 h, 892^ v\ ? 
 
 Old neglected coughs from ordinary catarrh, and what is known as 
 the old man's cough, come under that condition of common inflamma- 
 tion to which the stimulating expectorants are adapted. But, howev- 
 er protracted may be the specific varieties, as in hooping-cough, and 
 pulmonary phthisis, they cannot be employed without endangering 
 life. Their effect, indeed, in hooping-cough is so obviously bad that 
 they are not often employed in its treatment ; but, in pulmonary 
 phthisis, and especially in the catarrhal affections of scrofulous consti- 
 tutions, we every day witness the penalties which are paid for substi- 
 tuting morbid anatomy for the vital signs of disease, and in defiance 
 of the plainest demonstrations which therapeutical agents can supply 
 (§ 137, c, 662 «).— Note F p. 1114. 
 
 S92|, h. The sympathies to which the lungs are liable fiom many 
 diseases of other parts, especially of the digestive organs, and the 
 more or less reciprocal effects of their own diseases, by which end- 
 less reflex nervous actions may be set in operation, together with the 
 situation of the lungs in a bony cavity, frequently render it difficult to 
 ascertain their exact pathological conditions, and to distinguish what 
 may appertain to pulmonary disease from what may be due to the play 
 of sympathies. The stethescope, like the long-established method of 
 percussion, has contributed much to clearing away the obscurities, and 
 has done its good part in substituting pathological considerations for 
 mere effects, and has shown us that cough, difficulty of breathing, &c., 
 are not diseases, but merely symptoms of disease. The scientific physi- 
 cian, therefore, no longer administers expectorants, &c., for the relief 
 of cough, or dyspnoea, but he applies the various agents to overcome 
 pneumonia, pleuritis, bronchitis, laryngitis, pharyngitis, &c. In one 
 case there is something tangible, intelligible, and susceptible of cer- 
 tain and speedy relief; in the other, or where the prescription is made 
 to the symptom alone, all is confusion, uncertainty, and death. Or, it 
 may be some organic affection of the heart, or gastritis, or enteritis, 
 or little*more than moderate degrees of indigestion, upon which the 
 cough or dyspnoea depends and yet where, from want of a proper 
 anatomical knowledge, or of physiological and pathological science, 
 the most unhappy mistakes are made with the expectorants, but where 
 the better informed are often greatly aided, in their embarrassments, 
 by the stethescope. 
 
 But great as is the acquisition of the stethescope, the reign of mor- 
 bid anatomy has surrounded it with many abuses ; the vital sio^ns are 
 either neglected or held to be of very suboi'dinate importance, and the 
 instrument is turned in pursuit of structural lesions. If cough and dysp- 
 noea supervene upon abdominal derangements, the source of the symp- 
 toms is not seldom found in some special lesion of the heart, or, others
 
 THERAPEUTICS. EXPECTORANTS. 641 
 
 detect in the supposed cardiac lesions the cause of an intermittent 
 or irregular pulse that depends on hepatic disorder (§ 390 h, 688 /.-, 
 806, 811). These mistakes are a fruitful source of nialpratice, and 
 are common among the disciples of morbid anatomy(^ 697, 699 c, 701). 
 
 892|, i. The foregoing considerations appear to be indispensable to 
 all who would enter understandingly upon the treatment of pulmonary 
 affections, or to distins;uish what is relative to the lun^s from what is 
 due to other organs, or to comprehend the modus operandi of the re- 
 medial agents, whether they be employed under the denomination of 
 antiphlogistics, vesicants, pectorals, expectorants, &c., or their philo- 
 sophical and comprehensive name of alteratives. 
 
 To the young practitioner, at least, I would say that it should never 
 be forgotten that every inflammatory state of the mucous tissue of the 
 lungs, however mild or chronic, is liable to become exasperated, and 
 to give rise to pneumonia, or to croup, or what is extremely common, 
 to phthisis pulmonalis. And when we again consider how often the 
 last aflection has been developed by the stimulating expectorants, I 
 think that I do not err in my estimate of their relative uses and de- 
 structive effects in saying that mankind would be benefited by exclu- 
 ding from the treatment of pulmonary diseases all the reputed mem- 
 bers of that group of remedies excepting those which belong to the 
 first of the foregoing subdivision (§ 892|, c). Independently of the di- 
 rect practical results, attention would be turned upon bloodletting, 
 antimonials, &c., and their sti'ikingly salutary effects in numerous 
 cases of common inflammation of the pulmonary mucous tissue, and 
 in the early stages, especially, of those inflammatory states which lead 
 to pulmonary phthisis, would revolutionize the whole system of mor- 
 bid anatomy, and eradicate the pathology which has been founded 
 upon it. The laws of the nervous system should banish the " sipeciality". 
 
 In the next edition of my Materia Medica (and I make the sugges- 
 tion on account of its practical bearing), it is my intention to substi- 
 tute for the term Expectorants another which shall refer to their mo- 
 dus operandi ; probably. Alteratives adapted to Pulmo?iic Iriflamma- 
 tions, and I will rank bloodletting as the first, in a general sense.* This 
 will take in, also, tartarized antimony, and ipecacuanha, in emetic 
 doses. Its advantages may be variously illustrated. Almost any con- 
 dition, for example, of muco-pulmonic inflammation may be accom- 
 panied with a strong predisposition to inflammation of the pleura, or, 
 they may occur together, or in the form of pleuro-pneumonia. Very 
 many turn dii'ectly to the expectorants, and, if they find their atten- 
 tion arrested at once, under an equivalent denomination, by bloodlet- 
 ting, and tartarized antimony, and unfettered by the .term expecto- 
 rants, the appropriate remedies may have a good chance of raising 
 inquiry, and their ti'ial may awaken new views in pathology, and dis- 
 sipate some of the prejudices against loss of blood. The practitioner 
 will soon imbibe the conviction which experiment produced in the dis- 
 tinguished Cleghorn, that bloodletting can scarcely be misapplied under 
 any conditions of pneumonia, and be led to avoid the stimulating ex- 
 pectorants, as he will all the tonics, when he approaches the treatment 
 of most inflammatory affections (§ 1005, h). In proportion as the loss 
 of blood is less likely to be useful where any form of pulmonic in- 
 flammation, to which this remedy may be adapted, shall refuse to 
 yield to its power, so in a gi-eater ratio will the non-stimulating ex- 
 
 * This improvement was made in the edition of 1848. 
 
 S s
 
 642 INSTITUTES OF MEDICINE. 
 
 pectorants, and all other means, be likely to fail. How unavailing, 
 therefore, must be those stimulating expectorants which are so often 
 prescribed, even by those who confide in early bloodletting, at the ad- 
 vanced stages of pneumonia ! The sole object in view is that of in- 
 creasing or starting expectoration, without any reference to the mor- 
 bific virtues of the supposed remedy. Let us, therefore, have the 
 best remedy, however late, whatever the sex, whatever the constitu- 
 tion or the age ; and that remedy, in the cases supposed, will be the 
 loss of blood, as affording the best chance for life. Whenever acute 
 forms of inflammation subside into a chronic state, neither the pathol- 
 ogy nor the principles of treatment change, unless as it respects par- 
 tial modifications. In a general sense, the direct antiphlogistic plan 
 should be continued (§ 752, &c., 1007 h, c, d, 1008). 
 
 In the language of the celebrated Dr. Freind, " There are some, 
 perhaps, who may think these various inquiries into disease may not 
 he of much service to the healing art. However, they must allow me 
 to affirm, that it is of very great importance to physic that we have 
 an accurate knowledge both of the peculiar signs and of the nature 
 of each distemper, and, also, of its seat ; for these being found, we 
 shall be much happier in our inquiries into the means of cure. Who- 
 ever, therefore, perfectly understands the nature of a pleurisy, or peri- 
 pneumony, will easily perceive what immediate relief may be had 
 from opening a vein ; for, upon this point so depends the whole safe- 
 ty of the patients, that, if you should depart from this kind of medi- 
 cine in vain will you seek for any other." 
 
 But, I would finally say of pneumonia, that however the disease 
 may abate under the direct effect of loss of blood it not unfrequently 
 happens that the symptoms recur with more or less violence. It is 
 this which we are to anticipate and watch, and to repeat the remedy 
 fi'om time to time as returning symptoms may suggest, and before 
 the disease can have recovered its original severity (§ 1005, h). In this 
 manner, we shall constantly make advances upon it, and, with the aid 
 of other remedies judiciously devised, we shall not often fail of suc- 
 cess. These, however, are cases in which firmness, and a constant 
 recourse to pathological considerations, are more or less in requisition. 
 Sanguine hopes may be called up by the great relief which is yielded 
 by the first outlet of blood, but, to be only in a few hours disappoint- 
 ed by the formidable signs of returning inflammation; and when, at 
 last, we shall have met them again and again by our principal reme- 
 dy, the disease may appear to have come to a stand, and scarce fal- 
 ters under the combined effect of general bloodletting, leeching, anti- 
 monials, &:c. This is no time for discouragement, but rather to fear 
 that our means, in coming short of the mark, have not been applied 
 in sufficient vigor. Now is the time, I say, to push the high princi- 
 ples of our noble science, to throw off the trammels of prejudice, and 
 let the blood flow, till, by the relief it brings, we win new trophies for 
 ourselves, and for medicine (§ 1005 a, b, c, d, e,J',g, 7i, 1007 b, c, d, 
 1008, 1068 c).—See Y.S., 1860, at p. 872. Also, Note F p. 1114. 
 
 COUNTER-IRRITANTS. 
 
 893, a. I enter now upon the consideration of those remedial agents 
 which establish their influences upon internal organs through the me- 
 dium of the skin ; and here is opened to us a display of those sympa
 
 THERAPEUTICS. COUNTER-IRRITANTS. 643 
 
 thetic processes which take then- origin in cerebro-spinal nerves along 
 with the sensitive fibres of the sympathetic, and terminate in tlie motor 
 fibres of the ganglionic system (§ 113, 224, 454 a, 461-461^, 465, 
 473 c, 478, 488^, 489, 512, 514/-/?;, 51G rf, nos. 12, 13, 520, 891^^, k). 
 
 That vesicants and leeches operate in the foregoing manner was ex- 
 pressed by me in the London Medico-Chirurgical Revieio in 1834. See 
 p. 827, § 1056. — Also, Rights of Authors, p. 914. 
 
 Counter-irritants exert their effects upon parts remote from the seat 
 of their application in the same manner as when cold applied to the 
 surface excites the renal function, or lights up pneumonia, and through 
 the very complex mechanism set forth at the beginning of this section, 
 and in other places. Here, too, in the case of counter-irritants, we 
 meet with an embarrassing diversity of central parts which govern the 
 reflex nervous actions, and perplexing results as the irritant may oper- 
 ate through one centre or anothei- — sometimes taking the route of the 
 brain and spinal cord, and then proving morbific, or at other times op- 
 erating through the ganglia or plexuses of the sympathetic nerve, or 
 some portion of the nerve itself, in the vicinity of the counter-irritant, 
 and then only proving curative (§ 233f, 455 a, 456 a, 461^ a, 473 c, 
 478 b, 483 c, 889 g). We shall see, too, in all these influences the 
 clearest demonstration that the nervous power is modified in its nature 
 by the impression transmitted by the agent to the nervous centres (§ 
 481, 89H5r, k), and that it operates either as a directly morbific cause 
 or is curative of existing disease by substituting pathological conditions 
 more favorable to the recuperative tendency of the organic properties 
 (§ 854, 900, &c.). Exactly the same philosophy, therefore, is applica- 
 ble to the modus operandi of counter-irritants that I have hitherto rep- 
 resented as characterizing all other agents. But such is the diversity 
 in the details relative to the laws and phenomena of the nervous sys- 
 tem, whether resulting from its direct or reflex action, whether excited 
 by the will, by mental emotions, or by direct physical irritations of the 
 nervous centres in the former case (§ 227-230, 245, 481), or by trans- 
 mitted influences to those centres from remote parts in the latter case, 
 or as certain cerebro-spinal nerves are limited to a subservience of vol- 
 untary motion and sensation, or as others co-operate with the sym- 
 pathetic by contributing to the essential office of the latter in harmo- 
 nizing the organic functions, variously affecting the organic products in 
 vital constitution, and perpetually exciting or depressing the secretory 
 and excretory processes, and seeing how the latter mechanism is the 
 great medium, through its physiological characteristics, of the trans- 
 mission of the disturbing effects of morbific causes, and the restorative 
 of such as are remedial (§ 113, 500 ^r, and references above), and, with- 
 al, the isolation of intermediate nerves when the mind or physical 
 causes operate upon individual parts, and yet all determined by pre- 
 cise, however complex, laws, we find ourselves in a labyrinth where no 
 light is admitted from the surrounding effulgence of inorganic nature, 
 and recognize the impracticability of expounding its problems in any 
 other than a language as foreign from chemistry and physics as are the 
 functions and laws and phenomena of living beings, and the necessity 
 of a copious analysis of all its parts (§ 5^ b, 59, 64, 165-169).* And 
 this leads me to recur to what I have said of the terms motor, sensitive, 
 and reflex action in § 475, that I may now add that reflex action should 
 be regarded s& expressing simply a general result without implying in 
 * Se& Notes Aa p. 1131, Dd p- 1132.
 
 644 INSTITUTES OF MEDICINE. 
 
 the least the philosophy of the process. It may be made to stand for 
 any hypotheses expressive of reaction, though least of all for that of 
 galvanism, or any other emanating from the science of chemistry. The 
 reflection even of polarized light, with all its modifications, would not 
 serve as an analogical basis for the reflection of any influences trans- 
 mitted to the nervous centres or of the nervous power, and all analogy 
 disappears in those influences which take their rise in the centres them- 
 selves, or such as I have designated as direct developments of the nerv- 
 ous influence, and which, from the absence of centrq^etal impressions, 
 and from engaging only the centrifugal nerves, discloses the defective 
 import of the term reflex action. . Kor will I neglect this opportunity 
 of adding to § 409 k the important fact that the hypothesis of galvan- 
 ism, as applied to reflex action of the nervous system, violates the in- 
 dispensable requisite of a continuous circle, and contents itself with the 
 most irregular segments, and these segments and curved lines consisting 
 of two parts differently endowed, and manifesting peculiarities of func- 
 tion that bear no analogy to galvanism. Nay more; for in a still more 
 discreditable manner it professes to be the agent concerned when the 
 nervous influence, as in mechanical irritation of the nervous centres, en- 
 gages only the centrifugal nerves, and then operates in a straight line ! 
 The experiments upon the frogs prove nothing beyond the fact, for 
 here a continuous circuit is formed and galvanism developed. They 
 are nothing more than the rudest experiments with inorganic matter.* 
 893 b. In my Materia Medica and Therapeutics I have arranged Coun- 
 ter-irritants, with numerous other remedies, as an Order of Antiphlo- 
 gistics, and under the genei'al denomination of Cutaneous and other Lo- 
 cal Ajyplications. The counter-irritants consist of Vesicants, Rulefacients, 
 Suppurants, Escharotics, Potential Cauterants, and Actual Cauterants. 
 
 893 c. Vesicants are by far the most important, though mostly con- 
 fined to the blistering insects. The two next groups operate essentially 
 after the manner of vesicants ; but escharotics and cauterants are gen- 
 erally limited to simply local effects, and with only that obscure instru- 
 mentality of the nerves which must arise from their incorporation in 
 compound tissues (§ 746 c), though often giving rise to local reflex ac- 
 tions, especially moxas, but too moderate for much effect upon internal 
 parts. It is otherwise, however, with vesicants, rubefacients, and sup- 
 purants, which not only exert their useful effects through local nervous 
 centres, but in unsuitable states (§ 893 n, p) the first two often send 
 their influences to the cerebro-spinal axis, and thus develop a general 
 reflex action that disturbs especially the motions of the heart and ar- 
 teries, which are far more readily aflfected by these causes than the 
 functions of any other organ (§ 113-117, 224, 226-233f, 339, 409 h, 
 446 a, 454-461^, 478, 480-485, 489, 490, 500 dd, k, m, 512, 516 d, no. 
 3, 524 d, no. 7, 526 a, b, 687^688, 714-719, 746 c, 826 cc, 829, 846, 
 891^ g, k, 8925, 892^ v, 893 1, 902, 904c-905, 905|, 952, 961 a, 1059). 
 Again, also, when vesicants lead to irritative inflammation, which is 
 often the case with children, and in the sanguine and nervous tempera- 
 ments, or in others where general irritability is morbidly increased, the 
 nervous power may be brought into geiicral operation, and we may wit- 
 ness the full display of reflex nervous actions in one almost universal 
 commotion of the body (§ 150). This may also follow too extensive an 
 application of a blister, or of rubefacients, though no excessive irrita- 
 tion be produced in the skin ; just as a scald of limited extent may be 
 
 * See Notk'y p. 1130, Eick p. 1150.
 
 THERAPEUTICS. COUNTER-IRRITANTS. G45 
 
 salutary, while another less intense, but spreading over a greater sur- 
 face, will be often fatal. In all these cases, however, the effect is 
 morbific, and they exemplify the very close analogy between the op- 
 eration of morbific and remedial agents (§ 901). It is, indeed, the 
 amount of the agent, whether physical or mental, and the existing state 
 of the body, which makes all the difference between salutary and 
 morbid results. The amount of a remedy, which had been curative 
 in one case, may, in the same dose in another case nearly analogous, 
 or if not exactly applied, lead to a fatal issue. In the case of vesicants, 
 their action should be so circumscribed as to operate mostly through 
 local nervous centres, or by contiguous, not by remote sympathy ; and 
 hence a use of these terms (§ 497, 638|). Bloodletting will secure this 
 by lessening irritability and general reflex nervous action (^ 224, 1038). 
 
 In the preceding discussions upon the materia medica I have been ex- 
 tensively employed in seeking out the provisions which the Author 
 of Nature has so bountifully, however intricately, ordained for the re- 
 lief of those principal diseases of mankind, fever and inflammation. 
 And yet we have often had occasion to see that many of the most val- 
 uable agents for these purposes are directly productive of inflamma- 
 tion when unskillfully applied. This is often exemplified by many of 
 the cathartics ; and the Peruvian bark, and its analogous tonic asso- 
 ciates, will relatively cure or exasperate intermittent fever according 
 to the exact conditions under which they are administered. We have 
 seen, indeed, that even wine, brandy, &c., now and then become rem- 
 edies for fever, and even for inflammation (§ 752, &c., 892^,^). The 
 apparent contradictions I have endeavored to reconcile, and to show 
 that the occasional coincidence in the results of agents which are 
 opposed to each other under ordinary circumstances is due to a com- 
 mon law which governs the operation of all causes upon organic life. 
 The causes operate upon those properties in which life fundamentally 
 consists, and thus give rise to healthy, or morbid, or curative effects, 
 just as they happen to affect those properties (§ 137 d, 150, 151, 177, 
 189 b, 350k, 350^, 569 a, 638, 852 a). In disease, as we have seen, 
 their susceptibility is variously altered from the natural standard, and 
 variously so in any given disease, as in fevers and inflammations ; 
 according to the numerous fundamental and transient circumstances 
 already set forth. It may be, therefore, that, in a few cases oi common 
 inflammation bark or wine will place the diseased conditions in as fa- 
 vorable a state for the recuperative efforts of Nature, as bloodletting 
 and cathartics will do it in most other instances ; and when either 
 produce this auspicious change they are antiphlogistics. It is upon 
 this principle, therefore (or that of the general tendency of a vast 
 range of therapeutical agents to establish salutary changes in febrile 
 and inflammatory disease, when duly employed), that I have assem- 
 bled the most useful part of the Materia Medica under the general 
 denomination of Antiphlogistics. — See Note Ee p. 1133. 
 
 The foregoing remarks are preliminary to a farther exposition of 
 the same principles which are concerned in the therapeutical opera- 
 tion of the group of agents upon which we have now entered, and 
 which are curative by exciting inflammation, or analogous conditions; 
 and the best of them are such as will eflfect, in a given time, the near- 
 est approach to a full development in the skin of the most simple form 
 of common inflammation (§ 721, 722, 729 a). These means are, prin-
 
 640 INSTITUTES OF MEDICINE 
 
 cipally, cantharides, issues, and setons. Their immediate action ia 
 strictly morbific ; and they have no salutary effect upon existing in- 
 flammations till they produce a corresponding disease, or, at least, 
 that raoi'bid irritation which forms the access of inflammation, in some 
 part of the surface of the body. Then it is that this artificial inflain 
 mation or irritation so modifies the natural one, that the latter may 
 subside, rapidly, without any other curative influence ; while the ar- 
 tificial one is so peculiarly constituted by the nature of the remote 
 cause, that that, too, readily takes on a disposition to subside, and 
 thus the patient escapes from the inflictions both of Nature and of 
 art (§ 133 c, 137 e, 150, 151, 639 a, 852, 853, 854 c, d, e, 858, 905 a). 
 
 893, d. It has appeared to me a matter of no little importance to 
 consider the foregoing facts and the philosophy which concerns them ; 
 since, in connection with what has hitherto been said of the operation 
 of internal agents, and connected with what is yet in prospect rela- 
 tive to the special influences of loss of blood, they open widely a view 
 of the great principles of solidism and vitalism, and of the stupendous 
 laws by which healthy and morbid processes are carried on, and illus- 
 trate that connecting medium between them which is constituted by 
 the various gradations of the restorative movements as instituted by 
 remedial agents under the great recuperative law of organic beings. 
 The whole is but an intimate chain of analogies from the most perfect- 
 ly healthy state to the gravest conditions of disease (§ 901). 
 
 We see, also, distinctly exemplified by the mode in which blisters, 
 setons, &c., produce their favorable results, that absolute remedies in- 
 stitute the process of cure in virtue of their morbific qualities ; and 
 this becomes the more striking when we associate with the alterative 
 influences of vesicants upon internal inflammations, through the arti- 
 ficial disease which is established in the skin, those natural cutaneous 
 inflammations, as erysipelas, &;c., that are subdued by the direct con- 
 tact of the vesicant with the inflamed surface (§ 893 I, 1059). 
 
 893, e. We may now pause, for a moment, to observe how clearly 
 the various effects of cantharides prove the operation of curative 
 agents, either by a direct action upon the organic properties of a dis- 
 eased part to which they may be applied, or through the instrumen- 
 tality of the nervous power when they extend their therapeutical sway 
 to distant organs, and how, also, the nervous power is variously mod- 
 ified, and variously reflected upon remote parts, according to the na- 
 ture of its exciting causes (§ 227, 228, 230, 233^, 497, 500). The 
 common mode in which cantharides, setons, moxa, scalding water, 
 burns, &c., relieve or increase deep-seated inflammations, or disturb 
 the system at large, is clearly manifest ; and since only one of the 
 foregoing agents is liable to absorption, every precept in philosophy 
 divests the coincident effects of cantharides of a shadow of possibility 
 that they are due to an absorption of the agent. We have seen, too, 
 how erysipelas may be removed by the direct action of cantharides 
 upon the part inflamed ; and this (especially when associated with the 
 remote effects of all other remedial agents) assures us, as a next link 
 in the demonstration, that a modification is imparted to the nervous 
 power, according to the special virtue of the remote cause, which op- 
 erates, in that particular instance, upon the remote part in a mode 
 corresponding more or less with that which is observed in the primary 
 action. And now if we look at what is often goins forward in the blad-
 
 THERAPEUTICS. COUNTER-IRRITANTS. 647 
 
 tier, we shall see yet farther (something for the senses, something for 
 "experimental philosophy") that the nervous power actually acquii-es 
 the virtue of an inflammatory agent, and analogous, too, to the specific 
 characteristic of that virtue as it appertains to cantharides. Now 
 carry this to those inflammations which are constantly springing up in 
 different parts as consequences of each other, in the natural round of 
 disease, and you will come with me to the conclusion that the same 
 philosophy obtains throughout. It is exclusive of absorption in the 
 case of the bladder, besides other obvious objections. 
 
 It appears, therefore, that Avhen erysipelas yields to the direct action 
 of vesicants it is by the substitution of the kind of inflammation which 
 cantharides produces in the sound skin, and which subsides spontane- 
 ously and speedily. Again, other local applications, as nitrate of silver, 
 iodine, mercurial ointments, &c., will effect the same result by introduc- 
 ing other and very different pathological changes, or the erysipelatous 
 inflammation may be subdued by loss of blood, or by cathartics, or by 
 the constitutional action of mercury, or perhaps by stimulants. It is 
 manifest, therefore, from all this variety of means, leading to a common 
 result, that the cure depends in all the cases upon the substitution of some 
 artificial pathological condition which is capable of spontaneous subsi- 
 dence, though the changes which are thus forcibly introduced are as va- 
 rious as the remedies (§ 854, 892 b, c, 897-902, 904 d, 905, 1059). 
 
 But, though the cantharides supply an apt illustration of the whole 
 philosophy of our subject, and, like the natural developments of in 
 flammation which follow each other by reflected nervous actions, de 
 note a modification of the nervous power in great conformity with tho 
 nature of the causes by which it is brought into operation, there is, 
 nevertheless, a great variety of remedial agents, which, in their thera- 
 peutical doses, manifest no action upon the organ to which they are 
 applied, and through which they overcome disease in parts remotely 
 situated ; as also other important ones, like mercury, when applied to 
 the skin. And, although it be rendered obvious by the morbific effects 
 of these agents that they modify the nervous power in their therapeu- 
 tical aspects as much according to the nature of the several agents, 
 respectively, as do cantharides, issues, setons, or as when one natural 
 inflammation supervenes upon another, I have made the qualification 
 which is due to a subject hitherto so entirely unexplained, that the 
 modifications of the nervous power take place under the influence oj 
 its 0W71 natxire (§ 228, a, 8921 c, 896-901, 1059, 1088 h, c). 
 
 Finally, in respect to the modus operandi of cantharides, when con- 
 sidered in ks analogies to other vesicants, issues, &c., we have an in- 
 tei'esting view of the specific relations which the special virtues of cer- 
 tain remedial agents sustain toward the modified irritability of partic- 
 ular parts of the organism, and a proof, also, of the diversified condi- 
 tions of irritability in different parts, and of the remai'kable manner in 
 which the nervous power is reflected with salutary or morbific effect 
 through certain motor nerves by the peculiarities of each exciting and 
 modifying cause (§ 233|, 500 g), while there is simultaneously pre- 
 sented by the operation of cantharides a curative influence upon all 
 parts that are affected by disease, and a morbific one upon a special 
 part that was antecedently in its natural state (§ 150, 151, 188 a, 
 190 a)\ but its action is useful only through local nervous centres. 
 
 893, y. From what has been now said, it is manifest that vesicants,
 
 648 INSTITUTES OF MEDICINE. 
 
 issues, setuns, and other counter-irritants do not produce their favora- 
 ble effects through the discharges to which they give rise ; though thia 
 is one of the principal interpretations in the humoral pathology. The 
 effusion instituted by cantharides is so unimportant that it can scarce- 
 ly be taken into the account in explaining the curative influences of 
 this agent (§ 863). Moreover, it frequently happens that blisters af- 
 ford all the relief of which they are capable by acting merely as rube- 
 facients. This, indeed, is oftener true than is commonly supposed, 
 since vesicants are generally permitted to remain till vesication is es- 
 tablished ; though in numerous cases this extent of their action is un- 
 necessary (§ 497, 1038). 
 
 Since, therefore, cantharides will often answer its intention when 
 employed only as a rubefacient, and operates at all limes through the 
 vital impressions it exerts upon the skin, it may appear unimportant 
 to some whether this or another agent be employed for the purpose 
 of counter-irritation. Such, indeed, is, unfortunately, supposed to be 
 true by many practitioners, who resort to mustard cataplasms, or am- 
 monia, &c., where cantharides would be a far more useful agent. So 
 true is this where active inflammation affects any of the important 
 viscera, and vesication has become appropriate, and may be of the 
 highest importance, the rubefacients, which operate speedily, have 
 little or no salutary effect, and are often detrimental by increasing 
 constitutional irritation (§ 150, 151). 
 
 893, g. The foregoing remarkable difference in results {/) is ow- 
 ing, in part, to the difference in the virtues of the remedies, and, in 
 part, to the difference in time occupied by the several agents respec- 
 tively. In all cases of very rapid irritation of the surface, vesication, 
 &c., whether induced by ammoniated lotions, mustard, boiling water, 
 moxa, &c., the curative effect upon deep-seated inflammations is far 
 less than whei'e the artificial disease is more slowly instituted. It is, 
 nevertheless, of no little moment, in the case of vesicants applied for 
 active forms of disease, that the irritation of the skin should advance 
 with considerable rapidity, and that vesication should ensue, at adult 
 age, in from six to twelve hours. That is the most useful period ; 
 and when the full action of cantharides is longer delayed, whether by 
 some defect in the remedy, or by a subdued irritability of the skin, 
 the curative effect is commonly less obvious. — See p. 298, ^ 476^ h. 
 
 It is also proper to observe, in a philosophical as well as practical 
 sense, that time has various influences, according to the modification 
 of disease, its seat, its duration, the constitution, sex, age of the sub- 
 ject, &c. It relates to the nervous power, and is explained in ^ 479. 
 
 But, in no respect is the influence of time so remarkable as seen in 
 the difference of results in the treatment of acute and chronic diseases ; 
 in which respect counter-irritation is on a par with other remedial in- 
 fluences. When inflammation is recent, the usual rapidity with which 
 cantharides operates is best suited to almost all forms of the disease ; 
 :,\xl when it has run into a chronic state, and has become the subject 
 of habit, it frequently happens that tardy suppurants, such as setons, 
 issues, tartar emetic ointment, &c., are highly useful (§ 535, &c.). Yet 
 there is no doubt that the difference in results as it respects the time 
 of these cutaneous agents, in the acute and chronic forms of inflamma- 
 tion, has been often much overrated; especially the advantage of a 
 suppurating surface in chronic diseases. It is apt to be supposed, in
 
 THERAPEUTICS. COUNTER-IRRITANT^J. 64 J 
 
 these cases, that there is something to be discharged, either " concoct- 
 ed matter," or such as refuses to be concocted. 
 
 893, h. Although it be true that chronic inflammations oppose to 
 counter-irritants the obstinacy of morbid habit, and naturally suggest 
 the long-continued and uninterrupted influence of issues, &c., expeii- 
 ence has fully shown, that, in most cases of low indolent inflamma- 
 tions they are surpassed by a frequent succession of blisters. This 
 experience, too, has mostly banished from use the savine ointment, 
 and other agents, which were but lately and largely employed to 
 maintain the action instituted by cantharides. The difference goes, 
 with an endless variety of analogous facts, in illustrating some of the 
 profound problems of organic life. The uninterrupted action of issues, 
 the prolonged ulceration of vesicated surfaces, &c., are more or less 
 apt to establish a morbid habit peculiar to the modifying agents; and, 
 although it be a first step in the series of changes which are necessa- 
 ry to establish the full recuperative process, the pace is retarded by 
 the habit induced. To break this force of habit, it is only necessary 
 to intermit the agent during the time required by the healing of a blis- 
 ter. The curative impression remains, and the irritability of the or- 
 gan diseased undergoes an increased susceptibility to the agent at its 
 successive renewals. Each repetition gains upon the last, and often 
 presents the aspect of cumulative influence. The principle is shown 
 in relation to many things, and may be seen in the action of antimo- 
 ny, opium, &c., in former sections (§ 550-556, 558 h, 889 m, 902 i). 
 
 The influence of habit of which I have now spoken, as it respects 
 the artificial change induced in chi'onic inflammations by the uninter- 
 rupted operation of issues, &c., grows out of the analogous habit which 
 the agent establishes in the artificial or curative disease, which soon 
 lapses into that chronic state which is less and less sensibly felt by 
 parts morbidly affected ; while those parts, and the entire system, are 
 gradually accommodating themselves to the artificial irritation, and by 
 which this irritation loses still farther its sympathetic and curative in- 
 fluences upon the morbid conditions for which it is instituted. But 
 if, on the contrary, a succession of irritations be employed, the habit 
 of which I have spoken is neither established in respect to the system, 
 nor the parts diseased, nor in respect to the artificial condition ; but 
 eveiy successive repetition of' the irritation produces nearly as pro- 
 found an impression as the first (§ 150, 151). Here, too, along with 
 the coincident effects of numerous internal agents, we may call up the 
 advantages of repeated leeching, as presented in a subsequent sec- 
 tion (§ 926), and in which reflex nervous action is equally concerned. 
 
 The same great principles are involved in all the cases. An ele- 
 gant philosophy obtains throughout ; and, although founded upon the 
 great Institutions of Organic Nature, it is surrounded by so many of 
 the qualifying circumstances that are incident to the instability of the 
 vital properties, it can be fully appreciated and converted to the high 
 practical purposes of which it is susceptible only by a careful, impar- 
 tial, and unremitting attention to the phenomena of organic beings. 
 
 893, ^. The principles to which I have just adverted (§ 893, h) he 
 Et the foundation of other practical facts connected with the success 
 of counter-irritation. The impression upon the skin, for instance, 
 must be carried to a certain intensity, and that will depend upon the 
 nature and force of disease, and other obvious contingencies. If it be
 
 650 INSTITUTES OF MEDICINE. 
 
 slight, the necessary impression may not have been made ; while, on 
 the other hand, if in excess, then it may not only disturb the general 
 functions of" the body, but aggravate the inflammation which it is the 
 design of the remedy to relieve. In this respect, therefore, there is a 
 close analogy with the action of remedies, when administered inter- 
 nally, as it respects their doses. 
 
 Another important point to be observed is the extent of the surface 
 over which an artificial irritation should be established. This will 
 manifestly depend upon a variety of circumstances ; upon the nature 
 of the irritant, upon the extent, force, and situation of the disease, &;c. 
 [f the usual agent, cantharides, be employed, and the surface imtated 
 be of narrow limits, it may be insufficient to break in upon the mor- 
 bid process, however intense may be the artificial irritation. On the 
 other hand, however, if a very large surface be irritated, its reflex 
 nervous action may be morbific, although the artificial irritation be 
 not intense. The difference in effects is of the same nature as that 
 which attends the small, deep burn of moxa and an extensive superfi- 
 cial scald ; the former being of no importance, while the latter may 
 be speedily fatal through a sudden and violent reflex nervous action. 
 
 But, there is a great diffei'ence between the effects of an extensive 
 surface vesicated by cantharides, and by scalding water; and this 
 probably arises mostly from the difference in the times which the 
 remedies occupy. In the former case, the system is gradually accus- 
 tomed to the reflex nervous actions, and may be but little disturbed, 
 while, in the latter, the violence of the impression upon the system is 
 proportioned to its instantaneousness ; and the extent of the surface 
 irritated being great, a violent shock ensues. In one case the rem- 
 edy operates through local centres of the sympathetic nerve (§ 497, 
 893, «, c), in the other the cerebro-spinal axis is involved, and a gen- 
 eral, sudden, prostrating nervous influence is developed (§ 476^ A, 
 479,509,893, c,p). 
 
 It is eA^ident, therefore, that there is only a certain parallel between 
 the effects of vesication by cantharides and scalding water, whether 
 upon a small or an extensive surface, — scarcely exceeding the par- 
 tial coincidence by which I have endeavored to illustrate the differ- 
 ence between small and large vesications by cantharides, and to ex- 
 pound again the principles concerned- in the effects of agents which 
 operate gradually or with great rapidity. The difference, indeed, is 
 80 great between the effects of vesication when the gradual result of 
 cantharides, and those which are instantly induced by scalding water, 
 that we may safely vesicate an extent of surface by the former agent 
 which it might be fatal to attempt by the latter (§ 891, w). The tinc- 
 ture of cantharides, when applied to the skin, produces vesication 
 with great rapidity, is far less curative, and oftener disturbs the con- 
 stitution, than when vesication over the same extent of surface is pro- 
 duced by the common plaster. — See Experiments ^ 476J A, 479. 
 
 Nevertheless, there are certain inflammations, especially of a neu- 
 ralgic and rheumatic character, and not affecting important organs, in 
 which a rapid and violent imtation of a very small surface, as by moxa, 
 will sometimes overcome the disease. But these intense, sudden, and 
 limited irritations, in affections of any of the important viscera, are 
 never useful (§ 479). 
 
 If the disease be of a different character from inflammation, as the 
 suddenly painf al affections of the stomach that are incident to indiges-
 
 THERAPEUTICS. COUNTER-IRRITANTS. 65^ 
 
 don, or, as in colic, &c., the rapid irritation which is produced by the 
 rubefacients may then afford immediate relief, and more effectually 
 than might be yielded by the vesicating action of cantharides. These 
 rubefacients are, also, often abundantly efficacious in the declining 
 stages of articular rheumatism, or in low chronic states of that disease. 
 But this is a peculiar modification of inflammation which will also 
 yield, under the same circumstances, to some internal remedies which 
 exert no salutary influence upon the common, or other modifications 
 of inflammation (§ 661, 662, 756 a, b, 892 b, 892 J v,904 d, 1059). 
 
 893, k. The vesicating plaster is generally made too small to yield 
 all the benefit of which it is capable. Four inches square is a com- 
 mon size for the thorax and abdomen ; while six or eight inches 
 square are not only equally safe, but far more efficient, under the or- 
 dinary circumstances which justify or require this remedy. Indeed, 
 so comparatively safe is it to institute an extensive irritation by means 
 of cantharides, when the state of the system is properly prepared, and 
 the force of disease is otherwise moderated, and so important is it in 
 certain conditions of disease to effect a very powerful impression, es- 
 pecially in the cerebral inflammations that refuse to yield to copious 
 abstractions of blood, that I have sometimes rescued patients by the 
 apparently desperate practice of vesicating simultaneously the entire 
 scalp and a large extent of surface upon the neck and shoulders. 
 Where bloodletting has been thoi'oughly practiced, and inflammation 
 remains obstinately seated in some great vital organ, a blister of twelve 
 inches square may be necessary to determine a sufficiently powerful 
 nervous influence, of which six inches would fail (^ 479). 
 
 But, in respect to inflammation of the brain, it should be distinctly 
 understood that vesication of the scalp is entirely inadmissible, un- 
 less the irritability, and therefore the susceptibility, arising from the 
 morbid state, be greatly lessened by abstractions of blood, cathartics, 
 &c. The irritation of the scalp will be otherwise propagated with 
 morbific effect upon the brain ; which arises, in this instance, partly 
 through continuous sympathy along the communicating vessels (§ 
 498). Nor is it expedient to incur the risk when immediate danger 
 is not impending, but to apply the agent to the neck and shoulder. 
 The same objection lies against the application of blisters to the im- 
 mediate vicinity of the eyes and ligaments in their very irritable states 
 of inflammation. But if, in these cases, the disease have lost its activ- 
 ity, or be of a chronic nature, the vesicant is then most efficient when 
 applied near to the part affected. It sometimes happens, however, in 
 chronic conditions, that the skin in the immediate vicinity becomes 
 sympathetically affected through the same influences from the parts be- 
 neath as are propagated upon them, at other times, by vesicating the 
 overlaying skin. These morbid states of the adjacent surface are gen- 
 erally obscurely marked ; though sometimes abundantly apparent, as 
 in active forms of articular rheumatism. The obscure conditions oft- 
 en become strongly pronounced by an irritative, erysipelatous inflam- 
 mation which is set up by vesicants, and by leech-bites, and which 
 commonly aggravate for the existing time the natural disease; though 
 the morbific influence is apt to disappear, and leave the disease as it 
 was, as soon as the artificial irritations subside. 
 
 893, I. It may be now said, as a general rule, that the liability of 
 counter-irritants, when applied near to a part inflamed, to increase the
 
 (552 INSTITUTES OP MEDICINE. 
 
 inflammation, is in proportion to the intensity of the disease, the inten- 
 sity of the artificial irritation, and the rapidity with which it is pro- 
 duced. It may, therefore, be regarded as safe, in a general sense, to 
 apply vesicants and rubefacients immediately over the affected parts 
 in chronic inflammations. But this is far from being true of moxa, 
 where the affected part is in the vicinity of the surface. 
 
 And yet we have seen that it may be sometimes perfectly safe and 
 useful to place an epispastic in direct contact with certain inflam- 
 matory states of the surface. This, however, is never true of common 
 inflammation of the skin, and only so of a few specific varieties. Their 
 successful treatment in this manner, as in the case of erysipelas, opens 
 to us another illustration of the principles upon which remedial agents 
 operate. The disease, being a specific modification of inflammation, 
 has not the disposition to subside spontaneously which belongs to com- 
 mon inflammation. The remedial agent, therefore, varies the mode 
 of inflammation, and thus introduces a modification in which the prop- 
 erties of life are brought into recuperative action. But, it is otherwise 
 with common inflammation, since the virtues of cantharides are such 
 as to aggravate this condition when brought into immediate contact 
 with the part affected. The same explanation applies to the thera 
 peutical effect of the spirits of turpentine when applied to a bum or 
 a scalded surface ; since, in these cases, the inflammatory state is 
 turned from the common standard, and admits of the institution, by 
 other irritants, of modifications more favorable to the recuperative 
 process. And so of nitrate of silver (^ 893 d, 1059). 
 
 893, m. With the qualifications now made, it is obvious from what 
 has been said of the modus operandi of counter-irritants, that they will 
 be curative in proportion as they are applied to the vicinity of the seat 
 of disease. Their salutary effects, like their morbific, depend more 
 upon this approximation than upon any special sympathetic relations 
 between certain parts of the surface and the particular internal organs ; 
 since it is mostly through local centres of reflex nervous action that 
 these agents produce their curative effects (^ 497, 893 a, c, 905 a). 
 
 It is also a remarkable fact, that it appears to be of no great moment 
 in what particular tissue of comDound organs the disease is seated. 
 Inflammations of either are alike affected by irritants as they are by 
 loss of blood ; but varying, in all the cases, according to the general 
 vital constitution of the several parts (§ loO, 151). 
 
 893, n. We have seen that it is the tendency of inflammation to lim- 
 it itself to the tissue which it invades, and that its extension to other 
 tissues of the same organ, or to other parts, is by remote or by contig- 
 uous sympathy (§ 497, 498). It is also particularly true of certain 
 tissues that they are apt to extend the violence of their remote influ- 
 ences upon paits of similar organization ; especially in specific forms 
 of inflammation. Thus, rheumatic inflammation of the ligaments is 
 very apt to invade the pericardium, and sometimes the dura mater; 
 and, the peculiar inflammation which constitutes the mumps (cynanche 
 parotidea) often involves the testes or the mammae. There is much 
 reason to think, in the former case, where the heart so often partici- 
 pates, that the inflammation is first propagated to the pericardium, and 
 subsequently from that organ to the serous tissue of the heart (§ 141, 
 525-529). In the latter case, or that of the mumps, the affection of 
 the parotid will frequently subside when the other glands become af-
 
 THERAPEUTICS. COUNTER-IRRITANTS. 653 
 
 fectecl ; and the disease is then said to have undergone a metastasis, 
 — a magnificent display of our alterative reflex nervous action. Artic- 
 ular rheumatism affords constant examples of this phenomenon, in its 
 rapid and successive invasions of different joints, and the frequency 
 with which it subsides in one as it springs up in another (§ 524 a, 3). 
 
 Now, there is a prevailing error in the pathological construction of 
 this extension and subsidence of the disease, which has led to a veiy com- 
 mon error in practice. It is supposed that there is a translation of the 
 disease from one part to another, an actual movement of the complaint 
 — something, probably, after the manner of the gases, as represented 
 in a former section (§ 350j, n). The phenomenon, in consequence, 
 has long borne the significant name of metastasis ; and if gout happen 
 to go from the foot to the stomach, it wanders so much out of its way 
 that it gets in the s.tomach the well-known and expressive name of 
 misplaced gout. As all men, therefore, are greatly moved in their prac- 
 tical habits by theoretical views (§ 4), it is no less common to imagine 
 that the rheumatic or gouty affection may be driven or invited back to 
 its appropriate place. Hence the applications which are made to the 
 primary seat of the affection, but from which disease has taken its de- 
 parture. And so, also, counter-irritants are applied to the parotid 
 gland, should the testes, or mamm.ge, become affected in mumps, in 
 the expectation of calling back the disease which is so far astray. 
 
 In the first place, however, there is, in all these cases, nothing con- 
 cerned but reflex actions of the nervous system, and nothing is want- 
 ed to render the treatment appropriate and intelligible but a knowl- 
 edge of physiology and pathology. All the ambiguous results are di- 
 rectly referable to the laws which govern the operation of the nervous 
 power, which now presents itself in the compound aspect of a mor- 
 bific and remedial agent among parts which have either strong natu- 
 ral relations, or which are especially susceptible of morbific influences 
 that result in the condition which is the supposed subject of transla- 
 tion from one part to another; while, in its turn, tlio sympathetic dis- 
 ease propagates, after the manner of vesicants, curative impressions 
 upon the primary seat of the disease by like reflex nervous actions. 
 
 Secondly, the artificial irritation excited with a view to recalling 
 the disease (as in vesicating the joints when gout attacks the stomach, 
 and this, too, even when that organ maybe the primary and only seat 
 of the affection) is very different from the modification of inflamma- 
 tion which constitutes the pathological state of the disease itself, and 
 therefore would not become, by any reflected influence upon the parts 
 beneath, a substitute for it ; while it is certainly an anti-pathological 
 mode of recalling the specific, or any form of inflammatory disease, 
 in deep-seated parts, since counter-irritation is one of the principal 
 means by which we remove inflammation of these parts. 
 
 The foregoing practice, as founded upon the doctrines of metastasis 
 and revulsion, is contra-indicated not only by physiological laws, b-.it 
 by all experience. The practice has been wholly directed by hypothe- 
 sis, and has not been sustained by any favorable results. We need go 
 no farther in proof of this than the admitted failure of M. Louis, in his 
 application of "blisters to the legs," to remove, upon the foregoing 
 hypothesis, the gravest forms of inflammation and disorganization of 
 the brain, intestine, liver, &c., which befell the victims of " The Ty- 
 phoid Affection" at La Charite. And here we see again exemplified
 
 654 INSTITUTES OF MEDICINE. 
 
 in the extensive sway which may be exercised not only by the au 
 thority of a favorite writer, but in the pernicious tendency of con« 
 elusions in medicine that are founded upon the results of practice as 
 directed by errors in principles, the proneness of man to rest his in- 
 quiries, his hopes, his reputation, the happiness and the lives of man- 
 kind, upon simple views of the most abstruse, stupendous, and com- 
 prehensive Institutions in Nature, — the Institutions of organic life (§ 
 4, 5^, 5|, 349 d, 350i-350|). But, let us have an example in rela- 
 tion to the effects of counter- irritation by cantharides, as propounded 
 by the great head of the Necroscopic School. Thus : 
 
 " Blisters," says M. Louis, " ought to he banished from, the treat- 
 ment of the typhoid affection." " If they exercised any influence 
 upon the duration of the disease in the patients who have recovered, 
 it was hy prolonging it a little." 
 
 Again. *' I have not only rejected vesication from the treatment of 
 pneumonitis ; I have also ceased to employ it in pleurisy and pericar- 
 ditis." " How can we believe that the effect of a blister is to check 
 an inflammation, when this blister is one inflammation superadded to 
 another ]" ! " In thoracic inflammations, their usefulness is neither 
 strictly demonstrated (according to the numerical method), nor even 
 probable." 
 
 " One thing is viost assuredly heyond question, and we should never 
 be weary of repeating it : that the therapeutic value of blisters is not 
 known ; that it must be studied by the aid of numerous and carefully- 
 noted facts, just as if nothing at all were knoion about it." 
 
 If the reader be not conversant with the history of that kind of 
 "experimental philosophy" upon which the foregoing conclusions are 
 founded, or with the efforts which are in progress to give it an as- 
 cendency over the philosophy which Nature teaches, he may obtain 
 some knowledge of their extent by referring to foregoing sections (§ 
 5| a, 349 d, 350| Tik, Also, M.ed. and Physiolog. Comm., Essay on 
 the Writings of M. Louis, vol. ii.). 
 
 Instead, therefore, of the unavailing efforts of applying blisters to 
 the extremities for the relief of cerebral, or hepatic, or intestinal, in- 
 flammation, &c., let them be directed to the organs which are the seats 
 of disease, by applying them over, or in the vicinity of, their regions, to 
 obtain the advantage of local centers of reflex nervous action (§ 224), 
 
 As to the doctrines of metastasis and revulsion, which have had 
 their origin in the phenomena of reflex nervous actions (especially as 
 witnessed in the successive development and subsidence of disease 
 as they obtain in gout, rheumatism, and mumps), the whole system 
 is constantly supplying examples of the accession of one disease as 
 the sympathetic consequence of another, and the subsequent decline 
 of the primary affection as a sympathetic result of the secondary de- 
 velopment. And here, by-the-way, we are presented, in the natural 
 process, "with a perfect exemplification of the principle upon which 
 counter-irritants operate in subduing diseases remote from the seat of 
 their application ; and we may thus readily comprehend how it hap- 
 pens that the discharge from an ulcer, or a seton, or blister, &c., will 
 be suddenly arrested, or the superficial parts turned into the worst 
 conditions, by the occurrence of disease in some internal part (^ 740), 
 
 The foregoing play of sympathies, however, is far from being equal- 
 ly true of all organs, or of all forms of disease. It is most distinct-
 
 THERAPEUTICS. COUNTER-IRRITANTS. 655 
 
 ly pronounced where pulmonary phthisis is preceded by gastric de- 
 rangement, when the occurrence of the former often takes the lead 
 and relieves, for awhile, the latter affection ; but only again to light up 
 indigestion, and ulcerative inflammation in the intestinal mucous tis- 
 sue (§ 803, 804). But, it is rare, perhaps never, that remote diseases 
 are favorably impressed by any form of disease that may happen in 
 the alimentary canal. On the contrary, indeed, all such conditions 
 are likely to aggravate or to maintain any affections that may be re- 
 motely situated, their reflex nervous actions being morbific. 
 
 Nevertheless, such is the analogy between the reflex nervous ac- 
 tions of diseased parts, — between the rise and decline of diseases, in 
 certain parts, as consequences of each other, and the curative effects 
 of many internal agents, that a vast number of therapeutists, overlook- 
 ing the relations of the alimentary canal to all other parts, confound 
 these internal remedies with the external counter-irritants ; classing 
 them all under the name of revulsives or counter-irritants. And here 
 is opened another wide door to an excessive abuse of violent internal 
 agents, and where we may well contrast the ten-grain alterative dose 
 of tartarized antimony, and the most powerfully-irritating cathar- 
 tics, administered with a view of establishing counter-irritation in the 
 stomach and intestine, with that prejudice against bloodletting which 
 sees nothing of the counter-irritant in the effects of this remedy. And 
 how well does not all this submission to theory admonish us of the 
 importance of investigating the nature of the influences which are ef- 
 fected by loss of blood (§ 4) ! We all know what is doing in the way 
 of tartar emetic. I3ut let us take an example of the same philosophy 
 from among the cathartics ; for this is the only way of helping the 
 cause of humanity in such cases, or of arresting another evil (§ 878) 
 upon a more selfish principle. Let us go to the erudite and ablest 
 work on Materia Medica for an example ; and we will have others 
 respecting certain substitutes for bloodletting in a future section (§ 
 960). Thus, then, Pereira : 
 
 " Pliny truly observes that the juice of the elaterium apple is dan- 
 gerous when applied to the eye ; and Dr. Clutterbuck mentions that 
 some of it ' getting accidentally into the eye in one instance, it occa- 
 sioned severe pain and inflammation, with an erysipelatous swelling 
 of the eyelids, that continued the following day.' We have a farther 
 proof of its irritant properties in the inflammation and ulceration of 
 the fingers of those employed in its preparation. When swallowed, 
 therefore, elaterium irritates the gastro-intestinal membrane, and oc- 
 casions vomiting and violent purging." " In some dropsical cases, I 
 have known a single dose discharge several pints of fluid from the 
 bowels. The gripings, and the increased number of evacuations, 
 prove that the irritation is not confined to the mucous coat, but is ex- 
 tended to the muscular coat. Under the influence of a full dose, the 
 pulse is excited, the tongue becomes dry, and sometimes furred, and 
 great thirst is produced. Considered with respect to other cathartics, 
 we find it pre-eviinently distinguished by the violence of its purgative 
 effect." — Pereira's Materia Medica. — Notes H K pp. 1117, 1119. 
 
 And yet is this cathartic commended above all other hydrogogues 
 for the cure of dropsy ; and even boldly so, upon the principle of its 
 producing counter-irritation in the gastro-intestinal mucous tissue ; 
 that is to say, the same sort of inflammation which affects the fingers
 
 056 INSTITUTES OF MEDICINE. 
 
 when the juice is applied tu the skin. It should be also said of so 
 valuable a work as that from which the foregoing extract is made, — 
 valuable as a system of Materia Mcdica, — that Pereira approves the 
 practice, and of course, therefore, the principle. The principle is 
 thus stated by the author : 
 
 " Its effects," he says, " in dropsy, are two-fold ; first, absorption of 
 the effused fluid ; secondly, the stoppage of any farther effusion in 
 consequence of the metastasis of vital action from the seat of the 
 dropsy to the intestinal membrane." 
 
 And again, he says, " In apoplectic affections, elaterium, as a drastic 
 cathartic, sometimes proves serviceable on the principle of countcr-ir- 
 ritation:'—'No'r-E G p. 1116. Also, ^ 1065 d. 
 
 That is the doctrine. A metastasis of the inflammation to the in- 
 testinal canal ; and such is the virtual effect. But I have shoAvn that 
 counter-irritants exert their good effects only through local centres of 
 reflex nervous action, while they are injurious Avhen they develop a gen- 
 eral reflex action of any intensity through the brain and spinal cord, 
 however those organs may otherwise participate; and such is the perni- 
 cious effect attending this counter-irritation of the intestinal canal. 
 
 Opposed to metastasis, revulsion, derivation, &c., is the doc- 
 trine o? repulsion. Thus, in respect to the utility of vesicating the joints 
 in acute forms of i-heumatism and gout there is a strong array of oppo- 
 site opinions. The objections to the practice are founded upon the same 
 pathological conclusions that have led to the cultivation of ulcers, cu- 
 taneous eruptions, &c. ; it being supposed that it is often the effect of 
 counter-irritants to repel (as it is called) the disease from the joints, 
 and to establish it upon the heart, the stomach, or other important or- 
 gans. This supposed effect, therefore, is exactly the reverse of that 
 which I have just considered, or the induction of disease to sound 
 parts by counter-irritation. In one case, the advocates of metastasis 
 suppose that they invite disease from one part to another not diseased; 
 in the other they are employed in driving disease from the affected 
 part to another part not affected. 
 
 That is the modus operandi. But, its fallacy is shown, at once, by 
 the flitting character of gout and rheumatism ; suddenly subsiding in 
 particular joints and as suddenly invading others, or attacking the in- 
 ternal viscera, when counter-irritants are not employed. Indeed, it is 
 now known that inflammation of the tissues about the heart is a vei'y 
 common attendant of articular rheumatism ; and the fact that acute 
 gout is, at present, rarely treated by vesication, yet as frequently as ever 
 invades important oi-gans, disproves the assumption as to the tenden- 
 cy of blisters to produce these results. But, I am rot advocating the 
 employment of counter-irritation in acute forms of rheumatism and 
 gout ; certainly not till the intensity of disease is greatly subdued by 
 antiphlogistics of a sedative nature, and general reflex action reduced. 
 In connection with the last remark it is also worthy of observation, 
 that free bloodletting in acute rheumatism is strongly opposed upon 
 the ground of its tendency to involve the heait in rheumatic inflam- 
 mation. But, in all the reputed cases the inflammation had probably 
 already affected the heart before the abstraction of blood, and consti- 
 tuted cases for a very extensive application of the remedy. If loss oi 
 blood will surmount the disease more speedily in any other part than 
 the united force of all other means, it cannot, surely, fail of a corre- 
 Fponding effect upon the main source of the circulation (§ 500 m).
 
 THERAPEUTICS. COUNTER-IRRITANTS. 057 
 
 893, o. Among the evil consequences of vesication is a bad condi- 
 tion of cutaneous inflammation, which either refuses to subside and 
 annoys the patient by its excessive irritation, or it results in extensive 
 ulceration, or in gangrene. These conditions are ow^ing to a very 
 morbid state of the skin, generally consequent on some formidable 
 disease affecting the great viscera of the abdomen ; especially the gas 
 tro-intestinal mucous tissue (§ 689, I). They add, of course, greatly 
 to the evils of the disease, and hasten a fatal termination, which is apt 
 to ensue upon the disease itself These effects of blisters are most 
 frequently witnessed in scarlatina, and often along with parotis, and 
 ulcerated, or sphacelating, fauces. But, happily, they are rather rare ; 
 certainly less frequent than is surmised by many. It is never possible 
 to know the existence of the peculiar condition of the skin which gives 
 rise to these consequences ; no more so than we are able to infer the 
 predisposition to erysipelas which is often established by abdominal 
 affections (§ 689, 1). From their rarity, also, an apprehension of their 
 possible occurrence should never deter us from the use of blisters. 
 
 Strangury is another, and a frequent evil of cantharides, though it 
 does not often aggravate any existing disease. The urinary bladder 
 has no strong physiological relations beyond its own system of organs, 
 and pain is not apt to prove morbific, of itself (§ 140, 422, 891 m). 
 There is no way of preventing its occurrence in particular subjects 
 with any certainty. 
 
 893, p. The foregoing are the most obvious injuries which are produ- 
 ced by vesicants, especially by cantharides (§ 893, 6). These unfavor- 
 able results, indeed, are commonly regarded as the principal ones to 
 which the common epispastic is liable. But, there are others, which, 
 though too often neglected, are far more important, since they are 
 frequent, and often determine a fatal issue of disease. These evils 
 arise from morbific influences which are propagated abroad either by 
 too intense an iri'itation of the skin, or from creating the irritation un 
 der unfavorable circumstances (^ 893 c). 
 
 It is the last condition which is the most frequent cause of the un- 
 favorable effects of blisters, and which, in the hands of superficial ob- 
 servers, have led to the denunciation of this important antiphlogistic. 
 
 The inauspicious states for vesication depend, especially, upon too 
 exalted irritability of the parts diseased, or of other organs ; particu- 
 larly of the heart and general circulatory system. If blisters, or oth- 
 er counter-irritants, be applied to the skin in this state of morbid iiTi- 
 tability, the diseased parts are roused to a greater intensity of morbid 
 action, and the whole vascular system to a more violent movement ; 
 so that a series of untoward results is thus instituted, which sympa- 
 thetically, and mutually, aggravate each other, and give rise to new 
 morbid developments, till the multiplying reflex nervous actions maybe 
 arrested only by their own fatal tendency. Nor can I doubt that many 
 of those terrible inflammations, and structural lesions of all organs, 
 which abound in M. Louis' work on the Typhoid Affection, and which 
 have been taken as the basis of the most important principles in pa- 
 thology and therapeutics, were owing to the cause now under consid- 
 eration ; since this distinguished man was about as hostile to blood- 
 letting as he became toward vesication, after witnessing the latter's ef- 
 fects in the complicated malady which will be long celebrated in the 
 annals of medicine (§ 893 a, c). 
 
 T T
 
 658 INSTITUTES OF MEDICINE. 
 
 The system, in the advanced stages of fever, is generally in an ins- 
 table state, is oppressed with local congestions and inflammations ; or 
 whether so or not, the artificial irritant becomes a source of annoy- 
 ance, and often adds to the dangers it was intended to avert. This, 
 indeed, is especially the time when such useless local irritations should 
 be avoided, or quieted if they exist. Remaining inflammations and 
 fcongestions should be treated with as little additional disturbance to 
 the system at large as may be possible in those advanced stages of 
 fever which were the subjects of Louis' experiments, and of too many 
 others. Or, if it be necessary to resort to counter-irritants for their 
 removal, they should be, at least, applied in the vicinity of the affect- 
 ed organs, where, alone, they can be of any avail. 
 
 Independently, therefore, of the direct and immense advantages of 
 bloodletting, cathartics, antimonials, &c., we realize more sensibly the 
 force of their importance, in acute inflammations, at least, when we 
 consider that without the antecedent aid of one or another, but of 
 bloodletting especially, we are conapletely cut off" from the benefits of 
 counter-irritation. Nay, more ; so great are the prejudices against 
 the principal remedy for inflammation and fever, or so sparing is its 
 application, that cathartics inflict many evils when they might other- 
 wise be rendered highly salutary, or their necessity, as well as of 
 epispastics, superseded by moderating general reflex nervous action. 
 In all grave inflammations loss of blood is indispensable to the most 
 useful effects of cathartics, or to their safety, and is absolutely the only 
 condition under which counter-irritation should be attempted. Just 
 as long, also, as the disease may remain in force, or general or local 
 abstractions of blood may continue to be useful, vesication should be 
 delayed. This remedy may then succeed with the most happy effect 
 upon any remaining disease, even though it have passed into some 
 other form than that of inflammation. 
 
 In the chi'onic states of inflammation, whether of impoitant or un- 
 important parts, a frequent renewal of blisters may effectually sui-- 
 mount many obstinate maladies. But here, again, these agents are oft- 
 en powerless, though not as mischievous as in acute inflammation, till 
 decisive bloodletting have been adopted, and, not unfrequently, often 
 repeated. This is every day witnessed in those advanced stages of indi- 
 gestion where a low chronic gastritis is shown by tendeiness over the 
 region of the stomach, and where, too, the liver has generally become 
 more or less involved in morbid action. Vesication will not reach this 
 condition till general bloodletting or leeching shall have been duly pre- 
 mised ; and cases are not uncommon, where, after repeated and large 
 abstractions of blood, such is the force of morbid habit that the dis- 
 ease finally issues in copious haematemesis. There are, also, many of 
 the fluctuating states of the stomach in chronic indigestion, where no 
 inflammation has invaded this organ, in which blisters over the epi- 
 gastric region, and without any other remedial agent, bestow great 
 relief. The appetite and digestion are at once improved, and the pa- 
 tient started along upon the road to health, and placed in a state for 
 tbe full and rapid influence of change of air, exercise, &c. The anal- 
 ogy, too, in these cases, with the useful effects of tonics and stimulants 
 in others, contributes farther light upon the therapeutical influences of 
 the latter remedies (§ 890^). Again, among the sequoias of fevers is 
 constantly before us a variety of phases of indigestion in which vesi-
 
 THERAPEUTICS. COUNTER-IRRITANTS. 65S 
 
 cation of the epigastric and hepatic regions brings great relief to the 
 sufferer, when this remedy is properly sustained by a well-regulated 
 diet, and other salubrious habits. 
 
 893, q^. There are numerous remedies, besides those which have 
 been under consideration, that operate more or less upon the princi- 
 ple of counter-irritation, and yet exert an alterative action peculiar to 
 each. This is even true to a certain extent of leeching; the irritation 
 of the bites, and even the new action which is instituted in the capil- 
 laries of the skin by the leeches, being analogous to the irritative pro- 
 cess which is set up by the true counter-irritants (§ 498, 923). 
 
 But there are great modifications, in these respects, between the lo- 
 cal influences of leeching, and the effects of the true counter-irritants , 
 and, if we now turn our attention to the large group of agents under the 
 denomination of local alteratives, as set forth in my Materia Medica, 
 we shall see, that, in all the instances, each substance has an altera- 
 tive action j^eculiar to itself; while, in many of the cases, as with 
 iodine, the mercurial plaster, veratria, camphor, &c., there are asso- 
 ciated influences analogous to those which form the great characteris- 
 tic of the true counter-irritants. These, however, will of course de- 
 pend upon the amount of absolute irritation which the several agents 
 may produce in the skin ; some, as gum ammoniac plaster, proving a 
 very positive iiTitant, and affording relief to chronic inflammation of 
 the joints more in virtue of this counter-irritation than of alterative 
 properties peculiar to the agent (^ 227, 892 h, 900, 905 «, 1059). 
 
 That common principles, however modified in their general aspect, 
 and however varied in the details relative to the several agents, re- 
 spectively, are concerned in the principal results, is obvious from the 
 fundamental simplicity of organic laws, and especially so from occa- 
 sional coincidences in the curative effects of all the agents now under 
 consideration. We see, for example, in cases of indolent tumors, 
 chronic enlargements of the liver, spleen, &c., that almost any one of 
 these local alteratives will sometimes yield complete relief. We see 
 it following the application of either leeches, or blisters, or ammonia, 
 or mercury, or iodine, or even of simple friction, &c. ; and, if we next 
 regard the corresponding effects of many internal remedies for the 
 same conditions of disease, we shall not fail to detect a coincident and 
 harmonious philosophy throughout (^ 892 l, 892 J u, 892f «, 904 c). 
 
 In connection with the foregoing subject, it may be useful to some, 
 who may be baflBed in their attempts upon indolent tumors of low in- 
 flammatory gi'owth to know the advantages that have often accrued 
 to myself from the frequent application of a small number of leeches. 
 Where they may refuse to yield under this mode of treatment, vesi- 
 cants, or iodine, &c., may ultimately prove efficient, when they might 
 have been powerless without the antecedent influences of leeching. 
 The tumors, indeed, may not apparently have yielded in the least to 
 the virtues of the leech ; but this remedy will have placed the diseased 
 part in a state of susceptibility to the action of other agents. The 
 principle has been variously before us (§ bb^,c), and may receive an- 
 other exemplification in the frequent necessity of general bloodletting 
 and cathartics to the salutary effects of vesication, in the treatment of 
 acute inflammation (§ 137 d, 150, 151, 556 c, 890^^, 892^ u). 
 
 893, r. In all hemorrhages from important organs, we should regard 
 vesication as a remedy next in importance to the general and local ab-
 
 660 INSTITUTES OF MEDICINE. 
 
 straction of blood, if the latter be also appropriate, as it commonly is 
 in the early stage of the disease ; and when, at more advanced periods. 
 Nature takes on this recuperative effort, vesication is the principal re- 
 maining means by which we may contribute an aid that timely blood- 
 letting would have greatly surpassed, and would have given to art what 
 ultimately belongs to Nature (§ 805). — Notes F p. 1114, Ii p. 1139. 
 
 893J. Before entering upon the following Summary Eeview of the 
 General Philosophy of the modus operandi of Eemedial Agents, 
 whose operation I have resolved, essentially, by alterative influences of 
 reflex actions of the nervous system, and with a reference, also, to what 
 I have said so extensively of this universal agency in the organic life of 
 animals, I will recall an important ground by which the reader may be 
 aided in his conclusions upon this subject, and which had escaped ob- 
 servation till the publication of the Medical and Physiological Comment- 
 aries. Even Dr. Philip, in his experiments (§ 476-493), neglected the 
 analogy of which I am about to speak, referred the modifiied secretions 
 to chemical agencies, and sacrificed his great labors to the interests of 
 chemical physiology and the humoral doctrines. This analogy is the 
 admitted operation of reflex nervous influences in exciting muscular 
 movements. But that is the only result that is witnessed. There is 
 no obvious change in the muscular action from what is natural. Not 
 so, however, with the results in the great processes of organic life. 
 Here the secretions are not only increased or diminished, but modified 
 in their nature, and various morbid conditions produced or removed ; 
 and hence it is assumed that these results must be owing to very differ- 
 ent causes from that nervous power which simply produces contractions 
 in the muscles. It is entirely neglected, in this rationale, that the vas- 
 cular systems are totally different in their functions from those muscular 
 fibres upon which the nervous power makes its obvious demonstrations, 
 as in convulsions, vomiting, respiration, contractions Of the iris, of the 
 sphincters, etc. ; and, although there is a vague apprehension with some 
 that blushing is owing to nervous influences, yet as there is seen only a 
 transient redness, even this ground of analogical reasoning to changes 
 of vascular action that give rise to increased, or diminished, or otherwise 
 modified secretions, or the production or removal of disease, etc., is 
 equally regarded as an abstract fiict that supplies no information upon 
 the less obvious problems. Neither is it considered that the vascular 
 apparatus manifests a far more exquisite susceptibility to the direct ac- 
 tion of common stimuli than the muscular fibre, and therefore that the 
 vessels may be equally sensitive to that nervous influence which so readr 
 ily excites the fibre in muscular organs. Another difficulty consists in 
 comprehending the modifying influences of the nervous power upon se- 
 creted products, and in its production and removal of diseases, etc., ac- 
 cording to the nature of the remote causes ; and this grows out of the 
 habit of neglecting the phenomena and of reasoning alone from what is 
 physically demonstrable. It should be also considered that the cerfebro- 
 spinal system in subserving the structures of animal life exerts the ef- 
 fect only of a simple stimulus, while the ganglionic not only unceasing- 
 ly modifies the natural organic functions and products, but, through 
 this physiological constitution, to a far greater extent when morbific 
 or remedial causes operate (§ 113, 224, 356 a, 422, 455, 461«-461^, 
 475^, 487 h, 488^, 500 g, m, 524 d, no. 7, 526 d, 891^ g, k, 105^). — 
 Sec Note Aa p. 1131.
 
 THERAPEUTICS. REMEDIAL ACTION. C6J 
 
 SUMMARY REVIEW OF THE GENERAL PHILOSO- 
 PHY OF THE MODUS OPERANDI OF REMEDIAL 
 AGENTS. 
 
 " It seems to me that the explanation which represents Nature always pursuing a uni- 
 form course in her operations, drawing the same results from the same principles, has a 
 greater degree of probability than that which shows her separating, as it were, this phe- 
 nomenon from all the others, in the way which she produces it." — Bichat. 
 
 "Medicines differ from poisons, not in their nature, but in their dose." — Linnaeus. 
 
 " NaTURA malum SENTIENS GESTITAT MAGNOPERE MEDERI." — GaLEN. 
 
 "Natura repugnante, nihil proficit medicina." — Celsus. 
 
 "Natura deficiente, quicquam obtinet mebica ars, perit ^ger." — Hippocrates. 
 
 894, a. The philosophy which concerns the operation of morbific and 
 remedial agents was a subject of consideration in the first two vol- 
 umes of the Medical and Physiological Commentaries, and subse- 
 quently in an Essay which contributes to the third volume of that 
 work. The question has also been investigated, extensively, in different 
 parts of these Institutes. But, it is a part of the plan of the present 
 work that its consummation shall consist of a distinct exposition of the 
 important matter now before us, in the form of a s.ummary review of 
 the relative facts and doctrines contained in former sections. 
 
 894, b. In approaching, again, the modus operandi of remedial agents, 
 I may first repeat the most essential points, — that the vital principle 
 is a real substantive agent, of which the vital properties, irritability, 
 mobility, &c., are elements, implanted in organic beings for the anima- 
 tion of their structure ; that the nervous power was superadded also 
 to the animal kingdom; that all organic functions are carried on, 
 through their instruments of action, by the four vital properties which 
 are common to all animated beings ; that all vital agents, whether 
 stimulant or sedative, whether natural, morbific, or remedial, operate 
 directly upon these properties, as also the nervous power when con- 
 cerned in developing motion or changes ; that all disease consists in a 
 modification of these properties and a consequent change of function, 
 and is therefore only a variation of the natural states ; that the vital 
 property sensibility possesses a modification which I have denomina- 
 ted sympathetic sensibility ; that the nervous power is a vital agent, 
 and, like other agents, develops motion and induces changes by acting 
 upon the organic property irritability, and is exclusively the exciting 
 cause of motion in animal life ; that this power or property of the vital 
 principle in animals may be called, in a direct manner, into increased, 
 or preternatural, operation by direct impressions, physical or mental, 
 upon the nervous centres, or upon the trunks of nerves ; that this pow- 
 er is the efficient agent of remote sympathy, is brought into operation 
 by impressions made upon sympathetic sensibility, which are trans- 
 mitted by this variety of sensibility, through sensitive nerves, to the 
 nervous centres, and there develop the nervous power, which is re- 
 flected, through motor nerves, upon the irritability of such parts as 
 may be determined by the various influences hitherto expounded, and 
 thus become the exciting cause of motion, of morbific or therapeutical
 
 662 INSTITUTES OF MEDICINE. 
 
 chancres, &c., in those parts upon which its impressions ai'e made ; 
 that the nervous power is susceptible of modifications by the causes 
 which bring it into universal operation, whether physical or mental, 
 and thus partakes, under the injluence of its own nature, of the special 
 virtues of each exciting cause, to which principle is due its alterative 
 effects according to the nature of the exciting causes ; and, finally, 
 that a common principle is at the foundation of the philosophy, wheth- 
 er the manifestations of the nervous power be displayed in subserv- 
 ing the natural processes, or in disturbing their normal condition and 
 products, or in restoring disordered functions, or as the power may be 
 concerned in developing motion, voluntary or involuntary, when prop- 
 agated immediately from the nervous centres, and without, of course, 
 the intervention of sensitive nerves, and therefore in a direct manner. 
 
 895. These several fundamental points have been critically present- 
 ed in former sections (now too numerous for special reference), and 
 they have all an immediate interest in the operation of remedies. 
 They form the great principles which concern the natural operation 
 of vital stimuli, and are, therefore, fundamental in the production and 
 cure of disease. The plan of Nature is thus perfectly simple, consist- 
 ent, and sublimely beautiful, in its foundation. The details ai'e dis- 
 tinguished for their harmonious variety and intricacy, yet susceptible 
 of the most complete analysis. We trace the complexities to the con- 
 stitutional nature of the organic properties, — to their liability to multi- 
 tudinous variations from their natural state, — to the various natural mod- 
 ifications which they sustain in different tissues and organs, — to the 
 variety of those organs, and the differences in their respective func- 
 tions, — to their intricate connections and dependences by means of 
 sympathy, — and to the endless variety in the nature of the virtues of 
 foreign agents which are capable of inducing modifications of the or- 
 ganic states of every part, and according to the natui-e of each agent. 
 
 Such are the great points to be kept in mind ; but most of all, as it 
 regards my present inquiry, are the various considerations relative to 
 the nervous power, and its laws of reflex action, as hitherto set forth, 
 and through which I interpret all the influences produced by morbific 
 and remedial agents upon parts that are remote or but slightly distant 
 from the direct seat of their operation, and often, in part, upon their 
 direct seat of action, unless such influences are propagated by contin- 
 uous sympathy (^ 2 b, 143, c, 148-151, 495-529, 855, 895, 902/).* 
 
 896. The whole philosophy of the operation of morbific and reme- 
 dial agents rests, as we have seen, upon physiological principles. 
 Exactly the same philosophy relates, also, to the corresponding ef- 
 fects of mental causes. The wound, or the poison, or the errhine, 
 which convulses the muscles, the want of air which determines respi- 
 ration, the impression of light which guides the motion of the iris, the 
 irritation of faeces or of urine which maintains a contraction of the 
 sphincters, the food which excites the muscular action of the stomach 
 or the contraction of the pylorus, the cathartic which purges, the emet- 
 ic which vomits, the narcotic which arrests diarrhoea, or allays irrita- 
 bility, or induces sleep, the gastric stimulant or t^ie remote inflamma- 
 tion which rouses the sanguiferous system, or the sedative which pros- 
 trates the circulation, or as one or another may destroy life, produce 
 their effects through a common law which is relative to the nervous 
 power, and it is through that same law that the complex organization 
 
 * Continuous sym-iathv is continuous injluence of these Institutes (^ 129 c, /, 498 a).
 
 THERAPEUTICS. REMEDIAL ACTION. 6fiS 
 
 moves on in harmony in all its parts, that the mind brings into action 
 the voluntary muscles, that syncope is removed by pungent vapors, or 
 by a current of air, or by a dash of water, tliat cold to the surface de- 
 termines the first inspiration of the new-born being, that warmth to 
 the skin instantly rouses all the processes of life in certain prostrating 
 conditions of disease, that cold at the zero of Fahrenheit, or mechani- 
 cal in-itation, reanimates the torpid hibernating animal, and sends 
 up his temperature from forty or less to near a hundred degrees, that 
 the first contact of solid food with the stomach diffuses a warmth over 
 the cold surface of the famished traveler, or that tonics and stimulants 
 do the same, that shame or anger suffuses the countenance, or fear 
 withdraws the blood from the circumference to the centre and bathes 
 the skin in perspiration or renders the urine redundant and the blad- 
 der irritable, that cold, when suddenly applied, as suddenly increases 
 the excretion of urine, or the hot bath determines, as suddenly, its ex- 
 pulsion, that offensive odors, offensive sights, and even their recollec- 
 tion, lead to instant vomiting, or to purging, or to syncope, that an 
 liour's change from one part of the town to another suspends pertus 
 sis or promotes digestion or the healing of an ulcer, that one passion 
 cures the most obstinate maladies, or another is instantly fatal, — 
 each, and all, I say, determine their effects either through refiex or 
 direct action of the nervous system. Anatomy and experiment 
 confirm what each phenomenon, and all united, proclaim the work of 
 that mystic power, operating on those organic properties which are 
 the moving springs of every action, the proximate cause of every ef- 
 fect ; nor can another intelligible solution be rendered for a single 
 phenomenon now expressed, or thousands of similar import, while 
 every other must be in conflict with the pronunciations of Nature and 
 the demonstrations of art. Nor will an attempt be made (an attempt 
 that shall commend itself to the understanding) now, or hereafter, to 
 controvert the philosophy which is here presented. The first step in 
 its overthrow must be the overthrow of Nature. All must bow to 
 this conclusion, however unacceptable to the humoralist, or unpalata- 
 ble to the materialist (§ 1034, 1039, 1040, 1075). 
 
 897. It has been seen, also, that the fundamental philosophy of dis- 
 ease is perfectly simple, as also that which concerns its cure ; that dis- 
 ease is essentially nothing more than a deviation of the properties of 
 life from their natural standard, and a consequent corresponding 
 change in the functions over which they preside ; that the artificial 
 cure consists in a restoration of those properties and functions by 
 making upon the former certain impressions which enable them to 
 obey their natural tendency to a state of health ; that remedial agents 
 of positive virtues operate like the truly morbific, but less profoundly 
 in their therapeutical doses, and that the philosophy of their cure con- 
 sists in establishing, in a direct manner, certain morbid alterations in 
 the already diseased properties and actions of life which are more 
 conducive to the natural tendency that exists in the vital properties to 
 return from morbid to their natural states. 
 
 898. It follows, therefore, when disease subsides under the influ- 
 ence of remedial agents, that it is only in consequence of the great 
 law of recuperation, which is brought into sensible operation by the 
 production of morbid states which are favorable to its development. 
 But, if disease terminate fatally, it is owing either to morbid altera-
 
 664 INSTITUTES OF MEDICINE. 
 
 tions which transcend the recuperative tendency, or to physical ob- 
 stacles which have resulted from the altered vital conditions. If dis- 
 ease subside without the intervention of art, it arises from the opera- 
 tion alone of that natural principle which has been established for the 
 preservation of health, and the perpetuation of organic beings. Of 
 this we have remarkable and striking examples in small-pox, measles, 
 &;c. For wise purposes, as we have seen, a principle of mutability 
 has been established in the properties of life, and it is through this 
 principle, which is designed for useful ends in the animal economy, 
 that they are liable to be variously altered from their natural state by 
 physical and mental causes ; but it is this very principle which enables 
 them to receive salutary impressions from remedial agents (just as 
 morbific affect them), and to return to their natural condition. 
 
 899. The changes, therefore, to which the properties of life are lia- 
 ble, are almost of endless variety ; depending, as we have variously 
 seen, upon the nature of the operating causes, habits, natural and ac- 
 quired temperaments, age, sex, &c. ; and whenever they become dis- 
 eased, they pass through a variety of progressive changes till they 
 reach the acme of their morbid states. And so, on the other hand, 
 when remedial agents begin their operation, a series of other changes 
 sets in, and continues in regular progress until it ends in health. The 
 pathological conditions, therefore, of any given disease are constantly 
 varying, and may require frequent variations of treatment. 
 
 900. It being only necessary to introduce a peculiar morbid change 
 in diseased conditions that shall favor the operation of the natural ten- 
 dency of the properties and actions of life to return to their healthy 
 state, a very few remedial agents may be all that are requisite to the 
 attainment of that result; while experience shows that our materia 
 medica is encumbered with superfluities. Take a large variety of 
 pathological conditions, such, for example, as are presented by inflam- 
 mation, it is not necessary that a certain uniform change should be 
 established by the remedies, but only such as shall favor the recupera- 
 tive tendency. Bloodletting brings about one kind of change, cathar- 
 tics another, antimony anothei*, mercury another, and so on ; while 
 each of these agents may prove perfectly curative in many cases of all 
 the modifications to which inflammation is liable from absolute mor- 
 bific agents. And yet it is obvious that each one produces changes 
 peculiar to itself, while the changes induced by either will be as vari- 
 ous as the natural modifications of disease (§ 756, a). And just so it 
 is in respect to the great vai-iety of remedies which will tend to the 
 cure of intermittent fever. This disease will sometimes yield to 
 almost every thing in the materia medica, and may be suddenly bro- 
 ken up by an emotion of the mind. But every agent exerts chan- 
 ges in the moi'bid properties of life peculiar to itself, but such chan- 
 ges as enable the properties and actions of life to pass, afterward, 
 through a succession of spontaneous changes under the restorative 
 principle, till they end in health.* There is no other philosophy that 
 will account for any of these phenomena, while they all concur in 
 demonstrating its foundation in nature. Hence, also, I may add, what 
 I have already endeavored to expound, the occasional salutary effects 
 of alcoholic stimulants in the treatment of fever, and acute inflamma- 
 tions, and through which, in part, I have attempted to abolish the dis- 
 tinction between active and passive inflammation In these exam- 
 
 • See Notes K p. IJIQ, L p. 1120, Ek p. 1133
 
 THERAPEUTICS. REMEDIAL ACTION. 665 
 
 pies, the alcoholic stimulants do but introduce morbid conditions that 
 are favorable to the recuperative process, and are, therefore, so far on 
 a par with loss of blood (^ 756, 851, 854, 892 b, 8921 v, 1059). 
 
 901. Nevertheless, a distinction is very properly made into curative 
 ar»d morbific agents, however the former may be productive of dis- 
 ease, as they commonly are, in their medicinal doses when they do 
 not correspond with the existing pathological conditions. Their ab- 
 solute mode of action, however, is the same in all the cases ; an 1 al- 
 though, in a general sense, remedial agents exert their salutary ef- 
 fects by inducing new pathological states, and are generally liable to 
 produce disease when exhibited in health, these morbid states, when 
 not excessive, are of a nature to allow the full exercise of the recu- 
 perative tendency. On the contrary, however, there is a class of 
 agents which are more profoundly morbific, and whose results tran- 
 scend the natural recuperative process. It is for the removal of these 
 consequences that we employ the other class of morbific agents. Or, 
 there are yet other means, like exercise, air, &c., whose influences 
 are of the mildest alterative nature, and appear to co-operate in a di- 
 rect manner with a tendency to restoration which had already begun ; 
 or, as in hooping-cough, where the restorative process is often easily 
 introduced. Our remedies, therefore, are curative by substituting 
 new pathological conditions, and nature does the rest ; and it is only 
 with a view to a right interpretation of their modus medendi that I 
 have any disposition to depart from established phraseology, or to con- 
 found the operation of remedies with that of the ordinary causes of 
 disease (§ 137, 143, 150-152, 177-182, 185, 893 c, d, 1059). 
 
 That what I have now stated as to the substitution of one patholog- 
 ical state for another in the cure of disease, and that this is the only 
 contribution which nature receives from art, seems to be abundantly 
 obvious ; though the proposition which I have thus made appears not 
 to have been a subject of consideration. As a change arises when 
 efficient agents operate, and as that change, by the supposition, is not 
 a restoration of the morbid to the natural state it is necessarily a new 
 pathological condition. And so, also, of the unaided changes which 
 Nature institutes, till the natural state is fully established. Bloodlet- 
 ting, and emetics, it is true, will be sometimes followed, as in fevers 
 and in croup, by an almost immediate subsidence of the symptoms ; 
 but, during their rapid operation, they have only introduced new con- 
 ditions of the pathological states which enable the morbid properties 
 to resume, at once, a near approximation to their healthy standard. 
 It is certain that art can accomplish nothing more. 
 
 902, a. I now proceed to recapitulate the manner in which remedial 
 agents produce their effects upon parts remotely situated from the direct 
 seat of their application ; and this, as I have formerly said, is through re- 
 mote, contiguous, or continuous sympathy ; the agents exerting their 
 direct impression upon the parts with which they are in contact. Re- 
 mote, and evidently, also, contiguous sympathy, are conducted by the 
 nervous power through the medium of the cerebro-spinal and gangli- 
 onic systems ; while, as I have also endeavored to show, continuous 
 sympathy is independent of the nerves.* When, however, these en- 
 ter into the structure of parts, as in animals, they have a certain con- 
 tingent participation. But their primai-y connections may be wholly 
 severed, and disease may be yet propagated continuously along the 
 
 * Continuous injlucnce of these Institutes (§ 129 c, /, 498 a).
 
 666 INSTITUTES OF MEDICINE. 
 
 part to which they appertained ; as we observe, also, in plants. It 
 appears, therefore, that in these examples, the morbid condition ie 
 extended, in a continuous manner, from the organic properties of one 
 point to the next in apposition (^ 185, 233, 461, 475-^, 647-|, 746 c). 
 
 902, b. I have variously shown that the nervous power is capable 
 of acting as a vital stimulus to the organic properties, is liable to be 
 variously developed by morbific and remedial agents, and to be so 
 modified in its nature according to the virtues of such agents, that it 
 produces, more or less, in diseased parts, remote from the direct seat 
 of the morbific or remedial action, the changes which the agents them- 
 selves would exert were they applied directly to the remote organs. The 
 nervous power may be, also, equally determined with a morbific or cu- 
 rative effect upon the organic properties and actions of the great ner- 
 vous centre ; or upon any of its radiating parts. The philosophy is 
 also exactly the same when one diseased part gives rise to disease in 
 parts that are remote ; and when disease in remote parts, that has 
 been maintained by affections of other parts, subsides in consequence 
 of the restoration of the latter, it is owing to the removal of a perni- 
 cious modification of the nervous power that had been constantly 
 propagated by means of the latter upon the former {^ 409 k, SQl-g- k). 
 
 902, c. The type of the foregoing philosophy exists in various pro- 
 cesses which are naturally going forward in the animal body, A sin- 
 gle example of this nature is a key to the whole labyrinth. Thus : 
 
 " The whole system of respiratory nerves can be excited to action 
 by irritation of any part of the mucous membrane, from the mouth to 
 the anus, from the nostrils to the lungs," 
 
 Mechanical irritation alone is adequate to the greatest variety of 
 effect, as broadly stated in the foregoing law of sympathy. Tickling 
 the fauces provokes vomiting, irritating the anus produces purging, 
 and thus are the muscles concerned in respiration, and those of the 
 stomach and intestine, and even the liver and the salivary glands, 
 brought into unusual action by slight mechanical irritation of the fau- 
 ces or anus. Irritate the same tissue in the nose, and the respiratory 
 muscles are thrown into another mode of action ; irritate the larynx, 
 and another mode is excited; call up the recollection of the finger in 
 the fauces, and the mind may determine all the sensible results of an 
 active emetic, as set forth in ^ 500 i-m, o, 503, 514, 891^ k, 905 a. 
 
 There is the great principle. It is greatly the work of the nervous 
 power, excited in one series of the cases by impressions transmitted 
 from distant parts to the nervous centres, and in the other by the di- 
 rect operation of the mind upon the same central parts. It is through 
 that principle that emetics and cathartics produce their most sensible 
 manifestations, and the same is concerned in all their less obvious in- 
 fluences upon eveiy pare but the intestinal mucous tissue, except as 
 continuous sympathy may contribute a part of the influences which 
 extend to the liver, &c. It is the same as concerns the respiratory 
 movements, which, as I have said, may be regarded as an elementary 
 exemplification of the most entangled operations of the nervous pow- 
 er. The modus operandi may be repeated in its exemplifying rela- 
 tions to this subject. The point of departure, in the process, is the 
 raucous tissue of the lungs, from which the impression is transmitted 
 through the pneumogastric nerve, as well as through the ganglionic, 
 to the brain and spinal cord (especially the medulla oblongata), where
 
 THERAPEUTICS. REMEDIAL ACTION. 667 
 
 the nervous power is excited and reflected upon the organic proper- 
 ties of the muscles of respiration through the various motor nerves 
 of those organs. These muscles are, in consequence, thrown into ac- 
 tion, and the thorax expanded (^ 233|, 500 e, 514 I, &c.). 
 
 If the foregoing simple, demonstrable exemplification be duly com- 
 prehended, there can be no difficulty with all the rest. In the exam- 
 ple of sneezing, as a consequence of the action of light upon the eyes 
 (§ 514, I), the process is more complex, and shadows forth the fai 
 more intricate movements that are in progress, — the almost end- 
 less reflex nervous actions which are taking place, — during the progress 
 or decline of disease, or those which are set up by the operation of an 
 emetic, a cathartic, &c. (§ 1040). — Note D p. 1114. 
 
 902, d. Physiological examples of the foregoing nature abound in 
 the animal organization, and supply the most ample ground for the in- 
 terpretation of the effects of remedial and morbific agents in their 
 wide range of influences. The modifications of reflected nervous ac- 
 tions that relate to the respiratory system alone, as in coughing, crying, 
 laughing, yawning, &c., are a fruitful field of inquiry into great and 
 precise laws, and extensively applicable to the philosophy of medicine. 
 The only difference is, that, when disease is established in a part, or 
 when remedial agents operate, the organic properties of the part are 
 altered in their nature, and, of course, the organic actions over which 
 they preside. A specific impression, in the latter cases, is transmit- 
 ted to the nervous centers, the nervous power more or less mod- 
 ified in a corresponding manner, and from thence reflected through oth- 
 er nerves, or other fibres, to the same or other parts, and, according to 
 the nature of the modification, disease will be produced or mitigated 
 in those parts. However complex, and variable, therefore, the phe- 
 nomena, nothing can be more simple than the principle through which 
 all these changes are produced (^ 233|, 475i 647i, 893-^). 
 
 902, e. When an emetic operates, the modus operandi is essentially 
 similar to what happens in respiration. The mucous tissue of the 
 stomach being the point of departure, a different influence is propa- 
 gated to the nervous centres, corresponding with the nature of the 
 exciting cause, with the special vital constitution of that portion of the 
 mucous tissue, with the compound nature of the stomach, with the 
 special relations of this organ to the central parts of the nervous sys- 
 tem and to the respiratory muscles, &c. (§ 138, 149, 150, &c.), while 
 the nervous power is also modified in its nature according to the pe- 
 culiar virtues of the emetic (§ 227). The most sensible result, as in 
 respiration, depends upon the reflection of the nervous power upon 
 the respiratory muscles, while another current descends through the 
 motor fibres of the pneumogastric and sympathetic nerves to the mus- 
 cular tissue of the stomach. If the emetic operate also as a cathartic, 
 then a new^ chain of actions is established, in the same way, upon the 
 abdominal muscles, while a current of the nervous power is propaga- 
 ted upon the muscular coat of the intestines (§ 233|, 889 a-f). 
 
 902, y. But, in the foregoing case, something more happens than in 
 the natural processes. Here the exciting cause possesses peculiar vir- 
 tues, is of a morbific nature, and it not only makes peculiar impres- 
 sions upon the alimentary mucous tissue, according to the exact na- 
 ture of its virtues, but it modifies the nervous power in a correspond- 
 ing manner. If the stomach be the seat of disease, the direct impres-
 
 668 INSTITUTES OF MEDICINE. 
 
 sion upon that organ, or the change which an emetic may effect m 
 its vital condition, will be more or less varied from what is exerted in 
 a state of health. It may, therefore, prove curative to the stomach 
 more or less by this direct influence (§ 514 b, 658). But the nervous 
 power is also modified according to the impression produced upon the 
 organic properties of the stomach, and is sent abroad, with alterative 
 effect, upon various parts of the system. According to a law by which 
 diseased parts are far more susceptible of influences from vital stim- 
 uli than such as are not diseased, the modified nervous power will fall 
 with far greater effect upon the former than the latter. The organic 
 properties and actions of one may be profoundly and permanently af- 
 fected, while the latter are only moderately and very temporarily in- 
 fluenced. In consequence, also, of the deep effect which the modified 
 nervous power exerts on the diseased parts, they may return, at once, 
 to their natural state (§ 841, 2, b, 143, c, 148-151, 855, 895, 481 d). 
 
 But the milder influences which are set up by the nervous power 
 upon parts in health, or in comparative exemption from disease, play, 
 also, their part in the salutary process. If the emetic operate also as 
 a cathartic, impressions are transmitted from the intestinal mucous 
 membrane to the cerebro-spinal system, the nervous power developed 
 and modified according to the nature of these impressions, and radia- 
 ted abroad as when the result of the action of the emetic upon the 
 stomach, and with effects corresponding to this new development and 
 modification of the nervous power (^ 227-2334, 514 h, 889 a). 
 
 Again, the skin is influenced in the foregoing manner, and this or- 
 gan transmits that impression to the cerebro-spinal axis, and devel- 
 ops and modifies the nervous power accordingly, when it is, as in the 
 other instance, reflected abroad, and is felt by various parts according 
 to their degrees of susceptibility. Various other circles of modified 
 nervous influences set in, and become too complex for analysis ; but 
 all may fall with one concurring curative effect upon the diseased sus- 
 ceptible organs. Thus every part may have an allotment in the cu- 
 rative process ; as more distinctly expounded in foregoing sections 
 (§ 143, c, and references, 500-514, 516 d, no. 6, 863 d, 889 g, 893 a, c).* 
 
 902,^. We thus see that when vomiting springs from the operation of 
 tartarized antimony, and often from ipecacuanha, it is only one of the 
 consequences, and a minor one, of the peculiar irritation of the gas- 
 tro-mucous membrane. Other and far more powerful influences are 
 determined, simultaneously, upon the organic properties and actions 
 of distant and diseased parts (perhaps as distant as the most remote 
 extremity), by the same nervous power that shook the respiratory 
 organs during the act of vomiting. And often, indeed, does it happen 
 that those influences are propagated with the most profound effect 
 when the act of vomiting fails of being consummated ; and nausea, 
 alone, shall send with prostrating force the modified nervous power 
 over the whole system ; when we shall see it simultaneously bathing 
 the whole surface with perspiration ; pouring the saliva from the 
 mouth ; breaking down a tumultuous excitement of the heart and ar- 
 teries ; starting on the instant a torrent of bile, and an equal effusion 
 from the intestinal mucous membrane ; and, at the next moment, pre- 
 senting a magnificent play of reflex actions for the evacuation of the flu- 
 ids, after the manner of an active purgative, — these very effusions, 
 also, instituting other circles of reflex action, which join in the great 
 * See NoTK Cc p. 1132.
 
 THERAPEUTICS. REMEDIAT. ACTION. 669 
 
 work of curative movements. Should vomiting now follow^, then shall 
 you speedily see the vital energies returning, — the cold, pale skin 
 giving place to a florid hue and a warm perspiration, — the sunken 
 features starting into the fullness of health, — the gastric suffering gone 
 as a luxury obtained, — the general whirl of anxiety and distress con- 
 verted into calm tranquillity, — the headache dissipated, — the twang 
 of the croup, or the grunt of pneumonia, no longer sounding an 
 alarm ; — and, all this stupendous succession of events, from the be- 
 ginning of nausea to the restoration of the vital energies and the near 
 resolution of disease, — composing a most astonishing consecutive sc- 
 ries of reflex actions, — may require less time than I have hastily era- 
 ployed in this general allusion to the subject. And now can it be en- 
 tertained that this has been the result of absorption, or that the laws of 
 chemistry or physics have had any connection with the phenomenal* 
 
 902, h. The foregoing may be taken as an example of the principle 
 whicli concerns the modus operandi of all curative or morbific agents, 
 whether physical or mental, and of all the developments of disease that 
 arise as sympathetic consequences of each other. In respect to 
 emetics, howevei', it should be considered that all do not produce the 
 foregoing effects, and that with the exception of the act of vomiting, 
 the results will depend upon the precise nature of the emetic, or the 
 manner in which it modifies the nervous power and thus impresses 
 the organic properties. This explains the difference in results be- 
 tween tartarized antimony, ipecacuanha, sulphate of zinc, warm wa- 
 ter, tickling the fauces, the mechanical irritation of undigested food, 
 the shock of a fall, of a surgical operation, sailing, whirling, offensive 
 eights, offensive odors, loss of blood, and even their recollection ; 
 while the nature and effect of the greater number should lead the phil- 
 osophical inquirer to pause at the physical doctrine of absorption, 
 and survey the other difficulties with which it is fatally encumbered. 
 
 902, i. When the alterations, of a sympathetic nature, are more 
 slowly produced, as when mercury induces salivation gradually, and 
 brings the whole system under its influence, or when small, and re- 
 peated doses of tartarized antimony overcome inflammations of the 
 lungs, &c., the nervous pov/er is developed and modified at each suc- 
 cessive dose, and the repetition of its reflection upon the organic prop- 
 erties of diseased parts remote from the stomach establishes progi-es- 
 sive changes, till an absolute condition of disease may be induced in 
 certain parts, as when mercury salivates ; while the analogous influ- 
 ences which are exerted on parts already diseased supplant the natu- 
 rally morbid states by others of an artificial nature, from which the 
 organic properties are able to return to their healthy condition. But 
 these impressions must be frequently repeated ; for if the interval be 
 long between the administration of the doses of such agents as only 
 produce their effects in a gradual manner, the diseased conditions, not 
 being placed in the way of the recuperative tendency, will throw off" 
 the artificial impression, and the original intensity of disease will be 
 thus restored. The process which I am now considering is an exam- 
 ple of the cumulative effect of remedial agents, some of which are much 
 more remarkable than others, and the ultimate results are pronounced 
 with varying degrees of suddenness. This is also influenced by pe- 
 culiarities of constitution, or of susceptibilities of the organic proper- 
 ties to changes now under consideraton ; and therefore is it, that sal- 
 
 • See * 409 fc, 4761^ h, 514 -516, 943 a, 944 c, 1084
 
 670 INSTITUTES OF MEDICINE. 
 
 ivation may be speedily induced in one subject by less than a grain 
 of calomel, while no amount of the remedy will produce this effect in 
 others. And so of the morbific effects of digitalis ; an agent, also, 
 which exemplifies the suddenness with which cumulative agents may 
 produce an explosion of disease, although no symptoms had admon- 
 ished us of its approach. This principle concerns, also, the predis- 
 position to disease which is formed by miasmata, the virus of small- 
 pox, of hydrophobia (§ 516 d, no. 6, 647^ 657 a, 666, 904 bb, 1059). 
 
 902, k. The permanent operation of the nervous power in particu- 
 lar parts of the animal fabric, as in the sphincters, supplies an elegant 
 parallel with the foregoing uninterrupted influences of the same pow- 
 er as developed by remedial or morbific agents. This power oper- 
 ates as a perpetual stimulus to the organic properties of the muscles 
 just mentioned, in the same way as the ffeces and urine stimulate the 
 mucous tissue. And now, if we mutilate the inferior part of the spinal 
 cord, or obsei^ve the sphincter ani when relaxed in bad cases of apo- 
 plexy, or regard its condition when the spinal cord is merely divided, 
 we shall see the relative bearing upon other organs of these two 
 parts of the nervous system in their connected state, but with injury 
 of the brain, and how the spinal cord is capable of an individual 
 influence (§ 473-475, 476^-481, &c., 514^, &c.). 
 
 902, I. When mental causes operate in the cure, or production of 
 disease, they act directly upon the cerebro-spinal axis, and develop 
 and modify the nervous power according to the nature of each mental 
 affection ; and, as in the case of physical agents, the nervous power 
 thus developed and modified may be determined as well upon the or- 
 ganic properties of the brain and spinal cord, as upon other parts. 
 The blow upon the region of the stomach, or the opening of a thecal 
 abscess, which have destroyed life on the instant, operate in the same 
 way as the paroxysms of anger, or of joy, which have been as suddenly 
 fatal. In these cases the nervous power is alike reflected with a fa- 
 tal effect upon the brain as well as other important organs (^ 479). 
 
 902, m. A more intricate example may now be presented relative 
 to those natural means of cure which occur in a former section ; such 
 as change of air, exercise, &c. (§ 855). These are all positive rem- 
 edies, and, of course, they have their modes of operating. One ex- 
 ample will open the philosophy of the whole. How, then, does change 
 of air suddenly arrest an obstinate form of the hooping-cough ] There 
 is gastric as well as pulmonary disease, and the mucous tissue of the 
 stomach is preternaturally susceptible to the influence of many causes. 
 The air exerts its impression upon the lungs, and upon the general 
 surface of the body. But, there must be other agencies in operation 
 before the lungs will experience relief These agencies appertain to 
 the nervous power, which is developed by the foregoing impressions, 
 and reflected upon the stomach and other abdominal organs. If there 
 be disease here, it is more or less relieved, and the more so the great- 
 er will be the ultimate salutary impression upon the lungs. The 
 abdominal impression is transmitted to the nervous centres and the 
 nervous power reflected with its alterative influence upon the pulmo 
 nary mucous tissue, and thus ends the disease. The spasmodic ac- 
 tion of the respiratory muscles is, of course, arrested by withdrawing 
 the preternatural operation of the nervous power from those muscles, as 
 a consequence of the subsidence of disease in the pulmonary mucous
 
 THERAPEUTICS. REMEDIAL ACTION. 671 
 
 tissue (§ 902, c). And so, when change of air promotes the healing 
 of ulcers upon the extremities ; and should they not be complicated 
 with derangement of the abdominal organs, one of the sure evidences 
 that the foregoing is the modus opeiaRdi of this remedy is the im- 
 provement of appetite which commonly precedes any manifest abate- 
 ment of the remote affections. The same philosophy applies, also, to 
 the control which air and exercise frequently obtain over phthisis pul- 
 monalis (§ 514 c, 525 c, 527 b)* It is conspicuously seen even in the 
 operation of morbific causes ; and the two aspects of the subject go 
 to illustrate each other (§ 657, a). The principle is of the utmost im- 
 portance in medicine. Its laws are precise. Their knowledge will 
 lead to a greater dependence upon the functions of organic life (§ 
 878, 890-|- d. But these problems lie in the depths of physiology. 
 
 903. It is important to consider the distinction between impressions 
 which are made, in organic life, upon irritability and sensibility by 
 vital agents, whether natural, morbific, or remedial. The latter prop- 
 erty is the subject of impressions particularly in animal life ; though it 
 becomes more or less involved in organic, in all its natural modifica- 
 tions, by the accidents of disease. But the special modification which 
 I have considered under the name of sympathetic sensibility performs 
 the important part of transmitting impressions to the nervous centres 
 when they give rise to sympathetic movements in organic life. In- 
 deed, the whole rhythmic action of the organism is maintained by the 
 transmission of influences from all parts to the brain and spinal cord 
 through this modification of sensibility, and a consequent reflected ac- 
 tion of the nervous power upon all the organs, as each may require 
 the harmonizing influence of this great regulating property of the vital 
 principle (§ 233 J, 1037, b), through the potential sympathetic nerve. 
 
 The foregoing is the chief agency which sensibility exerts in organic 
 life, and the nervous power no other than that of a vital agent, acting, 
 like other agents, upon irritability, from which the influence is impart- 
 ed to tnobility. This we have also seen to be equally the case in ani- 
 mal life, when voluntary motion is performed. In all the cases, how- 
 ever, whei'e perception is excited, either common or specific sensibility 
 is more or less interested, though neither modification takes any part 
 in the organic or animal movements (§ 233^^, 524 d, no. 7, 647^, 893^). 
 
 If the brain, or any part of the nervous system, be the seat of dis- 
 ease, of irritation, &c., the preternatural development of the neiToub 
 power is, as we have seen, direct, and propagated directly, and with 
 very various effects, upon distant parts. In this process the motor 
 nei'ves are alone concerned, and therefore sympathetic sensibility is 
 not brought into operation. It is exactly the second part of the pro- 
 cess which takes place when influences are transmitted from one or- 
 gan to another through the medium of the nervous centres. There 
 is, therefore, no difference in the principle. The experiments of Wil- 
 son Philip, &c., illustrate the direct method (§ 477, &c.) ; the consti- 
 tutional action of remedies the indirect, or by reflex nervous action. 
 
 904, a. In considering the philosophy of the effects of the nervous 
 power it is important to regard its nature as liable to modifications 
 from the slightest influences, both physical and mental. This is evin- 
 ced by all the phenomena, is analogous to the natural and artificial 
 modifications of irritability and sensibility; and according to its modi- 
 fications, and other concurring causes hitherto expounded, it produces 
 * See Note F p. 1114.
 
 672 INSTITUTES OF MEDICINE.* 
 
 changes in the organic properties and functions; establishing or re- 
 moving disease, or killing in an instant. 
 
 I say, therefore, again and again, as more deeply seated than all 
 things else at the foundation of medical philosophy, the nervous 
 power is not only variously excited, exalted, or depressed, or modifi- 
 ed in its kind, and produces influences upon remote parts according 
 to these changes, but it is reflected upon particular parts according 
 to their existing susceptibilities, the nature of the remote cause, and 
 the part upon w^hich the remote cause may operate (§ 233|). Thus, 
 as I have said, one impression from cold, as a blast of cold air, or a 
 drop of cold water upon the skin, will rouse the respiratory muscles. 
 Another impression from the same cause will excite catarrh, or pneu- 
 monia, or pulmonary phthisis, or articular rheumatism (§ 649 l)-d, 657, 
 &c.). Mercurial ointment will determine the nervous power special- 
 ly upon the salivary glands, and liver, and the same effects arise from 
 the action of mercury upon the stomach. Cantharides, internally or 
 externally applied, irritates the neck of the bladder. One degree of 
 impression by tartarized antimony upon the stomach determines the 
 nervous power upon the respiratory muscles, and vomiting is the con- 
 sequence ; while it simultaneously reflects the same power upon the 
 skin as it does in smaller doses, and of which perspiration is a con- 
 sequence, — and so on. But these examples embrace only certain 
 parts of the influences in each case ; while in others they are far 
 more complex, — one sympathetic result becoming the cause of oth- 
 ers, till, through a single impression upon the organic properties of 
 the skin, various circles of alterative reflex nervous actions may be 
 instituted. Narcotics induce peculiar modificationis of the nervous 
 power when they are administered by the stomach, and the power 
 thus modified is not only reflected upon various distant parts with 
 effects corresponding with its modifications, but especially, also, upon 
 the organic and animal properties of the brain and spinal cord. 
 Hence the obtuseness of the senses, and the venous congestions of 
 the brain, which follow their improper administration (^ 891^ g, k). 
 
 904, b. We have seen that hydrocyanic acid, strychnia, &c., will 
 destroy life, when applied to the tongue, before one act of inspiration 
 can be made, and that, when swallowed by man in speedily fatal dos- 
 es the odor of the acid is indistinguishable in the blood, or within the 
 organism (§ 350^ p, 827 d). Wedemeyer and Miiller testify to the fa- 
 tal effect of one drop of the hydrocyanic acid, within a single second, 
 when introduced into the eye of a rabbit. And so of strychnia. It is 
 also allowed by Miiller, who defends the doctrine of absorption in all 
 cases, that from a minute to two minutes are necessary to one round 
 of the blood's circulation. The case is a plain one ; the contradic- 
 tion obvious (§ 494, dd"). Besides, the action of these poisons must 
 begin at the instant of their contact with the living parts, and what is 
 progressive throughout the entire second of time is physiologically the 
 same as at the beginning of the second. Magendie kills " the most 
 vigorous dogs" by. applying to the fauces one di-op of the hydrocyanic 
 acid, " after two or three hurried inspirations." Pereira says that he 
 " once caused the instantaneous death of a rabbit by applying its nose 
 to a receiver filled with the vapor of the pure acid. The animal was 
 killed without the least struggle." And so did Magendie. Pereira adds, 
 that in cases of this nature, " the rapid action of the j^oisons seems
 
 THERAPEUTICS. REMEDIAL ACTION. 673 
 
 almost incompatible with the idea of their absorption." — Pereira's 
 3Iat. Med., p. 27, 242. The experiments by Stilling and Van Deen 
 settle the question as to absorption (§ 494). Consider the action of 
 opium. Apply it to the rcucous tissue of the intestine, and the local 
 impression is such that it immediately arrests the peristaltic move- 
 ments. Apply it to the surface of the brain, and it instantly lessens 
 the action of the heart and capillary blood-vessels, &c. Now^ combine 
 these phenomena, when opium exerts its direct action upon the stom- 
 ach, and indirectly upon the heart, capillary system, &c., and consider 
 the natural relations between the stomach and nervous centres. Take 
 a substantial, physical fact, as supplied by the advocates of absorption. 
 Thus (Note Aaa p. 1146): 
 
 " It is very singular," says Sigmond, " that a pill of opium, admin- 
 istered by the stomach at night, will be vomited up in the morning, 
 after having produced its narcotic effect. This is an observation which 
 Van Swieten originally made." — Sigmond's Lectures, &c. 
 
 My doctrine of alterative reflex nervous action clears up the 
 obscurity, and admits of the only explanation (§ 512, b, 891^ k). 
 
 " I am acquainted with a physician in London," says Sigmond, 
 " who, on taking opium, although in a very minute quantity, will have 
 over the surface of the body a scarlet efflorescence" (§ 891, e). — Ibid. 
 
 Is not this phenomenon due to the same principle as that which is 
 concerned when indigestible food occasions analogous eruptions, or 
 when they spring up, as in infancy especially, from gasti-ic and intes- 
 tinal derangements, or when the blotches of a surfeit vanish during the 
 operation of an emetic, or as croup disappears under the same influ- 
 ence ] Turn to the experiments of Philip, Alston, Hall, Stilling, 
 Buniva, Van Deen, Kreimer, Procter, Girtanner, Johnson, &:c., and 
 they will be found to confirm my conclusion (§ 399, 483, Exp. 21, 484, 
 485, 828 &),* that they depend upon alterative reflex nervous actions. 
 
 The following are other facts which demonstrate the local operation 
 of remedial and morbific agents, and the dependence of their constitu- 
 tional effects upon the laws of reflex nervous action. Thus : 
 
 " An imponderable quantity of atropia," says Pereira, " is sufficient 
 when applied to the eye, to cause dilatation of the pupil." 
 
 Now consider the effect of this " imponderable quantity" in connec 
 tion with the analogous effect of imponderable light {§ 514, k), and 
 the modus operandi of the latter will be found to coincide with that 
 of the former. The cases are remarkably parallel, and the more in- 
 teresting as showing the transmission of influences through sympathet- 
 
 * In connection with what I have incidentally said in a former section of the advanta- 
 ges of opium in the cerebral congestion which is induced by the intemperate use of alco- 
 holic hquors, and which constitutes a prominent part of delirium a potu (§ 891, r), I may 
 say that we witness here, in the manner in which the irritability of the nervous tissues 
 is relieved, and the subsidence of disease as a consequence, not only the special modifi- 
 cation of irritabihty, according to the nature of the remote cause, but also the speda] 
 adaptation as a remedial agent of what is morbific in cerebral congestions as induced by 
 any other cause (§ 150, 151, 191, 650, 662, 686 b, 976 h, 1058 y). 
 
 But, although a knowledge of the remote causes aid us greatly in the treatment of dis- 
 ease, we may not proceed upon this consideration alone, as is commonly done, more em- 
 pyrically, in delirium a potu. Opium rarely fails of being pernicious, in that afiection, if 
 there be much gastric or hepatic derangement, until this condition be more or less over- 
 come. It is always useful to premise a cathartic, of which calomel should generally form 
 a component part ; and, in many cases, bloodletting is an indispensable remedy. But 
 here, again, the exact pathology, and the complications of the disease, should be well as- 
 certained, or bloodletting may prove as pernicious in some, as opium does in others. 
 
 There are also certain states of the brain attendant on maniacs in which opium is beu 
 "ficial ; but we must be sure of the right, or we shall be sure to go wrong 
 
 TJu
 
 674 INSTITUTES OF MEDICINE. 
 
 ic sensibility as pronounced in an expanded nei've and as implanted 
 in the skin of the eyelid, or in the tunica conjunctiva, and therefore 
 throuo-h different sensitive nerves, while in all the cases, the motor nerve, 
 and the part which is impressed by the nervous power are exactly 
 the same (§ 233|). It is also worthy of remark, as exemplifying the 
 modification of the nervous power by preternatural agents, that the 
 motion of the iris is very different under the different influences of the 
 remote causes (§ 74 a, 188J d, 514, I, 1042), 
 
 " It is a very interesting fact," says Sigmond, " that the application 
 of hyoscyamus and belladonna to the eye was not applied to any prac- 
 tical purpose until a gentleman by accident applied a piece of the 
 herb to his eye, when the effect remained for three weeksJ" 
 
 He states, also, that a dilatation of the pupils may be produced by 
 only approximating the leaves of hyoscyamus or belladonna to the 
 eyes. This is a closer parallel with the effect of light than the prece 
 ding statement by Pereira (p. 344, § 516 d, no. 6). 
 
 Observe how many individuals are liable to violent erysipelatous 
 inflammation over the whole surface of the body from approaching 
 only within a few yards of several species of rhus; while, on the oth- 
 er hand, many are entirely insusceptible of its action, as many are of 
 the constitutional effects of mercury (§ 585, b). 
 
 Here, again, is another fact, coincident with the foregoing, and which 
 also elegantly illustrates the different natural modifications of the or- 
 ganic properties ; even in different parts of the same continuous tissue 
 (§ 133, &c.). "As an enema," says Sigmond (I quote from the advo- 
 cates of absorption), " hyoscyamus, in any quantity, cannot be given." 
 Authorities are quoted to show that it then produces delirium, and 
 even apoplectic symptoms, and also when the " fumes were inhaled " 
 (§ 827 b, 1066) — Lectures in London Lancet, Feby. 18, 1837. 
 
 The snuff which regales the nose, and the tobacco which equally 
 delights the mouth, are violent poisons to the intestinal mucous tissue ; 
 and the constitutional results harmonize with the local effects in either 
 case (§ 133, &c., 150, 151). Again, if remedial or poisonous substan- 
 ces act by absorption, why is tobacco smoke so innoxious when inhaled 
 by the lungs, and yet so deleterious when swallowed, or when con- 
 veyed into the rectum? Most remedial agents, indeed, produce con- 
 stitutional effects according to the natural vital modifications not only 
 of the mucous, and other tissues of different parts, but of one contin- 
 uous tissue, as the mucous membrane of the eyes, nose, fauces, oesoph- 
 agus, stomach, small and large intestines, larynx, trachea, and lungs. 
 Where would philosophy be ; where our interpretation of these vari- 
 ous consequences, if we followed the chemist in his physical views of 
 life 1 What would tobacco affect in such a case 1 Would it nauseate 
 by affecting chemical affinity, or cohesion, or elasticity, or would the 
 nose or the mouth enjoy through any such properties of matter, — or 
 would galvanism help our understanding ] Is it through any such 
 properties that we feel the smart when the fire burns 1 Does not 
 Pereira supply an important fact against his general doctrine of op- 
 eration by absorption when he defends a moderate practice of opium 
 smoking, — especially as the whole volume of smoke is drawn into the 
 lungs'? — {Mat. Med., p. 1293.) Shall we not rather look to what is 
 known of the natural modifications of irritability in the mucous tissue 
 of different organs % If opium offend the stomach, the principle is the
 
 THERAPEUTICS. REMEDIAL ACTION. 67£ 
 
 same as when urine excoriates the mucous membrane of the lungs, 
 and thus produces the most violent reflex nervous actions. But the 
 distinguished author above quoted shall lay down our principle him- 
 self. Thus : 
 
 " Sir B, Brodie," he says, " found that an infusion of tobacco, thrown 
 into the rectum, paralyzed the heart, and caused death in a few min- 
 utes. But if the head of the animal be previously removed, and arti- 
 ficial respiration kept up, the heart remains unaffected ; proving that 
 tobacco disorders this organ through the medium of the nervous sys- 
 tem only" (§ 484, b).—Ibid., p. 869. Also, Note B p. 1113. 
 
 Should we not rather say, through the medium of the brain in its 
 connection with the organic nerve, while other parts may suffer reflex 
 nervous actions through the spinal marrow, or even the ganglionic 
 system alone. And now contrast with the foregoing peculiarities of 
 tobacco and opium the fact that tliQ inhalation of the fumes of hyos- 
 cyamus produces vertigo, tremors, laborious respiration, &c. ; and 
 that hydrocyanic acid, in the quantity of a drop, or in vapor, on ac- 
 count of the coincident relations of its virtues to the naturally modi- 
 fied organic properties of various parts, is instantly fatal, whether ap- 
 plied to the mucous tissue of the eyes, nose, mouth, stomach, or lungs. 
 And so of the spirituous extract of nux vomica. If absorption be good 
 in some of the cases, it should be equally so in the others. Consider, 
 too, how the habitual use of narcotics reduces the susceptibility of the 
 stomach to the influence of each one, respectively, and not to the oth- 
 ers, and how the constitutional effects go on, pari passu, in the ratio 
 of the local effects. And consider, also, how music assuages suffer- 
 ing, or the expectation of the dentist relieves toothache. And why, 
 according to the doctrine of absorption, should not medicines produce 
 the same constitutional effects when injected into the bladder, as when 
 administered by the stomach 1 Are you doubtful as to the manner in 
 which certain substances produce their constitutional effects when 
 applied to the skin, as mercury and tobacco, for example 1 Consider 
 the foregoing case of hydrocyanic acid ; or how an issue relieves deep- 
 seated inflammation ; or, again, how belladonna, or hyoscyamus, when 
 applied to the lids of the eyes, as when to the stomach, produces dil- 
 atation of the pupils (§ 1066, p. 838, § 1057^). 
 
 904, bb. Let us observe the constitutional effects of tartarized antimo- 
 ny when administered in small and repeated doses. This substance 
 possesses, in a general sense, the power of lessening the irritability of 
 the stomach (in relation to its own virtues), where the doses are small 
 at first, and gradually increased. From this principle, indeed, results 
 the necessity of increasing the doses as far as they may be borne 
 without nausea, for the purpose of maintaining the same influence 
 upon disease as is exerted by the first and smaller doses. In this 
 way, in certain affections, as in articular rheumatism, we may some- 
 times rapidly increase the doses from the sixteenth of a grain to two 
 grains, although the first dose shall have actually produced vomiting, 
 while the two grains are borne without nausea. It is also certain 
 that this progressive increase of the remedy, as far as may be admit- 
 ted by the stomach, is indispensable to the full influence upon disease 
 which was exerted by the smaller doses before the remedy had sub- 
 dued the irritability of the stomach (§ 516 d, no. 7, 558, 578 d, 841). 
 
 Now were the physical, and not the physiological, doctrine true,
 
 676 INSTITUTES OF MEDICINE. 
 
 there should be no necessity for this regular and rapid increase of 
 the doses. The neai'er, indeed, each dose approaches the point of 
 nausea so will the general arterial excitement, and local inflamma- 
 tions, be held in subjection ; from which it is plainly manifest that the 
 remote effects depend upon the amount of influence produced upon 
 the stomach. And so of opium, and all the narcotics, and, indeed, of 
 various other agents which are freely assumed to operate through the 
 circulation. As to antimony, croup often subsides when nausea begins. 
 But again, on the contrary, we may obtain an exactly opposite se- 
 ries of results from tartarized antimony ; by which we prove our prop- 
 osition by the converse of the foregoing phenomena. We may begin 
 the treatment by one eighth of a grain without producing nausea ; but 
 in an hour or two afterward, a repetition of the same dose nauseates 
 the stomach, and prostrates the whole system. Again, at the same 
 interval, we repeat the same dosB and vomiting ensues, accompanied 
 by still greater constitutional effects. We then reduce the quantity 
 to the twelfth of a grain and again we have nausea and vomiting, with 
 still greater constitutional results. AVe go on to reduce the dose in 
 this manner, and, as I have witnessed in adults, it has been necessary 
 to diminish the quantity to the thirtieth part of a gi'ain to avoid pro- 
 tracted nausea, and a general prostration of the system. Here, then, 
 the remedy not only continues to nauseate the stomach in greatly di- 
 minished doses, but, as in the opposite case, there is a constant ratio 
 between its impression on the imtability of the stomach and its con- 
 stitutional influences and its special effects on diseased remote organs. 
 However the dose may be diminished, so long as it impresses the ir- 
 ritability of the stomach, it breaks down the general arterial excite- 
 ment, and often overthrows inflammation just as fully, and rapidly, as 
 when two grains are administered with a similar effect upon the stom- 
 ach. Nor is this all which antimony opposes to the doctrine of ab- 
 sorption ; since in the cases first supposed, when it finally produces 
 nausea after repeated and gradually-increased doses it does not re- 
 duce the irritability of the stomach after that dose, as after the begin- 
 ning of the remedy, and when it did not produce nausea. On the 
 conti-ary, the gastric irritability is now brought up to a full relation to 
 the remedy in that last dose, where it either remains permanently for 
 some time, or is quite as apt to increase in susceptibility to the anti- 
 monial influence, so that it may be necessary to diminish the next fol- 
 lowing dose to avoid a renewal of the nausea, and perhaps vomiting. 
 In the mean time, the effects on the constitution, and on remote dis- 
 ease, are exactly conformable to the amount of influence upon the 
 stomach. Clearly, then, its effects depend on reflex nervous actions. 
 
 904, c. Pereira has rendered our best standard work on Materia 
 Medica liable to the objection which I am now considering, as he has, 
 also, to that of reasoning from the effects of remedies on man in health, 
 and even upon the naturally modified constitution of animals and 
 plants, to the altered susceptibilities of man as they exist in disease. 
 Of tartar emetic, he says, we do not know "the mode in which it pro- 
 duces its curative effect." And again, a universal opinion — 
 
 " Shall we deny the efficacy of bloodletting in inflammation, of mer- 
 cury in syphilis, of cinchona in intermittents, and of a host of other 
 remedies, simply because we cannot account for their beneficial ef- 
 fects % The fact is," he continues, " that in the present state of mir
 
 THERAPEUTICS. REMEDIAL ACXrON. 677 
 
 knowledge, we cannot explain the modus 7nedendi of a large number 
 of our best and most certain remedial agents." — (Pereira's Mat. Med., 
 vol. i., p. 417. 1839.) 
 
 This supposed ignorance is mostly predicated of the failure of de- 
 tecting the medicines in the circulation ; but will it apply to such ob- 
 sei'vers as explain their modus operandi on other principles, and in 
 conformity with well-established facts'? If "bloodletting be effica- 
 cious in inflammation, mercury in syphilis," &c., they are so through 
 great and immutable laws ; and shall we rest in ignorance of those 
 laws because we cannot deny the efficacy of the remedies ] Is it not 
 this very common representation of the topics before us, and of the 
 phenomena of living beings, which has led to so general a disi-egard 
 of the great principles in medicine, and to the revival of the exploded 
 creeds of the iatro-chemical and iatro-mechanical philosophers ] Or 
 is it any argument against the interpretation of the properties and laws 
 of organic beings, of their modifications in disease, of the modus ope- 
 randi of remedial agents, as set forth by one inquirer, that fifty differ- 
 ent and conflicting systems have been projected by others 1 Such, 
 indeed, must be the position of every disputed topic when universal 
 truth shall ultimately prevail. The argument, therefore, however 
 common, is necessarily fallacious (§ 892, h, 905f , 829, 830). 
 
 There is no objection to admitting that all remedial and morbific 
 agents find their way, very scantily, into the circulation, excepting as 
 it regards the matter of fact, and a respect for those principles which 
 nature has ordained for their exclusion so far as to prevent their in- 
 gress in injurious quantities. No conclusions, as I have shown, can 
 be forined from the effects of injections into the circulation ; which 
 are the rudest facts in relation to a topic of this nature. It therefore 
 becomes the merest assumption to affirm that the minute proportions 
 of medicines, which may force their way through the well-guarded 
 portals of the organism, produce those remarkable results which we 
 witness after their administration by the stomach : while we are met 
 at the threshold of the inquiry by the clearest interpretation of their 
 modus operandi in the perfectly demonstrable laws of sympathy, in a 
 stupendous display of reflex actions of the nervous power in the nat- 
 ural conditions of the body, and as modified by a vast variety of ex- 
 periments, and by the morbid processes that are perpetually before us. 
 904, d. Again, take the grand characteristics of the cinchonas, arse- 
 nic, calomel, and the whole group of agents for intermittent diseases. 
 Of cinchona, Pereira says (after having expounded its operation as a 
 tonic through the process of absorption), that in intermittent diseases 
 its " methodus medendi is quite inexplicable." — [Ibid., vol. ii., p, 1002, 
 1006. 1840.) But, is not its mode of operation just as intelligible in 
 one case as in the other ? Does not the whole system of nature, 
 where common results are concerned in any integral part, enforce the 
 belief that the same laws are concerned in both cases ; and do not all 
 the relative facts in physiology, all that is known of the properties of 
 life, and of the constitutional effects of vital stimuli of any denomina- 
 tion proclaim the fact, that nature is just as consistent in this in- 
 stance as she is in the simple principles which determine the phe- 
 nomena of gravitation, of chemical affinity, of the attraction of cohe- 
 sion, of repulsion, &c., or, in more sensible physics, of electricity, of 
 light, of magnetism, &c.? If we refer, as does Pereira, to the effects
 
 678 INSTITUTES OP MEDICINE. 
 
 of cinchona as a tonic upon the healthy system, we must explain the. 
 metJiodus operandi before we can apply it in the least to any paralle 
 effects upon morbid and enfeebled states of the system. . But we may 
 not speak of " augmentation of cohesion of the organic mass," &c. 
 (5 890, 890^). — Ihid., p. 1002. These are only effects of an antece- 
 dent operation, in which the whole modus operandi consists (§ 842). 
 But the mode in which cinchona pi'oduces its effects in the perfect or- 
 ganism being just as obscure as in diseased states, we start with our 
 interpretation of its modus operandi in intermittents just as we do of 
 the mode in which cinchona produces its fullest effects in health ; or 
 raises the vigor of the stomach, sharpens the appetite, and braces up 
 the animal man, in dyspeptic affections. 
 
 Now the mode in which cinchona accomplishes these last results ia 
 no more obvious than its action as a febrifuge. One must certainly 
 be as plain as the other, since the essential influences and changes 
 are exerted upon the organic properties of living parts, which are 
 governed by simple and immutable laws. To explain the operation 
 of a given cause upon two principles where the results are of the 
 same genus, and nearly of the same species, would be to disjoint na- 
 ture completely, and to render her a deformity. 
 
 With this fundamental principle, we move forward to the interpre- 
 tation of the effects of cinchona when it exasperates or produces dis- 
 ease ; and so of other morbific agents. All the results, as they vary 
 from those which follow the ordinary stimuli of life, depend upon the 
 mutability of the organic properties and actions. Upon these, mor- 
 bific causes, like the natural vital stimuli, make their whole impres- 
 sion ; but they go farther in that impression than the natural stimuli 
 of life. That is to say, they make their impression so pi'ofoundly, 
 and in virtue of their peculiar attributes, as to alter the natural condi- 
 tion of the organic properties and actions ; and this alteration consti- 
 tutes disease. All that follows are but mere " sequelae." Remedial 
 agents, as we have seen, are capable of doing the same thing; and 
 when direct in action, they operate upon the same principle. It is 
 for this reason, therefore, that they produce disease in the healthy or- 
 ganism ; and when they contribute to the cure of disease, it is in vir- 
 tue of that morbific action which they exert on healthy parts. They 
 are a class of morbific agents, however, which produce only such dis- 
 eases, in health (if not administered in great excess), as are of a tran- 
 sient nature ; and when, therefore, administered for the cure of dis- 
 ease, they induce a morbid state more favorable than the pre-existing 
 to the natural tendency of morbid organic properties and actions to 
 return to their healthy standard (^ 892 h, 893, 901, 1059). 
 
 Thus we get at a common principle of the meihodus operandi of cin- 
 chona as a tonic ^ as z. febrifuge, and as a morbific agent; and it is 
 equally applicable to all other remedies which possess absolute reme- 
 dial virtues. This philosophy enables us at once to understand how 
 arsenic, cobweb, opium, alcohol, mental emotions, and almost every 
 thino- else, are, like cinchona, more or less curative of intermittent 
 fevers ; and though the alterations which are direct'y instituted by 
 these various agents are unlike in all the instances, and correspond 
 with the peculiar virtues of each agent, each one induces such chan- 
 ges in the organic properties as enable them to take on their natural 
 tendency toward a state of health, — some being more conducive than
 
 THERAPEUTICS. REMEDIAL ACTION. 679 
 
 Others, and either liable to exasperate the disease. We thus see, also, 
 how it is that our remedies must be well adapted to the eccisting pa- 
 thology, or they will prove morbific ; since their operation is as well 
 regulated by the nature of the morbid conditions as by the virtues of 
 the remedies (§ 79, 150, &c., 857, 890| d, 892 d). We must look 
 for the reason of this ready subversion of intermittent fever to solid- 
 ism and vitalism. We must regard nature in her recuperative efforts 
 as strongly pronounced during the periods of intermission, and thus 
 learn from her that the moibid properties of life may require but a 
 slight impression to establish an unintermitting tendency toward a 
 state of health (§ 177-182, 557 a, 756 a, 775). 
 
 That there is a methodus operandi, in all the foregoing cases, is too 
 certain to be questioned ; and such being the fact, it is quite a becom- 
 ing occupation for the human mind to interrogate its nature ; or as 
 the Wise Man, "it is the glory of God to conceal a thing, and the glory 
 of man to find it out" (§ 892, h, 905|).— Notes K L pp. 1119, 1120. 
 
 905, a. I will now present a comprehensive example which illus- 
 ti'ates the foregoing doctrines. A seton, passed through the skin of 
 the neck, removes inflammation of the eyes. In this instance, nothing 
 can possibly enter the circulation, but the whole influence of the se- 
 ton upon the eyes must be exerted through reflex actions of the 
 nervous system. By tracing out all the effects of which this seton is 
 capable we may show that it involves all the principles which are 
 concerned in the production of disease and its cure (§ 63-81). 
 
 In the first place, the seton establishes an inflammation in the part 
 of the skin in which it is inserted. Here we have the whole inter- 
 pretation of morbific agents in producing their direct diseases. 
 Like the seton, all others act upon the irritability of parts, directly 
 or by reflex action, alter its nature, and involve the other organic prop- 
 erties in corresponding changes, when a change of function ensues as 
 a consequence ; and then may follow a variety of physical results. 
 
 Now let us consider the seton in its curative aspect, as it relates to 
 the ophthalmic inflammation. The morbid state of the skin operates 
 as a peculiar stimulus, the result of which is transmitted to centers of 
 the nervous system, where it develops and modifies the nervous power, 
 and reflects it through organic nerves (^ 893 a).* The intensity of the 
 nervous power, thus developed, is not sufficient to alter the organic 
 properties of any part excepting the susceptible ones which conduct 
 the inflammatory affection of the eyes through their instruments of 
 action, and therefore no sympathetic disease is produced. But irri- 
 tability being pretematurally susceptible in the inflamed eyes, the 
 nervous power operates with effect upon it, and alters the nature o^ 
 that and other properties so as to enable them to return to their nat 
 ural state; and thus the inflammation subsides (§ 150, 151, 854). 
 
 We will next see how this seton may become the cause of disease 
 in other parts by reflex action, and we shall then, also, have the whole 
 of the principle which is ever concerned in the development of sec- 
 ondary diseases ; and we shall see, too, that the principle is precisely 
 the same as that which concerns the curative effects of remedies when 
 they operate upon remote parts through the medium of another part; 
 as in the curative effect of the seton upon the inflamed eyes. 
 
 Let us, then, suppose that the seton is permitted to remain in the 
 
 neck after it has accomplished the cure of the eyes, till, finally, it ex- 
 
 * In this curative effect, as in the case of vesicants (§ 893 c), centres of the sympa- 
 thetic nerve are more interested than the cerebro-spinal axis Note Dd p. 1132.
 
 nSO INSTITUTES OF MEDICINE. 
 
 cites a severe degree of inflammation in the surrounding skin. By- 
 and-by, we find the patient beginning to lose his appetite, the tongue 
 coats up, and other marks of a diseased state of the stomach set in. 
 This organ, therefore, has become involved in disease in consequence 
 of the neglected and irritative state of the seton. Still, however, the 
 mischief is allowed to go on, and the eyes, which had been relieved 
 by the seton, again become inflamed. The seton has been the essen- 
 tial cause of this round of phenomena ; and since nothing can -have 
 been introduced into the circulation, from beginning to end, we must 
 look to the nervous influence for the remote developments of disease, 
 as in the former case for the curative results (§ 514, Ji). The seton, 
 after the cure of the eyes, had taken on a higher and modified state 
 of inflammatory action, and it transmitted to the brain and spinal cord 
 such influences as developed the nervous power in greater intensity 
 and a more morbific condition. This state of the nervous power, be- 
 ing reflected abroad, fell with greater force upon the stomach than on 
 other parts, from its peculiar susceptibilities, and its close natural re- 
 lations with the skin and cerebral system (§ 233|). The stomach has 
 also the eyes much under its control, and the eyes are now particular- 
 ly liable to be injuriously affected by reflex actions instituted by the 
 stomach on account of their recent inflammation, which left them in a 
 more than usually susceptible state. The stomach, therefore, in trans- 
 mitting its morbid impressions to the cerebro-spinal axis, co-operates 
 with those from the seton in increasing and reflecting a morbific nervous 
 influence upon the eyes. Thus, like vesicants, setons are mobific when 
 their action extends beyond the centres of the organic nerve (§ 893 c). 
 
 We have now to consider the natural tendency of the properties 
 and actions of life to return from diseased to their healthy states. The 
 seton, as we have seen, is the sole cause of the new developments 
 of disease in the stomach and eyes, and these eflects ai'e maintained 
 by keeping up the irritative inflammation of the skin. If, therefore, 
 we withdraw the mechanical irritant from the skin, the inflammation 
 of the part will subside spontaneously ; and having thus removed the 
 exciting cause of disease in the stomach and eyes, these parts, also, 
 return spontaneously to their healthy states. Thus it is, also, that the 
 irritation of setons, issues, blisters, &;c., when applied over the joints, 
 &c., for the removal of inflammation of the ligaments or other tissues, 
 may, after having greatly fulfilled their purpose, ultimately keep up a 
 degree of the disease, or increase its intensity. But, if the skin be now 
 healed, the disease will subside spontaneously, — the very healing of 
 the skin reflecting salutary influences. This is often verified by the 
 effects of remedies when administered internally ; disease being ulti- 
 mately aggravated by the means which were at first curative, but 
 again yielding with rapidity as soon as the remedy is discontinued. 
 In all the cases, the ultimate subsidence of the aggravated conditions 
 of disease is owing to the artificial modifications of their pathological 
 cause. This recuperative law lies at the foundation of therapeutics, 
 and it shows us that the first and greatest step in the treatment of dis- 
 eases is to remove their exciting causes ; when the natural physio- 
 logical constitution may require no other aid from art (§ 853). 
 
 The only remaining consideration to complete the essential philos- 
 ophy of the operation of remedial and morbific agents relates to the 
 direct action of remedies in curing diseases of parts to which they
 
 TBERAPEUTICS. REMEDIAL ACTION. 681 
 
 may be applied. If an emollient poult/.ce, as it is called, or opium, 
 or leeches, &c., be applied to the inflamed skin, they may hasten the 
 subsidence of the inflammation. This is done by their direct altera- 
 tive action upon the diseased properties of the part, as in the case of 
 morbific agents ; and in proportion to the subsidence of the primary 
 affection may be that of the sympathetic diseases. But, the sympa 
 thetic affections may be also hastened in their decline by the direct 
 application of remedies to the sympathizing parts ; or, we may con- 
 tribute to the cure of the whole by addressing remedies directly to 
 one of the organs which has been sympathetically involved, as to the 
 stomach in the foregoing case ; or, the sympathetic affections may go 
 on independently of the cure of the primary disease, and require a 
 distinct treatment ; or, it may be necessary to cure them first, before 
 the primary disease can be removed. The diseased state of the stom- 
 ach, for example, in the foregoing case, may, in its turn, establish a 
 morbific reflex nervous action upon the seton, and thus complicate the 
 principle as to exciting causes, and institute a mixed condition of 
 reflex nervous influences. This, in fact, is more or less the case, in 
 most diseases, after the morbid state is propagated from the primary 
 seat. In the example now stated all the diseased parts act and react 
 upon each other, each becoming a point of departure for the develop- 
 ment of a morbific nervous influence, and each affection, therefore, 
 contributing to maintain and aggravate the others. Other organs join 
 in, though perhaps not essentially disturbed, and take their part in the 
 disease according to their degrees of affection, and more or less, also, 
 according to their relative vital importance and constitutional rela- 
 tions ; while the great movement of diseased action may be variously 
 influenced by the contingencies which grow out of constitution, tem- 
 perament, age, habits, external influences, &c. (§ 512, &c.). 
 
 And so, on the other hand, when the curative process begins, wheth- 
 er instituted by nature or by art, the whole organic system may con- 
 cur in the salutary change which is started at a single point (§ 143, c, 
 and references there). It is all the work of the physiological laws. 
 
 905, h. The vast advantages which are every where arising from 
 warm poultices, and warm fomentations, both in the hands of the phy- 
 sician and the surgeon, lead me to advert still farther to the philoso- 
 phy which concerns their effects, in the hope that it may not only tend 
 to their more frequent substitution for powerful agents, or for the sur- 
 geon's knife, and, therefore, to a better appreciation of the recupera- 
 tive law, and a greater reliance upon Nature herself, but that it may 
 contribute light upon the fundamental cause of disease, and the reme- 
 dial action of all things else. 
 
 In what I have hitherto said of the foundation of disease in common 
 physiological principles, and of the near approximation, in their path- 
 ological states, of all the varieties and modifications of inflammation, 
 in connection with what has been variously and specifically stated of 
 the common mode of action which obtains with all efficient remedies, 
 from the vesicant to the sedative, it is evident that the remedial action 
 of poultices, and hot fomentations, falls under the universal philoso- 
 phy. From blisters and irritating cathartics we readily pass along an 
 intermediate series of analogies that are represented by other agents 
 till we arrive at tonics and stimulants. In a former section I was 
 employed in endeavoring to show, through the operation of these last
 
 B82 INSTITUTES OF MEDICINE. 
 
 agents, that there is no ground whatever for the distinction which has 
 been made of inflammation into active and passive, or sthenic and 
 asthe-nic, conditions (§ 733^) 752-756). The example supplied by 
 erysipelas, in which blisters and leeches may afford relief when ap- 
 plied to the inflamed surface, either separately or conjointly, is only 
 another impressive evidence of the close approximation of the various 
 pathological states of inflammation ; and the variety in the remedial 
 virtues of the curative agents which have now passed under review 
 goes to prove that they operate merely by inducing conditions of dis- 
 ease more favorable to the recuperative process. Loss of blood pro- 
 duces one kind of change, cathartics another, tonics another, vesicants 
 another, and so on ; but each one induces a change from which the 
 morbid properties are capable of passing to their natural state (§ 
 892|, h). These principles enable us to understand how a great va- 
 riety of physical and mental causes will often succeed in removing 
 some particular malady, as one or another may be brought into action 
 at its different pathological phases, as in intermittent fever ; and rec- 
 oncile, also, those embarrassing contrasts which have led to many er- 
 rors in pathology and therapeutics, as when tonics and stimulants re- 
 move inflammation, or when patients equally survive the treatment 
 of gastro-enteritis by capsicum or lobelia, as practiced by the bold 
 and unprincipled empiric. A more violent inflammation may be the 
 temporary consequence ; but it differs from the original in being mod- 
 ified by the peculiar morbific virtues of capsicum or lobelia, and in 
 which modifications the diseased properties are sometimes capable of 
 exerting their recuperative energy (§ 1059). — See Note Ee p. 1133. 
 
 This conducts me to a more circumstantial exposition of the reme- 
 dial action of local sedatives, especially of those for which this sec- 
 tion was designed. In the mean time, however, on looking at the 
 group of local sedatives, as arranged in my Materia Medica, we find 
 linseed, and bread and milk poultices, holding the very first rank, 
 while sedatives of the most active virtues, such as stramonium, aco- 
 nite, belladonna, cicuta, cyanide of potassium, morphia, opium, hen- 
 bane, &c., follow the poultices and hot fomentations as infeiior reme- 
 dies. 
 
 But this aiTangement, like that of all other groups, is founded upon 
 the supposed relative usefulness of the several agents in fulfilling the 
 objects of each group, respectively. Since, therefore, emollient poul- 
 tices and warm fomentations effect the greatest amount of relief, and 
 are far more generally applicable in practice than all the rest, as local 
 sedatives, they should hold the first rank in the arrangement, notwith- 
 standing the activity of their virtues is immensely less than that of the 
 other substances which I have mentioned. It is the effect of all, how- 
 ever, to lessen irritability and sensibility, and thereby to moderate or 
 subdue inflammatory action. But rqany of the local sedatives go far- 
 ther than this. They also affect irritability and sensibility, especially 
 the former property, in their existing nature or Jciiid, and, of course, 
 induce a corresponding change in the kind of action. Now, it is this 
 alteration in land, beyond the mere sedative effect, which makes up 
 the differences between the various agents of the group of local seda- 
 tives. Poultices and warm fomentations produce the least of this 
 change in kind ; their effect scarcely reaching beyond that of reducing 
 an exalted state of irritability and sensibility, or of keeping it down
 
 THERAPEUTICS. REMEDIAL ACTION. 683 
 
 where it is liable to ensue. The acetate of lead follows next, in this 
 simple but most valuable effect. 
 
 The foregoing moderate influences, with little or no specific altera- 
 tion in kind of the morbid properties and actions, is just what is want- 
 ed in a vast number and variety of morbid states, as in superficial in- 
 flammations, abdominal irritations, sprains, bruises, piles, &c., or as 
 means of prevention in the hands of conservative surgery. There is 
 nothing comparable, for these purposes, with warm poultices and 
 warm fomentations. Their immense services in the healing art, 1 
 say again, should turn the attention of physicians and surgeons with 
 increasing reliance upon recuperative Nature. Let us study the pre- 
 cepts as inculcated by the fathers of medicine, an imbodiment of 
 which may be seen in three of the mottoes at the head of a former sec- 
 tion (§ 894).— IN'oTE E p. 1114. 
 
 In respect to the poultices, &c., no doubt the moist heat exerts some 
 slight alterative effect beyond that of simply reducing the exalted prop- 
 erties and actions of inflammatory conditions. But, all the other chan- 
 ges and results which take place are brought about by Nature, and 
 not by the poultices (§ 878, 891 i, 891 1 g-1^. 
 
 If local inflammations, to which poultices and warm fomentations 
 are applicable, have given rise to disturbing reflex actions, or to in- 
 flammation of other parts, these sympathetic results may subside spon- 
 taneously when the primary disease gives way. But the poultices have 
 nothing farther to do with any of these great movements of Nature 
 than simply to lessen the irritability of the inflamed part with which 
 they are in contact. In conservative surgery, poultices have even less 
 participation in all those terrible compound fractures and dislocations 
 whose cure they enable Nature to conduct with but even little inconve- 
 nience to their subjects, and which, till in recent times, were doomed to 
 the amputating knife. In all these cases, the simple agents are only 
 instrumental in keeping down irritability, and thus preventing inflam- 
 mation and constitutional disturbances. They act partly upon the prin- 
 ciple of keeping exciting causes out of the way of Nature (§ 856, a). 
 
 Finally, a word as to the contribution which is made by these great 
 I'emedies toward the resolution of those phlegmonous inflammations 
 which are disposed to result in suppuration, or how, in other cases, 
 they promote that disposition. 
 
 If the phlegmon have not reached the turning point, as it were, of 
 the inflammatory process, or when the formative is about passing into 
 the suppurative stage, an emollient poultice, by lessening irritability, 
 will be very likely to promote resolution, and thus to prevent the sup- 
 purative stage. 
 
 But, when suppuration has begun, Nature, herself, has taken on the 
 wq^'k of cure, and an abatement of morbid irritability is the first recu- 
 perative change in this natural process. Now it is, therefore, that 
 poultices, through their tendency to lessen morbid irritability, co-op- 
 erate with the natural process, and thus promote suppuration (§ 733, 
 735 a, 862). 
 
 GENITO-URINARY AGENTS. 
 
 905^, a. In c(>nsiderj,tion of what I have said o^ Emmenagogues (§ 
 892|, q), and to illustrate yet farther the action of remedial agents, 
 before entering upon the subject of bloodletting, I have concluded to
 
 684 - INSTITUTES OF MEDICINE. 
 
 set forth the ground of distinction which induced me to assemble into 
 two groups those agents which bear the general denominations, in my 
 Materia Medica, of Uterine Agents, and Genito- Urinary Agents. By 
 introducing, also, the several members of each group, along with the 
 numerical order of arrangement, it will be farther seen how far the 
 arrangement has been founded upon physiological principles, and how 
 far it is adapted to the modifications vvhich are presented by patholog- 
 ical conditions (§ 137 d, 872 b, 892^ b, c). There will be thus, also^ 
 farther exemplified the relative specific relations of many remedial 
 agents to certain tissues, or parts of a common tissue, and farther, also, 
 by the recurrence of the same agents in different groups, their thera- 
 peutical capabilities in their aspect of compound virtues (§ 129, 135, 
 136, 137 b, c, 150, 151). 
 
 Uterine Agents, in the order of their value {numerically). — 1. 
 Secalecornutum. 2. Oleum ergotce. 3. Cantharis vesicatoria. 4. San- 
 guisuga. 5. Guaiacum officinale. 6. Juniperus sabina. 7. Ferrum, 
 et ferri sales. 8. Aloe socotrina. 9. Balsamodendron myrrha. 10. 
 Hydrargyri sub-murias, etc, 11. Hydrargyri iodidum. 12. lodiniura. 
 
 13. Potassii bromidum. 14. Ferri bromidum. 15. Ipomaea purga. 
 16. Juniperus Virginiana. 17. Aristolochia serpentaria. 18. Ruta 
 graveolens. 19. Ferula asafoetida. 20. Sodae biboras. 21. Mentha 
 
 ' pulegium. 22. Helleborus niger. 
 
 Genito-Urinary Agents, in the order of their value {numerically). — 
 I. Copaifera multijuga. 2. Piper cubeba. 3. Cantharis vesicatoria. 
 4. Strychnos nux vomica. 5. Barosma crenata. 6. Abies balsamea. 
 7. Oleum terebinthinae (pinus et abies). 8. Pistacia terebinthus. 9. 
 Arctostaphylos uva-ursi. 10. Cissampelos pareira. 11. Laurus cam- 
 phora. 12. Tinctura ferri sesquichloridi. 13. Chenopodium olidum. 
 
 14. Chimaphilla umbellata. 15. Cinchona officinalis. 16. Amyris 
 Gileadensis. 17. Pistacia lentiscus. 18. Physalis alkakengi. 
 
 905^, b. The foregoing assemblages suggest, by the remedial vir- 
 tues of the several members of each class, respectively, a great varie- 
 ty of pathological conditions relative to the uterus in one case, and, 
 in the same manner, the genito-urinary organs in the other. We have 
 already seen how ergot is mainly useful in parturition ; and its ob- 
 vious effects through reflex nervous action supply a clear analogy 
 for expounding the effects of the other agents (§ 893^). The other 
 members of the Class of Uterine Agents are such as are denominated 
 emmenagogues, with the exception of the fourth. But, leeches should 
 evidently follow cantharides, in the oi'der of importance, as capable of 
 yielding relief, not only in the next greater number of cases, but in 
 very difficult pathological conditions of the uterus; while the high place 
 which they occupy is significant of irritable and inflammatory, or con- 
 gestive affections of the uterus which may often call upon their aid, 
 and admonishes the practitioner to beware of most of the other ageftts 
 which follow. It is not, however, to such cases alone that leeches to the 
 perinaeum are appropriate, but to many cases where menstruation has 
 been long arrested by slight derangements of the uterus, as sympa- 
 thetic consequences of gastric or other abdominal derangement, but 
 where the influence of vital habit is such that neither cantharides nor 
 the stimulating emmenagogues, if admissible, will affect the condition 
 of the organ ; though its susceptibility to these agents may be estab- 
 lished by leeching (§ 137 d, 892f q, 893 q). Should leeching, there-
 
 THERAPEUTICS. REMEDIAL ACTION. 685 
 
 tore, fail, it is appropriate that an emmenagogue which may now suc- 
 ceed, and often by itself, should stand next in the order of airange- 
 ment ; and of these, guaiacum is the best. 
 
 It need scarcely be said, that in the reference which I have made 
 to emmenagogues in section 892|, §', I embrace alone those which 
 have been hitherto grouped together with a special reference to the 
 symptom, and upon which the denomination has been founded (Ev in, 
 iiriv, month, and ayoj, to lead). 
 
 We soon come upon the ferruginous preparations, and these, again, 
 are significant that the uterine embarrassment often grows out of indi- 
 gestion, or, less frequently, that some primary affection of the uterus 
 has been the sympathetic cause of a gastric derangement that reacts 
 upon the uterus and maintains its pathological condition (§ 902 h, 
 905 a). But, it does not often happen in primary uterine affections 
 that an appropriate treatment will not readily succeed ; especially 
 leeches if inflammatory, or, otherwise, cantharides, and the subordi- 
 nate means. Such, however, is the disposition of the system, espe- 
 cially of the digestive organs, to sympathize with inflammatory, or ir- 
 ritable states of the uterus, that these cases soon become complicated, 
 and we may then turn to the example of the seton for the principles 
 of treatment, nor waste our efforts at unavailing attempts with em- 
 menagogues addressed to the symptom, hut let them he such as shall 
 meet the uterine complications. 
 
 Where ferruginous agents are proper, so, also, in a general sense, 
 is guaiacum, or some analogous means. But, the attendant gastric 
 derangement is apt to be accompanied by constipation, which is more 
 or less dependent on an associated functional derangement of the liv- 
 er (§ 129). Aloes, therefore, properly follows next in the order ; and, 
 although it may affect rather specifically the mucous tissue of the ute- 
 rus, urinary organs, and lungs, in its irritable states by reflex nervous 
 influences, it acts as an emmenagogue mostly by contributing relief to 
 hepatic disorder, augmenting the natural stimulus of the intestine, and, 
 in other ways, removing constipation, and thus, also, the symptom (§ 
 889 i, 889 /, 902 b, 1063 b). 
 
 The simple mercurial preparations, which follow as the tenth in or- 
 der, equally admonish us, also, to keep our attention upon the patho- 
 logical condition, and away from the symptom, excepting as it is very 
 vaguely significant of some morbid state of the uterus which can be 
 known only through other phenomena. The rank of this agent implies, 
 also, its degree of utility, the ratio of its frequency in contributing aid, 
 its adaptation to a variety of pathological conditions that maybe com- 
 plicated with the uterine derangement, and the probability that it may 
 be advantageously associated with leeching, and only as a subordinate 
 agent. It comes into use, especially, in inflammatory states of the 
 uterus, or when hepatic derangement takes the lead, and is inobedi- 
 ent to milder ti-eatment. 
 
 The next are the iodides of mercury, and the bromides of mercury 
 are about the same ; and, who does not see that their special refer- 
 ence is not to the uterus, but to some other visceral derangement ; 
 perhaps of a syphilitic, or scrofulous nature, or under those diatheses 1 
 But which, and how much, what the pathological shades, what the ex- 
 act condition of the uterus, how far it receives and reflects sympathet- 
 ic influences, are matters for critical inquiry (§ 894 h, 901, 902 b)
 
 686 INSTITUTES OF MEDICINE. 
 
 The union of mercury with iodine also suggests a general antiphlo- 
 gistic treatment, and that, like the more simple mercurials, it may be 
 often associated with leeching. 
 
 Iodine or the bromide of potassium is wanted next, on account of 
 the scrofulous diathesis, or other special conditions to which those reme- 
 dies are adapted. It denotes that the uterine function is often sus- 
 pended by chronic visceral disease which has gone on to disorganiza- 
 tion, especially of the liver or spleen ; though, in other cases, it sup- 
 poses the same condition of the uterus as a primary affection (§ S92J). 
 It may be only the indigestion so often incident to the scrofulous con- 
 stitution which arrests menstruation, and often without much derange- 
 ment of the uterine system ; and here iodine contributes an important 
 aid. The uterus surrenders as soon as the morbific reflex nervous 
 actions are withdrawn. The bromide of iron maybe often now call- 
 ed in advantageously (§ 150, 151, 894 h, 901, 902 I). 
 
 Jalap is wanted to carry out a decisive antiphlogistic treatment, 
 which is occasionally demanded ; sometimes for primary inflammation 
 of the uterus, or again for some general plethoric habit, or some ob- 
 stinate chronic gastritis, and where the functional derangement of the 
 uterus is of very little importance. In many of these cases, general 
 bloodletting should take the lead in the treatment ; and the menses 
 may start under the beginning impression of the remedy (§ 872 h, 
 892J h, c, 1060). 
 
 But, there are no cases which so constantly baffle the practitioner 
 as those which are presented by the nervous temperament ; and these 
 are common (§ 601). A reference to the characteristics of that tem- 
 perament will show us, at once, how it has happened that asafoetida 
 is the only agent that has been introduced with a specific reference 
 to ilie symptom, in this class of remedies. The whole body is so alive 
 to reflex nervous actions, as disease may touch upon one part or an- 
 other, and more profoundly as it may plant itself in gi"eater force, that 
 nothing can be now accomplished but through the precepts of the most 
 enlightened medical philosophy. It is here, too, that \ve see most 
 distinctly pronounced the complete possession which gastric derange- 
 ments may take of the uterus, and overthrow its function, or where it 
 may be interrupted by a sudden i-eduction of the temperature of the 
 feet, or by a midnight frolic, or by drawing the habitual corset a little 
 tighter. Now, too, any disturbance of the uterus, whether primary or 
 secondary, reacts on most other parts, while they, in their turn, resent, 
 as it were, the injury (§ 514, h, &c.). The treatment of these cases, 
 therefore, may be as complex as the morbid sympathies. But, in a 
 general sense, the best and often the only requisite emmenagogue 
 will consist of a carefully-regulated diet, early sleep, free exposure to 
 the open air, accompanied with a suitable kind of exercise, sometimes 
 shower bathing, or, at other times warm bathing, removal of corpo- 
 real restraints, cheerfulness of mind, and a little rhubarb and mag- 
 nesia to improve digestion, keep down acidity, and to help any slug- 
 gish state of the bowels. We must repair the constitution of theso 
 patients ; and there will then be no difficulty with the symptom. It 
 has been a neglect of the means, the neglect of pathology, and the 
 name of emmenagogue, which have led to most of the failures of art, 
 and have contributed to swell the nomenclature of " nervous diseases" 
 r§ 659, 855, 856, 878, 902 m). Nor has the fashion of " Specialities:'
 
 THERAPEUTICS. REMEDIAL ACTION. 687 
 
 which forms one of the perversions of morbid anatomy, as handed 
 over from France, and one of the roads to distinction and practice, 
 been wanting in a Uberal contribution to the very en"ors which it pro- 
 fesses to reform. The principal observers are generally able, always 
 industrious ; and would they but merge their tangible, isolated ob- 
 jects in the comprehensive philosophy of medicine, they would give 
 an impulse to science, and a direction to practice, which would bring 
 honor to themselves, and bestow a service on mankind. We need no 
 better demonstration of this than what I have just been saying of the 
 nervous temperament {§ 701, 960 c). 
 
 905^, c. We come, next, to the Genito-Vrinary Agents, where a 
 great variety of remedial virtues occurs, but, unlike the case of em- 
 menagogues, where all have a special reference to the genito-urinary 
 system, with the uterus excepted as to its relations to cantharides 
 and chenopodium. It is a group, therefore, which illustrates, through- 
 out, what is denominated specific action, and exemplifies extensively 
 the special modifications of irritability in different parts of the body 
 (§ 133, &c., 150, 191). 
 
 When, therefore, these agents are ehiployed with reference to the 
 genito-urinary system their local action is alone contemplated. The 
 favorable changes which they induce are of a direct nature as it re 
 spects that system of organs ; and they do not, therefore, contribute 
 relief by effecting the removal of diseases situated remotely from 
 those parts (§ 905^, h). 
 
 Hence, it is readily seen how liable to misapplication such a group 
 of agents must necessarily be without a sound knowledge of physiol- 
 ogy, and an enlightened view not only of the general conditions of 
 disease, but of the pathological varieties and shades of difference 
 which are constantly presented by any given common form of dis- 
 ease ; especially of inflammation (§ 639 a, b, 650, 662, 669, 671-674, 
 718, 722, 819 a, motto, no. 7). To such an observer the assemblages 
 in the various groups are peculiarly valuable, and for such, indeed, 
 are they alone designed. To him, each group, each remedy, every 
 virtue in a compound remedy, and whether so by Nature or by art, 
 has its individuality, which is recognized as the eye glances from one 
 agent to another, while it carries along an associated recognition of a 
 vast variety of pathological states, and a just appreciation of the rel- 
 ative therapeutical value of the various means which may be the sub- 
 jects of his transient inquiry. But, the group now under considera- 
 tion being exclusive, and, withal, not as liable to morbific effects as 
 are most other classes, the uninformed has less chance at mischief 
 than when he approaches the cathartics, &c. ; where physiological 
 and pathological knowledge is far more important. 
 
 It is readily seen, therefore, that one, or more, of the foregoing 
 agents may be exactly adapted to a given modification of disease, in- 
 flammation, for example, affecting either the mucous tissue of the va- 
 gina, or of the bladder, or of the urethra, while it would be very un- 
 suited to another modification ; and, from what we have seen of the 
 natural modifications of the vital constitution in the same tissue as it 
 may occur in different compound organs, and in different parts of a 
 continuous tissue as it traverses different organs (§ 134-137), it is ev- 
 ident that great circumspection is often necessary in the application of 
 these agents ; and farther, also, that what may be immediately useful
 
 688 INSTITUTES OT MEDICINE. 
 
 in some special state of inflammation as affecting one of the several 
 parts of the genito-urinary mucous tissue may be detrimental in an 
 apparently coincident form of the same disease in either of the other 
 parts; and vice versa (§ 137 c, 150, 151, 870 aa). Here we have, for 
 example, amenorrhcea, as considered in the foregoing section, de- 
 pending on active inflammation of the uterus where general blood- 
 letting may be demanded, and may be sufficient ; but, in event of its 
 failure to establish menstruation, cantharides, which would have been 
 otherwise pernicious, may now complete the requisite instrumentality 
 of art (§ 137 d, e, 143 c, 859 h, 863 d, 867, 871, 905 J b.) 
 
 Take, next, the same agent as the best internal remedy for leucor- 
 rhcBa. Here, again, the inflammatory states, which constitute that af- 
 fection, vary constantly, not only as to force and habit (§ 535, &c.), but 
 more greatly in the absolute modifications of inflammatory action. 
 For all this knowledge we must go to our general principles, then to 
 all the minutiae of symptoms (§ 685, 686). Among the last none are 
 so important as the exact character of the discharge, which varies, by 
 gradations, from purulent to mucous, and from this last to a bloody, or 
 a brown watery, or a more simple watery fluid; just as we have seen 
 of analogous phases in the condition of ulcers, or of intestinal inflam- 
 mation (§ 693, 740). Now, it is clearly wrong to treat any one of 
 these several conditions exactly in the same manner ; and where the 
 differences are broadest, so also must be the variations of-treatment. 
 In indolent states of the disease, and where the discharge is mostly 
 purulent, if the general health be tolerably sound, we may proceed, 
 at once, to the exhibition of cantharides ; and, as soon as slight stran- 
 gury takes place the disease will generally surrender. But, should 
 it, in the cases supposed, refuse to submit, or should the individual 
 be insusceptible of the special action of cantharides, as will common- 
 ly be denoted by the failure of its effect upon the bladder, we may 
 safely, and commonly with certainty of success, resort to vaginal in- 
 jections of the best nitrate of silver, in proportions varying from three 
 to eight grains in an ounce of water. But, if the discharge consist of 
 mucus, or any other than the puriform matter, cantharides will ag- 
 gravate the affection, and the nitrate of silver, at most, will do no 
 good. If it be mucus, it denotes an intensity of inflammation which 
 calls, at least, for a simple vegetable diet, and probably for leeches 
 to the perinaeum, along with the general antiphlogistic treatment. 
 In these cases, therefore, we have nothing to do with the genito- 
 urinary agents. Equally inapplicable, also, aVe they to those patho- 
 logical states from which result the watery discharges ; and here we 
 are completely thrown upon the special circumstances of every indi- 
 vidual case, and upon the general principles of the science. 
 
 This last remark leads me to another more important than the rest ; 
 namely that all the pathological varieties which go to constitute the 
 symptom may be variously complicated with morbid affections of oth- 
 er important organs, especially those of the abdomen, through alter- 
 ative influences of reflex action of the nervous system. This, indeed, 
 is always the case in the wateiy discharges, almost always in the mu- 
 cous, and very often in the puriform. In all the cases, too, the vaginal 
 or uterine affection may be entirely a sympathetic result of primary 
 disease in the digestive organs ; and such is usually the case where 
 the discharge is of a watery nature. We may be sure, however, that
 
 THERAPEUTICS REMEDIAL ACTION. 689 
 
 the sympathetic affection will react upon the system at large, espe- 
 cially in the more intense form which is denoted by the mucous pro- 
 duct; and this, whether the genital affection be primary or secondary. 
 
 Here, then, we must apply ourselves to the general health, attack 
 what may be the citadel of disease ; but, to do this efficiently, and 
 that our prescriptions may carry with them the combined virtues of 
 tuto, cito, et jucunde, the practitioner may not undervalue the Insti- 
 tutes of Medicine. 
 
 Whenever the uterus is the seat of disease in its mucous tissue, like 
 all other organs which may be especially affected in one of its parts, 
 the other component parts suffer, more or less, sympathetically {§ 138, 
 141 b, 514/, 528). 
 
 A common form of discharge takes place from the uterus which is 
 more or less of the nature of lymph. Here there is pretty high in- 
 flammation, as well as obstinate. It calls, of course, for general blood- 
 letting, leeching, &c. I say nothing of cases requiring local remedies. 
 
 Copaiva is the first among the agents in the group before us. This 
 denotes the frequency with which it is called into use in the treat- 
 ment of gonorrhoea, and its relative value for this specific purpose. 
 Cubebs follows next ; and as two agents of similar virtues in rela- 
 tion to a specific object, and of nearly equal pretensions, and both of 
 them stimulant, lead off in a general class of remedies, they are, by 
 the position they occupy, standing mementoes of the frailty and vul- 
 nerability of man, and incentives to study well the varying conditions 
 of gonoiThoea. Here we have rai'ely more than a local complaint for 
 our professional skill ; and yet, how much suffering is inflicted, how 
 many made wretched in their domestic relations, by the indiscreet 
 use of these two valuable agents, and by astringent injections ! The 
 haste of the patient may be always moderated, or conquered, by firm- 
 ness in the appropiiate means, and the practitioner rewarded in con- 
 science, and thanks, where he may elect, for the preliminary treat- 
 ment, that antiphlogistic plan which will speedily prepare the way 
 for the remedies of more local action, if it do not in itself succeed. 
 Here, too, we may notice in the contingent circumstance, as in all 
 other groups, that when gonon-hoea yields to general or local blood- 
 letting, or to cathartics, or to water gruel and perfect rest alone, an- 
 other of the multifarious demonstrations of the common mode of Re- 
 medial Action. 
 
 905|. In concluding the subject of Remedial Action as hitherto 
 expounded, and before entering upon that of loss of blood, I shall take 
 the liberty of protesting against the unreserved imputation of ignorance 
 as to the modus medendi of remedies, and of which I have quoted some 
 examples (§ 904 e, «fec.). It is true that they who allege this ignorance 
 cultivate the humoral and chemical doctrines, ignore all distinction in 
 the powers by which the two kingdoms are governed, and satirize the 
 laws of the nervous system if supposed to involve any thing moi*e than 
 chemical action. These positions certainly imply, as far as they reach, 
 all the acknowledged ignorance, and the objection, therefore, which I 
 now raise is against the imputation of this ignoi'ance to those who have 
 taken the trouble of informing themselves about the things which they 
 profess to understand. They object to a degradation to such a level. 
 Where the ignorance exists its confession is laudable and useful. 
 
 Xx
 
 690 INSTITUTES OF MEDICINE. 
 
 THE INFLUENCES AND MODUS OPERANDI OF 
 LOSS OF BLOOD, 
 
 Considered with a Reference to the practical Application of the Reme- 
 dy and the various Circumstances of Disease. 
 
 906, a. " The serous portion of the blood, or even pure blood, may escape from the over- 
 distended vessels, just as water transudes through the permeable sides of a vessel, in which 
 it suffers compression. To this source are to be referred several hemorrhages and dropsies 
 produced by simple transudation in a tissue mechanically congested ; and although these af- 
 fections have really nothing active in their nature, yet are they considerably diminished, 
 and sometimes altogether removed, by bloodletting, which, in such cases, acts in a man- 
 ner purely inechanical, by removing from the vessels the fluid by which their parietes 
 were kept in a state of over-distention." — Andral's Pathological Anatomy. 
 
 h. " If bloodletting be considered in a mechanical light, as simply lessening the quantity 
 of blood, I cannot account for its effects ; because the removal of any natural mechanical 
 power can never remove a cause which neither took its rise from, nor is supported by it." 
 — Hunter on the Blood and Inflammation. 
 
 c. " It is a great modern improvement in th-e practice of the healing art, in bleeding for 
 the cure of inflammation, to take the blood away as quickly as possible; since intense in- 
 flammations of the brain, lungs, bowels, &c., are equally removed by fainfness, whether it 
 happens after the loss of ten ounces of blood, or of fifty ; or even, as sometimes occurs, 
 when it happens without bleeding at all, after merely tying the arm m preparation."- 
 Arnott's Elements of Physics. 
 
 d. " If we have to deal with an extensive and violent inflammation, we do not abstract 
 blood by a minute opening ; we make a large orifice, or we open a vein in both arms at 
 the same time ; we place the patient in an erect posture, and endeavor to produce deli- 
 quum. It sometimes happens that the patient faints from fear, or before any considera- 
 ble quantity has been lost; and this faintness, as Dr. Arnott remarks, answers as well as 
 that which results from venesection" (§ 960, a). — Graves, in London Med. and Surg. 
 Journal, vol. iii., p. 391. 
 
 e. Ad extremos 'morbos extrema remedia exquisite optima." — Hippocrates (^ 960 h). 
 
 906, yi Whether the father of medicine, or his latest descendants, 
 be right or wrong in their medical precepts, especially in relation to 
 the therapeutical uses of bloodletting, it will be an object of the pres- 
 ent inquiry to ascertain (§ 376|, a). The contrast of views, especial- 
 ly when we consider the details inculcated by Hippocrates in respect 
 to loss of blood, as well as other remedies, suiting them all to the ex- 
 igencies of disease, or leaving the whole work to Nature, and, with 
 all his enlightened precaution, regarding the loss of blood as the re- 
 medium principale, renders it, I say, an object of deep interest to de- 
 termine the nature of the right, and, in so doing, to ascertain also how 
 far philosophy and practical habits have outstripped the Ancestor. 
 
 We may also, perhaps, come to some determination whether a 
 knowledge of the principles upon which bloodletting operates be 
 worthless, or necessary to its just and intelligible use (§ 893, n). 
 Whether we should know what absolute influences it exerts, or how 
 it exerts them, before we can appreciate its applicability, and its ap- 
 propriate extent, in many important morbid states where the remedy 
 may be more demanded than in other conditions whose phenomena 
 clearly indicate its necessity (§ 857). 
 
 Perhaps, also, it may be useful to science, as well as humanity, to 
 strip this remedy of its mechanical interpretations, and to place it upon 
 the dignified, practical ground of the physiological institutions of organ- 
 ic Nature, which, if unacceptable to the materialist, will, at least, 
 engage his attention as a philosopher. 
 
 906, g. Before entering upon the investigation of this subject i 
 take leave to say, that the modus operandi of loss of blood, as set forth
 
 THERAPEUTICS. LOSS OP BLOOD. 691 
 
 in this work, is exclusively original with myself. If there be any mer- 
 it in the philosophy, its abuse and misrepresentation by the British 
 and Foreig?i Medical Review, and the Medico- Chirurgical Review, of 
 London, entitle me fully to all the proprietorship. Whatever is said 
 of the vital influences of the loss, and of the whole theory of the asso- 
 ciate influence of the nervous power, appeared for the first time in 
 the Medical and Physiological Commentaries (§ 222, b). Copyists, 
 it is true, have appeared, especially of the accumulated facts, without 
 the slightest reference to him who performed the labor (§ 435, b). 
 
 Although, therefore, the same philosophy, and the same practical 
 applications of loss of blood, are preserved in the Institutes as set forth 
 in the Commentaries, they are now rewritten and presented in anoth- 
 er shape, with greater brevity, and with reference to that systematic 
 order which shall best subserve the young Inquirer. The same is 
 also true of other subjects which may have been investigated in the 
 Commentaries. — See Rights of Authors, p. 912.* — Note Wp- 1127. 
 
 907. Notwithstanding the practical importance of a distinct appre- 
 hension of the modus operandi of loss of blood, it should never be the 
 leading indication for its use ; but only subservient to the suggestions 
 of the morbid phenomena, of pathological principles, and of experi- 
 ence. The just application of the remedy should be determined by 
 these combined considerations (500 m^ 688, 694|, 826 cc^ Note Ll). 
 
 908. Again, by taking a comprehensive view of the direct influen- 
 ces of loss of blood, we shall not fail to discover the close analogy of 
 its modus operandi with that of all other remedies, and that it reflects 
 an important light upon the whole ground of remedial action ; while 
 its loss involves in its effects some principles peculiar to itself. 
 
 909. The hypotheses which have hitherto prevailed respecting the 
 operation of loss of blood have been, for the most part, mechanical ; 
 but I have demonstrated in my Essay on the Philosophy of its Opera- 
 tion, that the effects of blood-letting are wholly incapable of such ex- 
 planation. Nevertheless, even dry cupping, and ligatures to the limbs 
 as extensively inculcated by Erasistratus and facetiously commemorated 
 by Galen, are again restored as substitutes for loss of blood (§ 1004 c). 
 
 910. The numerous advocates of the mechanical doctrine of inflam- 
 mation and venous congestion predicate their views of the operation 
 of bloodletting in conformity with the supposed existence of passive 
 relaxation of the affected vessels, and stagnation of blood within them, 
 and extend the hypothesis to the hot stage of idiopathic fever. The 
 philosophy, therefore, is vitiated by the pathological views upon which 
 it is founded. Moreover, were the doctnne of debility (§ 569), pass- 
 ive relaxation of the vessels, and stagnation of blood, correct, it is ev- 
 ident that not only such relaxation, but that the stagnated and coagu- 
 lated blood, would not be suddenly removed by diminishing, to any 
 extent, the general circulating mass, as is constantly witnessed in in- 
 flamed parts ; while, also, were such a physical impossibility within 
 the power of the remedy, those vessels would immediately become 
 again congested, and the more so from the prostrating nature of the 
 remciy (§ 935, 977).— Note Dd p. 1132. 
 
 911. General bloodletting, cupping, and leeching, manifest some 
 important differences in their effects, but operate upon modifications 
 of a common principle. A knowledge of these modifications is ne- 
 cessary to a right administration of the remedy as it respects one ci 
 
 * The Works of Authors quoted in this Essay may be found in the " Commentaries.
 
 G92 INSTITUTES OF MEDICINE. 
 
 the other modes of abstracting blood. Neither method has been 
 founded upon any rational principle. 
 
 912. How, then, does bloodletting operate? How are diseased 
 parts immediately and permanently unloaded of their blood, in some 
 instances by the abstraction of two or four ounces of blood, when, in 
 other cases, under apparently the same circumstances, a great extent 
 only of the remedy will effect the same result 1 Why, in such cases, 
 may the former quantity induce syncope, when the latter has no such 
 effect 1 " Syncope," says Robert Jackson, " occurs sometimes in yel- 
 low fever from the loss of a few ounces of blood, sometimes scarcely 
 from the loss of six pounds." Why does this coincidence obtain 
 with so many other remedial agents ] Why do we see the redness of 
 an inflamed eye give way permanently while the blood is flowing from 
 the arm, and why does the same change take place as rapidly, and 
 even more perfectly, in any of the great organs when equally inflamed 
 and loaded with blood 1 Why may the action of the heart be weak- 
 ened by small quantities of blood taken by leeches, when larger quan- 
 tities would be required to produce a similar effect by venesection (§ 
 5 1 6 (Z, no. 6, 557, 686 b, 756 a, 775, 889 1, 893 a, c, 900, 904 c, 921 , 1059) ? 
 
 Now it is obvious that the foregoing results can be explained only 
 upon the physiological principles which I am about to set forth ; while 
 there is not one phenomenon attending all the diversified effects of 
 loss of blood that is not susceptible of a clear interpretation upon those 
 principles — an interpretation, too, which coiTesponds with all that I 
 have said of the modus operandi of every other remedial and morbific 
 agent — nay, even with the natural stimuli of life. 
 
 913. The inquiry now proposed will extend from the beginning ol 
 the physiological influences, through their gradations, to their con- 
 summation in syncope. It will be also accompanied by practical il- 
 lustrations, and by exemplifications of the various conditions of dis- 
 ease to which the remedy may be appropriate. 
 
 1. LEECHING. 
 
 914. It will be most useful, in the first instance, to observe the 
 phenomena, and deduce the principles, which attend the direct ab- 
 straction of blood from those extreme capillary vessels which are the 
 instruments of all morbid processes. Leeching, therefore, is first in 
 order ; the physiological eff^ects of which may be divided into seven 
 stages. Observe, also, that the vessels are torn not cut as in cupping. 
 
 915. 1st. The earlist effect of loss of blood consists in a contraction 
 of the blood-vessels. This is universally true of all modes of abstract- 
 ing blood (§ 944 c). 
 
 In leeching, an impression is first exerted upon the organic prop- 
 erties of the extreme and capillary vessels of the part by the direct 
 abstraction of their natural stimulus, the pabulum vitcB, as also by the 
 long-continued suction of the leeches, and by the subsequent effusion 
 of blood. These causes institute a change in the vital state of the 
 vessels (§ 189, 498, 930, 944 c). 
 
 916. 2d. A vital contraction follows immediately, as the conse- 
 (juence, in the extreme and capillary vessels of the part to which 
 leeches are applied. The removal of their natural stimulus is neces- 
 sarily felt by the highly-susceptible organic properties of the small 
 vessels (^ 188, 189. 191, 410, 411, 746 c, 931, 935 b. 1040^.
 
 THERAPEUTICS. LOSS OF BLOOD. 693 
 
 917. 3d. Then follows, by continuous sympathy and reflex nervous 
 action, a propagation of the foregoing changes to the entire system of 
 extreme and capillary vessels throughout the body. This arises from 
 the capillary series possessing, every where, an organization and func- 
 tion of a common nature, and from their exquisite sensitiveness to the 
 nervous power (§ 129 d, e, 141, 222-232, 482, 525, 526 a, 935 h). 
 
 918. 4th. The larger vessels, sooner or later, participate, sympa- 
 thetically, in the contraction. This sympathy, however, begins as 
 soon, at least, as the general capillary system feels the foregoing in- 
 fluences (§ 944 c). 
 
 919. 5th. A partial reflex nervous action begins upon the heart 
 as soon as the changes have somewhat advanced in the capillary ves- 
 sels to which the leeches are applied, and a rapidly-increased amount 
 of this cardiac influence ensues as soon as the whole capillary system 
 is involved in the contractions which the leeches institute at the place 
 of their application (§ 498^^^^, 524 a).* 
 
 The effect, as expressed in section 917, is originally propagated along 
 the extreme vessels by continuous sympathy, but reflex action is 
 soon brought into operation, when both denominations concur together ; 
 but it is chiefly by reflex nervous action that the heart is influenced 
 (§ 933. Y ox continuous sympathy see ^129 c,f, 498, 746 c, and Index II). 
 
 920. 6th. Such are the simple elements of the processes which take 
 place in leeching. But, during their progress they become more or 
 less compounded. The reflex nervous influence which is propagated 
 from the extreme to the larger vessels reacts from the latter upon the 
 former, and this reacting sympathy increases the contraction of the 
 small vessels. So, also, as soon as the vital changes in the extreme 
 vessels throw their reflex nervous influence over the heart the changes 
 which take place in this organ reflect back a sympathetic influence 
 upon the extreme and capillary vessels, by which their power over the 
 heart and larger vessels becomes multiplied (§ 514 h, &c., 526 a, 934). 
 
 This complex circle of reflex nervous actions continues to ad- 
 vance till the heart becomes overpowered in its action, and syncope 
 takes place (§ 222-233|, 498-514, 893 a, c, 894-905, 1039). 
 
 921. a. 7th. An artificial change being instituted in the extreme 
 vessels to which leeches are applied, where the organic properties 
 are most strongly pronounced, and that change being more or less 
 permanent, it continues to excite a powerful reflex nervous action 
 upon the whole capillary system, and thence upon the heart, long af- 
 ter the blood has ceased flowing (§ 514 g, &c., 516 d, no. 6, 939). 
 
 921, b. It is for this reason (no. 7), and this only that the powers 
 of the general circulation may he sometimes more prostrated, and be 
 longer maintained in a state of prostration, by the loss of four ounces 
 of blood by leeching than they might have been by the abstraction 
 of sixteen ounces of blood from a large vein, or by eight ounces taken 
 by the process of cupping (§ 514^, 930, 939/ 944 c).* 
 
 921, c. For the same reason, also, syncope sometimes comes on 
 only many hours after the discharge of blood has ceased. Stimulants, 
 too, may but slowly rouse the general circulation, because the pros- 
 trating influence of the artificial change in the extreme vessels can- 
 not be as soon overcome as when syncope is produced by general 
 bloodletting, where no such specific impressions are made (§ 514,g-, 
 516 d, no. 6), and therefore no persisting reflex nervous influence. 
 * See sensitiveness of the heart to the nervous influence at () 500 m, 826 cc, 829.
 
 694 INSTITUTES OF MEDICINE. 
 
 922, a. It is owing to the peculiar nature of the change established 
 in the vital condition of the lacerated vessels, by leeching, that the 
 blood continues to flow out for many hours. The process thus insti- 
 tuted must be somewhat analogous to that of secretion, and clearly 
 allied to the hemorrhagic action which nature institutes, though gen- 
 erally more prostrating than the natural process. 
 
 922, h. There is, however, a remarkable difference between the 
 direct effects of leeching and spontaneous hemorihage, in respect to 
 their force ; the former subduing inflammation and congestions more 
 fully and speedily than the latter. It is rare that an equal quantity 
 of blood spontaneously effused impresses the system with a force 
 equal to that from leeching; while large capillary hemorrhages are 
 daily occurring without very sensibly -reducing the animal or organic 
 powers, and where, too, the quantity of blood effused is so px'odigious- 
 ly great that it cannot be safely imitated by art under the same cir- 
 cumstances of disease. The nervous power is differently developed. 
 
 Although, therefore, in these cases, nature institutes a change stri- 
 kingly analogous to that of leeching, it is not of the safne specific na- 
 ture. In spontaneous hemorrhage, too, nature sets up, for her own 
 safety as it were, a special modification of action in the system at 
 large that shall sustain its powers under the enormous losses of blood 
 which are often necessary, by the natural process, to the cure of inflam- 
 matory and congestive diseases (§ 136 c, 150-152, 524 «, <Z, 890 e).* 
 
 923, a. Besides the foregoing play of vascular sympathies, a strong 
 impression may be propagated by the whole organ to which leeches 
 are applied to another organ with which it has strong natural sympa- 
 thetic relations. In low inflammations and venous congestions of the 
 liver, four ounces of blood taken from the verge of the anus by means 
 of leeches may break up those obstinate hepatic affections, when twice 
 as much from the skin over the region of that organ may produce far 
 less effect. Hei'e the specific impression is propagated, in part, along 
 the mucous tract of the intestines, in the manner expressed in sections 
 A%S,f,g; and this continuous sympathy gives rise to alterative reflex 
 nervous action, the former of which is my continuous influence {^ 498 a). 
 
 923, b. But, again, it is true in a more limited sense, that the influ- 
 ence of leeching may be propagated along the large blood-vessels to 
 the parts in the vicinity where there is a direct vascular communica- 
 tion ; though even in these cases, the impression is extended more 
 through the sympathies which bind together the extreme vessels, and 
 the nervous communication of the parts (§ 526, a). Comparatively 
 little seems to be due to the imputed derivation of blood. Thence, 
 upon our principles, appears the reason why, according to Dr. War- 
 drop, " in diseases of the head, as well as in diseases of the eye, more 
 particularly those affecting the internal parts of the globe, leeches ap- 
 plied to the frontal vessels give much more relief than is obtahied by 
 abstracting an equal quantity of blood from the temporal vessels by 
 leeches applied to the temples." He also states that a like advantage 
 will be obtained, in cerebral affections, by applying leeches to the li- 
 ning membrane of the nose, or behind the ears. He thinks the effect 
 greater than w^hen applied to other parts. — Note Do p. 1132. 
 
 923, c. In all the cases, however, the effects appear to be mainly 
 produced through the agencies which I have stated. Whenever I have 
 applied leeches to the nasal septum abdominal disease attended the 
 * NoTKs Ff p. 1135, Gg p. 1138, Ii p. 1139.
 
 THERAPEUTICS. LOSS OF BLOOD. 695 
 
 head -affections. The leeches have sometimes relieved the headache, 
 when general bloodletting, cathartics, &c., had failed, while the gas' 
 trie derangement had also persisted. But, simultaneously with the 
 relief of the head the secretions from the bowels improved, the tongue 
 cleared up, and the stomach and other abdominal organs were re- 
 lieved. It would appear, therefore, that, as in the case of leeches to 
 the verge of the anus under similar circumstances, the specific impres- 
 sion of leeching the nasal septum is propagated continuously and by 
 reflex nervous action, by the instrumentality of the mucous mem- 
 brane, to the viscera of the abdomen, and that the head is as well re- 
 lieved by thus removing this source of morbid sympathies, as by the 
 more direct impression (^ 524 a, no. 2). — Note U p. 1126. 
 
 923, d. Hence it follows, as shown also by experience, that leech- 
 ing will generally exert the greatest effect upon diseased organs when 
 applied to some part with which the organ affected may have strong 
 physiological relations (§ 129, 139, 140). For this reason, and for the 
 advantage of continuous sympathy, leeches should be applied to the 
 anus in muco-intestinal inflammation ; but, to the cutaneous region 
 when inflammation affects the peritoneal coat of the intestines or ab- 
 domen. There are greater natural sympathies between the skin and 
 peritoneum than between the mucous membrane and the peritoneal. 
 Where no remarkable relations subsist among organs the leeches 
 should then be applied near the vicinity of the part affected, as when 
 the pleura, or parenchyma of the lungs, or the joints, are the seats of 
 inflammation. In such cases we obtain the advantage of local reflex 
 actions as in the case of blisters, &c. (§ 497, 891-i-^-A:, 893 a,c,f). 
 
 924. And now a word more as to the doctrine of Revulsion^ or that, 
 for example, which supposes that when leeches are applied to the feet 
 for the relief of cerebral disease the effect depends upon the diver- 
 sion of blood from the head toward the feet. And so of cathartics in 
 their action upon the intestinal canal, and of blisters by diverting the 
 blood to the skin, &c. (§ 893, n). Nothing can be more unfounded. 
 But, do not leeches, when applied to the feet, exert a greater influ- 
 ence upon diseased conditions of the uterus than upon any other part ] 
 They probably do ; and it is a forcible illustration of remote sympa- 
 thy, and coincident with that which is supplied by the suspension of 
 the catamenia from exposure of the soles of the feet to cold, or by the 
 production of catanh when a current of cold air from a key-hole im- 
 pinges upon the neck. Just so, if the female now plunge her feet 
 into warm water, or apply leeches upon or near the soles of the feet, 
 the catamenia may be restored. So, too, in relation to cerebral affec- 
 tions, who does not know that a natural sympathy subsists between 
 the feet and the head ? " In affections of the head and thoracic vis- 
 cera," says Dr. Wardrop, " I have, in many instances, recommended 
 patients to apply leeches on the head, chest, and on the feet, alternate- 
 ly ; and almost universally , I may venture to say, a decided prefer- 
 ence has been given to theyle/."* The philosophy is the same in all 
 the cases, and revulsion is reflex nervous action. Dr. Wardrop, how- 
 ever, had already preferred the application of leeches to the nasal 
 septum, or to the temples, in affections of the head; though his obser- 
 vations as to the feet are also founded on sound experience. As to 
 leeching in amenorrhoea, the remedy has the greatest effect when ap- 
 plied to the perinaeum, or to the upper part of the thighs. — Note Dd 
 
 * It is well illustrated by Brown-Sequard's exper. of i}ro(iucing epileptiform convulsions as in ^ 1 U37 a
 
 696 INSTITUTES OF MEDICINE. 
 
 925, a. What has been now said of disease supposes that leeches 
 are appUed under circumstances favorable to their effect. Before this 
 condition can happen, however, in numerous cases where leeching 
 may be ultimately useful, it may be necessary to make a strong impres- 
 sion by general bloodletting ; and if two or more general bloodlettings 
 be likely to be wanted, the leeching should be delayed (§ 893 g-i, p, 
 927), or until the exciting nervous action is subdued. 
 
 925, b. Nevertheless, if the chance of leeching alone be taken in 
 these cases, the number of leeches should be very large for adults, 
 that the benefits of general bloodletting may be more or less obtained, 
 through a rapid and copious abstraction of blood. This practice will 
 often succeed in infancy when it will fail at more advanced age ; since 
 the loss of blood is more sensibly felt in the former case, and less is 
 required, and the requisite amount is therefore, also, more rapidly ab- 
 stracted, notwithstanding, too, the ratio of the loss, in proportion to 
 age and size, may be actually greater than in adults. Thus, too, the 
 advantatjes of g-eneral bloodlettintj are more or less obtained. In sim- 
 ilar cases cupping is also more beneficial to children than to adults 
 (§ 576, e). 
 
 925, c. Leeching, or cupping, however, should never supersede gen- 
 eral bloodletting in the cerebral inflammations and congestions of in- 
 fants. In the phlegmatic temperament of adults leeching may an- 
 swer where it would be inefficient in other temperaments (§ 600). 
 But I speak of these cases rather to illustrate a principle than to raise 
 any doubt as to the propriety of general bloodletting in the grave vis- 
 ceral inflammations of any age after infancy (§ 1009). — Note Ggg. 
 
 926. Experience teaches that frequent and small abstractions of 
 blood by means of leeches is often more beneficial in chronic inflam- 
 mations than a greater quantity at more distant intervals. This cor- 
 responds with what I have said of the vital influences of leeching, and 
 of the effect of habit in maintaining disease (§ 549, 560). In these 
 cases, the impression, being frequently repeated, maintains the salu- 
 tary change which may be produced more perfectly against the mor- 
 bid influence of habit than greater losses of blood at distant intervals 
 (§ 514 g, 535, 540, 542, 548, 549, 557). We see the same principle 
 more frequently exemplified in the effect of blisters upon chronic in- 
 flammation ; where it is better to apply them frequently, and to a 
 moderate extent, than more rarely and over a larger surface. The 
 philosophy is the same, also, in respect to the relative effects of a large 
 dose of calomel, and that dose divided into four. Analogies likewise 
 subsist between the salutary effects of copious leeching, extensive 
 vesication, and a large dose of calomel, in acute inflammations (§ 559, 
 893 //-). And so of numerous other agents. A common philosophy 
 obtains in all the cases, and each example illustrates and confirms the 
 principles on which all other agents operate. And I may here cairy 
 the same examples to illustrate the philosophy of the operation of gen- 
 eral bloodletting, and the peculiarities which appertain to that mode 
 of abstracting blood ; since, as will appear, its influence on the oro-an- 
 ic properties and functions is more immediately, and may be more 
 profoundly, felt than leeching or other agents ; and, being antiphlo- 
 gistic, it is therefore better adapted to high grades of active inflamma- 
 tion and fever (§ 557). The philosophy of the whole is alone re- 
 solvable through reflex actions of the nervous system (^ 893 h\
 
 THERAPEUTICS. LOSS OF BLOOD. 697 
 
 927, a. Notwithstanding, therefore, the last proposition in respect 
 to leeching, it often happens that the force of diseased habit is so great 
 as to demand a more decisive and more frequent resort to leeching. 
 It is even not unfrequent that the force of morbid habit attendant on 
 chronic inflammations requires the previous abstraction of blood from 
 a vein, and perhaps repeatedly and largely; not only with a view 
 to the special physiological influences of general bloodletting, but that 
 a large diminution of the general volume of blood may be suddenly 
 effected (§ 925, a). The utility and necessity of this practice are fre- 
 quently seen in the treatment of those chronic inflammations of the 
 mucous tissue of the stomach which follow long-protracted indiges- 
 tion, and especially if the liver also have become invaded by the same 
 condition of disease. The advantages of general bloodletting in these 
 cases relate as much to the general condition of the system over which 
 a morbific influence has been established as to the seat of inflamma- 
 tion. The general modification exerts a reacting effect upon the part 
 inflamed, and adds to the obstinacy of the diseased habit of the part, 
 and leeching will not reach these influences (§ 143 c, 847 g). Here 
 it is, particularly, that we witness corresponding, and even more suc- 
 cessful, eflforts of nature at relief in the torrents of blood that are ef- 
 fused from either the mucous tissue of the stomach or of the lungs ; 
 especially the former (§ 890, e). 
 
 927, h. Again, in certain mild, though obstinate cases of purely lo- 
 cal inflammations, and before the constitution is brought under the 
 influence of the morbid action ; or, in cases where exciting reflex nerv- 
 ous actions have been subdued by general bloodletting, local bleeding 
 by leeches is pre-eminently useful. In either of these cases, general 
 bloodletting continued to a large extent, by the suddenness and vio- 
 lence of its impression, may so disturb the system at large that the in- 
 flammation may be kept up by influences produced by this artificial 
 derangement of the whole body (^ 889 m, 889 mrri). But here there 
 is no countervailing action against the effect of leeching • and while 
 the small vessels engaged in the inflammatory process refuse to give 
 way if the disease have been of short duration, there is no danger of 
 establishing any injurious influences upon the general capillary sys- 
 tem. This, however, will take place, more or less, when leeching e^f- 
 ceeds that degree which is necessary to determine a change in the part 
 inflamed. It may even follow from very copious leeching in severe 
 chronic inflammations, where morbid action is rendered obstinate by 
 the influence of habit, before the diseased process yields. In the for- 
 mer case, the system is injured partly by the influences determined 
 by the excessive change induced in the instruments of morbid action, 
 . and, in part, by the general influence from an unnecessary loss of 
 blood. In the latter case, the bad effects appear to be mainly inci- 
 dent upon the loss of blood in its general relation to the system at 
 large. In these cases, therefore, it is important to graduate the extent 
 of leeching by the exigencies and the peculiarities of each individual 
 case ; and it is especially important with infants, upon whom leech- 
 ing produces not only its jDoculiar effects very powerfully, but, also, 
 more than in after life, the effects that appertain more strictly to gen- 
 eral bloodletting. Such is the obstinacy of the depressing change in 
 the instruments of disease, as liable to arise from leeching in in- 
 fancy, when this remedy has been earned far beyond any useful do-
 
 698 INSTITUTES OF MEDICINE. 
 
 oree in inflammations of the nature now under consideration atj,l its 
 influence upon the whole extent of the circulatory organs is main- 
 tained with such violence, that, having also superadded to it the gen- 
 eral effect from excessive loss of blood, it may be impossible to coun- 
 teract its destructive tendency (§ 514 g, 516 d, no. 6}. It is not alone 
 the effect that arises from an excess of general bloodletting with which 
 we now contend, but a greater, perhaps, in that pernicious chango 
 which has been induced in the extreme vessels to which the leeches 
 had been applied, and which, indeed, has been more or less propa- 
 gated by reflex nervous action over the system (921). 
 
 928. From what has now been said, the reason is apparent why 
 cautious leeching may be sometimes a means of relief in those inflamma- 
 tions that are now and then induced by a misapplied or an excessive 
 loss of blood. In these rare affections, the triumph of art is beauti- 
 fully illustrated when accurately guided by the light of science. The 
 effect should be limited, if possible, to local nervous centers. They 
 are cases, too, in which the distinction between general bloodletting 
 and leeching is forcibly shown, since the former has caused the dis- 
 ease and the latter cures it (§ 1024 a,/ Dr. M. HALL).-SeeiVo«ep. 708. 
 
 2. GENERAL BLOODLETTING. 
 
 929. In general bloodletting the effects are varied from those of 
 leeching, and in a way, as we have already seen, of practical im- 
 portance (§ 927, 928). Its influences may be considered under five 
 general aspects, and successively as in leeching : 
 
 930. 1st. The earliest impression is made simultaneously upon the 
 organic properties of the large and small vessels throughout the body, 
 since the loss of blood is now immediately coextensive with the whole 
 circulating mass, is suddenly withdrawn, and in a comparatively large 
 quantity. Here, therefore, as of the local vessels in leeching, a change 
 is instituted in the vital state of the blood-vessels throughout the body 
 (§ 526 a, 915, 921, 944 c). 
 
 931. a. 2d. The foregoing impression suddenly rouses the arterial 
 system to a greater, but very modified action, by which the vessels, 
 especially the extreme and capillary, are brought into a state of con- 
 traction, and far beyond any diminution of their contents that may 
 arise from the quantity of blood removed from the body (§ 916). 
 
 931. J. The contraction thus instituted is vastly greater in the small 
 than in the large vessels, mainly because of the greater endowment 
 of the former with irritabihty and mobility (§ 188, 205, 482, 944 c). 
 
 932. 3d. Owing, also, to the same causes through which the ex- 
 treme vessels feel the loss of blood more sensibly than the larger 
 ones, powerful reflex nervous actions are determined upon the for- 
 mer by the changes which take place in the larger series of vessels 
 (§ 222-233±, 409-411, 475^, 500 m, 687^688, 694|, 826 cc, 920). 
 
 933. 4th. As soon as the foregoing change begins in the vessels, it 
 throws a reflex nervous action over the heart. There is, as yet, so 
 little diminution of the general volume of blood, that the earliest in- 
 fluences upon the action of the heart must be due, entirely, to this re- 
 flex nervous impression (§ 919, 500 ?«, 826 cc, 829). 
 
 934. 5th. As the heart becomes influenced, it excites a powerful 
 reflex influence that falls upon the extreme and capillary vessels ; 
 between which and the heait there exist very strong vital and sympa- 
 thetic relations {§ 385, 526 a, 920, 1039).
 
 THERAPEUTICS. LOSS OF BLOOD. G99 
 
 Here, therefore, as in leeching (§ 920), the contraction, and other 
 changes, which take place in the small vessels, grow out of a double 
 influence ; namely, that which is exerted by the direct impression 
 from loss of blood, and that which is reflected upon them by the 
 changes that arise in the heart and larger vessels. And so, as in 
 leeching, reflex nervous action between the heart and blood-vessels 
 passes and repasses, and increases in an increasing ratio as the blood 
 flows from the arm, till its prostrating effect reaches the point of syn- 
 cope. In leeching, however, the sympathies between the heart and 
 blood-vessels are not as reciprocal as in general bloodletting ; but a 
 greater influence is often propagated in leeching by the small vessels 
 upon the centre of circulation (§ 921, and references in ^ 932).* 
 
 935, a. That the failure of the heart's action does not arise, as com- 
 monly supposed, from a mechanical diminution of the volume of 
 blood is shown by the frequent occurrence of syncope from the loss 
 of two or three ounces ; nor does it depend, in the least, upon with- 
 drawing the stimulus of blood from the heart. On the contrary, as it 
 respects both hypotheses, the blood is actually accumulated about the 
 heart in consequence of the contraction of the capillary vessels ; and 
 this accumulation, from the beginning, is a cause of the failure of the 
 heart's action, and is at its greatest extent when syncope takes place 
 (§ 936, and references in § 932). 
 
 935, h. It is also equally true that the general contraction of the 
 small vessels, in all the modes of abstracting blood, is not referable to 
 either of the foregoing causes; and for the reasons, in part, that the 
 contraction far surpasses any diminution of the general volume of 
 blood, that the phenomenon is always attendant on syncope arising 
 from mental causes, and that the contraction, if proceeding from elas- 
 ticity or from any other cause than one of a vital nature, could never 
 determine the powerful reflex nervous actions which it exerts upon 
 the heart (§ 916, 917, 932, 937). 
 
 935, c. In like manner, the diminution of the volume of blood in in- 
 flamed parts is only a remote effect of lessening the quantity of the 
 circulating mass. The blood is not only temporarily, but permanent 
 ly expelled from the injected vessels. This shows that its expulsion 
 is effected by a vital change in the condition of the vessels ; otherwise, 
 they would not contract in a ratio exceeding that of the correspond- 
 ing vessels of other parts, nor would their contraction be permanent. 
 Vessels that are enlarged in inflammation to many times their natural 
 diameter are often reduced to nearly their natural volume while the 
 operation of bloodletting is in progress (§ 910, 977, 1056). 
 
 Various circumstantial facts might be adduced to show the vital na- 
 ture of the contraction which attends the capillary vessels. The fol- 
 lowing are relative to idiosyncrasy ; and the principle which I have 
 set forth is an evidence of the accuracy of the reporter's interpreta- 
 tion of the phenomena, throughout. Thus : Dr. Paige, " of large ex- 
 perience and great respectability," states, in the November number 
 (1845) of the " New York Journal of Medicine," that, on bleeding 
 " a woman about forty years of age, and after having drawn a very 
 few ounces, and while the blood was still flowing from the vein, she 
 was taken with very severe pain all over the external parts of the sys 
 tem, and extending to the most remote extremities. I suffered the 
 blood to flow, however, but the pain increased instead of diminish- 
 
 * This sensitiveness of the heart and arteries to the nervous influence excited by 
 loss of blood corresponds exactl}' with that from all things else, as shown in § 500 m.
 
 700 INSTITUTES OF MEDICINE. 
 
 ing." " Several years afterward I met with exactly the same symp- 
 toms on bleeding a young man in case of an ardent fever ; but, having 
 thought much of the first case above mentioned, I had come to the 
 conclusion, in my own mind, that the pain depended on the spasmodic 
 contraction of the small vessels of the surface and extremities as they 
 became emptied of their blood, I, in this case, immediately admin- 
 istered a free dose of some diffusible stimulus (I think, of ammonia), 
 and the pain subsided very soon, so that I was able to take as much 
 blood as I wished" (§ 399, and references in ^ 932). 
 
 935, d. Again, bloodletting being, in popular language, a debilita- 
 ting remedy, its rapidly salutary effects contradict the prevailing hy 
 pothesis that inflammation and venous congestion are constituted by 
 debility of the vessels, and stagnation of blood. Had this doctrine 
 any foundation, the capillaries in inflammation, and the veins in con- 
 gestion, would immediately become more injected with blood, and 
 those diseases should be exasperated by what is known to be their 
 most efficient remedy. It also fully contradicts " coagulation." 
 
 The effects of bloodletting, therefore, prove that the pathological 
 cause of inflammation and venous congestion consists not only of an 
 increased energy of the organic properties, but that these properties 
 are also modified in kind ; while the rapid subsidence of the forego- 
 ing affection, under the influence of loss of blood, proves, abundantly, 
 that the whole process advances upon vital principles. The loss of 
 blood so impresses the diseased properties, that their pathological state 
 is changed on the instant (§ 137 d, 143, 150-152), and they are brought 
 to obey their natural recuperative law so immediately, that the vessels 
 of an inflamed eye contract and disappear while the blood is yet flow- 
 ing from the arm. And so of all other parts that are concealed from 
 observation (^ 476^ h, 478, 479, 503-506, 516 d, no, 6, 750 5, 751, 817). 
 
 935, e. The extent and durability of this change will depend upon 
 a variety of circumstances ; such, for example, as relate to constitu- 
 tion, the nature of the remote causes, and whether, also, the impres- 
 sion have resulted purely from the loss of blood, or, in part, from 
 mental emotions, or from gastric irritation ; and it will be often influ- 
 enced by the manner in which the blood may be abstracted, whether 
 from a large or a small orifice, or whether the operation be suspeJid- 
 ed for a minute and then resumed. Each of these circumstances, 
 also, discloses the nature of the principles upon which loss of blood 
 produces its effects, especially the agency of the nervous influence. 
 
 936, a. When general bloodletting is practiced in health the action 
 of the heart begins to fail as soon as the vessels begin to contract ; but 
 it is the tendency of inflammation to delay or prevent the vascular 
 changes under an equal loss of blood, while, on the other hand, those 
 changes are often promoted by venous congestion, or by numerous 
 adventitious influences, either mental or physical. 
 
 936, h. Again, it frequently happens, after the action of the heart is 
 more or less subdued by loss of blood, that it speedily recovers its 
 force on account of the removal of the prostrating influence of some 
 morbid condition, or of nausea, or of mental disturbance, which re- 
 moval may be suddenly effected even in the case of some depressinor 
 form of disease, and perhaps as soon as the blood begins to flow from 
 the vein (§ 938, h), just as the nervous power may be modified. 
 
 937, a. Since the influences of general bloodletting are exerted, from
 
 THERAPEUTICS. LOSS OF BLOOD. 701 
 
 the beginning, simultaneously upon the whole capillary system (§ 930), 
 the amount and rapidity of the primary change will depend on the 
 suddenness with which the blood is abstracted ; and whenever loss of 
 blood produces a great and sudden contraction of the whole capillary 
 system, however small the quantity, syncope will approach (§ 935). 
 
 937, T). And so, also, it was found by Le Gallois and Philip, in their 
 direct experiments upon the brain and spinal cord, that the extent of 
 the nervous influence upon the heart, blood-vessels, and alimentary 
 canal, depended, always, on the suddenness of the impression on the 
 nervous centres, and that when most sudden and violent it was capa- 
 ble of extinguishing at once the functions of life (§ 478, 479, 510, 511). 
 
 937, c. Now, as will have fully appeared, the sympathetic changes 
 which take place in the heart and blood-vessels, in general bloodlet- 
 ting, depend upon the operation of the nervous power ; just as, in the 
 direct experiments by Le Gallois and Philip, the organic functions 
 were variously affected according to the nature of the influences, 
 which were inflicted upon the nervous centres. It is, therefore, al- 
 ready apparent that the effects of bloodletting upon disease will often 
 depend much upon the rapidity with which the blood is abstracted. 
 And this important practical consideration points out another differ- 
 ence between general bloodletting and leeching, and why, in the lan- 
 guage of Mr. Travers, " syncope is in proportion to the suddenness, 
 rather than the quantity of the hemorrhage." Hence it is that syncope 
 follows from the loss of a smaller quantity of blood when drawn from 
 a large than from a small orifice, or from both arms than when from 
 one (^ 1056) ; from the more sudden excitement of reflex nervous action. 
 
 937, d. It is also another important practical, as well as phil- 
 osophical, consideration, that if tne subject be in an erect posture, 
 syncope will follow sooner than in the horizontal, from the greater in- 
 ability of the heart in the former case to transmit the blood to the 
 brain ; and this circumstance, as will appear, should govern us as to 
 thfi position of the patient. 
 
 938, a. Again, the ratio, in which the various influences that arise 
 from general bloodletting will succeed each other in disease, will also 
 depend on the existing condition of the organic states, especially of 
 the heart and blood-vessels (§ 143, 149, 150, 152). It often happens 
 that an increased and uniform susceptibility pervades the whole san- 
 guiferous system ; and when this peculiar state exists, the abstraction 
 of a very small quantity of blood may instantly determine a paroxysm 
 of syncope (§ 526 a, 961), the nervous power then acting intensely.* 
 
 93S, h. This proposition, like all the others which are made with- 
 out qualification, supposes the influences to depend upon the absolute 
 loss of blood, and not to be affected by adventitious causes, such as 
 emotions of the mind, intestinal irritation, &c. "When these accidental 
 and transient causes institute their reflex and prostrating nervous 
 actions, they should be carefully noted ; since it is commortly impor- 
 tant that a certain amount of blood should be abstracted to produce 
 the requisite impression upon disease. In such cases, therefore, it is 
 commonly necessary to go on with the operation, sooner or later, but 
 generally early, after the patient has revived. The nervous influences 
 of the adventitious causes generally make but little or no impression 
 upon disease ; and the loss of too little blood often adds violence to 
 inflammation and fever by imparting greater energy to the action of 
 
 * See p. 298, t) 4761 h, 479.
 
 70S? INSTITUTES OF MEDICINE. 
 
 the heart, or by relieving the general circulation when it may be em- 
 barrassed by some local venous congestion (§ 988). 
 
 3. CUPPING. 
 
 939, a. Cupping differs in some of its effects from leeching and gen- 
 eral bloodletting. Its influences are of an intermediate nature, but 
 are most allied to the latter. It never makes the profound impression 
 upon the vital condition of the parts to which it is applied that is ex- 
 erted by leeching, and its influences upon the system at large are also 
 less, under equal circumstances. Cupping, indeed, often fails of re- 
 lief where leeching is speedily efficient. In a genei'al sense, six 
 ounces of blood taken by leeching is probably equal in its curative ef- 
 fect"? to nearly twice that quantity abstracted by cupping. 
 
 939, h. In cupping, the blood is abstracted from the larger series 
 of capillary vessels, whose office is probably but little more than to 
 supply the smaller series, in which the organic properties are most 
 strongly pronounced (§ 384, &c.) ; nor is that action instituted, by cup- 
 ping, in those vessels from which the blood is taken, that obtains so pro- 
 foundly in leeching, and upon which no little of the general and local 
 effects depend, especially the peculiarity of the reflex nervous action. 
 939, c. The distinction is also explained by the persistence with 
 which the blood continues to be discharged long after the leeches have 
 performed their office, although smaller and fewer vessels are divided 
 than in cupping, and these few torn, while in cupping the blood ceases 
 to escape as soon as the cupping-glasses are removed. All of which 
 is absolute proof that a remarkable change is instituted in the vital 
 condition of the capillary vessels, by leeching, and that the prolonged 
 effusion of blood is in no respect of a mechanical nature, but wholly 
 due to a vital action which is artificially set up in the vessels, and 
 which is not at all instituted by cupping. 
 
 939, d. It is evident, therefore, from principle as well as experience, 
 that cupping-glasses should not be applied, as is often done, to pro- 
 mote the bleeding of leech-bites. It embarrasses the specific action 
 instituted by the leeches. A mechanical is substituted for a natural 
 process ; while, also, as in cupping, the abstraction of blood is so rapid 
 that its effects become more like those of venesection. 
 
 939, e. Cupping approximates general bloodletting not only in the 
 rapidity with which the blood is abstracted, but in which it determines 
 reflex nervous actions upon the whole ciixulatory system, and in the 
 quantity of blood which is required for its physiological and therapeu- 
 tical effects. It is more remotely allied to leeching in the change 
 which is locally induced, though this change is not of a specific char- 
 acter, but consists of a more simple vital contraction of the small ves- 
 sels that propagates comparatively little impression upon other parts 
 of the circulatory system. When the impression becomes general, it 
 is then mostly due, as in venesection, to the removal of a quantity of 
 blood adequate to a universal influence. 
 
 939, y. It becomes more and more apparent, therefore, that gener- 
 al bloodletting, cupping, and leeching are in some respects distinct 
 remedies, and that cujjping" is the least useful and rarely required. 
 The difference between them lies in a difference in the operation of 
 the principles which are common to the several modes. Some of these 
 differences appertain to the cerebro-spinal system, which is far more
 
 THERAPEUTICS- LOSS OP BLOOD. 703 
 
 concerned in the phenomena of general blood-letting than in the usual 
 effects of leeching, which is apt to engage mostly local nervous centres. 
 The effects of general blood-letting may be obtained in an inferior de- 
 gree by cupping, through mere inconsiderable degrees of the same in- 
 fluences, as, also, in a still lesser degree by applying cupping-glasses in 
 the operation of leeching. The difference in leeching is owing, in part, 
 to a more profound impression upon the sympathetic nerve, though the 
 other methods transmit their influences through this nerve (§ 921, 922). 
 
 Of the Nervous Power in its Relation to the Effects of Loss of Blood. 
 
 940. This very important element in the phenomena which arise 
 from loss of blood must be amply reviewed. It is the nervous power to 
 which are owing all the remarkable results that are in active progress 
 after the beginning of the constitutional effects of blood-letting. The 
 operation of this power commences at the earliest contraction of the 
 small vessels, and increases in the ratio of that contraction. It is the 
 same power that exerts so vast a range of influences in directing the 
 effects of all other remedial, as well as morbific agents, and whose char- 
 acteristics have been already extensively considered. The same philos- 
 ophy, too, is here applicable as in all other cases in which the nervous 
 power is instrumental in organic actions, or in modifying, or in propa- 
 gating disease (§ 222-234, 450-530). 
 
 941. The development of the nervous power from loss of blood is 
 owing to the vital impressions that lead to the contraction of the small 
 vessels. The influence upon the nervous centres is thus of two kinds — 
 that transmitted by vascular contractions in other parts, and that from 
 the contraction of their own vessels ; being, in the latter case, analo- 
 gous to what we have seen to arise from direct experiments (§ 476- 
 494), from the operation of the passions, and from the reflected action 
 of remedial and morbific agents (§ 227, 500, 944 c, 1039, 1040, 1056). 
 
 942. a. Now, therefore, in view of the extensive premises before us, 
 loss of blood, both by its profound influence upon the small vessels of 
 the nervous centres, and by effects transmitted there by vascular con- 
 tractions in other parts, develops the nervous power in a peculiar man- 
 ner and in unusual intensity (§ 227, 232). This influence of this pow- 
 er, reflected abroad, increases that contraction of the general capillary 
 system which is at first instituted, in all parts, in general blood-letting, 
 by the direct effect of loss of blood upon the organic properties of the 
 whole system of blood-vessels (§ 930, 931, 944 c).— Note Q, p .1122. 
 
 942, b. In leeching, the local impression generates an alterative re- 
 flex nervous action upon susceptible parts through centres of the gan- 
 glionic nerve, and when strongly made is transmitted to the brain and 
 spinal cord and occasions a general reflex nervous influence (§ 113, 
 224, 893 «, c). The general contraction of the vessels is thus more 
 and more accelerated as the loss of blood goes on, the nervous power is 
 more and more excited, and prostrates the action of the heart, and 
 this in an increasing ratio as syncope approaches — Note Dd p. 1132. 
 
 942, c. There is not, therefore, as has been universally supposed, a 
 withdrawment of the nervous influence from the heart during a parox- 
 ysm of syncope ; but, on the contrary, an increased determination of 
 that power upon the organs of circulation, which, indeed, is then at its 
 acme (§ 475^ 476^ h, 479, 481 c, 487 g, 500 m, 509, 828 b, 951 c, d). 
 
 943, a. Again, it has been shown by Le GaUois, Philip, and others,
 
 704 INSTITUTES OF MEDICINE. 
 
 that the stomach and intestines are readily and powerfully influenced 
 by impressions made upon the central parts of the nervous system (§ 
 491) ; as they also are, like the heart, by mental emotions. As soon, 
 therefore, as the nervous centres are influenced by loss of blood the 
 nervous influence is felt as well by the stomach as by the heart and 
 blood-vessels. This gastric irritation is propagated back to the brain 
 and spinal cord, and increases their depressing influence on all the 
 organs. This is especially manifest immediately before the occur- 
 rence of syncope, which it contributes to hasten. Hence, also, the 
 frequent nausea and eructations, and the intestinal evacuations, which 
 supervene upon the impressions made on the brain and spinal cord, or as 
 syncope approaches (§ 902, g). It is for this reason that cathartics 
 often operate during the progress of general bloodletting, when they 
 had failed antecedently, and where no intestinal inflammation had ex- 
 isted to interfere with their effects. And this consideration, by-the- 
 way, is impoitant to the practitioner when he is deliberating whether 
 bloodletting should precede the exhibition of a cathartic or an emetic. 
 
 943, b. But, it is also true that the intestinal disturbance is often 
 owing to the effect of nervous influence excited by some emotion of 
 the mind (§ 892|, b) ; when its reaction upon the nervous centres may 
 be equally as great as when the disturbance results from the loss of 
 blood, but has little or no effect upon disease, and may embaiTass the 
 practitioner, and sacrifice the patient to an imperfect application of 
 the remedy (§ 938). Nevertheless, it is important to say that excep- 
 tions sometimes occur ; and when such demonstrations are made, they 
 yield the most convincing proof of my doctrine of the agency of the 
 nervous power in the physiological results of bloodletting, and its al- 
 terative influence upon disease by whatever cause the influence may be 
 excited. Thus : *' A patient," says Dr. Armstrong, " was so alarmed 
 at the preparation for bleeding, that syncope occurred, and complete- 
 ly stopped an inflammation of the pleura." Again, " cheer up the pa- 
 tient, and he is always sure to do well" (§ 227-230, 232, 1067). 
 
 944, a. When syncope arises from the depressing emotions, or from 
 other causes whose primary impression is upon the brain, the action 
 of the heart is directly prostrated through the nervous influence, and 
 by a reflex action instituted by the stomach ; while a cei'tain depress- 
 ing effect is exerted by the nervous power upon the extreme and cap- 
 illary blood-vessels, and an influence from this change is propagated 
 by reflex action to the heart. The succession of changes then, as re- 
 spects the heart and blood-vessels, begins more on the side of the 
 heart than when they are determined by loss of blood ; the contrac- 
 tion of the capillary vessels being also more consequent on the failure 
 of the heart's action than on the alterative influence of the nei'vous 
 power. We must also explain, in the foregoing manner, the syncope 
 which follows blows upon the stomach, the crush of limbs, surgical 
 operations, &c. ; and when death is suddenly produced by any of 
 these causes, it is owing either to a sudden extinction of the cerebro- 
 spinal functions, or to a powerful determination of the nervous influ- 
 ence upon the heart, &c., by which the action of that organ is arrested 
 (§ 230, 480, &c., 510, 511). The same is true of the prostrating ef- 
 fects of nausea, and many other accidental influences which spring 
 up during the operation of bloodletting. — See ^ 476^ k, 479, 902^. 
 
 944. b. Since, therefore, in the case of bloodletting, its influences
 
 THERAPEUTICS. LOSS OP BLOOD. 705 
 
 are profound, not only on the instruments of disease, but upon the 
 whole capillary system, and the failure of the heart's action is greatly 
 due to this deep impression on their vital constitution, while in the 
 case of the accidental causes the effect consists mostly in a direct de- 
 pression of the heart's action, and a consequent failure of supply to 
 the capillary vessels, without essentially affecting their vital states, it 
 is obvious that we may not depend on syncope as a test of the influ- 
 ences of loss of blood (§ 959). 
 
 944, c. The contraction of the blood-vessels as arising from loss of 
 blood is an incidental result of a profound impression upon the vires vi- 
 tcv, which is essentially the cause of the development and modification 
 of the nervous influence. The contraction, therefore, is only an evidence 
 that such profound impression has been made, just as in other exem- 
 plifications by cathartics and emetics (§ 889 /, 902 g). The vascular 
 contraction occasioned by fear, &c., produces no such effects (§ 892f J, 
 900, 902, 954 d, 961 e, 966, 986 b, p. 837, ^ 1057^, p. 827, p. 920 Note). 
 
 944, d. Syncope is often consummated by removing the ligature. In 
 this case the action of the heart bad been enfeebled almost to an acces- 
 sion of the paroxysm, and the additional quantity of blood suddenly 
 thrown upon the heart, so far from rousing the organ, overpowers its 
 action. It is in this way, in part, when the heart has been gradually 
 prostrated during the access of congestive fever, that a sudden develop- 
 ment of the attack sometimes produces syncope. Something, however, 
 is evidently owing, in this case, to the reflex nervous influence of the 
 extreme vessels upon the heart, but probably more to the sudden deter- 
 mination of blood from the circumference at the access of the cold stage. 
 
 945. If syncope be obstinate, the means of relief will be such as 
 operate through the medium of the nervous centres, and should be of 
 such a nature as will subdue the depressing character of the nervous 
 influence, and render it stimulant to the heart and blood-vessels. 
 Pungent vapors to the nose, cold air, cold water dashed upon the 
 surface, stimulants introduced into the stomach and intestine, and ex- 
 citing means of a coi'responding kind, as well as perfect rest, will 
 therefore be the proper remedies (§ 481, e, 891|^ k). 
 
 In the Medical and Physiological Commentaries, vol. i., p. 178 
 (1840), I proposed, in cases of obstinate and alarming syncope, the 
 operation of acupuncturation of the heart ; deriving my suggestion 
 from Marshall's experiments upon frogs, which were revived by that 
 process when apparently dead from carbonic acid. Very lately (1843), 
 T see in the Annali TJniversali di Medicina, that Dr. A. Carraro has 
 successfully repeated these experiments, and makes the same appli- 
 cation to the human subject as had been done by myself. The whole 
 is also commonly supposed to be original with Carraro. 
 
 When syncope supervenes, if the subject be laid in a horizontal 
 posture animation returns, and it may be again suspended by revers- 
 ing the position. These phenomena depend upon causes now essen- 
 tially modified. " No mg,n ever saw the sensorial functions continue 
 a single minute after the heart had ceased to move. When the body 
 is horizontal, the heart circulates the blood more easily, than when 
 any part, and especially so large a part as the head, is elevated." If 
 syncope return when the head is again elevated, it will depend on a 
 more simple cause than what originally produced it. It will now 
 arise from a permanently enfeebled state of the heart, and " its ina-
 
 706 INSTITUTES OP MEDICINE. 
 
 bility to continue the circulation, and thus to supply the brain and ail 
 other parts with blood ;" and such is always the last in the series of 
 causes in a paroxysm of syncope. In the first instance the action 
 of the heart is prostrated through the nervous influence of the brain 
 and spinal cord; in the second, the functions of the brain are impair- 
 ed or suspended through the enfeebled action of the heart (§ 476-i-/). 
 946, a. Many examples may be found in my Essay on the Philoso- 
 phy of the Operation of Loss of Blood, which show the great altera- 
 tive nature of the nervous power as developed by bloodletting. Let 
 one sufiice at present. Thus : " A patient," says Dr. Armstrong, 
 " having lost only an ounce of blood, from the shock of the operation 
 ►syncope came on, and effectually removed an acute inflammation of 
 the brain" (§ 476|- A, 478, 479, 494, 509-511, 827 d, 828 h, c, 943). 
 
 946, b. Examples of the foregoing nature admit but one interpre- 
 tation. They are clear illustrations of the peculiar pi'operties and 
 laws by which organic beings are governed. They are simple ele- 
 ments of the whole philosophy of which I have spoken, as it respects 
 the specific nature of the properties and actions of life, of their mu- 
 tability, and of the tremendous influence which the nervous power is 
 capable of exerting upon them. It is the same, also, when life is in- 
 stantly extinguished by a drop of hydrocyanic acid, or of the alcohol- 
 ic solution of the extract of nux vomica, applied to the tongue, oi 
 by a blow on the epigastrium, by surgical operations, &c,, through 
 reflex actions of that power (§ 222, 455 d, 476^ h, 479, 500 c, 509,828). 
 
 947. The philosophy of syncope, as expressed by M. Piorry, has 
 been the philosophy of no small part of the medical world ; while all 
 the antecedent influences of bloodletting have been more universally 
 referred to the mechanical diminution of the circulating fluid, and syn- 
 cope construed upon this doctrine. 
 
 " Syncope,^^ says the eminent Piorry, " whatever may he its cause, 
 consists in a suspension or diminution of cerebral action. If it take 
 place sp)ontaneously and from a moral cause, it is the action of the en- 
 cephalon that is suspended ; it is the influence of this organ upon the 
 heart which is diminished^ 
 
 We have seen, however, in the ordinary state of the body, that the 
 nervous system has little other influence upon the organic functions 
 than that of contributing to their fundamental action ; these functions 
 being all carried on by the organic properties, which are maintained 
 in operation by stimuli peculiar to each, but mostly by the blood. 
 The nervous power becomes a stimulant, or depressant, or modifying 
 cause, to the organic and animal functions only as developed by those 
 stimuli or by other physical or moral causes (§ 177-191, 223, 226, 227, 
 232, 478, &c.). It is also fully demonstrated that the entire removal 
 of the brain and spinal cord does not affect the action of the heart, if 
 respiration be artificially maintained (^ 477, 479, 481 h), when the 
 muscular motion of the heart is excited by reflex action of the gang- 
 lionic system (^ 475-^). When we consider, also, how powerfully the 
 heart may be influenced by slight mechanical or other agents applied 
 to the brain, or spinal cord (§ 480, &c.), even when the cerebral cir- 
 culation is destroyed, and the whole inferior portion of the organ re- 
 moved, we shall better understand, in this way, how loss of blood, 
 odors, offensive sights, and mental causes, produce syncope, than by 
 supposing that it is through their direct suspension of the cerebral
 
 THERAPEUTICS.-vLOSS OF BLOOD. 707 
 
 functions. Violent passions have, doubtless, the effect of extinguish- 
 ing, at once, the powers and functions of the brain ; but then the ac- 
 tion of the heart ceases at once, and is clearly owing to the sudden 
 lesion of the brain, while in syncope the action of the heart is only di- 
 minished. Nevertheless, even in the former case, a pernicious ner- 
 vous influence is suddenly determined upon the whole circulatory 
 system (§ 479, 509, 510). Again, it is only the depressing emotions, 
 like fear, grief, disgust, and such causes as in any degree exert a sed- 
 ative influence on the circulation, that are known to produce undoubt- 
 ed syncope, while those like joy and anger, which always excite the 
 action of the heart, alone extinguish life instantaneously. One affec- 
 tion, too, is common, while the other is rare ; and when the latter 
 takes place it is probable that there exists an apoplectic predisposi- 
 tion. In one case the action of the heart is suddenly depressed ; in 
 the other it is powerfully excited. Doubtless, too, in the latter in- 
 stance the violent impulse of the blood upon the brain contributes, 
 per se, to the sudden subversion of the cerebral powers. While, there- 
 fore, in syncope from fear and grief the blood is, at the onset, divert- 
 ed from the head ; in sudden death from joy or anger a preternatural 
 quantity is determined upon the brain (^ 227, 476^ h, 500 m, 826 cc). 
 948. It appears, therefore, that the various changes which take 
 place in the action of the heart, when they arise from loss of blood, 
 are chiefly dependent on reflex nervous influence, or remote sympa- 
 thy, and that this influence is greatest when syncope ensues (§ 481, h). 
 Nor is there at any stage of that complex series of changes, from the 
 first impression that follows the loss of blood to their end in syncope, 
 a deficiency, but a redundancy, of blood at the centre of circulation ; 
 and, if death ensue, the vital fluid is always found accumulated in the 
 cavities of the heart (§ 1039). 
 
 949. Summarily, also, we have now seen that it is the effect of 
 loss of blood, per se, to so modify the vital states of the capillary 
 blood-vessels as to result in their contraction, and that when this con- 
 traction begins in the vessels as the effect of the loss, it excites the 
 nervous influence in proportion to the extent and suddenness of the 
 impression ; that this influence is then propagated abroad, and in- 
 creases the contraction of the capillaries at large ; that this effect of 
 the nervous influence is reflected back upon the nervous centres, by 
 which the nervous influence is still farther excited ; that circles of 
 reflex actions become thus established ; that the nervous influence is 
 now, also, exeited with a depressing effect upon the heart, and intes- 
 tinal canal, and that this effect is reverberated upon the brain and spi- 
 nal cord, by which the intensity of the nervous influence is farther in- 
 creased ; that the reflex nervous actions, and the multiplying causes of 
 nervous influence, become, therefore, exceedingly complex, and in- 
 crease in their ratio till the heart is prostrated by that influence and 
 by the central determination of blood, when syncope takes place as 
 an immediate consequence (§ 476^ 7i, 481 h, 500 m, 944 c). 
 ■ But, we have also seen, that if too little blood be taken, in certain 
 conditions of disease, results of an opposite nature to the foregoing, 
 and an aggravation of disease, may ensue, though they will be 
 brought about through the same physiological principles (§ 965, 
 983-989). Natural laws^'are at the foundation (§ 901, 904 a, bb). 
 
 And now I say, if the foregoing results of loes of blood be com-
 
 708 INSTITUTES ^F MEDICINE. 
 
 pared -vs'itli the effects of other remedial or morbific agents, it will be 
 found that a close analogy and harmony of laws distinguish their mo- 
 dus operandi. And such is always the simplicity of nature in her fun- 
 damental institutions (§ 137 e, 150-152). 
 
 950. From what has been now seen of the profound influences of 
 bloodletting upon the nervous centres, especially when syncope ap- 
 proaches, we readily account for those inflammations, and that fai 
 oveiTated irritation of modern physicians, which occasionally super- 
 vene on the loss of blood (§ 1020-1023); sometimes, though rarely, 
 from an excess of the remedy, but more frequently from its defi- 
 ciency, and still more so from its frequent application in small quan- 
 tities where a greater loss is demanded. If the loss be excessive, or 
 blood-letting not appropriate to the case, it gives rise to a morbific re- 
 flection of the nervous power upon the capillary blood-vessels. When 
 the loss is small and frequently repeated, an irritable state of the whole 
 vascular system is thus established, which may not only increase the 
 inflammation which the remedy was intended to subdue, but may be- 
 come the foundation of disease in other parts (§ 476^ /«, 479, 500 m, 965 
 &, 982-1001, 1005 e, 1024 ; also, Kriemer's Experiments, § 485). 
 
 In all these cases the whole system of capillary blood-vessels has a 
 large share in the primary impression; but a peculiar influence is de- 
 tei'niined upon them by the violence inflicted on the extreme capillaries 
 of the brain. Inflammation, therefore, may be lighted up, as a conse- 
 sequence, either in the brain or some other part, but especially the 
 brain (§ 230, 231). Hence, also, the general vascular excitement, and 
 that delirium, coma, stertorous breathing, and those convulsions, retch- 
 ings, and involuntary irftestinal evacuations ; some of which so frequent- 
 ly follow excessive loss of blood. Although blood-letting, therefore, be 
 a remedy for inflammation, the excessive use of it, as will be farther 
 shown, may ih(^uce that affection ; and even then the cautious abstrac- 
 tion of blood by leeches still proves, by its curative influence, as re- 
 ported by some, the nature of the afiection, and the sanative power of 
 the remedy when well directed (§ 901, 997, 1024 a, 1057).*— Note Q. 
 
 951, a. Let us now regard the foregoing morbific effect of loss of 
 blood (§ 950) in connection with two examples, one of coincident, the 
 other of an opposite, nature, to show the effect of the nervous power 
 upon the capillary vessels of all parts, as illustrative of this agency in 
 the operation of blood-letting, as well as of all other remedies. The 
 first example is the greatest glance that has been made toward the prac- 
 tical philosophy of the nervous system as expounded in this work, 
 and as first developed in the Aled. and Physiolog. Covim. — Thus : 
 
 '• It is certain," says Miiller, " that nervous influence is the princi- 
 pal cause of the accumulation of blood in the capillaries of certain parts 
 during the state of vital turgescence." " In the instantaneous injection 
 of the cheeks with blood in the act of blushing, and of the whole head 
 under the influence of violent passions, the local phenomena are evi- 
 dently induced by the nervous influence. The active congestion of cer- 
 tain organs of the brain, for example, while they are in a state of ex- 
 citement, is a similar phenomenon" (p. 827, p. 920 Note). — ^Note Q. 
 
 These several examples, however various may be the remote causes 
 of the phenomena, are so nearly alike that they may be regarded as one, 
 
 * The curative effect is to be explained by leeches operating through local aervous cen- 
 ters. See § 497, 893 a, c, 923 d, 939/, 974 6, 1024 a.
 
 THERAPEUTICS. LOSS OF BLOOD. 709 
 
 Rnd it is not less obvious that they involve the philosophy of inflamma- 
 tion as induced by loss of blood, or as it springs from other causes. 
 
 951, b. And now for the opposite result, which is brought about 
 by precisely the same immediate exciting cause, the nervous influ- 
 ence, though not so supposed by the distinguished observer. 
 
 " When a patient," says Dr. Armstrong, "had lost only an ounce 
 of blood, from the shock of the operation syncope came on and ef- 
 fectuafly removed an acute inflammation of the brain." Again, " a 
 patient," says the same writer, " was so alarmed at the preparation 
 for bleeding, that syncope occurred, and completely stopped an in- 
 flammation of the pleura" {See ^ 476-|^ h, 479, 955 a). 
 
 951, c. Looking at the foregoing examples in their true relations, 
 there may be advantageously considered, besides their immediate ob- 
 ject, certain other points which reflect a strong light upon the nature 
 of the nervous power, the causes and mode of its development, its 
 modifications by the nature of its exciting causes, its subsequent prop- 
 agation to parts remote from the brain and upon the brain itself, and 
 its remarkable influences upon all parts. In the examples before us 
 we see that power variously and in unusual operation. We see that 
 it is positively developed by excessive loss of blood, by shame, by the 
 violent exciting passions, producing a high arterial action, or inflam- 
 naation of the brain or of other parts in one case (§ 950), instanta- 
 neous injection of the cheeks with blood in another, and the brain and 
 whole head in another (§ 951, a) ; and these are corresponding re- 
 sults. We see, also, that an exactly opposite effect is produced by 
 the loss of only one ounce of blood, and in another instance by the 
 operation of fear alone (§ 951, b) ; an acute inflammation of the brain 
 being overthrown in the former case, and an inflammation of the pleu- 
 ra in the latter. The common nature of the modifying cause cannot 
 be mistaken ; and when we consider the variety of more remote ex- 
 citing causes, excessive loss of blood in one case, an ounce in anoth- 
 er, shame, anger, and fear in others, the close analogies, yet diversifi- 
 ed results, in one series of the cases, and the absolute opposition in 
 the other series, yet each example in this series exactly alike, though 
 involving the loss of an ounce of blood in one of the instances and 
 fear in the other ; when, I say, we consider these things, we must ad- 
 mit not only the common nature of the intervening cause, but that this 
 cause is liable to be variously modified by the agents which rouse it 
 into action, and that, however apparently estranged from each other 
 may be many of these agents, they modify the incidental cause in 
 modes corresponding with the effects. A common philosophy applies, 
 therefore, to all the cases, and this philosophy is equally true of those 
 morbific and remedial agents which determine the same effects upon 
 distant parts when applied to the alimentary canal, or to the skin, &c., 
 and therefore, also, of the whole compass of remote sympathy. The 
 type of the whole is in the examples before us (§ 475^, 500 m, 1056). 
 
 951, d. It is farther worthy of remark that the examples (§ 951, b) 
 show how powerfully the nervous influence may be determined upon 
 the organic constitution of the brain by the loss of a single ounce of 
 blood, and in the case of the pleuritic inflammation by fear alone ; 
 while either case is a conclusive proof of the philosophy which I have 
 propounded of the modus operandi of bloodletting, and that it is in 
 no respect of a mechanical nature. These examples also demonstrate 
 my position that the nervous influence is most profoundly felt when 
 syncope comes on.
 
 710 INSTITUTES OF MEDICINE. 
 
 952, a. Some of the finest illustrations of the effect of bloodletting 
 upon the organic properties of the extreme vessels of the arterial sys- 
 tem, either directly through the loss of blood, or, by alterative reflex 
 nervous actions, are shown by the changes which take place in the 
 blood while flowing from the arm in inflammatory diseases. 
 
 952, b. Some of the most remarkable of the foregoing changes may 
 be induced by a very small loss of blood. Thus, a patient of mine 
 was attacked with pneumonia, after convalescence had begun from a 
 protracted fever. She was placed in an erect posture, and an ounce 
 of blood was drawn, in a full stream, into each of three wine-glasses ; 
 when syncope took place. In the first glass the blood had a thick, 
 strong, indented, buff, and a fimbriated edge ; in the second the buff 
 was sensibly less, and the other peculiarities were diminished ; in the 
 third they had disappeared. 
 
 952, c. On the contrary, however, in a case of inflammatory fever 
 Hewson observed the unusual phenomenon of the appearance of the 
 inflammatory buff only on the fourth cup. 
 
 952, d. " There is a very considerable difference to be sometimes 
 observed in the quantity of coagulable lymph in blood taken in differ- 
 ent cups from the same patient at the same bleeding. In some in- 
 stances this difference has been observed nearly one half" — War- 
 drop. Sometimes more than one half. — Scudamore. " The same is 
 relatively increased during the continuance of bleeding; and it is sur- 
 prising how great a change will take place in this respect at minute 
 periods." — Thackrah. And so Gendrin, Stokes, &c. Again, how- 
 ever, the foregoing phenomena are sometimes directly revei-sed ; and 
 an increased quantity of fibrin, and a diminution of serum, have been 
 found in each successive cup. These conditions, too, as well as the 
 preceding, depend, in a measm-e, upon the rapidity with which the 
 blood is abstracted. Mead, the able humoralist of other days, ob- 
 serves, that " the blood may certainly undergo any imaginable changes 
 by alterations made in its motions only" (§ 500 m, 687^). 
 
 952, e. If syncope take place, the blood not only generally loses its 
 inflammatory characteristics {b), but the clot is often much softer and 
 more voluminous. Should the inflammation afterward go on, the 
 blood will be found to have resumed its former peculiarities. 
 
 952, yi Blood, drawn from a person, or from an animal about to 
 faint, coagulates very rapidly. In this case, the rapidity of coagula- 
 tion appears to bear a remarkable ratio to the depression of the or- 
 ganic properties of the solids ; as may be readily seen in slaughter- 
 houses. But, again, on the other hand, when death is suddenly pro- 
 duced through the nervous system by blows on the stomach, apoplexy, 
 &c., or by running, lightning, organic affections of the heart, &c., or 
 when the powers of life are greatly reduced by malignant fevers, the 
 blood generaly, though not always, remains fluid. 
 
 These seeming paradoxes are resolved by supposing peculiar influ- 
 ences of the solids upon the blood, according to the specific modifica- 
 tions of their organic properties ; these, as well as all the other dif- 
 ferences and changes, being, therefore, an evidence that bloodlettino- 
 produces its effects upon the vires vifce of the solids, and that the or- 
 ganic properties, other things being equal, will be affected according 
 to the quantity of blood taken, the manner of taking it, &c. 
 
 952, g. Musgrave, in adverting to the rapid changes which tako 
 place in the blood during the operation of general bloodletting, re-
 
 THKRAPEUTICS. LOSS OF BLOOD. 711 
 
 marks that these alterations " require the agency of some third power ; 
 for to suppose that the blood undergoes so sudden a change merely 
 by the quantity being lessened, would hardly be more extraordinary, 
 than to imagine that pouring a glass of brandy out of a bottle would 
 turn the rest into cider" (§ 1087).*-See Kriemer's experiment ^ 485. 
 
 952, h. How futile, therefore, the recent observations of Andral as 
 to the relative quantity of lymph in inflammatory diseases ! The most 
 bloodless subjects are often liable to inflammation, and the loss of one 
 or two ounces may affect, essentially, the proportion of lymph in the 
 next two ounces (^ 688 ee). Here, therefore, is proof in the very na- 
 ture of things, which stamps all these inquiries as humoral assump- 
 tions. Indeed, Andral, himself, had long before settled the fallacy of 
 these later observations by the well-grounded statement, in his Path- 
 ological Anatomy, that " no one solid can undergo the slightest mod- 
 ification without producing some derangement in the nature and qual- 
 ity of the materials destined to form blood, or to be separated from 
 it." And this, too, from the father of modern humoralism (§ 699 c). 
 
 GENERAL AND PRACTICAL OBSERVATIONS ON BLOODLETTING. 
 
 Of the General Extent of the Remedy. 
 
 953, The vital influences of loss of blood originate in the vital re- 
 lations of the blood to the organic properties of the solids. The blood 
 being the fahulum vitce, the solids are extremely sensitive to any loss 
 of this fluid they may sustain. This sensitiveness resides in the or- 
 ganic properties (§ 184, &c.). Inflammation and fever being also es- 
 sentially constituted by a morbid condition of those properties (which 
 are more susceptible for being thus affected (§ 137 d, 143 c)), the loss 
 of blood, especially in general bloodletting, makes an instantaneous 
 and profound impression upon them, by which their morbid condition 
 is so radically altered that nature reacts at once, and sometimes 
 completes the cure almost on the instant (§ 137 e, 151, 152). 
 
 954, a. There can be no general rule as to the quantity of blood 
 ■which should be abstracted in any given case of disease, or as to the 
 rapidity with which the abstraction should be made. This must al- 
 ways depend upon the circumstances of each individual case, and upon 
 the effects of the remedy during its application, which should, of course, 
 be superintended by the physician (§ 675). 
 
 954, h. It is, nevertheless, certain, in a general sense, that some 
 definite quantity of blood should be removed; and this, according to 
 the nature of the affected organs, the character and intensity of the 
 disease, &c. (§ 133-156). This is necessary not only to the present 
 effects, but to the permanent influences of the remedy. This perma- 
 nence cannot often be maintained without the continued operation of 
 a certain diminished supply of blood to the general capillary system 
 (§ 514 g, 516 d, no. 6). Dry cupping, therefore, and all similar ex- 
 pedients which are prompted entirely by enoneous views of the mo- 
 dus operandi of loss of blood, produce none of the effects which ap- 
 pertain to bloodletting in any of its modes. I cannot, therefore, 
 accede either to the dry cupping of the distinguished mechanical phy- 
 sician, Dr. Arnott, or to his opinion " that it is a great modern im- 
 provement in the practice of the healing art, in bleeding for the cure 
 of inflammation to take the blood away as quickly as possible; since 
 
 * This conclusion was no farther theoretical, but was founded upon a common-sense 
 view of the exigencies of the case.
 
 712 INSTITUTES OF MEDICINE. 
 
 intense inflammations of the brain, lungs, bowels, &c., are equally re- 
 moved by faintness, whether it happens after the loss of two ounces 
 of blood, or of fifty." — Arnott's Physics, &fc. 
 
 954, c. In general bloodletting, the nearer the loss is carried to the 
 point of syncope the more profound and permanent will be its effects. 
 In grave forms of inflammation and fever this amount of influence is 
 required, and perhaps at repeated applications of the remedy (§ 999). 
 
 954, d When syncope is induced by loss of blood alone it is a test 
 that the vital condition of the small blood-vessels has been strongly af- 
 fected ; but more or less so, in a general sense, in the ratio of the 
 quantity abstracted. Like the contraction of those vessels, syncope 
 is one, though a less simple, consequence of the vital impression ex- 
 erted upon them (§ 944 c, 961 e). 
 
 955, a. It should be said, therefore, in qualification of the statement 
 in section 951, h, that it is exceedingly rare that the loss of a single 
 ounce of blood, by venesection, will subvert inflammation of any or- 
 gan, especially of the brain, even though the nervous influence be so 
 intensely developed as to establish syncope (§ 961, c). The following 
 are common examples, and go with the others to illustrate my doc- 
 trine of the nervous influence. Thus, Dr. Armstrong : 
 
 955, b. " A patient, at the point of death from acute inflammation 
 of the pleura and lungs, was bled to the extent of fifty ounces, when 
 he had obtained no relief. If we had stopped here, in two hours the 
 patient would have died. After abstracting about six ounces more 
 blood syncope came on, from which he recovered convalescent." 
 
 If this patient had been bled in an erect posture and from both 
 arms, and had syncope followed the loss of fifteen or twenty ounces 
 of blood, it is scarcely probable that he would have been saved. 
 
 Again, another patient of Armstrong's " had been once bled, af- 
 ter which the inflammation of the pleura and lungs returned. He 
 had nearly expired from the bleeding ; but the symptoms were so ur- 
 gent that I determined to bleed him decisively, and I told his friends 
 that he might perhaps even die under the operation. I bled him de- 
 cisively, and syncope came on suddenly and continued some time, so 
 that I thought he would have died. He recovered afterward vdth 
 small doses of calomel and opium" (§ 892|, i, 1068). 
 
 955, c. Examples of the foregoing nature have been of constant oc- 
 currence, in the hands of enlightened understanding, from the time 
 of Hippocrates, who began the example. The proper rule in extreme 
 cases was observed, as above, by Armstrong, and was thus laid down 
 by Celsus : " It may happen," says Celsus, " that a disease may re- 
 quire bloodletting when the system seems unable to bear it. Yet, if 
 there appear no other remedy, and the patient must perish unless re- 
 lieved by a rash attempt, it is then the part of a good physician to de- 
 clare that bloodletting is the last resource of his art, but that it may 
 precipitate death. Having done this, he should bleed, if desired. 
 There can be no room for hesitation in cases like this, since it is bet- 
 ter to try a doubtful remedy than none at all. And this ought espe- 
 cially to be done when a paroxysm of fever has nearly destroyed a 
 patient, and another equally severe is likely to follow. So, also, in 
 palsy, and, again, when angina suffocates" (§ 892 c, 892^ i, 1068). 
 
 955, d. Here the importance is fully shown, not only of abstracting 
 a certain quantity of blood, but of obtaining a full impression from the
 
 THERAPEUTICS. LOSS OF BLOOD. 713 
 
 cerebro-spinal influence, in many cases of inflammatory affections, as, 
 also, the error of Marshall Hall's recommendation that " bloodletting 
 should never be carried to actual syncope, but only to the very first 
 signs of approaching syncope, which is, in fact, to be prevented by im- 
 mediately laying the patient in the recumbent position." Many exam- 
 ples of the foregoing nature are presented in the Commentaries, and 
 others will follow in the present work. 
 
 955, e. Where bloodletting has been already carried to a large ex- 
 tent, yet the original disease still perseveres ; or when we are called 
 at the advanced stages of inflammation or fever, or where inflamma- 
 tions may spring up in subjects exhausted by long confinement, or in 
 broken-doviTi constitutions, the rules of practice are less precise, and 
 depend more upon the circumstances of each individual case. But, 
 in a general sense, so long as any severe or obstinate inflammation 
 may be present, whether acute or chronic, we shall scarcely go wrong 
 in absti-acting more or less blood, not seldom freely, either by the lan- 
 cet or by leeches. This is the dictate of philosophy, and it is enforced 
 by the soundest experience. They are often cases, however, which 
 demand habits of critical observation, accuracy of judgment, and an 
 unremitting attention to medical pursuits. Otherwise, it will he often 
 but little better than the hazard of the die. Without these requisites, 
 where uncertainty prevails in critical conjunctures it is better to leave 
 the whole matter to nature. In such emergencies she will oftener 
 triumph than the unskillful practitioner, who may only embarrass her 
 efforts. " Medici plus interdum quiete, quam movendo, proficerunV 
 This principle holds in the foregoing cases where art is imbecile from 
 ignorance. And so it is from inadequate bloodletting in the early 
 stages of inflammation and fever. 
 
 But, let it be remembered that the two most important objects to 
 be considered in the treatment of disease is, 
 
 1st. To adapt our remedies in all respects to tlie nature and existing 
 condition of the patliological states. 
 
 2d. To carry tliem as far as and no farther than the institution oj 
 such a change as will enable Nature to tahe upon herself, most success- 
 fully, the work of cure (§ 857). 
 
 956. General bloodletting is the proper mode of depletion, espe- 
 cially after the age of infancy (§ 576, e), in all forms of fever, and in 
 all the active inflammations of the internal viscera. This is particu- 
 larly required at the beginning of the treatment, on account of the 
 universal change which general bloodletting induces in the sanguif- 
 erous organs ; thereby relieving, at once, the instruments of disease of 
 a redundant quantity of blood, and immediately reducing the force 
 with which the blood is distributed. There is also thus obtained a 
 farther important advantage from the potent reflex nervous influence 
 which is determined upon the instruments of disease by a great and 
 sudden change of action throughout the arterial system, as well as 
 from influences exerted upon the general vital conditions of numer- 
 ous organs ; the very eflect upon the skin, for example, and especially 
 upon the intestinal canal, reflecting a nervous influence upon other or- 
 gans which may be the seats of disease ; just as when antimony or ip- 
 ecacuanha send their influences abroad in a moi*e direct manner 
 through the intestinal mucous tissue, or call up the co-operation of 
 the skin with that tissue in subduing pulmonary inflammations (§ 
 614, h), by exciting a complex circle of reflex nervous actions.
 
 714 INSTITUTES OF MEDICINE. 
 
 957. On the other hand, if the treatment have been begun by ether 
 remedies, or if it have been neglected, and disease have thus acquir- 
 ed the force of habit (§ 539), or if general arterial excitement have ex- 
 isted and gone dow^n spontaneously, or, in neglected cases, under tho 
 influence of remedial agents, even of loss of blood, and however sud- 
 denly, the results in the preceding section can be obtained only in an 
 inferior degree by general bloodletting. Comparatively little change 
 of action may then be induced in the vessels generally ; or the effect 
 of general bloodletting may be lost in the influence of habit (§ 539, &c.). 
 Here, too, the remedy is on a par, in principle, with all others. Nev- 
 ertheless, general bloodletting is likely to be important at any stage 
 of visceral inflammation so long as the disease exists in much intensi- 
 ty ; whatever treatment may have been pursued, or however the dis- 
 ease may have been neglected. But, should a manifest abatement 
 have followed under any of the foregoing circumstances, leeching may 
 then become far more eflficient than venesection (§ 892| i, 1008). 
 
 958, a. In the ordinary forms of active inflammation, and where 
 
 f)racticable in fever (§ 961-970), the first bloodletting should be the 
 argest, and this should be in proportion to the exigencies of the case. 
 We may often accomplish all that is desirable by a single blow, as it 
 wei'e ; which is incomparably better, in grave inflammations and fe- 
 vers, than a dozen smaller ones, which may even fail, or prove detri- 
 mental, in the end, where greater decision, at the onset, would have 
 completed a cure (§ 950, 965). 
 
 958, b. It appears, also, from what has been said, that the opera- 
 tion of general bloodletting should always be conducted by the physi- 
 cian ; and it is doubtless owing to disappointments that have arisen 
 from consigning the application of this important remedy to the hands 
 of barbers and leechers that it has fallen into disrepute with many. 
 Leeching may be done by the unprofessional, because it operates 
 upon a modified principle from that of general bloodletting ; and it is 
 much less important as to the precise quantity of blood which should 
 be abstracted, particularly on account of slowness (^ 476^ h, 921, 937). 
 
 But, in general bloodletting, every thing may depend upon an ex- 
 act effect at the moment of the operation ; and that will depend not 
 only upon the precise quantity of blood abstracted, but upon the posi- 
 tion of the patient, the size of the orifice, the flow of the blood, the 
 management of the patient's mind so that mental emotions shall not 
 interfere, and upon other well-regulated influences which the skillful 
 physician can alone determine, and alone estimate. Nor can the most 
 experienced and gifted practitioner ever foretell, in any given case of 
 disease, what quantity of blood should be abstracted, by the general 
 method, under the best-regulated circumstances. 
 
 This practice of intrusting the operation of general bloodletting to 
 the ignorant will cease to be tolerated when the modus operandi of the 
 remedy shall come to be appreciated and acknowledged ; nor, until 
 then, will it undergo in the hands of the professional that just appli- 
 cation, according to the exigencies of disease, which rarely fails to 
 illustrate its remedial effects. 
 
 958, c. I must now refer the reader to those divisions of my sub- 
 ject where the distinctions are considered between leeching, general 
 bloodletting, and cupping, for other remarks relative to the just quan- 
 tities of blood that should be abstracted in certain given forms of dis-
 
 THERAPEUTICS. LOSS OP BLOOD. 715 
 
 ease, and which were there introduced for the purj)ose of illustrating 
 the distinctions between those several modes of bloodletting. 
 
 959, a. Finally, therefore, from what has been now said of the prin- 
 ciples upon which bloodletting operates, as well as from experience, 
 the rule as laid down by Dr. Marshall Hall, and other late writers, 
 that " Syncope is a uniform criterion of the quantity of blood to he ab- 
 stracted, and which the nature of the case may demand,"" is fallacious. 
 Dr. Wardrop gives us the same rule. " The state of fainting," ho 
 says, " is to be considered an index of the quantity of blood which is 
 necessary to be removed for the relief oi the disease." On the con- 
 trary, syncope may depend on so many other causes than loss of 
 blood, the actual tolerance at the first operation may be so little that 
 its repetition may be indispensable soon after the patient revives, and 
 perhaps to a large extent even before binding up the arm. These 
 cases of early syncope, where the remedy m§y be appropriate, are, 
 also, the very ones which most demand repeated abstractions of blood ; 
 and the effect produced at each application of the remedy should be the 
 measure of the quantity to be abstracted (§ GST-g-, 688 d, e, 936-938, 
 943, 944, 961, 967, 981-988), 
 
 959, b. " Dr. Moseley," says Robert Jackson, " advises us to bleed, 
 ad deliquium, in yellow fever. I coincide with him in recommending 
 extensive bleeding in this form of disease ; but I do not accede to the 
 rule which he assumes for judging of the measure. It is vague and 
 uncertain. Deliquium occurs sometimes from the loss of a few oun- 
 ces of blood, sometimes scarcely from the loss of six pounds. The 
 act of fainting is not, therefore, a rule of dependence for regulating 
 practice" (§ 992, 994).— Note Ff p. 1135. 
 
 960, a. Many expedients have been attempted as substitutes for 
 bloodletting; from the comparatively rational method by cathartics, 
 blisters, and other subordinate antiphlogistics, to the ne plus ultra ot 
 dry cupping. It would be difficult to assign their appropriate rank, 
 in theoretical conceptions, to some of the novelties which have been 
 brought forward, from time to time, to fulfill, or to surpass, the inten- 
 tions of bloodletting, or to banish this principal remedy from the heal- 
 ing art. Louis undertook its explosion with more signal success than 
 any other champion of the " meditation upon death." (See Exami- 
 nation of the Waitings of M. Louis, in 3Ied. and Phys. Comm., vol. ii., 
 p. 679-815.) Others, more inclined than Louis to lend a helping 
 hand to nature, resort to bold experiment, whose evil results, if inci- 
 dent to bloodletting, it must be allowed, would consign this remedy 
 to a well-merited reproach. Thus Pereira, in his Materia Medica, 
 remarks that, 
 
 " I tried tobacco somewhat extensively, a few years since, as a substi- 
 tute for bloodletting in inflammatory affections. But, while it produced 
 such distressing nausea and depression, that it was with difficulty I could 
 induce patients to persevere in its use, I did not find its antiphlogistic 
 powers at all proportionate, and eventually I discontinued its employ- 
 menty 
 
 Such, then, is the philosophy which rears itself against the well- 
 tried and faithful agent ; while it is regardless, by its own showing, of 
 the disastrous results of agents long since condemned as fruitless and 
 destructive, and would vainly endeavor to " substitute" them for the 
 safest and only effectual remedy for all grave inflammations.
 
 716 INSTITUTES <?F MEDICINE. 
 
 When Pereira urudertook to " substitute, tobacco for bloodletting 
 in inflammatory affections," it was with the full knowledge that its use 
 had been mostly abandoned, as wanting in curative virtues, and hos- 
 tile to life ; that surgeons, even, had greatly forsaken it as an enema 
 in strangulated hernia, on account of the frequent deaths it had pro- 
 duced (§ 892f b, 893 n). It was mainly such diseases as confirmed 
 dropsy, tetanus, intractable ileus, and hydrophobia, that were handed 
 over to its tender mercies. Nay, more ; our able author says of it, 
 himself, as employed for the relief of dropsy, that, 
 
 " In small doses, it is an uncertain diuretic, and in larger doses it 
 causes such a distressing nausea and depression, that practitioners 
 have long since ceased to use it in dropsical cases." 
 
 How many perished under the experiment with this unmanageable 
 poison in Pereira's attempt " to substitute it for bloodletting in in- 
 flammatory affections,'* either from the direct effect of the poison, or 
 from the neglect of bloodletting, our author does not say ; tbough con- 
 fessions here would have been some atonement to science and hu- 
 manity. — Note H p. 1117. 
 
 Nor may the contemners of bloodletting, and of those who com- 
 mend its judicious use, in the treatment of inflammations, complain 
 when " their poisoned chalice is thus commended to their own lips." 
 Were we to contrast the victims of tobacco, alone, during its rage 
 as a panacea, with such as may be assumed to have fallen, through all 
 time, by the lancet, it will not be denied by the stoutest prejudice that 
 the odds are fearfully on the side of the poison. It is profitable, there- 
 fore, to pursue this inquiry, and to interrogate yet farther the disposi- 
 tion which may exist in the most enlightened quarters to hold on upon 
 the worthless, but deadly engines of the Materia Medica. The ten- 
 dency may be, at least, to induce a greater toleration of the useful 
 means, and thus to compensate, in a measure, for the effects of poisons 
 when administered in what are regarded as their therapeutical doses. 
 We may, therefore, consult another eminent writer of our own day, 
 the able author of the American Medical Botany ; though he does not 
 say, nor have we reason to think, that he had " attempted to substitute 
 tobacco for bloodletting in inflammatory affections." I make the quo- 
 tation, therefore, to show how there will sometimes escape from the 
 best writers and practitioners an apparent justification of the woi'st 
 practices humanity is called upon to encounter ; and to contrast the 
 tacit acquiescence of all in commendation of poisons which operate with 
 deadly effect in their authorized doses (and not unfrequently conced- 
 ing, at the same time, the consequences here alleged), with the denun- 
 ciations of bloodletting which are wafted from transatlantic shores to 
 startle Americans into mute astonishment.* Thus, then, our author : 
 
 " At the present day," he says, " tobacco does not seem to be ex- 
 tensively in use, having passed into neglect rather because more fash- 
 ionable remedies have superseded it, than because it has really been 
 weighed and found wanting." 
 
 In this respect, the able writer is manifestly at fault ; and if we only 
 turn over this same leaf from which I have made the quotation, we 
 shall read on the next page as follows : . 
 
 "This powerful medicine has been also employed with some pal- 
 liative effect in hydrophobia, and certain other spasmodic diseases, 
 Its internal use, however, requires great caution, since patients have, 
 
 * This must now be qualified, as at p. 760 note^ and Note Mm p. 1141.-1865.
 
 THERAPEUTICS. LOSS OF BLOOD. 717 
 
 tn various instances, been destroyed by improper quantities adminis- 
 tered by the hands of the unskillful or unwary. Notwithstanding the 
 common use and extensive consumption of tobacco in its various forms, 
 it must unquestionably be ranked among narcotic poisons of the most 
 active class. The great prostration of strength, excessive giddiness, 
 fainting, and violent affections of the alimentary canal, which often at- 
 tend its internal use, make it proper that so potent a drug should be 
 resorted to by medical men, only in restricted doses, and on occasions 
 of magnitude." 
 
 Here, then, we are justly told that tobacco should be used with 
 caution even in hydrophobia. And, suppose it could be said* of 
 bloodletting, as the writer affirms of tobacco, that " patients have, in 
 various instances, been destroyed by improper quantities," even though 
 a part of the injury might be ascribed to " the hands of the unskillful 
 and unwary ;" the advocates of the remedy would scarcely allege, 
 on seeing it fall into disuse, what the foregoing writer does of tobac- 
 co, that "it has passed into neglect rather because more fashionable 
 remedies have superseded it, than because it has really been weighed 
 and found wanting." No ; they would acquiesce upon the ground 
 that it " had been weighed and found wanting." And now suppose, 
 again, that such " weighing and wanting" were plausably affirmed of 
 bloodletting, as is conceded, in reality, by its best advocates, of tobac- 
 co, even in the hands of the best practitioners, — in their own hands, — 
 or only through ignorance and carelessness alone, the remedy would 
 be so hunted down that the rational treatment of inflammationil and 
 fevers by bloodletting would probably subject the practitioner to pub- 
 lic odium. Indeed, we know that this was remarkably the case with 
 the illustrious Robert Jackson, when he first began the explosion of 
 the tonic and stimulant treatment which prevailed so fatally in the 
 British Army. He was generally denounced as " a murderer" by the 
 British Doctors ; till the astonishingly diminished mortality in the Brit- 
 ish Army soon showed them who the real murderers were (§ 569, e). 
 On the other hand, however, with what calm indifference we con- 
 template the ravages of the tonic and stimulant treatment of fevers, 
 and the no less inconsiderate use of the most violent agents of the Ma- 
 teria Medica, for the mere purpose of devising some expedient that 
 shall do away with the necessity of bloodletting in acute inflammations 
 and fevers ! (§ 1065, c, d, 1068, c).* 
 
 As to tobacco, in the treatment of strangulated hernia, we possess 
 in tartarized antimony, or even in the lobelia inflata, far better and 
 safer means for establishing a relaxation of the muscular system ; es- 
 pecially in the former agent. Nay, in very many cases, bloodletting, 
 to the extent of syncope, will not only accomplish the intention as 
 fully, but bestow the immense advantage of subduing any inflamma- 
 tion of the intestine, which is so apt to be produced by strangulation. 
 Besides the immediate hazard of life which is incident to enemas of 
 tobacco, there is the gi-eat objection, that should it fail of its contem- 
 plated purpose the prostration which it occasions will render an op- 
 eration by the knife of very doubtful result, but which might have 
 been perfectly safe before the administration of the tobacco. The pa- 
 tient will be little apt to bear the superadded shock which is inflicted 
 by so severe an operation ; and the intestine, too, in a state of inflam- 
 mation which will now contribute greatly to the same general ex- 
 * NoTcs F p. 1115, H p. 1117, Gg p. 1138, Mm p. 1141.
 
 71J? INSTITUTES OF MEDICINE. 
 
 haustion. And since the question, among surgeons, has turned main- 
 ly upon the abstract effect of tobacco as an agent of immediate death, 
 and witnout much reference to those ulterior results, and since it is no 
 proof that a remedial agent does not destroy because the patient sur- 
 vives its immediate operation, I may also say that its pernicious ten- 
 dency reaches these cases in the obstacle which it places in the way 
 of subsequent bloodletting, which is often important to the patient 
 soon after the i-eduction of the intestine, if it have not preceded it (§ 
 576, e)* 
 
 But, it is not alone this or that agent, or other individual means, 
 which has been attempted as a substitute for bloodletting in the treat- 
 ment of inflammations. The whole class of poisonous agents to which 
 tobacco belongs has been declared on high authority, as we have seen 
 (§ 891, c), to be "the most important medicines we possess." And to 
 justify yet farther what I have said of British therapeutics, and to sus- 
 tain the contrast with American philosophy and practice (§ 349 d, 
 350f k, kk, 709, note), I shall quote Pereira's Materia Medica rela- 
 tive to his opinion of opium when compared with the uses of blood- 
 letting, cathartics, antimonials, &c. 
 
 " Opium,''^ he says, " is undoubtedly the most hnportant and valuable 
 
 * The fascinations which attend tobacco as a luxury led to its extensive use as a rem- 
 edy for disease ; and the question arises whether, from what is now known of its perni- 
 cious effects when applied to the gastrointestinal mucous membrane, and even to the 
 skin, in health as well as disease, its moderate use as a luxury can be justified by the 
 physician? This question I shall briefly investigate, for another purpose, alsoj-that of il- 
 lustrating yet farther certain peculiarities of remedial agents in relation to vital habit 
 (^ 533, &c.). 
 
 There could be little doubt, upon principle, that the various modes of using tobacco 
 would be detrimental in most conditions of disease, on account of the increased suscep- 
 tibility of organs (^ 137 d,, 150, 151). But it would be still a question of facts in relation 
 to this particular agent (§ 650). The requisite facts are before us, and are decisive against 
 the luxury in morbid conditions. 
 
 But, this does not prove that the moderate use of tobacco will injure the health of those 
 who are in possession of health (§ 137, d). We cannot reason, as I have endeavored to 
 show, from the effects of remedies upon man in health to man in disease; excepting as it 
 respects their violence when manifested in healthy subjects. Of this principle tobacco 
 affords a very full exemplification, and shows that the principle is equally true in its op- 
 posite aspect, and that we may not reason from the effects of an agent which is deleteri- 
 ous in disease to its effects under the condition of health ; as, indeed, is shown by food 
 itself. 
 
 We must, therefore, take the facts in all the cases, and what other facts teach us as to 
 the constitution and laws of organic beings, and as agents operate upon different parts. 
 With this kind of philosophy, we are enabled (unexpectedly, according to the usual 
 method) to decide that the moderate use of tobacco is rarely deleterious in health, and 
 has, therefore, but little, if any, tendency to abbreviate life. The law of vital habit, as 
 well as observation,enablesus, also, to know that the habitual, is safer than the inter- 
 rupted, use of tobacco ; so, only, there be no excess. The insusceptibiUty, which the 
 contuiued use establishes, soon passes off on suspending the influence, and leaves the in- 
 dividual more or less liable to nauseating and other morbific effects, on resuming the lux- 
 ury. If this be often repeated, it would probably lead to chronic or other forms of disease 
 (§ 535, &c.). 
 
 There is, therefore, a remarkable difference between the ultimate effects of the habitu- 
 al use of tobacco and of most other poisonous agents of the Materia Medica. The narcot- 
 ics, for example, are constantly morbific, while continued in their moderate therapeutical 
 ilose, though less so by use than at the beginning. But this is not true of many of the 
 ordinary causes of disease, which observe a coincidence with the effects that arise from 
 the habitual and interrupted use of tobacco. The miasmata which lay the foundation of 
 fever are examples (§ 544, 550, 551, 552 a). This brings into view the differences in the 
 vital constitution of different parts of the mucous system, and the examples are clear il- 
 lustrations of those distinctions ; since, in the case of the poisonous agents of the Materia 
 Medica (including tobacco), they exert their influences upon the mucous tissue of the 
 stonaach and intestine, while tobacco, as a luxury, and miasmatic agents, are mostly op- 
 erative upon other parts. The same is seen in the skin, since tobacco will not establish 
 the habit of endurance in that organ (§ 136, 137 h, &c.). Tobacco is also another wit- 
 ness, m its associated aspects as a luxury and as a poisoa, against the doctrine cif opera- 
 tion by absorption.
 
 THERAPEUTICS. LOSS OP BLOOD. 719 
 
 remedy of the wliole Materia Medica." " Its good effects are not, as 
 is the case with some valuable medicines, remote and contingent, but 
 they are immediate, direct, and obvious ; and its operation is not at- 
 tended with pain or discomfort. Furthermore, it is applied, and with 
 the greatest success, to the relief of maladies of every day's occurrence, 
 some of which are attended with the most acute human suffering. 
 These circumstances, with others not necessary here to enumerate, 
 conspire to give to opium an interest not possessed hy any other arti- 
 cle of the Materia Medica ;" — and certainly not by bloodletting. 
 
 And now suppose that the Author of these Institutes had made the 
 same affirmation of opium, instead of having bestowed the like com- 
 mendation upon bloodletting in his fonner work ; he would have cheer- 
 fully acquiesced even in the misrepresentations of his Commentaries 
 by the British Medical Press, and in the countenance afforded by the 
 British Medical Profession of the great injustice inflicted upon himself, 
 as an atonement for the injury he might have done. — NoTEWp. 1127. 
 
 Nor did I scarcely do justice to the cause which I endeavor to ad- 
 vocate, when, in a former section, I spoke of the influence of the Brit- 
 ish " Association" in their concerted action to overthrow the fabric of 
 Medicine, and to raise upon its ruins the absurdities of a foreign Chem- 
 ist (§ 349, d). The record should have been also made that the work 
 on " Organic Chemistry applied to Physiology''' had been a year be- 
 fore the Profession, ere its successor, the work on *' Animal Chem- 
 istry applied to Pathology and Therapeutics," was " communicated to 
 the British Association for the Advancement of Science " and " Edited 
 FROM THE Author's Manuscript, by William Gregory, M.D., Pro- 
 fessor OF Medicine in the University and King's College," and before 
 other distinguished British medical writers became the systematic In- 
 terpreters of the Author's meaning, as well as Champions of his 
 doctrines (§ 350^, 350|, Aiil^f). The hurricane, I say, swept over 
 the Nation, and such was its force upon the Continent, and even in 
 America, that the learned in those Countries had serious doubts of 
 the stability of any science, and that the great bulwarks, which had 
 been slowly and progressively reared by the observation and wisdom 
 of a long series of ages, would be, hereafter, at the mercy of any as- 
 pirant. For all this, the British Nation must and will be held respon- 
 sible (^ 1062^-1065, 1068, a.) 
 
 And now, let us remember, that when radical and enduring changes 
 may be wrought in any science which is built upon the foundations of 
 Nature, and when, especially, the phenomena have been open to all, 
 they will hereafter advance as slowly, at least, as the errors had sprung 
 into existence. The wisdom of one generation is, at most, but a shad- 
 ow in advance of the last ; and, however discoveries may come up in 
 the open field of Nature, the great laws which have been educed 
 from what was known in the past will be of no easy subversion. Nor 
 can I doubt, that come what may to Medicine, we shall sooner or later 
 go back to Hippocrates, and begin a reconstruction upon the founda- 
 tions which his genius and observation had laid (376|^, 376f). 
 
 Developments of important facts in science and in art may advance 
 with rapidity ; but, even those details, which are apt to grow out of 
 principles already known, are commonly progressive according to the 
 sum of knowledge which may be handed over by one generation to 
 *he next succeeding. It is not, however, equally true, that a portion,
 
 720 INSTITUTES OF MEDICINE. 
 
 or the whole of mankind, relapse into ignorance, speculation, and su- 
 perstition, through the same gradual process. The decline of the 
 Roman Empire, and the subsequent darkness which overshadowed 
 the earth for six hundred years, or the later fall of Spain from the 
 highest to the lowest rank among the nations of Europe, are a melan- 
 choly commentary upon the rapid and disastrous influences of luxurious 
 ease, and arbitrary opinion, upon knowledge and philosophy, and illus- 
 trate the tardy pace of the human mind in regaining its independence, 
 recovering the path of Nature, and retrieving what it has lost. Nor is 
 it an improbable conjecture that the serious failure of a harvest in Eu- 
 rope, or any serious impediment to the outlet of British manufactures, 
 or an ascendency of Puseyism, would soon place our Ancestor by the 
 side of Spain. 
 
 But, practical examples in bloodletting are the best demonstrations 
 of the utility of the specific objects contemplated in the present arti- 
 cle. I shall therefore supply another, which may be derived from the 
 distinguished Mr. Liston, so able in surgery, and who advises 
 
 " Every practitioner to think twice of the prohahle and possible ef- 
 fects in every case of disease before he determines upon and proceeds to 
 open a vein for the purpose of draining off the vital fuid." 
 
 This distinguished surgeon also recommends the use of aconite for 
 the cure of erysipelas (§ 892|, d). Just now, also (1845), Dr. Flem- 
 ing (President of the Royal Medical Society of Edinburgh) appears 
 with an able work on the same most destructive agent; and, although 
 agreeing with him, most entirely, as to the value of this remedy in 
 neuralgia, when topically applied, and there be no active inflammation, 
 every consideration of experience is opposed to his declaration, that, 
 
 " Aconite not only effects a cure in a shorter period than any other 
 mode of trea.tment, in acute rheumatism, but appears to possess the great 
 negative advantage of not increasing the liability to extension of the dis- 
 ease to the membranes of the hearth 
 
 The great difficulty with bloodletting in acute articular rheumatism 
 has consisted in its too limited application ; and if the remedy, as is 
 said, be chargeable with the vice of lighting up the disease in the 
 heart, it is for the foregoing reason (§ 893 n, 950, 965, 1000, 1001). 
 Bouillaud is thought to have occasioned no little of this mischief by 
 " copious bloodletting," and mainly because of his expression, — " coup 
 sur coup." But, he rarely ventured beyond a pound or two of blood ; 
 and this quantity was made up by successive bleedings, — " coup sur 
 coup." His practice, therefore, was but a feeble resuscitation of that 
 far more successful treatment, in France, by copious abstraction of 
 blood. — {Med. and Phys. Comm., vol. i., p. 325, 326.) 
 
 Finally, I hold that the internal use of aconite is inadmissible in all ac- 
 tive forms of inflammation, and endangers life under all circumstances 
 of health or disease. Had Dr. Male, of Birmingham, who employed 
 this remedy to the extent of some eighty drops of the tincture in four 
 days, in augmented doses varying from five to ten drops, for the re- 
 lief of simple, chronic pain in the back, upon the recommendation set 
 forth in the work by Dr. Fleming, been as obviously the victim of 
 bloodletting as he was of the aconite, it can hardly be doubted that 
 such a case would have been marshaled against bloodletting in all 
 forms of disease. — Note H p. 1117. 
 
 Nor will I neglect this opportunity of objecting to the proposition
 
 THERAPEUTICS. — LOSS OF BLOOD. 721 
 
 ot Dr. Graves, of Dublin, that belladonna, instead of blooc letting, 
 should be employed in those congestive fevers in w^hich cereoral dis- 
 ease is attended by contraction of the pupil, and upon the ground, 
 mainly, that belladonna so affects the brain as to produce a dilatation 
 of the pupil. It is evident, however, that this reasoning is fallacious ; 
 for, if belladonna be given in any of the common forms of cerebral dis- 
 ease that disease will be aggravated in proportion as the pupil dilates 
 under the influence of this agent. In justice, also, to the remedy 
 which I advocate, I may say, if its applicability rested on no better 
 foundation, and if, especially, surrounded by the same objections as 
 belladonna, its recommendation would be justly regarded as rash and 
 unphilosophical (§ 469, 476 c, 487, 48S|-, 500 h, 569, 892 d, 906, mot- 
 to, d). 
 
 960, h. It may be also difficult to say, whether the mere negative 
 pretext for loss of blood, such as dry cupping, or the substitution of 
 violent internal agents without a plausible apology, or the more com- 
 mon and exclusive dependence upon cathartics, and other acknowl- 
 edged but minor antiphlogistics, has been most destructive of life. 
 Certain it is, however, that they who most discourage bloodletting are 
 genei'ally the greatest advocates of the violent agents of the Materia 
 Medica. And, it is not a little astonishing with what calm indiffer- 
 ence we contemplate the ravages of this unmitigated practice, or the 
 tonic and stimulant treatment of fevers ; and more especially when 
 the consequences are alienating multitudes to the soft embraces of 
 homoeopathy (§ 857, 878, 893 «).— Note H p. 1117. 
 
 960, c. I have already stated my opinion that, among the sequelae of 
 morbid anatomy as originally taught by the modern Parisian school, 
 and adopted by others, is the system of " Specialities ;" a name suffi- 
 ciently significant of its dismemberment of medicine. To this inno- 
 vation upon a comprehensive science, whose parts can be no more 
 separated, and viewed in the abstract, than any one of the great or- 
 gans of life can be separated from the rest, and yet go on with its own 
 functions and the residue of the shattered whole with theirs, may be 
 traced up many of the great errors in practice as well as in medical 
 philosophy (§ 129, 137 e, 163, 638, 685, 686). That the "special" 
 system was an immediate emanation from the hospitals of Paris is 
 evident not only fiom the natural relations of the pursuits, but from 
 the fact, also, that they sprung up together. Nature thus became dis- 
 jointed ; every thing in disease took on the aspect of materialism ; 
 nothing was to be seen but lesions of structure within, and blotches 
 and scabs upon the surface ; one kind of fever was located in the liv- 
 er, another in the spleen, and dropsy in " Bright's disease of the kid- 
 neys." Medicine was cut up, in the Parisian hospitals, into numerous 
 tragments, and brought under all the details of the mechanical princi- 
 ple of " a division of labor." Much, however, is owing to an igno- 
 rance of the laws of the nervous system in their relations to disease. 
 But, it is also to the same method, in part, that we must ascribe the 
 attempts of a smaller number to substitute tobacco, belladonna, aco- 
 nite, &c., for bloodletting, in the treatment of inflammation and fever ; 
 and it is upon this ground that Magendie' was led to imagine that he 
 had produced, in the presence of his class, yellow fever in dogs, and 
 typhus fever in cats (§ 744), and which, especially, has induced many 
 to believe in the matchless virtues of quinia as displayed by Piorry 
 
 Z z
 
 722 INSTITUTES OF MEDICINE. 
 
 when he attempted the dislodgment of intermittent fever from an in- 
 durated spleen (§ 892, Jc, 892| i). 
 
 960, d. But, it is not alone the intrinsic nature of the fundament- 
 al evil which has introduced the new system of teaching medicine. 
 There never was a time when so many zealous aspirants were com- 
 mended to places either by clamors, or by the force of industry. The 
 revolution was also only a part of the fashion of the day ; and its pre- 
 cipitation harmonized exactly with the achievements in medical chem- 
 istry, and other analogous varieties in the wide field of philosophy. 
 Fortunately, this corruption has not yet fastened itself upon the Medi- 
 cal Colleges of Great Britain or America ; and the hope may be there- 
 fore entertained that the worst of it has passed (^ 1008). 
 
 960, e. Nor will I leave the foregoing allusions to the comparative 
 value and abuse of the great agents for disease, without referring to 
 the general apathy which is manifested at the havoc which the whole 
 band of empyrics are dealing out with their domestic engines of death ; 
 while, were the lancet equally common in their hands, and only now 
 and then a startling slaughter, that solitary result would rouse the in- 
 dignation of the profession, and distm-b the peace of society. 
 
 960, _/! The advocates of bloodletting have sometimes affected its 
 reputation by the mere language in which it is recommended. They 
 are said to be rash ; and bloodletting shares the odium. Thus, Dr. 
 Elliotson, in speaking of enteritis, remarks, that " The first thing one 
 has to do is to bleed the patient well. You mitst set him vpright as he 
 can be, and bleed him from a large orifice without any mercy ^ The 
 prejudiced, or unreflecting, look only at the language ; but an upright 
 posture, and a large orifice, render the operation safe, and compara- 
 tively mild, though it proceed, as it should, ad dellquium. 
 
 960, g. I have no doubt that much of the antipathy to bloodletting 
 has grown out of an illusion natural to the fears of man. It is not 
 wholly predicated of debility; for we constantly meet with admoni- 
 tions against its use in high inflammations, which are not remarkable 
 for their prostrating effect. But, there is nothing more deeply implant- 
 ed than the knowledge of the immediate importance of the " vital fluid" 
 to the life of every animal ; and this conviction has been farther roused 
 into operation by perverting the authority of Holy Writ, that " in the 
 blood is the life thereof;" though, had Scripture said that in Calomel, 
 Jalap, and Emetic Tartar, or Tobacco, Aconite, Lobelia, and Bran- 
 dreth's Pills, is the death thereof, the quotation would have been 
 hourly apposite. We are, also, dead in a few seconds from the divis- 
 ion of a large artery ; and we scarcely see a difference in the rapidity 
 of the result when this method, or a division of the medulla oblonga- 
 ta, is employed for the destruction of life. Hence, many come to as- 
 sociate bloodletting, as practiced for the relief of disease, with the ex- 
 treme method of effecting death. I shall not dwell upon this want of 
 philosophy, but shall only now say, that it is the same defect which 
 leads the objectors to bloodletting in disease to its constant applica- 
 tion to pregnant women, and to others dying of apoplexy, or from the 
 shock of a fall, or from drinking cold water, and where there may 
 have been no other inducement for the practice than the capricious 
 desire of the subject, or the prejudice of society. I shall, however, 
 endeavor to indicate still farther the fallacy of the latter practice, and 
 to point out, as it respects disease, some of the principal causes wfiich
 
 THERAPEUTICS. LOSS OF BLOOD. 723 
 
 modify the necessities of the system in relation to its ordinary supply 
 of blood, and how it sustains the privation by the same contingent in- 
 fluences. 
 
 960, li. Let us, finally, have a word upon the doctrine laid down 
 and so well understood by Hippocrates, that, " Severe diseases require 
 sevei-e revicdies'^ (§ 906, motto, e). 
 
 From what has been said under the general consideration of Thera- 
 peutics, it appears that this rule is to be received in a broad, not a 
 universal, sense (§ 906, y). We have seen, for example, that it is re- 
 markably liable to exception in small-pox, &c. This grows out of 
 the nature of the predisposing causes of disease, which alter the prop- 
 erties of life according to the nature of each agent. Each one, as I 
 have said, affects them in hind,^ and in a way peculiar to itself. We 
 have seen this impressively exemplified in the self-limited diseases ; 
 and it is shown in the morbific effects of all the agents of the Materia 
 Medica. One will alter the vital states, either in health or disease, 
 more profoundly and more permanently than others. Such, also, is 
 the principle upon which depend the hereditary predispositions to dis- 
 ease. Then we have those dormant changes which constitute the pre- 
 disposition to idiopathic fever, and which may be in a state of incuba- 
 tion for a year or more before the final explosion. 
 
 In all such cases, the properties of life are more or less permanent- 
 ly affected, though not profoundly, till an explosion of more absolute 
 disease shall follow ; but often as the result of a long and impercepti- 
 ble series of morbid changes. In tuberculous phthisis, cancer, syphilis, 
 &c., the properties of life are deeply, as well as more permanently 
 and obstinately affected, and it may be impracticable for art to induce 
 such changes as shall place the diseased states in a recuperative con- 
 dition; though disorganization may be now the main obstacle. 
 
 Then we have the varieties and gradations of febrile and inflamma- 
 tory diseases, which, according to the nature of the predisposing causes, 
 either yield spontaneously, or submit readily to appropriate remedies, 
 or the force of disease may be too intense for active treatment (§ 961). 
 
 Here, too, we derive important lessons from experience, in a more 
 restricted sense, which go with what experience has reduced to prin- 
 ciples in respect to the modifying effects of the remote causes of dis- 
 ease, in establishing the principle that the treatment of disease must 
 be governed by the existing pathological states, and with a reference 
 to the nature of the predisposing causes, and that great modifications 
 may be necessary in diseases of a common genus, though all the cases 
 may be distinguished by equal violence, and by many prominent phe- 
 nomena that may be very analogous. It is now, therefore, that we 
 find the general rule, that " severe diseases require severe remedies," 
 may demand a great modification (§ 52, 137 d, e, 143 c, 150-152, 163, 
 650, 666, 670, 673, 674 d, 675, 685, 686, 847 g, 854 d, 856 b, 857, 
 858, 859 b, 861, 863, 868 b, 870 aa). 
 
 The application of the rule will depend, I say, in a general sense, 
 upon the nature of the remote causes, the organs affected, and the 
 extent in which the restorative principle is impaired. A vast variety 
 of diseases require no aid from art. Others, again, like pneumonia, 
 enteritis, &c., require a prompt and energetic, interference. But, 
 againfthere are maladies of great violence, as in the examples already 
 mentioned of small-pox, measles, scarlatina, &c., in which the same
 
 724 INSTITUTES OF MEDICINE. 
 
 treatment cannot be pursued, in a general sense, as in many diseases 
 whose symptoms are much more violent (^961, 964, 976, c). 
 
 It might, therefore, seem that Nature is here contradicting herself. 
 But it is far otherwise. The apparent contradictions are only illus- 
 trations of her perfect consistency, and of the great laws that morbific 
 causes alter the nature of the properties and functions of life accord- 
 ing to the virtues of each cause, and that artificial impressions can be 
 salutary only in proportion as the morbific causes impair the recuper- 
 ative principle. But, owing to constitutional peculiarities, and vari- 
 ous incidental influences, the disposition to the restorative process in 
 the self limited diseases may be more or less impaired, or inflammation 
 of important organs may supervene, when Nature will require the in- 
 tervention of art, according to the existing modifications and compli- 
 cations of disease. Again, as in the hot stage of fever, the very recu- 
 perative efforts of Nature, if I may say so, are often so excessive as 
 to result in actual increase, or in developments of, disease, and there- 
 fore require the interposition of art for a certain degree of restraint 
 (§ 675). These principles will be now illustrated by the efiects 
 
 Of Bloodletting in the Congestive Forms of Disease. 
 
 961, a. It often happens that idiopathic fever is attended with ve- 
 nous congestion of one or more important organs ; and, as we have 
 seen, it is the tendency of this inflammatory condition of the venous 
 tissue to embarrass the organs of circulation, especially the heart. 
 The same peculiar influences are sometimes witnessed in the inflam- 
 mations of other tissues ; particularly in the advanced stages of phthi- 
 sis pulmonalis (§ 961,y). In all the congestive forms of disease, es- 
 pecially when of an acute nature, the general susceptibility of the 
 system to the loss of blood is increased. I may also say that the pros- 
 tration which is induced by venous inflammation is quite different from 
 that which results from inflammations of' any other tissue (§ 135-137, 
 140, 150). It is also greatly different from that which attends the 
 cold stage of fever. In the first case, very morbific nervous actions 
 are reflected upon many important organs, and, unless artificially re 
 lieved, the powers of life may sink rapidly to a state of extinction. 
 Nature is, as it were, knocked down, and is incapable of a recupera- 
 tive effort. In the last cases, however, the impression is manifested 
 chiefly in the circulatory system. There is not that profound lesion, 
 in the absence of venous congestion, which prevents the recuperative 
 effort ; and hence it probably always happens in pure fever that reac- 
 tion soon follows the stage of depression (§ 675, 764). Something 
 like the converse of this is seen in those erysipelatous inflammations 
 of the throat which sometimes give rise to an apparently great com- 
 motion of the system. But, if there be no great amount of abdominal 
 disease attendant on these cases, the reflex nervous action is ex- 
 pended upon the circulatory apparatus ; when any remedy that will 
 relieve the throat will be followed at once by a subsidence of the ar- 
 terial excitement (§ 140, 927 h). But, these cases are apt to be com- 
 plicated with obscure, though severe congestive disease of the abdom- 
 inal organs, especially of the liver, which has thrown deeply a morbific 
 predisposition over many other parts, and which, in consequence, feel 
 more profoundly the influences propagated by the intense inflamma- 
 tion of the fauces In such instances, however, the general arterial
 
 THERAPEUTICS. LOSS OF BLOOD. 725 
 
 excitement is less than in some of the violent affections of the fauces 
 which may be greatly of a local nature, or where any accompanying 
 abdominal disease may be of a different nature from congestion (§ 
 689 I, 973), and according to the nature of the reflex nervous actions. 
 
 961, b. Venous congestion, independent of fever, is a common form 
 of disease, and manifests the same tendency, as when connected with 
 idiopathic fever, to embarrass the organs of circulation. But, this is 
 only a contingent effect ; since the general manifestations of the disease 
 in respect to the circulatory apparatus exist in a subdued form of that 
 excitement which attends the ordinary forms of inflammation (§ 390 b, 
 688 C-X-, 786, &c., 978). But, when venous congestion becomes sud- 
 denly aggravated, or other causes may increase the susceptibility of 
 ihe system so that the congestive disease may be more sensibly felt in 
 its sympathetic influences, there often takes place a general prostra- 
 tion of the animal functions, and a very impaired condition of the or- 
 ganic, through a peculiarly alterative reflex nervous action.* 
 
 It is, however, in congestive fever that we witness the strong dem- 
 onstrations of venous congestion in generating extensive and profound 
 lesions through its very morbific reflex nervous actions. This is espe- 
 cially true if the local disease exist at the invasion of the constitution- 
 al malady. It has then already shed a malign influence in connection 
 with the predisposition to the general disease ; and, as these influen- 
 ces progress together, they come in with intense force when the explo- 
 sion takes place, and, unless art should now interpose, the diseases go 
 on mutually exasperating each other, and calling into existence other 
 congestions, or inflammations, which make all haste to join in the 
 circles of disordered movements (§ 143, 514 Ji, 666, 902 g). The 
 presence of venous congestion not only aggravates the constitutional 
 disease, but, in itself, modifies the nature of that affection for the 
 worse (§ 786, &c.), prolongs the stage of intense morbid action (§ 
 764, a), often prevents the succession of the hot stage, and does its 
 own peculiar part in overthrowing the organic functions ; often ex- 
 erting its malign influence till subdued by art (§ 927). Here, too, it 
 is that art must make its demands upon science more extensively, more 
 deeply, than in any other conditions of disease. The proper manage- 
 ment of bloodletting, cathartics, &c., or whether a stimulant shall be 
 first administered, or whether under the most appalling aspects of the 
 combined force of disease we shall leave all to Nature till she will 
 admit of help, are often problems upon which life is poising at the 
 moment, and can be resolved only by the enlightened physician. 
 
 But, it commonly happens that remedial aid may be promptly and 
 efficiently administered ; and, it will be my purpose, therefore, to in- 
 dicate that system of treatment which is demanded in a vast propor- 
 tion of the cases (§ 1056, 1068, a). 
 
 As a preliminary step, I must refer the reader to what I have said 
 of the pathology of venous congestion (§ 786-818), and especially to 
 the Medical and Physiological Commentaries, for the proof of the in- 
 flammatory nature of venous congestion, and its dire effects upon or- 
 ganic life. It is also important to add, in this place, that although 
 there exist more or less apparent prostration of life in the aggravated 
 conditions of venous congestion, and of active phlebitis, as, also, in 
 congestive fever, the term is here employed in a conventional sense, 
 and not as significant of debility, or of any necessary depression of 
 
 * The blood often gravitates from congested veins after death, especially of the liver, 
 leading to a false conclusion that there had been no such affection (§ 699 c, 800).
 
 726 INSTITUTES OF MEDICINE. 
 
 vital action. The circulatory organs are, indeed, often more or less 
 sunken in their action ; but the immediate instruments by which the 
 morbid processes are carried on are actually exalted in their organic 
 properties. These properties, too, are now greatly diverted from 
 their natural state ; and it is that alteration in kind which essentially 
 constitutes the local condition of disease, and from which arise its mor- 
 bific reflex influences, and it is this, and the partial loss of volun- 
 tary control over the muscles of animal life, which have led to the 
 doctrine of debility (§ 410, 476 c, 487 h, 500 7i, 569, 639, 743, 746, 
 780, 915-921, 999 ^).— Note Ff p, 1135. 
 
 961, c. In consequence of the foregoing morbid state, the sudden 
 abstraction of two or four ounces of blood, in congestive fevers, ute- 
 rine phlebitis, &c., will often produce syncope. But, where the com 
 plications consist of the ordinary forms of inflammation and venous 
 congestion a greater loss of blood will be sustained at its first ab- 
 straction ; though generally less than when the same inflammation is 
 unattended with congestion (§ 137 d, 140, 476| 7i, 803, 804, 806, 973). 
 
 961, d. In the foregoing cases a small loss of blood will frequently 
 create a greater tolerance of the remedy ; especially if syncope super- 
 vene. It happens, therefore, in numerous cases, that we may proceed, 
 soon afterward, to abstract sixteen to forty ounces without producing 
 syncope. The first impression on the organic properties so modifies 
 their condition and lessens their susceptibility, and mitigates the force 
 of disease, and releases the embarrassed circulation, that the subse- 
 quent and greater loss of blood often fails of producing any powerful 
 influence, unless carried to a pretty large extent. Dr. Burnett, in 
 describing the congestive fevers of the Mediterranean, says, " it will 
 often happen, after a few oimces of blood have flowed, that syncope 
 will be induced. But, in the course of an hour the bleeding may 
 generally be repeated, and thirty or forty ounces may be taken away 
 without producing syncope." Such has been often my experience. 
 
 961, e. In cases of the foregoing nature there is more or less de- 
 termination of blood from the circumference, and its consequent accu- 
 mulation about the right cavities of the heart, by which this organ is 
 embarrassed in its action, generally contributes to the early syncope. 
 Among the results of the vital change effected in the capillary vessels 
 by a small loss of blood is their immediate expansion, and a returning 
 equilibrium of the circulation. It is true that loss of blood, by increas- 
 ing the contraction of the capillary vessels, increases, also, the deter- 
 mination of blood upon the heart; and it is in part, as I have said, for 
 this reason, that a small loss of blood often overpowers the circulatory 
 organs. But, when syncope passes away, this state of the circulation, 
 and other morbid phenomena, will have been more or less subdued. 
 The influence of loss of blood which results, as a primary effect, in 
 increasing, or producing a contraction of the capillary blood-vessels, 
 is so essentially different from that of the morbific cause which deter- 
 mines, apparently, the same phenomenon in the cold stage of fever, as 
 in the analogous conditions of venous congestion, that it alters the 
 morbid state, and thus places the vessels in a way to undergo an ac- 
 tive expansion ; or reaction, as it is called. And herein we witness a 
 critical instance of the alterative nature of loss of blood, and how its 
 influences are exerted, and how apparently the same phenomenon is 
 not the same, and may be, therefore, due to even opposite causes (§ 
 150-152, 650, 1039, 1040, 1056, 944 c, 954 d).
 
 THERAPEUTICS. LOSS OF BLOOD. 72T 
 
 961,y. We sometimes observe a similar prostration of the circula- 
 tory organs from acute inflammation, when attended with pain, espe- 
 cially of the intestines. Here, too, is the same inability at first to 
 bear the loss of blood, and the same tolerance created by its abstrac- 
 tion (§ 961, a). Thus, Dr. Wardrop : "A gentleman was seized with 
 acute pains in his bowels, accompanied with a good deal of tender- 
 ness on slight pressure, along with some degree of febrile excitement. 
 On opening a vein in his arm, only a few ounces of blood were re- 
 moved, when the pulse sank and he fainted. In two hours afterward 
 I bled him again, and he did not fall into a state of syncope until he 
 had lost about thirty ounces of blood" (p. 79, Note as to pain). 
 
 Many examples of the foregoing nature occur in the " Commenta- 
 riesP 
 
 962. When syncope is produced by a small loss of blood, and by 
 the loss alone (§ 938), and where this remedy is demanded, the dis- 
 ease is serious, and will probably require one or more prompt repeti- 
 tions of general bloodletting. Nothing short of this treatment will be 
 likely to subdue the obstinate venous congestions which are the usual 
 cause of the prostration of the system, and of the intensity of the fe- 
 brile force, if complicated with this constitutional form of disease. 
 
 963. If mental causes, or intestinal irritation, have contributed to 
 early syncope, we may generally proceed to the farther abstraction of 
 blood soon after the patient revives, which, in the cases now under 
 consideration, is commonly important (§ 937). If loss of blood, 
 alone, have been the cause of the early paroxysm, a longer interval 
 (four, six, or eight hours) may be most expedient, or necessary (§ 
 794, 795, 801). The state of nervous influence decides the whole. 
 
 964. a. In the cases now supposed, the prostration is sometimes so 
 great that it may be necessary to create a tolerance of loss of blood by 
 previous stimulation, or before resorting to the repetition of bloodlet- 
 ting (§ 961, V). And here, too, enlightened experience abounds in 
 the records of medicine. Thus: 
 
 " Immediately upon the application of warmth to the surface," says 
 Dr. Gallup, " take a little blood ; perhaps two, four, six, or eight 
 ounces, according as the patient may bear it. If he be a little faint, it 
 is nothing but what is common ; a little time will remove it. He will 
 soon bear a second bleeding in this condition better than the first." 
 
 Aretaeus not only describes this condition of disease, but advises 
 the same enlightened practice, especially if the congestion be the oc- 
 casion of great prostration and " syncope." " Venas itaque in cubito 
 protinus caedito, multumque sanguinis, sed non semel totum mittito ; 
 imo, et bis, et ter, alio die, quo interim vires instaurcntur repitito." 
 Alexander of Tralles discourses in the same manner upon this subject. 
 The language of A. Pare is remarkably graphic in describing the treat- 
 ment of the Plague and " Pestilent Diseases." It con-esponds with 
 the best philosophy of our own day. 
 
 " So soon," he says, " as the heart is strengthened and corroborated 
 ^ith cordials and antidotes, we must come to phlebotomy and purging." 
 " You may perceive that the patient is ready to swoon when that his 
 forehead waxeth moist with a small sweat suddenly arising, by the 
 aching or pain at the stomach, with an appetite to vomit, and desire 
 to go to stool, gaping, blackness of the lips, and sudden alteration of 
 the face into paleness, and, lastly, most certainly by a small and slo\^
 
 728 INSTITUTES OF MEDICINE. 
 
 pulse : and then you must lay your finger on the vein, and stop it until 
 the patient come to himself again, either by nature, or else restored 
 by art ; that is to say, by giving him wine, or any such like thing : 
 then, if you have not taken blood enough, you must let it go again, and 
 bleed so much as the greatness of the disease or the strength of the 
 patient will require or permit" (§ 892|, i). 
 
 9G4, h. No injury can grow out of the use of stimulants in these 
 cases while the powers and actions of life are so morbidly aftected as 
 to be still more injured by the loss of a small quantity of blood. In 
 these cases; bloodletting, without previous stimulation, impairs still 
 farther the vires vitse, which are now too morbid to react under its 
 influence, and it increases, permanently, the determination of blood 
 from the circumference to the centre. 
 
 964, c. In other cases like the foreacoin": disease is so intense at its 
 mvasion, and Nature so little recuperative, that it may be impossible 
 to create a tolerance of loss of blood. No reaction appears in these 
 cases, and all such patients must perish (§ 149, 150, 794, 795, 801, 
 808 b). Nothing will rouse an exciting reflex nervous action. 
 
 964, d. At other times, even in the active forms of inflammation, 
 the power of the system to bear the loss of blood may be destroyed 
 by other remedies. Thus, it frequently happens in croup, that emet- 
 ics, especially of tartarized antimony, render bloodletting impractica- 
 ble, particularly when they produce catharsis instead of vomiting ; 
 and the patients may then die from their inability to sustain the ne- 
 cessary loss of blood. Thence appears the importance of carefully 
 considering their relative order in the administration of remedies, es- 
 pecially where loss of blood may be essential. I am certain, from ob- 
 servation, that bloodletting has lost its reputation, with some, in pneu- 
 monia, &c., from its having been applied unsuccessfully under the 
 prostrating influence of tartarized antimony, and when, in conse- 
 quence, the powers of the system would only admit of a moderate loss 
 of blood, and would not bear the superadded depressing nervous action. 
 
 965, a. Dr. M. Hall, and some other writers, suppose that the pow- 
 er of the system to bear an increased loss of blood is owing to an in- 
 crease of disease ; which appears to me an important practical error. 
 On the contrary, the first bloodletting generally diminishes the activity 
 of inflammation, however it may subsequently acquire its original or 
 greater force. It is true that an increase of inflammation will act in 
 the manner supposed ; but it does not thence follow that there has 
 been an increase of disease in other cases because the patient bears 
 a second better than the first bloodletting. Indeed, in the cases now 
 before us an increase of the venous congestion after the first blood- 
 letting often diminishes the tolerance of loss of blood, on account of 
 the peculiar influences of that form of disease. This, too, is especially 
 apt to occur where the abstraction of blood has been inadequate to 
 the exigencies of the case ; and these cases, in consequence, have 
 brought great disrepute upon the remedy, though it be the only prac- 
 tice that supplies a chance of relief. 
 
 965, b. When too little blood has been abstracted for the exigen- 
 cies of the disease, although frequently repeated, it may increase the 
 force of the malady. Inadequate depletion so modifies the organic 
 
 Eowers that it rouses them into greater energy ; the whole circulation 
 ecomes released from its embarrassment in the capillarv system ;
 
 THERAPEUTICS. LOSS OP BLOOD. 729 
 
 and the heart being thus, and in other ways, set at liberty and invig- 
 orated in force, propels the blood with increasing violence. This me- 
 chanical influence, in itself, lights up the flame of disease, and kindles 
 it in other parts already disposed to join in the disordered movements. 
 But much is also due to an augmented irritability of the instruments 
 of action ; when irritability would probably have been lessened by a 
 greater loss of blood. The effect produced by the smaller loss, in 
 rousing and otherwise modifying the general capillary action, reflects 
 a stimulatiug nervous influence upon the immediate instruments of 
 the local malady, which, in its turn, had equally sustained, in the more 
 direct manner, an exalted state of action ; and thus are instituted cir- 
 cles of reacting sympathy between the general and local capillary ves- 
 sels (§ 982-1003). The same results, it is true, with the exception of 
 the morbific, attend the loss of blood when carried to the extent of 
 its curative influences (§ 961 d, 966, 994 b, 1005 e). The remedy, 
 therefore, in all grave visceral congestions, as well as in inflamma- 
 tions, should reach the point of absolute depression. The powers 
 of life are then not only subdued in energy, but the strength of the 
 impression places them in the way of the recuperative process (§ 
 961 e, 1056, 1068).*— Notes Ee p. 1133, Ff p. 1135, Go p. 1138, Ll. 
 
 966. Leeching is absolutely inadmissible in the foregoing forms of 
 disease. It is now a great object to relieve the heart of its morbid 
 sympathies with the capillary system, and of the accumulated blood, 
 and thus establish something like an equilibrium in the organs of cir- 
 culation. But, since it is the primary effect of loss of blood to pro- 
 duce a contraction of the capillary vessels, and to thus determine an 
 unusual volume of blood upon the centre of circulation, that mode of 
 bloodletting should obtain which is least obnoxious to these objections 
 (§ 921). This is genei'al bloodletting; and although it increase the 
 general contraction of the small vessels, its impression is then so rap- 
 id that it more or less subverts, with a corresponding instantaneous- 
 ness, their morbid state. An immediate- dilatation of the vessels is 
 the consequence, the blood circulates with greater freedom, and thus 
 the heart is enabled to throw off" the accumulated blood ; while the 
 favorable change induced in the extreme vessels moderates or re- 
 moves their depressing reflex nervous action, by which the heart is 
 farther roused into increased energy (§ 921, 934, 944 c, 965 b). 
 
 967. The prostration of which I have spoken in this division of my 
 subject is commonly mistaken for debility (§ 469, 476 c, 487 7i, 488|, 
 500 h, 569). Stimulants are therefore too apt to usurp the place 'of 
 bloodletting and other analogous means, and to occasion a frightful 
 mortality. On the contrary, there should be no delay of that decisive 
 use of the remedium principale which may be demanded by the exi- 
 gencies of the case. Seize the first moment that nature is ready, 
 should any preliminary steps be required (§ 964, a), or she will soon 
 advance to a more forbidding state, and baffle the well-directed eflforts 
 of art (§ 863,(^,999 0-1007, 1019).— Notes Ee p. 1133, Ff p. 1135, Ii. 
 
 968. Since, therefore, it is always important to do as much as mav 
 be requisite, and as nature may admit, at the early stages of disease 
 requiring the loss of blood, we must not be deterred by early syncope 
 from early attempts to abstract the quantity of blood which the exi- 
 gencies of the case may seem to demand. It is astonishing how soon, 
 111 congestive fevers, the morbid powers of life will rally under the 
 
 * It is a paradox to most that a large loss of blood maj' be curative wlien a smaller 
 would be fatal, but the former perhaps unnecessary to life (§ 1001, 1005 g).
 
 730 INSTITUTES OF MEDICINB. 
 
 loss of a few ounces of blood, and how soon we may subsequently 
 proceed to a more decisive use of the remedy, 
 
 969, a. Where venous congestion is associated with idiopathic fe- 
 ver, and the stage of reaction appertaining to the constitutional dis- 
 ease has come on, the prostrating influence of loss of blood is vastly 
 lessened, and far greater quantities are often borne at its first ab- 
 straction ; and this especially, as will appear in the next following di- 
 vision of our subject, if some active form of inflammation be also at- 
 tendant ; though even now it oftener happens that a second bloodlet- 
 ting is better sustained than the first. In all these cases the several 
 forms of disease constantly interchange modifying reflex nervous ac- 
 tions, and these modifications are as constantly varying, either sponta- 
 neously or through the operation of foreign causes. 
 
 969, h. It will appear, also, that simple venous congestion of the 
 brain sometimes manifests a strong exciting influence upon the organs 
 of circulation ; when bloodletting is borne, at its first application, to 
 an extent which never obtains under the usual depressing influence 
 of the disease (§ 688 c-f, h, 806, 978). 
 
 969, c. Although it be generafly true that it is the tendency of ve- 
 nous inflammation, whether in its active form, as in phlebitis, or in its 
 sub-active, as in venous congestion, to depress the general circulation, 
 and, when the latter is attendant on idiopathic fever to delay the stage 
 of reaction, and that it is the usual effect of loss of blood to increase 
 that depression, progressively, till syncope comes on, there are, never- 
 theless, numerous instances in which the remedy manifests an oppo- 
 site effect. That is to say, relief may be so instantaneous that the 
 pulse will increase in volume and force, the dark and trickling blood 
 spout out with a florid hue after a few ounces have escaped, and 
 while still flowing from the arm.* In these cases the . abstraction of 
 blood should be continued till the pulse is again subdued, or the ne- 
 cessary impression will not be produced (§ 806, 1056). 
 
 969, d. So variable in intensity are the morbid changes in the dif- 
 ferent varieties of congestive fever, especially the local congestions, 
 as in the plague, yellow fever, typhus, &c., at different times, that an 
 impression exists with many that those diseases must be treated at 
 one time with stimulants, while bloodletting may be necessary at an- 
 other. But this is neither true nor philosophical. On the contrary, 
 since the same disease is always essentially the same (or there is an 
 end to all medical philosophy, § 752, &c.); and since also disease is 
 most intense and malignant where bloodletting is, at first, most imper- 
 fectly borne, if this agent be important in the mild forms, it is more 
 so where the prostration, and, therefore, the amount of disease, is 
 greatest. This, too, is universally sustained by all the best experi- 
 ence (§ 1005. Also, p. 868-872, ^ 1068).— Notes Ff p. 1135, Kk. 
 
 970, a. Cases not unfrequently occur' which present many of the 
 phenomena of the prostrated conditions of venous congestion, and 
 congestive fever, which have no affinity with those diseases, but which 
 are constantly confounded with them. Such is the case with injuries 
 from falls, the shock of surgical operations, &c. Here the powers of 
 life are actually and simply reduced; certainly not modified as by 
 the action of specific morbific causes (§ 790 h, 961 h). 
 
 970, h. In the latter instances the abstraction of blood has been 
 often fatal, and should never be practiced unless some inflammation 
 • See Kbiemeb's experiment p. 310, ^ 485.
 
 THERAPEUTICS. LOSS OF BLOOD. /31 
 
 subsequently spring up. But if the prostrating nervous influence be 
 great, even though the brain have sustained concussion, stimulants 
 should be administered. This should also be the practice in the 
 analogous conditions which are produced by drinking cold water 
 when in an excited state from the united effect of hard labor and hot 
 weather. Opiates should be also employed to relieve the stomach. 
 In apoplexies, when the pulse is sunken bloodletting should be de- 
 layed, or cautiously practiced at first. The morbid state of the brain, 
 or pressure on the organ, has determined, in such cases, a perni- 
 ciously depressing influence on all the powers of life, and the impres- 
 sion from loss of blood superadded to this morbid influence may de- 
 stroy the patient at once. Bloodletting will be ultimately necessary, 
 and perhaps to a large extent. It commonly happens, however, that 
 an opposite or exciting nervous influence is determined upon the 
 heart and capillary vessels, at the invasion of apoplexy ; that the 
 pulse is full and bounding, the face flushed, &c. In these cases, de- 
 cisive bloodletting, cathartics, &c., are the principal remedies. — [Med. 
 and PJiys. Coinm., vol. i., p. 342-361 ; vol. ii., p. 234-238.) 
 
 970, c. There are many sympathetic affections supervening on con- 
 gestive disease of the abdominal organs which appear to most observ- 
 ers to be the leading condition of disease ; such as diff'use inflamma- 
 tion of the mucous tissue of the fauces, erysipelas, painful affections 
 of the head, &c. These, however, as I have before said, should be 
 considered rather in the light of symptoms, while the essential means 
 of cure should be directed to the primary and principal seat ot dis- 
 ease (§ 6S9, 1). In the cases supposed, many different tissues may be 
 affected, and there may be, also, much variety in the morbid states. 
 There is congestion (sub-inflammation) of the venous tissue of the 
 liver, &c., more active inflammation of the fauces, or of tlie skin. 
 But, the mucous tissue of the stomach, and intestines, is also more 
 or less severely affected, and the head suffers sympathetically. These 
 last conditions, however, are not inflammatory, perhaps ; but so near- 
 ly approximate that pathological state that they are readily converted 
 into it by any increasing force of hepatic congestion {§ 803), by the 
 undue irritation of cathartics, or by improper food, stimulants, &:c. (§ 
 527 d, 528, 529). All, other parts suffer, also, more or less, in their 
 vital states ; and, although variously, there is yet determined through- 
 out, by the leading conditions of disease, a general coincidence be- 
 tween the morbid states that may be strongly pronounced and those 
 which are less so, and where predisposition is only taking place (§ 
 143 c, 150-152, 870 aa). This may be more distinctly appreciated 
 by referring to what I have said of the influences of remote causes 
 (§ 630 c, 652, 657 a, 659, 689 /, 694|, 813, 817, 847 g, 1058 m). 
 
 I am now brought to the application of the foregoing remarks. 
 We see, therefore, from the analogy which prevails throughout the 
 moi'bid states, how a single remedy, like loss of blood, will strike a 
 blow at any one of the pathological conditions ; and the more pro- 
 found its influence upon the principal, the more completely will it 
 subvert the minor affections. But loss of blood is far from being 
 always necessary in these complex conditions ; and we may then find 
 that some internal remedy, as, for example, a compound of six or 
 eight grains of the submuriate of mercury, twelve or twenty of jalap, 
 and one to five of ipecacuanha, will stretch its power to every part of
 
 732 INSTITUTES OF MEDICINE. 
 
 the organism, touch every part with a corresponding salutary in. 
 fluence. and start every part at once on the way of recuperation 
 (§ 143, 2334, 514, 674 d, 733, 804, 811, 847 g, 1056, 1059). 
 
 The foregoing example is also a good illustration of an important 
 doctrine which 1 have propounded to explain what humoralism had 
 neglected ; the exemption of all parts of the body from any deleteri- 
 ous action of the blood in those local forms of disease which are ca- 
 pable of modifying its character. The blood is always affected in 
 nearly one universal way in any given condition of disease ; whatever 
 the sympathetic complexities. The whole condition of the solids, 
 from the highest to the lowest grade of disease, moves on under re- 
 ciprocal harmonizing influences of all parts upon each other, though 
 the greater malady exert a controlling power. The morbid blood, 
 therefore, is exactly adapted in its condition to all parts, and, there- 
 fore, molests none (§ 137 e, 143 c, 847, 870 aa, 984). 
 
 Of Bloodletting in the recognized Forms of Inflammation. 
 
 971. Although I have demonstrated in my Essay on Venous Conges- 
 tion, contained in the Medical and Physiological Commentaries, that 
 its pathological state is constituted by inflammation of the venous tis- 
 sue, the subject, notwithstanding its importance, has received as yet 
 but little attention from the hands of others ; but stimulants, as usual, 
 especially in Great Britain and France, continue to be the favorite 
 means of treatment ; though not so, nor ever so, in these United States. 
 The decision of the right still rests with futurity ; but that future, in 
 the prospective view of America, in the rise of the North of Europe, 
 and the retrospective view of Southern Europe, cannot be distant.* 
 
 972. I now approach, however, conditions of disease which have 
 been, from immemorial time, of an admitted inflammatory nature ; 
 however various the hypotheses as to their pathological cause. We 
 now lose sight, or mostly so, of that depressing influence of venous 
 congestion which so often gives malignancy to fever, and embarrasses 
 or disarms the hand of art, and are in the rriidst of innumerable mod- 
 ifications of the same pathological state as presented by other tissues, 
 that reflect upon the system a series of different influences, though 
 often of an intensely morbific nature (§ 935, d). 
 
 973. a. To comprehend fully the effects of loss of blood in the in- 
 flammatory conditions now before us, it is still important to bear in 
 mind the reciprocal sympathies among the capillary vessels of all parts 
 and with the heart, as set forth in the preceding divisions of our sub- 
 ject, since upon them depend, as in simple forms of venous conges- 
 tion and active phlebitis, the disturbing reflex nervous influences of 
 all local inflammations. But these constitutional results, although de- 
 pendent upon reflex actions of the nervous system as when they spring 
 from venous congestion and active phlebitis, present an aspect more 
 or less different. The local conditions exalt, instead of depressing, 
 the general action of the circulatory organs. There is an expanded, 
 instead of a contracted state, of the general capillary system ; the cir- 
 culation is free, the heart unincumbered with accumulated blood, and 
 beats with more than its natural vigor and frequency. These inflam- 
 mations, therefore, commonly act upon the system at large after the 
 manner of direct stimulants, and thus tend to counteract the depress- 
 ing effect of loss of blood (§ 226, 229, 500 m). 
 
 * The stimulating treatment of all diseases has become very general in the U. S. A. 
 —Notes F p. 1114, H p. 1117, Ee p. 1133, Ff p. 1135, Mm p. 1141.— 1865.
 
 THERAPEUTICS, LOSS OF BLOOD. 733 
 
 973 h. The point, therefore, to be now observed is an apparently 
 oposit<3 effect of reflex nervous action, excited by inflammation, upon the 
 organs of circulation from that w^hich attends the loss of blood or any 
 other sedative agent. One is exciting, the other depressing. One 
 excites general arterial action, the other subdues it. 
 
 974, a. Certain parts, under equal degrees of common inflammation, 
 maintain the general exciting influence upon the organs of circulation 
 against the depressing effects of bloodletting more than others, and 
 this is especially true of the brain (§ 230). In many forms, also, of 
 specific inflammation, as in acute rheumatism, the local vessels are in 
 a peculiarly irritable state, and produce an excessive exciting influ- 
 ence upon the whole sanguiferous system ; the heart itself often par- 
 ticipating, by sympathy, in the rheumatic inflammation (§ 525, 526 b, 
 527). Something in this respect is also due to the nature of the tissue 
 which may be the seat of the affection ; articular rheumatism, for ex- 
 ample, deriving an obstinate character from the peculiar vital consti- 
 tution of the ligaments (§ 133, 134). Here the affection may yield 
 only to gi-eat losses of blood ; especially if the chief dependence be 
 placed upon this remedy. Owing to the same persistence of local dis- 
 ease, and its general influences, cathartics make less impression than 
 in most other active inflammations, unless of the brain. For the same 
 reasons, also, gradually-increased doses of the antimonials are com- 
 monly borne to a large extent, and vascular action yields slowly to 
 their influence. A common principle is concerned with all the rem- 
 edies, according to their developments of reflex nervous action. 
 
 974, h. On the other hand, when inflammation, in rare instances, is 
 aggravated or induced by an excessive loss of blood, such is the com- 
 bined nature of the exciting cause and its curative effects, that the 
 modified irritability of the vessels may readily yield, at the moment, 
 to a farther loss ; but if general bloodletting be now practiced, it will 
 soon go on with its deleterious influence (§ 950). 
 
 974, c. Inflammation of the brain develops very powerfully and ob- 
 stinately an exciting nervous influence, which not only holds in sub- 
 jection, against the usual influence of loss of blood, the whole capillary 
 system and the heart, but this nervous power is determined upon the 
 vascular system of the brain itself with greater intensity than upon 
 the instruments of inflammation in any other part (§ 227, no. 1, 230). 
 Hence it is, that general bloodletting is commonly necessary to a 
 greater extent in inflammations of the brain than of other organs. 
 This is the reason, also, why general bloodletting is required by the 
 cerebral inflammations and congestions of infants, when leeching will 
 often succeed in inflammations of equal intensity in other parts at that 
 period of life (§ 576 e, 925 h, c, 951 b, d, 955, 992, 944 c, 1056).* 
 
 975, a. Again, another general law. So great is the sympathy be- 
 tween vessels of the same order, and especially those in which the 
 organic properties are most active, that while those which are engaged 
 in the process of inflammation remain unsubdued the whole series 
 throughout the body is liable to be thus held in a state of excitement. 
 This is peculiarly true when the brain is the seat of inflammation ; 
 for, while the contraction of its capillaries tends, as a sedative, to pros- 
 trate the general circulation, their morbid excitement, on the other 
 hand, not only contributes to sustain the general circulation, but the 
 influence of a stimulant is, by this cause, still exerted upon the organ, 
 
 * See Note Q p. 1122.
 
 734 INSTITUTES OF MEDICINE. 
 
 and still propagated to the heart and arteries (§ 226, 229, 230, 480- 
 483, 500, 526 a, 916-921, 929-936). The excitement of the vessels 
 of the brain is partly promoted by their peculiar relation to the organ 
 which- is the principal centre of the nervous power, and in part by the 
 tendency of that condition to prevent a contraction of the correspond- 
 ing vessels in other parts. This peculiarity depends upon a special 
 nervous influence which is exerted upon the vessels of the brain in a 
 state of inflammation (§ 231), and is thus distinguished from that con- 
 dition of the vessels in other parts when the seat of inflammation. In 
 inflammations of other organs, therefore, the nervous influence by 
 which excited vessels hold in partial subjection the corresponding 
 series throughout the body is less, and is sooner overcome by loss of 
 blood, and general prostration follows sooner, than when the brain is 
 the seat of inflammation (§ 140, 1039, 1040).— Note Hh p. 1138. 
 
 975, h. Hence the reason why greater loss of blood is generally ne- 
 cessary in cerebral inflammations to produce syncope than in similar af- 
 fections of other parts. In the latter cases, and where general bloodlet- 
 ting is used, the capillaries of the brain are brought imder impression as 
 soon as the loss is felt by the instruments of disease ; and the depress- 
 ing nervous influence then becomes a powerful co-opei'ating cause of 
 the general prostration (§ 930-934, 940-942). But, it is now obvious, 
 that when the brain is the seat of inflammation this influence is ob- 
 tained with greater difficulty. Before it can be established by loss of 
 blood a positive change in its highly-excited capillaries must be effect- 
 ed, and that opposite state of nervous influence which arises from their 
 excitement must be first overcome (§944c). This depression may be 
 often obtained most perfectly, and propagated most extensively, by 
 long-continued syncope. This will sometimes happen in most inflam- 
 mations of other parts, and sometimes of the brain itself, by the loss 
 of small quantities of blood (§ 951 h, 955 h, 1056).— Also p. 920 Note. 
 
 975, c. We learn from the foregoing philosophy the reason why, in 
 cerebral inflammations, there is oftener a rise of inflammation after 
 syncope from loss of blood, than in inflammations of other parts. But, 
 in all the cases, if a repetition of the remedy be required, the same 
 influences will, in a general sense, operate again, and again enable us 
 to abstract all the blood that may be salutary at the next operation ; 
 and so on, till a permanently salutai'y change is established.* 
 
 976, a. Again, in certain diseases where the cerebral and ganglionic 
 systems appear to be much involved, but in an unknown manner, and 
 where, perhaps, there are no special marks of inflammation in any 
 part of the body, vast quantities of blood may be lost without inducing 
 syncope. In these cases there is great nervous irritability. I have 
 seen upward of thirty ounces of blood taken from the arm of a man, 
 in hydrophobia, after the radial artery had ceased to be felt ; the pa- 
 tient being all the while in an erect posture, and remaining to the last 
 without any sense of faintness. Similar cases are recorded by the 
 East India surgeons. 
 
 976, h. On the other hand, we have an opposite state of the cere- 
 bral influence in some cases of mania, and the delirium of drunken- 
 ness, where, from its depressing effect, the condition of the system has 
 been erroneously compared to that of debility (§ 569, d). In some 
 particular cases bloodletting is imperfectly borne ; evidently from its 
 strong impression upon the nervous centres. In the case of drunk- 
 * See Note Ccc p. 1148.
 
 THERAPEUTICS. LOSS OP BLOOD. 735 
 
 enness there is- venous congestion of the brain, and so modified by 
 the remote causes as to often lead to early syncope (§ 816 h, 978). 
 
 976. c. Analogous modifications will also arise from any peculiar 
 manner in which the organic properties of other parts may happen to 
 be affected ; not only in specific inflammations, but from' those shades 
 of difference which attend common inflammation (§ 652 c, 722). Par- 
 ticular influences will be determined upon the whole system by these 
 modifications, according to the nature of the combined influences trans- 
 mitted to the nervous centres, by the exact modification of disease and 
 the special. influences it may exert on other parts, and give a cor- 
 responding direction to loss of blood (§ 150, 151, 228, 500, 514 h). 
 Thence it will appear that much will depend upon the natural rela- 
 tion of other organs to the nervous centres, and to other parts of the 
 body, and the special vital constitution of each (§ 133-138, 143-152). 
 
 Other, and more accidental causes, may contribute to these results. 
 They have all an important bearing upon the effects of loss of blood, 
 often playing an important part in the phenomena of bloodletting ; 
 leading to syncope from the loss of an ounce of blood where we may 
 have calculated upon a pound or more, or where yet more may be de- 
 manded by the exigencies of the case. The effect, therefore, of loss 
 of blood may throw, at once, a flood of light upon some obscure con- 
 dition of disease, as some ill-defined venous congestion, or upon some 
 natural peculiarities of constitution, &c. Or, again, it may be useless, 
 or hazardous, to bleed a patient far advanced in typlioid pneumonia, 
 or in the pleurisy of confirmed phthisis, or in less serious inflammations 
 incident to the scrofulous diathesis, oi* in the phlegmatic temperament. 
 
 It is therefore manifest, that peculiar impressions will be deter- 
 mined upon the nervous centres by the loss of blood, and thence re- 
 flected with vai-ying effects upon other parts, according to the natural 
 constitution of each individual, the nature, extent, force, duration, and 
 org-anic lesions of disease, the organs affected, especially if the brain 
 be its seat or otherwise participate, and according to the nature and 
 extent of the cerebral derangement, and the nervous influence which 
 may be exerted by this and by other parts (150, 151, 892| i, 1008). 
 
 977. But it cannot be too strongly urged, that in abstracting blood, 
 and in the administration of cathartics, emetics, antimonial altera- 
 tives, &c., it should be considered that it is the constant tendency of 
 an inflamed part to prevent a contraction of the capillaries of other 
 parts, and therefore to maintain the action of the general circulatory 
 system (§ 933, 944 c). We shall not obtain a proper amount of this 
 general impression, if important to the case, until the loss of blood is 
 sensibly felt by the part inflamed ; and this may depend upon a great 
 variety of circumstances, even upon the contingency of a large or small 
 Stream of blood, the posture of the subject, the state of his mind, &c. 
 But, in all severe inflammations the general impression should be 
 fully produced, and this is only effected at, or near the point of syn- 
 cope ; the patient being always in a sitting or elevated posture. 
 
 978. Although, as we have seen, it is the tendency of venous con- 
 gestion to depress the powers of circulation, there are many chronic 
 cases of this disease in which the law relative to inflammation of oth- 
 er tissues is found to obtain, though in an inferior degi'ee. The pulse 
 is more or less excited and hard, and loss of blood is more or less 
 borne, at the beginning of the treatment, as in the other cases. This
 
 736 INSTITUTES OP MEDICINE. 
 
 is especially true not only of chronic,butof the more rapid foimof the 
 disease, when affecting the brain. The chronic conditions, ho\vever, 
 sometimes become suddenly aggravated, and the general circulation 
 sinks down suddenly under this aggravated state, when syncope may 
 follow a small abstraction of blood (§ 688 c-h, 786, &c., 976 h). 
 
 979. Fi'om the foregoing considerations it appears that general blood- 
 letting is the great remedy for all inflammatory affections of important 
 organs, with those exceptions of a chronic nature to which leeching 
 is more appropriate, and which occur in that division of our subject 
 for the purpose of illustrating its philosophy (§ 914, &c.). There 
 should be no hesitation, in the active forms of this disease, with the 
 most cautious practitioner, in meting out a full measure of the capital 
 remedy. The tendency of the affection to sustain the system under 
 the loss of blood, and the phenomena of increased excitement, should 
 nerve the weakest arm to an obvious, easy, and important duty. This 
 duty, however, it is my purpose to enforce yet farther, when I shall 
 have reached the experience, and the details of practice, that remain 
 as the choicest legacies of the illustrious dead. — Note Hh p.1138. 
 
 980. The foregoing remarks upon the tendency of inflammation to 
 sustain the system under the loss of blood, and the rapidity with 
 which small losses, in venous congestion, will place the organic prop- 
 erties in a state to bear a measure which would prostrate the organa 
 of circulation in health, are farther illustrative of the great law of 
 adaptation, by which nature has contrived all things in organic life for 
 its ever-varying exigencies (§ 143 c, 733 d, 847 g, 870 aa). 
 
 Of Bloodletting in Simple Continued, and Simple Intermittent Fever, 
 
 981. Where fever is not complicated with local congestions and 
 Inflammations loss of blood is not often required, unless to reduce the 
 force of arterial excitement when so considerable as to endanger the 
 appearance of those local affections. If this condition, or any condi- 
 tion of the febrile action, do not soon abate under the influence of 
 cathartics, an emetic, and appropriate alteratives, recourse should 
 then be had to general bloodletting ; though it will not be often ne- 
 cessary to carry the remedy beyond a moderate extent. If the treat- 
 ment, however, be early and judiciously begun, the disease will com- 
 monly surrender, in its early stage, without the co-operation of the 
 principal remedy for those conditions of fever which are associated 
 with inflammation and venous congestion. 
 
 In the cases of high arterial excitement to which I have now refer- 
 red, it is important to consider that three principal causes are in op- 
 eration which may lead to the development of inflammations. The 
 most important is the morbid and highly irritable state of the capilla- 
 ry and extreme blood-vessels. The second is the force of the circu- 
 lation, which contributes, as a mechanical cause acting upon the mor- 
 bidly susceptible vessels. The third is the augmented volume of 
 blood in those vessels, and whose influence is chiefly that of a vital 
 stimulus (§ 137 d, 710 h, 784). 
 
 982. But, it often happens, as when fever and venous congestion 
 appear in connection, that inflammation presents itself simultaneously 
 with the constitutional malady, or the latter may be preceded by 
 either local form of disease, or these local states may spring up in 
 the progress of the general malady (§ 779, 813). In the last two in-
 
 THERAPEUTICS. LOSS OF BLOOD. 737 
 
 Stances, the affection which is first in order contributes mure or less 
 as an exciting cause of the supervening disease (^ 714, 715, 779). 
 If the general disorder then continue to advance, congestions or in- 
 flammations of other parts are liable. to spring up in quick succession ; 
 the general affection, and the local developments, and the predispo- 
 sition of organs to inflammation or congestion, being the principal 
 causes of the successive explosions of disease, and mutually aggrava- 
 ting each other (§ 137 d, 714, 715). 
 
 983. From w^hat has been now said, and of the treatment of inflam- 
 mation and venous congestion, we may make up our minds that there 
 can be no tampering with the complicated forms of fever, whether as- 
 sociated with one or the other of the local conditions of disease. In 
 either case, especially in continued fever, general bloodletting is more 
 imperatively demanded than by either of the local conditions in their 
 independent state ; and the earlier this important step is taken the 
 oetter. Nor should we strike with a sparing hand, nor move at a tar- 
 dy pace ; but rather let the first be a heavy blow, and as oft repeated 
 as the foe may rise, yet always proportioned to its own degree of 
 strength. Let those, however, who may not relish this " rash advice," 
 gather wisdom and moral courage from the experience and philoso- 
 phy that yet avvait us from abler hands. 
 
 984, a. Nevertheless, in the complications of intermittent fever with 
 venous congestion, and sometimes with inflammation, such is the na- 
 ture of the predisposing cause, and the local affections are so apt to 
 be imbued with its influence, that it frequently happens that bloodlet- 
 ting may fail of the requisite impression upon the local forms of dis- 
 ease, and the special aid of the Peruvian febrifuge, or analogoub 
 means, may be useful, or necessary, in subduing the local affections 
 after a due impression has been made by loss of blood, cathartics, &c. 
 In advanced typhus, stimulants, bark, and strong broths are important. 
 
 984, h. The foregoing reference to the remote causes of disease with 
 a view to some special deviation from the general principles of treat- 
 ment is exactly on a par with the antidotal treatment of poisons. The 
 quinia, which may be ultimately necessary to overcome intermittent 
 fever, or its associated inflammations and venous congestions, presents 
 a remote resemblance to the elaborate ferruginous mixture in cases 
 of poisoning by hydrocyanic acid, and other analogous examples. 
 It is true, that, in the latter cases the counter-agent acts in a purelj 
 chemical manner, while in the former the special agent operates 
 through vital influences alone. I have thus adverted to this analogy 
 in deference to the humoral pathology, and especially on account of a 
 vague belief that quinia cures intermittents by neutralizing the mias- 
 matic poison (§ 662, 809-816, 891^ k, 892 b, 892^ v, 894 c, d, 1059). 
 
 But the whole of this philosophy will be set right by considering 
 the modus operandi of the best antidotes for poisonous doses of opium ; 
 namely, coffee and the cold dash. Here there is no difference, in their 
 acceptation as poisons, between the opium and the miasma. Both 
 have equally established their morbific effects. 
 
 And now as to the "antidotes for opium." Who ever imagined 
 that coffee removes the morbid states by entering the circulation, and 
 there neutralizing the opium? The modus operandi is the same as I 
 have set forth for opiates in § 891^ g, h, and for the cold dash and 
 seton in § 514 d, 905 a. I need not add that the modus operandi of 
 
 A A A
 
 73S INSTITUTES OF MEDICINE. 
 
 quinia, in the cure of intermittents, is exactly equivalent to coffee 
 and the cold dash in that of poisoning by opiuni*(§ 137 e, 150-152, 
 662 a, h, 892 h, c, 904 c, d), and the nervous system will alone explain. 
 
 In all such cases, therefore, the special treatment may be considered 
 antidotal ; since, as in the cases where we merely attempt to neutral- 
 ize a poison while it yet exists in the stomach, we equally apply the 
 treatment in the former case to certain specific effects which have re- 
 sulted from causes which are alike distinguished by very special vir- 
 tues. In one case we attack the cause itself; in the other, the effects 
 which it may produce. 
 
 It is therefore sufficiently evident that in the administration of quin- 
 ia in the treatment of intermittent fever, and in other analogous ex- 
 amples, we leave, more or less, the general principles which apply to 
 the generic character of the diseases, and turn some agent of special 
 virtues against the modifying influences of such predisposing causes as 
 are capable of bending the general pathology from its more common 
 form. But, it is rare that the general plan of treatment is not more 
 or less in demand ; or that the special remedy will come under the 
 law of universal adaptation till the whole system is submitted to in- 
 fluences by such remedies as are consistent with all the varied coexist- 
 ing pathological conditions (§ 847 g, 870 aa). 
 
 Some other examples of practical importance will, at the same 
 time, advance our philosophy upon the subject under investigation. 
 Thus, bloodletting may, or may not be necessary in a scrofulous in- 
 flammation. If it attack the lungs, it will be important; especially 
 in its early and active stages. Here the remedy is of universal adap- 
 tation. If the superficial lymphatic glands be the seat of the affection, 
 leeches may be proper. But, in such cases, we are apt to leave the 
 general principles of treatment, and to refer specifically to the nature 
 of the predisposing cause, which is here implanted in the constitution 
 of the individual (§ 561, 586, 659, 661, 666). Experience has shown 
 that iodine, which does not belong to the remedies for common in- 
 flammation, is especially adapted to certain states of scrofulous in- 
 flammation. But, it is only to subdued forms of the disease that it is 
 suited ; while loss of blood is universally applicable in all the active 
 gi'ades of the disease, whatever be the part invaded, and may place 
 every pait, and the whole system, in a condition for the salutaiy ef- 
 fects of iodine (§ 137 e, 143 c, 150, 151, 163, 870 aa, 892 b, 8921- v). 
 
 Again, if the inflammation be syphilitic, and the constitution be in- 
 vaded by its predisposing influences, bloodletting, cathaitics, &c., 
 may or may not be necessary. But, a general antiphlogistic plan 
 should be pursued ; at least so far as to exclude stimulating food, 
 which may be all that the case will require (§ 856). In a general 
 sense, however, we should have a more direct reference to the nature 
 of the remote cause, and administer mercurial preparations ; since ex 
 perience has shown this to be the safest and most efficient treatment 
 Here, then, mercury assumes the character of what is called " a spe- 
 cific" (§ 865, 892 aa) ; though it is one of the antiphlogistics which 
 fall within the principle of general adaptation to inflammatory dis- 
 eases (§ 662, 859 b, 872 a, 890|, 892 b, c, 898, 900, 904 c, d, 1059). 
 
 984, c. When speaking of expectorants, and at other times, I have 
 stated the importance of deriving our indications of cure from what 
 we may witness of the results attendant on the recuperative efforts of 
 
 * This agrees with the efFects of a strong infusion of coffee in health. So,. also. Era. 
 mert found that coffee increases the violent action of nux vomica (§ SOS).
 
 THERAPEUTICS. LOSS OF BLOOD. 739 
 
 nature (§ 862, 863, 892| ^). 1 am now led to recur to the subject ou 
 account of the great abuse of the principle in the treatment of acute 
 inflammatory affections of the lungs by stimulating expectorants; 
 which are admiKistered for the reason alone that expectoration is one 
 of the consequences of the natural process of cure. On looking a littlo 
 farther, however, we find that bloody mucus, and pure blood, are 
 often expectorated in pneumonia, and in incipient phthisis ; and that 
 hemorrhages are frequently occurring, as the consequence of conges- 
 tion or inflammation, from all parts of the body. Here, then, is a 
 rsmed} for inflammations of all parts, suggested by Nature ; while 
 expectoration refers to one part only. What is thus inculcated as to 
 the practical application of the more comprehensive principle is en- 
 forced by all the most enlightened experience (§ 863, y").* 
 
 985. Finally, when bloodletting is judiciously practiced, it often su- 
 persedes the use of a long train of other remedial agents which may 
 ultimately bring relief, or lessens their number and dose, substitutes 
 the milder for the more energetic, prepares the way for their quick 
 and salutary effects, and saves to the patient much suffering, and se- 
 cures a speedy convalescence. 
 
 Of Bloodletting in the Cold Stage of Fever. 
 
 986, a. Bloodletting has been practiced successfully by many phy- 
 sicians in the cold stage of intermittent fever. It is not, however, 
 with any reference to this consideration that I have given to the sub- 
 ject the distinction of a chapter by itself; but for the greater purpose 
 of illustrating still farther the influences which are exerted by the loss 
 of blood, and the instrumentality of the nervous system. 
 
 986, b. That the disease should be thus suddenly arrested is entire- 
 ly conformable to what I have said of the modus oj^erandi of bloodlet- 
 ting, and goes to confirm the philosophy. The capillaries being then 
 in a state of universal contraction from disease, if loss of blood have 
 its special influences upon the organic properties of these vessels, it 
 should be the effect of such a cause, in suddenly, greatly, and univer- 
 sally increasing that contraction, by alterative reflex nervous in- 
 fluences, so to modify the morbid state as to interrupt the succession 
 of the hot stage. But the abstraction of blood must be carried to the 
 point of syncope, that it may thus determine a powerful nervous in- 
 fluence upon the instruments of the morbid process ; or that change 
 will not be established which is necessary to prevent the stage of re- 
 action. In these cases, however, the necessary quantity of blood is 
 commonly small ; and syncope, therefore, is easily induced. But, as 
 the morbid contraction depends upon a different cause, and as the vital 
 properties are differently affected from what bloodletting produces, 
 although the remedy occasion the same phenomenon, it often happens 
 that no inconsiderable loss of blood will be sustained before that 
 change can be established in the small vessels which is necessary to 
 perfect the contraction which is incident to bloodletting, and which is 
 the precursor of syncope {^ 1040, 1056, and " contraction" § 944 c). 
 
 987. How, therefore, shall we interpret by any other philosophy 
 than that which I have propounded the sudden interruption of fever 
 in its cold stage by the loss of a small quantity of blood, when no 
 amount, perhaps, would have arrested the disease if taken at any oth- 
 er period 1 The qujantities, also, necessary to suo<jess depend, in part, 
 
 * See Notes F p. 1114, Ff p. 1135, Gg p. 1138, Ii p. 1139.
 
 740 INSTITUTES OF MEDICINE. 
 
 upon the precise period of tlie cold stage ; whether at its beginnii.ir. 
 or near its termination in the hot stage. Less is necessary, cceteris 
 faribus, in the former than in the latter instance ; although nature, in 
 the latter case, is preparing for a recuperative effort (§ 675). And so 
 the result will be influenced by the application of the i-emedy dui-ing 
 the first paroxysm, or by its delay till a later, and this often in propor- 
 tion to the delay. It is true, diseases generally yield most I'eadily in 
 their forming stage ; but in intermittent fever the disease may be said 
 to be renewed, in a measure, at each paroxysm. Like other affec- 
 tions, however, it acquires more or less obstinacy from the force of 
 habit, and from the influence of local inflammations and venous con- 
 gestions which so often spring up in its progress. But that habit is 
 more or less broken during the intermission ; when Nature is aiming 
 at restoration (§ 557, &c.). — Note K p. 1119. 
 
 988, a. Here, also, may be shown absolutely the error of all the 
 mechanical hypotheses which have been put forth as to the philosophy 
 of bloodletting, and which have so extensively governed the applica- 
 tion, or, rather, have led to the neglect, of the remedy. If we con- 
 sider the prevailing one, that loss of blood operates by mechanically 
 reducing the volume of the circulating mass, and thus empties the en- 
 larged capillaries in inflammation and in the hot stage of fever, it is 
 at once contradicted by the immediate and salutary effect of the loss 
 in the cold stage of fever, when the same capillaries and the same in- 
 struments of disease are already so contracted that the blood has re- 
 ceded from them toward the central part of the circulation ; while the 
 immediate effect of the loss of blood is to determine an increased 
 volume upon the capillaries (§ 910, 935). 
 
 988, b. It is, howevei', unnecessary to pursue the inquiry ; but it is 
 well to advert to the fact that the phenomenon now before us is equally 
 demonstrative of the error of imputing syncope to the reduction of 
 blood within the cavities of the heart ; since, in the cold stage of fever, 
 blood is always accumulated about that organ, and as the contraction 
 of the capillaries is farther increased by loss of blood, so, also, is the 
 central determination (§ 935). 
 
 For the full understanding of the foregoing subject, the inquiring 
 reader will refer more extensively to what has been said of the agency 
 of the nervous power in determining the effects of loss of blood. 
 
 989. The foregoing considerations enable us to understand why 
 bloodletting is more useful just as the subsidence of the hot stage be- 
 gins than at its earlier periods. Nature is now consummating her 
 efforts at relief. The capillary vessels are every where about to con- 
 tract to their natural volume, as a consequence of another modification 
 of their vital state, and differing, therefore, from that of the cold stage, 
 and from that which is induced by loss of blood. The secretions are 
 about to break forth in virtue of this recuperative process, and blood- 
 letting will now accelerate what nature is instituting. At any othei 
 fltage of reaction this curative effect is less, since nature does not then 
 so co-operate with the remedy as when the hot stage is on its decline. 
 Should syncope, even, be induced during the rise of the hot stage, re- 
 action will be very apt to return, though it pursue a mitigated course. 
 A much smaller loss of blood will also subdue the general circulation 
 when the hot stage is beeiiminsr to decline than during its rise, and 
 leave a more permanent impression upon diseas^. Nevertheless, the
 
 THERAPEUTICS. LOSS OF BLOOD ' 741 
 
 violence of reaction, &c., may be such as to increase or give rise to 
 local inflammations ; and where this is apprehended, or for the relief 
 of pain, general bloodletting should be practiced early (§ 675, 803 d, 
 1003). This section involves diversified agencies of the nervous power. 
 
 Of Bloodletting in Apoplexy, 
 
 990, a. The modus operandi of bloodletting, as well as the adapta- 
 tion of this remedy to the special circumstances of disease, and its 
 critical influences according to those circumstances, especially in its 
 relative effects thi-ough the instrumentality of the nervous power, may 
 be now advantageously considered by contrasting its results in certain 
 states of apoplectic affections with what has been said of the counter- 
 acting nature of inflammation, and of the nervous influence, in prece- 
 ding sections. This influence must apply equally to all the cases. 
 
 990, h. It is the well-directed application of bloodletting which 
 constitutes the principal means in the treatment of sanguineous apo- 
 plexy ; and although it may be often important to delay the abstrac- 
 tion of blood, it will be generally necessary in the progress of the 
 cure. Such, indeed, is the concurring opinion of almost all writers 
 of eminence ; although it is a remarkable fact that the practice is not 
 founded upon successful experience, or any agreement in pathologi- 
 cal views. Even those who condemn bloodletting in pneumonia, en- 
 teritis, or other grave inflammations, are neither intimidated by age, 
 nor by expiring nature, when apoplexy makes its invasion. Some 
 are prompted by a supposed rupture of a vessel, which they expect 
 to stanch by bleeding from another; while a few, more philosophical, 
 regard the eff"usion as the result of a morbid process analogous to se- 
 cretion. It is with all, however, a mechanical operation. There is 
 too much blood in the brain, and it must be drawn off" by the lancet. 
 That is their modus operandi, and that the extent of it. Hence the 
 disastrous results of indiscriminate bloodletting in apoplexy. But, if 
 the philosophy which I have set forth as to the operation of loss of 
 blood be founded in nature, it will readily appear that the sudden and 
 violent lesions of the brain in apoplectic affections offer us cases for 
 great and unusual discrimination as to the time, extent, &c., of the 
 remedy; while, also, they confirm that philosophy, and enforce the 
 importance of an enlightened understanding of the principles through 
 which bloodletting operates. It is said by Clutterbuck, that " there 
 is perhaps no disease the treatment of which requires to be so much 
 directed by theory or general principles as apoplexy. The practice 
 in general use is, for the most part, unnecessarily violent; and, in 
 some respects, contradictory. Bloodletting to an unreasonable ex- 
 tent, vomiting, purging, blistering, sinapisms, and a great variety of 
 other stimulants, have all been administered with an almost indiscrim- 
 inate and unsparing hand ; as if, to insure recovery it were only ne- 
 cessary to have recourse to sufficiently active means, without much 
 regard to their nature or effects." 
 
 990, c. Besides the importance of a proper reference to the influ- 
 ences of bloodletting in cases of apoplexy, there are often present 
 certain inscrutable conditions of the brain which are liable to embar- 
 rass the most enlightened judgment. It is often impossible, for ex- 
 ampl<>, t:) understand the exact pathological condition of the brain, 
 upon which the due regulation of bloodletting may essentially de-
 
 742 INSTITUTES OF MEDICINE. 
 
 pend. If there be hemiplegia, it is almost certain that extravasatioc 
 ')f blood has taken place. This condition, with the rare exception 
 of the rupture of a diseased artery, is indicative of venous congestion 
 of the brain, with which inflammation may coexist (§ 803, 805). We 
 have, therefore, in these numerous instances, a formidable condition 
 of cerebral disease, and a laceration of the cerebral substance. Again, 
 however, there may be only a state of venous congestion, or of serous 
 effusion, or some pathological condition which is not denoted by any 
 visible signs after death. With the exception of paralysis, the phe- 
 nomena may be exactly the same in all these conditions of the disease 
 at its invasion. In the fii'st two varieties, bloodletting, sooner or later, 
 is probably necessary, in almost every case, to overcome the morbid 
 action ; though its early application may induce, or hasten, a fatal re* 
 suit. In the last two, which are known as serous and nervous apo- 
 plexy, the loss of blood is comparatively unimportant, and may be in- 
 jurious at every stage of the disease (§ 673). 
 
 990, d. But the treatment of apoplexy has been less the fault of 
 hypotheses than an unsuitable application of bloodletting ; neglect- 
 ing the peculiar relations which the brain sustains to other organs, 
 and the consequent modification of their properties and functions 
 when the brain is suddenly and violently disturbed. So far as this 
 organ is independently concerned, whether the proximate cause of 
 apoplexy consist in pressure from excreted blood, or simple inflam 
 mation, or venous congestion, bloodletting is clearly indicated, and, 
 to avert an impending attack, should be applied without much re- 
 serve. But when the paroxysm ensues, it is not alone the brain 
 which suffers in a new and peculiar manner. Every vital organ sus- 
 tains a shock, and each becomes a subject for particular care. Dis- 
 ease is now coextensive with the system, for the powers and functions 
 are universally deranged (§ 226, 227, no. 1, 230, 231, 480-485, 489- 
 492, 508-511, 943, 946,) and plainly deranged by nervous influences. 
 990, e. Hence the importance of ascertaining, as nearly as may be, 
 how extensively the powers of life are disturbed in each individual 
 case, that we may not complete their extinction by precipitate treat- 
 ment (§ 920, 934, 937, 940, 941, 943, 944, 947-949). 
 
 990, y! The consequences, which are determined by the sudden le- 
 sion of the brain in apoplexy, will not only depend much upon the 
 natural constitution of the individual, often upon the precise nature 
 and seat of the lesion, and the antecedent condition of the organ, but 
 they will be variously modified by the pre-existing state of other 
 parts ; whether the system was in a state of health at the time of the 
 seizure, or whether important organs may have been previously dis- 
 eased, and thus incur a more profound lesion after the attack, and 
 send back upon the brain the shock they have sustained, and again 
 receive the reverberation ; and whether, also, such disease may not 
 have developed the cerebral derangement, and remain a powerful 
 aggravating cause (§ 514, h, &c.). 
 
 990, g. The variety of lesion sustained by the properties of life, in 
 apoplexy, is denoted by the symptoms, and the symptoms only. The 
 pulse of an athletic subject may become, as in cases of concussion, 
 almost insensible at the moment of the attack ; while that of the fee- 
 ble may acquire a volume and force exceeding its natural state. The 
 general circulation is roused at one time, and prostrated at another.
 
 THERAPEUTICS. LOSS OF BLOOD. 74S 
 
 The nervous power has now the effect of an excitant upon the system, 
 and. again it is a deadly sedative (§ 226, 476, &c.). In one patient, 
 the pulse falls suddenly to forty sti'okes in a minute, while in another 
 it is as suddenly raised to more than a hundred. In one, it beats with 
 staid regularity ; in another, it intermits ; in another, it hobbles ; and. 
 in a fourth, it rises and falls in volume in coincidence with the pro- 
 longed acts of respiration. There is nothing uniform about it. 
 
 990, h. It need, not be said how profoundly the stomach is affected, 
 how variously respiration, how differently the voluntary muscles, the 
 sphincters, &c., suffer (§ 476, &c.), all referable to the nervous power. 
 
 990, i. Considering, therefore, the varied influences of the brain 
 upon the properties of life in apoplectic affections, and the manner in 
 which we have seen that bloodletting affects this organ, and the con- 
 sequent impressions which are propagated from it over the whole 
 system it must be obvious, where the general lesion is very profound, 
 that the abstraction of blood at the onset of the attack may so increase 
 the pernicious influence of the brain upon the sinking powers of the 
 system that neither nature nor art can repair the injury. This will 
 be especially true of such cases if we bleed to syncope (§ 940, 941). 
 But the abstraction of blood is powerfully felt, in a direct manner, by 
 the vital properties of every organ ; and where these powers are ex- 
 cessively depressed by the nervous influence, and that influence con- 
 stantly maintained, by the peculiar condition of the brain, it will hap- 
 pen, in the foregoing cases, that there will be no ultimate recoil from 
 the depressing effect inflicted by the loss of blood. Here will be also 
 another shock added to the direct injury from loss of blood, since the 
 violence thus inflicted upon the system at large will be extended, by 
 sympathy, to the brain ; while this organ will reflect every pernicious 
 impression it receives from others (^ 1056). — See p. 298, \ 476-2- ^• 
 
 990, h. It should be also considered that effusion probably exists 
 within the brain, and that bloodletting cannot reach this part of the 
 exciting cause ; that the effect of the effusion, although it be diminish- 
 ed, must continue for an indefinite time, and that if we lessen too 
 much the energies of the system, they will at last fail from its increas- 
 ing influence. While, therefore, we strive to arrest one evil there 
 should be an equal care not to increase another. 
 
 990, I. The importance of bloodletting will depend, also, upon the 
 nature of the fluid effused ; of which we may, perhaps, form some 
 conjecture from the antecedent history of the case. In serous apo- 
 plexy, the cerebral congestion, or inflammation, is generally, from 
 the beginning, in a low state, and is probably much subdued by the 
 effusion. It may be, therefore, chiefly the immediate object of blood- 
 letting to diminish the impulse of the circulation upon the brain, and, 
 perhaps, to lessen a state of congestion in the abdominal organs that 
 may continue to operate upon the brain. Serous apoplexy, however, 
 is not common. I)r. Cheyne and others consider the ratio of the san- 
 guineous to the serous as 98 to 100. 
 
 990, m. In the sanguineous apoplexy we have a more or less differ- 
 ent state of things, and other objects are presented for consideration, 
 than in the serous form. We have, then, not only to lessen the im- 
 pulse of blood, and to strike at any remote predisposing congestions, 
 but we must, as speedily as possible, reduce the congested state of 
 the cerebral veins, and thus arrest the progress of the hemoi'rhage,
 
 744 INSTITUTES OF MEDICINE. 
 
 and re-establish the natural circulation and healthy functions of the 
 brain. 
 
 But the moment when bloodletting may be applied with advantage, 
 and the extent of the remedy, must be directed as much, or more, by 
 the existing state of the general symptoms as by any pathological 
 condition that may have led to the paroxysm (§ 150, 151, 990 c). 
 
 990, n. It behooves the physician to meet every case of apoplexy 
 with entire self-possession, and to consider that no subject requires 
 the exercise of greater skill, and, perhaps, of firmness. It is often 
 now as with the surgeon when he is summoned to some embarrass- 
 ing operation, and in the right performance of which the life of the 
 subject is immediately concerned. The authority of custom, sanc- 
 tioned by the most acute and renowned observers, will be likely to 
 embarrass our judgment, paralyze our independence, and hold us 
 spell-bound, when all may be depending on the unbiased dictates of 
 the understanding. The difference of an hour in the application of 
 bloodletting maybe for the weal or the woe of the patient. Shall we 
 . deliberate 1 Professional reputation may be in peril ; but the greater 
 will be the reward to a sensitive and enlightened mind. Where art 
 can be of any advantage there will be always time for calm investi- 
 gation of doubtful cases. Such are the recuperative powers of na- 
 ture they will generally struggle for a time with success ; at least in 
 cases where art can be instrumental. " It is probable," says Heber- 
 den, " that far the greatest part of paralytic and apoplectic patients 
 would recover some degree of life and strength by the unassisted ef- 
 forts of nature." It is this partial recovery which we should await, 
 in certain cases, before resorting to the abstraction of blood. If Na- 
 ture be too much struck down by the blow for an independent effort, 
 we shall hardly contribute any useful succor by inflicting another. 
 If, also, the powers of life be greatly prostrated, action is, of course, 
 in a languid state. Whatever disease may exist in the brain is, for 
 the present, controlled by the same principle. Hemorrhage is sus- 
 pended ; and the functions, every where, whether natural or morbid, 
 are nearly at a stand. It is here, in the severest cases, in respect to 
 the general condition of life, as it is in concussions of the brain ; 
 when, it is said by Mr. Abernethy, " it would appear in the first stage 
 that very little can be done." This has now become the doctrine of 
 surgeons. 
 
 990, o. When bloodletting is of doubtful expediency in apoplexy, 
 and this is commonly only soon after the seizure in cases that admit 
 of relief, the abstraction of blood should advance slowly, and its influ 
 ence be carefully observed (§ 937). The result from a small quantity 
 of blood may be such a relief to the brain that the pernicious influ- 
 ence of the organ may be so withdrawn from the system that the rem- 
 edy may be soon repeated, and to a greater extent (§ 961, d). 
 
 990, p. Having brougiit the system, in bad forms of the disease, out 
 of its alarming prostration, either by moderate stimulation, or cautious 
 bloodletting, or, what is generally better, by intrusting it to its own 
 resources, it will become important to estimate the probable extent of 
 disease in the brain and other organs. And here I cannot but repeat 
 the important fact that sanguineous effusions are generally the result 
 of disease, and that they very rarely depend, even within the crani- 
 •im, upon any primary rupture of blood-vessels. Dissections prove
 
 THERAPEUTICS. LOSS OF BLOOD. 745 
 
 that this condition, in almost all cases of sanguineous apoplexy; is at- 
 tended by venous congestion. This view of the pathology, while it 
 is entirely more inauspicious to the hopes of the patient than that 
 which regards the effusion as the simple result of a ruptured vessel, 
 requires more energetic means of treatment than the latter. Indeed, 
 were simple rupture the source of the effusion I see not in what re- 
 spect art is likely to be instrumental. It cannot be, as is commonly 
 supposed, by diminishing the force of the circulation that we obtain 
 much ascendency over the complaint. Indeed, in many cases, where 
 the pulse is prostrated, relief is effected while the energy of the heart 
 rises under the influence of the lancet. The philosophy of the effects 
 of this remedy relates mainly to its impression upon the organic prop- 
 erties of the capillary vessels, directly and by reflex nervous action. 
 
 990, q. We may conclude, then, that with all the advantages of the 
 most enlightened pathology, and the most appropriate treatment, the 
 apoplectic must, generally, exist for a long time in a perilous con- 
 dition. In the early stages, a formidable state of morbid action is to 
 be overcome by energetic measures, whose timely application is more 
 surrounded by difficulties than in any other disease. The brain, too, 
 in the cases supposed, has sustained a fearful laceration, and a con- 
 crete effusion of blood is probably compressing and irritating the whole 
 organ, and which can, at best, but slowly undergo absorption. In san- 
 guineous apoplexy there is also an increased liability to repeated at- 
 tacks of the congestion and consequent effusion of blood. 
 
 990, r. It has not been my object to speak of cases that obviously 
 admit of immediate bloodletting. These are common, and may de- 
 mand an extensive application of the remedy. But the only rule that 
 can be assigned in regard to the quantity of blood that should be ab- 
 stracted will probably be found in the foregoing considerations. 
 
 990, s. In estimating the effects of cerebral disease on the system, 
 we must duly consider the various relations of the brain to other parts. 
 Considered simply as an organ, it is liable to the same modes of dis- 
 ease as other organs, and to the same relative sympathies as exist among 
 other parts. But this is a small part of the important relations of the 
 brain. It is especially destined to preside over the great functions of 
 the body, however they may be the result of powers that exist and 
 act in independence of the brain; and whenever its organic functions 
 become diseased, these specific relations to the system are affected in 
 consequence (§ 455, 456). This complex derangement, in apoplectic 
 affections, will produce the most varied results ; and, according to tho 
 influences of the brain upon other parts, and their reaction upon th<^ 
 brain, will be the endless variety of phenomena. 
 
 990^, a. In conclusion of the foregoing subject I may finally say, 
 that, from what has been here presented relative to the nervous pow- 
 er, and from the extensive researches of a more critical nature in pre- 
 ceding sections, it appears that the nervous power is peculiar to ani- 
 mals ; that it is a vital stimulus, sui generis ; that its important office 
 is to subserve the function of sympathy, and to impress upon the or- 
 ganic products some very special vital conditions ; that its only par- 
 ticipation in the function of motion is that of acting upon the organic 
 property, mobility, through its primary operation upon irritability ; 
 that it is extremely susceptible of influences from the operation of 
 external and internal causes, mental, vital, and physical; that these in-
 
 746 INSTITUTES OF MEDICINE. 
 
 fluences result in preternatural developments and various modifica- 
 tions of the nervous power, under the influence of its own nature, but 
 corresponding, also, with the nature of the remote causes, respectively ; 
 that it is then reflected with a special alterative effect upon remote 
 parts, according to their existing susceptibilities, and according, also, 
 to the nature of the causes by which it is developed or modified, 
 whether by the will, mental emotions, or by organic or physical causes, 
 and that the motor channels which are elected for its remote effects 
 are, apparently, independent of the order of the distribution of nerves ; 
 that, when thus reflected, it maintains, in one case, the harmonious 
 action of organs, or disturbs that harmony in another, or induces dis- 
 ease in another, or becomes a curative agent in another; according 
 to the nature of the influences which may be exerted upon it. 
 
 990^, h. Now, therefore, in view of all these things, as well as of 
 what has been hitherto said of the functions of organic life, and of the 
 consequences which have befallen the philosophy and the practice of 
 medicine from the prevalence of the chemical, physical, and humoral 
 doctrines of life, disease, and therapeutics, it is evident that there is 
 nothing of greater importance in medicine than a proper understand- 
 ing of the attributes of the nervous power, and that it must be re- 
 garded merely in the light of a vital stimulus, or a vital depressant, or 
 a vital alterative, and that it has no other participation in the actions 
 and results of animal and organic life (^ 227, 475-|^, 524 d. no. 7, 647-^). 
 
 I have, finally, reserved for this place another demonstrative proof 
 that the nervous power is in no other than the foregoing sense the 
 cause of a single phenomenon in organic beings, and that, therefore, 
 all the causes which bring it into operation, or otherwise affect its 
 pronunciations, exert their influences directly upon the power itself, 
 and that an irresistible analogy is thus brought to concur with the 
 many specific facts in proof of the direct operation of all other vital 
 agents upon the properties of life which are common to plants and 
 animals, and not upon the physical structure (§ 189). I say, then, 
 that, since the nervous system is carried into all parts of the organiza- 
 tion of animals, but has no existence in plants, and since both animals 
 and plants possess organic functions in common, and since, also, the 
 organic functions of animals are variously affected through the instru- 
 mentality of the nervous system, not only by causes operating directly 
 upon the nervous centres and the trunks of nerves, but indirectly 
 through the circuitous route of the sensitive and motor systems of 
 nerves, and, especially, farther, si7ice there is no anatomical union what- 
 ever hetwccn the extreme Jibres of the sensitive and motor nerves, nor be- 
 tween tliem and the fibres or ultimate parts of any other tissue, it follows 
 as a physical necessity that the organic properties and functions can 
 be influenced through the nervous system only by a real substantive 
 anient which is entirely different from the physical structure itself, and 
 which is capable of extending its influences from one tissue to another 
 between which there is no physical union, and that, therefore, all the 
 primary essential impressions must be exerted directly upon the agent 
 itself. Whence, also, it follows, that all the results which ensue in 
 other tissues, as consequences of the transmission of the nervous influ- 
 ence from the expanded nerves to those tissues, are due to primary 
 impi-essions by the nervous power upon the organic properties of such 
 tissues, through the medium of the complex structure. Lastly, it neces-
 
 THERAPEUTICS. LOSS OF BLOOD. 74"^ 
 
 sarily results from the foregoing demonstration, that the organic prop- 
 erties appertain just as much to a real substantive agent, and are as 
 different from the physical structure, as the nervous powder is different. 
 
 The foregoing facts and arguments relative to the disconnected 
 state of the nervous and other tissues are equally true of all the tis- 
 sues respectively, and as true, also, of the organic properties as of 
 the nervous power in the aspect of the anatomical facts (§ 168-185, 
 190-192, 200, 208, 215, 217, 219, 220, 226, 228, 230, 233, 233|, 234 
 c, d, e,f, 500, 1040, 1056). The soul offers a conclusive analogy {^115 b). 
 
 990^, c. Nevertheless, if the physical fact, even as to the sensitive and 
 motor nerves, were not demonstrably true," it would in no respect affect 
 the laws, since those of all vital functions are deduced from the phenom- 
 ena (§ 466) ; not, as with physical optics, from the mechanism (§ 131). 
 
 The Experience and Ophdons of Distinguished Physicians as to Blood-letting 
 ill Inflammatory, Congestive, and Febrile Diseases. 
 
 991, a. It would not be appropriate to this work to set forth the vast 
 range of experience in favor of blood-letting in the treatment of inflam- 
 matory, congestive, and febrile diseases, which I have explored in the 
 Medical and Physiological Commentaries, and as contributed by men 
 whose genius, observation, and success, will command the admiration 
 of ages. But great controverted questions call for something more than 
 opinions, however great the authority, or however those opinions may 
 imply all the requisite experience. Unless excepted, I refer to the early 
 stages of disease (^ 557 a, 869). 
 
 991, b. Bampfield introduces his remarks by saying, very justly, that, 
 " In medical science, all reasoning and hypothesis must yield to the 
 
 results of experience, and deductions from facts. I have employed 
 venesection," he adds, " not only in dysentery, but other internal and 
 external inflammatory complaints in the East and West Indies, with 
 the most happy results. And is it not our sheet-anchor, our principal 
 remedy, in the cure of yellow fever, when had recourse to within the 
 first eighteen hours of the attack ?" 
 
 Mr. Bampfield exposes the origin and fallacy of the objections that 
 have been made ajjainst bloodlettinjr. He " has been astonished and 
 shocked to find bloodletting in hot climates condemned;" — while oth- 
 ers, of the temperate climates, think it only adapted to the tropics, or 
 condemn it universally. — Notes Ff p. 1135, Go p. 1138. 
 
 992, a. Let us consider, next, the solemn statements of one who is 
 known as the " Ulysses of Medicine," from his vast practical oppor- 
 tunities in numerous climates, as Surgeon-general of the British Army; 
 and let us observe how his experience illustrates and confirms the 
 great principles relative to bloodletting, and the universality of those 
 principles, and their practical application under all circumstances of 
 climate. It should be premised, however, that I have rarely found 
 the heroic practice of Jackson necessary or expedient in its largest 
 extent; and should be inclined to attribute more to the modifying in- 
 fluences of climate in the following cases, were it not that his practice 
 was remarkably distinguished for its decision and success in various 
 parts of the globe, while it is sustained by many of the best observers 
 in every variety of climate. Thus, then, Robert Jackson : 
 
 " The end is not attained in many cases, particularly in the more 
 concentrated forms of fever that appear among the military in tropi-
 
 748 INSTITUTES OF MEDICINE. 
 
 cal climates, at a less expense than eighty or ninety ounces of blooA 
 drawn at once." After stating, in another place, that the quantity of 
 blood abstracted in fever, at one time, during the years 1813 and 1814, 
 at the Hospital of the Royal Artillery, was rarely less than three 
 pounds, frequently four or five, and sometimes six pounds. Dr. Jack- 
 son remarks that such quantities taken at once " may appear unsafe 
 to some readers. But I am warranted to say, from a retrospect of 
 the whole proceeding, that no accident occurred in any instance from 
 the most excessive bleedings that were made ; and I may add, that the 
 strength was so little impaired by this apparently revolting practice, 
 that the greater number of persons, who were treated in this manner, 
 returned to their duty within a fortnight, in the full vigor of health" 
 (§ 1019, (Z). Such, also, was Jackson's practice in other countries (§ 
 973 h). 
 
 992, h. Let us also hear Jackson upon the specific point of cerebral 
 inflammation, which demands, as I have said, more than any other 
 disease, a fearless and extensive use of the lancet (§ 974). 
 
 " The quantity of blood," says Jackson, " which may be abstracted 
 in cerebral inflammation, without even compromising the safety of the 
 patient's life, exceeds a measure which, were my experience of the 
 fact not clearly ascertained, I should not venture to lay before the 
 public. Four pounds, taken away at one time, may be considered a 
 moderate bleeding in the more concentrated forms ; six pounds have 
 been taken on several occasions, and a hundred and twelve ounces at 
 a single bleeding in some. The practice, so formidable in appeai'- 
 ance, implied no danger. It saved life by direct effect (§ 938 i, 955, 
 1019 d). The practice is reasonable in theory (§ 924-934, 942, 944, 
 948, 949). It is proved in experience to be founded in truth. The 
 quantity., moreover, is to he Pleasured by the effect which arises under the 
 abstraction, not by an ojnnion formed under the presumption of what 
 may be right." 
 
 In some cases of fever attended by cerebral inflammation Jackson 
 sometimes abstracted a hundred and sixty ounces of blood, or ten 
 pounds (avoirdupois), in a day ; and he remarks in connection with 
 this statement, that, " instead of danger at the time, or debility as a 
 consequence of such extraordinary depletion, fainting did not always 
 occur, and the patient, in inost cases, returned to his duty within eight 
 days'' (§ 974, 1068 c).— Notes Ff p. 1135, Hh p. 1138, Ccc p. 1148, 
 
 992, c. In the foregoing (§ 992, b), as in the concentrated forms of 
 fever (§ 992, a), we have a clear exemplification of what I have taught 
 as to the tendency of inflammation to maintain the system against the 
 depressing influence of loss of blood, and that when the brain is the 
 seat of inflammation an exciting nervous influence is more powerfully 
 developed, and operates with greater force upon the diseased state of 
 the organ, and upon the heart and whole capillary system, than a sim- 
 ilar affection of any other part (§ 480-483, 971-974). 
 
 Secondly, — " The quantity," says Jackson, " is to be measured by 
 the effect which arises under the act of abstraction, not by an opinion 
 formed under a presumption of what may be right. Whatever be the 
 quantity, it is the effect produced which constitutes the -rm-ly. for guiding 
 the measure." I have thus repeated this doctrine, for it is the most 
 important that can be found in the annals of medicine. This rule is 
 universal, and it is for this reason that the best practitioners never sug-
 
 THERAPEUTICS. LOSS OF BLOOD. 749 
 
 gest the quantity of blood which should be abstracted in any given 
 form or case of disease. 
 
 Thirdly, — " Instead of debility, as a consequence of such extraor- 
 dinary depletion," says Jackson, " fainting did not always occur ; and 
 the patient, in most cases, returned to his (military) duty within eight 
 days, in the full vigor of health" (§ 1019, d). 
 
 What an admirable illustration is this of the fallacy of the tempo- 
 rizing practice, or the more sad effects of the stimulant treatment ! 
 How forcibly it evinces the importance of making a decisive impres- 
 eion, at one blow, in all grave inflammations ! How truly does all 
 this proclaim the existence of peculiar properties of life, in whose al- 
 teration the essence of disease consists, and whose restoration is ef- 
 fected by the direct impression upon them of loss of blood ! How for- 
 cibly does it refute the humoral pathology, and that not less errone- 
 ous assumption that disease is constituted by some positive change oi 
 structure, or the yet more glaring fallacy that it consists in debility ! 
 
 092, d. I have said that it has not often fallen to my lot to carry out 
 Jackson's practice, excepting in principle (§ 992, a). This may be 
 owing, in part, at least, to the fact of having commonly enjoyed the 
 opportunity of applying remedies at the early stages of disease. 
 Where I have found the full extent necessary, it has been mostly 
 among children ; estimating the ratio of the loss according to the rel- 
 ative ages and size. The most remaikable example has occurred in 
 the case of my only child ; whose general history of health is stated 
 in the Commentaries for another purpose (vol. i., p, 693). 
 
 Not long after his very protracted disease had given way, and be- 
 ing at the age of nine years, he was suddenly and violently attacked 
 with well-marked inflammation of the brain, lungs, and small intes- 
 tine. I raised him to an erect posture, and bled him till syncope 
 came on. The symptoms gave way ; but, in six hours afterward, 
 those of the brain, and, in an inferior degree, of the lungs and intes- 
 tine, had reappeared. I then bled him again, in the same posture, 
 and to the extent of syncope. Before exhibiting any medicine, I still 
 awaited the ultimate effect of the loss of blood. The cerebral symp- 
 toms gradually presented themselves again, and I bled him, for the 
 third time, as before, at the expiration of about twelve hours after the 
 second bloodletting. Soon afterward, I gave him one tea-spoonful of 
 castor oil, which completed the direct course of treatment. In two 
 days after the last bloodletting, I took him upon the rail-road a dis- 
 tance of five miles, and returned (§ 955 b, 958 a). It may be worth 
 adding, in connection with my former statements relative to his ex- 
 treme infirmity of health during the first seven years of his life, that 
 he has enjoyed a very robust constitution since the illness described 
 in this section ; being now seventeen years of age (§ 870 aa, 892^ i, 
 974, 1068). 
 
 The quantity of blood abstracted in the foregoing case was very 
 large at each abstraction, and exceeded, in the ratio of the age and 
 size of the subject, what I shall have recorded of the experience of 
 others. 
 
 993. The experience of Moseley corresponds with that of Jackson, 
 and where the remedy had been apparently of ample extent, he re- 
 marks that, " it has frequently happened in the fever of the West In- 
 dies, that accidental bleeding from the orifice when the patient had
 
 750 INSTITUTES OF MEDICINE. 
 
 fallen asleep., to far greater quantities than has ever been directed to 
 be taken away, has carried off the fever entirely, and the surprise on 
 discovering a profusion of blood in the bed has been changed to joy 
 for the alteration produced in the patient" (§ 973, b). 
 
 There are few practitioners of much experience who have not wit- 
 nessed similar events (§ 1019, e). 
 
 994, a. And how well is all this sustained by Dr. Rush, who has 
 " always observed that the cure of a malignant fever is most com- 
 plete, and the convalescence most rapid, when the bleeding has been 
 continued until a paleness is induced in the face, and until the pa- 
 tient is able to sit up without being fainty." " Bleeding," he adds, 
 " should be repeated while the symptoms, which first indicated it, con- 
 tinue, should it be until four fifths of the blood contained in the body 
 are taken away ;" — being conformable to the precept of Celsus, that 
 
 " We must not run from one remedy to another, so long as that re- 
 mains which was there at first" (§ 1007) ; — or, as Porter has it, "it is 
 not sufficient to diminish an increased action, unless the constitution he 
 kept, until the 2>eriod of danger is over, in a condition that will render 
 a renewal of that action unlikely to occur'"' (§ 954, h). 
 
 994, h. The same result of an almost unsurpassed experience is 
 again and again reiterated by Rush. " The half-way practice of mod- 
 erate bleeding," he says, " has kept up the mortality of pestilential fe- 
 vers in all ages and in all countries. It is much better not to bleed at 
 all than to draw blood disproportioned in quantity to the violence of 
 the fever (§ 960, h). Bleeding must not be discontinued so long as 
 the symptoms which first denoted its necessity continue." 
 
 In very pi'ostrating forms of fever, he says, that " bloodletting les- 
 sened the sensible debility of the system. Hence patients frequently 
 rose from their bed, and walked across the room, ^ftiv horns after the 
 operation" (§ 569 e, 898, 992).— Note Ff p. 1135. 
 
 995. And so, also, Armstrong: "In pneumonia," he says, "bleed 
 your patient to approaching syncope ; otherwise, instead of benefiting 
 him, you will do him harm" (§ 960, V). 
 
 And again : " In inflammations of the serous membranes, or of the 
 parenchymata, I bleed," he says, " more decidedly than I ever did." 
 " I have treated nearly three hundred cases of severe enteritis with 
 bleeding, &c., and with a success far greater than I have heard from 
 any other plan. There is no success on record at all comparable 
 with it" (§ 1005, e, i). 
 
 996. And so Mr. Lawrence, who says, that, 
 
 " In cases of inflammation, where the blood comes freely out of the 
 vein, I generally let it run on till it stops ; for that seems to me the 
 only way of doing good" (§ 960). 
 
 997, a Wardrop, in his excellent work on Bloodletting, lays down 
 the same rule and the same experience. Thus : 
 
 " When a large quantity of blood is not taken away at the first 
 bleedintr, in inflammation, or at a second depletion quickly succeed- 
 in "■, I have generally found that, on all future occasions, it is seldom 
 practicable to abstract any considerable quantity, however necessary 
 it may appear; and thus it is, that when copious bleedings are not 
 employed at the cnmmencemjnt of the treatment of inflammatory dis- 
 eases, and if the patient afterward recover, it has generally been from 
 the employment of a great number of bleedings. Moreover, it is only
 
 THERAPEUTICS. LOSS OF BLOOD. 751 
 
 in such cases wherein the pernicious effects of bleeding are exemplified" 
 (§ 950). " There seems always," he says, " to be a disposition in pa- 
 tients, as well as in medical men, to economize blood" (§ 960, 1007 b). 
 
 997, b. It is an aphorism with Gregory, that, in severe inflamma- 
 tions and fevers, " the danger of a large bleeding is less than the dan- 
 ger of the disease." 
 
 998, " With gangrene, infarction, and abscesses in prospect," says 
 Beddoes, " transient syncope, from loss of blood, is a slight evil. The 
 rule, that the constitution recovers much more kindly frora debility by 
 bloodletting than by disease, affords great encouragement" (§ 569, 
 1007 b). " Numerous facts show that in high inflammations the lancet 
 can scarce be used too freely." 
 
 999, a. Jackson says that " Dr. Rush carried subtraction of blood 
 to a great extent in yellow fever ; but the quantity subtracted was ob- 
 tained by repeated subtractions, not by abstraction at one time. The 
 mode of depletion was not abrupt, such as arrests disease by force, 
 and such as I have in view in the present history" (§ 929-934, 938 Z>, 
 942, 944, 948, 949, 955). 
 
 999, b. It may be true that Dr. Rush sometimes fell short of the 
 proper effect. It may be true that his moral courage was unequal to 
 that of his great cotemporary, since each was extensively denounced 
 as "a murderer;" and Rush could hardly fail of being sometimes 
 embarrassed by his strange delusion that " debility is the universal 
 predisposing cause of disease." Nevertheless, a glance at a preceding 
 section (§ 994) will assure us that the general charge is without founda- 
 tion. His philosophical acumen led him to bleed extensively, and 
 with success, in many cases where there appeared no hope to others 
 but in powerful stimulation. There is also a distinction to be made 
 between the yellow fever of Philadelphia, and that which called forth 
 the heroic practice of Dr. Jackson. The prostration of the heart from 
 intense sympathetic influences reflected from the vessels engaged in 
 the morbid processes was often greater, and there was less active in- 
 flammation to sustain decisive bloodletting, and more of venous con- 
 gestion to diminish the tolerance of loss of blood, and to impart ma- 
 lignancy to fever, in the former, than in the latter instance. Nature, 
 therefore, frequently interposed an obstacle which compelled the 
 American philosopher to be sometimes content with small and repeat- 
 ed abstractions of blood {§ 974, 975, 977, 983, 985).— Note Frp. 1135. 
 
 999, c. The foregoing reference to Rush's doctrine of " debility" 
 (§ 999, 5) leads me to an extension of a preceding section, where I 
 have explained the acceptation in which I employ the term prostra- 
 tion (§ 961, b), and which goes with former sections in elucidating the 
 nature of that condition which is commonly mistaken for " debility" 
 (§ 487 h, 569). What I now purpose saying is, that the condition of 
 the heart takes a very large share in those morbid demonstrations 
 which have led to so many theoretical and practical errors. But, the 
 heart, in these cases, is mostly obedient to disturbing influences prop- 
 agated upon it by the instruments which are carrying on the morbid pro- 
 cesses, and where the powers may exist in a very exalted, though, also, 
 otherwise modified, state. Those extreme vessels, however, determine 
 upon the heart a prostrating nervou-3 influence, and often, also, an ac- 
 cumulation of blood about its right cavities, which contributes yet 
 farther to the embarrassment of the organ. This will be readily ap-
 
 752 INSTITUTES OF MEDICINE. 
 
 preciated from what has been variously said upon relative topics in 
 former sections ; but the whole principle may be seen by refemng to 
 the instrumentality of the nervous power in the operation of loss of 
 blood ; while, also, the philosophy which is there set forth borrows a 
 conesponding illustration from the subject embraced in this section 
 (§ 916-922, 929-938, 942-949, 500 m, 687-^-089, 694|). 
 
 The heart, being prostrated in the foregoing manner, increases, by 
 reflex nervous actions, the morbid state of the instruments of disease, 
 complicates all the phenomena, and does its large part in leading all 
 but those who will take the trouble to investigate the philosophy of 
 life, and analyze the symptoms of disease, and apply them critically, 
 according to the share which belongs to each tissue and organ, to rest 
 their intellectual efforts upon the syinptoms alone, and their hopes in 
 tonics and stimulants. But, he who will penetrate this seeming labyr- 
 inth, yet accessible to all, will discover, at once, that the remedies 
 should be addressed to the immediate instruments of disease, and that 
 whatever will bring relief to these will certainly relieve the heart, and 
 dissipate the phantom, debility ; while, on the other hand, every cause 
 that may increase that pathological state of the instruments which are 
 the absolute seat of difficulty and danger, will as surely engender, 
 sooner or later, increasing embarrassment of the heart, and a conse- 
 quent multiplication of the morbific influences which radiate from the 
 centre of the circulation (§ 892 c, 965 b, 966-968, 500 ?«).— Nole I. 
 
 1000. Few medical philosophers have done so much for therapeu- 
 tics as Sydenham ; and with his name is associated one of those great 
 revolutions in practice in which bloodletting is the foremost remedy. 
 There was then, as now, that timid caution which has contributed so 
 largely to the common prejudice against the abstraction of blood. 
 
 " Nothing," he says, "is more frequently urged as a capital argu- 
 ment by those who condemn bleeding, than the mischief which arises 
 from bleeding in an improper manner" (§ 892 a, 892^ c, 960 a, 1005). 
 
 1001, a. The "improper manner" to which Sydenham refers (§ 
 1000) is justly, however forcibly, expressed by Botallus. Thus : 
 
 " Bleeding does no service in many cases, either because persons 
 have recourse to it too late, or use it too sparingly, or commit some 
 error in both these particulars. But, if our fears be so great, and we 
 take away so small a quantity of blood, how is it possible to judge 
 what good or mischief bleeding may do? For, if a disease which re- 
 quires the loss of four pounds of blood for its cure, and yet but one 
 be taken away, destroy the patient, it does not therefore prove de- 
 structive because bleeding was used, but because it was employed in 
 an improper manner (§ 950, 965 h). But ill-designing and indolent 
 men endeavor to lay the fault to the bloodletting ; not because it did 
 really do mischief (otherwise than by its improper use), but because 
 they desire to give every body an ill opinion of it. Or, suppose they 
 do not do it from wickedness, they cannot be excused from ignorance 
 and perverseness." It is also his opinion that " one hundred thou- 
 sand men perish from the want of bloodletting, or from its not being 
 timely employed, where one perishes from excessive bloodletting, 
 when practiced by a physician'^ (§ 1005). — Note p. 729. 
 
 1001, b. Botallus was critically right in qualifying his remark by 
 adding, " when practiced by a physician." No little of the preju- 
 dice which rational medicine encounters arises from the former indis-
 
 THERAPEUTICS. LOSS OF BLOOD. 753 
 
 creet use of the lancet, in the hands of the surgeon, immediately af- 
 ter concussions from falls, &c. The sad experience of some of the 
 most able has led to admonitions like that which is recorded in a for- 
 mer section (§ 960 a, page 720 ; § 1007, h). 
 
 But shall physicians deliberate when inflammation is careering in 
 the great organs of life ? Can there be a question of the applicability 
 of bloodletting to phrenitis, pleuritis, peritonitis, pneumonia, and to 
 many other grave inflammations, under their ordinary circumstances? 
 It is true, we have lately seen practitioners, Dr. Dickson, for exam- 
 ple, boasting of their success without having " ever wetted a lancet." 
 But I do not believe that this exclusive practice has many open advo- 
 cates ; and to admit its imputed results would be to renounce the dic- 
 tates of our own and of common observation. A more limited oppo- 
 sition, however, to bloodletting in grave inflammations is making an 
 inroad upon former experience ; nor is it the least remarkable cir- 
 cumstance that it enlists the most able disciples of the anatomical 
 school. And although they may often admit the utility of the remedy 
 in a general sense, when they come to its practical application to par- 
 ticular diseases, we are told that it is either useless, or prejudicial (§ 
 960). [The " stimulating plan" is now in vogue, 1 860. — Note, p. 872]. 
 
 1002, a. But once more, as to the prostrating forms of fever, from 
 which it will farther appear that neither the yellow fever, nor others 
 of an analogous character, have been so modified by climate, seasons, 
 &c., as to preclude the abstraction of blood; and that if loss of blood 
 be demanded by simple inflammation, it is much more so when in- 
 flammations are complicated with idiopathic fever, and especially when 
 that fever is of a " malignant nature," and constantly imparting its 
 malign influence to the local developments (§ 999, b). 
 
 Dr. Stevens, of the West Indies, the celebrated advocate of the 
 saline treatment of fevers, afl&rms, in his late work on the Blood, that, 
 " Those who were well bled, in the yellow fever, and properly evac- 
 uated in the beginning, almost invariably recovered." " He took 
 blood till he had nothing to fear from increased action." I have in- 
 troduced this statement for the purpose, also, of showing that the 
 credit which he imputes to the saline treatment of yellow fever is 
 wholly due to the decisive bleeding and purging which he adopted. 
 The saline practice in fevers was pretty largely in vogue some cen- 
 turies ago, and has been lately brought forward to give plausibility to 
 the humoral doctrines. 
 
 1002, h. Mr. Evans recently states, that in the Indies " we bleed 
 largely in the yellow fever, repeating the operation in two hours if 
 there remain the slightest pain on pressing the epigastrium ; and, in 
 general, if any gastric aflection remain after the second bleeding, to- 
 ward the close of twenty-four hours, we repeat it a third time, and 
 apply the leeches afterward." 
 
 This practice, as I learned on a visit at different islands a few 
 years ago, prevails throughout the West Indies ; and, in Eastern In- 
 dia, it is well known that bloodletting was never in higher repute in 
 all congestive fevers than at the present day. 
 
 1002, c. Baker remarks, that it is necessary to abstract, by repeated 
 bleedings, twelve or more pounds of blood in the malignant fevers of 
 Brazil. The distinguished Hillary urges free bloodletting on the first 
 a'ld second days of yellow fever, and in the worst forms of the disease 
 
 B B B
 
 754 INSTITUTES OF MEDICINE. 
 
 1002, d. " Here is a case," says Mills, " of the typhus gravior of 
 Cullen, or such as is commonly denominated putrid. The petechige 
 (so much dreaded by the opponents of bloodletting) disappeared after 
 the second bleeding; an effect I daily witness fiom the use of the 
 lancet, which clearly proves that this symptom proceeds from vascu- 
 lar action."* And so, also, Dr. Parry ; who introduced the only suc- 
 cessful or philosophical treatment, that of bloodletting, in purpura 
 hemon'hagica ; now treated by stimulants and astringents, but in vain. 
 
 1002, e. By the same process of induction from the vital phenom- 
 ena that conducted Parry to the true pathology of purpura hemor- 
 rhagica, Lind, Blane, Milman, Rouppe, Fordyce, Girtanner, Pinel, 
 Baglivi, Heberden, De Haen, Moore, Bampfield, Darwin, Beddoes, 
 Woodall, and others, inferred the inflammatory nature of scurvy (the 
 great pillar of humoralism), and practiced bloodletting as the first step 
 in its treatment. Diet here illustrates the vis medicatrix (§ 853). 
 
 1002, y. What shall be said of the celebrated jail fevers, where ev- 
 ery body now stimulates ? Let us hear the illustiious Pringle, who, 
 more than any one of the old school, taught the pathology of living 
 putridity. He was' one of the last of a long line at whose beginning 
 stands the Roman projector of humoralism ; having died in 1782, 
 when solidism again triumphed for awhile. He was a man of vast 
 experience, great success, and of universal renown. He was an 
 English baronet, pi'ofessor, physician-general of the British forces, 
 and studied and treated diseases in Germany, Flanders, Scotland, 
 London, &c. He was, in brief, like Robert Jackson, a "Ulysses in 
 Medicine," and, like Jackson, he found that the same diseases required 
 the same general treatment in all climates ; being utterly regardless 
 of the humoral doctrines at the bed-side of disease. 
 
 Pringle, I say, bled in all forms of fever — jail fever, typhus syn- 
 copalis, and whatever the imaginary degree of putridity. " Bleed- 
 ing," he says, " in putrid fevers, is indispensable." " It is the first 
 thing to be done in the beginning of the treatment." 
 
 Riverius, an eminent French physician of the seventeenth century, 
 like Pringle, considers "putridity a reason for bleeding at all stages 
 of petechial fevers," — " non ullum unde eirvincrc periculum" — nor did 
 any injury result from it. 
 
 Grant says that, "even in the putrid diathesis of fevers (as he calls 
 it), where much evacuation is required, more or less blood ought to 
 be taken before proceeding to other evacuations." 
 
 Baillou, in the enlightened days of humoralism, advises "bloodlet- 
 ting in all ^mtrid and malignant fevers, even when there is a tendency 
 to hemorrhage from dissolution of the blood" (§ 1002, c). And so of 
 many other distinguished theorists in the school of putridity. 
 
 1003. Let us now regard the language of the best experience as 
 to the treatment of a form of fevers for which " bark" is commonly 
 supposed to be an almost unfailing specific, but which, even its alka- 
 loids, often entails the most obstinate forms of local chronic disease, 
 when untimely, or excessively, employed (§ 892, &c.). Thus : 
 
 " It may be laid down," says Armstrong, " as an established prin- 
 ciple, that if venesection does not absolutely cure intermittent fevers, 
 it paves the way for other remedies, and is, on that account, highly 
 necessary." Or, as Hippocrates has it, " he who would purge bodies, 
 must first make them permeable:' Baglivi, Torti, and other distin- 
 * See Note T p. 1125.
 
 THERAPEUTICS. LOSS OF BLOOD. 755 
 
 guished Italian physicians, affirm, positively, that the local complica- 
 tions of their intermittents could not be cured without bloodletting. 
 Sir John Pringle, in treating the intermittents, mild or malignant, in 
 " low, marshy countries, found it necessary to begin with opening a 
 vein, and to repeat the operation according to the urgency of the 
 symptoms." "A person," he says, " unacquainted with the nature of 
 this disease, and attending chiefly to the paroxysms and remissions, 
 would be apt to omit this evacuation, and to give bark prematurely." 
 This is what led Cleghorn into his fatal mistake (§ 1005, h). But we 
 ultimately hear from him, that, " for his part, when called early enough, 
 he used to take away some blood from all people, of all ages, when 
 affected with tertians, unless there was a strong contra-indication." 
 And so Senac : " the physicians bleeding five or six times in an epi- 
 demic tertian." Cragie says, that, in Great Britain, remittents re- 
 quire the loss of twenty-five to thirty ounces of blood (§ 960, a). 
 
 1004, a. It would be superfluous to extend the foregoing species 
 of testimony afforded by modern practitioners in favor of bloodletting 
 in the treatment of inflammatory, congestive, and febrile diseases. In 
 the article on Bloodletting, embraced in the Medical and Physiolog- 
 ical Commentaries, I have presented the experience of all the distin- 
 guished practitioners from the earliest ages of philosophical medicine, 
 and it may be there seen that without exception they have concurred 
 in their testimony as to the transcendent utility of blood-letting. 
 
 1004, b. The " father," himself, says, that, "in all active inflamma- 
 tions we should open a vein, and if the disease be vehement and pros 
 trating, the loss of blood will bring strength to them that lose it, — 
 ' robur ipsis affuerit.' " He abstracted blood for the relief of those 
 syncopes which attend the worst forms of congestive typhus ; as did, 
 also, Galen, Celsus, Aretaeus, Trallian, Paul, Aurelian, Avicenna, &c. 
 1004, c. Oribasius, about three hundred years after Christ, states 
 that he was bled to the extent of two pounds for an attack of 
 the plague, and that his reliance was mainly upon this remedy. 
 Galen bled largely in this disease, and he is the first who records the 
 quantity. " I remember," he says, " to have taken away in some in- 
 stances, at one bleeding, six pounds of blood, which immediately ex- 
 tinguished the fever, nor was there any loss of strength in consequence'" 
 (^'992). Such was his success by this mode of treatment, that the 
 spectators exclaimed, eacpa^ag, avdpcons, ~ov TrvpeTov; — "Oh! man 
 thou hast cut the throat of the distemper."* Avicenna says that he 
 has sometimes abstracted, in the plague and " putrid fevers," at one 
 bleeding, five or six pounds of blood, — " quinque aut sex sanguinis 
 librcB. auferantur" (§ 1019, d.) Bleeding largely in the plague was a 
 general practice after the revival of learning, and was practiced 
 through the 16th, 17th, and 18th centuries; as it was, also, in other 
 fevers, and in inflammatory and congestive affections. The exigen- 
 cies of the disease was the criterion as to the quantity of blood to be 
 abstracted. Septalius states that it was the universal custom of phy- 
 sicians to bleed in the plague of 1575 and 1576. " Communi consen- 
 su in hujusmodi nobilc remcdium nullo modo pretermittendum esse dccre- 
 verant.''' And so Riverius, of a similar epidemic, " Deo sit laus et ho- 
 nos ! quotquot hoc tractati sunt modo f elicit er evaserunt P^ In later 
 times, Faulkner commends bloodletting in the plague, and says that 
 "when the blood was in a dissolved state, the remedy was not less 
 
 * Galen's success so raised the hostilit)- of the Roman phj'sicians as to banish him 
 from Rome for several years ; they denouncing the remedj', and he immortalizing them.
 
 756 INSTITUTES OF MEDICINE. 
 
 favorable." Assalini remarks that, "At the commencement of the 
 plague, I saw the necessity of making use of bleeding in proportion 
 to the strength of the patients." — Note Ff p. 1135. 
 
 And, as to the less prostrating forms of fever and inflammation, 
 Baglivi supplies an example of the general practice in the 16tl, 17th 
 and 18th centuries. He observes, " Omnes acutas et inflammatorias 
 febres, hie Romae, curare incipio per sanguinis missionem." And so 
 of all the eminent Roman physicians dow^n to the recent day of Rasori. 
 
 1004, d. It has been often thought remarkable that Hippocrates 
 had never designated the quantity of blood which may be demanded 
 by any given form of disease. The reason is, he was too much of a 
 philosopher. He knew that no rule, in this respect, would be useful ; 
 but, on the contrary, unwarranted by nature, and liable to the worst 
 results. Look at his writings, and you will find him bleeding accord- 
 ing to the symptoms, and the general history of the case. This, in 
 deed, he often says, was his rule. He had no other in relation to 
 quantity. 
 
 1005, a. Before leaving these practical considerations it may be 
 well to listen to the confessions of a disastrous experience which befell 
 some of the most enlightened of our profession from their neglect or 
 misapplication of bloodletting. Let us select examples of prostrating 
 forms of disease, where it too commonly happens that its nature and 
 exigencies are misapprehended, or imperfectly understood, and where 
 " debility" is regarded as the essential pathology, and is supposed to 
 demand the stimulant plan of treatment. These examples will cover 
 the whole ground, and disarm the stoutest prejudice in other less ter- 
 rific foi'ms of prostrated strength. 
 
 1005, h. The distinguished Mr. Hey shall speak first, and of those 
 cases of puerperal fever in which *' debility" presents its most ap- 
 palling aspects. This able man had unhappily treated the disease 
 either with tonics and stimulants, or with inadequate bloodletting. 
 He finally introduces a case (his ninth case), which was the last in 
 which Mr. Hey employed the bark and wine, or procrastinating, treat- 
 ment. It was the last mistaken act that divided the professional life 
 of Mr. Hey into two distinct eras. The patient died, and with her 
 death came his full conviction of his error. " If the disease," he says, 
 " is clearly ascertained, no other consideration is of much importance. 
 The state of the pulse affords little information, either as to the pro- 
 priety of bleeding, or the quantity of blood to be taken away ; and if 
 we are deterred either by the apparent weakness of the patient, by 
 the feebleness and frequency of the pulse, or by any other symptom, 
 from bleeding copiously, we shall generally fail to cure the patient." 
 
 1005, c. And now mark another maxim of this able man, who felt 
 his way to truth over many a victim of malpractice ; and what he says 
 of puerperal fever is equally applicable to all other fevers when com- 
 plicated with inflammation or venous congestion. " There is a vast 
 difference," he says, " in the puerperal fever at different times, and in 
 different situations and circumstances. In some cases it appears like 
 a phlegmonous inflammation ; in others it destroys with more rapid- 
 ity and certainty than the plague. But, the means of cure are pre- 
 cisely the same in both ; but in the worst forms the measure of blood- 
 letting is greater and less limited, and the period within which it must 
 be employed is far more circumscribed." " The truth is." he says
 
 THERAPEUTICS. LOSS OF BLOOD. 757 
 
 Estill lamenting his mistakes), " that bloodletting has seldom been fairly 
 tried. Either the quantity of blood taken away has been too small, 
 or the time when it was taken too late for any use ; and thus the prin- 
 cipal remedy for the disease has been brought into disrepute" (§ 965 h, 
 1000, 1001. — Also, § 500 m, 694f, showing the import of the pulse). 
 1005, d. But Mr. Hey was mistaken as to the novelty of the prac- 
 tice. Like many others, he depended too much upon his own genius 
 and experience ; neglecting the past, and thinking that medicine is 
 the work of a day. Hence his ignorance of the labors and of the 
 choice experience of his predecessoi's. Bloodletting had predomi- 
 nated, as the only great remedial agent for all inflammatory affections 
 and fevers of the most depressing character, ages before Mr. Hey 
 came to illustrate the truth by other martyrs ; and this in England, 
 GJ-ermany, Arabia, Italy, — the island of Cos (§ 1004, b). The " dis- 
 repute" of which Mr. Hey speaks was then only local, not general ; 
 for, while the temporary reign of the " bark and wine treatment" crip- 
 pled the best practitioners in Great Britain, reason and sound practice 
 were unrestrained in other countries. — Note Ff p. 1135. 
 
 1005, e. The equally able and distinguished Mr. Gordon had the 
 same melancholy experience with bark and wine, and the procrasti 
 nating treatment of puerperal fever; and, like Mr. Hey, he shifted 
 his practice to early and copious abstractions of blood, and has left a 
 record of the happy fruits of his dear-bought knowledge. He has one 
 remark which proves the inutility or the positive injury of inadequate 
 bloodletting. " He lost," he says, ** every patient when he bled only 
 to the extent of ten or twelve ounces ; but that all recovered w^hen 
 he had the courage to abstract twenty or thirty ounces" (§ 950, 965 b). 
 Armstrong, by " copious bloodletting, lost only five out of forty-three 
 cases" (For the works &c. quoted see Med. and Phys. Comm. ut cit.). 
 
 1005, yi And here is Denman, the eminent author of works on Mid- 
 wifery, who, like Hey, and Gordon, had carried havoc into the cham- 
 bers of puerperal women. He, too, once bowed at the fascinating 
 "idol. Debility;" but having lost most of his patients under the se- 
 ductions of this ignis fatuus, he turned himself to the Genius of philos- 
 ophy, and, as a noble atonement to inankind, left behind him, like 
 Gordon, and Hey, a record of his errors. 
 
 " I am now convinced," he says, " by manifold experience, that my 
 reasoning was fallacious, and my facts groundless, and that which 1 
 had considered proofs of the insufficiency, or the impropriety, of blood- 
 letting in puerperal fever, ought, in reality, to have been attributed 
 to the neglect of performing it in an efficient manner, and at the very 
 beginning of the disease" {§ 1000, 1001).— Note H p. 1117. 
 
 1005, g. Leake says that, " every puerperal woman, in Lowder's 
 time, who was blooded, died ; ten ounces being considered a large 
 bleeding;" while Leuret, accustomed to the timid practice of Low- 
 der, affirms that, " he had never seen a woman escape after bleeding." 
 Here it will be readily perceived that the inefficient bloodletting ag- 
 gravated the disease (§ 950, 965), just as it is allowed to have done, 
 in the same affection, by Hey, and Gordon, and Denman. 
 
 1005, h. With the familiar name of Cleghorn are associated, as in 
 the former instances, a sound judgment and large experience. Let 
 us consider his experience in a pestilential, prostrating, bilious pneu- 
 monia that ravaged the island of Minorca ; and let us not fail of being
 
 758 INSTITUTES OF MEDICINE. 
 
 admonished by his example, also, of the importance of taking for our 
 guide the lofty principles of our science, and the experience which is 
 taught by adversity as well as by happier auspices. 
 
 This epidemic pneumonia was complicated with idiopathic, conges- 
 tive, fever, attended by " insidious intervals and treacherous remissions," 
 and by great prostration, or " debility" (§ 569). And now mark the 
 vacillating treatment so characteristic of weaker minds, or where ig- 
 norance of medical philosophy leads to an obstinate adherence to 
 the suggestions of prejudice and timidity. Mark, also, the uselessness^ 
 or the injury, of small abstractions of blood, and the triumph of great- 
 er (§ 950, 965, 1000, 1001). 
 
 " I attempted," says Cleghorn, " to cure the patients by bleeding 
 once or twice a day, except during the insidious remissions ; but they 
 generally perislied. This unforeseen event startled me greatly, and 
 led me to review the whole progress of the disease," &c. He then 
 determined " to adopt the advice of Duretus, and to use the lancet 
 with more caution." But his failures became still more frequent and 
 mortifying (§ 811-815)— Note Ff p. 1135, Ccc p. 1148. 
 
 " At length I was convinced," he says, " that instead of too much, 
 too little blood had been taken away in the beginning, and that I had 
 been misled by the insidious intervals. I then began to bleed more 
 plentifully, taking away thirty or forty ounces within the first three 
 days of the distemper. This method succeeded well in several of the 
 cases" (§ 965, b). 
 
 Still he was not satisfied. " At last," he goes on, " about the mid- 
 dle of March, when the disease raged with the utmost fury, having 
 found that there was the most absolute necessity for bleeding largely 
 without delay, in order to preserve life, I began to put in practice the 
 following method of cure, which seldom or never failed; not only 
 in young, robust people, but even in those of more advanced age, pro- 
 vided I saw the sick before tlie end of the third dayP 
 
 This " method" consisted in abstracting blood in the horizontal pos- 
 ture, " till the pains abated or the patient began to faint ; taking from 
 eighteen to twenty-seven ounces, avoirdupois. If the symptoms con- 
 tinued, a few hours afterward the same quantity was again taken 
 away, without regarding the state of the blood, &c. Next morning, 
 if there were any remaining symptoms, the bleeding was repeated, and 
 the blood carefully weighed. From fifty-four to sixty ounces were 
 frequently taken away during the first twenty-four hours of attend- 
 ance. If any symptoms returned, the patients were immediately bled 
 again to the asnount of fourteen or twenty-seven ounces." 
 
 What a contrast in treatment, — what a contrast in results ! Blood- 
 letting, decisive bloodletting, was at last almost the only remedy em- 
 ployed, and it now succeeded in every instance where its timid appli- 
 cation had been, before, as universally fatal (§ 950, 954 b, 965 b, 1000 
 1001). But a " horizontal posture" is unfavorable and may not be safe. 
 
 And here let us not fail to observe the same results in the practice 
 of Cleghorn as in that of Jackson and others in analogous epidemics 
 (§ 992-999). "Under this method of treatment, it was remarkable," 
 says Cleghorn, " to observe how rapidly the sick recovered their usual 
 health and strength, notwithstanding the great loss of blood which they 
 had sustained ; while many, who had been bled more sparingly, con- 
 tinued in a languid, infirm state, for some months.'" Patients of the lat-
 
 THERAPEUTICS. — LOSS OF BLOOD. 759 
 
 ter diss were only imperfectly relieved. Congestion still remained 
 about some of the great viscera, especially the liver, by w^hich, also, 
 the powers of digestion were maintained in a prostrated state. Un- 
 der these circumstances, eri'ors in diet, and mental and bodily fatigue, 
 often contribute to maintain and exasperate the consecutive derange- 
 ments ; till, at last, it frequently happens that a slow increase of the 
 local diseases becomes the exciting cause of another explosion of the 
 constitutional malady. Thus the patient not unfrequently goes on 
 revolving, year after year, through mitigated and exasperated condi- 
 tions of disease, which more decisive treatment by bloodletting, at its 
 onset, would have prevented (§ 868, 883 h, 892 d). 
 
 I have stated the several successive steps of Cleghorn's plan, that 
 each may be compared with the others. The quick transition from 
 wx'ong to right evinces the hand of a master. The record is full of 
 the most important instruction ; and while I hold it up to the present 
 generation, I would that not only its practical instruction, like the sad 
 experience of Gordon, and Hey, and Denman, should be duly regard- 
 ed, but equally, too, that the frankness of each should be emulated. 
 
 1005, i. Dr. Boyd, also, subsequently to Cleghorn's time, in descri- 
 bing the malignant fever of Minorca, states that bloodletting must be 
 carried to the extent of positive relief, without reference to quantity. 
 He sometimes repeated the operation four times in a day. Our inland 
 practitioners, at the south and west of New York, will see in the 
 congestive fever of Minorca a simile of their own as sometimes com- 
 plicated with "bilious pneumonia;" while their practice responds 
 more or less to that of Boyd and Cleghorn. 
 
 1005, J. Erysipelas is another wide-spread and prostrating disease 
 in its epidemic form, which has beguiled the multitude into the fatal 
 use of " the bark and wine treatment." In his Essay on Bloodletting, 
 Dr. "Wardrop states that, " during a long attendance at a public hos- 
 pital, a certain physician had never known bloodletting employed in 
 erysipelas, and that nearly all the cases that he had seen of that dis- 
 ease, affecting the head and face, had terminated fatally." And so 
 Armstrong: " The wine and bark system is of all the most fatal prac- 
 tice in erysipelas." " Five individuals had erysipelas in one house, 
 were treated with bark and wine, and all died" (§ 995). 
 
 When " erysipelas" presents itself as an epidemic, it displays its 
 connection with a far graver form of disease in the abdominal viscera ; 
 especially hepatic congestion. And such, probably, is always its com- 
 plications when sporadic only. But, the symptom is conspicuous ; 
 and hence the name, and hence, also, the usual treatment. The at- 
 tention is apt to be turned, mainly, to the sympathetic inflammation 
 of the skin. The obscurely marked, or what Cleghorn would call the 
 " insidious," affection of the liver, &c., is not appreciated, and the force 
 of the treatment, therefore, too often takes the wrong direction. Noth- 
 ing, indeed, is more common in " epidemic erysipelas" than an absence 
 of the cutaneous affection in the worst forms of the disease; and these 
 very cases, from their exact resemblance in all other respects to those 
 which are marked by the symptoyn, go by the same name, and get the 
 same treatment. I have seen many instances of this nature ; particu- 
 larly during the late prevalence of the disease in Vermont and New- 
 hampshire. I have seen their subjects fall victims to the disease within 
 two and three days from the attack, where there was no inflammation
 
 760 INSTITUTES OF MEDICINE 
 
 of the skin; and, in other instances, where the skin was mottled with 
 patches of a low degree of inflammation. I found the practitioners, 
 however, generally taking the right course, and regarding the affec- 
 tion of the skin as symptomatic only. But, the disease jiresented it- 
 self in a very grave form ; and it was interesting to obser\'e that, 
 while it had many victims under opposite modes of treatment, the 
 greater success of the depletive plan generally won over the few who 
 had preferred stimulating (§ 689 /, 861, 894, mottoes, 905^ h, 961 5, 
 964 c. Also, Med. and Physiolog. Comm., vol. ii., p. 6u3-607, Article 
 Erysipelas). 
 
 1005, k. Let us consider, also, the adverse re?j xlw of the stimulant, 
 and even of the tartar emetic treatment of pneutrionia (§ Q92^,g). It 
 is the opinion, for example, of Dr. Stokes, that '* General bloodletting 
 is not to he considered the chief means of removing the diseased " In 
 the typhoid form, the best practice is to use wine in conjunction with 
 local bleedings." " Grenex'al bloodletting," he says, " is to be used 
 with extreme caution, and the vital forces are to be carefully support- 
 ed." But, " In two instances only has he seen pneumonia cut short by 
 bleeding" ! This admission appears to be conclusive against the doc- 
 trine of " saving the vital fluid," according to this distinguished writer, 
 and especially that of "supporting the vital forces by wine" (§ 569 c, 
 983).— Stokes, on Diseases of the Chest, p. 226, 227, 231. 
 
 Dr. Williams, in his work on Diseases of the Chest, appears to have 
 enjoyed as little success in the treatment of pneumonia, and for the 
 obvious reason that he considers " local depletion the utmost that 
 can be attempted in typhoid pneumonia. Considerable advantage 
 may, under these circumstances, be sometimes obtained from dry cup- 
 ping on the chest, which, for a time," he thinks, " tends more effectu- 
 ally than even bloodletting, to draio the fluids from the congested or- 
 gans, while it does not waste the blood from the system" (§ 960), 
 This philosophy has numerous admirers, who regard it, with Dr. Ar- 
 nott, as " a great modern improvement in the healing art," and as 
 one of the luminous proofs that the nineteenth century has witnessed 
 a great revolution in medicine; or, as Louis has it, that " medicine is 
 now in its infancy." Apropos, of this distinguished Frenchman, who 
 is opposed, mathematically, to the abstraction of blood in pneumonia, 
 erysipelas, " typhoid fever," and acute intestinal inflammation ; with 
 their complications, also, of other local inflammations. And so, too. 
 of many other distinguished French physicians, who rely mainly on 
 the watching system, or on the tartar emetic practice. But, what are 
 the results % Chomel makes the average mortality from pneumonia, 
 at the hospitals, one in four; Louis lost one in three; and Legarde 
 one in three. Leconteulx reported twelve out of thirty, by the anti- 
 monial treatment. These last were treated by Laennec. 
 
 But, in these United States, where bloodletting is thoroughly prac- 
 ticed, the loss does not exceed one in twenty to twenty-five. There 
 is here, however, no exclusive system, no " numerical method;" but 
 the treatment proceeds upon Hippocratic principles. The symptoms, 
 and various other circumstances, attending each individual case, reg- 
 ulate the practice. It is not all bloodletting, nor all tartarized anti- 
 mony. Cathartics, calomel, blisters, &c., form as well a part of the 
 treatment. Nor have we much knowledge of the effects of bloodlet- 
 ting in the advanced stages of the disease : mainly for the reason that 
 we adopt it early (p. 517, note).* — Notes F p. 1114, Mm p. 1141. 
 
 * Our large cities and hospitals, but not the countrj-, must be now excepted (p. 872, 
 P.S.).— 1860.— Bloodletting is now every where greatly abandoned.— 1667.
 
 THERAPEUTICS. LOSS OF BLOOD. 761 
 
 It is said by Dr. Osborne, in his work on Dropsical Diseases, that 
 " Since what has been termed the tartar emetic treatment has been 
 introduced into Great Britain, and the practice of bleeding has con- 
 sequently been to some degree discouraged, it appears to me that the 
 advanced stages and fatal terminations of pneumonia have been fre- 
 quent; and in this judgment I am confirmed by records on the large 
 scale" (§ 960, a).— See P.S. 1860, at p. 872.— Note F p. 1114. 
 
 1005, I. As to any modifying influences from climate in England, 
 either in respect to pneumonia, or other inflammations, or all the va- 
 ineties of fever, we have only to consult such authors as Armstrong, 
 Jackson, Johnson, Wardrop, Elliotson, Lawrence, Smith, Davies, 
 Weatherhead, &c., &c., to be convinced that those diseases are now, 
 as ever, the same there as in America, and require the same general 
 plan of treatment. Looking back to the age of Sydenham, and along 
 the intermediate periods, we find that every thing, on this subject, 
 has remained without any essential change. It is practice alone that 
 has fluctuated. And, if we cast our recollections through the vista 
 of time, over various countries, till we reach the age of Hippocrates, 
 we shall still find that diseases, of a given denomination, have been 
 the same, and have ever required the same general treatment, 
 
 1005^, «. From what has been now said, under the present division 
 of my subject, and more especially from the wide range of experience 
 presented in the Medical and Physiological Commentaries, it appears 
 that there is one universal consent among the great physiological 
 practitioners as to the importance of decisive bloodletting in all forms 
 of active inflammation, and in high grades of fever ; whether it appear 
 in the shape of the plague, of yellow fever, of typhus, or other inflam- 
 matory or congestive forms. It has been so from the earliest days of 
 the science ; in all countries, in all climates, in all constitutions, at all 
 ages ; and, whether in the Mediterranean or the Caribbean Isles, the 
 jungles of Asia, the pestiferous regions of Africa, the paludes of Italy, 
 or the high, and temperate, and salubrious countries of Europe and 
 America, we witness the immutable principle that diseases and their 
 general method of cure are every whei'e nearly the same. Constitu- 
 tion, habits, and age, certainly modify the details of treatment, more 
 or less ; climate comparatively little. The great fundamental laws 
 of disease remain without change, as do, also, the leading conditions 
 of disease. We have all that Hippocrates described before our own 
 eyes, and we are astonished at the identity. We think him, at one 
 moment, a prophet; and when, at the next, we realize a simple narra- 
 tive of only what he observed, we are either amazed at his sagacity 
 and philosophy, or that we should have been so slow to have discov- 
 ered the truth ourselves (§ 624,1068, Note Ggg p. 1151).* 
 
 lOO.'i^, b. The human constitution, its laws, susceptibilities, &c., are, 
 in a general sense, every where the same ; while the remote causes 
 of disease are the same now as at the beginning of time, produce 
 their effects upon the same properties, whose nature cannot be per- 
 manently affected (§ 180-182, 286), and whose results are connected 
 by a chain of analogies. The pathology of inflammation, or of simple 
 or congestive fever, therefore, is the same, respectively, in principle, 
 at all times, and in all countries, and the great principles of treatment 
 must also be immutable. But, modifying causes impart various shadea 
 of difference to every epidemic, to every individual case. To under 
 * See N0TK8 Ff p. 1135, Go 1138 Hh 1138.
 
 7C2 INSTITUTES OF MEDICINE. 
 
 Stand the complex, or even leading condition of each case, what ita 
 general nature, what peculiarities may arise from various causes, what 
 the exact adaptation of remedies, how much the successive changes 
 may be due to nature or to art, requires unceasing vigilance (^ 624). 
 
 1006, a. And now let me ask, whether the vast expenence, and the 
 precepts relative to bloodletting, of the able physicians who have giv- 
 en to medicine its rank and dignity, are to be impugned by chemists, 
 or by the prejudice, or the limited, or the careless, observation of 
 many physicians, who are too apt to deceive themselves into the be- 
 lief that they imbody the only experience which can be available in 
 disease, or which enlightened philosophy can approve (§ 1007, V) % 
 
 Doubtless, it will appear absurd that I should have embraced the 
 chemists, and as foremost, too, in the preceding interrogatory. But, 
 is it not the order of the day (§ 5^ a, 349 d, 960 a, page 719) ? And 
 being so, I will reply, once more, in the language of Dr. Paris, when 
 he was defending medicine against the harmless recreations of the 
 Chemists, about the year 1825, and mainly because Professor Brande 
 had ventured upon the open opinion that chemistry was neglected in 
 medical education, and that the " London Pharmacopeia is a record 
 of the want of chemical hnowledge where it is most imperiously requir- 
 ed." The answer, perhaps, is abundantly set forth in a former sec- 
 tion (§ 676, h). As showing yet farther, however, the instability of 
 science, and as embracing a precept which every lover of truth will 
 do well to ingraft upon his morning prayer, I shall quote Dr. Paris 
 once more, though upon a subject simple in its nature, and of very 
 minor importance to that which is relative to the laws of organic life 
 and the great principles of medical science. Thus : 
 
 " I cannot conclude these observations upon Mr. Brande's attack, 
 without expressing a deep feeling of regret, that a gentleman, whose 
 deserved rank in society, and whose talents and acquirements must 
 entitle him to our respect, should have condescended to countenance 
 and encourage that vile and wretched taste of depreciating the value 
 and importance of our most venerable institutions, and of bringing 
 into contempt those acknowledged authorities which must always meet 
 with the approbation of the best, and the sanction and support of the 
 wisest, portion of mankind (§ 676, b). And I shall here protest against 
 the prevailing fashion of examining and deciding upon the preten- 
 sions of every medicinal compound to our confidence, by a mere chem- 
 ical investigation of its composition, and of rejecting, as fallacious, ev- 
 ery medical testimony which may appear contradictory to the results 
 of the Laboratory. There is no subject in science to which the max- 
 im of Cicero more strictly applies, than to the present case. Let the 
 Ultra Chemist, therefore^ cherish it in his remembrance, and profit by 
 its application : 
 
 " ' PRjESTAT NATURiE VOCE DOCERI, QUAM INGENIO SUO SAPERE.' " 
 
 Paris' Pharmacologia, p. 103. London, 1825, (§ 1034).^ 
 
 And now, for the purpose of showing how any special commentary 
 upon any given substitution for the well-settled method of induction 
 or for any well-ascertained laws of Nature, is alike applicable to any 
 other fundamental innovation, and how, also, the overthrow of one 
 grand scheme of the day is the immediate parent of another, I shall 
 quote from the Medical and Physiological Co?nmentarics a paragraph 
 relative to M. Louis" attempt to foist upon medicine the celebrated
 
 THERAPEUTICS. LOSS OF BLOOD. 763 
 
 ••NuMEUiCAL Method," and ask tho reader to apply it to " Organic 
 Chemistry in its Applications to Physiology ;'" and to " Animal Chem- 
 istry applied to Pathology and Thei apeutics .'" Thus : 
 
 " Thus mounted upon the wreck of philosophy, ' the Numerical 
 Method' (' Organic Chemistry^) became the engine in learing that fab- 
 ric whose construction it was destined to serve. This is the charm 
 with which the Numerical Method (Organic Chemistry) is invested ; 
 while it gives to its author that ascendency in mind which few can 
 truly obtain by the legitimate rules of induction. ' After much delib- 
 eration,' as Isocrates says, ' he found the thing could not be com- 
 passed in any other manner ;' or, as our Author has it, ' fortunately 
 for the progress of science, the Numerical Method (Organic Chemis- 
 try) is considered by the most judicious and experienced men as a 
 necessary instrument for establishing general principles in medicine^ (§ 
 6^ a, 349 d, 960 a, page 719). Accordingly, former systems, and for- 
 mer facts, yeZZ as by enchantment (§ 376^, 433). The mind sickened 
 at the absence of all principles to guide it, and was therefore the more 
 willing victim when assailed by the irresistible power of numbers 
 {symbols) (§ 960 a, p. 719). If the demonstration was made with re- 
 iterated professions of a regard for facts ^ it was because the method 
 could have had no existence without them ; while the perpetual epi- 
 thet of ' rigorous' left no room for skepticism. But, as related, ac- 
 cording to Lord Bacon, 'of good Queen Bess, the Commissioners 
 used her like strawberry-wives, that laid two or three great strawber- 
 ries at the mouth of their pot, and all the rest were little ones. So 
 they made her two or three good prizes of the first particulars, but fell 
 straightways.' " — {Med. and Phys. Comm.., vol. ii., p. 782.) 
 
 " This manner of digression, however, some dislike as frivolous and 
 impertinent; yet we are of Beroaldus' opinion, — such digressions do 
 mightily delight and refresh the reader. They are like sauce to a 
 bad stomach ; and we do therefore most willingly use them." 
 
 1006, b. The reader will recollect that I had been last speaking 
 of the respect which is due to the experience of the great sages in 
 medical philosophy. I was early led to listen to their conclusions, 
 and to adopt their counsel, as summarily expressed in the foregoing 
 maxim derived from Cicero (§ 1006, a). For thirty years I have 
 watched attentively the effects of bloodletting as practiced by myself 
 and by many others, and have long since come to the conclusion, that 
 it is safer to put " the two-edged sword" into the hands of the igno- 
 rant, or the imbecile, or those who make a trade of the profession, 
 than to foi'ever blunt its edges, so that it will not cut, before it be trust- 
 ed to their use. We every where see victim after victim sacrificed to 
 timid admonitions, and worse example ; while you, and all of us 
 know, that it is a rare phenomenon that a patient is slain, seldom in- 
 jured, by the lancet. This is the test, and the strength of it is before 
 the reader.* 
 
 1006, c. On the other hand, is it not too often the case that eminent 
 and able teachers, who constantly instruct us to pause where blood- 
 letting is indicated, observe a phlegmatic silence as to the .injurious 
 tendencies of active internal agents, or urge them upon us as if they 
 were as powerless as water % These, not bloodletting, make up the 
 great abuses of practice. Here, protestations against abuse would come 
 with a benign effect ; or if uttered, they are apt to be in an unworthy 
 spirit of distrust of the whole medical art. — Note F p. 1114. 
 
 * In 1870, after a practice of fifty-four years, large and without intermission, I reiter- 
 ate the same. Vide § 1068, h, p. 870. ,
 
 764 INSTITUTES OF MEDICINE. 
 
 Let us at least consider that all other remedial agents of any great 
 importance, even those of the best antiphlogistic nature, are irritants 
 under many circumstances of inflammation, and are, therefore, more 
 or less liable to increase that affection, unless morbid irritability be 
 previously subdued by loss of blood. This is even true of antimo- 
 nials and ipecacuanha, in irritable states of the alimentary canaL 
 How obvious, then, the importance of often preparing the way for 
 their salutary effects by loss of blood ; and, in doing which, we also 
 greatly supersede the necessity of other remedies. 
 
 1006, d. If we contrast even the scanty cases of injury from uterine 
 hemorrhage, and other accidental losses of blood that may be sustained 
 in health (or try our best at the records of excessive bloodletting, as 
 preserved by the most watchful Brunonian), with the terrible and 
 wide-spread effects of procrastination, or timidity, in the use of the 
 remedy where it has been demanded by disease, and, more than all, 
 with the " bark and wine treatment," we shall have little to fear from 
 the possible abuses of the lancet. A few may be rash from ignorance, — 
 perhaps from the encouragement of others ; but will not this encour- 
 agement stimulate a host to lay aside their fears, and to moderate 
 their Brunonian practice 1 Where, then, according to the " numeri- 
 cal method," will be the balance (§ 569, e)] — Notes F H. 
 
 1006, e. Where inflammatory diseases are comparatively mild, their 
 mildness will naturally restrain every practitioner ; and when ex- 
 isting in severity, there will be little or nothing to fear from the 
 liberal abstraction of blood so long as the symptoms resist this princi- 
 pal remedy, and its proper auxiliaries. At most, there can be only 
 now and then a disastrous result; while timid caution has its myriads 
 of victims. Defective judgment there must always be; ; and it is bet- 
 ter, therefore, that it should lean to the side of safety. If going 
 wrong, the error, in respect to excess of bloodletting, will be very 
 soon discovered. The timidity of man needs no encouragement, 
 when the question relates to " debility," and " the precious fluid" (§ 
 569, e). But come to cathartics and emetics, nay, tobacco, opium, 
 aconite, belladonna (§ 960, a), he is bold and indiscriminate. Here is 
 opened, I again say, an inexhaustible field of inquiry, — far more ab- 
 struse and difficult than the management of bloodletting. You may 
 bleed in intestinal inflammation, perhaps to a vast extent, and speedi- 
 ly surmount the disease ; when, had an irritating cathartic been ex- 
 hibited, the scale might have been as speedily turned in the other di- 
 rection (§ 878, 893 n, 1063 c, 1064, 1065). 
 
 1006, y^ Different ages of the world appear to have been distin- 
 guished by different degrees of moral firmness, and by remarkable 
 differences in practical habits ; and the light of settled experience and 
 of the best philosophy in medicine is almost as apt to suffer a parox- 
 ysm of darkness at the advanced as at the earlier stages of science. 
 Certain it is that knowledge had reached a high advance at the time 
 of Hunter, when bloodletting had given a temporary place to the stim- 
 ulating plan of treatment. Theory and experience governed in one 
 case, hypothesis in the other. No sooner, however, had Mr. Hunter 
 announced the substitution of the stimulant for the depletive treat- 
 ment, than we hear from Robert Jackson, that " Abstraction of blood 
 in contagious fever, which, but a few years since was viewed with 
 abhorrence, even branded with the epithet of murder, is noiu consid- 
 ered the main engine of successful treatment" (§ 960, a, p. 717).
 
 THERAPEUTICS. LOSS OF BLOOD. 765 
 
 And, if we look abroad upon the characteristics of the present day, 
 do we not find in animal magnetism, homcBopathy, the humoral pa- 
 thology, the supplications to the laboratory of the chemist for revela- 
 tions as to the laws and processes of living beings, in health and dis- 
 ease, and many kindred errors and superstitions, a melancholy com- 
 mentary on the human mind ] 
 
 1006, g. The general treatment of inflammatory and febrile dis- 
 eases having been well ascertained by Hippocrates and his immedi- 
 ate successors, all departures from their philosophy must be of short 
 duration. It will remain forever a model in the science of medicine, 
 as much as Grecian architecture, and Grecian poetry, will continue 
 to be the true models of taste through all coming time. The reason 
 is, that the philosophy of medicine, like the principles of taste, has its 
 foundation in nature, and that, of all her institutions, medicine is the 
 most intensely interesting. The master-spirits of antiquity observed 
 nature correctly, and drew their conclusions from this only source of 
 correct knowledge. They formed no deductions from the distortions 
 of nature, erected no hypotheses upon the ruins of organization, nor 
 sought in the laboratory of the chemist what can be found only in liv- 
 ing beings. Drawing their conclusions from Nature herself, they must 
 remain impregnable against all the adversities of time. The fabrics 
 of philosophy may be mutilated ; but the breach will be soon repair- 
 ed, and the offender will find his proper place in the archives of his- 
 tory. Where the foundation has been substantially laid, the innova- 
 tions of error are like the momentary peltings of the storm upon the 
 " house that is built upon a rock" (^ 376J, 376|).— Note Ff p. 1135. 
 
 1007, a. The general experience of which I have hitherto spoken 
 has been mostly relative to bloodletting in the active conditions of in- 
 flammatory and febrile affections". But its advantages are very far 
 from being limited to diseases of a concentrated form, and of rapid 
 progress. They reach, also, and profoundly, the moderated condi- 
 tions which make up the varieties of chronic inflammation. And 
 here, again, I cannot but entertain the hope that I may have so dem- 
 onstrated the close similitude of those forms of inflammation which 
 are contradistinguished by the designations of active and passive, that 
 they will cease, at least, to be regarded as extremes of disease that 
 require exactly opposite modes of treatment ; and, therefore, that a 
 better practice may obtain in those chronic cases which have been 
 generally consigned to " bark and wine, and an invigorating diet" (§ 
 752-756. Also, Med. and Phys. Comm., vol. ii., p. 524-546). 
 
 1007, b. A few examples will best illustrate and enforce the prin- 
 ciple ; and to render them emphatic and comprehensive, let us select 
 constitutions broken down by prolonged suffering and wretchedness. 
 An instructive case is recorded by the eminent Kentish. It was the 
 squalid subject of a mortified extremity, which had been advancing 
 to its present state for a year. At this period the leg was removed 
 above the knee. The patient had been crowded for months with ton- 
 ics and stimulants, and " was reduced to bones." The stump put on 
 an inflammatory action. The admirable surgeon saw nothing but 
 death in prospect, unless he opposed the dictates of philosophy to the 
 prejudices of the lookers-on. " What !" said they, " bleed a poor 
 man who has been confined above a year, and is quite reduced to a 
 skeleton! Oh, shame! shame!" But philosophy triumphed, and ig-
 
 766 INSTITUTES OF MEDICINE. 
 
 norance stood rebuked. Blood was drawn, and nature began to ral- 
 ly. Still, the system remained oppressed with the effects of former 
 disease, and of former practice. More blood was again and again 
 taken ; and at each outlet nature acquired fresh vigor. The inflam- 
 mation gave way, and the patient recovered. Near a year afterward 
 Kentish saw his patient, who was then, at sixty years of age, a mon- 
 ument of the benefits of science, and of moral courage (^ 863 h. 
 998, 1001). In such cases the hypothesis oi an<Bmia displays its worst. 
 
 Dr. Borland, a hospital surgeon at St. Domingo in 1796 and 1797, 
 jast away the tonic and stimulant plan which had prevailed, and em- 
 ployed bloodletting and cathartics in the treatment of ulcers. By 
 these means "he often succeeded," says Jackson, "even in persons 
 who were emaciated to the last degrees of emaciation by the contin- 
 uance of the disease" (§ 992, a, 1057 k). 
 
 1007, c. Here is another case of a parallel nature; only more il- 
 lustrative of the safety and utility of bloodletting in enfeebled states 
 of the constitution, where disease may demand the remedy in more 
 robust subjects. It is a case of diabetes, by Dr. Barlow, in the 
 " Cyclopaedia of Practical Medicine," The subject, a hoy, was re- 
 duced by the disease to a feeble and emaciated state. In this condi- 
 tion he was bled to the extent of 209 ounces, or thirteen pounds, 
 within fifty-one days. The operation was repeated twelve times ; so 
 that each bleeding of this emaciated boy averaged seventeen ounces. 
 The result of it was, a rapid restoration of health and strength, and 
 a return to his plough (§ 992 h, 1032, (Z).— Note Z p. 1130. 
 
 1007, d. Again: "A lady," says Dr. Wardrop, "in a state of preg- 
 nancy, had been greatly debilitated," &c. "She was emaciated, and 
 BO feeble, that her recovery was, by those around her, considered hope- 
 less. She had a distinct tenderness, on pressure, in the epigastrium, 
 and her pulse, which at first gave the impression of great languor, on 
 more minute examination, was very contracted, feeling like a thread, 
 and incompressible, while the heart's action was vigorous. Bloodlet- 
 ting was immediately resorted to, though with hesitation, by the med- 
 ical attendants. No sooner had a few ounces of blood flowed from 
 the vein, than the pulse began to rise and acquired volume, and up- 
 ward of twenty ounces were abstracted before its vigor was sub- 
 dued." Recovery then went on progressively (§ 997). 
 
 1008, The foregoing cases of chronic inflammation (§ 1007), which 
 are common in the walks of the profession, concur in showing that 
 medicine is a science of principles, and that a general treatment is 
 universally applicable to inflammation at all stages of its existence, 
 and under all circumstances. Bloodletting may not always be an ap- 
 propriate remedy; but a low, or non-stimulant diet, may be the prin- 
 cipal antiphlogistic means (§ 752-756, 960, 975 c, 1006 h). 
 
 Of Bloodletting in Infancy and Old Age. 
 
 1 shall now devote a brief consideration to the applicability of 
 bloodletting to the diseases of infancy and of old age ; especially with 
 a view of presenting the experience of a few able practitioners. 
 
 1st. Of Bloodletting in Infancy. 
 
 1009, a. We have already seen how the operation of remedial 
 agents, as well as the pathology of disease, is more or less modifiei
 
 THERAPEUTICS. LOSS OF BLOOD. 767 
 
 by the physiological peculiarities that ai'e incident to the well-marked 
 stages of life (§ 153-159, 574, &c.). 
 
 1009, b. These peculiarities are stiongly pronounced in infancy; 
 and, when speaking of that period of life, it was seen that diseases are 
 marked by great activity, and by a rapid progress (§ 576). Hence it 
 is obvious that there should be a corresponding promptitude of treat- 
 ment, and with remedies that make their impression speedily and pro- 
 foundly. But, it was also said, that nature is now strongly inclined 
 to the restorative process, and that there is great susceptibility to the 
 action of remedial agents. For these reasons, therefore, the same 
 remedies operate with greater effect than at adult age ; so that in 
 many cases where general bloodletting would be indispensable at the 
 latter age, leeching may be equally efficient in infancy ; or an emetic, 
 or a cathartic, perhaps, may effect what loss of blood could alone 
 achieve in later life (§ 1008). 
 
 1009, c. But, where bloodletting is demanded by the diseases of in- 
 fancy there is no age at which it is better borne, and none at which 
 its early application is so important. It may be also said, in a gen- 
 eral sense, that either general or local bleeding is indispensable in all 
 the grave internal inflammations of infantile life ; and that the general 
 method should always be practiced in the cerebral inflammations and 
 cerebral congestions of this age, as of all others (§ 974). In similar 
 affections of other organs, leeching is generally preferable in early in- 
 fancy, as indicated under the philosophy of the operation of loss of 
 blood (§ 927 b, 925). 
 
 1010, a. The annals of medicine abound with the best experience 
 in favor of bloodletting in the inflammatory affections of infants. 
 
 Sydenham remarks, that, "bloodletting maybe as safely performed 
 in young children as in adults, and in some of their diseases there is 
 no curing them without it." 
 
 1010, b. Rush was an unhesitating advocate of bloodletting in in 
 flammatory diseases at all stages of infancy. " It is more necessary," 
 he says, "in the diseases of infants, than in adults" (§ 1017, c). 
 
 1010, c. Piorry canfies bloodletting in the cerebral inflammations 
 and congestions of infants to a great extent, — entirely beyond any 
 thing which I have witnessed ; quite as far as quinia in his treatment 
 of indurated spleen (§ 892, k). He employs from one to several ven- 
 esections, and twenty to fifty leeches to the head, with purgatives, 
 &c. This is, doubtless, excessive ; but such is the fatality of infantile 
 phrenitis, and such the ability to bear the loss of blood in cerebral in- 
 flammation, that the remedy should have no limit short of affording 
 relief (§ 974, 992 b). Again, it is the experience of this distinguish- 
 ed observer of the effects of loss of blood, that, " in many young 
 children affected with trachitis, large evacuations of blood have en- 
 feebled them but little;" though "excessive hemorrhage has sometimes 
 produced convulsions." Such has been my own observation, and also 
 of excessive umbilical hemorrhage. I have seen no resulting death. 
 
 1010, d. Evanson and Maunsell think, "that in the child, more 
 particularly, bleeding is required in the first stage of all acute inflam- 
 mations. It may be practiced with safety in the youngest infant, pro- 
 vided we hold in view the relation between the necessities of the case 
 and the strength of the patient." " The buffing f>f the blood," say 
 they, " is not a safe guide in the child ; as we have diseases absohito-
 
 768 INSTITUTES OF MEDICINE. 
 
 ly requiring bleeding {e.g., croup, bronchitis, &c.), which seldom pro- 
 duce the appearance in question." 
 
 1011. It is unnecessary to multiply examples of the foregoing ex- 
 perience. They abound in the archives of medicine. Even at an 
 early era of the art bloodletting was practiced as fearlessly in infan- 
 cy as it was at adult age. 
 
 1012. As to my own habits, they have been always uniformly one 
 way. Where inflammation has affected any important organ, or has 
 been otherwise attended with danger, and it seemed not likely to yield 
 at once to milder means, I have taken no risk, but have resorted, with- 
 out delay, to the remedium principale ; nor have I ever had occasion 
 to regret a practice which I would so earnestly commend to others 
 (§ 576, e. Also, P.S. 1860, at p. 872, and Note F p. 1114). 
 
 1013. Finally, it cannot be doubted that Lommius is right in the 
 opinion, that, 
 
 *' It is much more eligible to snatch a child, by means of bloodlet- 
 ting, from imminent danger of death, however the strength may be 
 wasted, than to let him perish by the violence of the fever." 
 
 2d. Of Bloodletting in Old Age. 
 
 1014. Here, again, as every where else, we find that physiology 
 lends its powerful aid in the treatment of disease, and agrees with the 
 most enlightened experience. Old age is but a summary expression 
 of all the natural obstacles which have accumulated in the way of the 
 organic functions, and which are about to arrest them forever (§ 580- 
 584, 633). The properties of life are now most incapable of sustain- 
 ing any of the lesions by which they are invaded at earlier ages. 
 They are approaching their natural extinction, and are readily abol- 
 ished by disease. They are crippled by physical causes of their own 
 production, and have lost much of their susceptibility to the ordinary 
 effects of remedial agents. Changes from a morbid to a healthy con- 
 dition are slowly determined, — save only by that remedy which makes 
 its powerful, instantaneous, and simultaneous impression upon the 
 main instruments of vital action throughout the body. In every part 
 the properties of life sustain a deep and abiding effect from loss of 
 blood. Their condition is directly and instantly altered in the instru- 
 ments of disease, and this alteration is maintained by corresponding 
 reflex nervous influences determined by other parts (§ 514, 7i), as 
 well as by the continued operation of a diminished volume of blood, 
 and an equalized circulation. The secretions break forth ere we bind 
 up the arm ; and thus nature comes to our aid by another efficient pro- 
 cess (§ 862, 863). It is all the work of a moment ; and the great 
 revolution begun in every part, it may, and often does, terminate 
 speedily in health. 
 
 In the formidable diseases of old age, therefore, the remedies must 
 be such as shall reach profoundly the properties and actions of life, 
 and reach them without delay. Such as would be insufficient in youth 
 must surely fail when declining nature is least disposed to co-operate 
 with art. 
 
 1015. a. The foregoing conclusions are amply corroborated by a 
 large and enlightened experience, which equally demonstrates the 
 groundless nature of the prevailing objections to bloodletting in all tho 
 diseases of old age ; save only those apoplectic affections in which tho
 
 THERAPEUTICS. LOSS OF BLOOD. 760 
 
 system may be least able to sustain the shock of the operation (§ 
 990). 
 
 In the Mem. de I'Acad. Roy. de Med., 1S40, is a report by M, Prus, 
 setting forth the safety and advantages of bloodletting as practiced ex- 
 tensively in the inflammatory affections of the aged occupants of the 
 two immense establishments, the Hospice de la Vieillesse, and Bicetre. 
 He also adds, that, in consequence of the changes which the arteries 
 undergo in aged people, we should always examine the state of the 
 pulse at the heart. "How often," he says, "have patients, whose 
 radial pulse was feeble and irregular, but whose heart announced an 
 energetic action, been bled with the highest advantage, and thus pre- 
 served from a speedy and otherwise inevitable death !" 
 
 1015, b. Such, too, is the experience of Hourman and Dechambre 
 in their treatment of the inflammatory diseases of the old women of 
 La Salpetriere ; and M. Piorry bears his testimony, that aged men 
 bore the same abundant bleeding [des saignees ahondantes) as the old 
 women of Salpetriere. 
 
 1016, Such, then, is enlightened hospital experience, and only a 
 small proportion of such experience. It is manifest, therefore, that if 
 bloodletting be thus admissible and important with the aged inmates 
 of public infirmaries, there is no ground for that distinction which 
 has been set up, in a genei*al sense, between hospital and private pa- 
 tients, and which enjoins the use of tonics and stimulants in one case 
 where it admits of bloodletting in the other (§ 752-756). 
 
 1017, a. But, since " experientia docet," it may be useful to some 
 to be informed circumstantially of what has happened, in the way of 
 expei'ience, in the private walks of the profession. 
 
 Hippocrates, Galen, Celsus, Trallian, and other ancients, advocated 
 bloodletting in the inflammatory diseases of old age. " In bleed- 
 ing," says Celsus, " the physician should not consider so much the 
 age as the strength of the patient." 
 
 1017, b. We are told by Wepfer that it is a very prevailing custom 
 among the Swiss, even at eighty and ninety years of age, to resort to 
 bloodletting once a year, or oftener, as a prophylactic. 
 
 " I admonish you," says Vitel, " against the advice of those physi- 
 cians who would dissuade you from bleeding the aged, who may be 
 the subjects of inflammatory or eruptive fevers. The fear of debility 
 is unfounded. Bloodletting is as necessary to them as to the young, 
 and not less beneficial." 
 
 F. Hoffmann remarks, " Communis, s,edi pessimus error est, eetatem 
 senilem plane non ferre sanguinis subtractiones, quasi vero in gran- 
 daevis non redundaret sanguineus latex, ut potius ejus et virium de 
 fectu laborarent." " In senili astate magis necessaria sanguinis missio, 
 quam alia ad morbos grandaevis familiares arcendos," etc. " Venae- 
 sectio sepius senibus utilissima, imo ad longaevam vitam confert." 
 " Complura certe memoria teneo exempla senum, qui ad nonagesimum 
 annum fere, salvi, incolumes et a morbis aetate provectis familiaribus 
 immunes vixerunt, solo vencBsectionis remedio, bis per annum admisso.''' 
 " Id quod etiam a me in peculiari dissertatione, De Magna Vence sec- 
 tionis ad intam sanavi et longam Remedio, assertum est ac demon- 
 strandum." — Opera, t. i., p. 135, 455, 450. 
 
 Forestus bled the aged equally without hesitation, — " firmus puer, 
 et robustus senex, tuto curantur." 
 
 Ceo
 
 770 INSTITUTES OP MEDICINE. 
 
 Van Swieten, the able practitioner and learned commei.tator, con- 
 siders bloodletting as important at the extremes of age, as at the in- 
 termediate periods. 
 
 Finally, all the best writers of the sixteenth and seventeenth cen- 
 turies advocate bloodletting for the inflammatory and febrile diseases, 
 not only of middle age, but at the extremes of life. They protest, 
 also, against arresting spontaneous hemorrhages, even when occurring 
 at advanced age. The Brunonians have looked on with admiration, 
 when nature has thus rescued the sick from the evils of the bark and 
 wine treatment (§ 890, <?).— Notes Ff p. 1135, Go p. 1138, Ii p. 1139. 
 
 1017, c. In later times, the records of medicine continue to abound 
 with demonstrations of the safety and necessity of bloodletting in the 
 inflammations and fevers that may befall old age. 
 
 From what was stated of Rush's experience of bloodletting in in- 
 fancy (§ 1010, Z>), it appears that he considered the i-emedy most im- 
 portant at the extremes of life ; for, in another work, he says, " Expe- 
 rience proves that bloodletting is more necessary, under equal circum- 
 stances, in old age, than in any other." — (See my 'Examination of Re- 
 vieivs, in Med. and Phys. Coram., vol, iii,, p. 76-78.) 
 
 Hosack deprecates the prejudice which exists against bloodletting 
 in old age. 
 
 Sir Gr, Blane demonstrates the safety and utility of the remedy in 
 the inflammatory diseases of aged people. He states the case of an 
 individual at the age of one hundred years, who was cured of pneu- 
 monia by free bloodletting from the arm. In another instance, a lady 
 of eighty-two years suddenly lost, by spontaneous hemorrhage from 
 the nose, a quart of blood, " which was followed neither by faintness 
 nor weakness, but by improvement in health, in point of vigor and 
 alacrity." 
 
 Frank cured an octogenarian of pneumonia by bleeding him nine 
 times. Gui Patin cured his father of pneumonia, at the age of eighty, 
 by bleeding him freely from the arm eight times. Freteau bled at the 
 age of seventy to the extent of four pounds in six days. 
 
 And thus might I go on with numerous other coincident authorities ; 
 all showing individually, and proving collectively, that old age,^er se, 
 constitutes no objection to loss of blood. But, were there even haz- 
 ard in the remedy, its possible dangers would be incomparably less 
 than those of many acute diseases which now so readily destroy. It 
 is no defense that the patient dies naturally, when the chances of life 
 are withheld by the neglect of bloodletting. 
 
 Spontaneous Hemorrhage. 
 
 1018. I shall now briefly consider nature in her efforts to relieve 
 the system of inflammations and congestions ; since it is from the va- 
 rious expedients of Nature that we derive many of our best indications 
 of cure ; and the summary mode in which she institutes the hemor- 
 rhagic process, and the consequent relief of protracted diseases, are 
 alone conclusive against the Brunonian doctrine of debility, and may 
 encourage the timid practitioner in the use of the lancet (§ 862, 863, 
 890 e, 990 m). 
 
 1019, a. John Hunter has seen several quarts of blood thrown up 
 from the stomach in a few hours, even by emaciated patients ; and 
 recovery has speedily followed thjB evacuation. Cases of this nature
 
 THERAPEUTICS. LOSS OP BLOOD. 771 
 
 are witnessed by all practitioners of much experience. The same im- 
 mense quantities of blood are often discharged from the lungs, and in- 
 testine ; breaking up the most formidable congestive fevers, and chron 
 ic inflammations which have resisted all other means of treatment for 
 years (§ 733 d, 890 e). 
 
 1019, h, Lancisi relates the case of a man of seventy years of age, 
 who suddenly lost, in a threatened attack of apoplexy, eleven pounds 
 of blood from his nose, and four more in fifteen days afterward, with- 
 out any sensible failure of strength. 
 
 1019, c. Boerhaave "has known almost the entire blood of the body 
 to have been lost by hernoiThage, and yet the subject recover." 
 
 1019, d. Haller relates many examples of excessive hemorrhage, 
 xn one of his cases, one hundred and twenty-five ounces of blood were 
 lost at each menstruation, for several years ; besides a daily abstrac- 
 tion of blood from the arm for fourteen months. In another instance, 
 he states that one thousand pounds, or four barrels of blood, were lost 
 in one year, or nearly three pounds daily for that period. In another 
 there was a hemorrhoidal flux of five pounds daily for sixty-two con- 
 secutive days, or a total of three hundred and ten pounds ; being prob- 
 ably twice the weight of the whole body. One more lost one hundred 
 and ninety-two ounces, or about thirteen pounds, from his stomach, in 
 a single night, and recovered. Haller, himself, lost one hundred and 
 twenty-eight ounces, or eight pounds of blood, within twenty-four 
 hours. — (See special references in Med. <^ Phys. Comm. vol. i.) 
 
 1019, e. Similar examples are constantly presented to our observa- 
 tion, and a large variety may be found assembled in the Medical and 
 Physiological Commentaries. They show us that when Nature takes 
 the work in hand she does not stop to calculate the ounces, or the 
 pounds, but pushes on till she has accomplished a rational purpose. 
 "Honest Brunonians," says Dr. Beddoes, "have, of late, minutely 
 recorded cases, to them incomprehensible, where immense discharges 
 of blood have suddenly stopped protracted fever, and left the patients 
 improved in strength" (§ 890, e, 993).— Notes Ff p. 1135, Go, Ii. 
 
 1019, yi Among the multitude of these extraordinary hemorrhagic 
 eff"usions it is rare that death is an immediate consequence (§ 890, e), 
 and rarer still where art has superintended the loss of blood. In the 
 latter case, syncope comes, in good time, to the aid of the patient; 
 far sooner than in the spontaneous process. Nor can art imitate na- 
 ture in the full extent of her depletory system. The philosophy 
 which respects the difference in effects appears to be this. When the 
 remedy is instituted by nature, the parts concerned in the morbid ac- 
 tion are made the instruments of relief, and the general law of adap- 
 tation is in force (§ 137 c, 733 d, 847 g). The peculiar modification of 
 action upon which capillary hemorrhage depends, and the influence it 
 exerts upon the system at large, resist the earlier effects of loss of 
 blood when artificially abstracted in the same way as the loss is resisted 
 by inflammations. I have seen this principle operating with various 
 effect in inflammations, according as they are modified by remote caus- 
 es, and according to the activity and extent of disease, the organ or 
 organs affected, &c. (§ 805, 813, 922 b). 
 
 1019, g. The more we interrogate nature as to the loss of blood the 
 more shall we find her proclaiming that this is her expedient, beyond 
 any other, by which she attempts the removal of fearful diseases.
 
 772 INSTITUTES OF MEDICINE 
 
 Haemoptysis, haematamesis, the hemorrhoidal flux, intestinal henvjr- 
 rhage, are all instituted for this purpose. We constantly witness the 
 spontaneous effort where the properties of life are so prostrate that 
 art looks on with dread and amazement ; and what nature had thus 
 wisely begun is often declared to be the effect of a putrid disruption 
 of the living body, and calls for every counteracting means. Fortu- 
 nately, these means sometimes consist of the lancet, and other anti- 
 phlogistic remedies. But this, with many, is only where the strength 
 is vigorous, and where it is feared that unrestrained nature may pos- 
 sibly reduce it. Examples of this kind are common in pulmonary 
 hemorrhage ; and, although in these instances the blood be taken with 
 a view of astringing a suspected rupture of a blood-vessel, the error 
 does not affect the true philosophy of the case ; and when nature may 
 be too " sparing of the vital fluid" to overcome the real condition of the 
 lungs, a singular illustration will be obtained of a co-operation of the 
 lancet toward a salutary result where it had been employed to de- 
 feat the curative effort of nature (^ 922 b, Note Bbb p. 1148). 
 
 1019. h. But error is often committed in these cases. If hemor 
 rhage be profuse, it should be allowed to go on within the limit of 
 safety ; since the depletion proceeds from the instruments of disease. 
 A rapid abstraction of blood from the arm, superadded to the hemor- 
 rhage, may airest the spontaneous discharge too speedily ; while that 
 which is artificially taken would be more curative if left to the natu- 
 ral process. But, again, where the spontaneous discharge is small, 
 the lancet may be imperatively demanded ; while it is here employed 
 with greater caution than in the former cases. — Note F p. 1114. 
 
 Of misapplied and excessive Bloodletting, " Morbid Irritation,'^ and 
 ''^excessive Reaction from Loss of Blood." 
 
 1020. In the Medical and Physiological Commentaries I have in- 
 vestigated extensively those reputed consequences of loss of blood 
 which are known as " morbid in-itation, and excessive reaction" (vol. 
 i., p. 239-281). 
 
 1021. We certainly meet with examples of the foregoing nature, 
 arising from improper bloodletting. But, it is generally too little, not 
 too great a loss of blood, which does the mischief. The untoward re- 
 sults are owing to the unfavorable impression which is thus made upon 
 the organic properties, both by the direct effect of the agent, and by 
 the operation of the nervous influence upon the heart and the main 
 instruments of vital action (§ 965, b). The heart, in consequence, 
 beats either with greater frequency or greater force. This is what is 
 denominated "irritation" and "excessive reaction," and is assumed 
 as a proof that too much blood has been abstracted ; when, on the 
 contrary, had the loss been carried to a greater extent these phenom- 
 ena would have been rarely presented (^ 500 m, 687-|, 694f ). 
 
 1022. And now to show conclusively that the foregoing consequen- 
 ces depend more or less upon imperfect bloodletting, and a consequent 
 aggravation of disease, it will be found, as I have shown extensively 
 in my former Essay on Bloodletting, that in most of the cases recoi'd- 
 ed by Dr. Marshall Hall and other advocates of the doctrine of " ex- 
 cessive reaction," that the symptoms and post-mortem appearances, 
 as by themselves recorded, denote either the antecedent existence of 
 inflammation and a subsequently exasperated degree, or inflammation
 
 THERAPEUTICS. LOSS OF BLOOD. 773 
 
 resulting from the loss of blood, or from an antecedent predisposition. 
 The last two causes may act conjointly ; and, as I have already shown, 
 too small an abstraction of blood is not an unusual cause of inflamma 
 tion. Excessive bloodletting, on the other hand, is a rare phenom- 
 enon ; but, unlike too small a loss, it may establish inflammation in- 
 dependently of any antecedent predisposition (§ 950, 965 b). 
 
 1023, a. When inflammation is induced by excessive loss of blood, 
 the physiological influences are not the same as those which obtain 
 when it ensues upon, or is aggravated by, too small a loss (§ 965 b, 
 1022). In very numerous cases of this nature there has been a pre- 
 existing tendency to the disease ; or, more frequently, a morbid con- 
 dition already established, but not fully developed. Thus, it is not an 
 unusual event that the physician abstracts blood for pain in the head, 
 or a " stitch in the side," or for some uneasiness of breathing. The 
 abstraction of blood is judiciously moderate. But, there has been an 
 accumulating tendency to inflammation ; and the blood thus abstracted 
 proves not to have been commensurate with the demands of the case. 
 It releases and gives force to the general circulation, and increases 
 the irritability of the extreme vessels. Phrenitis, pneumonia, or pleu- 
 ritis, is the consequence. The physician is alarmed by the unexpect- 
 ed event ; yet so like inflammation are the consecutive symptoms, 
 that he ventures upon the lancet for their relief. But, the symptoms 
 had followed upon the loss of blood, and his decision is restrained. 
 He therefore stops at the very point of mischief, and adds another im- 
 pulse to disease. He may yet bleed again and again, as the malady 
 resists all other agents ; but the same caution prevails, and the evil 
 increases at every partial outlet of blood {Note p. 729). 
 
 These cases accumulate rapidly upon the hands of the unskillful or 
 timid. Records are examined, and parallel examples are found to 
 abound. Dissections are made, and reveal the usual physical signs 
 of inflammation. The conclusion, therefore, comes up, as expressed 
 by Dr. Hall, that there is a disease " exactly like inflammation, but 
 totally different from it" ! 
 
 Just so it is with child-bed women. There is often a great ten- 
 dency, in these cases, to local inflammations ; and these may be more 
 or less speedily developed by moderate flooding, especially if there 
 have been previous venous congestion, as is very frequently the case 
 (§ 803, 965 b). Dr. Hall has many of these examples, and were they 
 really cases of simple irritation, or simple exhaustion and excessive re- 
 action from loss of blood, they could not be adduced to illustrate the 
 effects of bloodletting in disease. They should form a class by them- 
 selves ; designated as cases of the morbific effects of " excessive loss 
 of blood" upon the comparatively healthy system. They must, there- 
 fore, be admitted to have no bearing upon cases where bloodletting 
 may have been demanded, and to be worse than useless for illustrating 
 the effects of bloodletting as a remedy. As' well might one say, that 
 cathartics shall not be given in disease, or only so with fear and trem- 
 bling, because they may be pernicious in health. And he, being well, 
 who should physic himself in order to be better, would be mad in- 
 deed should he attempt to remove the evils of his mistake by swal- 
 lowing one dose after another. Just so it is in respect to bloodletting, 
 or accidental hemorrhage, in health. If inflammation follow in the 
 \atter instance, it will be important to ascertain whether excessive
 
 774 INSTITUTES OF MEDICINE. 
 
 bloodletting have been the exciting cause, or whether it did not 
 spring from a previous disposition to disease ; since the treatment 
 will be entirely different in the two cases. The former case is rare, 
 as known from the accidental and profuse hemorrhages that are daily 
 occurring. Nor is even simple in-itation a common result; the inju- 
 ry consisting mainly in feebleness. And here I may say, that it is a 
 remarkable fact, that the effects described by Dr. Hall as incident to 
 lying-in women rarely supervene upon excessive flooding; thus show- 
 ing that in the cases of disease the affection existed already, or waa 
 about taking place. 
 
 1023, h. When, however, inflammation is actually induced by ex- 
 cessive loss of blood, the effects of the physiological influences are dif- 
 ferent from those which I have set forth as constituting the philoso- 
 phy of the operation of loss of blood, as the effects are morbific in 
 one case, but are not so, or are curative, in others. The modus ope- 
 randi, however, is exactly the same in all the cases ; and, being so, 
 the morbific effect confirms my philosophy of the modus operandi of 
 the curative influences. In the former case, an injury is inflicted, 
 suddenly, and severely, upon the vires vita, of all parts, and the ner- 
 vous influence is powerfully determined upon all. The brain suffers 
 the impression particularly ; and if " irritation," or " excessive reac- 
 tion," follow, I know of no recorded instance which has not also pre- 
 sented the usual phenomena of inflammation, either in the bxain or 
 some other organ. If death ensue, effusions of serum, or of lymph, or 
 disorganization, &c., are the concurring results. Still, however, an- 
 other cause, and not the loss of blood, may have produced the dis- 
 ease, and have been overlooked, as is most probable ('^ 1006). 
 
 1024, a. Dr. Hall, who, particulai'ly, called our attention to the 
 foregoing " irritation," and " excessive reaction," as frequent effects 
 of excessive loss of blood, and distinguishes those conditions from in- 
 flammation, concedes that " exhaustion fi'om loss of blood is not only 
 not incompatible with repletion and a tendency to effusion within the 
 head, but it actually supposes that condition of the encephalon, when 
 long protracted." He also states that leeches to the head are one of 
 the remedies. So, too, may general bloodletting relieve the symp- 
 toms, but only temporarily in the cases supposed ; since, when in- 
 flammation is induced by an excessive loss of blood, such is the com- 
 bined nature of the exciting cause and its curative effects the modifi- 
 ed irritability of the vessels may readily yield, at the moment, to a 
 farther loss, but will soon display the morbific influence (^ 901). 
 
 1024, h. In my remarks upon the physiological effects of bloodlet- 
 ting I endeavored to show that, when the loss of blood is canned to 
 a state of syncope, and more especially to any injurious excess, the 
 greatest severity of its influence is sustained by the brain (§ 950). 
 It is to the head, then, that we should generally look for the local inju- 
 ry, if any attend the reputed cases of irritation and exhaustion from 
 an excessive loss of blood. This is precisely what we find stated by 
 the late writers who have treated of this subject; at least in a general 
 sense. 
 
 1024, c. But, as the question under consideration is of no little prac- 
 tical importance, it may be well to have before us Dr. Hall's highly- 
 descriptive account of the severe grades of what he calls " exhaustion 
 with excessive reaction," and as supplying the most ample proof that
 
 THERAPEUTICS. LOSS OF BLOOD. 775 
 
 the supposed condition is, in reality, a state of active inflammation. 
 Thus : 
 
 " The beating of the temples," says Dr. Hall, "is at length accona- 
 panied by a throbbing pain of the head, and the energies and sensi- 
 bilities of the brain are morbidly augmented ; sometimes there is in- 
 tolerance of light, but still more frequently intolerance of noise and 
 of disturbance of any kind, requiring stillness to be strictly enjoined, 
 the knockers to be tied, and straw to be strewed along the pavement ; 
 the sleep is agitated by fearful dreams, and the patient is liable to 
 awake or to be awoke in a state of great hurry of mind, sometimes 
 almost approaching to delirium ; occasionally even continued deliri- 
 um ; more frequently there are great noises in the head, as of singing, 
 of crackers, of a storm, or a cataract ; in some instances there are 
 flashes of light ; sometimes there is a sense of great pressure or 
 tightness in one part or round the head, as if the skull were pressed 
 by an iron nail, or bound by an iron hoop." 
 
 1024, d. Now, the foregoing symptoms, which Dr. Hall considers 
 as denoting a state exactly o/^^oszYc to that of inflammation when they 
 attend considerable losses of blood, are precisely such as are charac- 
 teristic of cerebral inflammation when induced by other causes. But, 
 as if to remove all doubt as to this conclusion, this distinguished phi- 
 losopher reiterates the foregoing account, and designates other phe- 
 nomena not less significant of cerebral inflammation, such as "frequent 
 delirium," "hardness of pulse," "huffy blood," &c. ; and, to give to 
 the subject its utmost force he calls to his aid the opinions of Cook, 
 Coke, Kellie, Tweedie, Hammond, Cox, and others ; all of whom 
 agi'ee in testifying to the symptoms that mark, exactly, the character 
 of inflammation of the brain. Nay, more, he allows this conclusion, — 
 that they are " attacks which resemble inflammation of the head, chest, 
 or abdomen, and yet are totally different in their nature." 
 
 Thus then, as to our author's excellent description of the general 
 phenomena, which he imputes to this disease that is considered so op- 
 posite to inflammation, they are, to my mind, conclusive against our 
 author's doctrine. 
 
 1024, e. Morbid anatomy contributes, also, its corresponding proof. 
 " The next point for our consideration, in the inquiry into the morbid 
 effects of loss of blood," says Dr. Hall, " will be that of the organic 
 changes induced during the state of sinking. These are chiefly ob- 
 sei-ved in the brain, in the cavities of the serous membranes, in the 
 bronchia, in the lungs, and in the track of the alimentary canal, un- 
 der the forms of effusion, oedema, and tympanitis." At other times, 
 our author admits of morhid redness, and absolute disorganization, as 
 rapid consequences of this affection so opposite to inflammation. 
 
 1024, y! Such, indeed, is the entire coincidence between our au- 
 thor's supposed cases and those of inflammation, that we are told by 
 the author that there is often no other test of their distinction than the 
 treatment which is adapted to inflammation. We must bleed ; and 
 if the patient bear it well, — ivell ; — if otherwise, we must then en- 
 deavor to repair the wrong. This after-knowledge, this dependence 
 for the diagnosis upon the effects of treatment, may help the under- 
 standing; but will it be likely to help the patient, or to improve the 
 science ? And how is the treatment improved by this species of in- 
 telligence 1 The greatest zealot would abandon the diagnostic test
 
 77b INSTITUTES OF MEDICINE. 
 
 it' lie found it injurious. But, says Dr. Hall, the patient " may be 
 greatly relieved by the loss of blood ;" " the temporary relief which 
 follows general bloodletting may be so uniform as to impose on the 
 inexperienced." Then I maintain that the loss is useful. 
 
 1024. g. In the foregoing cases, as related by Dr. Hall, and others, 
 where there had been bloodletting, we may generally recognize the 
 occurrence of cerebral inflammation independently of the loss of blood, 
 and often of its pre-existence ; and I as sincerely believe that farther 
 bloodletting was the proper remedy for the disease. In the cases 
 where irritation, and excessive reaction, are said to have been con- 
 sequent on spontaneous hemorrhage, it is not less apparent that, in 
 most instances, inflammation had already existed, or there was a strong 
 predisposition to it. 
 
 1025. There are few practitioners in the United States who have 
 seen more of bloodletting than myself; and I am therefore quite con- 
 versant with cases of the foregoing nature, as I have met with them 
 in the hands of others. In numerous instances where the attending 
 physician had imagined " excessive reaction, and prostration from ex- 
 cessive loss of blood," I could discover nothing but the onward march 
 of inflammation, that called for greater abstractions of blood ; and that 
 this opinion was right has been generally confirmed on resuming the 
 depletive treatment. — Hole p. 763. 
 
 1026. Finally, as I have said in the " Commentaries," the rules for 
 bloodletting which have been propounded by Dr. Hall, and all others 
 of a like nature, are captivating by their simplicity. This was the 
 secret of the popularity of Brown's Elements of Medicine, and of the 
 long, unmolested sway of the Humoral Pathology. A later and more 
 universal example is seen in the chemical views of life and disease. 
 
 Many have imbibed an erroneous impression that Dr. Hall is a warm 
 advocate for the use of the lancet ; and, as the case of Dr. Hall is very 
 extensively applicable to physicians, I shall state the nature of the 
 misapprehension. Dr. Hall advocates bloodletting only in certain af- 
 fections where few would deny the propriety of the remedy ; and in 
 such cases he commends its liberal use. But, what he has so far said 
 with emphasis has the effect of discouraging its application in the vast 
 class of congestive fevers, and depressing inflammations, and even in 
 many of the cases to which, on general principles, he admits its ap- 
 plicability (Rights of Authors, p. 913, and Index II, art. Hall, M.). 
 
 But it is not alone by his exclusive precepts that his purpose is at- 
 tempted. On more than one occasion he broadly affirms, that " it is 
 difficult to say whether more injury has been done by an undue, or 
 by an inefficient, use of the lancet." Such is the balance which is 
 often struck by apparent advocates of bloodletting ; but, I am still apt 
 to think, with Botalli, that " One hundred thousand men perish from 
 the want of bloodletting, or from its not being timely employed, where 
 one perishes from excessive bleeding, when prescribed by a physician." 
 
 General Conclusions as to Bloodletting, 
 
 1027. From all that has been now said on the subject of bloodlet- 
 ting, I arrive at the following general conclusions : 
 
 1. That loss of blood produces its direct and efficient impression 
 upon the vires vitcB of the capillary blood-vessels, by modifying their 
 8ction.
 
 THERAPEUTICS. LOSS OF BLOOD. 777 
 
 2. That the quantity of blood to be abstracted relates directly to 
 the foregoing impression. 
 
 3. That the most salutary effect of loss of blood will, therefore, 
 consist in its nearest approximation to a full but just impression upon 
 the vires vitce. 
 
 4. That, to produce and maintain the foregoing impression will re- 
 quire the abstraction of a certain quantity of blood in every case, the 
 measure of which will be the antecedent and resulting symptoms. 
 
 5. That bloodletting may add to the force of disease by coming 
 short of that impression ; or, it will be injurious if carried to excess, 
 or may even induce new inflammations. 
 
 6. That bloodletting may be a remedy for other diseases than inflam- 
 mation and fever. 
 
 7. That, when employed as a prophylactic, on passing from northern 
 to tropical countries, it must be with such moderation as shall not in- 
 crease irritability ; and then only in the plethoric and robust. 
 
 8. That general bloodletting, cupping, and leeching, operate upon 
 common principles, which are more or less modified in each mode of 
 abstracting blood. That cupping is intermediate, in this respect, be- 
 tweeiT general bloodletting and leeching. 
 
 9. That general bloodletting is a far more important remedy than 
 leeching ; and that, while cases constantly arise in which the latter 
 cannot be substituted for the former, there are numerous instances in 
 which general bloodletting cannot take the place of leeching. That 
 cupping will sometimes answer the purposes of either, and may be, 
 though rarely, better. 
 
 1 0. That the nervous system has a special and large allotment in the 
 effects of loss of blood, and that loss of blood operates, in the first place, 
 by inducing a profound effect upon the extreme blood-vessels when the 
 influence thus exerted is propagated by sensitive fibres of the sympathetic 
 or nerve of organic life upon the nervous centres, the nervous power ex- 
 cited, and then reflected through excito-motory fibres of that nerve 
 upon the sanguiferous organs, and with_a special alterative effect upon 
 the susceptible capillary blood-vessels that may carry on the morbid 
 process, that, when the vessels of the nervous centres contract, the reflex 
 nervous influence is increased by the projection of a direct development 
 of that influence upon the sanguiferous organs, and that these influences 
 multiply in an increasing ratio till syncope takes place. 
 
 11. That in bloodletting five principal objects are contemplated: 1. 
 To reduce the volume of blood. 2. To thus establish a change of action 
 in the capillary blood-vessels. 3. To thus obtain the alterative action 
 of the nervous influence. 4. To reduce the exciting nervous influence 
 attendant on inflammation and fever, whether reflex or direct, that dis- 
 ease shall abate, and that cathartics, counter-irritants, &c., when neces- 
 sary, may operate without exciting a morbific reflex nei'vous action. 
 5. To thus, also, prepare the way for other remedies by promoting their 
 salutary effects and preventing their deleterious, which have equally a 
 reference to the condition of the nervous influence. 
 
 12. That spontaneous hemorrhage, occurring at adult age, should not 
 be restrained, unless manifestly proceeding to excess. 
 
 "Truth, like a single point, escapes the sight, 
 And claims attention to perceive it right ; 
 But what resembles truth is soon descried. 
 Spreads like a siu'face, and expanded wide." — Pomfret.
 
 APPENDIX. 
 
 PROGRESS OF " PHYSIOLOGICAI> AND PATHOLOGICAL CHEMSTRY," OR 
 " EXPERIMENTAL IVIEDICINE." 
 
 1028. During the former editions of the foregoing work the Author 
 has seen no inducement to modify any of his conclusions, or to disturb 
 any of the facts upon which they are founded, and, for the same reason, 
 every statement appears in the present edition (1857) as presented orig- 
 inally in 1847. Whatever may have been subsequently disclosed in 
 Physiology and Chemistry is essentially in harmony with all that the 
 author incorporated in the foundation upon Avhich his Institutes are 
 erected, and places them beyond the probability of being much invali- 
 dated. In his discussion of Organic Chemistry as applied to Physiology, 
 Pathology, and Therapeutics, it is evident that he could not cjoubt that 
 this invasion upon Medicine would prove ephemeral, and that the Chem- 
 ist would soon retreat into the appropriate field of Nature. (§ 4^- d, 5^- 
 6, 1 8, 42-67, 349 a, 350| n, 351, 356, 376^, 435 c, 676 b, 960 cZ, 1006 a, &c.) 
 
 These expectations have been realized sooner than the author had an- 
 ticipated, as he will now show, for the benefit of his junior readers, by a 
 few extracts from one of the latest and most approved works upon Or- 
 ganic Chemistry, by the justly celebrated Professor Lehmann. It is 
 true, our Author has favoured us with an able and elaborate Treatise in 
 behalf of " Physiological Chemistry ;" but whoever mfty peruse its pages 
 will everywhere discern the obstacles which necessarily beset his path, 
 and the vagueness of his conclusions, and many unavoidable contradic- 
 tions, after having discarded those indispensable elements which are 
 summarily involved in the foUow^ing quotations, and which amount to 
 a virtual admission that we must seek in the doctrines of vital solidism 
 for the only true philosophy of life and disease. Thus, our Author : 
 
 1029. " As soon as we subject to investigation the highly compli- 
 cated chemical phenomena of life, toe enter upon the actual domain of hy- 
 pothesis. It unfortunately happens, however, that the correct logical con- 
 ception of an hypothesis has been completely lost sight of, and its place 
 supplied by the vaguest fictions ; whence the term has fallen into such 
 discredit that many have been desirous of setting aside all hypotheses, 
 unmindful that even the simplest form of experiment cannot be pre- 
 sented without their aid. 
 
 " Physiological Chemistry has given rise to many delusions of this 
 nature, owing to its imperfect development, and to the necessity presented 
 by Physiology and Pathology for chemical elucidation. Some few isolated 
 deductions were drawn from superficial chemical experiments, and ar- 
 ranged in a purely imaginary connection by the aid of chemical symbols 
 and formulae, for whose establishment analysis in many cases did not af- 
 ford any sanction. Thus, for instance [a very important and comprehen- 
 sive example], in the attempt to form a conclusion regarding the meta-
 
 780 INSTITUTES OF MEDICINE. 
 
 morphosis of the blood from an elementary analysis of its solid residue, 
 and of the composition of the individual constituents of the excretions, 
 there is an utter absence of all scientific groundwork; for, independently 
 of the fact that the elementary analysis of so compound a matter as the 
 blood is incapable of yielding any reliable results, and cannot, therefore, 
 justify the adoption of any special chemical formula, it is surely most 
 illogical to attempt to compare the composition of the blood collefttively 
 with that of the separate excrementitious matter. In such deductions, 
 expressed by chemical formulae, the addition of atoms of oxygen, and the 
 subtraction of those of water, carbonic acid, and ammonia, are lohoUy 
 arbitraivj, for chemical analyses do not alFord the slightest grounds for the 
 majority of these equations."* " Chemical equations having no other 
 foundation than the presumed infallibility of empyrical formulae, must 
 cause us to deviate from the path of physical inquiry, and involve us in 
 a chaos of the most untenable delusions." {VideTjVESiOr ^ 50, 409 h). 
 
 " Have the numerous analyses of morbid blood instituted during the last 
 icw years fulfilled the expectations of Physicians ? (§ 6h, a.) With all 
 due gratitude to the indefatigable investigators who, with no other aid 
 than that which zoo-chemistry could offer, boldly attempted to throw 
 light on those obscure inquiries, it must be admitted that, when we seri- 
 ously inquire into the recompense of all their labors and sacrifices, we find 
 that the result, although too dearly bought, was altogether inadequate to 
 satisfy the> requirements of Pathology. (§ 376J.) Have the numerous 
 analyses of the urine led to much more than the assumption of several new 
 species of disease, or so-called diatheses? (§427,691.) Although we 
 might have anticipated greater results, we can hardly wonder that the 
 efforts hitherto made should either wholly or partially have deceived our 
 expectations ; for although these investigations may have rendered chem- 
 istry no unworthy auxiliary to a physical diagnosis, analyses of morbid 
 products can hardly afford an insight into the chemical laboratory of the or- 
 ganism, while the means are wanting to prosecute them with the scien- 
 tific accuracy attainable in the case of mineral analyses. Animal Chem- 
 istry is still ivholly unable to afford us a precise, and at the same time a 
 practically useful method of investigating the blood; and how should it 
 be otherwise while we continue to be in doubt regarding the chemical 
 nature of its ordinary constituents? The mineral substances o^ nonnal 
 blood arc not yet determined, or, at all events, continue to be made the 
 subject of dispute; we scarcely know the names of the fatty matters it 
 contains ; one of its most important constituents,^inV?, cannot be chem- 
 ically exhibited in a pure state ; we are ignorant of the nature and mode 
 of secretion of the globulin of the blood-corpuscles; we are still far from 
 being able to separate and determine the so-called protein oxides (§ 18, 
 53 c, 409 a, b) ; and we are also ignorant of the excrementitious sub- 
 stances occurring in the blood. How, then, amidst these and a thousand 
 OTHER UNCERTAINTIES AND DOUBTS, Can an investigation of the blood be 
 scientifically and trustworthily conducted? We analyze healthy and mor- 
 bid milk; and yet we are ignorant of the substances whose admixture we 
 have termed casein. The urine, in its morbid conditions, presents many 
 varieties ; and yet our knowledge of that secretion, frequently as it has 
 been analyzed, amounts to little more than an acquaintance with the quan- 
 titive relations oi some of its priricipal constituents; creatinine and hippu- 
 ric acid have not been determined by any analysis, while absolutely noth- 
 ing is known regarding the most important pigment of this secretion. 
 
 • This sustains my criticism of LiEBio.p. 221-222, h 409 b.
 
 Organic Chemistry. — APPENDIX. — Physiology. 781 
 
 Many experiments have been made and theories broached on nutrition 
 and digestion, and yet to almost the present day the existence of lactic 
 acid in the gastric juice has been contested. Although hypotheses are 
 not wanting regarding the mode of action of Pepsin, we knoiv nothing of 
 its nature (§ 363-365), and we are wholly ignorant of the proximate met- 
 amorphosis of albimiinous bodies in the stomach during digestion. Will 
 Mulder be able, even with his most accurate analyses, to support his 
 protein theory by the aid of sulphamide and phosphamide ? Or is this 
 term destined to indicate a x>o.st epoch of Organic Chemistry? (§ 38-51, 
 350f n, 376^, 409 a, h.) When such is the state of Organic Ghemisti^j, can 
 we wonder that there should be obscurity regarding the chemical pro- 
 cesses in the animal body, their various isolated and combined actions, 
 their casual connection, and their dependence on external influences and 
 internal conditions'? Unfortunately, we might be led to believe, from 
 the lectures and writings of many physicians, that, ti-usting to the apho- 
 ristic and often highly apodictic assertions of certain chemists, they felt se- 
 cure of having reached the object of their inquiries. (§ 5|, a.) Although 
 at present little more than the direction is indicated, we may hope in 
 due time, and after innumerable efforts, to see our endeavours crowned with 
 success/" And so said Fourcroy seventy years ago, p. 9, §5, 376^. 
 From all which, it appears that our friends are upon the MTong track. — 
 Professor Lehmann's Physiological Chemist?^, vol. i., p. 19, 23, Philadel- 
 phia, 1855. 
 
 1030. Again, we have a summary admission f»om this eminent Chem- 
 ist which shows us forcibly that there can be no dependence upon organic 
 analyses for any knowledge of the natural or morbid processes or prod- 
 ucts of the living body — not even, indeed, of the elementary constitution 
 of the tissues in their natural condition. Thus : 
 
 " The theory of the chemical nature of the animal tissues is a depart- 
 ment of physiological chemistry which, as yet, has been very little culti- 
 vated, and the reasons of this unsatisfactory state of our knowledge are 
 too obvious to require any detailed exposition. We will, therefore, sim- 
 ply observe, that the most important obstacle to the chemical investiga- 
 tion of the tissues is, that their elements are too intimately combined or 
 associated with one another to admit of their being pi-epared for chemical 
 analysis by a previous mechanical separation. This separation of the va- 
 rious elementary tissues which are deposited among, penetrate between, 
 and envelop each other, is rendered the more difficult by the circum- 
 stance that, with scarcely an exception, they are equally insoluble in the 
 ordinary indifferent menstrua employed by chemists. If we have re- 
 course to the stronger or more energetic solvents, as, for instance, acids 
 and alkalies, we have seldom any assurance that the dissolved substance 
 is the, otherwise, unchanged histological element, and the portion remain- 
 ing undissolved is, in reality, a simple chemically pure material. Indeed, 
 in a majority of cases, there cannot be a doubt that the chemical consti- 
 tution of the tissue on which we are experimenting is entirely changed by 
 such reagents" (§ 53 b, 417 a). And so of the blood and secretions, § 1029. 
 (Professor Lehmann's Physiological Chemistry, vol. ii., p. 174.) 
 
 Among the many very luminous comments by which our author dis- 
 credits organic analyses we should naturally expect to find the same 
 discouragement of pathological chemistry. On entering upon the con- 
 sideration of " Exudations and Pathological Formations," he remarks 
 that,
 
 783 INSTITUTES OF MEDICINE. 
 
 ♦'We have often had occasion to comment upon the inefficiency and 
 imperfection of our chemical knowledge, when compared with the great 
 eocpectations which have been entertained in respect to its applications to 
 Physiology and Pathology ; yet there is scarcely any subject which more 
 thoroughly calls for our confession of weakness and incapacity than the one 
 we are now about to consider" (§ 5, 376^, 676 5, 1006 a). Again: 
 "The science of Pathological Histology, which alone can guide the 
 Chemist, is so full of uncertainties, subjective conceptions, and varying con- 
 jectures, notwithstanding some signal advances, that it scarcely ever pre- 
 sents any starting-point for chemical investigation." — "A Chemist can- 
 not be satisfied that he knows a substance until he has submitted it to 
 an elementary analysis, and can attain, at all events, an approximate de- 
 termination of its atomic weight. In fact, a body which has been sub- 
 mitted by the Chemist to a few reactions only, however striking they 
 may be, but for which he is unable to establish a formula based upon el- 
 ementary analysis, may be almost considered as unknown to him (§ 1029). 
 In this sense (and in exact investigations Ave can only take this view) all 
 substances, as transition stages fx-om the protein-bodies of a plastic exu- 
 dation, are tvholly unknown to us, and must remain equally unexplained 
 until we are able to elucidate the mystery of protein" (§18 d, e, 53 b, 409 
 a, b). The troubles multiply after death, among which is the " rapid 
 decomposition, even while the body is yet warm," and upon Avhich we 
 have quoted a luminous remark of Tiedemann in § 54, a. " In a word," 
 says our Author, " whiie even the quantitative investigation of objects de- 
 rived from healthy animals has to contend with such difficulties that very 
 few animal juices admit of being very accurately examined, the qualita- 
 tive analysis of pathological products is opposed by insuperable obstacles." 
 " If, therefore, we have very slight prospect of being able to trace patho- 
 logical processes by a qualitative examination of exudations, or of attain- 
 ing any scientific aim by such a mode of procedure, we are led to inquire, 
 with some hesitation, whether the quantitative analysis of these products 
 would be attended "by any better results." — Lehmann, ibid., vol. ii., p. 
 271-274. 
 
 I have taken the liberty of placing many of our Author's words in 
 Italics and capitals, and have introduced references to Sections in these 
 Institutes, and shall preserve this plan hereafter for the sake of the read- 
 er's eye, and, more or less, as a substitute for comment. Many of the 
 remarks which I have rendered emphatic in all the foregoing quotations 
 express a fundamental fact, which vitiates all organic analyses beyond 
 the mere disclosure of a probable elementary composition. Upon this I 
 have hitherto insisted as an insuperable ditficulty (§ 53, b, &c.). I may 
 also say, in explanation of my general silence upon our Author's facts 
 and hypotheses, that I am not aware of any one whose essential nature 
 I have not examined and controverted in the foregoing work. But a 
 better reason may be found in the consideration that our Author has, 
 himself, surrounded his facts and hypotheses, throughout his work, with 
 admitted doubts, distrust, and ambiguities, of which the foregoing are 
 but a few examples. It is, however, an able, but, as appears to me, an 
 abortive attempt to reconstruct the fallen fabric of Organic Chemistry. 
 Our Author is merciless upon the past, and, as our extracts show, is al- 
 most hopeless for the future (§ 626 5, 819 5, and Notes, pp. 196, 911).
 
 Organic Chemistry. — ^appendix. — Aniraal Sugar. 783 
 
 PRODUCTION OP ANIMAL SUGAR. 
 
 1031, a. It is now my purpose to bring under the test of the forego- 
 ing results of chemical experience, as well of certain physiological prin- 
 ciples, the new function which has been lately ascribed to the liver of 
 generating sugar, in connection with the supposed mechanical filtration 
 of sugar from the blood by the kidneys and maramge. But, independ- 
 ently of this great incongruity between the supposed catalytic action of 
 the liver and the mechanical oflace of other complex glandular organs, 
 we are startled with the announcement that the liver is a farther excep- 
 tion to the principle of analogy in discharging multiplied and perfectly 
 distinct functions in the economy of life. " Qu'il re'sulte de la que le 
 foie n'est pas un organe simple, mais un organe a fonctions multiples, 
 puisqu'il se'crete d'une part du sucre, de I'autre de la bile." — Cl. Ber- 
 nard, Leqons de Physiologie Exp., &c., p. 88 ; 1854, 1855. 
 
 Without, certainly, denying the alleged fact in respect to the liver, it 
 is proper to inquire into its probability until it becomes established, and 
 in doing this we shall have analyzed some important facts in their rela- 
 tion to the functions of glandular organs. Should the supposed forma- 
 tion of sugar by the liver, as a product distinct from the bile, and des- 
 tined to subserve totally different purposes, be rendered no longer doubt- 
 ful, we shall hail it as a remarkable accession to physiological science, 
 however much it may disturb any supposed principles, or however little 
 may be its practical bearings ; and, whatever may be the final issue, 
 nothing can detract from the great merit of the inquiries which con- 
 ducted the philosopher to the supposed discovery. (§ 5^, a-f.) Our 
 argument, however, will be particularly with Professor Lehmann, who 
 has gone more fully than Bernard into many important bearings of the 
 question. 
 
 1031, b. Now, in respect to the production of bile. Professor Lehmann 
 is a perfectly orthodox Physiologist ; but, apparently, only so because 
 the reagents employed in Chemistry have not yet transformed the constit- 
 uents of blood into any of those so-called proximates which they so read- 
 ily effect in the bile. (§ 54 a, 1029, 1030.) Doubtless, however, when 
 that shall have been consummated, as is not unlikely to happen, the 
 liver will lose its isolated rank in Physiology, and fall to the level of 
 other "strainers." Thus, our Author: 
 
 " In passing to the consideration of the individual biliary substances, 
 and inquiring which of these exist preformed in the blood of the portal 
 vein, we find that none of the most essential constituents of the bile can 
 be detected in it." " The error of supposing that biliary substances have 
 been demonstrated in the blood of the portal vein by means of sugar and 
 sulphuric acid, arises from the similar reaction which Pettenkofer's test 
 gives with olein and oleic acid." — Lehmann, ibid., vol. i., p. 480. Our 
 author says, also, that " During the slow passage of the blood through 
 the liver, it undergoes such important modifications, that a vaevQ filter- 
 ing off of certain constituents of the blood through the liver is not to be 
 thought of." And so Miiller, § 42, and Mulder, § 350f e, and Liebig, 
 § 53 c, 409 b. 
 
 It is even denied by Kane and others, that the bile is absorbed into 
 the blood in cases of jaundice — only the coloring matter. "The prob- 
 lem," say Becquerel and Rodier, " as to whether the bile passes into the 
 blood has occupied the attention of Chemists as well as Fhysicians, but
 
 784 INSTITUTES OF MEDICINE. 
 
 it does not appear to have been thoroughly solved by either." — Bec- 
 QUEREL AND Rodier's Pathological ChemisU-y, p. 239. London, 1857. 
 
 As to lactic acid and urea, Lehmann declares that " The recognition 
 of lactates in healthy blood is just as difficult or impossible as that of urea 
 in the same fluid." — {Ibid., vol. i., p. 96.) The supposed pre-existence 
 of Liebig's "important instrument," pro^em, in the blood (§ 18 c, 409), 
 and of the great digester, pepsin, also, is abandoned ; which, indeed, may 
 be equally said of most other organic products. 
 
 Now, in these facts which Chemistry has been gradually learning in 
 its career of " experimental philosophy" it should recognize a very strong 
 analogy in proof that the formation of all the secreted products of an 
 organic nature, and in the natural condition of the body, depends upon 
 the organs by which they are elaborated, and that they had no pre-ex- 
 istence in the blood. The various modifications which lymph undergoes, 
 as deposited by the most simple structures in different parts of the body, 
 reflects a flood of light upon our subject (§ 408, 409 e-h) ; and I may 
 appeal to Liebig for a great general law which carries our analogy 
 through all organic nature (§ 42). The analogy, however, supplied by 
 the simple tissues should be at least conceded to the glandular organs, 
 since it is here corroborated by a strict analogy of structure ; and where 
 chemical reagents determine from the blood the same so-called proxi- 
 mates which they are capable of deriving from the secretions, these sup- 
 posed proximates should be regarded equally as artificial transformations 
 (§ 43, 53 b, 54 b, 417, 1030), and Organic Chemistry should cling to 
 catalysis as its only consistent and dignified ground (§ 350| a-g, 409 j). 
 But such has never been the philosophy of Organic Chemistry. It dis- 
 cards, ostensibly, the organic force, or vital principle, or plastic power 
 (for they are convertible terms), while there is scarcely a modern treat- 
 ise upon chemical physiology which does not invoke the aid of that 
 power in its lucubrations upon the phenomena of life, and then with 
 senseless ingratitude casts it away as a phantom of the imagination ; 
 though it should be excepted in behalf of Lehmann that he is consistent 
 throughout in disclaiming all connection with any thing but the mere 
 properties of dead matter. It is not, therefore, remarkable that, when 
 these philosophers manufacture sugar or urea out of the blood they 
 should neglect their pronunciation relative to the constituents of the 
 bile. Our able Author is of this number, although he finds much diffi- 
 culty with diabetic urine. But this is partially overcome by the assump- 
 tion that " no one can doubt that it is, for the most part at all events, 
 derived from vegetable food." — (Lehmann, ibid., vol. i., p. 259.) And 
 " M. Mialhe, especially, believes that the formation of sugar can not be 
 independent of a saccharine or amylaceous diet." — (Becquerel and Ro- 
 DiER, ibid., p. 249.) No one, however, acquainted with the literature 
 of medicine is ignorant of the fact that the saccharine matter in diabetes 
 is said to be often as abundant when the patient subsists as exclusively 
 upon animal as vegetable food, and that there are those who have con- 
 sidered a vegetable diet most conducive to the disappearance of saccha- 
 rine matter in diabetes. (See Essay on the Philosophy of Diabetes, in 
 Medical and Physiological Commentaries, \o\. i., p. 674-682 (1840), where 
 this ground is considered, and where the Author anticipates the ultimate 
 failure of detecting sugar and urea in the general circulating mass of 
 blood, in opposition to the statements then in vogue ; or, as Christison 
 had it, the blOod is sometimes " loaded with urea." Also, ^ 1007 e).
 
 Organic Chemistry. — APPENDIX. — Animal Sugar. 785 
 
 Nor can th-- laboratory approach an intelligible answer why such a 
 profusion of saccharine matter is elaborated during lactation, unless it 
 be allowed to be the product of the mammary gland (§ 424). Whence 
 comes this substance in the nursing-mothers of the human race that are 
 wholly restricted to a meat diet, as in dyspeptic troubles, if vegetable 
 food, as is admitted (ut supra), must yield, " for the most part at all 
 events," that substance to diabetic urine? Or where shall we look for 
 it in the nursing-mothers of the strictly carnivorous tribes % Will the 
 laboratory answer why saccharine matter is not accumulated in the 
 blood when lactation is suppressed ? Or if, according to Bernard, sugar 
 be found throughout the circulating mass of blood during digestion, 
 why is not some small part of it at least "strained oiF," as in diabetes? 
 According to this Philosopher, when it gets involved in the circulating 
 mass, it must be an effete substance, since it is said to be generated by 
 the liver to be extinguished in the lungs for the uses of the general 
 economy. Nor will it do to assume that the quantity is too small ; for 
 it appears to be far more easy of detection by Bernard in the blood of 
 the renal arteries than urea can possibly be under any circumstances. 
 The fact, therefore, contradicts the experiments. Moreover, is it prob- 
 able that the same disposition would be made of sugar by the lungs when 
 circulating in arterial blood as when presented to those organs by the ve- 
 nous blood of the hepatic veins? (§ 409, e.) No incongruous hypotheses 
 will answer here ; and it is evident that the Chemist would avoid the in- 
 quiry. (See Lehmann, ut cit., vol. ii., p. 344.) 
 
 It is true, it made no difterence with CI. Bernard (who, doubtless, had 
 the foregoing facts before him) whether animals were fed upon vegeta- 
 ble or animal food. He was always sure to find sugar somev^iere be- 
 tween the liver and the lungs, or, at all events, in the supposed laboratory 
 itself But we will hear him : 
 
 " We fed a great number of dogs, at the College of France, during six 
 or eight months exclusively with meat. The animals being then killed, 
 1-90 gr. of sugar was found in the liver, and this is as large a propor- 
 tion as is found in dogs that have been allowed a mixed diet (ralimenta- 
 tion mixtey\ — Bernard's Le(^ons de Physiologie Exj)., appliq. a la Medi- 
 cine, p. G9. 1854-5. 
 
 Bernard also allows the fact (important in its connection with the 
 foregoing), that long abstinence occasions an entire failure of the pro- 
 duction of sugar. Nor did he find it in any of the cases beyond the pre- 
 cincts of the liver, which farther embaiTasses the phenomenon of lacta- 
 tion in cai'nivoi'ous animals, and of diabetic sugar as it presents itself in 
 man when subsisting upon animal food alone. Moreover, Bernard failed 
 of detecting sugar in the liver of some diabetic patients, which leads 
 Becquerel and Rodier to say that, 
 
 " The theory of Bernard, although bearing the stamp of probability, 
 presents, nevertheless, certain difficulties which farther experiment can 
 alone remove. As long as the absence of sugar in the livers of a certain 
 number of diabetic patients remains unexplained, his theory must be re- 
 garded as incomplete." — Becquerel and Rodier, ibid., p. 249. 
 
 Nevertheless, there appears to us no difficulty in accounting for the 
 production of sugar either by the mammse in lactation, or by the kidneys 
 in diabetes, although the subjects subsist exclusively upon animal food, 
 or be subjected to prolonged abstinence. Glucose or grape sugar, which 
 is said to be identical with diabetic sugar, consists of twelve atoms each 
 
 D DD
 
 786 INSTITUTES OF MEDICINE. 
 
 of carbon, hydrogen, aild oxygen. These are the main constituents of 
 the blood, whatever the diet ; and if the Chemist fail of fabricating sugar 
 out of the blood or liver after prolonged abstinence, it does not show in 
 the least that it may not be generated by some part of the living organ- 
 ism. But it does show that Organic Chemistry is at fault in its prem- 
 ises when it confounds the living body with a chemical apparatus. Well, 
 therefore, has it been said, when chemically considered, that 
 
 "M.Bernard, while asserting that the liver may secrete sugar without 
 the ingesta of such alimentary substances as are usually considered ne- 
 cessary to its formation, nevertheless admits that prolonged abstinence 
 may even produce complete disappearance of the sugar. This result — 
 the formation of sugar without constituent materials — is the most un- 
 acceptable portion of his theory, and new experiments are requisite before 
 it can be satisfactorily proved." — Becquerel and Rodier's Pathologi- 
 cal Chemistry, p. 248. 
 
 Nor is it a less interesting feature of the subject, that the liver should 
 be regarded as the producer of saccharine matter in virtue of its or- 
 ganization and properties, both by Bernard {xit cit.) and by Lehmann {ut 
 cit., vol. i., p. 257, 624 ; vol. ii., p. 344), as, also, of the bile, while the 
 mammary gland in fulfilling its wonderful final cause, alike in all its va- 
 riety of structure, and the kidney in a special form of disease, are de- 
 graded to the mere mechanical office of filtration. (§ 408, 424.) I need 
 not speak of the dormant condition of the former gland in all mammif- 
 erous animals in the absence of maternal relations, but may say that, 
 according to Lehmann, " in a normal state it is probable that no sugar 
 Jinds its way into the urine" (§ 829), and that " it is only seldom we 
 meet with saccharine matter in other diseases than diabetes ;" and even 
 "in the blood of diabetic patients, I never could find," says Lehmann, 
 " more than 0-047 p. m. of sugar ;" {ut cit., vol. i., p. 257, 623.) Becque- 
 rel and Rodier go farther than this : 
 
 "The only disease," say they, "in which it has been found is diabe- 
 tes ; and in this its presence has given rise to so much difference of opin- 
 ion, that doubts remain in the minds of many respecting it. It is cer- 
 tainly, however, found in no other disease. Among the thousands of 
 specimens of serum which we have examined, it has never been once de- 
 tected ; nor has any other Chemist alluded to its presence except in dia- 
 betes. But even in this disease, its existence in the blood has been con- 
 sidered doubtful, and is even denied by some Chemists — Guendeville, 
 Vauquelin, Segelas, Wollaston, and Henry." And, as to the test of 
 light, "it is as the result of upwards of a thousand analyses of the blood 
 by means of the polarimeter, that we feel authorized to affirm, that if 
 sugar exists in the blood of persons suffering from other diseases than 
 diabetes, the fact is extremely rare and exceptional — Becquerel and 
 Rodier's Pathological Chemistry, p, 71, 72. 
 
 It appears, therefore, that Organic Chemistry has receded to about 
 the conclusions which we adopted upon physiological grounds seventeen 
 years ago, and fortified by the observations of a distinguished Chemist of 
 that day, whom we quoted in the Atedical and Physiological Commeiitaries 
 (vol. i., p. 674), in the following manner, and to which we now refer in 
 behalf of vital solidism. Thus, the Commentaries : 
 
 Mr. Kane has stepped forward in behalf of the dignity of chemical 
 science, and it is to such philosophers that an " acknowledgment" is due 
 from Physiologists, In respect to the blood of diabetes, he remarks,
 
 Organic Cliemistry, — ^APPENDIX. — Animal Sugar. 787 
 
 that, " the resalts of these analyses show that in diabetes, the relative 
 proportions of the organic principles remain quite within the limits of 
 the composition of the blood in perfect health. In fact, the blood cannot, 
 as far as these experiments go, be considered as at all aifected in this 
 distressing malady." — Kane, in Dublin Journ. of Med. and Chem. Science, 
 vol. i., p. 24 (Compare with \ 5i a, 847 «, 1007 c). 
 
 But, however this may be, it cannot be doubted that, in the multitu- 
 dinous experiments which are made with chemical reagents, some pro- 
 * cess may be found which is capable of generating from the blood a trans- 
 formation more or less analogous to saccharine matter. Upon the whole 
 ground, also, of the chemical philosophy of organic products, no objec- 
 tion can be alleged against our conclusion ; since, if the formation of 
 sugar in the vegetable and animal organism be a chemical phenomenon, 
 nothing would be more likely than its manufacture by the Chemist out 
 of other organic compounds having the requisite elements, though this 
 conclusion is very far from showing the accuracy of the former. But, it 
 is far more important to science and philosophy, and especially to prac- 
 tical medicine, that we have Lehmann's authority for saying that these 
 analyses cannot be trusted. (§ 1029, 1030.) 
 
 § 1032, a. Let us now consider the question in connection with urea. 
 We have seen that Lehmann states that " the recognition of lactates 
 in healthy blood is just as difficult or impossible as that of urea in the 
 same fluid" (§ 1031) ; and he remarks that "many Chemists have long 
 sought in vain to detect urea in normal blood ; Simon believed that he 
 had found it in calves' blood, and Strahl and Lieberkuhn, and recently 
 Garrod, maintain that they have detected it in human blood. Without 
 doubting the correctness of these Chemists, it is only recently that I have 
 been able to convince myself by decisive experiments that urea is pres- 
 ent in normal blood." — (Lehmann, ut cit., vol. i., p. 153.) But may it 
 not have been an artificial product ? (§ 417, 1029.) 
 
 Becquerel and Eodier remark that " urea probably exists in healthy 
 blood, but in too small a quantity to be discovered by chemical analyses." 
 This conjecture arises from the supposed discovery of urea in the blood 
 by Prevost and Dumas after extirpating the kidneys of animals, and 
 from its discovery by some Chemists, " chiefly in Great Britain," in 
 Bright's disease. But Becquerel and Rodier have failed of detecting it 
 in that affection. The question is then propounded — 
 
 "Does the same thing occur, however, when, from any other cause, 
 the urinary secretion is greatly diminished, as in retention of urine, and 
 in the various diseases to which the kidney is liable? On this subject, 
 analysis is as yet silent ; and here, as in Bright's disease, much remains 
 to be done." (Sec cases of both in3fed. andPhys. Comm., vol. i., p. 601, n.). 
 
 As to the prevailing prejudice which often refers cerebral disorders to 
 a urea-diathesis, these Authors remark that 
 
 " It has indeed been asserted that when the accumulation (of urea) 
 became considerable, we might attribute to it those cerebral symptoms 
 which are commonly met with in the last stage of many renal diseases. 
 This may possibly be the case, but it altogether remains to be proved." 
 And, as to kiestine, which has become ingrafted upon the philosophy of 
 pregnancy, it is now said by Becquerel and Rodier that " this discovery is 
 a pure illusion.'''' — Becquerel and Rodier, ibid., p. 70, 353. (See Medi- 
 cal and Physiological Commentaries, article Humoral Pathology, where ob- 
 jections are brought against the supposed absorption of urine in cases of 
 suppression.) — Note Z p. 1130, an explanation oi urcemia.
 
 /bb INSTITUTES OF MEDICINE. 
 
 But Lelniiann has finally succeeded in elaborating urea from healthy 
 blood, and therefore again violates the analogy both of function and or- 
 ganization which he ascribes to the liver, of Avhich he affirms " that a 
 mere Jiltej'ing off' oi' certain constituents of the blood through the liver is 
 7iot to be thought of;'' and although, "like Becquerel, he has failed in 
 establishing the fact that there is an augmentation of urea in certain 
 forms of disease, although English physicians have shown an inclination 
 to assume a urea diathesis" (aramia), yet, having finally elaborated urea 
 out of the blood, he neglects not only his own forcible analogy, but the 
 fact that urea is readily formed in the laboratory, in a variety of ways, 
 especially by transformations of cyanite of ammonia and of urine ; and, 
 therefore, not only overleaps the clearest induction from the premises that 
 chemical reagents may, at least, accomplish the same artificial result 
 when brought to act upon blood (§ 53, c; Liehig), but, in common with 
 other distinguished Chemists, is led to regard the kidney as a mere strain- 
 er. (§ 409 e, 4:'22, 423.) Whether, however, " catalysis," or the philos- 
 ophy of '' strainage" be adopted, before either can prevail beyond a me- 
 chanical age, they must answer us, in some slightly intelligible manner, 
 how it happens, in conformity with the known facts of either Chemistry 
 or Mechanics, that the urine undergoes such sudden augmentations from 
 the operation of fear and from the contact of cold air with the surface 
 of tlie body (§ 246, 422, 892|) ; and why, also, the milk is liable to sud- 
 den and remarkable changes from mental emotions. But this would be 
 of very little importance were it confined to the source in which it orig- 
 inated. Our Author, however, has contributed a good part toward as- 
 signing to the liver its proper rank in nature — abating the catalytic doc- 
 trine of its modus ojjerandi; and it may therefore be reasonably expect- 
 ed that the time is near when the contrast in function between the liver 
 and testis on the one part, and the mamma and kidney on the other, as 
 now presented for the government of medical philosophy, will turn the 
 attention of Physicians from the dogmas of the Laboratory, and the an- 
 alogies drawn from " Strainers," to the study of living nature, and end 
 in restoring Physiology to its proper cultivators. (§ 4^ d, 376 1, 409 i, 
 493 d.) 
 
 1032, b. It is true, the kidney is an organ of excretion, and may, 
 therefore, eliminate any foreign matter from the blood, though not by 
 filtration. We do not deny that effete organic compounds, even sugar 
 if it stray through the lacteals in morbid states (§ 192, 277-295, 826- 
 827), may be eliminated more or less unchanged by the kidneys ; though, 
 for reasons already assigned (§ 38-51, «&;c.), this fact cannot be satisfac- 
 torily determined, either as to the blood or urine, by chemical reagents ; 
 and for this, too, we have the authority of Lehmann, Liebig, and Mulder. 
 (§ 42, 53 c, 450J e, 409 y, 1029.) But wea is not introduced from with- 
 out, and holds the same relation to the urine as cholesterin and the jtsz- 
 nous 2'>rinciple do to the bile, if we allow these and urea to exist natural- 
 ly in the conditions in which they are presented after the application of 
 chemical reagents. (§ 53 b, 417 a, 1029, 1033.) But it is quite other- 
 wise, in the former respect, with saccharine matter, which abounds in 
 vegetable food. If this, therefore, were not destined for the nuti'ition of 
 animals, and underwent no change in the process of digestion, it should, 
 like any other foreign substance, be freely eliminated, in the same or 
 some modified condition, by the kidney. But the general failure of de- 
 tecting it in the circulating mass of blood, in connection with the great
 
 Organic Chemistry. — appendix. — Animal Sugar. 789 
 
 amount which is appropriated by man and herbivorous animals, and its 
 great abundance in milk and diabetic urine, and its absence in all but 
 diabetic urine assure us of two facts, namely, that it does not enter the 
 circulation unchanged, in healthy states of the body (§ 192, 277-295, 
 826-827), and that the mammary gland is capable, under certain very 
 remarkable physiological influences, and the kidney in a special form of 
 disease, of recombining its elements into saccharine matter, whether those 
 elements exist in intimate union with the blood, or be derived from the 
 disintegration of the tissues. But in morbid states of the digestive or- 
 gans, as always attend diabetes, it might be supposed that saccharine 
 matter would be readily taken up by the lacteals, when, like any other 
 effete substance, it should be excreted by the kidney in some shape or 
 other (§ 192, 277-295, 426, 826-827). It is certainly a remarkable 
 coincidence that the mamma and kidney should, in special conditions of 
 those organs, and in such conditions only (§ 424, 426, 427), be alike 
 capable of forming saccharine matter out of the blood. But this is en- 
 tirely less remarkable than the double function assigned to the liver of 
 generating bile and sugar for important uses in the animal economy. 
 Nevertheless, while the former circumstance disproves the physical ra- 
 tionale of filtration, it is more improbable that the mamma and kidney, 
 under those special conditions, and those only, should alike become 
 " strainers" of a substance which is admitted to exist in a greatly insuf- 
 ficient amount, at most, in the circulating mass of blood. It is also, I 
 repeat, a far more probable hypothesis, that the kidney should produce 
 sugar out of certain elements of the blood in that remarkable affection 
 known as diabetes mellitus, than that the liver should not only perfonn 
 liabitually the two great functions of generating bile and sugar (the one 
 for important uses in digestion, and the other for nutrition), but that its 
 saccharine function should be abnormally increased in diabetes and also 
 when required by the exigencies of lactation, and then applied to that 
 specific purpose — and when, also, there is a special gland provided for 
 the generation of milk.* Let it be considered, too, that the formation of 
 sugar by the mammary gland has no reference to the internal economy, 
 but, totally unlike the uses attributed to sugar as supposed to be gener- 
 ated by the liver, it is destined to undergo the same process of digestion 
 as the sugar which is supplied by plants. Now, these are principles 
 which can be set aside only by absolute demonstration (^ 1086). 
 
 Moreover, in diabetes the condition of the urine is remarkably altered 
 in other respects, especially in regard to quantity ; and the quantity 
 alone denotes an essential change in the natural function of the kidney. 
 And it may be said farther, for the sake of the analogy, that in morbid 
 conditions of all organs, indeed of all parts of the body, and according to 
 the nature of the malady, the secreted products are diverted from their 
 natural character. This is even strongly exemplified in the various 
 phases of common inflammation, and not less remarkably in the specific 
 forms of that disease (§ 733, 740-741, 653 c). And again, I say, since 
 it is allowed that sugar is not absorbed by the veins or lacteals, it would 
 be clearly a foreign substance if intermingled with the circulating mass 
 of blood, and would be at once excreted by the kidneys, and, therefore, 
 in lactation, were the sugar generated by the liver, it should not go by 
 way of the mammary gland. It appears to me that Nature is not so 
 
 * " Crystallized milk-sugar has exactly the same empj-rical formula as anhydrous 
 glucose, so that it therefore contains equal equivalents of carbon, hydrogen, and oxygen."
 
 790 INSTITUTES OF MEDICINE. 
 
 inconsistent as to justify the supposition tliat she has provided against 
 the entrance of sugar, unchanged, into the general circulation, and at the 
 same time has constituted the liver, or any other part, with a view to the 
 reproduction in the torrent of the blood of what she has so carefully ex- 
 cluded in her arrangements for supplying the requisite means of nutria 
 tion — and this, more especially, as she has provided the mammary gland 
 for the generation, in part, of saccharine matter, though not to be con- 
 founded with the torrent of blood, but to undergo transformation in the 
 stomach.* Or why, again, has she so completely provided for the meta- 
 morphosis of sugar in the alimentary canal, if it is to be at once regen- 
 erated by the liver (§ 409, ^»-411) ; and thus, also, impose upon this organ, 
 in violation of all her analogies, two perfectly distinct functions for the 
 generation of products of fundamental uses in the animal economy, and 
 whose uses, respectively, are perfectly distinct from each other ? It will 
 be no answer to say that, in ordinary states of the body the hepatic 
 sugar is at once disposed of in the lungs ; for, besides the fundamental 
 objections already made, this hepatic sugar is supposed, in lactation, to 
 be partly diverted from its great physiological purpose to supply means 
 of nutrition to an external subject, which has no more relation to the in- 
 dividual than the plant has to the stomach ! Or, if we glance at diabe- 
 tes, there is the same inconsistency there. And yet another objection 
 may be seen in another violation of analogies, in supposing that a glan- 
 dular organ pours into the torrent of the circulation one of its most im- 
 portant products, while another not less specific takes the ordinary course 
 toward open surfaces (^ 417). — Notes N R pp. 1121, 1123. 
 
 CI. Bernard appears to be aware of the inharmonious nature of the 
 new function which he has assigned to the liver with that of the pro- 
 duction of bile. "Is it pi'obable," he says, "that the albuminous sub- 
 staiiies of the blood, on reaching the hepatic cells, separate into two 
 compounds, a hydrocarbon, destined to form sugar, and a nitrogenous 
 one for liile ? If this were so, these two compounds would be formed at 
 the same moment." Bernard thinks, therefore, that "his experiments 
 seem to denote that the formation of sugar and bile does not take place 
 simultaneously, but that they alternate with each other." {Lemons, ut cit.) 
 But this will not correspond with the consistent philosophy of organic 
 life. It is also worthy of remark that Bernard's explanation of the dis- 
 position of the supposed hepatic sugar in the lungs is very unsatisfactory, 
 even in a chemical sense ; and, farther, that there is scarcely any agree- 
 ment between him and Lehmann as to the uses of sugar in the animal 
 economy (§ 83, 316, 409/, i, 419 b, 423, 424). 
 
 I shall now introduce a paragraph which denotes the course of argu- 
 ment pursued in the Medical and Physiological Commentaries upon the 
 questions before us : 
 
 When the secretion of milk is suppressed, I have there said, do we find 
 that the saccharine matter is accumulated in the blood, or do we find a 
 trace of it there, or is its secretion "replaced" by any other part? Or, 
 shall Ave go on believing with Puzas, Leveret, Sauvages, Van Swieten, 
 Selle, Astruc, Eaulin, and many others, that it is generated by the legs, 
 and forms the proximate cause of phlegmasia dolens ? Or, when the se- 
 cretion of bile is suspended, do its peculiar constituents appear in the 
 blood, or their elaboration devolve upon any other part? We have 
 shown that it is not so. Would you believe the oath of any one who 
 might swear that he had detected semen in the blood, or in the saliva of 
 
 * Notwithstanding the exigencj' of digestion, even educated ph3-sician.s (except in 
 physiology) apply butter, &c., to the skin as a means of nourishment (§ 1088 b-d)[
 
 Organic Chemistry. — appendix. — Animal Sugar. 791 
 
 a female? And yet it is affirmed to exist in the blood, (See note, 
 p. 589. Also, this work, § 83, h, note.) Shall we admit that the virus 
 of the rattlesnake, the viper, the bee, &c., exists in the blood? If the 
 viper and rattlesnake die after the removal of their venom-glands, it is 
 far from proving that it is in consequence of an accumulation of their 
 specific virus in the blood. It is the same logic here as it has been with 
 urea after extirpating the kidneys. Do we find the peculiar odor of the 
 skunk, of the beaver, of the musk, &c., in the blood ? Thus might we 
 go on with a thousand different formations, which, if admitted to exist 
 in the blood, would, of course, assign to this fluid as many component 
 parts. But if, on the other hand, it be absurd to suppose that the latter 
 formations do not depend upon their peculiar emunctories, why is it 
 not equally so to imagine that animal sugar, urea, or cholesterine, &c., 
 are merely strained off from the blood ? {§ 409, e.) Finally, as to urea, 
 about which humoralism has been so much concerned in the philosophy 
 of diabetes, we may say, that Le Canu, whose analysis of the blood is 
 admitted to be the best, agrees with former Chemists in denying its nat- 
 ural existence in that fluid. — Med. and Phys. Comm., vol. i., p. 680. 1840. 
 
 § 1032, c If, however, the validity of the experiments by which, sac- 
 charine matter and urea are said to have been obtained by analyses of 
 the blood, and of other parts, be admitted, there is not much difficulty in 
 interpreting the supposed results in conformity with a standard supplied 
 by "experimental philosophy" — not even the curious phenomenon de- 
 clared by Bernard of the existence of sugar in all parts of the circula- 
 tion during digestion, but its subsequent limitation to the blood between 
 the liver and the lungs. (§ 48, 49, 53 c, &c., Liebig ; 350f e, /, Mulder; 
 1029, Lehmann.) 
 
 The blood is so constantly fluctuating in its effete materials (§ 426, 427), 
 that they may be regarded as taking an important part in the transfor- 
 mations, either contributing directly to the artificial formation, or exer- 
 cising predisposing affinities upon the elements of the blood, when chem- 
 ical reagents are brought into action upon this fluid (§ 6, 54 a) ; and, if 
 we now consult the foregoing references, we shall find the most eminent 
 Chemists virtually coinciding in this opinion. But I may quote the 
 more specific, and later authority of Lehmann, which I shall do in the 
 language of a Keviewer, for the sake of some other statements which 
 occur in the same connection. Thus : 
 
 " It is a doctrine generally accepted by the Physiologists of the pres- 
 ent day, that the glandular organ furnishes nothing to the secretion, but 
 that its tissue (or, at all events, certain of its cells) exerts a catalytic 
 action on the elements of the blood as it traverses the organ. In accord- 
 ance with this view, Lehmann has afforded us a very satisfactory expla- 
 nation of the origin of the sugar in the liver. On comparing the compo- 
 sition of the blood of the portal and hepatic veins, he found that the 
 saccharine blood of the hepatic veins contains less fibrin and less hsema- 
 tin than the non-saccharine blood which enters the liver by the portal 
 vein. He then proved, by a very logical chemical, process, that pure 
 crystallized hjEmatin might he resolved into glucose [grape sugar] conjugated 
 with a nitrogenous substance," &c. — British and Foreign Med. Rev., Jan., 
 1857, p. 32. New York. 
 
 Now, it is true that this experiment is against our purpose, excepting 
 in the important fact that it is supposed that blood, in certain conditions, 
 may be chemically transformed into sugar. But how far is the experi-
 
 792 INSTITUTES OF MEDICINE. 
 
 ment reliable as to the distinction which is made between hepatic and 
 portal blood (§ 1029)? Let us hear Bernard: 
 
 " Since the publication of his Lemons, Bernard has been led to give 
 up Lehmann's explanation, and has been driven to the belief, from certain 
 experiments which he has recently made, that it is not in the blood, hut in 
 the HEPATIC TISSUE itself, that we must search for the substance ivhich precedes 
 and directly gives origin to the sugar.'" — British and Foreign Med. Rev., ibid. 
 
 Our interpretation will also readily explain the reason why saccharine 
 matter, or something analogous to it, may be made out of the hepatic 
 blood, or out of the liver, when it has not been produced, or but in a 
 minute quantity, from portal blood. In the one case the i-equisite con- 
 ditions are present; in the other they are not. This is obvious enough 
 from the quantity of bile elaborated from the portal blood (^ 417). 
 
 Again, this kind of " experimental philosophy" will explain the reason 
 why, according to Vernois, " sugar may be found in the liver of the 
 foetus and not in that of the mother, and vice versa ;" and why it is found 
 in the liver particularly after respiring an irritating vapor, which, 
 through the reflex action of the lungs, modifies the whole sanguiferous 
 function, and consequently the condition of the blood. Associated with 
 this there may be something appertaining to the liver Avhich may often 
 enable chemical reagents to effect a transformation analogous to sugar. 
 Again : if such be the philosophy, we should probably find the Chemist 
 often failing to produce sugar from the liver in various conditions of 
 disease. Accordingly we learn from Becquerel and Rodier that " in 
 140 cases, wherein the nature of the disease was noted by M. Vernois, he 
 only found sugar fifty-six times." — Ut cit., p. 247, 248. 
 
 § 1032, d. As the variety of means which have been employed to in- 
 crease the supposed normal proportion of sugar in the blood, and the 
 artificial production of diabetes, in no respect affect our conclusions, it 
 is unnecessary to speak of them. Our interest lies in the great physio- 
 logical problems alone, under the direction of the leading facts. But I 
 may say of Bernai'd's experiment of producing saccharine urine by prick- 
 ing the floor of the fourth ventricle between the roots of the pneumo- 
 gastric and auditory nerves, that it is not only an elegant exemplification 
 of the wonderful mysteries of the nervous system in its influences upon or- 
 ganic functions, especially so in connection Math the inductive process by 
 which he arrived at the experiment, and should admonish him, profoundly, 
 of the fallacious nature of his chemical and mechanical doctrines of life, 
 but that it demonstrates a direct influence upon the functions of the kid- 
 ney which places the mechanical hypothesis of " strainage" upon its prop- 
 er footing. It is in vain to assume that this influence was exerted spe- 
 cifically upon the liver, and that that organ was thus stimulated to an 
 extraordinary production of sugar ; for the condition of the kidneys was 
 not affected alone in the elimination of sugar, but in two other and oppo- 
 site respects, according to the precise place in which the floor of the fourth 
 ventricle was pricked between the origin of the nerves. In one place the 
 urine would be increased in qnantity, and yielded an abundance o^ albumen ; 
 while a little variation of the place of puncture rendered the urine small 
 in quantify, and restricted the organic matter to sugar alone. (Bernard, 
 Lerons, «fec., p. 339-340.) Moreover, the kidneys and ureters were quite 
 as violently affected by this prick as the capillary circulation of the ab- 
 dominal organs, while the vessels on the surface of the liver "were more 
 apparent tlian natural" The whole capillary system of other parts of the
 
 Organic Chemistry. — APPENDIX. — Animal Sugar. 793 
 
 abdomen was thrown into a state of great activity and engorgement, and 
 I shall quote the statement in a note* for the purpose, also, of showing 
 how remarkably the vascular system may be affected by apparently the 
 slightest impressions upon the nervous centres, and variously, too, as the 
 impressions may be a little vai'ied (iit supra), and to show, moreover, the 
 absurdity of referring the physical products to the united agency of the 
 nervous power and the chemical forces, and how great the fallacy of ex- 
 pecting to give direction to practical medicine by any analyses of the 
 blood or secretions while they are unceasingly changing in disease 
 through influences propagated by the nervous power (§ 5 J, e). Nor 
 will the reflecting mind fail to observe the vast contribution which this ex- 
 periment makes to the incalculable importance of those by Wilson Philip, 
 as herein recorded, nor how forcibly the experiment confirms the applica- 
 tions which I have made of the English Philosopher's (§ 476-494, &c.). 
 
 But again : if it be assumed that the influences were exerted, in the 
 experiment, upon the liver, and that the kidneys merely "strained off" 
 the redundant sugar, how does it happen that no sugar ever appears in 
 the urine during the digestion of food, Avhen, as affirmed by Bernai'd, it 
 is found throughout the circulating mass of blood? Why never found 
 in the urine in any hepatic affection, and never in any other disease than 
 diabetes? And what shall be inferred of the pathology of diabetes, or 
 of the indications of cure as supplied by Organic Chemistry, when we 
 contemplate the successful treatment, by bloodletting, of the remarkable 
 case recorded in § 1007, c? — Note Z p. 1130, on urcemia. 
 
 Since the foregoing was written, information has reached us that later 
 observers have shown, that, whatever may be the influences exerted by 
 the injury of the fourth ventricle, as it respects the hepatic blood, they 
 have no bearing upon the functions of the liver, but of the lungs. From 
 these observations it would result that the special condition of the hepat- 
 ic blood is owing to some modification of the respiratory function, which 
 is rendered farther probable by the injury being inflicted at the origin of 
 the pneumogastric nerve (^ 461). 
 
 1033, a. After the remarks in the foregoing section (§ 1032), and 
 upon the hypothesis that it is truly sugar which is discovered in blood 
 by the reagents (tests), or whatever compound it may be, it must be con- 
 ceded in behalf of the hypothesis, that the same apparent result is brought 
 about by different modes of proximate analysis. But even this coinci- 
 dence neither establishes the certainty that the products consist of sugar, 
 nor render it unquestionable whether any two of them are alike. (§ 54, 
 a, b.) It is but a guess, liable to the doubts which are so forcibly ex- 
 pressed by Professor Lehmann in sections 1029, 1030. Nevertheless, in 
 a physiological sense, it is the most involved and important inquiry which 
 Organic Chemistry has yet presented, and hence the space which is here 
 allotted to it. Should this persevering Offspring of the inorganic world 
 succeed, in connection with experiments upon living nature, in establish- 
 ing the supposed double function of the liver, it will have contributed a 
 large service to Physiology. But such ai'e the complete contradistinc- 
 
 * "Quand, apres avoir pique cliez im Chien ou chez un Lapin Torigine des pneumo- 
 gastriques, nous lui avons ouvert la ventre au moment oi^ la surexcitation porte'e sur la 
 foie presentait son summum d'intensite, nous avons vu qu'alors il y avait une plus grande 
 ectivite de la circulation abdominale, le S3-steme capillaire etait gorge de sang, et les 
 vaisseaux de la surface du foie plus apparents qu'a I'etat normal. Les reins sont alors 
 eux-m6mes tres surexcites, les ureteres sont tres irritables ; il suffit de la toucher avec 
 la pointe d'un liistouri pour les voir se contracter energiquement." — Bernard, Ler^ons, 
 &c., p. 331, 1854-55.— See Budge's Exp. § 494 e, and § 635.
 
 794 INSTITUTES OF MEDICINE. 
 
 tions between organic and inorganic beings, that it may be safely conv 
 eluded that it can go no farther than to distinguish the difference between 
 the physical constitution of one substance and another. Here it ends, 
 and here the vitalist takes up the result and carries it into the profound 
 labyrinth of organic life. Even so Liebig, § 18 c, 42, 53 c, 59, 64 e, 
 350, nos. 59, 79. (Also, § 5, 6, 53 b, 222 b, 351, 362, 376i, 409 j, 
 All, &c.) 
 
 In the mean time, as an appendage of some moment to the foregoing 
 discussion, and that it may be compared with the extracts from Leh- 
 mann's work, in sections 1029, 1030, I shall now state, as an example 
 of searching for sugar, an unsuccessful process observed by Lehmann for 
 detecting its presence in the portal blood of horses : 
 
 " The blood, after being neutralized with dilute acid, and treated with 
 four times its quantity of water, was coagulated by heat, the expressed 
 and filtered fluid was evaporated, the residue extracted with sjnrit of 85°, 
 and the spirituous fluid precipitated by an alcoholic solution of potash. 
 The portion insoluble in water was mixed with a little water, filtered, 
 treated with dilute sulphuric acid, for the purpose of effecting the meta- 
 morp)hosis of any dextrine that might be present, and then examined fob 
 sugar" ! — Lehmann's Physiological Chemistry, vol. ii., p. 391. 
 
 There is also the celebrated test known as Barreswill's solution, which 
 consists of "carbonate of soda (in crystals) 40 parts; bitartrate of pot- 
 ash 50 parts ; caustic potash 40 parts ; distilled water 400 parts. Make 
 a solution, and add the following : Sulphate of copper 30 parts ; water 
 100 parts. Filter the two solutions when mixed. This solution, when 
 added to a liquid containing glucose, gives a reddish precipitate of re- 
 duced copper." 
 
 Another chemical test is that of caustic potash, " a fragment of which, 
 added to serum containing glucose, gives an albuminous precipitate of a 
 brownish color, due to the combination of albumen with ulmate of potash." 
 
 Becquerel and Rodier say, that the chemical processes I'elied upon are 
 " almost exclusively" the last two — B. and R.'s Patholog. Chem., p. 72, 
 73. Lehmann commends Trommer's test, which consists mostly of caus- 
 tic potash and sulphate of copper, but which has been disputed. " But 
 if this test be not admitted," he says, " equal objections may be advanced 
 against all the reagents employed in mineral chemistry ; the application 
 of most of them demanding more precaution and skilful manipulation 
 than this test." He thinks well of the polarizing apparatus ; says that 
 " Pettenkofer's test is not available for the detection of sugar ;" and he 
 would not trust the fermentation-test, nor Maumene's. After mention- 
 ing these, and their attendant qualifications, we have the farther discour- 
 aging remark, that '' all other tests which were formerly employed for 
 the discovery of sugar are open to so many sources of fallacy, as com- 
 pared with the methods we have already indicated, that we may pass 
 them over in silence." — Lehmann, ut cit., vol. i., p. 251, 256. 
 
 1033, b. Now, all the foregoing (§ 1033, a) would be commendable, 
 did it end, so far as Chemistry is concerned, with the experiments them- 
 selves ; although, as we have seen (§ 1029, 1030), it can rarely supply 
 any reliable ground for induction. But it is an example only of a vast 
 amount of experimental Chemistry which has been carried far into the 
 labyrinth not only of the physiological but morbid states of the body, 
 and commended to Physicians under the illusory name of " experimental 
 medicine."
 
 Organic Chemistry. — ^appendix. — Animal Sugar. 795 
 
 But, suppos-^ it to be all true, there never was and never will be a 
 physician who will or can apply it in practice, very few who can under- 
 stand it, no one qualified for the analyses, no time, in acute diseases at 
 least, for inquiries so difficult and tedious, and no one who will fall into 
 the absurdity of applying to a competent Chemist, if he can find one, to 
 search for disease in morbid changes of the blood, or secretions, not even 
 of the urine. In chronic affections, a few simple observations upon the 
 latter, and which are alone reliable, will sometimes inform the physician 
 of the presence of some unusual substances as the products of disease; 
 but this knowledge can never aid him much in the treatment of the mal- 
 ady (§ 427). Take the strongest of all examples, diabetes mellitus; a 
 knowledge of the existence of sugar in the urine has neither contributed 
 to a knowledge of the pathology of the disease, nor given the slightest 
 direction to an enlightened practice. An exclusively animal diet has 
 not reached the pathological condition, and the sugar has gone on as 
 usual whatever the food consumed. Nor is it any better with the " urea- 
 diathesis," or with " albuminous urine," whether the latter respect the 
 kidneys or dropsical conditions ; but, on the contrary, it has led to many 
 blunders between the presence of disease and the ingesta, or between one 
 disease or another (§ 426, 427, 639, 673, 675, 679, 686 d). If the Phy- 
 sician rely upon these superficial and uncertain, or imaginary signs, if 
 he have not the sagacity to discover the nature of disease through the 
 ready and intelligible signs supplied by Nature, or cannot avail himself 
 of experimental observations upon the eflfects of remedies which have 
 been accumulating for ages, or be incapable of applying in practice the 
 principles which have been founded upon these observations in their con- 
 nection with other intelligible principles in physiology and pathology, 
 his case is as hopeless as must be that of his patients (§ 5^-,/'). And 
 yet, it is a remarkable fact, that many medical Authors, who take the 
 "experimental medicine" of the day upon trust, are vastly more certain 
 of the accuracy of the experiments, and of their application to the heal- 
 ing art (and yet without applying them), than the very able men who 
 have been employed long and assiduously in the inquiry. (§ 1065, h, c.) 
 
 It was but very recently that the Medical Profession in Europe and 
 America calculated upon Morbid Anatomy as a grand basis for medicine, 
 and the present writer took a long ground against it. And Avhere is it 
 now ? Dissipated by Liebig as by an enchantei''s wand. Where now 
 is the so late "Numerical Method?" (§ 1006, a.) Swallowed up by the 
 Laboratory. Where, the Humoral Pathology, which Andral reproduced 
 and ingrafted upon Vital Solidism ? (§ 819, &c.) Ingrafted upon Chem- 
 istry. Where the so late " experimental philosophy" which aimed at the 
 causes and cure of human maladies by the introduction of poisons and 
 remedial agents into the circulation of animals? (744.) " Given place 
 to an ' experimental philosophy' in which organic life has no participa- 
 tion" (§ 5|^ a). Where the " division of labor" in the fragmentary sys- 
 tem of " specialities ?" Concentrated in the hands of Organic Chemis- 
 try (§ 960, c). Where, I ask, are the memories even of those so recent 
 as Hunter and Bichat ? All buried in the common Cemetery. Where, 
 in brief, is Organic Life ? Echo ansvvei's, extinguished by the Labora- 
 tory (§ 695-709. See, also, the Author's Essays on Morbid Anatomy, 
 and on the writings of M. Louis, in Medical and Physiological Comment- 
 aries). 
 
 § 1034. Finally, in the discussion of controverted questions between
 
 796 INSTITUTES OF MEDICINE. 
 
 the Physiologist, as he looks upon animated nature in its healthy and 
 morbid aspects, and the Chemist, who is, or should be, concerned alone 
 with dead matter, it is sometimes difficult to maintain a perfect modera- 
 tion of style when the Laboratory becomes dogmatic, and especially when 
 exclusive (§ 1, i, 350, Mottoes). And I may be now permitted to at least 
 correct a misapprehension of Professor Lehmann's, Avho, in the seclusion 
 of the Laboratory, like all others of the same laborious and abstract pur- 
 suits, is evidently uninformed of the doctrines of the vital Physiologist, 
 or does him an injustice which I should be unwilling to surmise. I al- 
 lude to the following paragraphs, although there is much more of the 
 same nature : 
 
 "We have not hesitated to avow that we have assumed a thorougldij 
 radical point of view in reference to specific vital phenomena and vital 
 forces ; for we cannot rest satisfied with the mysterious obscurity in which 
 they have been artificially enveloped." 
 
 Our Author then proceeds to designate the Science of Life as a sys- 
 tem of " metaphysicology" and to confound Physiologists with the " ad- 
 vocates of a romantic poetry of nature f^ though, it is true, he had the 
 encouraging success of Liebig before him (§ 350, Mottoes). Thus, our 
 Author : 
 
 " It would be well if these spiritualists would look down from the high 
 stand they have chosen, and deign to believe that there are some among 
 those experimentalists, who, clinging to matter, and gathering their facts 
 Avith ant-like industry from the lowly earth, notwithstanding that they 
 have long held communion with the poet-philosopher, Plato, and the 
 philosophical natural inquirer, Aristotle, and have some familiarity with 
 the Paraphrases of Plegel and Schelling, are yet unwilling to relinquish 
 their less elevated position. If these happy admirers of their o"\ati Ideal 
 had descended from their airy heights, and closely examined organic and 
 inorganic matter, they would not have deemed it necessary to assume, 
 that, besides carbon, hydrogen, nitrogen, and oxygen, organic substances 
 must also contain an organagenium, or latent vital force, or Avhatever else 
 they may be pleased to call it. Had they sought information from a 
 Chemist, they would have learned that, when exposed to the clear light 
 of rigid logic, there is no essential difference betaveen organic 
 AND inorganic BODIES. A Chemist, totally unacquainted with organic 
 matter, would a 2>riori have deduced all these iiicideidal differences of mat- 
 ter from the doctrine of affinity and the science of stoichiometry, evolved 
 from dead matter. (§ 1052.) However these advocates of a romantic 
 poetry of nature may despise the swarm of industrious investigators, 
 who are often unwearingly occupied for years together in endeavoring 
 to collect a ^q\v firm supports for the great edifice of a true philosophy 
 of nature, we do not despair of seeing our work rise in simple grandeur, 
 more durable and lasting than these sophisms of natural philosophy, 
 which, passing through ages, from Pythagoras and Empedocles to Schel- 
 ling and Hegel, have, like the sand of the ocean shore, been alternately 
 upborne by one wave and ingulfed by the next." — Lehmann's Physio- 
 logical Chemistry, vol. i., p. 33, 34. — See p. 157, § 350, mottoes h-l. 
 
 That this is not a hasty rhapsody appears from a note, in which our 
 Author states that he had "expressed similar ideas in an Article which 
 appeared in the ' GegenAvart.' " At another time, also, he caricatures 
 the doctrine of vital solidism as " a belief in supernatural forces of mat- 
 ter."— /ied, vol. ii., p. 380.
 
 Organic Chemistry. — APPENDIX. — Vital Solidism. 797 
 
 There is no doubt that our amiable Author (whom no one is disposed 
 to disturb in his legitimate pursuit) is very correct as an expositor of 
 the objects and opinions of Organic Chemists when he asserts their be- 
 lief that " there is no essential difference between organic and inorganic 
 bodies ;" as, indeed, appears abundantly in these Institutes. It is, there- 
 fore, all a foregone conclusion with the Chemist, before he approaches 
 the living being with acids, and alkalies, and metallic oxides, and retorts, 
 and crucibles, that he will quickly " deduce all the incidental differences 
 of matter (animate and inanimate) from the doctrines of the Laboratory 
 as evolved from dead matter." Hence, it is evident, besides his affirma- 
 tion, that our Author has deduced all his knowledge of Haller, Baglivi, 
 Hunter, Bichat, Mliller, C. Bell, M. Hall, Tiedemann, and other illus- 
 trious Physiologists of recent times, from what he has gathered from 
 "the Poet-Philosopher, Plato, and the philosophical natural inquirer, 
 Aristotle, along with the Paraphrases of Hegel and Schelling ;" glanc- 
 ing, it is true, at their kindred, Pythagoras and Empedocles, but skip- 
 ping over, even, such ultra " Spiritualists" as Hippocrates, Celsus, Ga- 
 len, Aretaeus, Avicenna, &c., from whose works he might have " deduced 
 a priori all the incidental differences" between them and their modern 
 Antitypes. (§ 4^, 5-6, 189, 292, 334, 350i, 350^5', 351, 360-3G4, 36G, 
 376i, 3761 ^', 744, 1005 a, 1029, 1030, 1075 b.) 
 
 Nevertheless, although our Author " cannot rest satisfied with the 
 mysterious obscurity in which the vital phenomena have been artificially 
 enveloped," and, although "a Chemist, totally unacquainted with organic 
 matter, would a 2)riori have deduced all these incidental differences of 
 matter from the doctrine of affinity and stoichiometry evolved from dead 
 matter," he is coerced, not unfrequently, to contradict himself (§ 626, b), 
 and to admit, as in the following example, that the " incidental difler- 
 ences" relative to absorption alone have been altogether beyond any ex- 
 planation in physics, which is apparently a very simple phenomenon 
 compared with many other processes of life, even as it occurs in plants 
 (§ 1053). Thus, our author : 
 
 "If, however, we still continuously encounter a number of phenomena 
 in the living body, which seem to be at variance with the endosmotic laws 
 with which we ai'e at present acquainted, and if many interesting exper- 
 iments, as, for instance, those of Bocker, still appear to defy explanation 
 by simple molecular action, this merely proves that Ave are still deficient 
 in the physical knowledge necessary for the comprehension, in a physical 
 sense, of the casual [!] connection of such phenomena." (See § 1052.) 
 "We may, however, conclude, from the scanty facts before us, that the 
 movements of soluble matter within the living organism, and more es- 
 pecially the phenomena of absorption, must be stipposed to depend upon 
 certain physical laws." — Lehmann's Physiological Chemistry, vol. ii., 
 p. 376-399.— Also ^ 176 d. 
 
 And again, our Author, still forgetting himself, is at considerable 
 pains in showing that " if zoo-chemistry ever fulfil its object, it must be 
 by the joint aid of Chemistry and Physiology." — Ibid., vol. i., p. 24. But 
 how far our Author (and Liebig, Avho is of the same opinion) is quali- 
 fied to reason upon the profound problems of life will sufficiently appear 
 from the following jumble : 
 
 "Weariness of the senses is the diminished impressibility of the nerves 
 of sense, but its cause cannot reasonably be sought for in any other than 
 a CHEMICAL CHANGE, experienced by the conducting substance of the
 
 798 INSTITUTES OF MEDICINE. 
 
 nerves. Such a chemical metamorphosis of the nerves of sense from 
 external impressions can no longer greatly excite our astonishment, since 
 we have witnessed the unexpected phenomenon of a picture produced sud- 
 denly, and as it were by magic, from the chemical changes effected by 
 the i-ays of light 07i an iodized silver plate [!] Should we not be equally 
 justified in saying that the iodized plate, which, after being exposed for 
 a few seconds to a sti-ong light, gives oiily faint and half-effaced images, 
 IS WEARIED LiivE THE RETINA, whcu, after repeated and continuous per- 
 ception of an image, it gives back only the faint outlines of the object?" ! ! 
 —Ibid., vol. i., p. 30. (Also § 349 e, 350 1 n,2), 350f e,f, 350| e.) 
 
 But this is only an example of a vast amount of a corresponding na- 
 ture by which I have endeavoured to show that Chemistry and Physiology 
 are profoundly distinct from each other, and that when the Chemist de- 
 parts from his legitimate pursuit to gather laurels in Medical Science, 
 whatever may be his ability, he is acting the part of a mere Charlatan 
 (§ 3761 626 b). 
 
 Our Author takes it hard that Chemical Philosophers should meet 
 with any opposition in their invasions upon Physiology and practical 
 Medicine, notwithstanding his own declaration that they are not to be 
 trusted in their organic inquiries (§ 1029, 1030). But since he indulges 
 the illusion that none but the most imaginative have raised an obstacle 
 to the ambitious career of Organic Chemistry, it is not quite apparent 
 why our Author's self-complacency should have been so much disturbed 
 as seems to be implied in the concluding part of a foregoing quotation 
 (page 796). The capital error of our friends is forcibly presented in that 
 extract — " Who are often unwearingly occupied for yeais together in en- 
 deavouring to collect a few firm supports for the great edifice of a true 
 philosophy of nature," and which has been often the subject of comment 
 by eminent Philosophers, as may be seen at pages 157, 173, § 350, Mot- 
 toes, h, i, h, I, and No. 97 of pai*allel columns. 
 
 Our Author's error, therefore, as will be readily seen, proceeds from 
 an unceasing devotion to the phenomena of dead matter (§ 376 j), which, 
 as a consequence, leads to a total disregard of all the facts which have 
 been accumulated by the students of living nature, and an oblivious- 
 ness to the grand consideration that even such students can have no just 
 appreciation of the natural processes of animated beings unless also 
 well skilled in Pathology and Therapeutics (§ 5^ e, f, 5| a, 6, 53 c, 
 129, 134, 137 d, 151, 163, 165 h, 167, 191, 234-235, 237, 285, 303|, 
 3761 376|, 447 a, b, c, 516 d, No. 6, 676 b, 801'a, 819, 1006 a, 1029, 
 1030, 198, 640, 1060). 
 
 But our Author has now the consolation of knowing that he has 
 achieved his object of convincing a multitude of Physicians (§ 5^, a) that 
 they are worthy of his rebuke, and that the true philosophy of medicine 
 can be acquired only through an implicit dependence upon the Labora- 
 tory of the Organic Chemist (§ 376^-). Nevertheless, our Author is too 
 shrewd a politician not to have observed the action which has been set- 
 ting in against a pursuit in which the Physiologist and Physician have 
 had no participation whatever ; nor is he less aware of the causes. Lest 
 the monopoly, therefore, should be lost, he deals a few blows upon the 
 most submissive part of the Profession in this wise: 
 
 "Enthusiasm," he says, "in the cause of Organic Chemistry has de- 
 generated among many Physiologists and Physicians into a fanaticism, 
 which, even in the best cause, tends to invalidate a host of truths in its
 
 Organic Chemistry. — appendix. — Vital Solidism. 799 
 
 t;ndeavours to uphold a single fact (§ 5i a, 530). — ^Lehmann, iUd.^ 
 ;o\. i., p. 1. 
 
 But, then, how will our Author compromise the trouble with this 
 class of "Physiologists and Physicians," if " there is no essential differ- 
 '^nce between organic and inorganic bodies," or, especially, if " a Chem- 
 •st, totally unacquainted with organic matter, would a priori deduce all 
 the incidental differences from the doctrine of affinity and the science of 
 stoichiometry, evolved from dead matter f Our Author's entire work 
 proceeds upon these premises, along with a profusion of ridicule upon 
 the physiological doctrines of life and disease, of whose deductions from 
 the phenomena of living nature, through a long course of ages, he is as 
 profoundly ignorant (as he virtually admits) as he is able and accom- 
 plished in that mere physical department of science to which he has 
 devoted his thoughts and his labors. Our Author, therefore, seeing the 
 "handwriting upon the wall," as appears in preceding quotations (§ 1029, 
 1030), ventures the future upon denunciations of those whose peculiar 
 province it is to unfold the Science which Nature has isolated from all 
 others in its fundamental laws. But I ask our Author and others who 
 have not been less vehement in unmannerly malediction upon all Med- 
 ical Philosophers of the past, whether the phrensy of a morbid ambition 
 is not most likely to react upon themselves '? (§ 6, 376^.) And I put it, 
 also, to Physicians, whether they will continue to follow the wake of 
 Organic Chemistry, or assume the independence of thinking and acting 
 for themselves ? And here I shall take the liberty of repeating a pas- 
 sage from the Commentaries which covers a greater range of the fictions 
 that have been substituted, in recent times, for philosophical medicine. 
 The Author was referring, specifically, to M. Louis's attempt to prepare 
 the way for his anatomical and numerical methods by proclaiming that 
 '■^Medicine is now in its infancy f while it is but just to the French Phi- 
 losopher to say, that the German is more dogmatically abusive, in vari- 
 ous parts of his work, of every Physiologist and Physician who has ad- 
 mitted "a vital force or whatever they may call it" (in our Author's 
 language), from Hippocrates to the present day. The Commentaries thus : 
 
 "That the World should have passively acquiesced in this unreserved 
 obliteration of all its medical knowledge and principles (executed, too, 
 in no very gracious manner), was neither just to itself, nor watchful of 
 its dignity. That it should have received the ostracism with a com- 
 mendation proportioned to its abruptness and insensibility must remain 
 forever the most extraordinary record of all human affairs ; and, when 
 after ages shall look back upon the present, groping its way in a mid- 
 night darkness of its own creation, and rejoicing, as it were, with the 
 prattling " infancy" of a once noble and stupendous science, and witness, 
 as its results, the experimental processes by which the new being was 
 to be carried forward to maturity — the myriads of victims who furnished 
 their quota to the morbid anatomist — the attempts at converting morbid 
 into healthy blood by chemical agencies, first in a ' porringer,' and then, 
 by analogy, up to the living organism — the conflict between the remain- 
 ing disciples of Nature and the abuses of the Laboratory — the almost 
 universal substitution of the forces of physics for those specific powers 
 which had hitherto rendered Physiology and Medicine intelligible and 
 consistent sciences, besides a multitude of other strange devices, contrib- 
 uted and cordially received from all manner of workmen, as choice ma- 
 terials for the new foundation — when, we say, after ages shall look back
 
 800 INSTITUTES OF MEDICINE. 
 
 upon this dark spot on the brightest escutcheon of the world, it must be 
 regarded without sympathy, and as an act of voluntary humiliation 
 (§ 376^, 530, 819 b). — Medical and Physiological Commentaries, 
 vol. ii.," p. G84. 1840. 
 
 § 1035. Although the foregoing review of Physiological and Patho- 
 logical Chemistry may be unimportant to all but the present writer, he 
 will, nevertheless, say, that personal considerations had nearly deterred 
 him from making them. In all his writings he had regarded his position 
 as so isolated, that he had not anticipated much sympathy and less en- 
 couragement, and he has, therefore, been agreeably disappointed in find- 
 ing numerous and very able advocates, and by many unexpected and 
 very distinguished honors that have been conferred upon him by the 
 most renowned Medical Societies in Europe. These marks of recogni- 
 tion, he hopes of approval, have always awakened the most profound 
 gratitude. But the more he has prosecuted his studies, the more impos- 
 sible has he found it to modify his opinions on Medical Philosophy, and 
 the more desirous has he become of submitting this enlarged experience 
 to the judgment of mankind ; and, although he is not unmindful that 
 perfect independence is conceded to the Cultivators of science, yet he is 
 most anxious to be just to those whose writings have proved to him a 
 fountain of knowledge, and whose kindnesses have aAvakened the deepest 
 sensibilit)'. And, while thus employed in this very personal manner, he 
 will not forego the gratification of uniting to that of the medical world his 
 own admiration of the labors of Becquerel and Rodier, and particularly 
 of those researches which are presented in their work on " Pathological 
 Chemistry in its application to the Practice op Medicine." The 
 very flattering dedication to himself which occurs in the London edition 
 of that work might, in connection with the considerations just stated, 
 have prompted him to have still maintained the silence (unimportant to 
 be sure) which he has for some time observed, did he not find in the work 
 so great an amount of enlightened research, and which he can heartily 
 commend to the American Medical Profession. It is, indeed, rather a 
 system of practical medicine than Avhat the Title imports. Its authors 
 have been attentive observers of disease, and their valuable experience is 
 presented in its direct relation to Pathology and Therapeutics. Their 
 pathological chemistry of the blood is, also, but little liable to the objec- 
 tions so forcibly stated by Professor Lehmann (§ 1029), since it often ex- 
 tends but little beyond the specific gravity, and the proportions of water, 
 globules, albumen, fibrin, and fatty and extractive matters, in different 
 forms of disease, and their comparison with a noi'mal standard. And, 
 although these analyses advance our knowledge of pathological condi- 
 tions, the present writer cannot but adhere to his opinion that the treat- 
 ment of disease must turn essentially upon the import of symptoms and 
 of remote causes, in comiection with the principles which have been de- 
 duced from the phenomena of healthy and morbid actions, and from the 
 results of hygienic and therapeutical treatment (§ 413-403, G39-709) ; 
 nor has he any doubt that his Authors think so too. They belong to 
 the school of Vitalists, ever designating the blood as the vital fluid, and 
 quote, approvingly, from Simon's Animal Chemistry, the following en- 
 lightened opinion respecting yji?7», which stretches far into other great 
 problems in vital physiology. Although stated as an abstract fact, it 
 associates with itself the whole labyrinth of physiological results, and is 
 unapproachable by chemical laws. Thus :
 
 Physiology. — appendix. — Structure. 801 
 
 " The fibrin, in its normal physiological condition, is the result of the 
 transformation of a certain amount of the globules. This transforma- 
 tion, which is of a vital 7iature, is due to the action of the oxygen of the 
 atmosphere on the one hand, and, on the other, to the numerous reactions 
 which take place during the passage of the blood through the different 
 tissues and organs of the body. The globules, before being assimilated 
 to these tissues, and thus contributing to interstitial nutrition, pass 
 through a transition state, which is the fibrin (§42)." — Becquerel and 
 Rodier's Pathological Chemistry, p. 105. 
 
 However much the writer may differ from the chemical school of med- 
 icine, his attention has been directed to their researches during the great- 
 er part of his professional life, and, he acknowledges, with intense inter- 
 est and never-failing information, while he also commends to his medi- 
 cal class the same habits of inquiry. He had known nothing of the com- 
 position of organic nature, nothing of those elementary combinations 
 which so forcibly distinguish it from the inorganic kingdom, and many 
 other relative details, nor could these Institutes have been written, with- 
 out the revelations afforded by Chemistry (§ 376f, b). 
 
 PROGRESS OF PHYSIOLOGY. 
 
 STRUCTURE OF ORGANS. 
 
 1036. Many interesting disclosures have been recently made in the 
 minute anatomy of some of the complex organs, and the microscope* has 
 been brought to bear advantageously upon the subject in connection with 
 improved methods of minute injection. The structure of the kidnej^, 
 whose rank in organic life I have advocated in foregoing sections (§ 417, 
 422-427, 892f a-c, 1032), has been subjected to much critical inquirj', 
 and although the exposition of its elaborate organization call up an as- 
 sociation with the most complex mechanism of art, it reminds us as lit- 
 tle of " a strainer" as it does of a musical instrument (§ 1032). But the 
 most curious and intensely interesting discovery relative to this organ is 
 Brown-Sequard's development of a startling function appertaining to the 
 renal capsules, and which should silence forever all attempts to "deduce 
 the incidental differences between organic and inorganic bodies from the 
 principles evolved from dead matter" (§ 1034, Lehmann). 
 
 The anatomical details of the nervous system, especially of the spinal 
 cord, have been also ably investigated by Lenhossek, Van Der Kolk, 
 Brown-Se'quard, and others, and impart a great interest to the study of 
 the organic life of animals. All this, and much more of a correspond- 
 ing nature, opens very widely the wonderful mechanism of organic be- 
 ings, develops more forcibly that incomprehensible variety of Omniscient 
 Design which is apparently excluded from the mechanical constitution 
 of inorganic bodies, and thus, and in other ways, aids in placing the 
 chemical and physical doctrines of life and disease upon their proper 
 level. (See Index, article Design.) 
 
 Nevertheless, it must be conceded that this knowledge does not indi- 
 cate the functions of organs, or their modus operandi, or the physiologi- 
 cal laws which they obey, nor ever will. It simply enables us to trace 
 out the channels through which the properties of life carry on their stu- 
 pendous work (§ 130, 131 ; Bichat, Liebig, Milton). As it affects, there- 
 fore, in no other respect the facts and the doctrines set forth in this work 
 than to give them confirmation, I shall not advert specifically to the dis- 
 
 E 1.: ic
 
 802 INSTITUTES OF MEDICINE. 
 
 coveries in this branch of Physiology (§ 2 c, 83, 131, 133 a, 136, 699- 
 708). 
 
 THE NERVOUS SYSTEM. SYMPATHY. 
 
 1037, a. There is, however, one discovery relative to the nervous sys- 
 tem, which, although it do not disturb in the least any law or proposi- 
 tion laid down in these Institutes, but goes to confirm the whole, and, 
 withal, corrects a partial error in the supposed functions of a portion of 
 the spinal cord, I shall now state in a summary manner. I need not 
 say that this interesting disclosure comes to us from Dr. Brown-Sequard, 
 whose genius and industry have also enlightened the physiological world 
 upon special influences of the nervous system, which, if not as important 
 in their relations to the laws of that system, are more attractive. Among 
 these may be mentioned his remarkable experiment of producing epilep- 
 tiform convulsions, through a special association of the nervous influence 
 with a particular point in the skin by sections of the spinal cord, and an 
 extension of the researches begun by Petit, Magendie, and Flourens, upon 
 turning and rolling, developing, apparently, as in the auditory nerve, 
 centres of nervous influence in the nerves themselves ; which appeared in 
 a collation of his writings, entitled " Experimental Researches applied to 
 Physiology and Pathology, p. 18, 36, 80, 84, 99 ; 1853. 
 
 These experiments, therefore, like Bernard's, of pricking the medulla 
 oblongata (§ 1032, d). not only possess a refreshing novelty, but consti- 
 tute now and forcible methods of demonstrating the influence of the 
 nervous power upon organic actions and muscular motion, and of illus- 
 trating the laws of sympathy ; while, also, they contribute a welcome 
 part in rescuing Physiology from Organic Chemistry (222-235, 452- 
 530, 635, 893 a, c, 902, 905 a, 924). 
 
 § 1037, b. Brown-Sequard' s discovery relative to the spinal cord modi- 
 fies the statement made in the brief sections 405, 468, at pages 290, 291, 
 so far as the experiments show that a division of the posterior roots of 
 the spinal nerves does not destroy sensation, and which are conductors 
 only to the central gray matter. It would have been sufficient, there- 
 fore, to have stated this fact (in itself unimportant to these Institutes), 
 did not the experiments reflect, in other respects, a great amount of light 
 upon our doctrines of remote sympathy, and place them upon a clear 
 and intelligible ground. They present, also, an admirable analysis, as I 
 apprehend, of the anatomical media of common and specific sensibility 
 (§ 188 h, 197-199, 450), and that element of remote sympathy which I 
 have designated as sympathetic sensibility, and which belongs especially to 
 the organic life of animals (§ 197, 201-204, 451 d, 903). The conclu- 
 sions at which Dr. Brown-Sequard arrived are summarily and well ex- 
 pressed by a Reviewer as follows : 
 
 " 1. The idea that the sensitive impressions are conducted to the en- 
 cephalon along the posterior columns is entirely erroneous. 2. The gray 
 matter of the spinal cord, although itself deprived of sensibility, is an 
 organ of transmission of the sensitive impressions. 3. There are two 
 kinds of sensitive fibres in the posterior columns of the spinal cord, some 
 going up towards the encephalon (centripetal or ascending fibres), some 
 going in the opposite direction (centrifugal or descending fibres). 4. There 
 are also ascending and descending fibres in the posterior gray horns, and 
 very likely in the posterior parts of the lateral columns. 5. These as- 
 cending and descending fibres in the posterior columns come mostly, if
 
 Befiex Action. — appendix. — Organic Properties. 803 
 
 not entirely, from the posterior roots of the spinal nerves. 6. The pos- 
 terior roots send also fibres to the posterior gray horns, and very likely 
 to the posterior parts of the lateral columns. 7. All these fibres soon 
 leave the posterior columns, the posterior gray horns, &c., in order to go 
 into the central gray matter. 8. All th^se sensitive fibres decussate veiy 
 near to their entrance into the spinal marrow from the posterior roots. 
 9. There are some transverse fibres in the spinal cord, coming from the 
 posterior roots, which do not seem to transmit sensitive impressions. 
 The motor nerves remain, after their entrance into the spinal marrow, on 
 the same side, until they reach the lower part of the medulla oblongata, 
 where they decussate." — Medico-Chirurgical Hevieiv, p. 183, July, 1856. 
 
 In his work on " Experimental Researches applied to Physiology and 
 Pathology" (1853), after relating his experiments on the crossed trans- 
 mission of impressions in the spinal cord, the Author remarks: " I be- 
 lieve I am entitled to conclude, from the facts above stated — 1st, that 
 most of the impressions made on one side of the body are transmitted to 
 the sensorium by the opposite side of the spinal cord, so that the impres- 
 sions on the left side of the body are transmitted by the right side of the 
 spinal cord, and vice versa ; 2d, that the assumed function of the cross- 
 ing of fibres in the pons Varolii, and the neighboring parts, does not be- 
 long to these fibres, but to the fibres of the spinal cord, all along which 
 they cross each other" (p. 67, 68). 
 
 The foregoing, and other experiments, were repeated by Dr. Brown- 
 Se'quard in some of the Medical Colleges of this country during the win- 
 ter of 1856-7, at many of which the present writer was so fortunate as 
 to be a spectator. — Note A a p. 1131. 
 
 § 1038. The experiments upon the auditory and other nerves (§ 1037, 
 a), which (as well as the organization of the nerves, particularly the 
 auditory) denote special centres of nervous influence in the nerves them- 
 selves, concur with other facts in supplying indications through which 
 we may quite readily comprehend the philosophy of contiguous sympa- 
 thy. The plexuses, also, and the ganglia, are thus rendered more palp- 
 able media through which, in part, the phenomena are brought about 
 (§487^,497,499a,516cZ,No.9,520-523,524c^, No.4, 893 a, c). 
 
 THE NERVOUS POWER. ORGANIC PROPERTIES. 
 
 § 1039. Moreover, we are indebted to Brown-Se'quard for a multitude 
 of experiments illustrative of the laws of reflex action, as applied by 
 myself to pathology and therapeutics (see references p. 912), and 
 variously establishing the laws of the vital functions as set forth in these 
 Institutes (§ 462-494, &c.). The experiments enforce the distinction 
 between the nervous power and the properties of oi'ganic life (§ 167, 168, 
 170 a, 172, 175 a, b, 176-178), assure us that the former acts only as a 
 stimulus, or other modifying cause, to the organic properties, variously 
 modifying organic actions, and developing muscular motion, voluntary 
 or involuntary, through its operation upon the essential properties of 
 life that are inherent in all parts, profoundly concerned, as a modifying 
 agent, in the processes of disease (§ 222-240), and fulfilling the great 
 laws of sympathy (§ 452-534). Some of these results are remarkably 
 open to observation; such as the influence of the nervous power upon 
 the small bloodvessels, and vessels of secretion, whether by irritating or 
 dividing a nerve. That by our Author, of paralyzing arteries by the 
 division of nerves, confirms the similar ones by Buniva and others
 
 804 INSTITUTES OF MEDICINE. 
 
 (§ 399, 485), and, with analogous observations, establishes the doc- 
 trine inculcated in these Institutes upon the main ground of the phe- 
 nomena of life, that the whole Capillary System possesses the power of 
 an active dilatation and contraction (§ 384-387, 392 a, d, 393-399, 410, 
 411, 746, 747, 914-920, 929-934, 940, 947, 950, 951, 961, 974, 975, &c.). 
 "My experiments prove," says "Brown-Se'quard, "that the bloodvessel* 
 are contractile, and that the nerves are able to put them in action."— >- 
 (ExPER. Res., &c., p. 10, note.) As an example, Claude Bernard pro- 
 duced dilatation of the bloodvessels of the face by dividing the cervical 
 sympathetic nerve ; Brown-Sequard occasioned a contraction of the 
 same vessels by applying galvanism to that nerve, and hence regards the 
 sympathetic as the motor nerve of the bloodvessels of the face. — Ibid. 
 This doctrine was advanced by me in 1 834, in Med. Chir. Rev. — See p .827 . 
 Experiments of the foi'egoing nature have, indeed, been multiplied by 
 Physiologists to an incalculable extent ; but perhaps no one of them has 
 revealed the prodigious influence of the nervous power upon the capil- 
 lary bloodvessels and the secreting apparatus so impressively, or made 
 such havoc with Chemical Physiology, as Bernard's simple operation of 
 pricking the medulla oblongata (§ 1032, d). As the whole of this ground, 
 however, has been gone over extensively in the earlier part of this work, 
 the present reference to the subject is to simply show that the laws and 
 principles herein inculcated have been abundantly confirmed by subse- 
 quent researches. Indeed, all these experiments are only equivalent, as 
 it respects the functions of life, to those which Avere performed by Wil- 
 son Philip, and far less with the universal reference that distinguished 
 the corresponding labors of this Philosopher, and without his great phys- 
 iological objects. But these experiments appear to have been forgot- 
 ten (p. 290-321, § 462-494, and p. 107, § 224, &c.). Indeed, we see it 
 just now announced that " all these facts [late observations, but analo- 
 gous to such as abound in these Institutes] establish beyond doubt that 
 the bloodvessels, as well as muscles of animal life, may contract by a re- 
 flex action." — (Brown-Sequard, in Boston lied, and Surg. Journ.., July? 
 1857, p. 477.) This fact alone is evidently fatal to the catalytic and every 
 other chemical doctrine of secretion (§ 409 hh, k, 493 cc, 893 a).* 
 
 where the nervous power exerts its effects. 
 
 § 1040. Let us now observe where the Nervous Power exerts its effects. 
 Authors are in the habit of speaking of the Nervous Influence as acting 
 upon organs as a whole, and not upon their minute structure. This is 
 doubtless for the purpose of brevity ; and, although in these Institutes 
 the Nervous Power is generally correctly represented as exerting its ef- 
 fects upon the minute organization, as in § 231, 233f, 245, 395, 410, 
 447, 450, 483, 487, 516 a, 896, 902, 917-924, 940, 946 b, 949, 950, 
 951 c, 953, 961, 971-980, 986 b, 990^, 999 c, &c., I have also frequent- 
 ly employed the collective method. This is calculated to defeat a right 
 apprehension of the action and compass of that power as a vital agent. 
 I am therefore prompted, in this reference to the subject, by the desire 
 of turning the attention of the student to the specific fact, that he may 
 the more readily appreciate the offices of the Nervous Power in its rela- 
 tion to the properties of life in their fulfilment of organic functions, or as 
 they are essentially engaged in the voluntary and involuntary movements 
 of the muscles of animal life. 
 
 Whenever, therefore, the Nervous Power is concerned in modifying or 
 
 * Kkikmeu had long before shown, ■what Bernard has lately done, tho iiifiiience of 
 the nerves upon the blood, and applied \>y me to important principles (§ 485, 1)52, &c.).
 
 Reflex Action. — ^APPENDIX. — Organic Properties. 805 
 
 otherwise aiFecting the actions of organs, its influence is exerted either 
 upon the individual bloodvessels, or upon the minute vessels by which 
 the secreted or excreted products are generated, or upon such other mi- 
 nute parts as may enter into the structure of organs — reaching, therefore, 
 to the vasa vasorura, and as well, in all these respects, to the nervous 
 system itself when the Nervous Power is determined upon it (§ 230, 509, 
 950) ; or, when it excites motion in muscles it is by acting upon the in- 
 dividual fibres through their inherent properties. 
 
 DISTINCTION BETWEEN THE NERVOUS POWER AND THE ESSENTIAL PROP- 
 ERTIES OF LIFE. 
 
 § 1041. Many of Brown-Sequard's experiments, as well as Bernard's 
 and other late observers, confirm, also, the distinction which I have en- 
 deavoured to show, extensively, between the Nervous Power and the es- 
 sential Properties of Life, and that the functions, whether organic or vol- 
 imtary motion, are carried on by the latter, to Avhich the Nervous Pow- 
 er sustains the relation of a vital stimulus. (See Index, Articles Nerv- 
 ous Power, Organic Life, Vital Properties, and Organic Functions.) Some 
 of these experiments are curious as well as ingenious. As examples : 
 
 "I have succeeded," says Brown-Sequard, "in keeping alive, from 
 the 8th of April until the 4th of July, a young cat, about which I have 
 already published a note in Med. Exam., 1852. The palsied parts in 
 this animal had grown in length as much as the sound parts. The 
 growth was such in the palsied limbs that they had acquired more than 
 double the length they had at the time of the operation. The functions 
 of organic life appeared to exist without any disturbance."* 
 
 Again, says our Author : 
 
 " I lately made an experiment with a view of ascertaining how long a 
 limb, separated from the body of an animal, may be kept alive by means 
 of injected blood. I succeeded in retaining local life in one of the limbs 
 of a rabbit more than 41 hours. The animal was a very vigorous, full- 
 grown one. I killed it by hemorrhage, and, two hours afterward, rigid- 
 ity had begun in most of the muscles of the two posterior limbs, and 
 only a few bundles of muscular fibres had still a slight irritability. A 
 fine injection of defibrinated blood was then pushed in the femoral artery 
 of the I'ight posterior limb. Fifteen minutes after the beginning of the 
 injection, local life, i. e., irritability, was restored in the limb receiving 
 blood, and cadaveric rigidity had disappeared." — Experimental Research- 
 es, ^c, ut cit., p. 15, 92. Also, § 109 b, 171, 193, 261, 264, 493 cc. 
 
 Corresponding with these observations are many others in a chapter 
 " On apparently spontaneous actions of the contractile tissues of the animal 
 hodif {ibid., p. 101-124). In speaking of Spontaneous Movements in 
 limbs of persons who have died of Cholera, our Author remarks, that 
 " Physicians who know how quickly after death the nervous system 
 loses its vital powers will admit easily that these movements cannot be 
 the result of the action of that si/stem.^' Certainly not, any farther than as 
 the Nervous Power operates as a stimulus to the organic properties, the 
 probability of which, in the cases before us, I have endeavoured to show 
 in § 637. In these cases the Nervous Power is maintained in operation 
 after apparent death by the special influences of the disease. Something 
 like this is seen in the rise of temperature in subjects dead of apoplexy 
 (§ 447, d). And this leads me to refer to the common phraseology, " ex- 
 haustion of the nervous power," to express conditions of the system which 
 
 * In such cases the palsied parts continue to be supplied with the modifying stimu- 
 lus of the nervous power through the sympathetic nerve (§ 461 Jr, 487 b, 483 c, 490).
 
 806 INSTITUTES OF MEDICINE. 
 
 are especially due to its powerful operation (§ 940-952). The express 
 sion is evidently without any meaning. 
 
 § 1042. But, as I apprehend, the foregoing phenomenon, in being anal- 
 oo-ous to the movements of the limbs which take place in decapitated an- 
 imals, is very different from the contraction of the intestines, the heart, 
 &c,, which take place even after the extirpation of the organs (§ 259- 
 265) ; and I am happy to quote Brown-Se'quard as sustaining an im- 
 portant doctrine in these Institutes, that, " contrary to the general opin- 
 ion, a nervous action is not necessary for these contractions," but that 
 they may be excited by other stimuli (§ 264, 475^, 476^ c, 498 e). 
 
 But the special object of this section is to refer to our Author's exper- 
 iments upon the iris. In 1847 he disclosed the curious fact that light 
 may act as a direct stimulus upon this organ, "so as to produce a con- 
 traction of its muscular fibres, manifested by a constriction of the pupil." 
 Very recently, in the London Philosophical Transactions (as quoted in 
 the London Philosophical Magazine), he announces the results of farther 
 experiments, which show that the pupil of an exsected eye contracts and 
 dilates, alternately, according to the degree of light. "I uniformly 
 found," he says, " that the yellow part of the spectrum acted as well as 
 undecomposed light, and that the other parts had either no action at all, 
 or only a veiy slight one" (§ 188-|, d)- "From these experiments it 
 follows thijt it is not the chemical or calorific rays, but the illuminating," 
 which produces the phenomenon ; that " it is not a chemical action, but 
 that it is by a peculiar dynamical influence that light produces con- 
 traction of the iris." "The power of the iris to contract when stimu- 
 lated by light lasts extremely long, particularly in certain animals. In 
 eels it lasts sixteen days in eyes taken out of the orbit." Muscular 
 fibre-5, therefore, "may be stimulated without the intervention of nerves. 
 In tlie iris of the eel the nerve-fibres are found very much altered a few 
 days after the extirpation of the eye, and they are almost destroyed iu 
 twelve or fifteen days after extirpation, i. e., at a time when muscular 
 irritability is sometimes still existing." — London Philosojyhical Magazine, 
 Supplement, p. 520; July, 1857. 
 
 The foregoing experiments go with a multitude of others in showing 
 that the power by which motion is carried on is implanted in all parts, 
 and that the nervous power is simply a stimulus in developing motion, 
 and, therefore, to a certain extent, on common ground with other stimuli 
 (§ 205-215, 233, 259-265). But they are less remarkable in this re- 
 spect than some other examples which I have quoted in the Iledical and 
 Physiological Commentaries, particularly the pulsation of an extirpated 
 heart of a sturgeon after " the auricles had become so dry as to imsile 
 when they contracted and dilated" (vol. i., p. 17).* 
 
 The interesting fact relative to the iris of an extirpated eye is its obe- 
 dience to light, while it is not aifected by mechanical irritants. We may 
 not conclude, however, from the experiments, that light has any direct 
 action upon the iris in the natural state of the organ. On the contrary, 
 I apprehend that Nature has not adopted any such multiplication of 
 causes, but that she has placed that muscle entirely at the disposal of 
 the nervous influence, and by which the direct action of light upon it is 
 counteracted ; nor will it be an easy matter to disprove a conclusion so 
 well sustained by all analogy (§ 500 /, 514 k, 1072 a). Could we, how- 
 ever, reason in this case from analogies supplied by plants, the phenom- 
 enon would be readily intelligible. But I apprehend that it is merely an 
 
 * This extreme case is related circumstantiallj- in Dunglison's Human Plij-siology, 
 vol. ii., p. 148, 1836.
 
 Beflex Action. — appendix. — Animal Heat. 807 
 
 incidental result of the organic constitution of the iris in its relation to 
 light as a remote exciting cause.* 
 
 ANIMAL HEAT IN CONNECTION WITH THE NERVOUS SYSTEM. 
 
 § 1043. Among the contributions to Physiology made by Brown- 
 Se'quard few are more interesting than those relative to the production 
 of Animal Heat, and which concur in demonstrating (what is so ex- 
 tensively presented in these Institutes) its dependence upon a purely vital 
 process, and, therefore, independence of any chemical agencies (§ 433- 
 448). Some of these experiments I shall state briefly, and would invite 
 the advocates of the chemical rationale to interpret the phenomena 
 through any known analogies in the world of mere matter, if they can ; 
 or render the supposed connection between the Nervous Influence and 
 the forces of inorganic bodies in the production of animal heat, or any 
 other result of life, in the slightest respect intelligible. But let us hear 
 our Author. 
 
 § 1044, a. In his experiment of dipping a hand in cold water two 
 facts are farther confirmed through which, in part, I had endeavoured to 
 show that animal heat does not obey the laws of dead matter, and that 
 its production is a vital, not a chemical phenomenon. Thus : 
 
 " I have found," says Brown-Sequard, " that the chilling of one hand 
 plunged in water, at the temperature of freezing-point, acted very strong- 
 ly on the temperature of the other hand. But, at first, there is no regu- 
 larity at all in the quantity of degrees of temperature lost by the hand 
 which remains out of the water ; and, secondly, we have found once 
 that this hand did not lose any fraction of its temperature. In one case 
 we have observed that the hand kept in the atmosphei'e did lose 22° F. 
 in seven minutes. The ordinary loss of temperature has been of between 
 6° to 8° F." But observe that " the greatest diminution of the temper- 
 ature of the mouth has been nearly 1° F., and this only in one case." — 
 {Exp. Researches, &c., p. 33.) — Note T p. 1125. 
 
 Now, in the first place, is seen in the foregoing paragraph a strong ex- 
 emplification of reflex nervous action in its relation to animal heat, and 
 it is peculiarly valuable to the Vital Physiologist, since it is the same 
 as concerns any other organic product (§ 446, a), places the whole on 
 common ground, and as fully pronounced by Bichat, Hunter, and Phil- 
 ip, and as set forth at page 270, § 447, d, &,c. Secondly, the experiment 
 is not less important in showing that the cooling of the hand in the at- 
 mosphere was not at all owing to the general reduction of the heat of 
 the body, and therefore effectually contradicts the law of slow commu- 
 nication of caloric which obtains with dead matter, as applied to animal 
 heat by Edwards, Liebig, Roget, Billing, and others, who cultivate the 
 chemical hypothesis (§ 438 a-c, 440 e). It is also an exception to our 
 Author's doctrine that " a great many facts prove that the degree of 
 temperature and of the sensibility of a part is in close relation with the 
 quantity of blood circulating in that part." {Eap., &c., p. 9.) Indeed, 
 our Author remarks, that " Dr. Tholozan and myself have observed that 
 the greater the pain felt, the more the tempei'ature was diminished in 
 the hand left in the air'' (p. 34). 
 
 § 1044, b. The foregoing experiment Avas reversed by immersing the 
 
 hand in water at a temperature of 108° F. But our Author " found no 
 
 evident deviation of the temperature of remote parts, as the mouth and 
 
 hand, not immersed in the water." — {Ibid., p. 35.) This experiment 
 
 * When PhysQstigma, applied on the ej-e after death, produces contraction of the 
 iris, it must be through the motor ciliarj- nerve. — 1864.
 
 808 INSTITUTES OP MEDICINE, 
 
 contributes with the other, by its failure of a sympathetic effect upon the 
 opposite hand, in illustrating the effect of the nervous influence in mod- 
 ifying the calorific function, through the well-known fact that cold is of 
 incomparably greater power, in this respect, than heat ; while the anal- 
 ogy supplied by the increase of urine on the contact of cold air with the 
 surface of the body (as related to the sympathetic reduction of tempera- 
 ture in the hand that was not immersed in water, § 1044, ct), goes to the 
 proof that animal heat is as much a product of vital action as any of the 
 more sensible secretions. But all this is entirely allied to the production 
 of pneumonia, and other inflammations, by a very temporary chilling of 
 the surface of the body, and is mostly interesting to the Physician by its 
 association with these greater phenomena, since it is of no little import- 
 ance in practical Medicine whether a diminution of animal heat depend 
 upon a mere chemical contingency, or some profound lesion of the or- 
 ganic functions (^ 1057 g). — ^Note Aa p. 1131. 
 
 From these premises, it appears that when the temperature of the body 
 falls from the application of cold to the surface, or rises from that of 
 heat, the local action induced on the sui'face, and mostly so the reduc- 
 tion or elevation of its temperature, are of a vital nature, and that the 
 general or constitutional effects are sympathetic, as set forth at p. 246, 
 § 440, e, and shown by many direct facts, some of Avliich may be seen 
 at p. 253, § 441, d. 
 
 § 1044, c. Farther on (ibid-, p. 73-77), our Author has a Chapter on 
 Experiments showing the effect of injuries of the nervous system upon 
 animal heat, which concur with the foregoing (§ 1044, a, h) in their only 
 intelligible import, and bear a general correspondence with those to 
 Avhich reference is made in these Institutes, but which are examined 
 more particularly in the Medical and Physiological Commentaries, in 
 the Essay on Animal Heat. But the modifications of animal heat by 
 morbid influences upon the nervous system, of which our Author has 
 but little to say, are far more important in a physiological, as well as 
 practical, sense, than the experiments (§ 446-447, d). 
 
 But our Author is far from being alone in the more recent experi- 
 ments which contribute with the older ones in illustrating the effects of 
 the nervous influence upon the generation of animal heat. Bernard has 
 been largely in this field ; and Budge and others have followed up the 
 inquiry. As all these observations, however, correspond with what had 
 been before ascertained, and only go with the earlier to confirm the doc- 
 trine about which these Institutes have been interested, their statement 
 would be superfluous. 
 
 § 1045. Sequard has, also, many observations to show the difference 
 of temperature in different parts of the body, which correspond with 
 those of Bichat, Hunter, Davy, and others (p. 270, § 447, d, &c.), and 
 which I have employed as another proof that there is no analogy between 
 the laws which regulate the temperature of warm-blooded animals and 
 dead matter ; for it had been well determined that every part has not 
 only its own independent heat, but, when not exposed to the contact of 
 the air, the temperature is without change in the several parts respect- 
 ively, however much it may differ in any two contiguous parts (p. 270, 
 § 447, (/). 
 
 This very palpable proof has hithei'to received no attention at the 
 hands of the Cliemist ; but its accumulation must lead to a recognition 
 of the fact, and not only dispose of the doctrine of free interchange of
 
 Reflex Action. — APPENDIX. — Animal Heat. 809 
 
 heat as resulting from the contiguity of parts, but present an equal ob- 
 stacle to the chemical hypothesis in the failure of the blood to produce 
 an equilibrium of temperature, as would of necessity be the case were 
 there any applicability to warm-blooded animals of the fundamental laws 
 of an interchange of caloric which obtains in dead matter (§ 440 e, No- 
 14, 1034). Nor has this fact ever been stated as an objection. 
 
 FARTHER FACTS RELATIVE TO ANIMAL HEAT FROM THE ARCTIC ZONE. 
 
 § 1046. In treating of the function of Calorification (p. 234-279) I 
 have examined, extensively, Liebig's philosophy of Animal Heat, and I 
 have brought up, among other objections, numerous facts which contra- 
 dict the assumed ratio between the consumption of food and of oxygen 
 gas as the main element of a uniform temperature, and the superadded 
 contingency of clothing as one of the subordinate means ; and have fol- 
 lowed him into the Arctic regions to inquire into the accuracy of his 
 facts. It is now my purpose to extend this inquiry by consulting the 
 experience of a late Explorer of the North, from which it will be seen 
 that food and clothing are even less important to animal heat than to 
 other products of organic life. This information is obtained from Dr. 
 Kane's late Arctic Explorations, and will be stated in a rather desultory 
 manner. I might, indeed, appeal for similar facts to other explorers 
 who have wintered in the Arctic Regions since this work was published ; 
 but Di". Kane is the latest, most capable, and has supplied ample mate- 
 rials. I shall also dispense with farther comment, w^hich has been fully 
 provided in the earlier pages. But I shall do the w^ork thoroughly in 
 other respects, that this subject may be taken completely out of the 
 hands of Chemistry. 
 
 It may be farther premised that Dr. Kane became ice-bound at Rens- 
 selaer Bay, in latitude 78^ 58^, in September, 1853, where he remained 
 till the spring of 1855, and that the following observations refer to that 
 latitude, or to his more northern lointer expeditions. 
 
 § 1047. In the first place. Dr. Kane presents a general fact which 
 corresponds with what I have said of acclimation and constitution, in their 
 relation to organic heat and vital habit (§ 441 J-442 c, 443 c, d, 447 g, h, 
 535-540, 615-619, 626 b, &c.). Thus, our Author : 
 
 " The mysterious compensations by which we adapt oui-selves to cli- 
 mate are more striking here than in the tropics. In the Polar Zone, the 
 assault is immediate and sudden, and, unlike the insidious fatality of hot 
 climates, produces its results rapidly. It requires hai'dly a single win- 
 ter to tell who may be the heat-making and acclimated man. Peterson, 
 for instance, who had resided for two years at Upernavick (lat. 72° 40^), 
 seldom enters a room ivith a fire. Another of our party, George Riley, 
 with a vigorous constitution, established habits o^ free exposure, and 
 active cheerful temperament, has so inured himself to the cold, that he 
 sleeps on our sledge-journeys icithoid a blanket or any other covering than 
 his walking-suit, while the outside temperature is 30° Fahrenheit below 
 zero (§ 440 c, No. 11, 442 a, b). The half-breeds of the coast rival the 
 Esquimaux in their powers of endurance. The North British Sailors, 
 of the Greenland seal and whale fisheries, T look upon as inferior to none 
 in capacity to resist the Arctic Climate" (§ 1048, b). — Kane's Arctic 
 Explorations, vol. i., p. 245. 
 
 § 1048, a. We will now come to the subject of Food, which plays so 
 conspicuous a part in the chemical philosophy of Animal Heat (§ 440, a,
 
 810 INSTITUTES OF MEDICINE. 
 
 Nos. 1-8), though there will be something more about clothing (§ 440 c, 
 1047). I may say, however, at once, that Dr. Kane and his party were 
 capable of maintaining their natural temperature with constitutions im- 
 paired by disease, and when often nearly destitute of food, fuel, and 
 proper clothing, and with the thermometer ranging for months from 60° 
 to 90° Fahrenheit below the freezing point. 
 
 Our Author intimates that he had little faith in alcohol " as a fuel for 
 the furnace" (§ SSOf /, 438 b, c, 440 hb, No. 9, 441 b, c). He had three 
 laws, only, for the government of his party, the second of which was, 
 ^^ Abstinence from all spirituous liquo7-s" This law was uniformly en- 
 forced, and alcohol was " burned" for cooking purposes alone. 
 
 During his long detention at Rensselaer Bay the daily journal is most- 
 ly made up of a recital of hardships, of which the privation of food, 
 want of fuel, and destitution of clothing, form the most appalling. It is 
 this feature of the Narrative, this incessant struggle for the maintenance 
 of life, which forms its main interest ; and the development which is 
 thus afforded of a very extraordinary man constitutes the great merit of 
 the work, and reconciles us to an otherwise fruitless undertaking. The 
 fiction of "Kobinson Crusoe" is no match for our Author's realities. 
 He found, it is true, some benevolent sympathy among the Esquimaux, 
 but encountered in the Bears a foe that was equally struggling for life. 
 They devoured the food at the sevei'al depots, and it became often ex- 
 hausted on shipboard. 
 
 Under these circumstances winter expeditions were undertaken into 
 still more Northern regions, with the thermometer fluctuating from 40° 
 to 60° Fahrenheit below zero — often 90° below the freezing point. In 
 the first of these enterprises they were cheered on by the depots before 
 them, but soon to suffer the chill of disappointment, and an unsatisfied 
 hunger. Nor did Summer bring them relief; for, in its veiy midst, only 
 the most scanty supplies of food could be obtained. On the 8th of July, 
 1854, our Author records in his journal that "we have neither health, 
 fuel, nor provisions." (Vol. i., p. 312.) July 17th, 1854, he writes, 
 " The young ice bore a man this morning. It has a bad look, this man 
 suspecting August ice. It is horrible — yes, that is the word — to look 
 forwai'd to another year of disease, and darkness, to be met without fresh 
 food and tvithout fueV '^ 3foss was gathered for eking out our winter 
 fuel ; and willow stems and stone-crops, and sorrel, as antiscorbutics, 
 collected and buried in the snow." (Vol. i., p. 343, 348.) 
 
 The party entered upon the second winter "a set of scurvy-riddled, 
 broken-down men ; our provisions sorely reduced in quantity, and alto- 
 gether unsuited to our condition ;" and the Engraver has added a por- 
 trait of the spectacle. (Vol. i., p. 349.) 
 
 October 2Gth, 1854, thermometer 66° Fahrenheit below freezing. 
 January 7th, 1855, thermometer had been ranging since from 70° to 92° 
 Fahrenheit below the freezing point. At this time he also writes, 
 " We require 7neat, and can not get along without it. Our sick have fin- 
 ished the dear's head, and are now eating the abscessed liver of the animal, 
 including some intestiiies that were not given to the dogs. We have now 
 about three days' allowance ; thin chops of raw frozen meat, not exceed- 
 ing four ounces in weight for each man per diem" (§ 440 bb, No. 9). 
 A few days later, January 30th, he says, " I gave Wilson one raw meal 
 from the niasseter muscle which adhered to another old bear's head / 
 was keepini/ jar a specimen^ (Vol. ii., p. 17, 34.)
 
 Eeflex Action. — appendix. — Animal Heat. 811 
 
 January 22d; Dr. Kane and Hans went on a dog-journey of 91 miles 
 in pursuit of meat, but unsuccessfully. His outfit, in food, consisted of 
 " a roll of frozen meat-biscuit, some frozen lady-fingers of raw hashed 
 fox, and twenty-four pieces of ship-bread." February 4th, '* I made," he 
 says, " a dish of freshened codfish skin for Brooks and Wilson. They 
 were hungry enough to relish it." February 9th. " Still no supplies. 
 Three of us have been out all day {night) without getting a shot. Hans 
 thinks he saw a couple of reindeer at a distance." " I have not permit- 
 ted myself to taste more than occasionally an entrail of our last half- 
 dozen rabbits." February 10th. "Hans comes in with three rabbits. 
 Distribution : the blood to Oleshen and Thomas, and to the other eight 
 of the sick more full rations, consuming a rabbit and a half" (§ 440, bb. 
 No. 9). "My journal tells of nothing but sick men, profitless hunts, re- 
 lieved now and then by the signalized incident of a rabbit killed or a 
 deer seen, and the longed-for advent of the solar light." (Vol. ii., p. 21, 
 37,41,42,43.) 
 
 The party lived on much in the foregoing manner till March 10th, 
 1855, when one of them returned from a distant Esquimaux hut with 
 some walrus meat. Thermometer now at 72° Fahrenheit below freez- 
 ing. This meat was soon exhausted. But, March 24th, there had been 
 another windfall, of which he says, " Our ptarmigan gave the most sick 
 a raw ration, and to-day we killed a second paii", which will serve them 
 for to-morrow. I am the only man now who scents the fresh meat 
 without tasting it. I actually long for it, but am obliged to give way to 
 the sick" {§ 440, bb, No. 9). Vol. ii., p. 83. 
 
 § 1048, b. Again, as to the effect of cold in reducing the heat of man 
 (§ 1047). During the last foregoing period — March 15, " Hans and My- 
 ouk returned at eight o'clock last night without game. Their sleep in 
 a snow-drift about twenty miles to the northward, in a temperature 54° 
 Fahrenheit below zero (86° below freezing), was not comfortable, as 
 might be expected. The marvel is how life sustains itself in such circu7n- 
 stances of cold. I have myself slept in an ordinary overcoat without dis- 
 comfort, yet without fire, at a temperature of 52° Fahrenheit below 
 zero," or 84° below freezing (§ 440, c, No.' 11). Vol. ii,, p. 69. 
 
 Again : " I firmly believe," he says, " that no natural cold as yet 
 known can arrest travel. The ivhole stouj of this winter illusti-ates it. I 
 have both sledged and walked 60 and 70 miles over the roughest ice, in 
 repeated journeys, at fifty degrees below zero ; and the two parties from 
 the south reached our Brig in the dead of winter, after being exposed to 
 the same horrible cold." — Vol. ii., p. 78. — Also p. 257, § 442 b. 
 
 Extracts of the foregoing import may be readily multiplied. But I 
 shall only add our Author's remark that " it is a little curious that a 
 short allowance of food does not show itself in hunger. The first symp- 
 tom is loss of power [not loss of temperature], often so imperceptibly 
 brought on that it becomes evident only by an accident." — Vol. ii., p. 
 284. 
 
 § 1049. Let us now contrast our Author's unprejudiced experience in 
 Tea with the speculations of Chemistry upon ^^ alcohol, blubber oil, and 
 talloiv candles," in their aspect of " fuel," as set forth in former sections 
 (§ 440, a-bb, Nos. 7, 9, &c.). 
 
 " Under circumstances of most privation," says Dr. Kane, " I found no 
 comforter so welcome to the party as our great restorative, Tea. We 
 drank immoderately of it, and always with advantage." On his remark-
 
 812 INSTITUTES OF MEDICINE. 
 
 able retreat homewards, tliey " had been limited for some days to three 
 raw eggs and two breasts of birds a day ; but we had a small ration of 
 bread-dust besides ; and when we halted, as we regularly did for meals, 
 our fuel allowed us to indulge lavishly in the great panacea of Arctic trav- 
 el— Tex:'— Vol. ii., p. 261, 282. 
 
 This Tea acted simply as a stimulus to the nervous system, and among 
 its results was an elaboration of heat, just as is explained of alcohol and 
 animal food in § 440 h, 441 c. 
 
 § 1050. Not a little has been assumed of the voraciousness of the Es- 
 quimaux and Samoyedes in proof of the chemical doctrine of animal heat, 
 and there has come to be a settled belief that they would perish with cold 
 unless forever addicted to a gluttonous repast upon walrus and blubber 
 (§ 440, bb^i No. 9, &c.). Nothing but a visit to their settlements could 
 have deprived Chemistry of this plausible fallacy. This has been effect- 
 ed by Dr. Kane, who found the habits of the Esquimaux near his own 
 winter quarters, in regard to food, precisely the same as those of other 
 savages inhabiting tropical climates. He says of them, that 
 
 "However gluttonously they may eat, they evidently bear hunger 
 with as little difficulty as excess," as I have endeavoured to show 
 (§ 441, c). And again: "Among the Esquimaux generally, the coldest 
 months of the year, January and February, are often, in fact nearly al- 
 ways, months of privation." {Ibid., vol. i., p. 418 ; vol. ii., p. 131.) Near 
 our Author's station they Avere as destitute as his own party. 
 
 If we now consult the records which have been carefully made by res- 
 idents in tropical regions, it will be found that where food is abundant, 
 the savages gorge themselves far more habitually than the wanderers of 
 the polar zone. The following example will dispose of the question be- 
 fore us. Thus, in the "Asiatic Researches" there is a description of 
 the Island of Nicobaras, in the Bay of Bengal (mean annual temperature 
 70° F.), by G. Hamilton, in which he says of its inhabitants, that 
 
 "They are veiy fond of sitting at table with Europeans, where they 
 eat every thing that is set before them, and they eat most enormously. 
 They will drink bumpers of rack as long as they can see. A great part 
 of their time is spent in feasting and dancing. At their feasts they eat 
 great quantities of 2^ork, which is their favourite food. Their hogs are 
 remarkably/ fat, and they eat their pork almost raiv" (§ 440 bb, 441 c). — 
 Asiatic Researches, vol. ii., p. 382. London, 1799. — Note Oo. 
 
 "the primordial cell." 
 
 § 1051, a. The present inquiry refers specifically to what is said at 
 pages 36-49 (§ 03-81) on the development of the germ, and to a uni- 
 versal characteristic distinction between plants and animals, at § 11. 
 The former subject possesses an importance both in a physiological and 
 religious sense, since there are many Philosophers who assume that 
 there is but one primordial cell which serves as a foundation for all or- 
 ganic beings, and that the development of this cell into a plant or an 
 animal, or into a particular plant or a particular animal, is due entirely 
 to the special physical influences that may act upon it, and not at all to 
 any original difference in the sti-ucture of the cells or their endowments 
 of life ; and this assumption professes to be predicated of the revelations 
 of the microscope ; though it is not difficult to understand that the chem- 
 ical doctrines of life and Lamarck's transmutation of species have had 
 their share in the project (§ 350f-350). Upon this hypothesis, there-
 
 Structure. — APPENDIX. — Primordial Cell. 818 
 
 fore, the only reason why men are not mushrooms is, that in one case the 
 nucleus-cell of a human ovum is subject to physical agents, during its de- 
 velopment, different from those which develop a mushroom. Hence it is 
 assumed, that if it were possible to subject the germ of a plant to the 
 agents which unfold the human ovum, it would necessarily grow into an 
 intelligent, responsible being. This purely speculative assumption, which 
 ^strikes at the whole foundation of organic nature, might be variously ar- 
 gued upon physiological grounds (§ 72-70, 121-123, &c.) ; but the neces- 
 sity of this is superseded by continued observations with the microscope, 
 which has been lately correcting its own errors (§ 83, 131), and granting 
 us an opportunity to again believe that the Almighty created the germs 
 of every species of animals and plants with a rudimentary structure and 
 organic endowments as various as the species, so that each one should be 
 developed by special physical agents alone, and the progress of develop- 
 ment result in the particular species, and in nothing else, or, at least, in 
 a near approximation, as in the very limited hybrid (§ 190, 1052 h).* The 
 microscope, indeed, has ascertained that even a cell is not an indispensa- 
 ble requisite in the germ either of plants or of animals. To this effect 
 I shall now quote a late able writer, who is thoroughly conversant with 
 his subject, and without any hypothesis in view: 
 
 § 1051, b. "The general result," he says, "of recent microscopical 
 investigation in regard to the lowest forms of vegetable and animal life, 
 seems to us to lead to this conclusion — that organisms may possess an 
 independent existence, may go through all the phenomena of growth, 
 multiplication, and reproduction, and may even possess considerable 
 power of spontaneous motion [involuntary], without having advanced 
 even so far in the differentiation of their powers as to possess those at- 
 tributes which are involved in the ordinary idea of a ' cell' (§ 2G0-265). 
 By way of explaining our meaning, we shall select an illustration from 
 each kingdom ; and the comparison of the two will enable us to inquire 
 in wliat lies the essential difference between them. 
 
 " One of the humblest known Protophytes, the PahnogloEa macrococca, 
 whose multiplication gives origin to the green slime tliat is found on 
 damp stones and walls, consists of isolated particles of a spheroidal shape 
 and greenish color, commonly imbedded in a stratum of gelatinous mat- 
 ter, which an ordinary observer would at once pronounce to be vegetable 
 cells. But a careful examination shows that there is here no definite 
 distinction between ' cell-wall' and ' cell-contents ;' the whole particle 
 being composed of a nearly homogeneous mass of ' protoplasm,' through 
 which chlorophyll-granules are dispersed." " These particles, increasing 
 in size, undergo duplicative subdivision by the usual process of elonga- 
 tion and constriction ; and it is observable that the nucleus gives indi- 
 cations of the commencement of this subdivision earlier than the particle 
 which incloses it. Each new cell, if such it may be called, then begins 
 to secrete from its surface a gelatinous envelope of its own ; so that, by 
 its intervention, the two are usually soon separated from one another." 
 "There appears to be no definite limit to this kind of multiplication, 
 and extensive areas may be quickly covered, in circumstances favourable 
 to the nutrition of the plant, by the products of the duplicative subdivi- 
 sion of one primordial cell. This, however, is simply an act of growth 
 precisely analogous to the multiplication of cells in the earliest embryonic 
 condition of the higher Plants and Animals, before any differentiation 
 of organs begins to show itself" " Now, for such a mass of protoplasm 
 * See Notes Pp p. 1142, Q<j p. 1345.
 
 814 INSTITUTES OF MEDICINE. 
 
 to become converted into what is generally regarded as the type of the 
 Vegetable cell, a series of changes must take place in it, involving a dif- 
 ferentiation between the cell -wall and the cell-contents ; and this involves 
 a greater consolidation of the external layer of the protoplasm, in a 
 more complete liquefaction of its internal portion" (§ 64-65). 
 
 *' The successive stages of this formation may be best traced out by 
 careful observation of the process of cell-growth in the higher Algge ; but 
 the study of the development of new organs in Phanerogamic plants leads 
 to the same conclusions, and the results at which Mr. Wenham has 
 lately arrived, from observations chiefly made on the newly-imported 
 aquatic weed, Anacharis akinastrum, are so instructive that we shall sub- 
 join a brief summary of them. He finds that when a new leaf is being 
 formed from the main stem, it commences, not as is commonly supposed, 
 in a single cell, but in the simultaneous development of some hundred at 
 once, tvhich make thev^ appearance in the midst of a mass of protoplasm which 
 is inclosed in a membrane that subsequently seems to become the epi- 
 dermis of the leaf. This mass is, at first, homogeneous ; but it is soon 
 seen to contain a multitude of cavities of irregular size and shape, filled 
 with liquid, while the protoplasm between them becomes more viscid." 
 " These cavities are next observed to be lined with a definite membrane ; 
 and within this, protoplasm, chlorophyll, and cyclosis-currents subse- 
 quently become indistinguishable." 
 
 " Turning now to the Protozoa, we find in the Amaiba, and in the Ac- 
 tinophrys, types of animal existence, which, in so far as we are yet ac- 
 quainted with them, may be legitimately ranked on the same level as the 
 Palmogla^a, although placed on the other side of the boundary-line. The 
 body of each of these creatures is a minute mass of a substance which 
 long since received from Dujardin the appropriate name of 'sarcodc,' 
 and which seems to be the equivalent of the protoplasma of the Proto- 
 phyta ; resembling it very closely in chemical composition and in general 
 attributes, but being endowed in addition with a high degree of contrac- 
 tility. The body is not inclosed, in either of these beings, by a distinct 
 limitary membrane, although the outer stratum of the sai'code obviously 
 possesses more consistence than its inner part, the latter being semifluid. 
 Vacuoles or clear spaces are seen in various parts of the sareode-body ; 
 and in these are very commonly observable alimentary particles, intro- 
 duced in the way to be presently described. Besides these vacuoles, a 
 contractile vesicle, which pulsates at tolerably regular intervals, is always 
 to be distinguished, sometimes in the interior of the body, sometimes 
 near its surface, and sometimes projecting above its siu-face." 
 
 "In these creatures, although they have neither digestive cavity, 
 mouth, nor anus — although they are, to all appearance, nothing else than 
 jmrticles of animated jelly not even confined ivithin a definite membrane, the 
 prehension and ingestion of food, the extraction of its nutritive portion 
 by a digestive process, and the rejection of what cannot be thus reduced 
 by an act of defecation, are performed as characteristically, and in real- 
 ity as perfectly, as in the highest animaW (§ 14, h).* Continued in § 1052. 
 
 * Dakwin's late purely speculative yforlx. On the Origin of Species {an offset of the 
 Vestiges of the Natural History of Creation., p. 183-188), in whicli the Author tLinks that 
 "in a distant future light will be throtvn on the ohigin of man" ! and whose title reveals 
 its object, may be tried, in part, by the foregoing facts, and especiallj' bj' those at p. 
 896-905, 911, 924, 927, regardless of the sheer assumption which forms the essential 
 basis of his worlv. His difficulty would be as great in assigning his "owe primordial 
 form" to any other cause than " a Creator" as all its supposed varietj^ of develojiments. 
 Ever}' relative fact in science, of anj' importance, contradicts the whole of this violentl}' 
 revolutionary scheme. See Humboldt and Licwis in connection, p. 922, 924. — 1860. 
 Also mj' work on the Soul, and Instinctivic Puinciplk, edition 1871.
 
 Animals and Plants. — APPENDIX. — Boundary-line. 815 
 
 THE GREAT FUNDAMENTAL DISTINCTION BETWEEN ANIMALS AND PLANTS, 
 OR THE BOUNDARY-LINE. 
 
 § 1052, a {Refers to § 1051). It will now be interesting to the student 
 of Physiology to observe the Universality of Nature's laws in any one of 
 her great departments, in the manner in which she has established a rad- 
 ical distinction between the vegetable and animal kingdoms, and carried 
 out from the lowest to the highest, in both kingdoms respectively, the 
 fundamental plan of rendering one the Producers of organic compounds 
 out of the elements of matter, and the other Consumers of those com- 
 pounds, and how this characteristic will readily distinguish the lowest 
 species of one kingdom from the lowest of the other (§ 13-14, 18, 173, 
 185, 298-303 ; and Index, article Plants). By this brief recurrence to 
 the subject, which is made for the sake of the following quotation, which 
 brings into view the great economy of life as manifested in the boundary- 
 lines of the Animal and Vegetable kingdoms, and which confirms the 
 principles expressed in this work (in the references to sections just made), 
 we shall refresh our knowledge of the wonderful elaboration of living be- 
 ings, enlarge our conceptions of the peculiar properties and laws by 
 which they are governed, obtain a renewed evidence of Creative Power, 
 and be quickened in our adoration (§ 409, 493 a ; and Index, articles 
 Design and Creator).* The foregoing Writer (§ 1051) goes on as follows: 
 
 "If we now compare an Amccba or an Actinophijs, in its quiescent 
 state, with a Palmoglcea, or an equally simple Protophyte, we can scarce- 
 ly assign any structural characters by which one could be differentiated 
 from the other. But when we look at their physiological actions, how 
 wide is the distinction. The Protophyte, like the Phanerogamic plant, 
 obtains the materials of its nutrition from the air and water that sur- 
 round it, and possesses the marvellous power of detaching oxygen, hy- 
 drogen, carbon, and nitrogen from their previous binary combinations, 
 and of uniting them into chlorophyll, starch, albumen, and other ternary 
 and quaternary combinations ; bvit the Protozoon, in common with the 
 highest members of the Animal kingdom, is, to all appearance, destitute 
 of any such combining power, and is consequently dependent for its sup- 
 port upon organic substances previously elaborated by other beings ; so 
 that it must in the end derive its sustenance, directly or indirectly, from 
 the Vegetable kingdom" (§ 13-14, 17, 303-304). "Again, the Proto- 
 phyte obtains its nutriment by the absorption of liquid and gaseous mole- 
 cules which penetrate its body by simple imbibition (§ 289-295, 303 d, 
 303^); while the Protozoon, though destitute of any permanent mouth, 
 stomach, intestine, or anus, extemporizes (so to speak) all these organs 
 for itself whenever there is occasion, ingests solid particles into the inte- 
 rior of its body, and there subjects them to a regular digestive process." 
 
 " Thus, then, by attending to the nature of their food, the mode of its 
 introduction, and the character of their respective movements, a line of 
 distinction may be drawn between the Protophyte and the Protozoon, 
 scarcely less definite than that which separates the insect from the plant 
 whose leaves it devours, or the elephant from the tree on whose tender 
 shoots it browses." — Medico-Chirurgical Revieiv, p. 3-7, April, 1856 ; 
 New York edition. The italics are generally mine. — Note Fff. 
 
 And now, will Orgftnic Chemistry pretend that there are only " inci- 
 dental, casual differences between living and dead matter," and that 
 " there is no essential difference between organic and inorganic bodies," 
 
 * That plants subsist upon elements, and animals upon organic compounds, is alone fatal 
 to "one primordial cell" (§ 1083, 1085, Notes, P p, page 1142, Q q, page 1145).
 
 816 INSTITUTES OF MEDICINE. 
 
 and that "a Chemist, totally unacquainted with organic matter, would 
 u priori have deduced all these incidental differences of matter from the 
 doctrine of affinity and the science of stoichiometry evolved from dead 
 matter"! (§ 1034, Lehmann.) Nay more; I ask the Chemist if he will 
 even hazard an assumption as to the "incidental differences" between 
 the fundamental law which enables the Plant to exert " the marvellous 
 power of detaching oxygen, hydrogen, carbon, and nitrogen from their 
 previous binary combinations, and of uniting them into chlorophyll, 
 stai'ch, albumen, and other ternary and quaternary combinations," and 
 that other fundamental law which deprives the Animal " of any such 
 combining power, but renders it dependent for its support upon organic 
 substances previously elaborated by the Vegetable kingdom ?" And, be- 
 fore taking leave of our able Chemist, I would respectfully ask him upon 
 what logical ground he can reconcile the doctrine of" simple imbibition" 
 (the "lamp-wick" doctrine, § 289, 291, 350, Nos. 21, 22x65, 23x66, 
 231x67, 68, 69, 70, 25, 26, 26^, 27x71, 72, 73, 74, 75, 76, 11, par- 
 allel columns) with " the marvellous power possessed by Plants of detach- 
 ing oxygen, hydrogen, carbon, and nitrogen from their previous binary 
 combinations, and of uniting them into chlorophyll, starch, albumen, and 
 other ternary and quaternary combinations f^ (§ 13-18, 37-42, 48, 53, 
 293-295, 303-304, 360, 409 c-411, and the next following sections, 
 1053, 1054.) It is fatal, also, to the doctrine of unity of cells (§ 1051, a). 
 
 § 1052, b. And now a word upon the philosophy of hybrid animals. 
 Much has been said in these Institutes upon the mutability of the Proper- 
 ties of Life, both as to the transient and permanent nature of their man- 
 ifestations, and much as to the influence of physical agents according to 
 the nature of these changes. This principle, indeed, lies at the founda- 
 tion of physiology, pathology, and therapeutics {^ 237-240), is deeply 
 concerned in the temperaments, vital habit, hereditary diseases, and in 
 all philosophical medicine. It pervades the work before us. 
 
 AVhen the reader shall have considered the foregoing in connection, 
 let him refer to what is said of the permanent changes which are in- 
 duced in the ovum by the male parent, and according to the peculiari- 
 ties of his physical and mental constitution (§ 72-81), and also to the 
 facts attendant on vital habit, acclimation, and the general insuscepti- 
 bility to a second attack of small-pox, measles, &c. (§ 535-568, 650, 
 653 b-d, 654 b, 659, 661, 664-666, 670. Also Index, Vital Pkoper- 
 
 TIES). 
 
 Now, we may readily discover in the foregoing facts the philosophy 
 which is concerned in the incapacity of hybrid animals to propagate their 
 varieties ; and it reflects no little light upon our general philosophy of 
 life, which so readily offers an explanation. This incapacity consists in 
 the simple element that the pi'operties of the hybrid animal have under- 
 gone such a mutation, and in strict conformity with the foregoing anal- 
 ogies, that the semen has lost its impregnating virtue and the ovum its 
 susceptibility to the action of semen. Or, if hybrids be sometimes ca- 
 pable of fruitful intercourse for one or two generations, it only shows a 
 correspondence in the ultimate extinction of the procreating faculty, 
 through repeated impressions upon the constitution, with the frequent 
 necessity of repeated vaccinations to extinguish the susceptibility to the 
 farther production of the disease. And so of occasional repetitions of 
 small-pox, measles, and. scarlatina, before the susceptibility disappears 
 (§ 054 b, 064). The principle is a profound attribute of life.
 
 Alsorption. — appendix. — Circulation. b 1 7 
 
 From the foregoing premises it is evident that any general failure of 
 animals to propagate with each other must be regarded as a fundament- 
 al test of species. It grows out of a law implanted in the constitution 
 of all organic nature, and a law, as Ave have seen, of the most compre- 
 hensive grasp. For the same reason, therefore, we may conclude that 
 the varieties which may ai'ise from the intermingling of different species 
 cannot propagate themselves beyond a few generations. All this may 
 seem peculiarly Providential. But it denotes a far more stupendous pro- 
 vision, in being an integral part only of one magnificent system of Unity 
 of Design (See references in this section as to vital habit &c.). 
 
 § 1052 c. It is confidently stated that about nine species of dioecious 
 plants have been known to yield fruit where it was impossible to have 
 had any communication with the male. We shall simply place this 
 conclusion in the category involved in § 1051, a. AVe are not, however, 
 disposed to question the absence of the male plant, but to assume, in 
 that event, the certainty of at least one male blossom or one hermaphro- 
 dite having been developed on the stem of the female. That is enough. 
 And, in this conclusion, we are warranted not only by all analogy in 
 both organic kingdoms, but by the specific facts which often occur ex- 
 tensively, as in the conversion of certain varieties of the strawberry 
 (fragaria), the ^^ Hovey^' for example, into exclusively starainate, and 
 therefore unproductive flowers (§ 5^ ^, c, 74, p. 280, § 449, d). 
 
 ABSORPTION AND CIRCULATION IN PLANTS. 
 
 § 1053. Although the laws which govern absorption and circulation 
 in Plants have been hitherto variously but incidentally considered in 
 this work, I am disposed to introduce here some more direct observations 
 on account of the immediate bearing of the subject upon absorption and 
 circulation as carried on in animals, and to thus, also, extend the anal- 
 ogy to the philosophy of vegetable heat, indicate the harmony in the 
 laws which govern absorption in Plants, the circulation of sap, and the 
 secreted products of vegetable organization, and the analogy between 
 these and the corresponding phenomena of animals (§ 293-295, 381, 
 445 d~g, and references in 1052 a; also § 409 hh, I, 493 cc, 893 a). 
 
 § 1054. Absorption by the roots of Plants is considered an inadequate 
 explanation of the circulation of Sap among those who advocate the 
 doctrine of capillary attraction. To interpret the process, the leaf, or its 
 equivalent, has been assumed as especially instrumental ; serving either 
 as an exhausting apparatus by evaporation, or under the designation of 
 endosmosis, or contributing its aid by supposed chemical influences, 
 through the operation of light, upon the ascending sap. Some one of 
 these hypotheses is considered an indispensable auxiliary to the doctrine 
 of capillary attraction as applicable to the circulation of sap. But, in 
 the mean time, all the remarkable facts as to the elective power of the 
 roots of Plants in their function of Absorption are left to be resolved 
 by "simple imbibition" or the "lamp-wick" doctrine, as it comes to us 
 from Liebig, Carpenter, and others (§ 289-292, 1052, and inferences 
 there. Also § 350, Nos. 26, 26k, 27, 77). 
 
 An ingenious application of the Chemical philosophy has been pro- 
 pounded to satisfy the supposed exigencies of capillary attraction not 
 only as it respects the ascent of sap, but as affording the true solution 
 of the downward motion; but it touches not the elective power of the 
 roots. This hypothesis is also thought to be a new obstacle to the doc- 
 
 Ffp
 
 818 INSTITUTES OF MEDICINE. 
 
 trine which ascribes life to a Plant, and the dependence of its circulation 
 and unique products upon vital actions, and notwithstanding, also, that 
 Plants possess a far greater organizing power than animals (§11, 42, 
 217, 298, 300, 1052); have exactly the same organic functions as ani- 
 mals (§ 249) ; and generate an endless variety of precise, unique, organic 
 compounds out of a fluid constituted of the same elements as the blood 
 (§ 34-37, 41-48, 136). The hypothesis derives, also, no little import- 
 ancefrom its application to the circulation of the blood, and the admis- 
 sion that, if it cannot be sustained in reference to Plants, it must be 
 equally groundless in regard to Animals. The doctrine comes recom- 
 mended to our attention by its distinguished Advocates. 
 
 I have already endeavoured to show the want of all foundation for 
 the more comprehensive principle set forth by Liebig, and of which the 
 foregoing is a corollary, that 
 
 " The Cause of the state o/" Motion is to he found in a series of changes 
 ivhich the food undergoes in the organism, and these are the rcsidts of pro- 
 cesses of decom2')osition, to which either the food itself or the str-uctures form- 
 ed from it, or jyarts of organs, are subjected'^ (§ 350, No. 1 , parallel columns). 
 
 This summary principle, in which oxygen gas figures conspicuously, 
 is the combustive doctrine of life. The Projector held it to be applica- 
 ble to every motion and to all the phenomena of living beings in health 
 and disease (§ 350, Nos. 3, 7, 9, 10, 12, 15, 17^, 21, 73, § 350^), and even 
 in death (§ 350, No. 49, 383). It was laid as the foundation of Thera- 
 peutics (§ 350§). It was also made to explain our very thoughts and 
 passions ; those being also imputed to the union of oxygen with the 
 combustible elements of the brain (§ 349 e, 1076 a), and which led us to 
 the demonstration upon " The Soul and Instinct." It is the circumstance, 
 also, of these fundamental doctrines being still the current Medical Phi- 
 losophy that has prompted another part of the Appendix (§ 433, 1034). 
 
 I cheerfully conceded that the foregoing " summary principle, were it 
 true, would be truly beautiful." I therefore felt the importance of show- 
 ing that it was not only deficient in every necessary element, but was 
 contradicted by all the phenomena of Sympathy, and by all that is 
 known of Pathology and Therapeutics. I am thus provided with a vast 
 series of facts in advance, which must be taken in connection with what 
 I am now to say of the corollary from the fundamental doctrine. This 
 corollary consists in the application of the general doctrine, above, to the 
 circulation of the sap and the blood. It supposes that 
 
 The movement of the sap, upward and downward, is generated in the 
 leaf by the action of light in promoting the decomposition of carbonic 
 acid gas, that ^^ marvellous power possessed by Plants" (§ 350, Nos. 68, 
 73, 74, 76, § 1052). The imperfect ascending fluid is thus converted in 
 the leaf into perfect sap, and the change is supposed to institute a pro- 
 pelling force in the imperfect juice, by which the perfected sap is driven 
 out of the leaf and through its downward course. The force, generated 
 in the leaf, is also considered, from the motion which ensues in that part, 
 as the most essential cause of the ascent of the sap, or that the fluid is 
 thus lifted from the roots to the summit of the most lofty trees. Such, 
 then, is the ingenious doctrine which it has been found necessary to sub- 
 stitute for capillary attraction in expounding the circulation of Plants; 
 as the illustration drawn from a "lamp-wick" was found to be applica- 
 ble only to the radicles in their supposed office of " simple imbibition" 
 (§ 289-293).
 
 Absorption. — ^appendix. — Circulation. 819 
 
 This principle has the merit of appearing to be equally applicable to 
 the circulation in animals as to that of plants (§ 350, No. 73, &c.), and 
 it forms a remarkable instance of consistency in a somewhat comprehen- 
 sive range of a purely factitious hypothesis, though it is regardless of all 
 the overpowering facts which declare its artificial character. The pul- 
 monary circulation is said to depend upon the union of the oxygen of 
 the air with the carbon of the venous blood, in consequence of which 
 this blood drives the decarbonized into the left auricle. But, in the case 
 of the systemic or greater circulation, the order of things is reversed ; for 
 here the motion is supposed to be generated by the union of oxygen with 
 the "structures formed out of the food." The same order of events ob- 
 tains in the livei' — all referable to " a series of changes which the food 
 undergoes in the organism," &c. This is Liebig's doctrine of the circu- 
 lation of the blood and sap, as expressed in the foregoing quotation, and 
 as may be seen farther in § 350, Nos. 3, 5, 6, 8, 9, 10 15, parallel col- 
 umns, and § 383. But the most curious facts about it are, as I formerly 
 said, that it " considers the circulation of the blood due to the agencies 
 of oxygen, and not at all to tlie action of the heart," and that it "is the 
 chemical substitute for the medical aphorism, ' uhi irritatio ibi affluxus,'' " 
 and that it is made the grand basis of all Pathology and Therapeutics 
 (§ 350, No. 10, § 350^-3501). The latter, indeed, should naturally flow 
 from the main physiological doctrine, if Nature be truly represented by 
 this (§ 1 fl, 2 h, 383, 447^ a, 638, 1089). 
 
 Doubtless, this remarkable doctrine of the circulation of the blood 
 might have been left to itself had it not been incorporated in the lead- 
 ing works upon Physiology, as in Dr. Carpenter's, and even carried into 
 popular systems, as by Mrs. Willard, whose appropriation of the philos- 
 ophy is regarded by Dr. Cartwright (in Boston Medical and Surgical 
 Journal) as singularly ingenious and original (§ 349 d, 433). 
 
 It is simply my remaining object, however, to inquire into the sup- 
 posed condition of the circulation in plants, as in all other relative top- 
 ics concerning man and animals the ground has been sufficiently ex- 
 plored, and since, also, if the hypothesis can be contradicted here, it must 
 equally fail, as is admitted, in respect to animals. I shall also endeav- 
 our to avoid a repetition of whatever I may have hitherto said, and limit 
 myself to the statement of a few simple facts. 
 
 In the first place, then, it appears to me that the hypothesis contains 
 a fatal element — the prodigious amount of force which is said to be gen- 
 erated in the leaf, as well as in the lungs and other soft structures of an- 
 imals. On this point I am bound to abide by the decision of the Chem- 
 ists, who say that such must be the consequence of the chemical changes 
 which are supposed to be in progress for the production of motion. ' As 
 expressed by these Philosophers, who designate it as " an inexpressible 
 force," or compare it, like Liebig, to a "steam-engine" (§ 350, No. 15), 
 it would be abundantly sufficient for any purposes in artillery or in blast- 
 ing rocks (§ 392, c). 
 
 In the next place, there are many other circumstances attending the 
 circulation in Plants, as well as Animals, not hitherto considered, which 
 it would not be easy to interpret by the Chemical doctrine, but which 
 are readily explained by the Vital. Where, for example, is the auxili- 
 ary power to capillary attraction (if the latter be included) — where, the 
 l^ves, or even buds, when vegetation starts from its hybemating state 
 in northern countries ? Observe the Acer saccharimim — the remarkable
 
 820 INSTITUTES OF MEDICINE, 
 
 vigour of its circulation before there is a development of the bud. In- 
 deed, the harvest of maple-sugar often takes place in the Northern States 
 while the earth is covered with snow to the depth of many feet. The 
 circulation, too, is most vigorous after frosty nights succeeded by warm 
 mornings ; and when the temperature of the air rises, for a night or two, 
 to some 40^ F., the flow of sap is apt to be greatly diminished, but is 
 restored in profusion on the return of frost. What in Chemistry will 
 explain such a phenomenon ? And, if it retreat before obstacles of this 
 nature, must it not abandon the whole ground? Nay, how palpable the 
 force of a single fact, when it is considered that the phenomenon is due 
 to the effect of heat as a vital agent on the irritability of vegetable or- 
 ganization, and, singularly enough, as admitted by Liebig (§ 350, No. 
 65) ; and whether operating at the higher and more uniform degrees, or 
 alternating at the freezing point, the exact explanation is involved in the 
 law of Vital Habit, as set forth in these Institutes at pages 3G3-370. 
 
 Such, mainly, is also true of the Vitis vinifcra, which was the subject 
 of many ingenious experiments by the celebrated Dr. Hales, as appeared 
 in his Vegetable Statics. And this brings us upon the fashionable ground 
 at which I have been aiming — that of " Experimental Philosophy." 
 These experiments are allowed to have been ably and critically conduct- 
 ed, and are standard references. Let us, t'lerefore, interrogate some of 
 these experiments, and see how far they correspond with Nature, or how 
 far they contradict her and bear out the Chemist ; and let us, at the 
 same time, take along the corroborating testimony of other eminent ob- 
 servers, who were obliged to conclude that " the sap moves with such 
 velocity and force, that it must be propelled by vital contractions and 
 dilatations of the vessels" (§ 293). Now, in some of Dr. Hale's experi- 
 ments there was not only an absence of leaves and buds, but the stumj) 
 alone was the subject of observation. There was wanting, therefore, 
 every thing that could contribute to the fundamental requisite of the 
 Chemist, and, indeed, I may say, what is considered indispensable by 
 all the physical Philosophers to the simple doctrine of capillary attrac- 
 tion as it I'egards the ascent of sap. , Take, as an example, Exj). xxxvi. 
 Thus : 
 
 " April 6th, at 9 A.M. I cut off a vine, on a Southern aspect, two 
 feet nine inches from the ground. The remaining stem had no lateral 
 branches. It was seven eighths of an inch in diameter. I fixed on its 
 top the mercurial gauge;" of double curve, to admit the flow of a few 
 inches of sap. 
 
 For several days the mercury was more or less pushed up by the sap, 
 according to the state of the weather. " April 14th, at 7 A.M. the 
 mercury rose to 20 inches high. At 9 A.M. 22 inches. Fine warm 
 sunshine. Here we see that the warm morning gives a fresh vigor to 
 the sap." "April 18th (12th day), at 7 A.M. mercury 32 inches high, 
 and would have risen higher if there had been more mercury in the 
 gauge. From this time to May 5th the force gradually decreased [the 
 life of the plant giving way]. On the 18th of April the force of the 
 sap was equal to 36 feet height of water. Here, the force of the rising 
 sap in the morning," the doctor concludes, '■'■ is 2^lainly oiving to the energy 
 of the root and stem" 
 
 In another and similar experiment, at the same time, " the mercurial 
 gauge being fixed near the bottom of a vine, the mercury was raised by 
 the force of the sap 38 inches, equal to 43 feet4-3 inches + i height of
 
 Absorption. — appendix. — Circulation. 821 
 
 water ; which force is near five times greater than the force of the blood 
 in the great crural artery of a horse ; seven times greater than the force 
 of the blood in the like artery of a dog ; and eight times greater than 
 the blood's force in the same artery of a fallow doe," as ascertained by 
 the rise of the blood in long glass tubes. 
 
 In these experiments it is sufficiently manifest that all the physical 
 hypotheses fail, since all of them assume that the leaf, or its equivalent, 
 is indispensable to the progressive rise of the sap. The result, I say, 
 shows, what all organic nature teaches, that so important a function as 
 the circulation, and so exceedingly variable as in plants, yet most ex- 
 actly suited in every species and every individual (but varied in all the 
 species), to the methodical steps in vegetation, is not dependent upon 
 the capricious operation of any chemical or physical agencies, and that 
 a force is established at the very base of a plant, that shall not fail of 
 the exigencies of vegetable life according to its progressive changes 
 (§ 392 b, 394) ; and the same general principle may be affirmed of every 
 great function of organic life. It follows, therefore, that the sap is 
 moved by something peculiar to living beings, and this is called a vital 
 action. The motion which we have seen, however, would prove utter- 
 ly destructive to the leaf, and even to all delicate branches, without a 
 gradually countervailing influence upon that action, and the subdivision 
 of vessels will not alone explain the diminution of force. We must 
 hence infer, what is denoted by other important facts, that the reduction 
 of force arises, also, from a modified action in the vessels leading to the 
 twigs and bud, as well as in the bud, or leaf, itself. Here a new action 
 is set up, and a new motion of the sap begins, which is propagated along 
 its downward course by a universal action of the vascular system, mod- 
 ified in different parts according to the special final causes of each part. 
 
 Although there were no leaves in the foregoing experiments, and, in- 
 deed, only a short stump of the vine, the results were not unexpected 
 to the Philosopher, who adopts the theory that the circulation of sap is 
 owing to temperature. But temperature could not be always made to 
 explain the phenomena, Capillary Attraction was little understood, and 
 Chemistry was yet unfledged. Accordingly, as in all cases where genius 
 departs from Nature, even the acute mind of Dr. Hales has a special hy- 
 pothesis for each apparent difficulty ; sometimes borrowing from the 
 theory of the Vitalist, though less so than most Organic Chemists, and, 
 like the latter, actually raising hypotheses in direct opposition to each 
 other (§ 350, &c.). Take the following examples, where the leaves had 
 obtained their full development, and which will farther show the error 
 of the physical hypotheses. Thus : 
 
 "July 4th, at noon, I cut off within three inches of the ground an- 
 other vine on the South aspect, and fixed to it a tube seven feet high, 
 and filled it with water, which was imbibed by the root, the first day, 
 at the rate of a foot in an hour, but the next day much more slowly ; yet 
 it was continually sinking, so that at noonday I could not see it so 
 much as stationary" — the life of the stump now giving way. 
 
 Here are two important facts. There Avas no apparent upward force, 
 though there may have been some mingling of the sap with the water ; 
 and, secondly, the water being vitally adapted to the plant, it was lit- 
 erally carried down to the roots from the tube at the rate of a foot an 
 hour. There was no chemistry here to effect or in any manner influ- 
 ence the descent ; and tlie water went the Avrong way for capillary attrac-
 
 822 INSTITUTES OF MEDICINE. 
 
 tion. The hypothesis of gravity would be absurd, while it is, also, con- 
 tradicted by the preceding experiments ; and the descent of the sap lias 
 been a greater problem to our rival friends than its ascent. The import- 
 ance and compass of the proof will be at once perceived. But he, who 
 made the experiment, seeing the want of agreement with the preceding, 
 thought, like a great many other Philosophers, that a conflicting fact 
 would justify a special hypothesis. Let us therefore hear the doctor 
 upon this troublesome point. Thus : 
 
 "Now, since the flow of sap ceased at once, as soon as the vine was 
 cut off the stem, the principal cause of its rise must, at the same time, 
 be taken away, viz., the great perspiration of the leaves.'' 
 
 That is the doctrine, along with capillary attraction, of a large section 
 of the physical school ; but it supplies no aliment to Chemistry. In all 
 the cases, the blunders arise from a defective observation of facts, and 
 from an ignorance in the difference between the physiological condition 
 of the vine and of other plants before and after leafing (§ 1034). In the 
 experiments first recited, the vine was in its budding season, when vege- 
 table life is in highest activity, and hence the profusion of sap, the force 
 of its circulation, and the development of heat (§ 445, e,f). On the con- 
 trary, in the last experiment Nature had accomplished her greatest of 
 objects in the development of the leaves ; and Dr. Hales might have am- 
 putated the largest limb, with all the other leaves remaining, and there 
 would have been no bleeding. The same descent of the sap would have 
 occurred, and prompted a different hypothesis. 
 
 And now contrast the foregoing experiment with his conclusion as 
 expressed in £ay9. xxxviii.; the words in italics being designed by myself 
 to facilitate the hasty reader. It is a hypothesis, directly opposed to the 
 preceding, for the purpose of expounding another fact : 
 
 " The sap," says the doctor, " begins to rise sooner in the morning in 
 cool weather than after hot days ; the reason of which may be, because 
 in hot weather much being evaporated, it is not so soon supplied by the 
 roots as in cool weather, ivhen less is evaporated." In Uxp. xlvi. he says, 
 " It was found that the trunk and branches of vines were always in an 
 imbibing state, caused by the g7'eat p'^rspiration of the leaves, except in the 
 bleeding season" when there are no leaves. At that season the problem 
 of the stump led him to conclude that " the force of the rising sap is 
 plainly owing to the energy of the root and stem" (Exp. x.x\i.). Will the 
 Chemist explain ? 
 
 In one of his experiments he attributes an effect to the "sun's warmth," 
 in making the vessels ^^ dilate and contract a little." This is what he 
 means by " the energy of the root and stem." Had he adhered to that 
 explanation, and had he a competent knowledge of the physiological laws 
 of vegetable life, he would have had no difficult problems to expound, no 
 conflicting experiments, no contradictions of himself. Few Philosophers, 
 however, as little informed in the philosophy of organic life, have been 
 as accurate in their experiments, or more capable of reasoning upon the 
 facts, than Dr. Hales. But thus it ever is with all who depart from 
 their main field of operations to build up the difficult parts of other sci- 
 ences. Hales was a divine, and, although adroit in experiments, and 
 better qualified by impartial habits than the Chemist, it is no detraction 
 from his (or their) exalted merits to say, that he knew so little of Phys- 
 iology he was incapable of applying or even perceiving the facts which 
 the student of organic nature may readily seize and convert to the phi-
 
 Absorption. — appendix. — Circulation. 823 
 
 losophy of life, and turn against the conclusions of the original ob- 
 server (p. 923-925, Humboldt). 
 
 Am I not, therefore, entitled to conclude, from these few observations 
 alone, that organic beings are contradistinguished from inorganic by what 
 is popularly known as life, or vitality, and with the summary remarks of 
 one of the greatest scientific Botanists of the age. Professor Lindley, of 
 the London University, as expressed in his able analysis of the " First 
 Principles of Botany," that, 
 
 1st. " The movement of the sap depends upon a vital irritability, and 
 is independent of mechanical causes" (§ 185, 188, 188.^). 
 
 2d. " The proximate principles are formed by the vital powers of the 
 plant acting, in conjunction with air and light, upon the fluids contained 
 in its system." 
 
 3d. ^^ All the phenomena connected with the growth of plants are caused 
 by an inherent vital action" (§ 293). 
 
 § 1055, I shall conclude the foregoing subject relative to the circula- 
 tion in Plants (§ 1054) by a quotation from Liebig's '■' Reseaixhes on the 
 Chemistry of Food, and the Motion of the Juices in the Animal Bodyj'^ 
 as a farther justification of what I have said of the tampering of Chem- 
 ists with the philosophy of organic life, in former sections (§5, 276-i, 
 676 b, 1006 or, 1034, &c.), and that it may be compai-ed with § 350, ^3ar- 
 allel columns, and § 350J n. It will be seen that it is nearly the com- 
 mon doctrine relative to the evaporation by leaves in explaining the 
 circulation of sap, as propounded by Dr. Hales (§ 1054). Professor 
 Liebig infers the principle fi'om experiments made upon dried mem- 
 branes ! as he had formerly done of the circulation in Plants from the 
 action of "a lamp-wick" (§ 289). Having found the membranes pervi- 
 ous to water, oil, &c., he proceeds to say, in a letter to Professor Hors- 
 ford, republished in the '^ A^ner^ican Journal of Science and Ar-ts'^ (May, 
 1848, p. 415), and which I quote for the brevity of the conclusion, that 
 
 " The employment of these results upon the processes in the animal 
 body scarcely requires a more detailed explanation. 
 
 " The surface of the body is the membrane from which evaporation 
 goes constantly forward. In consequence of this evaporation, all the 
 fluids of the body, in obedience to atmospheric pressure, experience mo- 
 tion in the direction towards the evaporating surface. This is obviously 
 the chief cause of the passage of the nutritious fluids through the walls 
 of the bloodvessels, and the cause of their distribution through the body. We 
 know now what important function the skin fulfils through evaporation" ! 
 (§ 350 1, n-q.) Our Author did not even think so far as to consider the 
 perpetual vicissitudes of the skin in that respect, nor how wonderfully 
 the blood becomes concentrated in the great internal vessels in the sweat- 
 ing stage of the malignant cholera, or as the same phenomena distin- 
 guish a paroxysm of fear. It is also worthy of remark that this distin- 
 guished Leader in Physiology here loses sight completely of his universal 
 chemical doctrine of motion, which had been put forth in his " Animal 
 Chemistry" (§ 1054). It forms, therefore, another antagonism for the 
 Parallel Columns. 
 
 If we may have sometimes appeared deficient in dignified sobriety on 
 similar occasions, we have not thought it necessary to render an apolo- 
 gy, but Jiave relied implicitly upon the sympathy of intelligent readers ; 
 and while we have not laughed at the able Chemists who have taken 
 upon themselves the labour of persuading Physicians that animals are
 
 824 INSTITUTES OF MEDICINE. 
 
 only minerals, but rather at the latter, nor have been offended at the ar- 
 rogance which admits no penetration of the most hidden recesses of Na- 
 ture but through that veil of ignorance which betrayed the Crispin into 
 the immortal rebuke of Apelles, Ave have, nevertheless, in our zeal to 
 save something from the wreck, endeavoured to show that all the pre- 
 cepts of the Laboratory justify our application of that rebuke; nor do 
 we feel responsible for any risible consequences. 
 
 EXPERIMENTS BY MYSELF TO ASCERTAIN AVIIETHER THE QUANTITY OF 
 BLOOD CIRCULATING IN THE BRAIN MAY BE REDUCED ARTIFICIALLY. 
 
 § lOoG. As the question whether the bloodvessels of the brain may 
 be brought under the influence of bloodletting like those in other parts 
 of the body is intimately connected with the philosophy of the operation 
 of loss of blood, as set forth in these Institutes (§ 941, 950, 975, &c.), 
 and has an important bearing upon the treatment of inflammatory and 
 congestive affections of the brain (§ 971-980, «fcc.), I shall now introduce 
 some experiments which I made many years ago in reference to the sub- 
 ject before us. Whatever may be thought of the theoretical conclusions, 
 the experiments demonstrate that the brain is on common ground with 
 all other organs as it respects the "influences of bloodletting," and that 
 is the important end at which I am now inviting the attention of the 
 reader ; nor am I aware that the experiments have been invalidated. 
 They were communicated to Dr. James Johnson, Editor of the Medico- 
 Chirurgical Revieu\ London, in 1834, who published an abstract of the 
 Article in the April Number of the Review for that year, and which was 
 introduced by the following prefatory remarks : 
 
 " The Editor having received a long paper from Dr. Paine, of New 
 York, is unable to insert it in the Med. Chir. Revieio, into which no orig- 
 inal articles can be admitted, excepting some short cases or pieces of in- 
 telligence. The Editor, however, has had a short analysis of Dr. Paine's 
 paper drawn up, &c. J. J." 
 
 The following is an abstract of " the analysis :" 
 
 " Marked and conflicting differences of opinion prevail, relative to the 
 proximate cause of cerebral affections. These differences we may truly 
 ascribe to the widely opposite conclusions which Physiologists have ar- 
 rived at as to the functions of the brain, more particularly of the state 
 of its circulation. Dr. Paine instituted a suite of experiments to deter- 
 mine, if possible, the normal state of the brain, so far as information so 
 derived might be connected with its abnormal changes. 
 
 " That the bi'ain is naturally incompressible, he regards as an estab- 
 lished truth. But, with reference to the opinion that the cranium must 
 always be filled, he thinks ' the spaces which exist between the parietes 
 of the ventricles, between the membranes, the skull, the convolutions of 
 the brain, «S:c., are not necessarily occupied by a serous fluid, but must 
 be, in part, pervaded by an aqueous vapour, which is, of course, suscep- 
 tible of condensation, not only from the decline of caloric, but by any 
 power exceeding its force of expansion. And so, on the other hand, the 
 elasticity of the vapour will promote a reduction, by loss of blood, of 
 the contents of the cerebral bloodvessels to any extent. The existence 
 of such an elastic vapour is inferable from what is known to exist in 
 other cavities of the body, and from what is respired from the lungs. It 
 must, therefore, be far more strongly pronounced in the cavity of the
 
 The Brain. — appendix. — Experiments. 825 
 
 cranium in consequence of the exclusion of atmospheric pressure, except- 
 ing so far as this operates through the openings in the skull.' 
 
 " To get rid of sources of ambiguity, connected with the otherwise un- 
 determined question, whether such vapor existed naturally, or was pro- 
 duced during changes in the condition of the brain, experiments were 
 performed (on calves), so as to exhaust the system of its blood. With 
 the results of Ivellie's experiments Dr. Paine premises a statement of his 
 unacquaintance, but hazards a supposition that the animals may have 
 been so bled by Kellie as to occasion fatal syncope ' before the body was 
 deprived of the circulating fluid ; and that, as condensation of the vapour 
 has taken place after the death of the animal, the blood has rushed into 
 the brain to supply the vacuum. Such, indeed, would be a necessary 
 consequence of vapour so condensed, and of any blood remaining in the 
 aorta, the cava, or the great branches connected with those of the head. 
 For this reason we shall always find the cavity of the skull, in the hu- 
 man subject, fully occupied by solid and fluid matter, to whatever extent 
 depletion may have been carried, unless the patient may have been tre- 
 panned during life, or before any reduction of the natural temperature. 
 It does not, therefore, follow that vapour cannot have existed within the 
 cavity of the skull during life because it is fully occupied by incompress- 
 ible matter after death.' 
 
 " The calves were experimented upon in this way : The aorta near 
 the heart, or the descending cava, was opened, when so rapid was the 
 hemorrhage that the heart's action ended only on the vessels' being fully 
 emptied. Lest condensation of vapour should possibly have arisen from 
 reduction of temperature, the head was instantly removed after the ani- 
 mal died. On examination. Dr. Paine ^ uniformly found the vessels of tlie 
 brain and of the membranes nearly deprived of their contents, and the organ 
 perfectly blanched.'' No disproportion in the quantity of the blood was 
 observed, whether the animal had been trepanned, or the external air 
 excluded. The serum- exhibited only ' a tinge of red' when the brain 
 was opened up, and, therefore, there could be but very little blood in its 
 vessels, or those of the pia mater. Not more than half a drachm, and 
 'always quite as much when the animal had been trepanned,' was ob- 
 served in the sinuses of the dura mater. Calves were judiciously select- 
 ed in preference to dogs, being less troublesome, and probably less liable 
 to cerebral excitement during ' an operation requiring some dissection.' 
 
 " The cranial contents were determined by comparing their weight 
 with a bulk of distilled water equal to the capacity of the cavity. The 
 dura mater was not included, and its sinuses were not disturbed so as to 
 admit of the entrance of water. Here are the results : 
 
 oz'5. drs. prs. 
 
 1. Brain — skull trepanned 10 4 20 
 
 Water — distilled 10 4 lo 
 
 2. Brain — skull trepanned 9 4 25 
 
 Water — distilled 9 2 
 
 3. Brain — skull trepanned 10 3 26 
 
 Water — distilled 10 2 'g 
 
 1. Brain — skull entire 11 1 5 
 
 Water — distilled 10 7 20 
 
 2. Brain — skull entire 10 6 10 
 
 Water — distilled 10 4 50 
 
 3. Brain — skull entire 10 2 40 
 
 Water — distilled 10 52 
 
 "On injecting quicksilver into the human brain an equal bulk of 
 bloody serum was always expelled. The average quantity of quicksil-
 
 826 INSTITUTES OF MEDICINE 
 
 ver, on injection into the brains of animals bled to death, was 'two 
 pounds in brains weighing ten ounces' (fx) ; the sinuses of the dura 
 mater admitted the maximum of this proportion. 
 
 " If these experiments be correct,* and otherwise trustworthy, less 
 blood circulates within the head than has been supposed ; and the amount 
 of sanguineous effusion has probably been overrated, unless the ratio be 
 higher in the human species. 
 
 " Independently of the experiments, Dr. Paine thinks that we are 
 authorized in believing the circulation within the substance of the brain 
 to be slow, and the quantity of blood small. As the organ chiefly fills 
 the cavity, little space only can be allotted to the membranes, and still 
 less to theh" chief vessels. The experiments sustain the conclusions de- 
 rived from anatomical facts, that the quantity of blood is much more 
 reduced than has often been conjectured. The very sparing provision 
 of absorbents with which the brain is provided is ' a negative argument,' 
 in Dr. Paine's opinion, ' that the brain has less use for blood ^han other 
 parts of the system, where these vessels abound.' ' To obtain a slow 
 circulation, an abundant and equable supply of blood was required ; we 
 find this provision made. Are not those vessels large and powerful, 
 which convey blood from the aorta to the confines of the brain ■? And 
 do we not see the brain carefully protected against the force of its own 
 circulation V Here we cannot but admire the philosophic views enter- 
 tained by Dr. Paine, which, howevei', the necessary limits allotted to his 
 Article only permit us thus to glance at. — Kote O p. 1121. 
 
 " The rate at which the blood circulates in the membranes is inferred 
 to be much more active than that within the proper substance of the 
 organ ; the bulk of transmitted blood being confined to the membranes. 
 Yet, from the tortuous coui'se of their vessels, the circulating fluid must 
 pass slowly compared to its progress in other great organs. It is prob- 
 able, too, from such considerations, that in health the proportion of serum 
 varies. If so, a variable state within the cranium is denoted ; and the 
 normal proportion of blood being ever, probably, nearly the same, it fol- 
 lows, in Dr. Paine's opinion, that ' any preternatural space must have 
 been occupied by vapour.' In accordance with the results of our Au- 
 thor's experiments, we have these principles deduced for practical guid- 
 ance, that 
 
 '* ' Blood may be abstracted from the brain in the same manner and 
 to the same extent as from other organs. 
 
 " ' That there takes place necessarily an active contraction of the blood- 
 vessels of the brain, as the exhaustion of their blood follows equally when 
 the external air is not admitted within the cavity of the cranium. 
 
 " ' That there must be a production or expansion of aqueous vapour 
 corresponding in bulk and elasticity with the diminished quantity of 
 blood and the decrease of pressure from the force of the heart and blood- 
 vessels. 
 
 " ' That the natural proportion of blood found in the brain, after its 
 copious abstraction from the system, arises from a quantity still remain- 
 ing in the vessels connected with those of the head, and which rushes 
 into the brain after death to supply the vacuum produced by the con- 
 densation of the vapour generated during the contraction of the cerebral 
 vessels.' 
 
 " Dr. Paine argues that the living system is under the government of 
 uniform laws. Universal contraction of the bloodvessels — a contrac-
 
 The Brain. — appendix. — Experiments. 827 
 
 tion greater in the extreme vessels than what is explicable by the mere 
 loss, is observed to be attendant on the abstraction of blood (§ 746 a, 912, 
 931, 935 b-e, 938 h, 944 a-c, Sec). Is not a similar contraction ex- 
 tended to the vessels of the brain, not less from the withdrawal of blood, 
 than likewise ' through the influence of sympathy with the vascular ac- 
 tion throughout the Ijody, an influence rendered still more probable by 
 the propagation of the sympathetic nerve along the arteries of the brain ; 
 that the topical abstraction of blood by cupping and leeching, if not also 
 vesication, operates by producing a sympathetic contraction of the ves- 
 sels within the brain ; that inflammation of the brain is relieved on a 
 common principle ; and that opposite inferences would involve the re- 
 markable exemption of a part from the operation of general laws, and 
 a violation of the usual simplicity of Design?' (§ 51C d, 756 b, 893 a-i, 
 915-921, 939, 974, 1039) Note Q p. 1122. 
 
 " The varying changes in the circulation of the brain renders proba- 
 ble the existence of an elastic vapor. This, it is inferred, is rendered 
 yet more probable from the rapid production of vapor when the temper- 
 ature is at 98^ F., atmospheric pressure being removed, which must be 
 greatly the case within the cranium, and allowing, also, for ' the resist- 
 ance of the circulating fluid,' ' Equal increments of temperature, by in- 
 creasing in geometric progression the force of vapor, would tend to em- 
 barrass the functions of the brain. But an admii-able provision of 
 Nature guards against the occurrence of such casualties.' As the bony 
 inclosure excludes the influence of atmospheric pressure, minus the open- 
 ings at the base of the skull, ' the generation of an elastic vapor is pro- 
 vided, the pressure of which at 98° F. to the ratio of steam at 212°, is 
 as If to 30. It will therefore admit of an easy condensation, such prob- 
 ably as would be produced by an inci'eased determination of blood to 
 the head, and more especially by blood extravasated;* and however the 
 general force of the circulation may be undetermined, it is abundantly 
 obvious, from the tortuous course of the vessels, and their minute subdi- 
 vision before entering the substance of the brain, that the current is here 
 sluggish and easily resisted, even if it be admitted that capillary circu- 
 lation depends upon the vis a tergo, as it does not (§ 392, c). It will not, 
 therefore, be difficult to imagine that there exists this farther harmoni- 
 ous relation, by which the ordinary force of the circulating fluid is ac- 
 curately counterbalanced by an aqueous vapour.' 
 
 " The minute subdivision of vessels before entering the substance of 
 the brain-^the obstacles checking the impetus of blood from the heart's 
 action — the absence of valves in the cerebral veins — the remarkable dis- 
 tribution of the sympathetic rierre, &c., are, in Dr. Paine's opinion, so 
 man^ powerful motives for believing that the circulation in the brain is 
 especially dependent on a specific action of the vessels themselves (§ 392 c, 
 &c.). The experiments tend to show that, if vapor exist naturally, its 
 quantity must be small. A small quantity, however, is quite sufficient 
 for meeting the exigencies of its purpose. The vapor may yet be found, 
 it is supposed, by subsequent inquii'ers, to enact a most influential part 
 in the cerebral economy, its great compressibility admitting of rapid 
 changes in the quantity of circulating fluid ; and by which, ' in severe con- 
 gestions, mechanical pressure is partly obviated, and the circulation less 
 embarrassed in portions of the organ not involved in disease.' 
 
 " If the production of vapor under the most probable circumstances 
 could be established, ' the uniformity of Nature, upon the questions be- 
 
 * In no other way can the largest quantities of extravasated blood be explaiqed.
 
 828 INSTITUTES OF MEDICINE. 
 
 fore us, would be recognized. No longer would there exist any neces- 
 sity of forming new doctrines to explain analogous changes which have 
 acquired the force of established laws among other organs; the treat- 
 ment of cerebral congestion or inflammation will be again placed on the 
 broad principle which determines the treatment of similar affections in ev- 
 ery part of the body ; and when the organ becomes the subject of venous 
 plethora or of high vascular action — when the carotids are beating with 
 a violence that communicates motion to the head, while the pulse in the 
 extremities is low, feeble, and oppressed ; when also the skin is cold, and 
 the blood, which may not be determined to the head, is accumulated 
 about the abdominal viscera, and the heart pulsates with exhausted ef- 
 forts, we shall be no longer obliged to adopt the difficult rationale, that 
 the abstraction of blood diminishes the violence of action in the brain by 
 its impression on the vis a tergo. We shall see it exerting its influence 
 on the vessels within the brain, as it obviously does on those of the abdom- 
 inal viscera which may be simultaneously affected by congestion ; we 
 shall not doubt that it equally induces a change of action in the vessels 
 attended by their contraction, in all the organs that may be involved 
 in analogous affections ; and we shall the more readily assent -to this 
 proposition and abandon the notion of a diminished vis a tergo, when we 
 find, as these changes progress, the pulse rises in strength and fulness, 
 and the heart beats with moi'e than natural energy; which now, indeed, 
 may require the farther abstraction of blood to lessen its violence and 
 remove the evil it originally produced ; now, indeed, the vis a tergo may 
 become a motive for continued depletion' (§ 498/, 750 a, 801, 806, 811- 
 813, 961 e, 965 h, 968, 969 c, 990 ?'). 
 
 " From a lengthened paragraph of highly ingenious reasoning, Dr. 
 Paine draws a corollary — that the force of the momentum of the circu- 
 lation within the brain may be determined ' with an approach to accu- 
 racy,' and that its force must be ' nearly in the ratio of the expansion 
 of vapor at 98° Fahrenheit, removed from atmospheric pressure.' " 
 
 Although the writer of the abstract is pleased to say that " with one 
 other extract we must reluctantly conclude this notice," I shall not re- 
 peat it here, and have omitted other parts, as not being immediately rel- 
 ative to my present objects. 
 
 But I will add, in conclusion, that Bonder has seen the arteries of the 
 pia mater contract when the cervical sympathetic nerve is irritated. 
 The brain was, of course, exposed ; but if contraction take place undei' 
 such circumstances, it is a law which must operate in the natural con- 
 dition. — Bonder's Physiologie des Menschen, p. 138, 140. 
 
 SEDATIVES. 
 
 § 1057,0. It will be seen in these Institutes, that, immediately follow- 
 ing the general subject of Therapeutics, and preceding that of the Modus 
 Operandi of Remedies, and extending from page 563 to 660, are disqui- 
 sitions upon the uses of various groups of the Articles of the Materia 
 Medica, and that among the number are Narcotics, which are considered, 
 in part, in their aspect as Sedatives. It is now my purpose to make 
 some general comments upon the virtues, and mode of operating, of the 
 entire group of Sedatives, and upon the differences which prevail among 
 the several members of the group (See, particularly, p. 583-593). 
 
 I understand by Sedatives those remedies whose general tendency is to 
 diminish vascular action in a direct manner ; though in some instances
 
 Tlierapeutics. — appendix. — Sedatives, 829 
 
 they may at first produce more or less excitement, which is followed by 
 diminished action as an ultimate result of the remedy (§891, q). Nay 
 more, the excessive application of the most powerful Sedatives — loss of 
 blood, narcotics, hydrocyanic acid, and cold, may light up inflammation 
 or venous congestion in the brain, whilst they simultaneously exert their 
 general sedative eftects upon the system at large until the cerebral affec- 
 tion gives rise to constitutional excitement (§ 743, 817, 827 c7, 950, 974 h, 
 1024). The various aspects of the modus operandi may be seen in ^ 891-|- k. 
 
 These opposite effects, however, are not common, nor is the excite- 
 ment ever strongly pronounced unless the sedative proves morbific. In 
 the extensive class of Stimulants and Tonics we are presented with 
 agents which illustrate, by their opposite virtues, the common attributes 
 of the Sedatives ; since it is the direct and equally uniform tendency of 
 the former to increase vascular action in a direct manner. As examples 
 of the two Classes, bloodletting, antimonials, hydrocyanic acid, and cold, 
 may be I'eckoned as standards of comparison for Sedatives, and alcoholic 
 liquors, spices, mints, the vegetable and mineral tonics, animal food, and 
 dry heat, as representing the virtues of Stimulants. 
 
 There are many things, however, which may increase vascular action, 
 and induce inflammation, which operate in virtue of some irritation they 
 exert (such as aloes, scammony, &c.), but whose action is very different 
 from that of stimulants. Indeed, tlie most powerful Sedatives, as we 
 have seen, may become irritants in excessive amount, and excite inflam- 
 mation. But they can never act as Stimulants in the proper accepta- 
 tion of this class of agents, but in virtue of morbific influences of an irri- 
 tating nature. Irritants produce disease when Tonics will not(i5> 188-191). 
 
 It appears, therefore, that Sedatives are liable to the same qualifica- 
 tions as we have seen of the groups of other remedies, being liable to be 
 more or less otherwise unless rightly administered. This qualification 
 is more strongly manifested in morbid than in healthy states of the body. 
 There must be a pathological condition which shall be in relation to the 
 peculiar virtues which are denominated sedative, or no sedative effect 
 may arise from the action of the remedy, and even an opposite result 
 may be the consequence, as often witnessed of opium when administer- 
 ed in high states of arterial excitement. And I am now led to remark 
 that the tei'm Sedative, like many other denominations of remedies, is 
 very far from conveying an adequate apprehension of the effects pro- 
 duced ; for the agents so called not only reduce the properties of life, 
 and lessen vascular action, but they exert more or less of a direct alter- 
 ative effect. That effect is most distinctly marked when they aggravate 
 or produce disease. (See Index, Article Alteratives.) 
 
 § 1057, b. Again : various Sedatives will be far from being suited to 
 many conditions of disease, when others of the group may be in the high- 
 est degree salutary. Take two of the most powerful. Loss of blood, 
 for example, will often save life where opium would be destructive ; and, 
 vice versa, opium will relieve the subject of gastric spasm induced by 
 drinking cold water, when loss of blood might destroy him. Even in 
 some conditions of inflammation, remedies which are commonly stimu- 
 lating and tonic will prove sedative when bloodletting may be at least 
 useless. Such is the case in intermittent inflammation, after suitable de- 
 pletion ; since Cinchona may then succeed, when loss of blood, antimo- 
 nials, &c., have ceased to be curative (§ G62 b, 675, 892 m-p). This 
 consideration brings up the importance of looking well at the patholog-
 
 830 INSTITUTES OF MEDICINE. 
 
 ical distinctions among closely-allied diseases, inasmuch as Cinchona, 
 and many other agents of active tonic virtues, are directly sedative (by 
 their alterative action), in suitable states of the system, in intermittent 
 fever, Avhile they aggravate all other fevers at the same early stages ; 
 and it is only the intermittent form of inflammation, and those venous 
 congestions which have peculiar miasmata for their predisposing causes, 
 in which Cinchona would not also prove stimulating. So far, therefore, 
 the foregoing tonics belong to the group of Sedatives ; and they show us 
 the difficulties of artificial arrangements of the Materia Medica. These 
 arise mostly from the compound virtues of remedies, and often, as in the 
 case before us, from certain important virtues being developed only by 
 special pathological conditions ; for, it is not the tonic, but the febrifuge 
 virtue of Cinchona, and analogous remedies, which does the service in 
 ihtermittents. The latter is then so completely in relation to the spe- 
 cial modifications of disease that it transcends or counteracts the mor- 
 bific action of the former (§ 150-151, and references there). 
 
 § 1057, c. In my ^'' T her a2'>eutical Arrangement of the Materia Medica^'' 
 I have given a rather different import to the group of Sedatives than is 
 common, having placed them as a special order of Antiphlogistics. The 
 group is composed of such as are most capable of subduing general arte- 
 rial excitement in a direct manner, though some of them may be little 
 suited to the relief of local excitement. Thus, the narcotics, when just- 
 ly applied, reduce the irritability of the whole system, and moderate 
 general excitement. But they have no great tendency to assuage local 
 inflammations, but, on the contrary, their tendency is more frequently to 
 increase them. In the arrangement, therefore, of the Sedatives accord- 
 ing to the restricted sense in which I have employed the term, I have es- 
 timated their therapeutical value according to their greatest usefulness 
 in allaying morbid irritability and sensibility, particularly the former, 
 in their appropriate relations to certain conditions of disease. 
 
 § 1057, d. We may next proceed to regard Sedatives under five ^xih- 
 dW\^\ox\s, r\^Ti\Q\y, Sedatives proper ; Narcotics; Cold; Alteratives capable 
 of nauseating, but without producing that effect; and Nauseants. 
 
 The first subdivision, or Sedatives proper, comprises Loss of Blood, 
 Plydrocyanic Acid, Cyanide of Potassium, Cyanide of Zinc, Ferro-cya- 
 nide of Potassium, Cherry Laurel, Bitter Almonds, Hydrosulphate of 
 Ammonia, Foxglove, Tobacco, Indian Tobacco. 
 
 The second subdivision, or Narcotics, embraces Opium, and its prepa- 
 rations as arranged in the order of their therapeutical value, Henbane, 
 Poison Hemlock, Lupuline, Lactucarium. Add also the '■'■ Senso-Para- 
 lysants" — Belladonna, Aconite, Stramonium, and Delphinium.* 
 
 The third subdivision consists of Cold only, and in its local action. 
 
 The fourth subdivision consists of Tartarized Antimony, to which Ip- 
 ecacuanha might be added. 
 
 The fifth subdivision, or the Nauseants, refers to such agents as are 
 sedative only when they produce nausea. There are many of this de- 
 nomination, but none of them are of much use in medicine as nauseants ; 
 but, on the contrary, they arc apt to produce an injurious irritation of 
 the gastro-intestinal mucous membrane when carried to the extent of 
 nausea. They are, therefore, not specified in our group of Sedatives. 
 
 § 1057, €. Now, there are certain well-marked analogies among all 
 the foregoing subdivisions, yet each differs from the others in some very 
 prominent characteristics. Indeed, there are no two of the remedies, 
 * See Note Nn p. 1141.
 
 Therapeutics. — ^appendix. — Sedatives. 831 
 
 however allied os Sedatives, which do not present some strong peculiari- 
 ties. Take, for example, the first two of the first subdivision — loss of 
 blood and hydrocyanic acid. These are the most immediate and power- 
 ful sedatives, in our acceptation of the term, yet each has its own pecu- 
 liar mode of reducing irritability and vascular excitement, nor do they 
 modify irritability and vascular action alike. .Each, however, as with 
 all other Sedatives, depresses irritability and action, and this is the only 
 stronf point of resemblance. The special differences consist in the dif- 
 ferent modes in which each Sedative alters irritability and action in their 
 kind (§ 854, 895-901 ; also Indexes, Alteratives). It is an ignorance or 
 neglect of this philosophy, and too often a contempt of all inquiry into 
 the modus operandi of remedies (shut out, indeed, by the prevailing chem- 
 ical doctrines of disease), which leads to a vast amount of malpractice, 
 and, in respect to the most important of the agents now before us, which 
 has prompted the substitution, in otherwise enlightened quarters, of opi- 
 um, digitalis, tobacco, aconite, veratrum viride (§ 891 c, 960 a, 1065) — 
 ay, even stimulants and tonics, for loss of blood and tartarized antimo- 
 ny, and often, too, where bloodletting is indispensable to life. — Note H. 
 
 Besides what has been now said of the more prominent distinctions 
 among Sedatives, there are others less distinctly marked among such of 
 the agents as are most nearly allied, as the Narcotics. These, however, 
 have been already indicated under the subjects of Narcotics, Therapeutics, 
 Vital Habit, &c. But it is more remarkable that some of the Sedatives 
 which have no point of resemblance, except in their effects upon morbid 
 conditions, bring about alterations, or changes in kind, of a con-espond- 
 ing nature ; as loss of blood and tartarized antimony, for example, in 
 their subversion of inflammation and fever. But the same remarkable 
 characteristic is strongly pronounced among many other remedies ; as in 
 the control which Cinchona, Arsenic, and Cobweb exert over Intermit- 
 tent Fever (§ 892 aa-c, 900, 904 c, &c.).— See Note Ee p. 1133. 
 
 § 1057,/. It is commonly said that " Sedatives exert their effects es- 
 pecially upon the nervous system." But this is far from being the case 
 with loss of blood and the antimonials, and only in a restricted sense as 
 regards those agents which have the greatest relation to the nervous sys- 
 tem. The nervous power is certainly involved throughout. But this is 
 also true of all other agents whose effects reach beyond the direct seat of 
 their operation. All exert their primary action upon the parts to which 
 they are applied ; and when the nervous power is brought into opera- 
 tion, it is, as extensively set forth in these Institutes, by a transmission 
 of the remedial influences to the nervous centres, and a consequent de- 
 termination of the nervous power either upon the organic constitution 
 of the brain or of other parts. If the action be exclusively local, the 
 nervous system participates only as a part of compound tissues, not by re- 
 flex action unless through local centres (§ 746 c). True, this doctrine has 
 no relationship to those physical ones which render the Science of Medi- 
 cine as simple and mechanical as the business of a shoemaker. 
 
 But, do not some of the Sedatives affect particularly the nervous sys- 
 tem, its central parts especially, just as other agents affect particularly 
 other parts, as cantharides the bladder, ergot the womb ? &c. Certain- 
 ly ; and this is especially true of the Narcotics. In excessive doses their 
 main fury is expended upon the organic constitution of the brain, and 
 venous congestion of that organ is one of the invariable consequences. 
 But this is effected through a very different process from what has been
 
 832 INSTITUTES OF MEDICINE. 
 
 hitherto supposed. The result is partly due to the reflex action of the 
 nervous power, in a modified condition, upon the capillary vessels of the 
 brain and spinal cord, but also more or less upon the heart, the stomach, 
 &c. (§ 228, 230, 508, 509, &c.). The intensity of the general effects 
 upon the system at large will often depend more upon the determination 
 of the nervous power uppn important organs i-emote from the brain, than 
 upon the amount of influence exerted by the nervous power upon the 
 organic properties of the brain and spinal cord. The general reflex ac- 
 tion may be so sudden and violent, as in the case of hydrocyanic acid, 
 that it shall destroy the life of the heart, the lungs, &c., without leav- 
 ing a trace of its influence upon the brain ; as is seen, also, in sudden 
 deaths from blows upon the epigastric region, surgical operations, &c. 
 (§ 470^ h, 508-510, 828 c, 904 b). At other times, as with opium, the 
 remote effects may depend much upon the morbid change which the 
 agent may establish in the nervous centres. But, in its ordinary me- 
 dicinal doses, opium exerts no such morbific effect upon the nervous sys- 
 tem ; when it rouses and modifies the nervous power in degrees of in- 
 tensity which are not morbific (if the remedy be properly adapted to the 
 pathological conditions), and in the same general way as all other reme- 
 dial agents, but in a way, also, both as to degree and modification of 
 the power, peculiar to the virtues of the narcotic (§ 227-229, and refer- 
 ences there). It is this special modification of the nervous power, and 
 its reflected alterative action upon various parts, which lessens and oth- 
 erwise modifies the irritability, sensibility, and, of consequence, the or- 
 ganic actions, of all parts of the body (§ 891^ k^ 893 o, c, 904 a, ft, 1059). 
 
 § 1057, (J. Cold is generally local in its operation so long as it is con- 
 fined to a limited portion of the surface of the body, and it is scarcely 
 beyond this local elFect that its operation as a sedative is witnessed. Its 
 reflex nervous actions are mostly of a stimulating nature. In its local 
 aspect it operates alone upon the organic constitution of the part, as 
 seen in its effects upon superficial inflammations. But there are remark- 
 able reflex influences, as when a current of cold air striking the neck 
 or chest occasions rheumatism, catarrh, pneamonia, &c., or when ex- 
 posure of the feet to cold arrests menstruation.* There is, also, a still 
 more remarkable and very uniform effect of this reflex nervous action, 
 but not of a moi'bific nature, in suddenly increasing the excretion of 
 urine ; and if with this phenomenon be associated the powerful effect 
 of fear as a diuretic (§ 892 J ft), there will be seen a display of results 
 which demonstrate the analogy between physical and mental causes and 
 the nervous power, and how the latter is developed by the former and 
 participates as an exciting or modifying cause in all the remote effects 
 (§ 224-227, 233i, 475^, 493 cc). Again: Avhen cold operates with 
 great intensity upon the whole surface of the body it occasions lethargy 
 and venous congestion of the brain. The pliilosopiiy is the same as when 
 liydrocyanic acid produces cerebral congestion. (See Essay on the gi-eat- 
 er action of Cold, in Med. and Physiolog. Comm., vol. ii., p. 590-602.) 
 
 The great variety of effects which Cold is capable of producing, be- 
 sides those to which I have adverted, such as its invigorating influences 
 when applied in the form of a shower-bath, both in health and many 
 chronic maladies, &c., are among the plain things which illustrate the 
 important agency of the nervous power in transmitting the influences of 
 remedial agenls from the direct seat of their operation to distant parts, and 
 show us how readily and with what intensity this power may be brought 
 
 * See also Brown-Suquard's experiment of immersing the Land in cold water, p. 807, 
 § 1044.
 
 Therapeutics. — appendix. — Ccistor Oil. 833 
 
 into operation bj any of the substantial agents of the Materia Medica, 
 or by morbific causes, while its universal manifestations in healthy states 
 of the body, or as disease of one part gives rise to disease in other parts, 
 establish the philosophy of our whole subject upon one common physio- 
 logical ground of alterative reflex actions of the nervous system. 
 
 § 1057, h. I have placed Tartarized Antimony in a subdivision by 
 itself, though many would probably arrange it with the Nauseants. But 
 the former produces very powerful sedative effects without exciting 
 nausea, as seen in the manner in which inflammations and fevers yield 
 to its quiet influence. But the principles concerned are exactly the 
 same in all the cases ; thougli great vai'iety arises throughout the whole, 
 even in respect to each individual agent, and according to its dose, the 
 frequency of administration, the precise pathological condition, the na- 
 ture of the organ affected, and many other modifying contingencies. As 
 it respects Tartarized Antimony, its influences involve a very important 
 modification of the simply sedative principle. This is its alterative 
 power, and by which it is rendered of the highest value in the treatment 
 of diseases (§ 150-151, 841, 857, 863 d, 892| g, 902 g, 904 hh, 476^). 
 
 § 1057, i. Finally : the group of Sedatives is designed mainly to bring 
 into connection a number of remedies Avhich have certain important 
 analogies, but variously and often greatly distinguished from each other, 
 that they may be considered comparatively; with a view to enlarging our 
 knowledge of the relationship of remedies, their points of difference, their 
 modes of operating, &c. It is, however, more artificial than any other 
 group, and is of very little use for practical purposes. 
 
 The Sedative Effects of Cotton-wool and of Castor Oil- 
 
 § 1057, Ic. In connection with the foregoing subjects, I shall briefly 
 indicate certain apparently sedative virtues belonging to common Cotton 
 and Castor Oil, as resulting from my own experience. 
 
 In the edition of my Materia Medica and Therapeutics of 1848, I re- 
 marked that 
 
 The virtues of Cotton-wool appear to be more than of an ordinary me- 
 chanical nature. It is evidently alterative as well as quickly sedative ; 
 and, doubtless, these remarkable effects are owing to some very peculiar 
 mechanical influence. The Author has employed it with the happiest 
 effect in poisoning by the Rhus toxicodendron ; particularly in his own 
 person, whei-e the hands and arms were severely inflamed, swollen, and 
 deeply ulcerated. The relief from suffering was immediate, and the 
 dressing was not removed till restoration had become complete. The 
 case had baffled other remedies. 
 
 I know not whether the remedy has been submitted by others to trials 
 beyond its well-known uses in burns and scalds, excepting by Mr. Jones 
 in cases of ulcers, who appears to have derived the same benefit from it 
 as myself (in London Lancet, Dec, 1850). 
 
 Very lately I had in charge an obstinate ill-conditioned ulcer upon a 
 highly varicose leg of a lady of delicate health, attended, also, by an in- 
 tense cutaneous inflammation surrounding the central half of the limb 
 from the knee to the ankle, and which was studded over with a crop of 
 suppurating eruptions. There was also a painful sense of burning and 
 itching. Failing of all relief from the usual remedies, excepting a mod- 
 eration of the sense of burning and itching from cold bread and milk 
 poultices, I resorted to the cotton- wool, the effect of which was rather 
 
 Ggo
 
 b34 INSTITUTES OF MEDICINE. 
 
 astonishing. The painful sensations were immediately removed, and the 
 cure completed in about a week, though a dry, thick, hard scab had then 
 formed uj^on the ulcer, which became detached in five days afterward, 
 when an elastic silk stocking was applied to the varicose limb. This oc- 
 curred in the hot weather of June. 
 
 A large mass of the wool should be applied, so as to form at least an 
 inch in thickness when bound down by a bandage ; and thus far in my 
 experience it should not be disturbed till there is reason to think that 
 it has fulfilled its purpose. But, having never been in pursuit of new 
 remedies, my experience in this particular is less than it otherwise would 
 have been. I think, however, that there can be no doubt of the great 
 superiority of cotton-wool to other means in the foregoing and analo- 
 gous affections, even if it be necessary to remove the dressing frequently, 
 as in cases of inflamed and chapped nipples. But even in these cases 
 the cotton should be closely applied by means of a bandage. In the 
 case of ulcers, it appears not to be of much importance that they should 
 be in a favorable state for healing, though I regret that I have not tried 
 the remedy in any of an eroding or malignant nature. It should be 
 said, however, that the co-operation of constitutional means must often 
 be necessary in the unfavorable cases which are not malignant, and that 
 in the latter we may hope for only a palliating effect. 
 
 § 1057, 1. Of Castor Oil I remarked, in the same Avork, that the Au- 
 thor called the attention of the Profession to the special alterative influ- 
 ences exerted by Castor Oil upon the Liver in his Letters on tlie Cholera 
 Asphyxia of New York, and again in the Medical and Physiological Com- 
 mentaries, and the alterative virtues of this remedy appear now to be ex- 
 tensively appreciated. I also said that, when frequently repeated (as 
 every day, or every other day), it is commonly necessary, and pretty 
 early, to reduce the quantity from one or two table spoonfuls to a tea- 
 spoonful, or even to a fourth of a teaspoonful, the remedy being remark- 
 ably cumulative in its effects. This is greatly owing, however, to the, 
 specific action of Castor Oil upon the Liver, and the consequent in- 
 creased production of bile. It is often peculiarly efficacious when ex- 
 hibited a few hours after calomel or blue pill ; is very useful to over- 
 come habitual constipation, on account of its alterative action upon the 
 Liver, when it should be given in small doses every evening (§ 556 b, 
 889 in, mm). Other comments follow upon its important uses as a ca- 
 thartic for children, and for pregnant Avomen, and in dysentery, scarlet 
 fever, chronic hepatic affections, &c., and after convalescence from acute 
 diseases, but always in such carefully regulated doses as shall not pro- 
 duce intestinal pain and mucous discharges. When thus regulated in 
 dose, its specific action upon the liver in inducing a free secretion of 
 bile is greater, in a general sense, than calomel or blue pill, and very 
 often more usefully alterative (§ 857). It cannot be too strongly insisted 
 that the dose should be accurately adjusted to the existing condition of 
 the intestines. If it produce griping, or frequent or mucous discharges, 
 the dose has been too large, and the useful effects of the remedy will 
 have been lost, or disease may be aggravated, especially if seated in the 
 alimentary canal. — See, as to mercurials and the liver ^ 1058 b. 
 
 1 now come to the special object of this paragraph — the soporific vir- 
 tue of Castor Oil, and this I shall present in an extract from my Lectures. 
 Thus : 
 
 There is another remarkable peculiarity about Castor Oil, which, like
 
 Therapeutics. — appendix. — Alteratives. 835 
 
 its special action upon the liver, and its cumulative effects, you will not 
 find in the books. It is that of exerting a soporific wfluence ; often calm- 
 ino- restlessness, both in children and adults, soon after its exhibition. 
 Nor does it, like many other cathartics, excite the general circulation 
 in active forms of inflammation and fever, where bloodletting is not pre- 
 mised, if given in proper doses (§ 871). And, on account of its anodyne 
 and soporific effects, I often exhibit Castor Oil in the evening in cases 
 where I should delay all other cathartics, unless the mercurial, till morn- 
 ing (§ 863 f/, 889 n). But it should be borne in mind that Castor Oil, in 
 full doses, is apt to operate within four or six hours after its exhibition, 
 and therefore, if given early in the evening it should be in such moderate 
 quantities as may not be likely to disturb the rest of the patient by its 
 cathartic effect before morning (§ 889, n). Having always observed this 
 precaution in my practice, I have generally left instructions to repeat 
 the same dose if necessary, or often a smaller one, at some hour in the 
 morning, or, perhaps, only an enema of warm water. I have thus found 
 the dose administered in the evening to have been very useful, though it 
 have not operated as a cathartic. At other times, both in acute and chron- 
 ic diseases, I have administered small doses of the Oil (as a teaspoonful 
 or less), at intervals of four to twelve hours, with the intention of delay- 
 ing a cathartic effect till some two or three doses shall have been admin- 
 istered — for the sake of its slowly alterative action upon the liver and 
 intestines (§ 857, 859 a, b, 863 d, 873, 902 i, 905 a). This method is pur- 
 sued in susceptible states of the intestines, and often in the advanced 
 stages of all diseases, and during convalescence. The ultimate result is 
 generally a copious production of bile. 
 
 ALTERATIVES. 
 
 § 1057A. It will be seen, by referring to Indexes, that the subject 
 of this article has been variously discussed in its relation to particular 
 remedies ; and I shall now make some general remarks upon the group 
 of Alteratives as assembled in the Author's Materia Medica and Thera- 
 peutics. 
 
 Many of these agents are derived from groups that bear other denom- 
 inations ; as some of the best, for example, are included among the Ca- 
 thartics and Emetics. But many of them belong alone to the group 
 before us ; and such of them as occur among remedies of other denom- 
 inations are reduced to the group of Alteratives merely by their dimin- 
 ished doses and greater frequency of exhibition. And, although these 
 last are, respectively, the same substances under different denominations, 
 they are very different remedies, in certain practical respects, as they 
 may stand in one group or another ; though they may act upon disease 
 in a more or less corresponding manner in whatever doses they may be 
 employed. 
 
 But there is a general characteristic belonging to the so called Alter- 
 atives, as intended in this work, which assembles them into a group. 
 That characteristic is their insensible operation compared with the mem- 
 bers of other groups ; and their action is to be appreciated only through 
 certain inconsiderable phenomena, and through the subsidence of disease 
 under their quiet influence — as when arsenic, or quinine, or cobweb 
 operate in the cure of intermittent fever. When other remedies belong- 
 ing to this group produce some j^rominent local effect, or are more ser- 
 viceable in their operation in certain large therapeutical doses, they are.
 
 836 INSTITUTES OF MEDICINE. 
 
 in such cases, ranked under other denominations. Such is the case, for 
 example, with tartarized antimony and ipecacuanha, which, in certain 
 therapeutical doses, operate powerfully as emetics ; whilst, in their ac- 
 ceptation as Alteratives, their doses are comparatively small and often 
 repeated, so that they operate in an insensible manner, though their 
 essential influence upon morbid states may be the same in whatever 
 doses employed. In one case, or by their emetic action, they may pro- 
 duce sudden and great influences upon morbid conditions, alter them 
 very speedily, and place them at once in the way of their natural return 
 to a state of health. In the other case, or when employed in their small 
 and repeated doses, they bring about the same salutary changes or alter- 
 ations without exciting even any nausea (§ 516 d, No. 6, § 902^). It is 
 therefore evident that these substances, like many others of the group of 
 Alteratives, may be, in reality, more immediately and profoundly alter- 
 ative when employed in full doses, as Emetics for example, than in their 
 small doses under the denomination of Alteratives. But it is also true 
 that both tartarized antimony and ipecacuanha are curative of a vastly 
 greater range of diseases in their small and frequently repeated doses 
 than when administered as Emetics. It is also readily apparent that 
 the same general remarks are equally applicable to calomel, blue pill, 
 colchicum, &c., which are cathartic in certain doses, but powerfully, 
 though more slowly curative in such small doses as do not produce purg- 
 ing, and which, therefore, in these small doses, I call Alteratives. 
 
 There are many things, however, which are as insensible in their op- 
 eration as our group of Alteratives that are not included in this group, 
 particularly the Tonics and Astringents. But the remedies belonging 
 to these denominations are very peculiar in their effects, which are a 
 good deal allied as the remedies may belong to one denomination or the 
 other. This common characteristic serves, therefore, as a basis of ar- 
 rangement for either group. But, in the case of the Alteratives, the 
 want of any general correspondence in the immediate effects of its sev- 
 eral members (with certain exceptions which are grouped into subdivi- 
 sions), and the absence of any direct and well pronounced result, have 
 led to this denomination. 
 
 It is thus seen that the denomination of Alteratives belongs properly 
 to all positive remedies, since it implies the absolute effect of all agents 
 that are truly remedial, whether physical or the salutary emotions. That 
 is to say, they produce such alterations of the morbid conditions as en- 
 ables Nature to accomplish the cure, or, more critically, the morbid 
 organic states are so altered to a condition less profoundly morbid, as 
 enables them to return spontaneously to their natural type (§ 853-856, 
 896-901). 
 
 Although, as Ave have variously seen, all agents which exert effects 
 upon parts remote from .the seat of their direct operation transmit their 
 influences through reflex action of the nervous power, the Alteratives 
 bring it into action somewhat differently from those agents which, like 
 Cathartics, and Emetics, and Loss of Blood, operate suddenly and with 
 gi'eat power, especially when the Alteratives are administered in their 
 usual small and repeated doses. They then develop the nervous influ- 
 ence progressively and continuously, and therefore bring about changes 
 in the morbid states in a gradual manner ; while in the other cases the 
 changes are introduced abruptly (§ 222-233^, 516 d, No. 6, § 551, 552, 
 556, 841, 863, 867, 894-896, 002 e-f, 904 bb, 476^ /i. 905, &c.).
 
 Therapeutics. — appendix. — Alteratives. 837 
 
 It will be seen, therefore, that the distinctions which are made of 
 remedies into Cathartics, Emetics, Expectorants, Astringents, «fec., are 
 merely arbitrary, and for the sake of convenience. As we have various- 
 ly seen, also, Cathartics, Emetics, &c., do not primarily cure by the 
 evacuations they produce, but essentially through their alterative action. 
 The evacuations or redundancy of the secretions are only consequences 
 of changes which the remedial agents effect by their alterative action 
 (§ 863, 889 f-h) ; and while Cathartics, for instance, are employed in 
 introducing such changes in the functional condition of the intestinal 
 mucous membrane, those very changes lead to all the alterations which 
 take place in diseased parts remote from the intestinal canal (§ 889,/). 
 Whatever part the redundant products may contribute towards the cure 
 of disease, they are not only the result of the alterative action of the 
 remedies, but their own tributary influences are of an alterative nature, 
 and mostly through the same principle of sympathy that governs the 
 remote action of the agents employed. It is the same as in ^ 944 c. 
 
 Many Alteratives, in the sense implied by the group now under con- 
 sideration, are remarkably applicable to a vast range of diseases ; but 
 nearly all the diseases, to which any of the members of this extensive 
 group are suited, are the various phases of inflammation and fever. 
 Hence the group forms one of tlie Orders of the class of Antiphlogistics. 
 
 Those Alteratives which are of this universal nature I have assembled, 
 in the order of their general therapeutic value, under the denomination 
 of General Alteratives adapted to inflammatory and febrile diseases in a gen- 
 eral sense. They are more or less suited to all the varieties of inflamma- 
 tion, whether acute or chronic. 
 
 There occurs another general assemblage which are more especially 
 adapted to specific forms of inflammation and fever, and these are ar- 
 ranged under subdivisions according to the specific forms of disease for 
 which they are employed, and in the order of their relative value. The 
 following are the subdivisions : 
 
 1. Adapted to scrofulous, and some other specific chronic inflamma- 
 tions. 
 
 2. Adapted to syphilis, and certain other specific chronic inflamma- 
 tions. 
 
 3. Adapted to syphilis complicated with scrofula. 
 
 4. Adapted to rheumatism and gout. 
 
 5. Adapted to intermittent fever, intermittent inflammation, and other 
 intermitting diseases. 
 
 6. Adapted to obstinate and chronic cutaneous diseases, carcinoma, 
 elephantiasis, &c. 
 
 Our class of Antiphlogistics embraces, also, a group of Alteratives 
 which are designated as local, on account of, particularly, their applica- 
 tion to the surface of the body. This, also, is an extensive group, and 
 is divided into Constitutional Alteratives, or such as extend their effects 
 by remote sympathy, and of which there are but few ; and, secondly. 
 Limited Alteratives, whose action is limited to the part to which they are 
 applied, or extended only by continuous or contiguous sympathy (§ 497- 
 498, 8181, 893, 905, &c.). 
 
 As all this practical grouping of remedies is relative to principles em- 
 braced in these Institutes, I formerly introduced the disposition which 
 I have made of the Order in which the group of local Alteratives occurs. 
 Unlike the Alteratives which are employed internally, the present assem'
 
 838 INSTITUTES OF MEDICINE. 
 
 blage does not appear as an order, but as a division under an Order of 
 Cuicmeous and other Local Affections. (See p. 643, 644.) 
 
 Tliese Alteratives (p. 643), which are employed locally, may operate 
 either constitutionally, through reflex nervous influence, like the inter- 
 nal alteratives, as the mercurials, or in a more cii'cumscribed manner 
 through the ganglia or other centres of the sympathetic nerve, or only 
 superflcially, as with Suppurants, Escharotics, and Sedatives ; but Ves- 
 icants, which ai'e embraced in the group, always exert useful effects upon 
 internal maladies through reflex action of local nervous centres (p. 642- 
 648, § 893 a-f, p. 652-655, § 893 m, p. 657-659, § 893^7, p. 679-681, 
 § 905 a). Other remedies included in the group must also operate upon 
 internal parts through local centres of nervous influence (§ 497, 1038), 
 such as Aconite in the relief which it affords to neuralgia. I have re- 
 lieved a very painful neuralgic affection of the whole extent of the sci- 
 atic nerve in fifteen minutes by rubbing along its course an ointment 
 of aconitin, which had refused to yield to other remedies. — The extens- 
 ive subdivision which is designed for diseases of the skin supplies ex- 
 amples of a purely local action upon the organic properties of the part 
 without the auxiliary aid of nervous influence (§ 658). Some of them, 
 however, will also exert constitutional eflfects through reflex nervous 
 influence, such as the mercurial ointments (§ 514 d, 826 d, &c.). Eem- 
 edies of that nature, therefore, are arranged also in another subdivit^ion, 
 indicating their extensive constitutional influences through the medium 
 of the skin and nervous system (§ 89H^, 893 a, 1059, 1088 b, 904 b).* 
 
 The foregoing details, and some others of a corresponding nature, are 
 farther designed to exhibit the advantages of the Author's system of a 
 Therapeutical Arrangement of the Materia IMedica. 
 
 § 1057|-. I shall now introduce a series of important remedies, not 
 only for the purpose of examining their special uses, but particularly for 
 a farther illustration of general principles in Medicine, and the Philoso- 
 phy of Organic Life, for which this Avork is especially designed (§ 1062^). 
 
 CHLORIDE OF MERCURY, AND THE BLUE MERCURIAL PILL. 
 
 § 1058, a. I shall speak mostly of Calomel as employed in full doses 
 for its cathartic eflect ; and this for the purpose, especially, of indicating 
 its remedial virtues. Its smaller and more repeated doses, however, will 
 be the subject of remark ; though, in whatever doses exhibited, it is its 
 alterative action which bestows the service (§ 889, a-g), which, indeed, 
 is true of most other remedial agents (§ 516 d, No. 6, § 638, 863 d, 896, 
 900, 902 g-m, 904 d, 905, and Indexes, article A Itercdires). 
 
 I need not say that Calomel is rarely actively purgative, although it 
 occupies the first rank among Cathartics in my Therapeutical Arrange- 
 ment of the Materia Medica, or that, to procure a cathartic effect, it is 
 commonly associated either with Jalap, Aloes, Rhubarb, Podophyllum, 
 Colocynth, Scammony, Gamboge, or Extract of Butternut, or, if exhib- 
 ited by itself, some other cathartic is generally prescribed within a few 
 hours afterward. The combinations, too, with the several articles are 
 most useful, in a general sense, in the order in which I have now stated 
 them. Thus, Calomel and Jalap are more extensively useful than Cal- 
 omel united with any other cathartic. Podophyllum resembles Jalap in 
 its action, but is much inferior; so that Aloes is the next adjunct on . 
 account of its adaptation to a great range of chronic affections of the di- 
 * NoTKs Dn p. 1132, Eic p. -133.
 
 Therapeutics. — appendix. — Calomel^ Blue Pill. 839 
 
 gestive organs, and next Rhubarb, and so on ; and it is well known that 
 it may be often useful to blend two or more of these together along with 
 the calomel. But the merits of each individual case should, of course, 
 be brought to bear upon the right combination at the time of prescribing 
 (§ 150-151, 857, 870 a, b, 872 a, 888 a-c, 1061). 
 
 As I shall soon set forth, however, it may be often most useful to ex- 
 hibit Calomel uncombined, and to administer some other cathartic at an 
 interval of some hours afterward. For this purpose Castor Oil generally 
 surpasses all others (§ 1057, I); and, next to this, in a general sense, we 
 may reckon Jalap combined with Tartrate of Potash (§ lOGO) ; and 
 next, the neutral saline cathartics (§ 1061); and next. Rhubarb along 
 with Calcined Magnesia and the Tartrate of Potash and Soda (§ 872 a, 
 1061). We need rarely go beyond the cathartics which I have now 
 mentioned, as ultimate aids to Calomel, with a view to purgative effects. 
 But it should be always considered tliat it is the alterative action, the 
 direct influence upon disease, that is to be chiefly regarded in the choice 
 of these remedies, and of none is this so true as of Calomel. Hence it is 
 evident that the precise circumstances of the disease must determine the 
 choice (§ 872 a, 883 a, 888 i). 
 
 But, though Calomel be not actively purgative, it is powerfully alter- 
 ative, and, in doses that are felt, it is never negative in its effects. It 
 alters the condition of disease either for the better or for the worse — too 
 often for the worse (§ 854). There is no other remedy that requires 
 more skill for its right administration — none, with the exception of loss 
 of blood and tartarized antimony, that i-eaches more profoundly diseased 
 conditions, or which will so often turn them to health, when wisely em- 
 ployed. And so, on the contrary, it is capable of inflicting great injury 
 if not suited to the case. 
 
 § 1058, b. Let us then consider, in a general manner, some of its use- 
 ful effects when employed in full purgative doses. Its action is mostly 
 exerted upon the stomach and duodenum. Here its first great curative 
 impressions are made, and from these parts powerful reflex nervous ac- 
 tions radiate over the whole system, though more so upon some organs 
 than upon others. Its effects are most strongly pronounced in some of 
 the glandular organs, especially the liver; and hence it is peculiarly 
 suited to diseases of that organ in many of their phases. But its action 
 upon this, and other parts remote from the stomach, will depend upon 
 the manner in which they may be affected by disease ; for we have va- 
 riously seen that the susceptibility of tissues to the action of remedies is 
 not only increased by disease, but will be influenced by its exact con- 
 dition — than which there is nothing more important to be known (§ 
 129 h, i, 134, 137 (Z-151, 240, 324, 556 c, 650, 662, 674 (/, 675, 854 
 bb, 855, 859, 870 aa, 871, 888, 892 c, 892^ a, b, 892^ d, 970 c, 1063 by 
 
 When the Avhole system is invaded by disease, as in idiopathic fever, 
 we may anticipate a universally favorable impression when this rem- 
 edy is rightly applied ; and this, too, whether employed in its largest or 
 its smallest therapeutical doses — though, as a gradual alterative for this 
 purpose, Tartarized Antimony is much better (§ 148, 557 a, 841, 892 c, 
 900, 902 i; and Indexes, Alteratives). When active inflammation affects 
 any part, Ave may generally calculate, if there be no objection to its use, 
 that a few grains of Calomel will reach that part advantageously, es- 
 pecially if Blood-letting have been premised (§ 672, 868, 871, 889^). 
 And yet, under circumstances of health, the same dose might have no 
 
 * Calomel and blue pill rarely increase the bile in health. Hence the great fallacy 
 of Dr. Scott's late experiments with mercurials upon healthy dogs (§ 694 6, 837 cc, 854 bb).
 
 840 INSTITUTES OF MEDICINE. 
 
 effect upon the same organ. This, however, is constantly more or less 
 true of all other remedies. 
 
 We have thus before us two great leading facts — that, in fevers, and 
 acute inflammations, especially if the latter affect any important organs, 
 the next great curative means after bloodletting, if the latter be required, 
 is, in a general sense, Calomel, in at least one dose, with a view, in part, 
 to a cathartic effect, though carefully regulated as to quantity. Wheth- 
 er a full dose should be repeated, or whether in any dose, and with what 
 frequency, will then depend upon the peculiarities of each case. The 
 general affirmation can be made with greater certainty, that one full 
 dose will be proper and useful in the early stages of disease, than we can 
 pronounce upon the probable advantages of its repetition. But, it is a 
 very common circumstance, where it may be inexpedient to carry this 
 remedy beyond one or two full doses, that Blue Pill may be afterward 
 exhibited with happy effect, when the continued use of Calomel would 
 have been injurious. 
 
 § 1058, c. This correspondence between the virtues of Calomel and 
 Blue Pill leads me, now, to speak of them comparatively. Notwith- 
 standing their affinities, they are well known to exert effects which dis- 
 tinguish them from each other. But tliis difference consists mostly in 
 the effects of one being more rapidly produced, and more strongly pro- 
 nounced than those of the other. Calomel is more irritating, rapid, al- 
 terative, and positive in its action than Blue Pill ; while in other re- 
 spects, the general results of both are greatly analogous. The resem- 
 blances and differences in their effects may be farther illustrated by com- 
 paring them, respectively, with general Bloodletting and Leeching (§ 925, 
 927 a, 929, 939 e, /, 95G-958, 966, 968, &c.). 
 
 From these analogies in their useful effects, and from their powerfully 
 alterative virtues, it is evident that the same coincidences Avill be likely 
 to obtain in their bad effects (§ 854 c fZ, 857) ; and such being the case, 
 whatever I may say of the injurious effects of Calomel, and of the pre- 
 cautions which should attend its use, will be equally applicable, though 
 in an inferior degree, to Blue Pill. 
 
 § 1058, d. It is a well-ascertained fact that, in numerous cases. Calo- 
 mel and Blue Pill have not their effects increased, beyond a certain quan- 
 tity, in the ratio of the increase. Ten grains of either Avill often pro- 
 duce as great a cathartic effect as fifteen grains ; or, at least, this is in- 
 ferable. Beyond fifteen grains the difference is still less manifest. But 
 below ten grains this ratio is less likely to appear; though five grains 
 will often operate with greater effect, in proportion to the quantity, than 
 ten grains. Nevertheless, the difference between five and ten grains, and 
 at other times between two and five grains, is so considerable that the 
 smaller quantity may be very beneficial when the latter would be very 
 injurious (§ 857). 
 
 But there are occasionally some very remarkable peculiarities in the 
 effects attending the smallest and the largest doses of Calomel, when they 
 are regulated according to the repute which Calomel holds as a cathar- 
 tic, and which are but little observed of Blue Pill. When employed, for 
 example, in very large doses, even far exceeding the largest in common 
 use, the cathartic effect is wholly counteracted by the peculiar nature of 
 some present intestinal disease ; or the dose may even arrest diarrhoea, 
 as Calomel often will, also, when employed in the minute doses of a 
 fourth or tenth of a grain. In respect to the large doses, I will quote an
 
 Therapeutics. — APPENDIX. — Calomel^ Blue Pill. 841 
 
 example which occurred at one of the London Cholera Hospitals in 1832, 
 where Mr. Bennett is said to have treated successfully 17 of 18 cases by 
 exhibiting to each patient, as soon as admitted, 120 grains of Calomel, 
 and afterward 60 grains, every hour or two, until some relief was ob- 
 tained. Several of the patients took from three to four ounces. Its di- 
 rect effect was that of restraining the vomiting and purging. These 17 
 patients recovered, and the record so far is undoubtedly true ; but, from 
 what we know of the fatality of the malignant cholera in the hands of 
 others, after the accession of those symptoms which are diagnostic of the 
 disease, we are bound to believe that, in most, and probably in all, of 
 these cases there existed only the premonitory stage, as it is called, 
 when the disease is always very easily controlled, and by much milder 
 treatment. 
 
 It has been long known that large doses of calomel — such as 20 or 
 30 grains — Avill ai-rest vomiting and diarrhoea attendant on particular 
 pathological conditions of the intestinal mucous membrane. This it 
 does in virtue of its profound alterative power, and shows us that it is 
 the alterative, and not cathartic, operation which contributes essentially 
 to the cure. It equally denotes, also, an error in the imputed sedative 
 effects of the remedy, as will be more distinctly seen in the entire failure 
 of such doses, and of others far more moderate, in the ordinaiy forms 
 of diarrhoea and vomiting, and in cholera morbus and cholera infantum. 
 But, in these last cases, particularly in cholera infantum, and often in 
 dysentery, we may obtain the greatest benefit from small doses of Calo- 
 mel — doses, when administered in cholera infantum, varying from the 
 fourth to the twentieth part of a grain. All of this, too, goes to dem- 
 onstrate that it is not the cathartic, but the alterative virtues of Calo- 
 mel which impart to it its remedial poAver. 
 
 These facts admonish us that we must study the virtues of remedies, 
 and their doses also, in their relation to diseased conditions, and that 
 we can form no just conclusions as to their remedial capabilities by any 
 other methods of observation, and, above all, that we have nothing to 
 hope from Organic Chemistry (§ 1058 h, note). 
 
 § 1058, e. Although Calomel and Blue Pill are capable of profoundly 
 morbific effects in many forms of disease, unless they have been preceded 
 by other remedies, especially in miasmatic congestions of the liver and 
 intestinal mucous membrane, where nothing may follow their precipitate 
 use but a discharge of viscid mucus, and an aggravation of till the symp- 
 toms, I shall not prolong this article by analyses which would involve 
 so great an amount of detail. Nevertheless, it is impossible to arrive at 
 any just conceptions of the virtues of remedial agents without referring 
 to their effects in various conditions of disease ; nor can we obtain any 
 correct view of their remedial capabilities by considering the operation 
 of a particular remedy abstractedly from other means which may be 
 associated with it in the treatment. A full dose of Calomel, for exam- 
 ple, may be very salutary in some given form of disease, if it have been 
 preceded by Bloodletting, as is often witnessed in congestive fevers, but 
 without which it may be very pernicious. At another time, its good 
 effects, or at least its best effects, can be secured only by associating with 
 it other remedies, or, by applying others after its administration. The 
 same, also, is more or less true of all other remedies ; each one influ- 
 encing, more or less, the effects of the others (§ 859 J, 863 e, 871, 872 a, 
 889 k).
 
 842 INSTITUTES OF MEDICINE. 
 
 § 1058, /. In continuing the subject of Calomel, I shall now consider 
 its uses in certain special forms of disease, when employed in its occa- 
 sional and full doses : 
 
 And first of dysentery, which is seated particularly in the lower tract 
 of the mucous tissue of the large intestine, though all the digestive or- 
 gans are more or less involved in morbid action. But the burthen of the 
 disease is upon the mucous membrane, where it probably consists at all 
 times of a peculiar modification of inflammation, though diffei'ing, in 
 different cases, according to the nature of its remote causes (§ 644-666). 
 
 Now, the treatment of this disease, not only by Calomel, but by other 
 remedies, will be influenced by the nature of the remote cause; and 
 this will be ascertained by the phenomena, and by tracing up the his- 
 tory of the patient for one or more months anterior to the attack. Its 
 principal cau.es are, mainly, two : 1st, crude, indigestible food, acting 
 in conjunction with changes of weather, and other common atmospheric 
 influences. 2d, miasmata, from decaying vegetable matter. 
 
 The first of these modifications is sporadic, and comparatively mild. 
 The second may present only sporadic cases, but is apt to occur more or 
 less epidemically, and is vastly the more obstinate and fatal form. Each 
 variety demands essential differences in the details of treatment, though 
 the same general principles are applicable to all the modifications. It 
 should I>e also premised that the miasmatic form is attended with a 
 special «;ondition of hepatic congestion, which is one cause of the greater 
 obstinacy and fatality of this variety of the disease, and which has a con- 
 siderable bearing upon the treatment (§ 650-652, 806-816). 
 
 With these premises before us, we are now chiefly interested about 
 the adaptation of Calomel to dysenteric disease, with a view especially 
 to its local effects. But, it is impossible, as I have said, to give any in- 
 telligible account of the proper use of one remedy, especially such a rem- 
 edy as Calomel, without speaking of it in connection with other reme- 
 dies which may, or should be, associated with it. We have formei'ly 
 seen that, when active inflammation is seated in the intestinal canal, 
 cathartics are hazardous till the disease has been more or less subdued 
 by other remedies, especially 131oodletting. Calomel, however, does not 
 irritate in the same way as other cathartics. But it will often do Avhat 
 is much worse in muco-intestinal inflammation. It may not only in- 
 crease its sevei-ity, but so modify its character as to render it very ma- 
 lignant, as in another example of a common abdominal affection to which 
 I have adverted, and also in scarlet fever. In such circumstances, it 
 never fails to affect the liver injuriously also. It has been therefore 
 found, in the best experience, to be the most successful and speedily 
 curative practice to abstract blood from a vein, or at least by Leeches, 
 as the first remedy, in cases of dysentery of much severity (§ 991, b). 
 But this is not commonly done, and Calomel is apt to be relied upon as 
 the principal remedy. It is a prevailing practice to exhibit, at the on- 
 set of the treatment, from 10 to even 20 grains of Calomel, and not un- 
 frequently to repeat this dose from time to time. When the disease is 
 of the milder variety, if other things go right, it will often succeed in t4ie 
 end ; though not so readily, and less frequently than when Calomel is 
 given in doses of two to five grains once in twelve or more hours; and, 
 in many cases, a grain or less of Ipecacuanha, also, once in four or five 
 hours, with more or less of some preparation of opium. A large medi- 
 cation by Calomel in any condition of dysentery is not a reliable, but
 
 Therapeutics. — APPENDIX. — Calomel^ Blue Pill. 843 
 
 often an injurious practice. Wiien proper bloodletting has not been em- 
 ployed, if the inflammatory symptoms do not soon yield, all internal 
 means should be suspended, and General Bloodletting, or Leeches to the 
 verge of the rectum, or a blister, or warm poultices, to the abdomen, 
 should be applied, and perhaps in succession. Alterative doses of ipe- 
 cacuanha may often -become very useful, perhaps Blue Pill, but more 
 probably well-regulated doses of Castor Oil (§ 1057, I). 
 
 So much for the milder, or sporadic form of dysentery. Coming to 
 the miasmatic variety, especially when prevailing epidemically, the 
 Practitioner who does not regard the modifying nature of the remote 
 predisposing cause, and the exact pathology, will prescribe empirically, 
 and be apt to administer large doses of Calomel, which, in this condition 
 ©f the disease, will be very likely to destroy the patient. Or, if he de- 
 pend upon astringents, or administer Rhubarb as is often done (§ 10G2), 
 or resort to Tonics and Stimulants, nothing but disappointment will 
 await him. General Bloodletting, often followed by leeching, is here 
 the great remedy. But, however we may subdue the morbid condition 
 by loss of blood, with the aid, also, of blisters, abstinence from food, «&c., 
 we shall generally find that Calomel must be managed with great pru- 
 dence, or the disease will not only be aggravated by it, but rendered more 
 malignant. — Notes Ff p. 1135, Go p. 1138. 
 
 As to Loss of Blood, Nature also proclaims in this variety of dysen- 
 tery, more distinctly than in the sporadic, the true principles of treat- 
 ment, for here the eft'usion of blood from the intestinal mucous membrane 
 is greater ; and this is plainly the remedy which Natui'e institutes for 
 her own relief (§ 805, 862, 8G3 e,/, 890 d-g, 1019).* 
 
 § 1058, g. In respect to fever, most of its varieties derive, at their early 
 stages, great benefit from a full dose of Calomel combined with Jalap 
 and a grain or two of Ipecacuanha ; or it may be most useful, in many 
 cases, to exhibit the Calomel uncombined, and to administer Castor Oil, 
 or a combination of Jalap and Tartrate of Potash, a few hours after- 
 ward. If an emetic be also indicated, a full dose of Ipecacuanha, per- 
 haps with Tartarized Antimony, may be preferable to the latter reme- 
 dies ; so that when vomiting begins, purging will generally take place 
 simultaneously. In this way prodigious alterative influences will be 
 exerted, and if employed near the invasion of disease it may be arrested 
 at once (§ 557 a). But it often happens, as has been variously stated in 
 this work, that bloodletting should be premised, and this, especially, if 
 there be any local inflammations or venous congestions, which are often 
 present at the invasion of the constitutional malady. 
 
 § 1058, h. When Calomel is employed in the treatment of Scarlet fe- 
 ver, it should be with great caution after the disease has advanced some- 
 what into the eruptive stage. At this period, Calomel, Senna, and Rhu- 
 barb have done a vast amount of mischief At or near the invasion of 
 Scarlatina, when the symptoms are severe, a moderate dose of Calomel 
 may be useful. Nevertheless, severe forms of this disease not unfre- 
 quently occur in which Calomel, administered at the very onset of the 
 attack, proves detrimental. If doubt exist as to the propriety of the 
 remedy, Castor Oil should be substituted, and perhaps little else should 
 be done (§ 858, 8G1). It may be also safely affirmed that Calomel 
 should be rarely exhibited after the disease has run its course for some 
 two or three days ; not often, indeed, when the eruptive stage has existed 
 for twenty-four hours. It will then aggravate the abdominal conges- 
 
 * In mild forms of dj-senterj- there may be an absence of blood, or the mucus only 
 tinged.
 
 844 INSTITUTES OF MEDICINE. 
 
 tions, and often convert a mild into a malignant form. And liere, too, 
 when Calomel affects the digestive organs perniciously, the salivary 
 glands often swell up suddenly from sympathy, and, not unfrequently, 
 the throat becomes ulcerated, gangrenous, &c. But these are only 
 secondaiy results of a far more alarming condition of disease in the ab- 
 dominal organs. The swelling of the glands, in these cases, is not at all 
 owing to the direct specific eftect of mercury upon them, as in cases of 
 salivation, nor is there any attendant flow of saliva ; but it is the result 
 of a highly aggravated state of the morbid condition of the abdominal 
 organs, inflicted upon them by this remarkable agent. The glandular 
 swelling which often occurs spontaneously from the same visceral cause, 
 presents a far milder form. There is not generally, however, much 
 danger from the swollen glands, or from the sphacelus of the fauces, sb 
 only they be not allowed to remain a source of constitutional irritation. 
 One may be relieved by a stick of lunar caustic, and the other moderated 
 by leeches and warm fomentations. What is thus witnessed about the 
 throat is only an index of a far more fearful evil in the great organs of 
 life. In these cases Nature, mainly, must work out the cure (§816 b.) 
 
 For the grave forms of Scarlatina, I am apt to prescribe a small dose 
 of Calomel at the beginning of the disease, but never repeat it ; and as 
 for the rest, I depend upon cautious doses of Castor Oil, as far as may 
 be indicated by the state of the abdominal viscera (§ 1057, 1). 
 
 I may finally add that, in all mild cases of scarlet fever, no risk should 
 be taken from Calomel. It is not then wanted ; and I have seen the 
 mildest converted into malignant cases by imprudent doses of Calomel, 
 and by Senna, Rhubarb, and the Saline Cathartics. Indeed, so suscept- 
 ible is the alimentary mucous tissue in this disease, and so peculiar is 
 its morbid condition, that solid food, even bread, will sometimes convert 
 the mildest into the severest cases, merely by its mechanical irritation. 
 It should be also borne in mind that in this, as in all other strictly self- 
 limited diseases, we cannot establish any modification of the pathologi- 
 cal cause which will prevent its running a regularly ordained course. 
 The natural state of tliese affections, in all favourable cases, is most likely 
 to result in their cure (§ 858,861). In the graver forms, art can only 
 moderate their violence, or meet with appropriate remedies any incident- 
 al local inflammations that may spring up in the progress of the specific 
 maladies (§ 137 c, 524 (/, 847, 858, 870fla).— ^ee P.S. 1860, p. B72. 
 
 § 1058, {. As to the treatment of measles and small-pox, I do not recol- 
 lect to have witnessed any injurious eftects from the use of Calomel, nor 
 do I find them stated by Authors. Perhaps one reason is, that Nature 
 has been more allowed, in these self-limited diseases, than in scarlatina, 
 to have her own way. But here the danger from Calomel is certainly 
 far less than in scarlet fever. 
 
 § 1058, k. In ivhoopivg-cough, Calomel, as a cathartic, or rather for its 
 alterative effects upon the abdominal organs, is often very salutary ; and 
 this especially so when the alvine evacuations present a morbid appear- 
 ance. Blue Pill, however, is often better. Bloodletting should come in 
 the moment that pneumonia may supervene, as it often does, and is the 
 great cause of the fatality of whooping-cough (§ 870, aa). But here, as 
 in other acute diseases, great moderation as to food is powerfully cura- 
 tive (§ 856). 
 
 § 1058, 1. In the ordinary forms of jaundice, whether complicated with 
 a gall-stone in the liver, or owing alone to hepatic disease, Calomel dis-
 
 Therapeutics. — APPENDIX. — Calomel, Blue Pill 845 
 
 plays some of its brightest advantages, and may be given, if apparently 
 indicated, in doses of 10 to 20 grains, two or three times a day, with 
 jalap, or, perhaps, aloes, or the resinous cathartics, at intervals, till the 
 difficulty is more or less surmounted. But Jaundice is often of too grave 
 importance to be always intrusted to those remedies; and Bloodletting 
 must then be the principal remedy, followed, perhaps, by a blister eight 
 or ten inches square over the epigastric region. If there be gall-stones, 
 Cicuta may be useful in relieving spasm of the biliary duct. 
 
 § 1058, m. Calomel is an admirable remedy, as it respects its transient 
 effect, in eri/sijjelas, a disease which is often sadly managed by tonics 
 and stimulants (§ 1005, j). The least important part of the disease is 
 also generally considered the most important, since, in all severe cases, 
 the inflammation of the skin is comparatively of little moment. Now 
 and then, however, when erysipelas springs up epidemically, tlie super- 
 ficial inflammation puts on the phlegmonous character, when ulceration 
 and sloughing are apt to follow ; and these conditions, as well as the 
 antecedent and remaining inflammation, form an important part of the 
 pathological complications. But of the pathology of this disease I have 
 spoken sufficiently (§ 970 c, 1005 /), and therefore come to the treatment. 
 
 The great curative means, in all severe cases, is early and full Blood- 
 letting, followed by five to fifteen grains of Calomel, and this in six or 
 eight hours afterward by Jalap and Soluble Tartar, or by Castor Oil. 
 If, by these means, a blow be struck at the abdominal disease, the in- 
 flammation of the skin will begin to give way, and nothing more may 
 be necessary than, perhaps, a moderate dose of Calomel, or of Blue Pill, 
 or, more probably, Castor Oil, or Leeches to the inflamed surface. Or, 
 Nitrate of Silver, pure and concentrated, or dilute Iodine may now be 
 pencilled over the whole inflamed surface. But, for subduing the re- 
 maining inflammation. Leeches are the best local application, in my ex- 
 perience, and they are dictated by the soundest pathological principles. 
 Nevertheless, whatever is done in severe cases should be done quickly ; 
 and, if the treatment have failed, at the onset, to sensibly mitigate the 
 symptoms, especially the cutaneous inflammation, which is only symp- 
 tomatic of abdominal disease, we may depend upon it that the latter con- 
 dition calls for farther general Bloodletting, and probably for another 
 dose of Calomel, or at least of Blue Pill, and more or less of Castor Oil. 
 If cerebral symptoms (which are also sympathetic of the abdominal con- 
 gestion) spring up, a large abstraction of blood will be indispensable. 
 
 I have never known Calomel injurious in erysipelas ; but it must be 
 added that I have almost always begun the treatment by abstracting 
 blood, which, as I have said, is a great means of preventing the morbific 
 effects of Calomel and Blue Pill ; and no fatal case has occux'red in my 
 practice (§ 1005, j?'). 
 
 § 1058, n. And now, as to acute rheumatism. Here, too, in all severe 
 cases, especially of articular rheumatism, there is much attendant dis- 
 ease of the abdominal organs, which contributes powerfully to maintain 
 the rheumatic affection ; and it commonly happens, in such cases, that, 
 after the inflammatory condition is subdued, there will be still remaining 
 a considerable amount of visceral disease, which will require, at least, 
 great simplicity of diet. In all severe cases, it will be often observed 
 that the abdominal affection precedes the rheumatic, but becomes much 
 aggravated as soon as the latter supervenes. 
 
 Calomel is a very useful remedy in acute rheumatism, in one or more
 
 846 INSTITUTES OF MEDICINE. 
 
 full doses, or yielding soon to Blue Pill, or Castor Oil, and rarely does 
 any harm. But, in all severe cases, a free abstraction of blood should 
 be the fii'st remedy ; and one or more repetitions of venesection, along 
 with leeches perhaps, are often important to a speedy removal of the 
 disease, and a fluid farinaceous diet is jiext in importance. Any other 
 practice which excludes Bloodletting in severe cases will be more profit- 
 able to the Physician than to the Patient. The next great remedy for 
 acute rheumatism, and often for chronic, is Tartarized Antimony, fre- 
 quently administered in augmented doses to just short of nausea. If the 
 heart he affected, the Loss of Blood Avill be so much the more important. 
 In a large proportion of cases, the disease will yield to this practice with- 
 in a week. But, however exact the treatment may be in other respects, 
 an allowance of solid food, even bread, or of animal broths, may prolong 
 the disease, especially the abdominal derangement, for many weeks. 
 Colchicum should not be necessary in the declining stages, nor should 
 opiates be employed (§ 870, b). 
 
 § 1058, 9171. The same general principles of treatment apply to acute 
 gout as to acute rheumatism (§ 1058, n), though in a moderated degree. 
 A full dose of Calomel, or of Blue Pill, is generally useful at the onset 
 of the treatment, one or the other, according to the derangement of the 
 abdominal organs. But here, if the paroxysm be at all severe, and we 
 would most speedily relieve the patient, he should be first bled. La^ly, 
 if necessary, and often pretty early, Colchicum may be exhibited. 
 
 § 1058, 0. In pneumonia, Calomel or Blue Pill, in one or more full 
 doses, at or near the beginning, is generally useful, rarely injurious. But 
 it is sometimes a better practice to obtain more of their constitutional 
 influence by exhibiting from one to four grains of either (to adults) once 
 in four to six hours ; though this is by no means recommended as 
 a general practice. It is better suited to advanced stages of pneu- 
 monia. If complicated with abdominal disease in the form of bilious 
 pneumonia, they are still more indicated, but unless cautiously adminis- 
 tered are liable to do injury. Bloodletting, however, is the great rem- 
 edy for all forms of pneumonia, and next to that Tartarized Antimony, 
 in increased alterative doses every hour or two, but kept below the point 
 of nausea (§ 904 bb, 1005 k, 1068 c). Leeches and Blisters may ulti- 
 mately be wanted, and perhaps more or less opium to tranquillize the 
 cough, as appears in other places (§ 892^^, 1005 h, Ic, 1017 c). 
 
 § 1058, ;). In the treatment of croup, which is apt to be complicated 
 with abdominal disease, a dose of Calomel is generally useful, often very 
 important. I generally exhibit it, in a moderate dose, along with suffi- 
 cient Ipecacuanlia to produce vomiting. If the symptoms do not then 
 yield, I take no risk, but proceed at once to the abstraction of blood from 
 the arm (§ 576 e, 1009-1013). There is no danger from the ordinary 
 forms of croup when Blood-letting is applied early. But the disease 
 advances with, great rapidity, and may quickly reach a stage when all 
 remedies will fail. If late in the disease an emetic be the first remedy, 
 it will certainly fail if blood-letting will not succeed ; or, if the latter, in 
 being first, will effect a cure, it would be probably baffled by the pros- 
 trating effect of a preliminary emetic (§ 576 e, 869). I may add that 
 I have lost but one patient of croup, and that in the early part of my 
 professional life. It is of greater interest, however, that the child was 
 rather the victim of the purgative action of Tartarized Antimony, ad- 
 ministered in cautious doses about once in twenty minutes.* The croupy 
 * See Not K Ggg p. 1151.
 
 Therapeutics. — appendix. — Calomel., Blue Pill. 847 
 
 • 
 
 symptoms vanished under this effect ; for there was no vomiting. I have 
 also witnessed the death of two adult patients in the hands of other 
 Physicians from the same cause, and where the doses given were but 
 three grains. There was no vomiting, but an uncontrollable watery 
 puro-ing, no abdominal pain, pulse extremely rapid and so small as to 
 be scarcely sensible to the touch when there was much remaining mus- 
 cular strength, and entire preservation of the mind (§ 863, d). Never- 
 theless, this has not deterred me from the occasional use of Tartarized 
 Antimony in emetic doses, especially in conjunction with Ipecacuanha 
 (§ 675, 857, 902 <;, &c.) ; and as an alterative in small and frequently- 
 repeated doses it transcends the Mercurials in fevers, and is scarcely in- 
 ferior in all acute inflammations excepting of the intestinal canal. 
 
 § 1058, q. And how is it with Calomel in acute injiammation of the 
 brain ? Certainly important. But after one full dose it becomes most 
 useful in doses of two to four grains once in four to ten hours. This, 
 however, is more of the gradually alterative plan, and when more of the 
 constitutional influence of the remedy is intended than we arc now con- 
 sidering, especially if all purgative effect be restrained (§ 51G d, 860, 
 863 d, 890 /, 902 {). There should be no active purging in cerebral in- 
 flammation by irritating cathartics, as is often recommended in the books. 
 They will propagate a pernicious nervous influence upon tlie brain. 
 Calomel, Blue Pill, Jalap, and Castor Oil are alone wanted, so far as 
 cathartics are concerned. The Drastics have been commended upon the 
 fearful doctrine o? counter-irritation, supplying an impressive contrast with 
 the objections alleged against Bloodletting (^ 889 g, 893 n, 1065 d). 
 
 But, as I have hitherto said, Loss of Blood is our chief remedy in 
 acute cerebral inflammation. So long as the symptoms continue to re- 
 cur, they should be promptly met by General Bloodletting. Set the 
 patient erect, and bleed him to the point of syncope. There is nothing 
 to fear from the remedy, but every thing from the disease (§ 974-975). 
 
 Leeching, and Tartarized Antimony in its small doses, which are so 
 valuable in other acute inflammations, are of little or no use here ; and 
 Blisters should be avoided till at least a decisive ascendency is obtained 
 over the disease. The latter remedy should never be applied to the 
 head, but to the neck and shoulders, unless the abstraction of blood have 
 been carried to a great extent. In some four or five cases, after having 
 bled the patients till the remedy became unavailing, I have rescued them 
 by covering the entire scalp, neck, and upper part of the shoulders with 
 a Blister. The effect Avas truly wonderful, as hope was nearly exhaust- 
 ed. But the Loss of Blood had been very great. I may add that the 
 head should be shaved early and kept covered with ice (§992, 1056). 
 
 Nor may we refrain from general bloodletting in venous congestions 
 of the brain, and at all ages, though generally in a very moderated de- 
 gree (§ 576 e, 925 c, 976 b, 978, 1010. Also p. 872 P.S. 1860), 
 
 § 1058, r. In respect to diseases of the serous tissues, they are probably 
 less influenced by the mercurials than of most other parts. Neither 
 pleurisy nor peritonitis are very sensibly benefited, nor are they apt to be 
 aggravated by full doses of Calomel, unless it be inflammation of the 
 serous coat of the intestines ; and hei-e there is but little chance for other 
 remedies until the disease has been broken down by loss of blood (§ 960 J", 
 995, 1005 e).— Note H p. 1117. 
 
 § 1058, s. Next, as to the kidneys. These and the renal capsules have 
 become specialties with many, who are apt to mistake what is merely
 
 848 INSTITUTES OF MEDICINE. 
 
 symptomatic for some positive disease of tliose organs. The urine is an- 
 alyzed, and a variety of pathological conditions are detected in the re- 
 sults, or some remote symptom is associated along (§ 42G, 427, 691, 
 905| b, 9G0 c, d, 1029, 1032 a). Hospitals supply the bulk of disorgan- 
 ized conditions. Other affections of the kidneys, especially such as are 
 acute, derive more or less benefit from the moderate use of Calomel ; but 
 Blue Pill is commonly to be preferred, particularly in diabetes mellilus. 
 
 § 1058, t. Where inflammation of any of the tissues of the eye is com- 
 plicated with gastric and hepatic disease, as is often the case, especially 
 in epidemic ophthalmia, the occasional exhibition of Calomel, in a deci- 
 sive dose, along Avith Jalap, or followed by Castor Oil, if necessary to a 
 full cathartic effect, is generally very useful ; and especially so if the ca- 
 thartic have been preceded by general or local bloodletting. 
 
 § 1058, u. Next to bloodletting. Calomel, in full doses, is the most im- 
 portant remedy for apoplexy, along with Jalap, «S;c. But there is great 
 variety here. There are cases in which no cathartic is admissible, and 
 others where none but Croton Oil will rouse the intestines. For the 
 rest, I refer to § 990-990^. 
 
 § 1058, V. Calomel, in one or more full doses, is indicated, generally, 
 in epilepsy, if bloodletting be also necessary. But, if loss of blood be not 
 required, Blue Pill is entirely preferable. Much will depend, in these 
 respects, upon the condition of the abdominal organs. If there be much 
 derangement here, a large blister over the epigastric region yields much 
 relief, though these are cases which are often greatly benefited by Loss 
 of Blood. A rigid attention to diet, and other natural habits, are the 
 great preventive means. But a reliance is apt to be placed upon some 
 fancied specific, and when the paroxysms come on the symptom is often 
 in the ascendant (§ 163, 884, 887, 891| e). I see,"however, by a late Re- 
 port of the Chairman of a " Committee on the effects of Bloodletting in 
 Epilepsy, Convulsions, &c.," embraced in the able " Transactions of the 
 Indiana State Medical Society," that a new view appears to be enter- 
 tained of the pathology of Epilepsy, which brings the disease, theoreti- 
 cally and practically, under the prevailing Brunonian philosophy (§ 1068, 
 a) ; and, as the document is brief, and is regai'ded by the Publishing Com- 
 mittee as a " Model Report," and, moreover, shows us what are the grow- 
 ing prospects of " Bloodletting," I shall quote it without abridgment : 
 
 " Having examined," says the Report, " the literature of the subject, 
 I find that none of our recent Authorities have any confidence in Blood- 
 letting as a remedy for Epilepsy, but, on the contrary, an opposite mode 
 of treatment is advised, the disease being one of debility instead of pleth- 
 ora. The question being altogether a negative one, and unsuitable for 
 a report, I wish to be discharged from farther duty." — TRANSAcnONS, 
 &c., p. 8, 40, IndianajMlis, May, 1857.— See p. 591, ^ 891^ e. 
 
 § 1058, w. Asthma supplies another example of greatly modified con- 
 ditions ; and it is only in the congestive form in which either Calomel or 
 Blue Pill are wanted. But nothing affords such prompt relief in con- 
 gestive asthma as General Bloodletting (§ 891^-,/). 
 
 § 1058, X. As in epilepsy, asthma, and hysteria, so in chorea, the treat- 
 ment is apt to be suggested by the prominent symptom, and the patient 
 accordingly treated by antispasmodics. liut they are rarely of any use, 
 and generally injurious in these diseases, Avhich are constantly supplying 
 instances of the importance of addressing our remedies to the exact path- 
 ological conditions (% 668, 672, 673, 675, 681 c, 685, 891^ ^, d).
 
 Therapeutics. — appendix. — Calomel^ Antimony ^ &c. 849 
 
 Cathartics, also, have been especially recommended by others for cho- 
 rea, and so exclusively by some as to render the practice empirical. 
 But no two successive cases are alike ; one may be greatly benefited by 
 repeated cathartics, and the next may admit of only their very moderate 
 use, or not at all. ' But it is my main purpose now to express my opin- 
 ion of the salutary effects of occasional doses of Calomel or Blue Pill in 
 those cases where cathartics are indicated. 
 
 § 1058, y. A full dose of Calomel, probably along with Jalap or Cas- 
 tor Oil, is generally useful in delirium tremens, as preliminary to the use 
 of morphia ; though opiates ai-e inferior to small doses of tartarized 
 antimony. If there be high arterial action, or much attendant disease 
 of the abdominal organs, or any important local inflammation. Blood- 
 letting should be premised in many of the cases. But this requires much 
 good judgment. In a large proportion of cases this remedy is not want- 
 ed, and in many it would be seriously injurious. Where doubt exists, it 
 should be avoided, and the main dependence placed upon the foregoing 
 antiphlogistic?, and perhaps a Blister to the nape of the neck. If 
 Bloodletting be practised, the patient should be in a sitting posture, and 
 its effects should be carefully observed while the blood is flowing from 
 the arm. I bled a very athletic man, with a bounding pulse, florid skin, 
 and furious delirium, to the extent of twelve ounces, from a large ori- 
 fice, when syncope came on in an instant of time, and tumbled him from 
 his chair. But it completely carried off the delirium, though there re- 
 mained much abdominal disease to be subdued by other means, of which 
 a dose of Calomel and Jalap was one (^ 662 c). — See Note p. 425. 
 
 In another case of a robust subject, which was complicated with in- 
 tense pleurisy, I bled the patient pretty freely; but he got no relief from 
 this or any other remedy. I advert to this instance, particularly, as 
 simple pleurisy yields readily to an early abstraction of blood {^ 624). 
 
 § 1058, z. In puerperal fever, Blue Pill, whatever may be the dose, is 
 more or less useful for its local effects, and much preferable to Calomel, 
 which is liable, in this disease, to irritate the abdominal organs injuri- 
 ously (§ 1058, y). But a prompt and large abstraction of blood, as w^e 
 have already abundantly seen, is the only reliable means (§ 1005, h-rj). 
 
 The relative value of Calomel, Blue Pill, Tartarized Antimony, and Ipecac- 
 uanha, as gradual Alteratives in the Treatment of Inflammations and 
 Fevers. 
 
 § 1059. Much has been said in these Institutes of the foregoing reme- 
 dies, as employed in small doses with a view to their gradually altera- 
 tive effects, but mostly for the purpose of illustrating principles. They 
 have been regarded also, with the same intention, as employed in their 
 full cathartic or emetic doses ; and it has been seen that, in whatever 
 doses administered, they operate upon one common principle — that of 
 altering or changing the pathological conditions. By that alterative vir- 
 tue the profound action of Calomel as a cathartic, or of Tartarized An- 
 timony, or Ipecacuanha, as an emetic, may, by a single blow, as it were, 
 overthrow a fever, or pneumonia, or croup, &c., when the same diseases 
 would subside only slowly under those minimum doses which may dis- 
 play no other remarkable effect than the substitution of healthy for mor- 
 bid actions. But, however great may sometimes be the curative influ- 
 ences of the maximum doses, the minimum are by far the greater auxili- 
 aries to Nature. Such is an abstract view ; for, in either case, it may 
 
 Hh h
 
 B50 INSTITUTES OF MEDICINE. 
 
 be indispensable that other remedies should have prepared the way for 
 their favorable operation, as bloodletting to secure their salutary, or to 
 prevent their morbific, effects either as cathartics, or emetics, or gradual 
 alteratives; or a preliminary cathartic to render useful the emetic or 
 the slowly progressive altei-ative (§ 672, 867, 871, «fec'). — Note Ee. 
 
 To enable us to comprehend the better how these agents quietly re- 
 move, in small and repeated doses, profound conditions of disease, it 
 should be considered how, also, they will sometimes overcome the same 
 by a single powerful impression — how Calomel will then display its pow- 
 er as a cathartic and unlock the liver,* or, at another time, calm the whole 
 gastric and intestinal tumult of the epidemic cholera^ — or yet again, in 
 the same full dose, will rouse the irritability of the stomach from apparent 
 torpor, and set in motion the whole mechanism of vomiting — besides nu- 
 merous other potent influences which Calomel is capable of exerting in 
 its higher doses. And turning next to the agents of emetic virtues, we 
 may trace out their unperceived operation as gradual alteratives by con- 
 sidering what has been said of the emetic effects of Tartarized Antimo- 
 ny in ^ 902, e-g, and by a reference to that philosophy of the operation 
 of all these agents, through reflex action of the nervous system, as vari- 
 ously set forth in this work, and a glance at which may be obtained by 
 simply referring to § 150, 151, 228-233|, 500, 506, 514, 516 d, No. 6, 
 § 549-557, 841, 854, 857, 863 d, 873, 889 b, 892| g, 902 e-h, 904 hb. 
 But before leaving this subject of the modus operandi of remedies I 
 shall employ the constitutional influences of the mercurials in farther 
 demonstration of the doctrine which I have propounded, that remedies 
 of positive virtues contribute to the removal of disease by substituting 
 for the more profoundly morbid other pathological conditions that sub- 
 side spontaneously, and this whether the action be exerted directly upon 
 the part affected, or upon distant parts through alterative influences of 
 reflex nervous action. The principle was exemplified in all its local and 
 constitutional aspects when speaking of the modus operandi of Counter- 
 irritants, the Seton, &c. ; but the constitutional action of the mercurials 
 supplies another apt illustration. That effect as displayed in the sali- 
 vary glands and about the tissues of the mouth is strictly inflamma- 
 tory. It also subsides spontaneously. But the disease for which the 
 mercurial had been employed, especially if acute, will have probably 
 disappeared long before the artificial inflammation. And so of pleurisy 
 after the application of vesicants. Now, what should be inferred from 
 these facts t Certainly that the mercurial had altered the condition of 
 the parts that were primarily diseased more or less according to the 
 manner in which it had altered the condition of the salivary glands and 
 mouth — perhaps only less intensely — only changing the already morbid 
 states to other conditions less profoundly morbid, and thus substituting 
 a pathological state which will subside more immediately than the tran- 
 sitory one instituted in the salivary glands. This, too, is farther seen 
 in the correspondence in the increased secretion of bile in hepatic dis- 
 eases as induced by the transient or more profound effects of the mer- 
 curials and the increase of saliva incident to salivation. The same 
 principle is shown by cantharides — externally or internally. The in- 
 flammation it induces in the skin or bladder subsides quickly, but be- 
 fore it shall have disappeared from the surface it may have removed a 
 pneumonia or a pleurisy ; and this result demonstrates, in itself, the de- 
 * See p. 839, § 1058 h, note.
 
 Therapeutics. — appendix. — Jalap. 851 
 
 pendence of the cure upon a reflected alterative nervous action upon 
 the thoracic organs, which is as completely, but less intensely and ti'an- 
 siently, morbific as when cantharides cures erysipelas by its direct ap- 
 plication to the affected surface (§ 854-860, S^l^g, 893 a, c-i, L 894- 
 901, 905). And so of the constitutional action of the unguentum hy- 
 drargyri as applied to the skin (§ 827 e, 904 c, 1088 b). Fi'om these 
 analogies we pass along the gradations that are supplied by cathartics 
 and emetics till we reach the less appreciable ones as manifested by io- 
 dine, quinine, &c. (§ 892^- c, 893 q), and, taking along the acrids in § 
 1065 a, we find that a common modus operandi appertains to the whole. 
 Tartarized Antimony. — Kanks here after Blue Pill. Others would 
 place it as the first of the alteratives, from its almost universal adapta- 
 tion to fevers and inflammations, and its great curative power. But, 
 though far more unexceptionably applicable to these affections than the 
 mercurials, it will not, in like manner, suddenly arrest continued fever, 
 or acute inflammations, and, although gradually succeeding where the 
 mercurials may fail, the latter not unfrequently have the same advant- 
 age over the Antimonial. But this comparison holds more with Calo- 
 mel than with Blue Pill. Again, the mercurials exert a profound in- 
 fluence upon chronic inflammations, of which Tartarized Antimony is 
 far less capable, though sometimes greatly more so, as in chronic rheu- 
 matism. The proper rank of Tartarized Antimony is probably imme- 
 diately after Calomel, as gradual alteratives (§510 d, no. G, 904 hb). 
 
 Ipecacuanha. — Dose, gx". J to gr. 1, once in four to six hours. The 
 repetition of one grain oftener than once in four hours will, in a majority 
 of cases, soon produce vomiting (§ 549-559, 841, 873 a). Ranks after 
 Tartarized Antimony. Is adapted to all the inflammatory affections to 
 which the antimonial is suited, but is much less efficient in most, though 
 far more so in a few, as in dysentery, where Tartarized Antimony, in- 
 deed, is inadmissible. May be also employed in many irritable condi- 
 tions of the alimentary canal in which the antimonial cannot. It is of 
 comparatively little use in chronic inflammations, excepting of the lungs ; 
 and renders very little service in idiopathic fever. Its advantages in 
 some cases of indigestion have procured for it a place among the tonics. 
 But it has no shade of a tonic virtue, though it will sometimes bring 
 about corresponding results by its peculiar alterative action (§ 89O2-, d). 
 
 JALAP. 
 
 § 1060. In the work on Materia Medica and Therapeutics, I have given 
 to Jalap in conformity with the results of general experience, the third 
 rank among the cathartics. There is no other, excepting Calomel and 
 Blue Pill, that is so powerfully alterative in inflammations and fevers, 
 and none so safe in connection with the curative virtues which are re- 
 quired in the early stages of these affections, and it is an early stage of 
 acute diseases to which I always refer. This comparative exemption 
 from objection is rather remarkable, when it is considered that, like 
 Scammony, the active principle resides considerably in a resinous sub- 
 stance, and that the resin of Jalap is an acrid cathartic. But this only 
 shows us that we must consult the direct effects of remedial agents upon 
 morbid conditions to ascertain their actual virtues as remedies (§ 5^ a, 
 675, 686, 837 cc, 854 bb, c, 904 c). All that is of any value in this 
 respect has been the result of experimental observation — observation 
 limited to effects upon diseased states of the body (§ 137, d). And what
 
 852 INSTITUTES OF MEDICINE. 
 
 a rebuke is this to the pretensions of Organic Chemistry ! Doubtless, 
 it is greatly owing to analogical conclusions from the apparent coinci- 
 dence in the resinous principles of Jalap, Scammony, &c. (§ 10G3), that 
 many have considered Jalap as unsuited to the acute stages of inflamma- 
 tion and fever as the other resinous cathartics. But experience shows 
 it otherwise. 
 
 In making this discrimination, however, in favour of Jalap, it must 
 not be entertained that it will supersede the necessity of Bloodletting in 
 acute inflammations of important parts, and in numerous cases of fever, 
 especially of all the congestive varieties, or that all the favourable cflTects 
 of Jalap, like those of other cathartics, will not be as often promoted by 
 previous Bloodletting in these affections ; though it may be less morbific 
 without. — See Note Ff p. 1135, as to Yelloio Fever. 
 
 When acute inflammation affects the intestinal canal, neither Jalap 
 or any other cathartic can be employed till the disease is essentially 
 overcome by other remedies. But even in these conditions it will pro- 
 duce less injurious irritation than any other active cathartic, excepting 
 Castor Oil ; and it may be a good deal divested of its irritating effects 
 by combining with it some proportion of Tartrate of Potash. 
 
 With the exception of the Saline and Mercurial, it is the effect of 
 most cathartics, especially of such as ai'e called Resinous, and of Rhu- 
 barb, and Senna, to excite the general circulation during their direct op- 
 eration ; and this particularly if acute inflammation or febrile excitement 
 be present. But the usual effect of Jalap is the reverse, if any pi-esent 
 artei'ial excitement be not very high, and the intestine be not in a mor- 
 bidly irritable state. Under these circumstances, the action of the heart 
 and bloodvessels diminishes in force and decreases in frequency during 
 the direct action of Jalap, which, in respect to uniformity, is a remark- 
 able property of this cathartic, though frequently witnessed of Castor 
 Oil (§ 1057, /). 
 
 But Jalap is recommended in the early stages of acute inflammations 
 and fevers, with the qualification already made, not only by its compar- 
 atively unirritating effects, and its depressing influence upon the organs 
 of circulation, but by its direct alterative effects upon diseases of all 
 parts, under appropriate circumstances. Indeed, its alterative action is 
 not especially manifested in any one organ ; but it appears to distribute 
 its effects more equally than any other active purgative upon all parts 
 that may be the seat of disease. So far, it is singularly adapted to idio- 
 pathic fever, and to inflammation of all parts, excepting of the intestines. 
 The copious secretion Avhich it determines from the intestinal mucous 
 membrane, and quite freely from the liver, is, also, another recommend- 
 ation of this remedy in the diseases under consideration (§ 143 h, c, 148, 
 163, 847 (J, 863 d, e, 871, 889/, h, i, n, 900, 902 g, i). 
 
 But Jalap is rarely given uncombined. It has not, as I have said, 
 any remarkably greater effect upon one organ remote from the aliment- 
 ary canal than upon another ; but by combining other remedies with it, 
 we may not only increase its own remedial influences, but produce spe- 
 cial effects upon particular organs. For this purpose Calomel is gener- 
 ally the best adjunct. The effects of this combination, when appropriate, 
 are Avell known to be remarkably great, each remedy contributing to the 
 effects of the other, extending them with greater force than either, indi- 
 vidually, to every organ of the body, and exerting a more special sway 
 over the liver, breaking; down disease wherever it exists in a direct man-
 
 Therapeutics. — ^appendix. — Saline Cathartics. 853 
 
 ner, and indirectly by influences that are exerted upon organs that are 
 not diseased, through salutary sympathetic impressions reflected, through 
 the nervous power, from these parts (as the skin for example) upon or- 
 gans that are diseased (§ 143 c, 514 //, 674 d, 676, 889 n, 902 g, m). 
 
 This knowledge of the virtues of Jalap enables us to understand ho\r 
 it is that the addition of a grain or two of Ipecacuanha often improves 
 its excellent qualities, especially when Calomel is also associated in the 
 compound. Ipecacuanha is not less remarkably universal in its influ- 
 ences, though determining a more special action upon the skin, and upon 
 the lungs in their inflammatory conditions (§ 2b, 143 c, 148-151, 855, 
 895, 902 /), contra-stimulant, powerfully alterative, especially when 
 thus appointed, and tributary to the purgative eftect. When, therefore, 
 brought into union with Jalap and Calomel in the dose of a grain or 
 two, or, if a more powerful etfect as a cathartic, depressant, and alter- 
 ative be wanted (§ 227), then the Ipecacuanha in the dose of five or more 
 grains forms a compound which is truly wonderful in its curative effects, 
 so only the remedy be suited to the exigencies of the disease. 
 
 In all that I am now saying of the uses of cathartics, or, indeed, of 
 any remedy, the remarks must not be taken in an abstract sense, but 
 they suppose that other remedial agents have been already employed, 
 whenever necessary, to place the disease in a proper condition for the 
 remedy under consideration (§ 1058, e). 
 
 I have now stated the most useful combinations which Jalap is capa- 
 ble of forming with other remedies. The only other of much import- 
 ance is its union with Tartrate of Potash (the bitartrate being often 
 injurious by the excess of acid). This and Castor Oil are, in a general 
 sense, the most useful adjuvants to Calomel, when the latter is admin- 
 istered in advance (§ 1057, I). 
 
 THE 'SALINE CATHARTICS. 
 
 § 1061. In the Author's Therapeutical Arrangement of Remedies Cas- 
 tor Oil and Aloes follow successively after Jalap, and then appear five 
 saline cathartics in the following order: 1. Tartrate of Soda and 
 Potash. 2. Sulphate of Magnesia. 3. Sulphate of Soda. 4. Phos- 
 phate OF Soda. 5. Tartrate of Potash. This order of arrangement 
 is intended, as throughout the whole plan, to indicate their supposed 
 general relative usefulness. I Avill here remark that Podophyllum is 
 placed as the fourth in order on account of its analogies to Jalap ; but 
 it should go down below the Juglans, as it is so fully superseded by 
 Jalap. It yields, however, a useful extract, which Jalap does not. 
 
 The virtues of these saline cathartics are very analogous, yet each one 
 is marked by certain peculiarities, but less individually characteristic 
 than such as distinguish most of the other members of this family of 
 medicines. In a general sense they are also distinguished from other 
 cathartics, excepting Jalap, by often directly lessening any general ar- 
 terial excitement which may exist at the time of their exhibition, and 
 they have obtained, in consequence, the appellation of Antiphlogistic 
 Catliartics. And yet their range of influence over severe forms of inflam- 
 mation and fever is greatly less than that of the Mercurials, and Jalap, 
 and Castor Oil. All these things illustrate ^ 500 m, 900, 902 g, h, 904 a. 
 
 But their adaptation to a vast range of mild fevers as ultimate reme- 
 dies, and to inflammations of comparatively unimportant parts, gives to 
 them the relative value which I have assigned them in the Systematic
 
 854 INSTITUTES OF MEDICINE. 
 
 Arrangement. But, in all inflammatory and irritable conditions of the 
 intestines, these cathartics rarely fail of being injurious. Nor should 
 they, as a general rule, be exhibited as a primary remedy in any disease 
 of much importance ; for, although they moderate general arterial excite- 
 ment, they are but feebly alterative, and are liable, by an irritative action, 
 to aggravate severe conditions of disease. Examples of this nature are 
 often presented to our observation in cases where some one of these salts 
 has been administered before summoning the attendance of a physician. 
 These are particularly the cathartics which render much of their service 
 by the secretion which they elicit from the intestinal mucous membrane 
 (§ 863) ; but least of all do they reach the function of the liver. 
 
 It is seen, therefore, to be a peculiarity of these cathartics to irritate 
 the intestinal mucous membrane without propagating an irritation to 
 the general circulatory organs, even in their excited conditions, so long 
 as they produce no injurious irritation of the intestines. On the con- 
 trary, if the disease be not intestinal, they will often gi-eatly moderate 
 arterial excitement during their direct operation ; and it is this circum- 
 stance which has given them a factitious importance in the treatment 
 of severe forms of disease. But the reduction of arterial action and of 
 heat is mostly due to the free elaboration of intestinal fluids, and the 
 absence of irritative virtues in the remedies. There is little or no alter- 
 ative action exerted upon the immediate instruments of disease, where 
 disease is at all profound. There is but little of that alterative reflect- 
 ed nervous influence instituted through the alimentary canal which con- 
 stitutes the most valuable effect of remedial agents (§ 150-151, 163, 228, 
 526 a, 714, 716, 854 c, 859 5, 860, 870 a, aa, 902, 904 a). Although, 
 then fore, the heat of the skin, and the excited state of the pulse, be 
 moderated by the saline cathartics, it is often so only to return soon with 
 equiil or increased intensity. The remedy has not, in such cases, estab- 
 lished salutary impressions ; and, in this way, the days steal on, but each 
 succeeding day bringing some ascendency of disease over what is gained by 
 the illusory "cooling effects," as they are called, of the saline cathartics. 
 
 Those who depend upon their cooling effects are also apt to employ 
 lemonade and oi*anges to aid in the cooling process ; and, although these 
 vegetable acids are set down in the books under the hypothetical denom- 
 ination of refrigerants (^ 819, a, Mottoes), and are strongly recommend- 
 ed for the purpose of cooling down inflammations and fevers, it is not 
 less certain that it is only an old relic of the humoral pathology, and that 
 these acids have not the slightest tendency to diminish febrile or inflam- 
 matory action ; but, on the contrary, they rarely fail to aggravate and 
 prolong both. They produce an injurious irritation of the gastro-intes- 
 tinal mucous membrane, thus inflicting a direct injury upon those organs 
 through which we endeavour to convey relief to others. 
 
 Such, then, is the deceptive nature of the whole of this refrigerant 
 system. Thousands are its victims ; when one good Bloodletting, and 
 a dose of some suitable cathartic, at the beginning, would effectually 
 cool down the patient, and probably save the necessity of any forther 
 active treatment in a great proportion of the cases. It is comparatively 
 a small evil, however, with that which arises from an indiscriminate and 
 excessive medication. 
 
 All this comes from the want of sound principles in physiology and 
 pathology — the want of medical philosophy — and a consequent leaning 
 upon the impracticable and visionary doctrines of the physical schools.
 
 Therapeutics. — appendix. — Rh ubarh. 855 
 
 RHUBARB. 
 
 § 1062. llhubarb follows next in our Therapeutical Arrangement, and, 
 doubtless, there are many who think it entitled to a higher rank. But, 
 ■with all its reputation, its uses are comparatively circumscribed. It is 
 not suited to any conditions of acute inflammation or fever, till, at least, 
 they are far on the decline (§ 872, a) ; nor is it, at any time, a proper 
 purgative when an active effect is required. Indeed, the real advantages 
 of Khubarb, as a cathartic, are limited almost to cases of diarrhoea un- 
 attended with intestinal inflammation, to indigestion, and to the stage of 
 convalescence from most diseases, whether acute or chronic ; and, I may 
 also add, to scrofulous subjects when affected by indolent conditions of 
 inflammation. I am speaking of it in its relations to disease as a cathar- 
 tic, though it may exert simultaneously other veiy desirable effects. In 
 smaller doses, other objects are in view, and they can have no participa- 
 tion in assigning the rank as a cathartic (§ 890, b). 
 
 Now, the reasons of this limitation are rendered obvious by consider- 
 ing the effects of Rhubarb upon certain diseased states of the body. 
 When exhibited in fevers and acute inflammations, which make up 
 the great amount of diseases, it aggravates them like stimulants and 
 tonics; and it is also well known that it exerts the useful effects of 
 tonics where these remedies are appropriate, as in dyspectic affections 
 (§ 10G5). Aloes, scammony, &c., increase them by irritant virtues. 
 
 Whilst, therefore, we thus learn that Rhubarb is not suited to febrile 
 and inflammatory conditions of an active nature, the objections show 
 us that it is well adapted to the periods of convalescence from those 
 affections. Its mild tonic and cathartic virtues, as then manifested in 
 small doses, give to it, under those circumstances, a high value as an 
 auxiliary to Nature in her recuperative efforts. But in these cases, 
 even, it should not be given uncombined (§ 872 a, 1064). 
 
 By its frequent effect in arresting diarrhosa, it is known to possess, 
 also, what is called an astringent property. But of this I have already 
 spoken (§ 890, h). 
 
 We have now seen that Rhubarb is cathartic, tonic, stimulant, and 
 astringent ; a combination of virtues which distinguishes it remarkably 
 from all other cathartics. These united virtues impart to it a high value 
 as a cathartic in certain conditions of disease, and a good substitute 
 could not be supplied for it in those conditions. It enables us, also, to 
 employ rhubarb most advantageously in many forms of disease where 
 we do not desire its cathartic, but only its laxative effect that arises 
 from small doses. In these small quantities, too, as a grain to five 
 grains, the tonic effect of the remedy, which is then commonly desirable, 
 is more strongly pronounced than in large doses. — Note Ee p. 1133. 
 
 On account of these numerous virtues of Rhubarb, according, in part, 
 to the quantity administered and the nature of the disease, I have ar- 
 ranged it not only among the cathartics, but among the alteratives, and 
 tonics, and astringents. For the first of these purposes it is most useful 
 when combined with Calomel, or Calcined Magnesia, or the Tartrate of 
 Soda and Potash, or the Sulphate of Potash ; as an alterative it is often 
 useful, in small doses, in chronic inflammations, on account of its useful 
 effect upon the alimentary canal and liver ; as a tonic in dyspeptic cases, 
 and in convalescence from acute diseases, when its action upon the liver, 
 and its laxative effect, are also tributary to the cure ; and, as an astrin-
 
 856 INSTITUTES OF MEDICINE. 
 
 gent, in cases of diarrhoea unattended by intestinal inflammation, and in 
 large or small doses according to the precise nature of the disease. 
 
 Great mischief is done by the exhibition of Rhubarb in dysentery 
 and scarlet fever. It is employed theoretically in the treatment of the 
 former disease, on account of the astringent as well as cathartic virtue 
 of this remedy, while the tonic and stimulating are completely neglected, 
 as well as its pernicious effects (§ 892^, g). 
 
 SCAJUMONY, ALOES, COLOCYNTH, SENNA, COLCHICUM. 
 
 § 1062^. Three of the foregoing remedies, Scammony, Senna, and Col- 
 chicum, are produced here, not only for the purpose indicated in § 1057^, 
 but to exemplify the manner in which remedial agents of powerful mor- 
 bific virtues arc commended to an indiscriminate use in those enlight- 
 ened quarters where Bloodletting is nearly or altogether proscribed, and 
 to thus institute a farther contrast between the abuse of the Materia 
 Medica and the neglect or denunciation of the '■'■ Remedium Priricipale" 
 (§ 819 b, 891 c, 954 b, 960 a-h, 1000, 1001, 1003, 1005-1006, 1007 b). 
 
 SCAMMONY, ALOES, AND COLOCYNTH. 
 
 § 1063, a. The cathartics following Ehubarb (§ 1062) in our Thera- 
 peutical Arrangement are, respectively. Calcined Magnesia, Carbonate 
 of Magnesia, Colocynth, and Scammony, the last of which, therefore, 
 occupies the 15th rank as a cathartic of general usefulness, Aloes hold- 
 ing the 5th, or next after Castor Oil. 
 
 Scammony is a more irritating cathartic than Aloes or Colocynth, to 
 which it is a good deal allied in its effects upon morbid conditions, al- 
 though, unlike the latter it contains a large proportion of resin, which 
 is the active principle (§ 1060). It operates with energy upon the whole 
 intestinal canal, and exerts an alterative reflex nervous effect upon the 
 liver, often inducing a redundant flow of bile in the inactive conditions 
 of that organ. It is well suited, therefore, when properly combined, to 
 habitual and obstinate constipation, where no intestinal inflammation is 
 present. It is, for like reasons, and, like Aloes and Colocynth, curative 
 of chronic diseases of organs situated remotely from the abdominal vis- 
 cera, and which owe their origin to those abdominal affections of which 
 I am speaking, or, having a different origin, become complicated with 
 them (§ 905, a). These three remedies, indeed, are generally adapted 
 to like conditions ; though Aloes is much the best, and Colocynth is 
 more alterative and remedial, and less irritating than Scammony. Each 
 is pernicious in all inflammatory and irritable states of the intestinal 
 canal, as well as injurious in all fevers, and in all acute inflammations 
 of important organs. Nevertheless, Scammony, like Aloes and Colo- 
 cynth, is more or less adapted to mild inflammations of the mucous tis- 
 sue remote from the abdomen, as in catarrhal affections (^ 904 a). 
 
 § 1063, b. An important error prevails in regard to the action of 
 Scammony and Aloes upon the intestinal canal, it being supposed that 
 they exert their effects (particularly Aloes) upon the lower tract of the 
 large intestine. This conclusion has grown out of the irritation of the 
 anus which often attends the operation of Aloes ; but it is mostly due 
 to the morbid bile which Aloes elicits from the liver. The Mercurials 
 and Castor Oil have often the same effect in hepatic congestions, and it 
 often occurs when no cathartic has been exhibited. Either for this 
 reason, or because, perhaps, Aloes contains no resin, Pereira remarks^
 
 Therapeutics. — appendix. — Aloes^ Senna., &c. 857 
 
 in his great work on the Materia Afedica, that "Aloes irritates less pow- 
 erfully than Jalap" ! The misapprehension has led to a great extent of 
 malpractice, particulai'ly to the administration of this cathartic in 
 fevers and acute inflammations, and even in morbidly irritable states of 
 the small intestines. Aloes is, also, for the same reason, in part, with- 
 held from pregnant women, lest its supposed action upon the rectum 
 should give rise to abortion, a result which was denied by Denman, 
 while, also, Aloes is an emmenagogue of some pretensions. As to the lat- 
 ter fact, it restores menstruation in two pi'incipal ways: 1st, by its spe- 
 cial sympathetic action upon the mucous tissue, remote from the intes- 
 tine, in its morbidly susceptible conditions, as witnessed in catarrh and 
 gonorrhoea ; and, 2d, by its removal of indolent hepatic troubles and con- 
 stipation, of which amenorrhoea is so often merely symptomatic. 
 
 The simple fact that Aloes affects readily and powerfully the hepatic 
 function in its morbid states should leave no doubt of its special action 
 upon the upper portion of the intestinal canal ; but, that this is truly 
 so may be rendered evident, and Pereira's comparison of Jalap and 
 Aloes contradicted, by the following experiment, which may be readily 
 tried by the advocates of Aloes and Scammony, bearing in mind that, 
 when constitutional excitement ensues, or when allayed, by the opera- 
 tion of cathartics, it is mostly in consequence of their action upon the 
 small intestine (§ 718, 889 i). 
 
 Let us, then, regard two patients, affected as nearly alike as may be 
 with remittent fever. The skin of both is preternaturally Avarm, the 
 pulse moderately full, and 100 beats in a minute. This is so far their 
 corresponding state ; the disease in its incipient stage, and there has been 
 no treatment. Now, to one we will give 30 grains of Jalap, to the 
 other 12 grains of Aloes; and let us take an observation of their symp- 
 toms at the time of the second alvine evacuation. The pulse of him who 
 is purged by the Jalap has descended in frequency from 100 to 80 beats 
 in a minute ; while the Aloes has carried it up in the other to 120, be- 
 ing a difference of 40 beats. The skin of the former patient has become 
 cool, and soft Avith an insensible perspiration. This patient is also 
 placid, and feels himself relieved. On the contrary, the skin of the other 
 is ardent and dry, his face flushed, his eyes wild, his head annoyed with 
 pain, and his whole system in an agitated and harassing state. This is 
 the test, and by this should we be governed both in practice and in 
 theory. It illustrates also the principles in ^ 500 m, 863 d, 904 a, kc. 
 
 § 1063, c. The objections which I have made to Scammony as an ii*- 
 ritating cathartic lead me now to fulfil the purpose expressed in § 1062^, 
 as I shall have occasion to do, also, when I come to the merits of those 
 popular remedies, Senna and Colchicum. For this object I shall look 
 into Pereira's elaborate and standard work upon the Materia Medica (as 
 I have done on former occasions, § 891 c, 960 a), as one, among others 
 quoted to the same effect, which represents the opinion of many. 
 
 '^ Scammon?/," says Pereira, " w prmcipally valuable as a smart 2)urga- 
 tivefor children, on account of the smallness of the dose necessaivj to produce 
 the effect, the slight taste, and the energy, yet safety, of its operation." 
 
 I shall not speculate upon the probable consequences of this eulogium 
 upon one of the most irritating and drastic of the purgatives that are 
 entitled to a reputable place in the Materia Medica, nor inquire how far 
 it may have contributed to the success of homoeopathy (§ 878). But I 
 am entitled to assert, in the first place, that such is the great liability
 
 858 INSTITUTES OF MEDICINE. 
 
 of Scammony to produce constitutional irritation, and excite intestinal 
 inflaramation in Children, that it should never be exhibited to them un- 
 der any circumstances (§ 576 d-577) ; and for the ordinary purpose of 
 cathartics it is entirely unsuitable at any age. 
 
 Again : as to the attractive " taste" of medicines, which appears to be 
 often of paramount consideration. Calomel, even, is recommended for 
 Children upon this worse than mere empirical ground ; and, of one of 
 the most valuable remedies, and most appropriate for Children, Fereira 
 says, that, " As a purgative for Children, Castor Oil has been used on 
 account of its mildness ; but its unpleasant taste is a strong objection to its 
 use." Compare this with what he says of Tobacco at § 900, a. Nei- 
 ther is the " small/less" of a requisite dose to be for a moment weighed 
 against the virtues of a better remedy. 
 
 § 1064. The popularity of Senna as a domestic medicine, and the ex- 
 tensive use of it by the Profession, lead me to some comments Avhich 
 would not be otherwise made. If Bloodletting, in the treatment of in- 
 flammations and fevers, is to receive no quarter from those who build 
 their hopes upon a more popular practice, or lose sight of pathology in 
 the novelties and promises of Organic Chemistry, let us see to it that 
 they do not escape without rebuke for their lavish use of the violent ar- 
 ticles of the Materia Medica (§ 819, b). — Note H p. 1117. 
 
 Pereira, in his able work upon the Materia Medica, supplies the best 
 authority as to the general estimation in which Senna is held. "Taken 
 by the stomach," he says, " Senna acts as a sure and safe purgative ;" 
 and again he repeats, " It is a very safe purgative, and may be given to 
 Children, Females, and Elderly persons ivith great security." 
 
 That Senna is a " sure purgative" is as true as the same affirmation 
 by our Author of Scammony (§ 1063, c) ; but it is nearly as far as Scam- 
 mony from being entitled to the same general commendation of being 
 " very safe." On the contrary, in my judgment, there is no other ca- 
 thartic, in the hands of Physicians, which has been more extensively in- 
 jurious than Senna ; and this being so, I shall indicate its bad qualities 
 before speaking of its good. 
 
 In the first place. Senna is rarely capable of any very salutary effect 
 upon inflammations, either acute or chronic, or upon fevers. By its ir- 
 ritative virtue, it excites the general circulation ; and as it is profoundly 
 irritating to the whole mucous tract of the bowels, it rarely fails to ag- 
 gravate idiopathic fever, or to exert injurious reflex nervous influences 
 upon any inflamed organs. We have already seen how Rhubarb is mis- 
 applied in this manner, especially in dysentery (§ 1062). But that rem- 
 edy inflicts its injuries in active forms of inflammation and fever by its 
 tonic and stimulating properties — Senna, by its irritating (§ 889, a). 
 And here, by the way, it is apropos of the Author to Avliom we are now 
 paying our respects, that he says of Rhubarb that, "Given at the corn- 
 viencement of disease, it is a very popular remedy ; and though doubtless 
 it is often employed unnecessarily, it rarely if ever does harm." True, he 
 also says that " it is not fitted for inflammatory or febrile cases." 
 
 But, as to this Senna, it may be safely said, that it should never be 
 employed but with a simple view to its purgative effect, and then only in 
 constipated states of the bowels when unattended with any inflammation 
 of those organs. The griping of Senna is proverbial ; and Physicians
 
 Th^apeutics. — appendix. — Colchicum. 859 
 
 have vainly flattered themselves that this effect may be counteracted by 
 uniting Manna, or the Saline Cathartics, or a purgative Tincture, or 
 some carminative, like Coriander or Anise, with an infusion of Senna ; 
 nor does a moderated heat in its preparation lessen the evil. What, 
 then, does that griping imply, considering its universality? Certainly, 
 an excessive irritation of the intestinal mucous membrane, and such, too, 
 as is very likely to result in disease of the intestines, if these organs be 
 in a morbidly irritable state. If any disposition to inflammation be 
 present in any one of the tissues of the intestines, the action of Senna 
 will be very likely to develop an attack of that disease. If any venous 
 congestion affect the liver, it will be aggravated by the irritating prop- 
 erties of Senna. And, as it regards inflammations of other parts, and 
 idiopathic fever, it is very likely, as is known in the best experience, to 
 send its morbific influences abroad from the abdominal organs over those 
 affections. Among the worst and most common manifestations of this 
 are the sad effects of Senna in the treatment of scarlet fever. 
 
 The objections to Senna grow out of its radical fault of possessing 
 very little alterative virtue of a useful nature, and a great deal of a mor- 
 bific (§ 854, d). But a difference in this respect obtains in difterent cli- 
 mates ; which applies, also, more or less, to other irritating cathartics, 
 and to Tartarized Antimony in emetic doses. In latitudes north of about 
 40° these remedies are better borne than in the more southern ; the rea- 
 son of which is, that in New York and South there either exist in most 
 complaints, or there is a great tendency to, derangements of the abdom- 
 inal viscera. 
 
 Having, therefore, so little to say in commendation of this notorious 
 member of the Materia Medica, and having dwelt sufficiently long upon 
 its demerits, it only remains to be added, that it is most salutary when 
 it takes along some one of the meritorious neutral salts. 
 
 COLCHICUM. 
 
 § 1065, a. The most obvious effect of Colchicum, in small and repeat- 
 ed doses, is that of irritating the intestinal mucous membrane, as evinced 
 by a purgative effect. In larger doses it produces nausea, vomiting, and 
 hyper-catharsis. Indeed, this remedy is commonly arranged with the 
 cathartics, though it is rarely employed with the usual intentions of a 
 purgative. I am quite satisfied, however, that it will not often afford 
 much relief in gout or rheumatism (to which its uses are mostly restrict- 
 ed) till it produces some purgative or laxative effect. For this reason, 
 particularly, I have given it a low rank among the Cathartics in the 
 Therapeutical Arrangement of the Materia Medica. This effect, indeed, 
 is what we are to carefully watch ; since, when it begins, if the dose have 
 been large, or the intestines unusually susceptible, the purging is liable 
 to be excessive and injurious. 
 
 Various incidental results are stated by Authors as following the use 
 of Colchicum, such as occasional sweating, occasional increase of the 
 flow of urine, &c. But these are only contingencies to which almost all 
 remedies may lead, under particular circumstances of disease, and are of 
 very little importance in an abstract sense (§ 422 b, 863 d, e, 892f ). It is 
 worthy of remark, however, that Colchicum often reduces the frequency 
 of the pulse, though at other times it exerts an opposite effect. But the 
 interesting fact relates to the diminished frequency, which has been taken 
 hypothetically as a ground for the administration of Colchicum as a
 
 860 INSTITUTES OF MEDICINE, 
 
 remedy for all kinds of inflammation, and is one of the expedients that 
 have been devised for getting rid of Bloodletting. This brings me to 
 one of the objects set forth in § 1062^. 
 
 " J/r. Haden^'' says Pereira, '■'■xoas, the first to direct attention to the advan- 
 tages to be taken of this effect in the treatment of inflammatory diseases {ut 
 cit, § 1063, c).— Note I p. 1 118. 
 
 I know not to what extent this very limited view in Therapeutics 
 may have prevailed ; but it has been, probably, the occasion of an effort 
 now making in the United States to substitute for Bloodletting that very 
 violent agent the Veratrura Viride, which has been long known to less- 
 en the frequency of the pulse by an acrid narcotic virtue which it pos- 
 sesses, and which belongs to some of the acrid cathartics. The whole of 
 this practice appears to have been suggested by a similar error in respect 
 to Digitalis, and by the attempts that have been made to substitute To- 
 bacco and Aconite for Loss of Blood (§500 m, 826 cc, 893i, 960 a). 
 
 Neither Colchicum nor Veratrum exert any antiphlogistic effect ex- 
 cepting upon those specific forms of inflammation which constitute rheu- 
 matism and gout ; and both of them will aggravate these diseases in 
 their acute condition till they are effectually moderated by Bloodletting, 
 Tartarized Antimony, or other direct Antiphlogistics. In that respect 
 they are upon common ground with quinine in its relation to intermit- 
 tent inflammation, and with iodine to the scrofulous. They are very 
 remarkable exceptions to all the general antiphlogistic means which are 
 alike adapted to the early stages of the specific and common forms of 
 inflammation, and which are indispensable at that stage, as preliminary 
 remedies, to the favorable action of the specific ones upon the special 
 modifications of inflammation to which they are alone adapted (§ 662, 
 671, 892 m, p, 892i^ c, e, ti). More remarkable exceptions occur in 
 guaiacum and other substances of allied virtues Avhich are peculiarly 
 suited to chronic rheumatism, while they aggravate any other form of 
 inflammation. Nor is it an uninteresting fact, that all these things, 
 Colchicum, Guaiacum, Veratrum, Asagrtea, Delphinium, Xanthoxyl- 
 lum, Aconite, Mezereon, Savin, are acrids (^ 892 b, 892-|- r, 904 a). 
 
 § 1065, b. These, however, are only strongly pronounced character- 
 istics ; for the critical observer will find the same distinctions prevailing 
 in various degrees throughout the Materia Medica, and they show us 
 that experience, and not theory, is, or should be, at the foundation of all 
 our knowledge of the virtues of remedies (§ 2, c) ; and not only so, but 
 that we can have no just apprehension of their relations to disease with- 
 out a long series of trials in the endless variety of pathological condi- 
 tions, their fluctuations, their localities and sympathetic influences, or as 
 they may involve the universal body, according to the range of inquiry 
 which pervades these Institutes ; and when the student shall have ex- 
 amined its details and principles, and seeing that there is not a conflict- 
 ing fact or induction, but that it is a perfectly consistent and harmoni- 
 ous whole (§ 1, a), let him interrogate himself as to whether he can sum- 
 mon a fact or a doctrine from Organic Chemistry that will disturb that 
 relationship, or withstand its united force. 
 
 § 1065, c. But, however this may be, so long as the Chemical doc- 
 trines are in the ascendant, we may not hope that experiments of the 
 foregoing nature will cease to occupy the place of rational Medicine. 
 *Nay more ; failing in these, and considering the unpopularity of anti- 
 phlogistic remedies and the acceptable nature of the invigorating, we
 
 Therapeutics. — appendix. — Colcliicum. 861 
 
 need not be surprised that the Chemical treatment of disease is so ex- 
 tensively governed by the Brunonian philosophy. Of that philosophy I 
 have said something in these Institutes, and adduced an example of its 
 prevalence in the British Army when Robert Jackson undertook to 
 demonstrate its real merits (§ 621a, 890^/, 960a, p.717, §569 e, 1006/, 
 1068). But how little would this Reformer rely upon human efforts 
 could he how read the brief paragraph which follows : 
 
 ^^ Costly 3Iedicine. — A London (Eng.) paper says: 'The consumption 
 of Avines in our public hospitals constitutes one of the heaviest items of 
 their expenditure. The wine account at Guy's Hospital last year,£l083 ; 
 the spirit account, £376 — total, £1459 ($7295). At St. Thomas's, the 
 wine account was £629 ; spirit account, £521 — total, £1150 ; or £2609 
 ($13,045) in one year in the (two) borough hospitals alone.' " — Boston 
 Med. and Surg. Journal, July 2, 1857, p. 448. — Note F p. 1114, 
 
 § 1065, rf. Again, as to Colchicum. This is also one of the many vio- 
 lent remedies that have been employed not only as a substitute for 
 Bloodletting, but commended in doses at which Bloodletting revolts 
 (§960, a, p. 717). Thus: 
 
 " In some experiments," says Pereira, ut cit. (made with Colchicum on 
 a healthy individual by Dr. Levvins), " debility, a feeling of illness, and 
 headache were experienced. This feeling of debility is not, however, to 
 be referred to the evacuations produced, for, as Dr. Barlow has observed, 
 the number of motions is sometimes considerable without any propor- 
 tionate diminution of strength. I have known, says Dr. Barlow, even 
 twenty stools occasioned by a single dose of Colchicum, the patient not 
 complaining of the least debiHty." — Note G p. 1116. Also, p. 656. 
 
 Now here is something of which we have a right to complain. In 
 the first place, that Dr. Barlow should isolate a case of this nature, and 
 put it forth to show that we have nothing to fear from " twenty stools" 
 by a single dose of this most violent substance ; and, secondly, that Pe- 
 reira should quote it for the same purpose, and in opposition, even, to 
 Dr. Lewin's experiment upon a healthy individual. 
 
 Having done this mischief, Pereira ultimately relates instances of 
 death from over-doses of this medicine, and remarks that, "in poisonous 
 doses, Colchicum acts as a powerful poison." Now, to my apprehension, 
 when "a single dose" of any "powerful poison" pi'oduces "twenty 
 stools," it is verging very closely upon its poisonous effects; and when- 
 ever Colchicum may treat our patients in that reckless manner, we may 
 fear, at least, some troublesome intestinal inflammation as a consequence. 
 There never was, and never will be a patient purged twenty times by "a 
 single dose" of any cathartic, without being the worse for the violence 
 inflicted upon his intestines (§ 960, a, p. 717). There can be no topic 
 more worthy of professional criticism. 
 
 But I have been actuated in this disquisition only by a sense of the 
 importance of considering well how the violent agents of the Materia 
 Medica are often commended to our rash and indiscriminate use ; and 
 in so doing, to show, also, how probable it is that the same inconsider- 
 ate view of the subject has led to protestations against the most import- 
 ant of all remedies in the treatment of inflammations. — Note Hp. 11 17. 
 
 § 1065, e. There can be no doubt that Colchicum manifests a much 
 greater control over gout than rheumatism ; and, although this is gen- 
 erally conceded, all practitioners do not agree as to the extent of its in- 
 fluence. Some of .the most able and accurate observers, such as Sir E.
 
 862 - INSTITUTES OF MEDICINE. 
 
 • 
 
 Home, and Dr. Paris, pronounce it a specific for the disease; while 
 others, like Sir C. Scudamore, consider it, at best, only a palliative. In- 
 deed, Scudanaore, in his treatise on the gout, is disposed to look upon 
 Colchicum with great suspicion, believing that, although it be a present 
 means of relief, it increases the tendency to a repetition of the paroxysms. 
 He thinks, also, that it loses its remedial eft'ects by frequent use, al- 
 though considerable intervals intervene between the attacks. Very 
 much, however, will depend upon the particular circumstances of the 
 case when the remedy is exhibited. If given at the onset of acute gout 
 without antecedent Bloodletting, or when the abdominal organs are in 
 a morbid state, we may look for disappointment. 
 
 ON THE ACTION OF CHLOROFORM, AND ANALOGOUS AGENTS IN PRODUCING 
 INSENSIBILITY WHEN INHALED.* 
 
 § 1066, a. The general prevalence of the Chemical or other physical 
 doctrines of life, and the consequent interpretation of Pathology and 
 Therapeutics upon the same principles, has necessarily led to as exten- 
 sive a revival of Humoralism, and, as one of its dicta, that the causes 
 of disease, and the curative means, so far as the nature of things will 
 admit, are absorbed into the circulating mass of blood, where they effect 
 their results in the blood or the solids through some chemical process 
 (§ 40-46, 350, 3501-3501, 821 c, 828 d, 830, 837 a, 840, 893 e, 904 b, 
 905 a, 1034). All but Setons, Cold, Mental Emotions, &c., are carried 
 to this account (see Indexes) ; and even some of the soundest Physiolo- 
 gists in other respects maintain that the poison of the Viper, Hydrocyanic 
 Acid, and the spirituous extract of Nux Vomica are absorbed when the 
 last two destroy life in a second of time, notwithstanding, also, it is pal- 
 pable that their fatal action must begin on the instant of their contact 
 with the lungs or the mouth (§ 350^ 7?, 441/, 487 g, h, 494, 826, 827, 
 828 a-e, 829, 904 b, &c.). 
 
 And so, to question the assumption that chloroform and analogous 
 agents produce their effects only after being combined with the circu- 
 lating mass of blood, according to Liebig's or some kindred hypothesis 
 (§ 350|, n, p), is held to be an evidence of ignorance in Physiology, and 
 unworthy a moment's consideration. But, before this doctrine can be 
 sustained, the facts in the foregoing references, and a multitude of others 
 contained in this Volume, must be disproved. True, the blood is said 
 to be changed in its colour, but that Avould necessarily arise not only 
 fi'om the exclusion of atmospheric air, but from the morbific action of 
 the anaesthetic through the ordinary laws of sympathy, and is upon the 
 same ground as the supposed absorption of Carbonic Acid Gas (§ 419, 
 827 b). Again : some may have supposed that they have smelt those 
 agents in the blood (§ 282). But the sense of smell is apt to be fallacious, 
 especially when in pursuit of some particular odour or some favourite hy- 
 pothesis, and it is difficult to contradict it. But this would prove noth- 
 ing as to their mode of operating ; since, especially, others have failed 
 of detecting the odour of the most fragrant and fatal (§ 494, 827 d, 904 
 I), c). Moreover, the odour of chloroform and of sulphuric ether is very 
 diffusive and impressive, so that if even a minute quantity of either sub- 
 stance entered the circulation, it should be detected without the aid of 
 the imagination. A drop of ether will impregnate the air of a large 
 room. We have had reports of alcohol having been thus observed, and 
 they have been appropriarted by the Chemist accordingly (§ 440 bb, No. 
 
 * I will not forego this opportunit}' of expressing mj' full conviction that the honor 
 of this discovery, and of its lirst practical application, belongs to Dr. Houack Wklls.
 
 Anoesthetics. — appendix. — Chloroform^ dc. 863 
 
 9, § 441 c, 104S-1049) ; nay more, of the blood burning like a flaming 
 current as it issued from a vein, and even of the spontaneous combus- 
 tion of inebriates.* (See all the reported cases in 3Ied. and Physiolog. 
 Comm., vol. i., p. 576-581, where each one is shown to be without 
 foundation.) But alcohol is not absorbed (Liebig, p. 172, § 350, no. 94). 
 The veins of different organs have been, also, found congested after 
 respiring the Antesthetics, but less frequently of the brain than of some 
 other parts. But this, too, proves nothing of absorption ; for the same 
 is the case Avhen Hydrocyanic Acid, and the spirituous extract of Nux 
 Vomica, whether taken by the stomach, or applied to the mucous mem- 
 brane of the eyes, or nose, or mouth of rabbits, destroy life in a second 
 of time (p. 675, § 904 b, 494 dd, 826 d), or the virus of a snake in a 
 minute (§ 828 c). And let these observations be taken in connection 
 with Girtanner's experiments and those of others (§ 494 b-dd), and with 
 the remarkable results from pricking the floor of the fourth cerebral ven- 
 tricle (§ 1032 d) and with the respiration of ammonia, &c. (§ 827 c). 
 
 But the question is not whether Anaesthetics or Isitrous Oxide be ab- 
 sorbed, as very possibly they are more or less, but whether they produce 
 their eflfects through the medium of the blood, or by reflex actions of 
 the nervous system. (See § 284, 1088 d. This distinction is fully con- 
 sidered in various places. See Index ii.) 
 
 As the whole of this ground, however, has been gone over extensive- 
 ly in these Institutes, it is mostly the purpose of the present Article to 
 bring the question under the ti-ial of facts embraced in the foregoing sec- 
 tions, and others to which they refer, along with our demonstrations of 
 the nervous power and its laws of reflex action ; though the subject might 
 have been left to a single consideration, which appears to me to be con- 
 clusive against the doctrine of operation by absorption, and which I shall 
 now address to the Physiologist. 
 
 § 1066, b. In the first place, then, it is conceded that the blood is 
 from one to two minutes, at least, in going the round of the circulation 
 (§ 904, b). It should, therefore, occupy nearly that time after the res- 
 piration of the Anesthetics is begun before insensibility takes place, 
 which is equally true, also, of Hydrocyanic Acid and the extract of Nux 
 Vomica (the latter of which is not volatile, § 494 dd., 826 d), which have 
 been known to destroy animals in a second of time (§ 904, b). But this 
 is not the specific fact to which I have adverted, though it should be 
 taken in connection. 
 
 I say, then, if insensibility depend upon the absorption of the Anaes- 
 thetic agents there should be no necessity for their unceasing respiration, 
 or quick repetition, to maintain their eflfects. The blood once charged, 
 or however modified, should be capable of prolonging insensibility far 
 beyond any thing that is observed in experience. But if, on the con- 
 trary, the efi^ect arise from the influence of the agent upon the pulmonary 
 mucous membrane, and be thence propagated by the nervous system, it 
 would be quite likely to subside soon after atmospheric air is freely ad- 
 mitted to the lungs, as in § 481, a-h. Precisely the same peculiarities 
 attend the respiration of the nitrous oxide gas (§ 827, c). The subject 
 is quickly brought under its power, and his faculties are often fully re- 
 stored in less than half a minute after atmospheric air is substituted. 
 This is as true oi Amylene as of chloroform and sulphuric ether. Thus, 
 Dr. Orton, of Binghamton, N. Y., on administering siij. of amylene, 
 produced '■'■ complete insensibility in about two mimites." "Just as I was 
 * It has been lateh' reaffirmed bj' French chemists that alcohol, chloroform, &c., occur 
 within the body, after their ordinar}' use, in a free state. See § 350, nos. 43, 94. — 1861.
 
 864 INSTITUTES OF MEDICINE. 
 
 about to perform the surgical operation intended, the flexible tube with 
 mouth-piece separated from the inhaler, and before I could adjust it my 
 patient had completely recovered her usual sensation." The inhalation 
 was repeated, and " the larger nail torn from the toe without the slightest 
 uneasiness."* {New York Journal of Med., Sept., 1857, p. 2S6.) Now, 
 will any one believe, with his logical powers awake, that such a sudden 
 transition, in either of the cases, could ppssibly happen were the phe- 
 nomena owing to an incorporation of these substances with the circu- 
 lating mass of blood ! Give to the Chemical, or any other physical hy- 
 pothesis, the greatest possible latitude of construction, or expound the 
 results upon the vital theory, it is plain that when these agents are once 
 circulating in the labyrinth of the organism, and in sufficient quantity to 
 produce the astonishing momentary effects, they would continue to do 
 so, in gradually diminishing degrees^ until ample time should have elapsed 
 for, at least, their elimination by the emunctories. 
 
 Again : the doctrine of absorption is contradicted by the necessity of 
 diluting the ansesthetics with atmospheric air to prevent immediate 
 death, which may happen so quickly as to preclude the hypothesis. This 
 necessity of dilution supposes, therefore, the action of the Anaesthetics 
 upon the nervous system of the lungs, and their transmitted influence 
 over the entire organism by the reflex action of the nervous power ; and 
 this is farther seen in the fact that a greater amount would be absorbed 
 during a long-continued respiration of the diluted agents than could hap- 
 pen when only momentarily exhibited in a concentrated state, and there- 
 fore death should as certainly follow in the former case. Moreover, all 
 the earliest phenomena denote the direct action of the agents upon the 
 lungs. Why are the effects so difterent when taken by the stomach ?! 
 
 The whole philosophy, therefore, is perfectly explicable through what 
 is known of the different susceptibilities of the various tissues, and in 
 their various parts to the action of external and internal causes, and the 
 wonderful attributes of the nervous system ; and which enable us to 
 comprehend the reason why the Ansesthetics so rarely affect the organs 
 of organic life (§ 233|, 422, 425 d, no. 7, 481 a-h, 487 h, 500 g, m, 891^ 
 g, k, 893^, 1088 c, and Indexes, Art. Structure, Nervous Power). 
 
 By the same philosophy we as readily comprehend the reason why 
 the respiration of the fumes of Hyosciamus and of Opium establishes 
 profound effects upon the whole organism, when no such result arises 
 from smoking tobacco (§ 904 h). But what is very exact and compre- 
 hensive is the effect of ammonia when respired as a counter-poison for 
 hydrocyanic acid. Here can be no relief from absorption, for hydrocy- 
 anate of ammonia is an active poison. 
 
 * I have introduced this case for the purpose, particular!}-, of referring to the remarlc- 
 able fact that " the e3-es of the patient were not closed at any time during the operation, 
 but she seemed to amuse herself with an examination of the apparatus. She answered 
 questions put to her with considerable promptness, and, in fact, conversed with m}' as- 
 sistant during the period of insensibilitj-," nor "was she aware that the nail had been 
 removed when she recovered her sensibilitj-. The pulse was but slightlj' accelerated." 
 
 There is no contradiction between this statement and that "complete insensibility" 
 was effected. The latter refers to common sensibilit}-, the source of pain ; and the ex- 
 periment illustrates admirably the distinction between common and specific sensibility- 
 (§ 197-201). The experiment, in thus sliowingthe limitation of the anesthetic influence 
 to the nerves of common sensation, and in leaving the mind unaffected, as, also, the ac- 
 tion of the heart, goes with our other facts in disproving operation b}' absorption. 
 
 The anah'sis which the experiment has supplied as to the modification of sensibility 
 may be carried analogicall}- to the organic properties, and be thus emploj-ed in corrob- 
 orating our analysis of those properties (§ 170 a, 172, 175 «, 6, 183-193, 205-221). 
 
 f That death is owing, as surmised bj- some, to the exclusion of atmospheric air, is 
 contradicted by the phenomena, and by the failure of restoratives (§ 634). — See Note 
 M p. 1120.
 
 Remedial Action. — APPENDIX. — Mental Emotion. 865 
 
 THE INFLUENCE OF THE MINB UPON THE ACTION OF REMEDIAL AGENTS. 
 
 § 1067, a. Much has been said in this work upon the influence of the 
 Mind in the production and cure of diseases ; and it is now my purpose 
 to extend this inquiry, very briefly, to the influences of the mind upon 
 the action of physical agents, both as predisposing the body to the action 
 of foreign morbific causes, and as modifying the operation of remedies. 
 It will thus form an Appendix to what is said of the "General Philos- 
 ophy of the Modus Operandi of Remedial Agents," or, rather, a group- 
 ing of many relative observations that are disseminated through the In- 
 stitutes. (See Indexes, Articles Remedial Action, Remedies, Mental Emo- 
 tions, Mind, and Will-) The subject is practically important, and goes 
 far in denoting the laws which govern the operation of physical agents 
 upon the body, and in drawing a broad line of distinction between Chem- 
 istry and Physiology. 
 
 I say practically important ; for who, indeed, of the Medical Profes- 
 sion has not suffered the experience of seeing the useful effects of reme- 
 dies defeated by the despondency of his patient, or by some saddening 
 emotion awakened by the indiscretion of friends, and often by a brief at- 
 tention to business engagements, or by far simpler occupations of the 
 mind? But there is great variety in these respects, according to the 
 pathological conditions and the mental influences. The differences in 
 results coincide, also, with such as are witnessed of physical agents ; the 
 same philosophy interprets the operation of both ; and the same careful 
 regulation of one is often as important as that oPthe other. 
 
 It is a matter of daily observation, in acute diseases, that the casual 
 visits of relatives and friends, however much enjoyed by the sick, leave 
 them for the worse ; an effect entirely the reverse of what is witnessed 
 of the same excitements in chronic forms of disease. But this corre- 
 sponds with what is seen of the difference in the results of bodily exer- 
 cise and tonics and stimulants in acute and chronic maladies. On the 
 other hand, however, the subject of acute disease may be essentially ben- 
 efited by the subdued cheerfulness of an habitual attendant. He may 
 be, in like manner, seriously disturbed by listening to a page from a Ro- 
 mance, when, on the contrary, he would derive an advantage from an 
 appropriate Chapter of the Bible ; and yet both of these are remedial in 
 chronic diseases. Nevertheless, there is a perfect consistency in the phi- 
 losophy which attends the effects of those causes in the two cases — 
 whether Nature be embarrassed by mental troubles and pleasurable ex- 
 citements, or aided by placid cheerfulness a;nd buoyant hope. The moody 
 dyspeptic is invigorated in his digestion by every kind and degree of men- 
 tal enjoyment, and his laxative and tonic medicines are sure to serve him 
 best when his constipating melancholy is occasionally broken by hilarity 
 of mind ; while the subject of fever, though lacerated by exhilarating 
 emotions, is started along by every smile of his Medical Attendant, and 
 every remedy yields a boon to Nature under the influence of that smile, 
 when a solemn countenance may make all the odds between recovery 
 and death. In acute diseases, it is the tranquil emotions that do the 
 service, while all of a joyful nature are scarcely less embarrassing to art 
 than they are instrumental in the cure of chronic maladies. So nicely 
 graduated is this principle in its operation, that it often happens that the 
 subject of fever will make greater improvement in the hands of a com- 
 mon nurse than in those of a sympathizing friend. And yet there never 
 
 In
 
 866 INSTITUTES OF MEDICINE. 
 
 fell from the lips of the Medical Attendant a word of encouraging pity 
 that did not tell favourably on his Castor Oil or his Narcotic. 
 
 It is, of course, impossible to analyze the precise influences of the mind 
 upon the action of remedies in mitigating or aggravating disease. The 
 principle is abundantly pronounced in morbific effects of the mind, that 
 are independent of other causes, in embarrassing the favourable action of 
 remedies ; and it not unfrequently happens that the mental condition 
 may bafile the best efforts of art, not only as a fundamental evil, but as 
 crippling the curative means ; while, on the other hand, when the same 
 mental trouble is supplanted by happier thoughts, its baneful conse- 
 quences not only yield as a spontaneous effect, but are hastened in their 
 decline by the new mental influences. From these premises we may 
 reason to all the transient and infinitely diversified affections of the mind 
 that spring up in the progress of diseases which have their origin in phys- 
 ical causes alone, and calculate, with much exactness, the effect of one 
 passion or another in aggravating or moderating disease, and how far 
 they may embarrass or facilitate, through those modifying influences, the 
 effects of remedial agents. But, to carry this analysis into practical ef- 
 fect in the treatment of acute diseases, there must be the same reference 
 to their nature and fluctuations that is demanded for the right applica- 
 tion of the Materia Medica, though it may be comparatively unim- 
 portant (^ 167/, note, 476 c, 476^, 500 k-p, 509, 891i/c, 892f h, 951 c)- 
 
 We have variously seen how the susceptibilities of organs to the ac- 
 tion of physical agents are increased by morbid states, and it is exactly 
 tlie same with mental "emotions as with the physical causes; and with 
 what prodigious power, especially in acute diseases, the latter may oper- 
 ate, can be readily inferred by considering how, in healthy states of the 
 body, one passion, as fear, will agitate the voluntary muscles, depress 
 the circulation, but impart a bounding motion to the heart, give rise to 
 vomiting, open the floodgate of the kidneys, expel the contents of the 
 bladder, protrude the eyeballs, drive the blood from the face, and bathe 
 the skin with perspiration ; or, how anger braces up the voluntary mus- 
 cles, rouses a vehement circulation, «fec. ; or, how shame strikes at the 
 capillaries of the face and injects them with blood ; or, how marvellous- 
 ly love plays Avith its shafts ; or, how hope ever gladdens the heart ; or, 
 how joy and anger may be instantly fatal. 
 
 So fixr, therefore, as the mind can have a bearing upon the action of 
 remedies, it is by its direct influences upon the pathological states, 
 through Avhich it renders them more susceptible of either salutary or 
 morbific impressions from physical agents, or renders them inoperative ; 
 while, also, it co-operates simultaneously, as an independent means of 
 cure, or proves a direct morbific cause (^ 233f, 500 k, 647^, 903). 
 
 If the inquiry be extended to many of the familiar phenomena of the 
 organic life of man, it will be seen that the mind is more or less in- 
 terested in all the healthy functions ; and it goes to supply more delicate 
 illustrations of the influence of the spiritual part upon morbid states of 
 the body. This, for example, is habitually seen in the improved appe- 
 tite and more vigorous digestion, on occasions of festivity. Nor is it 
 alone the unflinching manner in which the stomach meets its unwonted 
 task (and much to the admiring wonder of the chemical philosopher), 
 but it yearns for the multitudinous variety as the odour regales the nose, 
 or the clattering of dishes delights the ear, and under the influence of 
 which the mouth overflows with saliva. And now, if we reverse the
 
 Berriedial Action. — appendix. — Mental Emotion. 867 
 
 case, and suppose the Party, as soon as completing the repast, to be 
 thrown into a paroxysm of fear of a few hours' duration by some im- 
 pending catastrophe, it is certain that digestion would have made but 
 little or no progress. Observe, again, hoAV some remedies of active vir- 
 tues are more or less governed in their effect upon comparatively healthy 
 individuals by the varying conditions of the mind, as seen in the sus- 
 pended or defeated operation of cathartics by any close attention to the 
 daily atFairs of life, and how, on the other hand, their effect is promoted 
 by giving the attention to the anticipated results (§ 500 e, 7m, 902 /). 
 
 § 1067, aa. A well-marked example will illustrate the complex in- 
 fluences of physical agents and of the will and mental emotions when in 
 simultaneous operation. Thus, when the voluntary muscles are slight- 
 ly affected by nux vomica an aggravation of the spasm is often produced 
 by any sudden alarm. A lady to whom I had administered a few very 
 small doses of strychnia suffered some twitchings in the muscles of the 
 legs when she walked in a careless manner, but was able to govern her 
 limbs steadily by a careful effort of the will. In this condition she 
 walked into Broadway, when, on being a little jolted by an uneven 
 stone, she began to stagger, and, struck with alarm lest she should be 
 considered intoxicated, she fell upon the pavement. This is not an un- 
 common example ; and now for the rationale. That the spasmodic ef- 
 fects of nux vomica are owing to influences transmitted by the organic 
 nerves of the gastro-mucous tissue to the cerebro-spinal axis, and a con- 
 sequent development of the nervous influence and its reflection upon the 
 voluntary muscles through cerebro-spinal nerves, needs no farther dem- 
 onstration. The will was capable of surmounting that development by 
 its own forcible excitation of the nervous power that gives rise to vol- 
 untary motion (§ 893^) ; but the sudden alarm not only arrested the op- 
 eration of the will and allowed the tetanic its unrestrained action, but the 
 alarm generated an exciting nervous influence which concurred power- 
 fully with that of the physical cause. The philosophy as to the will is 
 the same as when conia counteracts the spasmodic influence of strych- 
 nia, or as when coffee increases it (§ 891^ g, k, 984 b, note), only, in the 
 case of the mind the excitation of the nervous influence is direct, in that 
 of physical causes reflex. And so of the will and sea-sickness (§ 113- 
 117, 222-2331, 245, 266, 476 e, 500 c, 6381, 647^, 893, 893^, 1077). 
 
 § 1067, b. Upon what principles, then, are we to interpret all the va- 
 riety of effects which the different mental emotions display in the or- 
 ganic life of man? Simply, as already explained, by their operation 
 thi'ough the medium of the nervous power, and the modifications which 
 they bestow upon that power according to the nature of each passion. 
 There is thus, throughout, a perfect coincidence between the operation 
 of the mental and physical causes, since, whenever the latter give rise 
 to effects beyond the direct seat of their operation, and thus bring the 
 nervous power into action (§ 1039-1041, and references i\\Gve), their re- 
 sulting influences will, as in the case of the passions, depend upon their 
 precise nature, and the special manner in which they modify the nerv- 
 ous power, as set forth in the foregoing sections (§ 227-232, 500 k-p^ 
 503-505, 647i, 649 b, c, 657, 892 b, 892f, 893 e, 894 b, 902 g-l). 
 
 § 1067, c. From what has been now said of the coincidences between 
 the effects of the mental emotions and remedial and morbific agents, and 
 that they all operate upon a common principle (§ 854c-857, 859 5-860, 
 894-905), and as the former are in perpetual operation, either for good
 
 SOS iNsrrnrKs ok mkohink, 
 
 or for ovil, it booomos oviilont that tho rruv>titionor inuv bo as u\tolli)^i 
 blj :uul as imioh intoivstoil in ivgulatii\>;' thouvouttil us tho plivsioal troat- 
 mont of ilisoa!?o. Tlio h»ttoi" jivnorallv propoiuloralos, oftou }.!;iv'utlv, in 
 iuiportanoo; but oirat^ions arc oonstMutlv arij*iu^^ in whioh (ho forunT 
 should tako tho h\ul, \vhih> it has at all tituos tho atlvaulaf^o of briui* 
 oonvortod to tho salutary otVoots of physioal r»n»u"ilios. 
 
 Would our limits admit, wo oouUl tiraw \\\hh\ (ho historios ol luiuvoy 
 for a vast amoiu\t t>f matorials (o illustralo (ho |)hih>;H>|tliv and pnuMioul 
 importanoo of our subjoot, l>u( all (his will nwulilv su(',|!,»'st ilsolf to 
 those Avho may study tho i>houi>moua of iusaiiiiy in o(>iuu>o(ii>u wi(h (ho 
 philosophy of (ho mind in its rolatious (o or^jauio lito. 
 
 § 1007, (/. What >vo havo ni)w and hidiorto s»<on «>r (h(> pn^oino oorro- 
 spondence betwoou tho olloots i>f tho passions and of physiorti aj^ontu in 
 the or<:;anic lifa of man may bo carried wi(h (ho olfoot ol" (hit ch^iirost 
 demonstration in proof of (ho subs(an(iv»>, s*'lf-ao(inj; naluro of tlu> Soul 
 (§ 10(!!)-1077). 'i'his must bt^ oouccdod by IMiilosophiMs of (U'ory si'hool i 
 and those who nj!;roo with (ho pri-sonl. wiidM' in his (•ons(ruoli(in of (ho 
 operation of the nervous power will se»t how j;reM(ly (he deinoiiiU radon 
 is extended by re<2;Mrdin}.!; (ha(. pow(M' as (ho mediinn (hron^di whh'li 
 physical agents cxer( (heir elfocts upon parls n^mote from (he direcl sent 
 of their oj)eration. Here wo have a conunon oxeitinj* cunso lor (ho com- 
 nion phenomcnn. Tho mental (Muotions, in on(t casi^, Itring th(« norvouN 
 power into action by their dinuit inllnenee upon (ho (,';rea(. jiervouM cen- 
 tre, while physical causes, in tlio chhoh Hiipposod, develop the power in- 
 directly, and in all (he cases ea(rh nffcnt modillen (ho povvej- lUMMtrdinj/ (o 
 its own siM^cial nature, and dircicis it in ho compliealed n nauna^r, and ne- 
 cordiiif!; to an incalenlabh! anioinil, of c(tntinf.^(!nt cireuniMdineeM, lhr'(Hi;<li 
 a la])yrinth of nerv(;s, as to form tla; most dilllcnlt problem in riiyMJolii- 
 gy (§ 2.*].").^, 47 ry-};, r>()() r-p, (i47i, H!M, !)()ti /). 
 
 IJut to the mere practical imui, who aspircH beyond (he walKn of em 
 piricism, the eflirct of the piiHsions in the production t\.\n\ cine of dirteiiMo, 
 and their nndenialjh-, operation (lii'on;.di tli(; ni^rvourt \towci; Kiipply a 
 ready apprelKinsion of those analo;_M)UH problems which n,t(,eiid the openi,' 
 tion of morbific and remedial n<ry.niH of a phyHi(t»d natun^, and a fniitful 
 means for contesting with the (JlHimist the field of I'hyMiolo^'y,* 
 
 HAVE DISEASES UNnKJtOONK OMANOKH OK TVI'K W/TIIIN IMK I.AK'I' I'Oirl V 
 YKAKH, OU IIAVK NKW ONKH AI'I'KA UKO "if 
 
 § 10G8, a. Vy change of type F mean that radical chanj/e vvliich In 
 supposed to justify the Kubstitution of the Ktiuudjiting iov (Im! antiphlo- 
 gistic treatment of inflammatrwy and feld'ile djfteaMen. In (hi/i accepta- 
 tion I answer the interrogatory as it haw been in ail pact time by every 
 truly enlightened and impartial obwirver. .John lirovvn, tlie gn;at An- 
 tagonist of Nature, and who lefwls a lio«t in liix train, i« in no re«f»ect an 
 exception ; for, whatevcT may have been biw geniuH, be bjwl vf.ry little 
 practical knowlwlge, waH intemperate in li'in })af<if«, and the revolntio/i 
 which he achieved was prompt/;d by Sift'ifito'/tly towardn (lullen and oth«;r 
 early friends. As it is important to nnderntand the ground (if*on whieb 
 this School originally stood, I shall intrr;<Jijc^; u brief ><,k etch of itM origin 
 from the ^'ArruirvMn J'Jnc>/c/y//Mdia.'* 'i'buH: 
 
 " lirown wa.s suhnhtf-A, a» an indigent Kcholar, to a i/ndii'itoun tdU-.iul' 
 ance on the \f-j:X\xT(:n Hvlinburgb), and (AdiuntA the (patronage hi l)i. Cul- 
 len, who (:mp]oy<A birn an a iuUtr in bi« ov/n family, huiiini lUiti <:<ntrm 
 * Se*: rnv work ori tti* ^>f;i. ami> Inwtfu.tivy. l'nint,ii'i,K, t-AitU/n i'/'/IS,
 
 Dimlhi^H, AI'I'KHUIrt. ('Iniii'ii iij 'I'lliir. MOO 
 
 nC hi inly, liii iiiiii'rioil, mill m<^I/ ii|i ii lioiinliii^-lionHK, hiil. Iiulnl, iiinl ln'catrto 
 lHiiiKrii|il, Aliniil, lliiu liiiit<, liy ii luiif/ rtiiiiHti iW'iim«IiIiiIIoii on llic uii)- 
 iiimI (lyMlMin, iiilil lli« vigour ol' liin nwii iitlml, tWywlM hy hniiid i'iuiiliii|j;, 
 IhiI' Ht^«'uiii|)^il hy III lit) or no <ii«l Iroiii |iiiit'|)('ul olmcrvalioti, Jut (f|uhoruU:<l 
 II imw lliMory of iiiMilirJiiu, 'I'liti iit»ull< wiih, Uik |Mtl»li<'i(l.ioit ol' liiu hlla- 
 nimilK, Mt'iliiHiiii', wlih'li lio (iii'll)«ir «tM|tliiiMi'(| in n coni'Hft of priviiUi l«t> 
 hnim, Iti'own f^rrupit'tl nl no int<iin» l.o jmikIi IiIh ilorlrintM. A m^w ini'il' 
 ii'iil liin^iiiijjii wiM liili'oiliii'.fil ( Itlitiin loliilly iiJ< viu'innrit willi ioi'inui* 
 iiliinionn vvim niiiinliiini'il ( iuhI IIim nionl. viinlttnl. nlMirtc. ol' ijic ri^giiliu' 
 I'i'iili'MHuirt ol' llm I Iniviii'ttily wiim pi'ihiVKi lH|/ly MllfTid, Al, jtiifylli, ru» 
 iiitui in rt'|Milulion, Iim i'*<|)iiii'ti<l, in IVHI), lo Lonilon. IIiim lie, t'ni|tiiiv« 
 oih'imI 1)1 (tHi'iltt lUlciilJon l)y liii^ ( )|iMi'i'viilionM on lliti ( )|(| MynliniH oC 
 I'liywiis linl, willionl. unfctiMw.''- 'I'liti diiy oCwncciHM, liovvcvi'i', w/i« nol. \(>\\^ 
 
 • liijiiyi'ij. 'I'lm I'llvinnifH nf flti'diniin liinl IIim ii(lviinliij/M id' litiin}^, wi'ill.«'U 
 In liiiUni nn<l ua l\n\ Hiniplirily of iln iloi^Mint^H, itml iJiti prnrljcti inrnN 
 i'iiIchI, w«irii noviO timl ruMciniilinfy, nil IOiu'o|i(i hook lH*i^iinui i^nHniti'iiil hy 
 llm rlninn (8 (1^1 /^ HIIOA /, IMIO </, p. 717, 71!), <l HMMiy, KMlA r). 
 
 ii iDiiH, //. Ilniliir my own oliMt^rviiUon iJifiut Ihih hi'«n no rhiingM lu 
 llm ('jiiniu'irr ol'iliMniiHuH, vvilli Mil* hiniplx «<H<'i'|ilion llnil. Honm loi'lnii Inivii 
 Jint'n \t<M nnyiiililin(i, williin I In* liihl Iwtuily y*-m'H llimi dining, lint pit" 
 
 • iMlin^ Iwi'niy. Ilnl. Iliin ipnililli-nlion Ih nnmlly liniili'<| lo lint ronnnon 
 lorniM ol' lonil vi'iionrt rmiyyuihtun lonl ninfiCMliv** I't-vi'i'tt (ii 7^7 7HA, 7Hli 
 MIH, Mill ir/O), 'i'liithit iillt'i'lionti linvit yir|i|i-i|, iluriii^, lint liillci' pt'l'ioil, 
 lo riillnti' Nnnilh'r nliHlindionis ol' MoimI, nml hnnilli r «Io>ii'm ol nn'ilii'im*, 
 purlicnlnrly rtillnii'lii'H Itiil pii'iimtly ||nt t^iinnt (iitnnriij nnxlit ol'litnil,* 
 iMinl. IniM Ititcn iiniinpt^nHiililn lo mi t-nily r<tfovitry, or lo ii, ooniplt'lti r(*> 
 iriuvnl III lint tliiii'iir-it, or lo llni pi'i'hfrviilion ol' lil'ti ( wliild, on Mm con* 
 irmy, llm pi'tiviiilini?; Kninonlmi li'ttii|,iiiiiii|, Imu htutii illHliii{iiiieln*(| hy llM 
 loi'iiMti' tliHMhIi'oiiH (tItiti'iH (ii lOllH, (/), In pi'ool' ol' l.liiiH, I ncttil only nilvcrl 
 
 10 |,|iu ttHiuiHHivtf inoi'Liillly wliiuli Iimm iillitinlttil llm yellow I'cvi'i' williin iv 
 It'W liilit yttni'M, mill in llm Irttiitnutnl. of wliidi lint Mliniiilalin^, pliiii Iihm 
 liiutn ^i'liiti'iilly pi'iii'litiitil ( |nimi;xi.h, mlicltt /.imti n/' ll/ntul). Ah mi t')itun« 
 |iln of lint nioi'liilily, inn|><r lli't hiiiiiiiliilinf, niitlliod, i|. itt hIiiUhI in llm 
 nliitt Wi'poir ol' II ( !oiiiinill('tt olntix I'liyhicimm oii iIm' " ^ illuw ji'i'ver ii|, 
 Noil'ollt, Virpjniii, in IM/Wi," lliiil, 
 
 "'lint niiiiili<t|' oriliMilliii wiiH iilioiil. VOOII, or <iint lonilli ol'llnt tmliiM 
 popniiilion iitiniiiniiif/ in llm cily. VVIn'ii wtt roiihidi'i' lliiil linU' ol' IIiIh 
 |iopnlMlioii wiiH liliD'K, miioti|/ wlioiii llniit wi*rit I'ltw <l<tiillih, il< Hci'inti 
 proliilliltt iJiiil, moi'ii lliiui oint lliii'il ol' nil lint wliilrn itMinKtttl, tlieil." - 
 Ui^fnirf, &,(i., |), JIM I IMitli I, ViiKiiiiii, IM[,7.* Nmtmm I'', I'r, C.i, li, 
 
 '*' III lli<i MHiiin l(u|iiirl II JH hliili'ij ihiil Him yt'll'ivv Ikvi " in IIn hviiijil » wim miiikIi 
 
 IliM niillKi MM nil llm ({iMiil i>|ili|> lull n lliill lliivii tni iiiliwl kIIIiih Ii«i>' hi iiltinu Iii'I i>" ( |i. IIM), 
 
 11 Willi iHiilv ill llii» I'lilili'iiiii Hull Miiiiii |ili\Mii'iiiiiH i<iili<iliiliM<i| llm liii|M< Hull Hill Mini' 
 
 • iliiil I'linliii'it of linn vviiiilil |)iMvii II »/ii'ii(//ii I'm lliu illHiiiitiii. 
 
 Ilni'ii, mIhii, vvti iiitini, loiiiiiiu iiIImii' lni|iiiiliiiil nlMliiiinuilH, wllli iiii iilmnrMiliuii iiI'i'iiihIi. 
 
 llIu Wi<l|{lll III llm iliinllilio til riiMlil({iiil|nl|tir'n III' vt'll'iW t'l'VUI. Tlllin ' 
 
 '' hi IIII luiHM IIihI «v<t liMVii liiniwii III liKiinl iif tviin Hmiii llm Iniinl rniiHiiii In MiiH|Mirl Hint 
 llm ilJMiiiiMu vviiH i'iiiilii|(liiiin Miiiii/ liiiiiilinl.i III iMii' |iiiiijilii, llyliiK fi'iiiii llm iiuhHIiiiioii, 
 
 Kliimiil mill ill,, I III Hm iii>l|ililiiillii|{ i iIIi'm iiikI I'llii'rt, In Inililn iiinl |iilviili< limimin, III 
 
 liiliriiKiiliui iiinl Iiiim|iI|iiIh, nmli r nil |iiihtilli|i< viiiii'liin nl jilin i> iiml i li< iini'iliimo, iiinl ) i>l, 
 vvii liiivii mil IikiimI iir II «M».i//ii iimliiino' In tvlilrli II tviia nvnr iillii|j«i| llnil llm illtmii^u witN 
 I •iliiniiinliiiliMl III Hill iilliniitiiiili III' I'lli'iiiln" ( |i IIH I. 
 
 'llm fiii«i{iilii|^ n)i|ii<iiiiul ill llm finiiili nitllliiii nflliiti wnrli, iiinl n U |ili<iniiMil, In tinitiN 
 iinnilM III llilii tiUtli kiIiiImii llm InllnwIiiH i«i<iiliiliiiii, iiiihmihI iiy llm " AdimIiwiii giiui'uiu 
 llim iiml Hiiiilliin »iiiii\.'iill.iii," III llM liHiiHi iiiiiiiinl tii'ttnlnii, Imlil .liiiin, iHlHIi 
 
 '• ll,n„ll>,>,l, riiiil llio III linn 111' llm liinl. I'lilivi'llll I llm i|lliihliiill nl' llln mU-WnUt- 
 
 ^Ihrnmumi nf y»ll<iw I'nviii' In Im rniiinl nil jhikk Hi nl IIh 'rriiiiain'llniiM, tin iiinl In litiriiliy 
 ruulllliiiuil" It i|iiuHltnii In liiivii liiiuM nnllliiil ii|iiiii Hm |ilittnan|i|ili>al ((iniihiln i<iiiliiiii'tu|
 
 870 INSTITUTES OF MEDICINE. 
 
 As to the acute and chronic forms of intiammation, I have observed 
 sitill less of the modifying etfects of remote causes (§ 64-4-67G, 710-756). 
 In the acute form, as aifecting all great organs, the same amount of 
 bloodletting, the same cathartics, though in smaller doses, the same alter- 
 ative antimonial treatment, &c., have been either necessary to life, or to 
 an early and perfect recovery. In all these respects, pneumonia, pleuri- 
 sy, intiammation of the brain, peritoneal intiammation of the intestines, 
 puerperal peritonitis, rheumatism, c\:c., have remained without modifica- 
 tion, or with the exception only that Cathartics require a more careful 
 regulation of their doses (§ 857, ttc). In these conclusions I am also 
 sustained by what I have learned of the histories of disease throughout 
 the United States (§ 969 d, 1005 /, 1005^, 1006/, g). 
 
 All this, however, is inferable, as it respects my own experience, from 
 what appears in this work, which was published originally as late as the 
 year 1847, and continued in repeated editions without modification ; and 
 I advert to the subject now, that I may not be misapprehended (§ 1004, 
 1005A). It may be also proper, in consideration of the preference which 
 I have hitherto given to the experience of others as being of greater 
 weight than my own, to repeat (§ 1025), that I have, doubtless, seen as 
 much of the etfects of Bloodletting in private practice as has been wit- 
 nessed by any other Physician during my professional life, which ex- 
 tends over a period of more than forty years, while also I have been al- 
 ways unremittingly and actively engaged, up to the present time, in the 
 practical duties of Medicine. — yhte p. 763, Notes Ff p. 1135, Gg, Hh,* 
 
 § 1068, c. Moreover, haying adverted in this work to the treatment 
 which I pursued in a case of inflammation aft'ecting one of my own fam- 
 ily (§ 992, (T), and a case of remittent fever of which another member 
 was the subject (§ 870, aa), I shall state briefly the practice which was 
 piir>ued in one of simple pneumonia with which I was seized in March, 
 1847, as supplying evidences, at least, of my profound convictions upon 
 all the questions before us. The first remedy adopted was the loss of 
 blood to the extent of about two pounds. This was followed by five 
 grains of Blue Pill, and in a few hours afterward by about two drachms 
 of Castor Oil. Some ten hours after the Bloodletting, the symptoms 
 having recurred, I was again bled to the extent of about 24 ounces. I 
 now took at intervals of about four hours, half a grain of Ipecacuanha 
 and two grains of the compound powder, the latter to allay the cough. 
 Alterative doses of Tartarized Antimony were also employed at intervals 
 of two or three hours, but not to the extent of producing nausea. About 
 twelve hours after the last Bloodletting, the symptoms having again re- 
 turned, though in a diminished degree, twelve large leeches were applied 
 to my chest, and the bleeding maintained for several hours (§ 925, a). 
 This was towards the decline of the day. The Alteratives were con- 
 tinued, and a Blue Pill of about five gi-ains was taken. On the follow- 
 ing morning, the symptoms having again increased, I desired my medical 
 friend, Dr. James C. Bliss, to bleed me again. It was his opinion, how- 
 ever, that I might recover with tlie aid of the other means alone. I re- 
 plied that I did not fancy the risk when I had so sure and safe a remedy 
 in the farther loss of blood, and expressed a wish that he would '• carry 
 out upon myself the practice which I liad inculcated in my medical 
 writings, and which I taught my Medical Class." I had then in mind, 
 
 in § C5U-6o3 a-<l. The result shows the distinction between the instant application of 
 sound principles and the tardv conclusions from complicated facts. 
 * Also N..TK GciG p. 1151.'
 
 Diseases. — appendix. — Change of Type. 871 
 
 also, the experience which prompted the remarks just antecedently pub- 
 lished in § 8924 7, 1006 h, c. I was accordingly bled to the extent of 
 about 20 ounces, when the symptoms vanished entirely and permanently 
 (§ 955, by 
 
 On the ninth day after the last Bloodletting, when my medical friend 
 called in the morning, he found me outside of the house, at my early 
 morning exercise of sawing wood (§ 992, b, c). So other medicine was 
 taken, and no blister was required. It should be said, also, that my 
 disestion had been impaired for a long time antecedently, and that it 
 became subsequently much improved (§ 1007, b). — Note Hh p. 1138. 
 
 § 1068, d. One case more, as farther illustrating the object of this 
 Section. It may be interesting, also, on account of the usual fatality 
 of the disease, and the embarrassing circumstances by which the case 
 Avas surrounded ; while it will go to show what have been the practical 
 habits of the writer, and that he has inculcated nothing upon Ae subject 
 of Bloodletting that has not been warranted by his own experience. The 
 patient was one of our medical students, E. P. .Johnson. M. D. of the 
 Class of 1850-51. I found the fauces of an intense redness, tumefied, 
 and attended with a complete inability to swallow. Any effort at deg- 
 lutition was arrested at once by the suffering which it produced. There 
 w^as great constitutional imtation, much restlessness, pulse rapid, hard, 
 and small. Strength prostrated. No ditnculty in respiration (§ 140, 
 525-530, 689 /, 718). 
 
 There was, at this time, a great deal of clamour in the Profession 
 against Bloodletting under any circumstances ; and as this case would 
 be well known to the Class, I felt some regret that it had fallen into 
 my hands, particularly as I apprehended a fatal issue, and that discredit 
 would be brought upon the principal remedy upon which I saw that I 
 must rely. Nevertheless. I sat the patient half erect in his bed, and bled 
 him till syncope began to approach. The quantity of blood taken was 
 about 40 ounces ; an extent of the remedy which I practice only in severe 
 forms of inflammation. 
 
 In a few minutes afterward the patient was able, after repeated and 
 painful efforts, to swallow a dose of Calomel and Jalap — about 10 grains 
 of the former and 20 of the latter. This operated within a few hours, 
 but brought no relief. ' The throat remained of the same intense redness, 
 and the patient could no longer swallow. Accordingly, on the same 
 day, I bled him again to approaching syncope, when I abstracted about 32 
 ounces more of blood, the head and shoulders, according to my habitual 
 practice, being elevated. Nothing more was done till the day following, 
 when, finding the patient no better, I directed the application of twelve 
 large Leeches to the anterior part of the neck. They executed theu* of- 
 fice well, and the bleeding was kept up for some four hours, but the pa- 
 tient was apparently worse in the evening. But, having done so much 
 in so short a time, I concluded to await the issue of the last remedy till 
 morning. Nothing could be swallowed, and the inflammation was too 
 intense for a blister (§ 893,/*). Curiosity was now on tiptoe about the 
 bleeding, and the general merits of this remedy were to be judged by the 
 issue of the case. I supposed, indeed, that it had been already con- 
 demned. Added to this. I felt an extreme degree of anxiety to save the 
 life of my patient. So, on the following morning, one of the coldest in 
 the "Winter, I arose at four o'clock, and walked to the house of the pa- 
 tient, about a mile. "What then happened I shall relate circumstantially,
 
 872 INSTITUTES OF MEDICINE. 
 
 as it may be of benefit to some others under similar exigencies, and, as 
 I trust, tor many generations to come. 
 
 The scene, when I entered the room, was in every respect of the most 
 dispiriting nature. Johnson was apparently moribund. His mind was 
 abolished, the fauces as red and tumid as ever, and a thread-like pulse 
 running with almost countless rapidity. I stated to his nurse and class- 
 mate, the now Dr. Oliver, that the only remaining chance was from a 
 farther abstraction of blood, but that the probability of immediate death 
 was so great that it was inexpedient to risk any farther the reputation 
 of this important remedy. Tliat something, however, might appear, at 
 least, to be done, I directed a large blister to be applied to the nape of 
 the neck and shoulders, and left the patient with the expectation of find- 
 ing him dead at my next visit. 
 
 No sooner, however, had I left the door of the house than I was be- 
 set by a painful consciousness that I had been in some measure deterred 
 from a repetition of bloodletting by a fear that the patient might die un- 
 der the operation, while, on the contrary, one more application of the 
 remedy might save his life. In any event, it could but shorten it a little. 
 This train of thought continued till I had walked some quarter of a mile 
 on my return home, when I found myself almost unconsciously return- 
 ing to carry out the practice which my judgment prompted. 
 
 I then stated to Oliver that I had returned for the purpose of giving 
 to Johnson his last chance, and that if he died in my hands it was a 
 sad responsibility to which all should be willing to submit, irrespectively 
 of any consequences to themselves, or to practical medicine ; that it was 
 our duty to give to the patient the only remaining chance for life, even 
 though the means employed might be likely to hasten a death which 
 would be otherwise certain. 
 
 The head and shoulders of the patient were raised, and about twenty 
 ounces of blood were abstracted (§ 973-980). The relief from the last 
 bleeding was such that the patient could swallow water within an hour 
 afterward ; and from that time his convalescence went forward steadily 
 and rapidly (§ 955 b, 994, 1000-1001, 1005). 
 
 The circumstances of the foregoing case, particularly the nature of the 
 disease and attending symptoms, rather than the quantity of blood ab- 
 stracted, impart to it its principal interest. In Several cases of inflam- 
 mation of the brain and lungs, where I have had the same successful 
 conflict with disease, the bleedings have been much more numerous, es- 
 pecially in phrenitis, and the quantities of blood abstracted have av- 
 eraged a greater amount at each application of the remedy. There has 
 been, also, in the cases to which I refer, the same exigency for the last 
 bleeding, aud the same apprehension that it might hasten death (§ 756 h). 
 
 P.S. 1860. — Finall}', as nothing carries conviction lilte reliable statistics, and as no 
 city has a more salubrious climate than New York, and to place its excess of mortality 
 on'tbe prevailing "stimulating plan," let us loolc at the statistics for Januarj-, Februarj-, 
 March, and April, 1860, as obtained from the City Inspector's Report. During those four 
 months there were 8283 deaths, of which the following are some of the startling details : 
 PsicuMONiA, 602; Bkonchitis {pneumonia'?), no ; 0i£oup,312; Consumption, 1159; 
 ScARi.KT Fkvicr, 1000. Probabl}- about 1 in 11 from Pneumonia of all the deaths (see 
 note, p. 760). — Of London it is said by the Dublin Medical Press — " that the deaths from 
 pneumonia in London number froml.SO to 150 weekly, [about the same proportion as in 
 the citv of New York] ; but that in Dublin a death from that disease is of rare occur- 
 rence.'"'— (Boston Med. and Surg. Journ., May 31, 1860.) The "stimulating plan" pre- 
 vails in London, the lancet is used in Dublin.— See Notks F p. 1114, Mm 1141. 
 
 A Note which has stood in this place since 1860 is now incorporated with other re- 
 marks in NoTK Ggg p. 1151.
 
 The Soul. — APPENDIX. — Instinct 873 
 
 PHYSIOLOGY OF THE SOUL AND INSTINCT. 
 
 DEMONSTRATION OF THE SOUL. 
 
 § 1069. In the year 1848 I published an Essay on the " Soul and 
 Instinct, physiologically distinguished from Materialism." As 
 this is the only attempt made, so far as I am aware, to demonstrate the 
 substantive existence of the Soul and Instinctive Principle upon physio- 
 logical grounds, but, on the contrary, has been evaded (§ 350|, gg), and 
 as the question is intimately connected with many of the great topics 
 embraced in these Institutes, and forms an important subject in Physiol- 
 ogy, I shall incorporate with them the essential parts of the demonstra- 
 tion contained in the Essay.* 
 
 § 1070. The evidence turns wholly upon physiological facts; my es- 
 sential premises are relative to the Nervous System, and are admitted by 
 all. They are variously presented in this work, but must be now stated 
 briefly to render the argument at once intelligible, and that it may ap- 
 pear a consistent whole. This involves, necessarily, a recapitulation of 
 facts which have been hitherto presented in different parts of this work. 
 
 § 1071. 1. The brain, or an equivalent ganglion, is the or'gan of in- 
 tellectual, instinctive, and all perceptive functions (§ 197-199-2-, 455). 
 
 2. The spinal cord, and the nerves which depart from it, are, among 
 other uses, the organs through which the Will transmits its influences to 
 the voluntary muscles (§ 227, 233, 258, 473-475, 476 c, 500 dd). 
 
 3. The ganglionic or sympathetic nerve is designed, in part, to con- 
 nect together, in harmonious action, the involuntary organs, or those upon 
 which life essentially depends. It is also through this nerve, especially, 
 that the passions display their effects (§ 96-108, 113-117, 126-130, 
 455, 523-524, and references there, and Index II., art. Mental Emotions). 
 
 4. The cerebro-spinal and sympathetic systems of nerves are intimate- 
 ly blended with each other, so that the brain, or its equivalent, is the 
 great centre of both systems, and the spinal cord a less general centre, 
 while the ganglia of the sympathetic nerve are now well ascertained 
 to be local centres to that nerve. Of this character, also, are, doubtless, 
 the semilunar and other plexuses, while, in very recent times, it is render- 
 ed probable that certain nerves are special centres of nervous influence 
 (§ 1037, a) ; all of which, however, are more or less subordinate to the 
 brain (§ 487 g, 497, 499 a, 516 d, No. 9, § 520-523, 524 d, No. 4, § 1038). 
 Whatever, however, may be true of these local centres, it is of no im- 
 portance to my demonstration. 
 
 In consequence of the foregoing union of the two systems of nerves, 
 the cerebro-spinal system has certain organic influences upon the es- 
 sential organs of life (§ 110-117). Physical irritation of the brain and 
 spinal cord may be thus transmitted directly to the voluntary and in- 
 voluntary organs (§ 473-494, 1039) ; and the Passions, but not the Will, 
 by their direct action upon the brain, may readily affect these essential 
 or involuntary organs through the sympathetic nerve (Index II., J/ew- 
 tal Emotions). 
 
 The influence of irritations of the expanded extremities of the sympa- 
 thetic nerve may be also transmitted to the voluntary organs through 
 thfc circuit of .this nerve and the great nervous centres, as seen in the 
 
 * Some things that I have said of Instinct lead me to state that the original edition 
 was distributed extensively, and aclcnowledged in the literar}- journals in 1848. A ki£- 
 WKirxEN AND I'iNLAKGED EomoN will sooii he published — 1870.
 
 874 INSTITUTES OF MEDICINE. 
 
 convulsions of children arising from dentition, intestinal irritation, &c. 
 So, too, on the other hand, from the same intercommunication of the 
 cerebro-spinal and sympathetic systems, irritations or other affections of 
 the voluntary organs may be felt by the involuntary through influences 
 transmitted by the sympathetic nerve (§ 454-475i 500-524, 891i, g, k). 
 
 5. The familiar fact must be next stated, that the nerves are composed 
 of two kinds, one of which transmits the influence of the Will and of 
 the Passions, and the effects of other causes, from the nervous centres 
 towards the circumference, while the other kind transmits impressions 
 from the circumference to the nervous centres. The first of these two 
 orders of nerves is concerned in the development of voluntary and many 
 involuntary motions, and are hence called exciio-motoi^ nerves. The 
 second order are nerves of sensation, or sensitive nerves, though the in- 
 fluences transmitted by them to the nervous centres are felt, in the nat- 
 ural state, only Avhen propagated through the nerves which supply the 
 organs of sense (§201-204, 227,451-453, 462-4754-, 500, 1037 b). It 
 should be also remarked that, while some of the two orders of nerves are 
 wholly or mostly of one kind or the other — either excito-motory or sensi- 
 tive — a very large proportion of the nerves are composed of fibres of both 
 orders, though perfectly distinct from each other in arrangement and 
 function. This double order pervades the entire body, and has brought 
 the physiology of the nervous system within the range of the most ex- 
 act experiment, and has become the foundation of many important laws, 
 which are as clearly ascertained as any in astronomy. The two orders 
 of nerves, or fibres of compound nerves, never interchange their func- 
 tions, one of them being always employed in transmitting impressions to 
 the brain and spinal cord, and the other as purely centrifugal in its 
 oflice (^ 466). 
 
 It is also important to understand that my demonstration is concerned 
 particularly with the system of excito-motory nerves, both voluntaiy and 
 involuntary, or those nerves or fibres of compound nerves which trans- 
 mit influences from the brain towards the circumference. Nevertheless, 
 many examples of nervous influence will be introduced, in which the 
 other kind, or sensitive nerves, are equally engaged along with the excito- 
 motory, as contributing to the demonstration. It may be said, too, that 
 when the latter are alone concerned, as in all acts of the Will, or when 
 the Passions operate, or when motions follow in the voluntary or invol- 
 untary organs from mechanical or other physical irritations of the nerv- 
 ous centres, the projection of the nervous influence is in a direct line from 
 the central parts of the nervous system towards the circumference, and 
 generally terminates there (§ 245) ; but that, when both orders of nerves 
 are interested, the influences are circuitous. With these last, however, I 
 shall be employed only for supplying illustrations in proof of the sub- 
 stantive existence of the Soul and Principle of Instinct, and of their mo- 
 dus operandi through the excito-motory nerves (^ 500 dd, i, k). 
 
 § 1072, a. Having thus stated our anatomical and physiological prem- 
 ises, I shall next endeavour to render the demonstration of ready compre- 
 hension by the uninstructed in the physiology of the nervous system by 
 stating many illustrations derived from the operation of physical causes 
 to serve as parallel examples with the operation of the Soul and In- 
 stinctive Principle. 
 
 We have seen that influences may be transmitted from the brain and 
 spinal cord towards the circumference by impressions made directly upon
 
 The Soul. — APPENDIX. — Instinct. 875 
 
 those centres, as when they are irritated by mechanical or other agents, 
 or when the Will or Passions operate (§ 1071, No. 4). We have seen, 
 also, that impressions may be made upon these centres through irritations 
 produced in distant organs, and then reflected from the nervous centres 
 upon other distant parts, and even upon the parts from which the irrita- 
 tions proceeded originally (§ 512-524, 1071, Nos. 4, 5). This transmis- 
 sion of influences from remote parts to the nervous centres, and which 
 is perpetually going forward between those centres and all other parts, 
 in natural states of the body (§ 111-113, 455-458, 500), evinces the 
 great and inscrutable susceptibility of the brain and spinal cord, and en- 
 ables us the better to comprehend the action of an Immaterial Substance 
 upon the brain, and its transmission of influences to all parts of the body. 
 An immense proportion of the natural influences upon the great nervous 
 centres (and they are unceasing and manifold beyond the compass of 
 imagination) proceed from distant parts, and are circuitous in their ulti- 
 mate destinations. They begin in the expanded extremities of the sen- 
 sitive nerves, or sensitive fibres of compound nerves, in all parts, by which 
 they are transmitted to the nervous centres, where they make their won- 
 derful, and, as it were, infinitely complex but unfelt impressions, Avhich 
 are then reflected from those centres upon other parts througli excito-mo- 
 tory nevves or the motor fibres of compound nerves (which are also called, 
 in such cases, nerves of rfiflexion). The palpable exceptions to these re- 
 flected influences, and wliere the transmitted impressions terminate in 
 the central parts of the nervous system, are normally confined to the im- 
 pressions transmitted from the organs of special sense, as in seeing, smell- 
 ing, &c., and when no mental emotions are excited (§ 194-204, 450-451). 
 
 We will now come to our examples of transmitted and reflected influ- 
 ences, which are clearly exhibited in respiration, in vomiting, in con- 
 tractions of the iris, in the permanent contraction of the sphincter mus- 
 cles, in spasms from teething, or from irritations of the intestines, &c. 
 
 In breathing, for instance, two principal nerves are concerned, and the 
 diaphragm is the principal muscle which is moved. The sensitive fibres 
 of the pneumogastric nerve, and more or less of the sympathetic, are the 
 parts through which an impression, arising from want of atmospheric 
 air, is transmitted to the nervous centres, which is then reflected upon 
 the diaphragm through the phrenic nerve, and calls it into action. Now, 
 the lihrenic nerve is also the excito-motory nerve through which the Will 
 operates upon the diaphragm in voluntary respiration. The other res- 
 piratory muscles have similar relations to the pneumogasti'ic and to 
 other excito-motory nerves, and the Will operates as readily upon the 
 intercostal muscles as upon the diaphragm. But the diaphragm is con- 
 spicuously marked in this respect, and its importance is inferior only to 
 that of the heart. For farther details relative to the coincidences be- 
 tween voluntary and involuntary respiration, and voluntary and invol- 
 untary coughing, &c., I would refer the reader to § 500, c-7j??; and to 
 § 902, b-g, for the physiology of vomiting, its various modes of produc- 
 tion by physical causes, and the exact coincidences (as in involuntary 
 and voluntary respiration) between their effect and vomiting brought on 
 by Mental Emotions. 
 
 In seeing, there occurs the very complex example of the motions of the 
 iris, which are entirely of an involuntary nature ; while the iris stands 
 in the same relation to perfectly distinct nerves as does the diaphragm. 
 In the former case, the optic nerve not only conveys the impression to
 
 876 INSTITUTES OF MEDICINE. 
 
 the brain which is recognized by the mind, but it is also the sensitive 
 nerve for the iris, by which the pupil is exactly adjusted to the degree 
 of light, while, according to some, the excito-motory nerve of the iris 
 goes from the ciliary branches of the lenticular ganglion through its 
 communication with the third pair of cerebral nerves ; but, according 
 to other and later observations, " the cervical sympathetic is one of 
 the motor nerves of the iris, and the spinal cord is the origin of the 
 nerve fibres going from the sympathetic to the iris."* The brain is 
 the bond of union in all the cases ; but, for an obvious final cause, the 
 iris, unlike the diaphragm, is withdrawn from the Will (§ 514, k). As 
 the stimulus of light, however, is indispensable to the natural contx-action 
 of the iris, and is so far unobserved, it will be readily understood by the 
 uninformed how a similar impression upon the pneiimogastric nerve in 
 the lungs is necessary to the involuntary motions of the diaphragm ; and 
 since the transmitted impressions to the brain excite no sensation, either 
 in the foregoing cases, or in all the endless variety of reflex actions in 
 which physical causes institute the movements, it becomes evident that it 
 is no objection to the supposed action of an immaterial substance upon 
 the brain that it is not felt. 
 
 We have now seen that the principle is exactly the same, whether im- 
 pressions made directly upon the nervous centres give rise to motion in 
 parts that are voluntary or involuntary (§ 1071, No. 4, and references 
 there), or whether the impressions upon those centres be occasioned by 
 influences transmitted to them from remote parts, and which, by reflexion, 
 equally give rise to motions. But, in all the latter cases, the resulting 
 motions are involuntary, as are all in the other cases excepting such as 
 arise from the operation of the Will- But, in the case of the direct im- 
 pressions, it is particularly important to remember that the motions 
 which are produced by tlie Passions are essentially involuntary, and, there- 
 fore, so far exactly coincident with such as arise from irritating the brain 
 mechanically (§ 1071, No. 4), and by our demonstration, the same, also, ' 
 with any reflex movements that ai'ise as the eflTect of impressions propa- 
 gated from distant parts upon the nervous centres. 
 
 Itmay be finally added that the twonervous systems, and So^/iorders 
 of nerves, co-operate together in giving rise to motion in the organs of 
 organic life, so far as organic actions depend upon the nervous system 
 (§ 172, 176, 177, 226-233f, 1041); while only the brain and spinal 
 cord and the excito-motouj nerves are concerned in developing the mo- 
 tions Avhich are brought about by the Mind, or the Instinctive Principle, 
 or by Mechanical or other direct physical irritations of the brain. In 
 ordinary respiration, for example, the sensitive fibres of the pneumogastric 
 nerve are indispensable for the transmission of an exciting influence from 
 the lunss to the nervous centres ; but in voluntary respiration the pneu- 
 moo'astric nerve is not concerned, but only the nenvns centres and the 
 excito-motory nerves of the respiratory muscles. In the former case, the 
 irritation of the nervous centres proceeds from the lungs, and therefore 
 does not originate in the brain or spinal cord, and so of all reflex actions ; 
 in the latter case, those centres are directly irritated by the Will In the 
 former case, also, a cause totally distinct, and originally remote from the 
 nervous centres, makes its impression upon them, and calls the nervous 
 power into operation ; while in the latter case, or that of voluntary res- 
 
 * Brown-8equard remarks that " this fact is well established by Budge and Waller." 
 ^Exp. Research., p. 10, 1853 ; also, § 1042.
 
 The Soul. — ^APPENDIX. — Instinct. 877 
 
 piration, precisely the same nervous influence is brought into action, and 
 through the same nervous channel, by the Will, and therefore, by parity of 
 reason, by a cause as distinct from the brain and spinal cord as is the cause 
 of the irritation in the former case. The first is true of all involuntary mo- 
 tions when the nervous centres are irritated by impressions propagated from 
 other parts ; and the last is true of all voluntary motions, and of all the in- 
 voluntary, when tlie irritating cause is applied immediately to the centres. 
 
 These coincidences in results of irritations of the brain and spinal cord 
 as brought about by irritations of parts remote from those centres with 
 such as follow their direct irritations by mechanical causes, and the coin- 
 cidences between the effects of indirect irritation of the nervous centres, 
 as in involuntary respiration and vomiting by emetics, with the same ef- 
 fects of the mind in voluntary respiration and vomiting occasioned by 
 disgust, and the coincidences, also, between the efl^ects of mechanical irri- 
 tations of the brain with such as ensue upon the operation of the mind 
 and its passions, and a general concurrence of the coincidences, through- 
 out, as to a manifest cause irritating the nervous centres, as well as a gen- 
 eral coincidence in results, form the groundwork of this demonstration 
 (227, 228, 233|, 475-^, 476 c, 500 c-p, 647^, 844, 902 I, 1067 aa). 
 
 § 1072, b. Let us now be critically understood, both here and in for- 
 mer places in this work, when speaking of the Passions as elements of 
 the mind, and as producing involuntary effects. It certainly is not in- 
 tended to be implied that they are not more or less associated with acts 
 of intellection, and, perhaps, always brought into operation by some act 
 of the Mind properly so called. This is also doubtless true of the Will, 
 which appears to depend more or less upon the previous exercise of re- 
 flection, comparison, and judgment, in man, but moved into action in 
 greater independence in animals — that is, instinctively. This remark 
 may apply, also, to the Understanding (§ 241 b, 243). If, however, the 
 Passions and the Will be the results of intellectual processes, the former, 
 by their great variety and their peculiar operation in organic life, while 
 the latter and all the higher faculties of the mind are excluded from that 
 department of life, and the sameness of the Will, throughout, in princi- 
 ple and results, evince an individuality that renders them equivalent to 
 elements or properties of the Soul and Instinctive Principle. They are 
 as precise and peculiar in their phenomena as any admitted faculties, 
 and their results are far more strongly pronounced. They must, there- 
 fore, be taken as equivalents, and as the only practical ground of discus- 
 sion. All beyond is, at least, metaphysical (§ 243-246, 903, 1067). 
 
 But the question which is thus raised, in anticipation of any caviling, 
 has no bearing upon our demonstration, nor upon any of the topics dis- 
 cussed in these Institutes. It is equally immaterial whether the Pas- 
 sions and the Will be distinct elements of the Soul and Instinctive Prin- 
 ciple, acting independently, or summoned into operation by the higher 
 faculties, or whether they be, respectively, the concurrent results of those 
 faculties. In the latter case, they would be employed in a collective 
 sense ; and, as the results are the same as if they were distinct entities, 
 and entirely different from other manifestations of Reason and Instinct, 
 they are as properly designated by the specific names of Passions and 
 Will, and the former resolved into Love, Hatred, Anger, &c., as any of 
 the Faculties upon which they may depend are known by other names. 
 They may be called mere Emotions ; but still they would belong to men- 
 tal processes, and that is enough for all the purposes that can bear any
 
 878 INSTITUTES OF MEDICINE. 
 
 relation to physiological inquiries, or to our present objects. It would 
 be, indeed, equally to our purpose, were it conceded that the stimulus 
 which gives rise to the Passions emanates from other organs than the 
 brain, since they operate through the medium of the nervous system, are 
 under the control of the mental faculties, and are palpably associated 
 with them either as co-ordinate elements or as resulting emotions. The 
 remote stimulus, upon this hypothesis, simply rouses the mind into ac- 
 tion. The conclusions, therefore, which I shall have predicated of them 
 can not be affected by any hypothesis of a metaphysical nature, nor by 
 any supposed involutions of other organs with the brain (§ 167/, 175 h, 
 183, 188 a, 227, 230, 232, 241-245, 476 c, oOO f-p, 902 1, 1067. Also 
 Indexes, article Will)- — ^Note Hh p. 1138. 
 
 Having thus disposed of this question to meet any subtleties of the 
 speculative philosopher, I shall now interrogate the physiological facts 
 as to the individuality of the Will as a property of the Soul and Instinct, 
 when it will be found that it is in no respect the same complex emana- 
 tion of either as the Passions. It is not obedient to any analogous laws, 
 nor does it operate through the same mechanism as the Passions. It is 
 distinguished from the Passions by the simplicity and precision of its re- 
 sults, by its great final cause, by its operation in animal life, and through 
 the cerebro-spinal system, while the Passions operate mostly in organic 
 life and through the sympathetic system. In all these respects the Will 
 is on common ground with Judgment and Reflection, while it is the most 
 important and uniform characteristic of the Instinctive Principle through- 
 out the animal tribes (§ 476 c, 500 h). 
 
 § 1073, a. It is allowed by all that some invisible, intangible principle 
 exists in the Nervous System, commonly known as the Nervous Power, 
 which is extensively concerned in the processes of animal organization; 
 and I have endeavoured to show that this power is a vital agent, which 
 is very vai'iously brought into action either by physical or mental causes, 
 and that when motion is produced by direct or indirect physical irrita- 
 tions of the brain, or by the Will or the Passions, it is in consequence of 
 the development of this nervous power, and the direction of its influence 
 upon the organic properties of the parts that are brought into motion. 
 It operates equally in organic and animal life, but through very different 
 channels and with very different results. It is most important in the 
 organic life of animals, though its greatest final cause is relative to ani- 
 mal life. Its transmission to the former is through involuntary nerves, 
 whether it be consequent on the operation of physical causes, or when 
 the Passions disturb the organs in that department of life ; and it is 
 through the cerebro-spinal or voluntary nerves that the Will operates 
 upon the organs of animal life, and when injuries of the brain or spinal 
 cord, or when the Passions affect these organs. Such are the general 
 facts (§ 1072, a). When the Will produces muscular motion, it is by 
 developing the nervous power, and transmitting it to the voluntary mus- 
 cles, when it stimulates the muscles, and brings them into action through 
 their own inherent power. And just so of the Passions, and of physical 
 causes. There is no wandering of the Will or of the Passions into the 
 organs which they affect, as has been always vaguely supposed, no more 
 than of physical agents when, on being applied to the nervous centres, 
 they excite analogous motions (§ 233). It is also important to under- 
 stand that the nervous power, by whatever cause developed, is liable to 
 act with intensity upon the brain (§ 230, 509, 950, 1040). I have also
 
 The Soul. — APPENDIX. — Instinct. 879 
 
 endeavoured to show that the nervous power is developed by the mind in 
 all acts of intellection, and that there is then an associate action between 
 this power, the brain, and the mind ; though beyond the analogies sup- 
 plied by the Will and the Passions this may be hypothetical (§ 234). 
 
 But all that is embraced in this Section, whether as to the nature of 
 the nervous power, or its mode of development and action, or whether it 
 have any existence, is unimportant to my demonstration (§ 234, e-h). 
 It simply facilitates an understanding of the phenomena upon which the 
 demonstration depends. (See Indexes, Articles Nervous Power, Sym- 
 pathy, Remedial Action, Oi-ganic Life, &c.), 
 
 § 1073, b. I may say, also, that in the Medical and Physiological Com- 
 mentaries I have endeavoured to show that the Nervous Power forms a 
 bond of union between the Soul, the Principle of Instinct, and the Brain, 
 and that this Principle is instrumental not only in the results of Sensa- 
 tion as set forth in the present work, but in the acts of Intellection. The 
 phenomena of the Nervous Power in developing voluntary motion when 
 the Will operates, and of the Passions in their demonstrations in Organic 
 Life, supply many forcible evidences of the instrumentality which I as- 
 sign to the Nervous Power in the concerted action between the Soul, the 
 Principle of Instinct, and the Brain. (See Indexes, Articles Will and 
 Mental Emotions.) 
 
 § 1074. From what has been now said of the ground of my reason- 
 ing, you begin to perceive the consequences which must logically follow. 
 You begin to discern the force of the analogy between the eiFects of those 
 elements of the mind (or emotions, if it be preferred, § 1072, h), the Will 
 and the Passions, and of mechanical and other physical agents when ap- 
 plied to the brain. You see, already, that if the brain be influenced by 
 SOMETHING Avhen physical agents acting upon it give rise, in consequence, 
 to motion in the voluntary muscles, and in the heart, bloodvessels, stom- 
 ach, «&;c., SO must it be equally influenced by something, and that something 
 must be equally an exciting and analogous cause, when the Will gives 
 rise to voluntary motion, or when the Passions affect the action of the 
 heart, produce blushing, or excite vomiting, &c. From the exact iden- 
 tity of effects in the two cases, there must be an analogy among the 
 causes and their modus operandi ; and therefore the Soul and Principle 
 of Instinct (of which the Will and the Passions are prominent character- 
 istics) are as much distinct causes as are the mechanical ii-ritants or other 
 physical agents which determine the corresponding movements. I say, 
 that such is your mental constitution you cannot resist this conclusion, 
 however prone you may be to materialism. Here is an animal Avhose 
 brain is shocked by a blow or irritated mechanically, and spasms follow 
 in the voluntary muscles ; and you see that the Will is even capable of 
 imitating that convulsive affection. Here is another whose brain is ir- 
 ritated by the application of alcohol, and you see the heart beating more 
 actively as a result ; and here is a third whose heart is as quickly enfee- 
 bled in action by the application of tobacco to the brain, just as it is 
 excited by joy and anger in the one case, or depi*essed by grief and fear 
 in the other (§ 481 a-h, 487, &c.). You also witness the same spasms 
 in the voluntary muscles from the operation of the Passions as arise from 
 mechanical causes when affecting the brain (§ 486, 487 g). Consider, 
 for example, a paroxysm of hysteria, where convulsions of the voluntary 
 muscles are brought on by some mental irritation, and where they are ex- 
 actly the same as when produced by disturbing the brain mechanically.
 
 880 INSTITUTES OF MEDICINE. 
 
 Consider, also, how greatly analogous are these mental pai'oxysms to the 
 convulsions that proceed from teething and intestinal troubles ; and how 
 exactly alike are the voluntary and involuntary acts of respiration, one 
 of them being determined by the direct action of theil/md upon the brain, 
 and the involuntary act by an impression transmitted from the lungs to 
 the brain. How precisely the same, also, the involuntary contraction of 
 the sphincter ani and its contraction as effected by the Will, and where 
 the same philosophy is concerned in respect to causation as in the vol- 
 UHtary and involuntary acts of respiration (§ 500 o, 514/, g). Consid- 
 er, too, among the inexhaustible examples, the variety of effects which 
 result from the operation of an emetic, as set forth in § 902, g, and the 
 same effects as produced by a blow upon the head — all consequent upon 
 an irritation of the nervous centres — and then compare them with the 
 same results which ensue when vomiting is produced by disgust, and even 
 by its recollection ; and compare many of these results with the effects of 
 Fear — the bounding action of the heart, the small and rapid pulse, the 
 half-suspended respiration, the pallor of the skin and the copious perspi- 
 ration, the flood of urine, the hurried movements of the intestinal canal, 
 the ghastly countenance and frightful eyeballs, the trembling of the vol- 
 untary muscles and the prostration of their power ; or, compare the re- 
 sults of many physical causes, such as constipation of the bowels, with 
 the effects of Grief, either so influencing the nervous centres as to un- 
 dermine digestion, or so acting upon the brain as to overthrow the men- 
 tal faculties ; or consider how Hope, succeeding to Grief, will, like ton- 
 ics, cathartics, shower-bath, change of climate, &c., influence the nervous 
 centres in yet another manner so as to restore that digestion which Grief 
 had impaired. And what makes the tears flow, when Grief, or Love, or 
 Joy, or Anger, is in the ascendant, just as they do when snuff or other 
 physical agents irritate the nose? Why does the mouth water at the 
 sight of a bountiful feast, or on scenting its odour, or from its expecta- 
 tion alone, just as it will on chewing horseradish or tobacco? Why will 
 the sight of a pill-box, or offensive odours, or startling or other unpleas- 
 ant sounds, operate upon some after the manner of cathartics (§ 514 m, 
 844 a, 892f h, 944 h, 951 c)*? It is palpable enough, that, in one series 
 of the cases the effects are owing to some physical cause irritating the 
 brain and spinal cord, and which is totally distinct and different from 
 those nervous centres ; and, can any one be so regardless of the plainest 
 rule of pliilosophy as to suppose that the corresponding results, in the 
 other series, are not equally due to some cause which is alike distinct 
 and different from the nervous centres? All of them are the most fa- 
 miliar facts that engage our attention ; but such as are relative to the 
 mind have engaged us only as facts. 
 
 § 1075, a. We now revert to our statement relative to the nervous 
 power (§ 1073) in pui'suit of a common exciting cause by which all 
 the endless but analogous phenomena to which we have adverted are 
 brought about. It is readily granted that the mechanical and other 
 physical causes are not transmitted to the parts which they influence 
 through the medium of the nervous system, and we must therefore look 
 for some intermediate cause by which the remote effects are produced. 
 It is of no importance to our present objects whether this cause be gal- 
 vanism, or a nervous fluid, or nervous power, or a vibration of the nerv- 
 ous fibres, «&c. (§ 184 h, 234 a) ; and, from the analogy in the effects of 
 the Will and Passions, it is equally clear that these elements or eraana-
 
 The Soul. — ^.^PPENDix. — Insiinct. 881 
 
 tions of the IMind are not transmitted to the parts affected, but that they 
 must operate through the same intermediate exciting cause as the 
 physical agents. These unquestionable coincidences, therefore, not only 
 place the external and internal primary causes upon common ground as 
 substantive agents, but are demonstrative of their operation through 
 some common cause appertaining to the nervous system. This is also 
 farther sustained by the simplicity and consistency of Nature in her fun- 
 damental institutions, especially where the mechanism is the same, al- 
 though there be great diversity in the remote causes and results. 
 
 Nor do I entertain any doubt, however much the physical school may 
 look upon this question as an affair of "spiritualism" (§ 1034), that the 
 facts, which are of such an endless variety, so distinctly pronounced, and 
 so perpetually before us, will be universally allowed to establish the in- 
 terpretation rendered in these Institutes of the modus operandi of the 
 nervous power. There is not a phenomenon relative to the nervous sys- 
 tem which the doctrine will not explain, nor is there one which can be 
 consistently or intelligibly explained by any otner. (See Indexes, Articles 
 Nervous Power, Sympathy, Itemedial Agents, Will, and Mental Emotions.) 
 
 It is also evident from my premises, that, if the movements Avhiclf are 
 excited by the action of physical causes upon the brain be only remotely 
 due to those causes, and not to any primary change in the brain (which 
 includes the transmitted as well as direct impressions), it must equally 
 follow that the effects of the Will in developing voluntary motion, and 
 of the Passions in modifying the action of the heart and bloodvessels, 
 and other organs, cannot be due to any original, primai^ changes in the 
 condition of the brain, but, of necessity, to some causes as distinct from 
 the brain as are the physical. But, as this is the great point in material- 
 ism,, and forms the chemical doctrine of intellection, let us admit that 
 the remote effects brought about by physical impressions upon the brain 
 are due to simply some physical change in the organ, and that, there- 
 fore, the corresponding manifestations of the Will and the Passions are 
 equally owing to simply physical changes in the great nervous centre, 
 it will still follow just as logically that there must be in the latter case 
 as much an efficient cause for the cerebral changes as there is allowed 
 to be in the former. 
 
 § 1075, b. So far, then, the analogy is complete. But, in the case of 
 the physical agents the causes are of a passive nature, and require other 
 agencies to bring them into operation. How different, on the other 
 hand, with the Will and the Passions! Plere the causes are entirely 
 self-acting, originating their own actions in the Sensorium Commune. 
 This, in itself, establishes a radical distinction between the nature of the 
 Soul and Instinctive Principle, and of all physical causes, and is utterly 
 fatal to materialism. The self-acting nature of the Soul and of Instinct, 
 and especially of the rational faculty, transcends greatly tlie Principle 
 of Organic Life, which requires the operation of stimuli to rouse it and 
 maintain it in action (§ 75, 136, 188^). Nay more, the Will and the 
 Passions are among the most efficient causes in calling into action the 
 Principle of Life ; and being, in this respect, upon common ground with 
 all vital stimuli, the materialist will see in this analogy an insuperable 
 proof of the substantive existence and self-acting nature of the Soul, and 
 how, also, the same analogy distinguishes the Soul completely from the 
 Principle of Life, with which it has been confounded even by eminent 
 Vitalists. The group of the facts is here so very comprehensive, and 
 
 Kkk
 
 882 INSTITUTES OF MEDICINE. 
 
 80 demonstrative of the two most important problems in intellectual and 
 organic philosophy, that I pause in this manner upon the subject. But 
 so far as action is immediately concerned in the two cases an analogy 
 obtains, and we may reason upon that analogy from the self-acting Soul 
 to the existence of an active Principle of Life upon which organic mo- 
 tions depend (§ 234, 1034). But, we shall seek in vain, throughout the 
 wide range of Nature, for any direct similitude with the manifestations 
 of Reason or of Instinct; though, if we pass the limits of Nature, we 
 may discover in the results of Creative Energy that analogy with the 
 Soul which shadows foi-th the Image of God (§ 234, a-h). 
 
 § 1076, a. What has now been said is equally applicable to material- 
 ism, whether it regard the manifestations of mind as a chemical phenome- 
 non, or as elaborated from the blood ; and these are the only hypotheses 
 which have any intelligible foundation. They must, therefore, be now 
 considered more specifically. 
 
 The chemical supposes that all acts of intellection, all manifestations 
 of the Will and the Passions, all the impulses of Conscience, and all 
 Ad^'ation of the Deity, are results of " the chemical action which the ele- 
 m,ents of the food and the oxygen of the air mutually exercise on each other''' 
 (§ 349 e, 500 n, 1054). This is the hypothesis of combustion. But 
 enough has been said to show the impossibility of referring the phenom- 
 ena to a chemical process without, at least, an attendant cause to insti- 
 tute the process. This, however, is farther examined at § 500, nn, o, to 
 which I would refer the reader ; and what will soon be said of the doc- 
 trine of mental secretion will be alike applicable, in principle, to the 
 chemical hypothesis, and will cover the whole ground. 
 
 § 1076, h. But there is a class of Philosophers who have endeavoured 
 to render the chemical doctrine acceptable by admitting something like 
 a Soul, which is supposed to act as a predisposing cause of that com- 
 bustive process upon which tlie phenomena of Reason and Instinct are 
 said to depend. But it may be readily seen that the hypothesis is 
 illusory. 
 
 In the first place, the supposition of the dependence of thought, &c., 
 upon any chemical process necessarily places the agency of the supposed 
 principle, in its relation to the phenomena of Mind and of Instinct, upon 
 exactly the same ground as the simple chemical hypothesis ; for the re- 
 sults would still be chemical and nothing more. If oxygen unite with 
 another element, and result in combustion, it takes place under a special 
 law, and an exact chemical product ensues, which neither the Soul can 
 alter, nor imagination aiFect. The only part which the Soul would take, 
 according to any analogies borrowed from Chemistry, and which is neces- 
 sarily the part supposed, would be that of exerting merely a predisposing 
 affinity among the elements. This predisposing influence is meant to 
 embrace whatever may be supposed to result from its action upon the 
 doctrine of catalysis (§ 409 7, 350 J a-e). In this only view of the sub- 
 ject, the chemical tendency of the Soul would no more react upon itself 
 than that o? platinum, and the only result would be (in chemical phrase- 
 •Dlogy), a combustion of the elements of the brain, just as when hydrogen 
 and oxygen gases are submitted to the catalytic action of the metal. 
 And so of any other given chemical change. It always terminates in 
 one way. 
 
 Whenever, therefore, oxygen unites with the phosphorus of the brain, 
 according to the material doctrine of intellection, whether chemical or
 
 The Soul. — APPENDIX. — Instinct. 883 
 
 chemico-spiritual, it can form no other compound than phosphorous or 
 phosphoric acid, whatever the supposed activity of the combustion ; or, 
 if it unite Avith those other combustible elements of the organ, carbon 
 and hydrogen, the resulting compounds must be carbonic acid in one 
 case, and water in the other ; or, at most, a special triple compound of 
 those elements. An exciting, or predisposing, or any other agency of 
 the Soul, even were the soul a material substance, would in no respect 
 affect these results ; and to imagine that the Soul enters into either com- 
 bination, and is yet in perpetual operation, per se, would be a chemical 
 absurdity. Whatever consideration, therefore, may be given to chemical 
 processes thus instituted as the source of ideas, &c., it can be in no re- 
 spect different from that which attributes them to one of an uncompli- 
 cated nature, whether the soul be immaterial or material. 
 
 The difficulty will be readily appreciated, both here and in regard to 
 organic products, which are equally ascribed to a chemical process (for 
 these doctrines are essentially alike), should it be attempted to call in 
 the aid of the Soul, or the Principle of Life, in any of the manipulations 
 of the Laboratory. They are so far on common ground ; and, if the Soul 
 can promote combustion in the brain, or in any way modify its results, 
 or the Principle of Life subserve the chemical hypothesis of organic re- 
 sults (according to Liebig), they should be equally competent out of the 
 body, so only they could be brought into external operation. But no 
 imagination can surmise the possibility of applying them in a chemical 
 manner, and, least of all, eliciting by the aid of the Soul the phenomena 
 of mind from the most ingenious devices of Organic Chemistry. On the 
 other hand, however, there is no difficulty in regarding the Soul as a cause 
 acting through the vital constitution of an organ, and thus originating 
 all the phenomena of mind ; while, in so doing, we get rid of an unneces- 
 sary, as well as an unmeaning and mischievous multiplication of causes 
 (§ 171-221). — See ^455 a as to final causes of the union of Soul and Brain. 
 
 The Chemico-Spiritualist is thus coerced to the alternative of ascrib- 
 ing all intellectual and instinctive functions to the immaterial principles 
 in their co-operation with the vital constitution of the brain, or to deny 
 the existence of those principles (whether immaterial or material), and 
 throw himself exclusively upon the simple chemical rationale. If the 
 doctrine stand, it must be upon its own merits, and not through any 
 sophistry that may seem like a leaning towards the common faith of 
 mankind — no gilding the material device — no concession to what may 
 be considered the innocent but obstinate belief of the spiritual theorist, 
 in the trbst that he may finally discern the reality of his delusion. 
 
 Again, farther : the Organic Chemist maintains that all the processes 
 of life are owing to the same combinations of oxygen with phosphorus, 
 carbon, hydrogen, and nitrogen, as are supposed to give rise to intellec- 
 tion. The brain is thus placed on common ground with all other parts. 
 Why, then, are there no manifestations of mind or instinct in the liver, 
 intestines, or in the bones where phosphorus abounds? Or, turning to 
 the accommodating Chemico-Spiritualist, I may ask, if the Soul or Instinct 
 make all the difference as regards intellectual and instinctive manifesta- 
 tions, what makes the difference in respect to the corporeal phenomena ? 
 Nor is that all. If the brain be considered the source of intellection in 
 its organic condition alone, how are facts treasured up, and ever present 
 from childhood to decrepit age ? As the brain, like all other parts, is 
 constantly subject to renewals, the facts should go with the parts upon
 
 884 INSTITUTES OF MEDICINE. 
 
 which they are impressed, if the organ alone be their receptacle. Why, 
 again, are the events of childhood fresh to the Octogenarian, when those 
 of the day are speedily forgotten? Why may memory be trained with 
 a special reference to particular subjects, and to a forgetfulness of others, 
 or disciplined to a general compass of knowledge? Materialism must 
 here be consistent and stand on its own philosophy. But the Soul, on 
 the other hand, as also the Instinctive Principle, being one of an un- 
 changing nature (as proved by these very facts), holds fast the treasury 
 of knowledge, or the improvements it may gain (§ 180). 
 
 And here we come upon a demonstration which, were there no other 
 objection, would be fatal to materialism in either of its shapes ; for one 
 hypothesis supposes that intellection, &c., is the result of the combustive 
 process, and the other, of secretion. In either case, therefore, all ideas 
 should be as evanescent as the processes themselves. 
 
 Finally, such as are disposed to follow the Author any farther upon 
 this particular question will find in former parts of this work many sug- 
 gestions which have a direct bearing upon it, as in § 350| e-n, p. 180- 
 192. 
 
 § 1076, c. And now, as to the other branch of materialism, or that 
 which regards the phenomena of mind, &c., as the products of secretion. 
 This question has been incidentally discussed in these Institutes, but with 
 other objects than are now contemplated. As it bears, however, as well 
 upon the chemical as the functional doctrine, and as it is desirable to 
 amplify the argument, and that it may appear as an integral part of the 
 pi'esent demonsti-ation, I shall introduce it here (§ 175, c). 
 
 I have there said that in former works I have presented certain facts 
 which go to the conclusion that the Soul is a distinct, immaterial sub- 
 stance, and that the Instinctive Principle of animals is equally a distinct 
 substance from the brain. I then proceeded to comment upon the main 
 argument of the Materialists, drawn from analogy, that the mind, like 
 the gastric juice, bile, &c., is only a product of the organic functions of 
 the brain. I have there shown, also, that the supposed analogy is desti- 
 tute of foundation. It might be sufficient, in proof of this, to simply 
 say that the Mind and Instinct are wanting entirely in every known 
 attribute of the products of other organs, and are sui generis in all their 
 chai'acteristics. But there are other more absolute characteristics which 
 completely destroy the supposed analogy. What, for example, is tlie ef- 
 ficient cau§e of the production of bile, saliva, &c. 1 Certainly the blood, 
 in connection Avith organic structure and organic actions — chemical, if 
 you please. While these processes go on, bile, saliva, &c., are produced 
 uninterruptedly; or, if arrested, it is from the failure of the organic pro- 
 cesses. But it is just otherwise in respect to the Mind and the Instinct- 
 ive Principle. All their manifestations are completely suspended during 
 sleep, and often with great instantaneousness, or, to meet any sophistry 
 about dreams, I might say half suspended ; and yet the organic functions 
 of the brain continue to move on as perfectly as those of the liver, the 
 lungs, &c. Indeed, were any change of this nature to befal the brain, it 
 would be particularly manifested by some consequent modification of all 
 the organic actions, especially as those of the Mind and Instinct undergo 
 complete suspension. The continuance of all tlie organic results proves 
 that organic life is every where in perfect operation ; while, by equality 
 of reason, the suspension of all results in animal life proves that an 
 agent, upon which these results depend, has ceased to operate. In one
 
 The Soul. — APPENDIX. — Instinct. 885 
 
 case, organic functions must go on without interruption, and therefore 
 the moving causes upon which they depend must be in perpetual action. 
 In the other, it is ordained that the organs peculiar to the division of 
 animal life shall have periodical repose (though only as it respects mere 
 animal life), and, therefore, by parity of reason, their spring of action is 
 constitutionally fitted for quiescence as well as action, and this, as it re- 
 spects sleeping and waking, corresponds with the alternations of thinking 
 and not thinking during the waking time. The various gradations in the 
 suspension of mental and instinctive functions from their quiescence in 
 the waking state to profound slumber concur, also, in this pai't of our 
 demonstration. Nor is it at all important to our purpose whether there 
 ever be a complete suspension of the intellectual or instinctive functions. 
 But again : suppose some change in the oi'ganic condition of the brain, 
 as the cause of sleep (§ 500, n) ; what is it, I say, that so instantly rein- 
 states its organic functions when we pass from the sleeping to the wak- 
 ing state "? What arouses the organ to its wonted secretion of Mind, or 
 what, in the other case, restores the combustive process % Certainly not 
 the blood. Are there any analogies supplied by the liver, or by any other 
 organ ? Do you assume that some imaginary stimulus is propagated upon 
 the brain from other organs? Then I ask what brings this into operation, 
 and under such an infinite variety of unique circumstances'? In what 
 conceivable manner does it modify the organic functions of the brain so 
 as to excite the secretion of Mind, or how, in the other case, does it start 
 the combustive process '? Do the functions of any other organ supply 
 the slightest ground for such a conjecture ? Will it interpret the reason 
 why sleep is so prolonged in the habitually indolent, or, contrasted with 
 this, why the laborious and exhausted student often sleeps less than others, 
 whatever their occupation "? Is it said that this is the i-esult of habit, or 
 of self-discipline ? In either case it is an admission of a self-acting Prin- 
 ciple, which brings itself and the brain under these influences, and there- 
 fore it is necessarily that Principle which rouses the brain from its state 
 of suspended animal functions. It is a case, too, very strongly to our 
 purpose, for it denotes a remarkable cviltivation of the spiritual part, 
 which enables it to spi'ing into active operation from a dormant condi- 
 tion in habitually exhausted states of the body, while the brain, accoi'd- 
 ing to materialism, should resist all wakefulness till that organ, and all 
 other parts, are fully recruited by repose (p. 329-332, § 500, ?t-p, Liebig). 
 But the Materialist- is not convinced by the difficulties attendant upon 
 sleeping and waking ; and again, therefore, I ask him. What is it that 
 directs the special combustive or secreting process in all the acts of voli- 
 tion, in all the acts of intellection ; or what brings them into operation? 
 What are your conceptions of Creative Energy"? Are not the results 
 of Mind, however separated from Infinitj'^, precisely analogous to those 
 which are everywhere seen as the offspring of an Infinite Intelligence ? 
 But, if you admit a God, you Avill not reason from your debasing doc- 
 trines of the human mind to the Attributes of your Maker "? And I ask 
 the Materialist what answer he will make as to the condition of our Loi'd 
 before His appearance upon the earth, and as He was " manifest in the 
 flesh?" Was there no Spirit there? Nothing but material eliminations 
 of Mind from the blood, or a conflagration of the elements of the brain ? 
 For so you must have it, and so it is meant, whei'e the same mental 
 phenomena are so interpreted in man. Nay more ; so complete is the 
 analogy between the acts of ratiocination and those of the Creator, as
 
 886 INSTITUTES OF MEDICINE. 
 
 geen in the humble designs which are devised and executed by man, and 
 which, indeed, is all that we know of Him except from Revelation, it 
 would unavoidably follow, upon the doctrines of materialism, that all 
 the Designs of the Almighty Being were equally the results of chemical 
 or organic processes ! Or is this to be excluded from the pale of " science^'' ? 
 
 The questions and arguments now propounded must be answered 
 consistently, and in some conformity with the hypotheses drawn from 
 analogy. If that can be done (this simple physiological requisite alone), 
 then it must be conceded that the analogy is entitled to the gravest 
 consideration. So, on the other hand, should the hypotheses fail in this 
 indispensable requisite, materialism must stand convicted of sophistry, 
 insincerity, and a leaning to infidelity. 
 
 Here we might bring our demonstration to a close as it respects the 
 existence of the Soul, and its power of instituting actions in connection 
 with the material fabric. But there may be some who may be inclined 
 to follow us in a more extended inquiry than has now been presented, 
 especially as the demonstration will continue to be predicated of admitted 
 facts and principles, as set forth in these Institutes. 
 
 § 1077. What will be presented in the present section is mostly a 
 series of physiological examples which concur with the foregoing in 
 enforcing the conclusions at which we have already arrived. 
 
 It has been seen, extensively, that impressions upon the nervous centres, 
 by which the nervous influence is developed and detei-mined with various 
 effects upon distant parts, are all upon a par, in principle, whether tliey 
 result from agents applied directly to the centres themselves, or be 
 transmitted to them through the medium of parts remotely situated, or 
 whether the Will and Passions make their demonstrations. Take some 
 of the examples among the muscles which are botli voluntary and invol- 
 untaiy. Let these be, again, the respiratory muscles, including those of 
 the face. Now, their several movements are liable to numerous modifi- 
 cations, some of which are natural, as in sneezing, coughing, yawning, 
 laughing, and others more or less morbid, as asthma, hiccough, &c. In 
 all but two of these cases the movements depend upon the excitement 
 of the nervous power through some sensitive nerve, which are generally 
 the sensitive fibres of the pneumogastric, and the reflection of that power 
 from the brain and spinal cord, through motor nerves, upon a part of or 
 upon the whole of the respiratory muscles. In each process there is a 
 special irritation of the nervous centres, and in each the nervous influence 
 is brought into operation in a peculiar manner, and according to that 
 manner is the nature of the movement. In Asthma, a stronger irrita- 
 tion is propagated from tlie lungs to the nervous centres, and a more 
 intense motor excitement is reflected from the centres upon all the mus- 
 cles of respiration (often including those of the face), than in ordinary 
 breathing, and in some cases the Will comes to the aid of the irritation 
 propagated from the lungs. Here, then, it is seen that a prompting of 
 the Mind and the pliysical causes are brought into immediate co-operation 
 in rousing the brain and spinal cord. The physical cause is insufficient 
 io excite the requisite movements of the respiratory muscles, and there- 
 fore the Mind lends its assistance. Both act in perfect harmony togeth- 
 er ; nor can the slightest difference be observed in tlie results of either, 
 excepting as the Mind acts with greater energy, and brings the respira- 
 tory muscles of the face into action. 
 
 Now, upon the physical hypotheses of intellection, what is it that
 
 The Soul. — APPENDIX. — Instinct. 887 
 
 superadds to the respiratory movements, in the foregoing case, a cause 
 perfectly distinct from such as naturally governs the process? If it be 
 said, fluctuating conditions of the brain, what is the cause of those fluc- 
 tuations? AVhy is there at one moment only a moderate degree of the 
 supposed combustive or secretory process, and at the next a greatly 
 increased amount of one or the other, and this requiring as much a 
 cause as the excitement of the brain in the involuntary act? And here 
 we may again advert to the sphincter muscles as supplying a parallel 
 example. 
 
 Take another illustration — the acts of voluntary and involuntary 
 laughing. When the feet or arm-pits are tickled, laughing follows irre- 
 sistibly in many, as the effect of an irritation propagated to the nervous 
 centres by sensitive nerves supplying the skin of those parts (§ 514 ci, 
 649 b). The phenomena are the same as witnessed in ordinary laugh- 
 ing, where the Will and agreeable Emotions are the exciting causes. 
 The former soon becomes painful, and then goes on in direct opposition 
 to the Will. A man, for example, bound the limbs of his wife and 
 tickled her feet till she died of laughing, just as some die suddenly of a 
 strong mental emotion, " which," as Shakspeare says, " is as bad as die 
 with tickling." And here 1 would ask the Materialist what other con- 
 struction he can apply to the cases of sudden death from jotj and anger 
 than the powerful operation of some unseen cause upon the brain, and 
 through that organ upon organic life? What other condition than a 
 violent shock of the brain from a cause as distinct in its nature from the 
 organ, as the hammer whose blow upon the head is fatal through pre- 
 cisely the same physiological influences? (§ 230, 455, 476 J A, 478,479, 
 500/-nn, 507-509, 634, 902 /, 951 c, d.) 
 
 A case precisely parallel in its physiological rationale with death from 
 mental emotions {last references) occurs in syncope, when it arises from 
 seeing or hearing something offensive, or from the sight of a lancet. 
 Here the immediate cause, as in the case of death from joy or anger, is 
 the instant and powerful determination of the nervous influence upon the 
 brain, heart, stomach, &c. (§ 230, 479, 507-509, 634, 951). But there 
 must be something to develop that nervous influence in the brain, and the 
 common sense of every one assures him that it is a conscious agent which 
 does the work. But, for the fullest illustration of this subject, let us 
 analyze the physiological rationale of syncope as produced by offensive 
 odours. Here the Mind may have but little participation in the pros- 
 tration of the heart, &c., but the eflfect be mainly due to the physical 
 impression propagated to the brain through the olfactory nerve, and per- 
 haps, also, the nasal branches of the fifth pair (§ 514, m), which impres- 
 sion, in itself, develops greatly the nervous influence. But the Mind 
 may also contribute to that development ; for, if the odour Avcre not per- 
 ceived, no syncope might follow. Thus, again, are associated the phys- 
 ical and mental causes in producing a common effect, while in the case 
 of the lancet it is purely a mental emotion which determines the par- 
 oxysm. But, in respect to the odour, the Mind generally endeavors to 
 resist its effects, and as syncope may happen in spite of the effort, it is 
 evident that the depressing influence may be mostly due to the direct 
 action of the physical cause upon the brain, just as we shall soon see 
 how a strong light acting upon another pure nerve of sensation may pro- 
 duce sneezing ; but I think more the mental emotion (p. 79, note). 
 
 Let us now connect with the foregoing facts the syncope v/hich follows
 
 888 INSTITUTES OF MEDICINE. 
 
 blows upon the head, and it will be seen, as plainly as we see that the 
 physical blow upon the brain is the cause in one case and the odours in 
 others, that the Mind inflicts the blow in the remaining series, or that 
 of joy, anger, the lancet, «&;c. The physiological effects prove conclu- 
 sively, both in their nature and coincidence, that one cause is as much 
 an agent acting upon the brain as the other, and that both are equally 
 distinct from the organ (§ 514 m, 844 a, 892 J h, 944 h, 951). In all the 
 cases where the physiological effects are consequent upon mental pro- 
 cesses the Mind and the effects stand in the same relation as do the 
 physical causes and their effects in the other cases, and where the effects 
 are precisely the same in both series. To suppose the absence of a cause 
 in the former is a physiological absurdity, and to suppose any other 
 primary cause than the Mind, as a self-acting Agent, is a greater absurd- 
 ity. Nay more, the Mind, the brain, and the cerebro-spinal nerves are 
 absolutely indispensable to all voluntary movements, however true it be 
 that the power by which the movements are accomplished is implanted 
 in the muscles (§ 258-267, &c.) ; while the motions of organs in organic 
 life may go on without Mind, or brain, and even without cerebro-spinal 
 nerves (§261, 264, 455 a, 46H «. 478 b, 490, 1042). 
 
 I have said that in the several modified movements of the respiratoiy 
 muscles mentioned at the beginning of this section, all but two depend 
 upon irritations of the nervous centimes propagated through sensitive 
 nervous fibres from the lungs or other parts, and that, in all the cases, 
 the same excito-motory nerves bring the muscles into action. The two ex- 
 ceptions are voluntary laughing and yawning. In the former case, the 
 Mind, unlike involuntary laughing, rouses the brain without the inter- 
 vention of any sensitive nerves, and determines the nervous influence di- 
 rectly upon the muscles of the face through the excito-motory nerves ; 
 which is also true of the bloodvessels of the face in blushing, and of the 
 production of tears in weeping, though in the latter instances the nervous 
 influence is propagated upon the face and gland through motor fibi'es 
 of the sympathetic nerve. 
 
 In ordinary yawning, which is exactly a modified form of respiration, 
 the Mind may have but little or no participation in the act, but it may 
 depend alone upon a physical impression transmitted from the lungs to 
 the nervous centres, along, perhaps, with a concurring sense of uneasi- 
 ness propagated from the voluntary muscles ; or, if the Mind participate, 
 as in its efforts to relieve a sense of weariness, the physical and mental 
 causes act in co-operation, just as happens in severe cases of asthma. 
 At other times, a very different chain of causation may be observed, and 
 where, also, the mental and physical causes appear to identify them- 
 selves, as it were, with each other, as in sympathetic yawning, where one 
 yawns on seeing or hearing another yawn, or in talking about it; for, 
 in one case, an irritation is propagated both to the brain and Mind 
 through the optic nerve, and in the other case through the auditory 
 nerve, and simultaneously the Mind conspires with the physical irrita- 
 tions in exciting the nervous influence, and directing it upon the muscles 
 of respiration. But a paroxysm of yawning may be readily consequent 
 upon simply thinking about it, as will probably be the case with many on 
 reading this statement ; when the reader will, doubtless, feel quite assured 
 that his mind is as exclusively the cause in this instance, as the physical 
 irritation commonly is in ordinai'y yawning. 
 
 Just so, too, in respect to offensive odours, when they produce vomit-
 
 The Soul. — APPENDIX. — Instinct. 889 
 
 iiig instead oi syncope. In the former case the Mind may be more inter- 
 ested in the physiological effects than in the case of syncope from analo- 
 gous odours ; since the odours may be so far different in the two series 
 that disgust is in operation in one, but not in the other. A rose may 
 occasion syncope when just plucked from the bush, but vomiting only 
 when in a decaying state. The Mind, therefore, in the case of vomiting, 
 and the nervous influence, are brought into simultaneous operation by 
 the transmitted impression, and the Mind then co-operates with the 
 physical impression and occasions a farther development of the nei'vous 
 power, and thus increases the intensity of that degree which is created 
 by the physical impression. But the odours may produce either vomit- 
 ing or syncope, as also purging, by their own independent influence, and 
 in opposition to all resistance of the Mind ; or, on the other hand, the 
 Mind, as in breathing, yawning, and coughing, may be adequate to the 
 entire effect, for it will produce vomiting by reflecting upon the former 
 action of the odour, and which may have happened years antecedently. 
 Sympathetic vomiting, on seeing or hearing another vomit, is mostly of 
 this nature; but here, too, as in the case of the odours, the mind alone 
 may determine an act of vomiting by simply reflecting upon a disgusting 
 spectacle which had at a former time upset the stomach (^ 230-233*, 
 475i 500 c-2h 514 b, c, I, m, 647i, 844, 892f, 902 I, 1066). 
 
 To render the foregoing readily intelligible to the student, farther ex- 
 planations will be made. He has become sufficiently enlightened by the 
 demonstration to see that, in all the examples, the Mind is necessarily 
 a substantive agent, acting of itself upon the brain. The nervous influ- 
 ence which it develops, in the cases of vomiting, is exactly equivalent 
 to that which arises from the action of an emetic upon the stomach. 
 There is, however, one more link in the chain of causation in the former 
 than the latter case ; for when the Mind is the exciting cause, the nerv- 
 ous power is first projected upon the raucous coat of the stomach, where 
 it irritates the organ after the manner of an emetic. This irritation is 
 then reverberated, as in the case of the emetic, upon the nervous centre, 
 and thence reflected upon the abdominal muscles, diaphragm, and mus- 
 cular coat of the stomach, by which they are brought into spasmodic 
 action. When vomiting is produced by tickling the throat, the Mind has 
 no connection with the effects, but the physiology is so exactly coinci- 
 dent with that which is relative to the Mnd, that it goes with the rest 
 in showing how the Mind is necessarily a substantive, self-acting cause. 
 The chain of causation is the same here as In the case of the Mind, only 
 the flrst development of the nervous power is produced by the irritation 
 of the throat (§ 233f, 500 e-k, 514 b, c, 894-896, 902 e-^).— Note D. 
 
 Whenever vomiting springs from disturbance, or disease, or any novel 
 conditions of organs remote from the stomach and brain, the same chain 
 of causation obtains as in irritating the throat ; the point of departure 
 being the affected part, and the nerves supplying it are the organs of 
 transmission to the nervous centres. When the irritation, in these 
 physical cases, is thus made upon those centres, it is exactly equivalent 
 to the mental irritation when the Mind is the remote cause of vomiting, 
 and the subsequent steps in the process are exactly the same in all the 
 cases. The sickness and vomiting which spring from sailing, whirling, 
 riding, &c., depend upon the same chain of influences. In these exam- 
 ples, the remote impressions which are propagated to the brain arise, in 
 part^ from mechanical effects upon different organs, and they are, in
 
 890 INSTITUTES OF MEDICINE. 
 
 part, exerted directly upon the brain itself. In these instances, howevei*, 
 the Mind often participates in developing the nervous influence, through 
 some emotion that grows out of the physical influencee ; as may be known 
 from the fact that a strong determination of the Will to resist sea-sick- 
 ness will often prevent its occurrence, especially the act of vomiting ; 
 while, on the other hand, if one has made up his mind to be sick, he 
 will surely be so, though in the midst of a calm. In the former case, the 
 development of the nervous influence by the motion of the vessel falls 
 short of the intensity necessary to vomiting. And so of other analogous 
 causes ; and so, too, when offensive odours, disgusting sights, &c., operate, 
 or Avhen memoi^ turns them again upon the stomach. In all such cases, 
 and in various conditions of disease (§ 1067), the Mind, by resolving 
 not to co-operate with the physical causes, or keeping down fear and 
 other depressing emotions, may often yield no little protection to the 
 stomach. In this counteracting influence of the Mind we have, also, 
 another exemplification of its substantive existence and self-acting nature, 
 as contrasted with its co-operation Avith the same physical causes in 
 other cases (p. 78, § 167/, note, 1067 ad). — Note D p. 1114. 
 
 In section 514, Z, an example occurs, corresponding with the foregoing, 
 in which the physiology of sneezing is shown when occasioned by the 
 Sun's light impinging upon the retina. Here the circuit of nervous in- 
 fluence is very complex. And now observe hoAV perfectly the Mind will 
 do the same thing ; since, by thinking intently upon a former paroxysm, 
 the mind will develop the nervous influence by its own direct action upon 
 the brain — will determine that influence upon the lining membrane of the 
 nose, and give rise to the same irritation as the light of the Sun, or as 
 in the case of snuff; when the subsequent steps become alike in the sev- 
 eral examples. The only apparent difference, so far as effects are con- 
 cerned, between the physical and mental causes, consists in the self-acting 
 nature of the latter. The Mind, the nervous influence, and physical 
 agents are all on a par in principle, as it respects their character of sub- 
 stantive causes in relation to effects (§ 234, f, 475^, 647-^, 500 h-p). 
 
 Such are plain examples among a multitude of analogous ones. But 
 we must consider others less obvious, that Materialism may not oppose 
 us with specious problems in organic philosophy. It may be asked, for 
 instance. How will you explain the movement of the limbs during sleep 
 upon your doctrine? The ready answer is, exactly upon that doctrine, 
 since the facts are of the same nature with those already stated. In 
 these cases the act may be either voluntary or involuntary ; but, through- 
 out, it arises from some impression made upon the nervous centres. 
 Sleep may not be so profound as to suspend entirely the action of the 
 Will ; or, in other cases, the motion is owing, remotely, to some impres- 
 sion propagated from the limbs to the nervous centres. These remote 
 impressions arise from some constrained position, or analogous cause, 
 and may not awaken perception, or call the Will into exercise ; though, 
 doubtless, in most cases the Will is roused into action. If involuntary, 
 the phenomenon is then coincident, both as to cause and effect, with the 
 motions of decapitated animals, as when, for example, a decapitated tur- 
 tle draws up its leg on being pricked, or as a bird flutters or runs on 
 striking off its head. Here the nervous influence proceeds, of course, 
 from the spinal cord alone ; and the example is another clear illustration 
 of the substantive, self-acting nature of the Mind (§ 451, c, d). 
 
 Let us next suppose that the Materialist will demand of us an expla-
 
 The Soul. — APPENDIX. — InsiincL 891 
 
 nation, upon our general facts, of the influences which are concerned irf 
 sleeping in the erect posture, which is common to many animals. The 
 physiology of voluntary and involuntary respiration, and jp,rticularly of 
 the action of the constrictor muscles, and the exact coincidences between 
 the voluntary and involuntary acts ^n either case, supply, respectively, 
 an answer to the interrogatory. It is evident, therefore, that in sleeping 
 in the erect posture, the muscles are placed by the Will in a state of 
 tension which determines upon them an unceasing nervous influence af- 
 ter the action of the Will is suspended, and in a manner analogous to 
 that which holds the sphincter muscles in a state of permanent contrac- 
 tion (§ 514 ^, 516 d, No. G, § 902 k). Indeed, there is always, as in the 
 case of the latter, a certain degree of involuntary nervous influence oper- 
 ating upon the voluntary muscles, by which their antagonism is balanced. 
 This is shown by the division of nerves, as when those of one side of 
 the face are divided, or paralyzed, the muscles lose their relation to those 
 of the opposite side. Another example occurs in the wry-neck. 
 
 The same explanation is applicable to the contracted leg of the bird, 
 in roosting.* The whole principle, in all its variety of manifestations, 
 according to the nature of the animal and the uses of parts, has its foun- 
 dation in consummate Design. The modifications in diiferent species of 
 animals correspond with those of Instinct, and are full of instruction to 
 the contemplative mind. Their final cause belongs to the same inscru- 
 table system of Designs as the varieties in Instinct itself; and, if we 
 may not trace out the exuct mechanism, or the remote causes in all the 
 cases, there are a multitude of analogous facts which have been clearly 
 ascertained, and which as clearly interpret the less demonstrable prob- 
 lems to every right thinking mind (§ 234, a-h). The route of the nerv- 
 ous influence among the organic viscera, and even among the voluntary 
 muscles, is often eluding the knife of the anatomist (§ 233|) ; and well 
 may he sometimes despair of success, yet rest in the conviction that Na- 
 ture operates by general laws, when he considers the fact that the Will 
 determines its influence upon whatever voluntary part it chooses, isolat- 
 ing many intermediate nerves, or electing one only and far remote from 
 its own seat of operation. And so he shall equally find it in organic 
 life, where the Passions play their part, at one moment upon the heart, 
 at another upon the skin, or kidneys, or genital organs, or raise the blush 
 of modesty in the capillaries of the face, or strike us dead in an instant ; 
 and he may witness far greater demonstrations of the same principle in 
 the operation of remedial agents (§ 852-888, 894-905). — Note A. 
 
 We draw to a close. If the discussion have been proti-acted, it has 
 been due to the magnitude and the novelty of the subject. We might 
 have rested the demonstration upon the operations of the Mind in its 
 function of willing alone, were there a ready acquiescence in the logic of 
 facts. Through these endless manifestations we almost see the Thinking 
 Being enthroned upon the great centre of the nervous system, wielding 
 at its inexpressible pleasure, and through the instrumentality of its or- 
 gan, that amazing power which as far surpasses electricity in the com- 
 pass and variety of phenomena, as the effulgence of Reason transcends 
 the glimmerings of Instinct. The Will but commands (§ 1072, b), and 
 Reason may be chained for hours to some abstract process, or tumultu- 
 ous passion settles down in tranquil submission. With inconceivable 
 rapidity of action it directs all the muscular movements which form the 
 various feats of dexterity, the flight of animals, and the melody of song. 
 * See § 500 dd, and Article Roosting, Index II.
 
 892 INSTITUTES OF MEDICINE. 
 
 ^nd let us consider, also, as we ponder upon these things, how exactly 
 the mind graduates the force of every muscle which it brings into action, 
 varying through every imaginable degree from the slightest touch to the 
 death-struggle of the combatant (§ 234 c-h, 235). 
 
 Who, then, shall be so unjust to his Keason as to imagine that all this 
 wonderful display of a single function of the Mind is the material prod- 
 uct of chemical mutations of the brain, or of any organic function of 
 that organ, and without a conceivable cause of the cerebral process ! 
 
 DEMONSTRATIOK OF INSTINCT, AND ITS DISTINCTION FROM THE SOUL.* 
 
 § 1078, a. In what I have said in the former part of this work of the 
 distinct nature of the Soul and Instinctive Principle, and of their connec- 
 tion with the main central part of the nervous system, my remarks have 
 referred to their immediate relations to the body, as established through 
 the cerebro-spinal and ganglionic systems (§ 234/, 241, 500, &c.). At 
 section 500, p, the deductions are made from a variety of facts, though 
 not altogether susceptible of direct proof. They involve a critical anal- 
 ysis of the various phenomena of which they are predicated, both in their 
 relations to Reason and to the mere Principle of Instinct. But, however 
 some acts of intellection in man may require the co-operation of the 
 brain more than other mental processes, thei-e can be no doubt that every 
 act of the Mind and of Instinct is the result of an inscrutable concur- 
 rence between the self-acting cause and the organ over which it presides. 
 It may be now said, also, that the brain is subservient to the Soul, inde- 
 pendently of its relations to the body, in all its higher functions, while it 
 manifests no such subserviency in animals ; nor have I any doubt that 
 all the facts warrant the conclusion that the nervous power is as well 
 concerned in the functions of the higher faculties as it demonstrably is 
 in the acts of the Will and the Passions. The instrumentality of the 
 brain in the former case comes through the property of the Soul which 
 is known as j^crception, and to which the senses are subordinate. The 
 same property belongs, also, to animals ; and so far as mere sensation is 
 concerned, or as it may give rise to volition in its simple relation to ani- 
 mal life, the results are apparently the same in man and animals. But 
 it goes no farther in animals, though in man Perception, as resulting from 
 sensation, is the great fulcrum of Reason, and the fountain of intellectual 
 knowledge. But that knowledge garnered up, every avenue to the Mind 
 may be shut, and the harvest of facts remains, and may be now multi- 
 plied, cultivated, embellished by the exercise of Reason alone upon the 
 organ through which the elementary knowledge had come. It may now 
 summon a host of intellectual images, and render them tributary to those 
 abstruse processes by which the laws of the Universe are scanned, and 
 Mind itself analyzed and understood. This is abundantly manifested in 
 the early displays of genius, where knowledge from external sources is 
 just in its dawn. It is fatal to the doctrine of cerebral images. 
 
 But no such phenomena ever marked the highest cultivation of Instinct. 
 It is all Instinct with animals, while this Principle is only feebly shadowed 
 forth in man (§ 241). And this leads me to indicate the most fundamental 
 distinction, in a physiological sense, between the Soul of man and the 
 Instinct of animals ; nor am I aware of any well-founded exception to 
 the distinction which I make. Among the latter, the whole sum of in- 
 stinctive processes is limited exclusively to the ivants and the uses of the bodjj. 
 Whatever may be the fundamental cause, it is in complete operation at 
 
 * See Note at p. 873.
 
 The /Soul. — ^APPENDIX. — Instinct. 893 
 
 the moment of birth, when its dawning has scarcely begun in the human 
 race (§ 241, c). It is as perfect and comprehensive in the Ant as in the 
 Chimpanzee. Each species of animal, and all the individuals respectively, 
 carry out an ordained plan of existence, and this is the compass of their 
 knowledge. From that particular path Instinct never diverges. It has 
 no higher aim in the brute than the mere perpetuity of organic life, and 
 it never operates without manifesting effects, either active or passive, in 
 t/ie mechanism of animal life. That is its grand characteristic, and its 
 broadest contradistinction from the Mind of man. It terminates there ; 
 and Reason, therefore, must prompt the conclusion that the Instinctive 
 Principle perishes with the body. But how different with the Soul, 
 which spans the sciences, rolls up its vast acquisitions through all gener- 
 ations, and sees in itself the "Image of God." All its noblest functions 
 have no relation whatever to the uses of the body. The untutored Savage 
 has all the perfection of life that is enjoyed by a Newton, and greater 
 instinct. He may become a Newton without a gain to his physical 
 wants, but with some loss of his well-disciplined instinct. Here, in the 
 exercise of Reason, all physiological analogies fail, while every impulse 
 of Instinct demonstrates its subordination to physiological laws. When 
 Reason operates, there is no participation of the nerves, as in the case 
 of Instinct, no influences seen upon any part of the organism. We look 
 upon its manifestations as emanating apparently from itself alone. And 
 since there is nothing in the manifestations of the Will when it operates 
 alone in the processes of Reason that denotes any influence upon the 
 animal mechanism, as is always the case in animals, and since, also, 
 that influence is strongly displayed in man Avhen the action of the Will 
 refers to the organs of volition, this distinction between its intellectual 
 and physical functions corresponds exactly with my inductions in regard 
 to the general constitution of the Soul, and the relation which it bears 
 in other aspects to the body. Hence, we may again conclude incident- 
 ally that, by parity of reason as it respects the uses of Instinct, the Soul, 
 which in its highest faculties is useless to the body, will continue to 
 exist without the aid of organic life. And, if I may deviate, for a mo- 
 ment, from my physiological ground, to final causes of a moral nature, 
 I would refer to the manifest design of animals for the husaan race, as 
 a farther proof of their absolute extinction when those ends are fulfilled ; 
 and, on the other hand, to the noble and sublime objects of man in his 
 no less obvious companionship with God, as equally conclusive of the 
 perpetuity of his being. 
 
 Nevertheless, the analogies between the Soul and the Principle of In- 
 stinct are such (§241, b), that if one be a distinct, substantive, self-acting 
 agent, so must be the other. But their great practical final causes, inde- 
 pendently of our other facts, are broad, fundamental distinctions between 
 them ; nor have these distinctions, within my knowledge, been hitherto 
 indicated. It is only, however, a display of the common law of analogies 
 which prevails throughout organic nature. The coincidences and distinc- 
 tion between Reason and Instinct are far less remarkable than the cor- 
 responding analogies and distinctions which are supplied by organic life 
 in its greatest extremes ; for there is not a single organic function of a 
 comprehensive nature performed by man that is not equally so by the 
 lowest plant. With greater reason, therefore, should we argue the iden- 
 tity of Man and Plants than of the Soul and Instinct* (See JVoie p. 873). 
 
 * As an example of the assumptions and sophistrj- of those who reject the Soul, take
 
 894 INSTITUTES OF MEDICINE. 
 
 § 1078, h. I am finally conducted to other and still more definite con- 
 tradistinctions between the Soul and the Instinctive Principle, and where 
 it Avill probably appear, also, that the brain co-operates less in the higher 
 acts of intellection than has been commonly supposed. But the Mind, 
 in all its functions, is not only more or less dependent upon its associate 
 organ, but the influences which it is capable of exerting upon it in con- 
 sequence, and thence upon the whole organism, are among the facts 
 which foi'm a broad distinction between the Soul and the Instinctive 
 Principle. Nor can it be doubted that the full exercise of the Mental 
 Faculties, as well as of Instinct, requires, in a general sense, a natural 
 condition of the brain or its equivalent ; and the greatest displays of the 
 former are apt to be seen where the organ is developed beyond the com- 
 mon standard. To these general facts, however, there are important 
 exceptions, several examples of which, as arising from organic disease 
 and injuries, may be seen in Medical and Physiological Commentaries, vol. ii., 
 p. 139, note. Equally true is it, also, that, from the co-operation of the 
 Soul and the brain in the processes of Reason, excessive exercise of the 
 Mind is felt injuriously in the organs of organic life, and too often per- 
 manently felt. The proper development of the brain is, also, arrested ; 
 and thus, in its turn, the Mind suffers a corresponding injury. Our gen- 
 eral premises lead to this conclusion, and our primary schools confirm 
 the principle in a lamentable amount of broken constitutions and smoth- 
 ered intellect. This, too, is one of our evidences of the substantive, self- 
 acting nature of the Soul ; and although the Instinctive Principle is 
 equally self-acting, we here come upon the remarkable distinction that 
 nothing like the foregoing has ever been witnessed from the severest dis- 
 cipline of Instinct. The Soul alone supplies these phenomena ; and, from 
 its incessant operation in undermining health, or disturbing the natural 
 action of the organic viscera, it must be regarded as separating the Soul 
 and Instinct widely from each other. — Note Hh p. 1138. 
 
 And this leads us to observe another and greater distinction ; for, 
 while the development of the Mental Faculties is retarded by overtask- 
 ing the Mind in early life, just the contrary effect obtains in animals. 
 By untiring zeal, and the lash of instruction, Instinct is often suscepti- 
 ble of influences in the infancy of animals, and only then; but here, again, 
 it is just the reverse with Reason in the infancy of man. This distinc- 
 tion is also of a radical nature when compared with the improvements 
 of Reason at later periods of life ; for what has been supposed to be a 
 
 the following, from the '''■Lectures on Physiology,'^ bj' the able and eminent Mr. Law- 
 rence : 
 
 "If the intellectual phenomena of man require an immaterial principle superadded 
 to the brain, we must equallj' concede it to those more rational animals which exhibit 
 manifestations differing from some of the human famih' onh' in degree. If we grant it 
 to these, we cannot refuse it to the next in order, and "so on in succession to the whole 
 series — to the oj'ster, the sea-anemone, the polypi, the microscopic animalcules. Is any 
 one prepared to admit the existence of immaterial principles in all these cases? If not, 
 he must cquallj' reject it in man." 
 
 This argument is often staring us in the face, and it is quite time that it should be 
 silenced, although "prepared to admit the existence of immaterial principles in all the 
 cases." But, waiving the assumptions upon which the conclusions are founded, it is evi- 
 dent that the analog}' fails as soon as we reach those animals which exhibit no rational 
 manifestations. So Ihe argument falls upon its own ground. Nor is that all ; for, as in 
 most cases where an author is at fault about principles, Mr. Lawrence contradicts him- 
 self. Thus, in another place he sa^-s that 
 
 "Although the external senses of brute animals are not inferior to our own, and though 
 we should allow some of them to possess a faint datcning of comparison, reflection, and 
 judgment, it is certain that they are unable to form that association of ideas in which alone 
 the essence of thought consists."
 
 The . Soul. — ^APPENDIX. — Instinct. 895 
 
 " cultivation of Instinct" is, in reality, no such thing, since it subserves 
 no useful purpose, and manifests itself only under the special influences, 
 respectively, by which the several impressions were originally produced. 
 The " tricks," &c., of the animal, whenever there is a deviation from the 
 natural operation of Instinct, require suggestions from the associate causes. 
 Unlike the improvements of the Rational Faculty, the artificial conditions 
 of Instinct do not operate without the excitements of the primary causes, 
 or their equivalents, and then always in exact conformity with the nature 
 of the external cause. In other words (for the distinction is important). 
 Reason acts independently of remote causes ; the artificial conditions of 
 Instinct require the agency of such causes to bring them into renewed 
 manifestations. In the former case the senses may not be interested ; in 
 the latter, impressions must always be made upon sense (as in seeing and 
 hearing), and transmitted to the brain, or some equivalent nervous cen- 
 tre, when Instinct will operate in an automatic manner.* It is only a 
 display of those low analogies between Instinct and the Soul to which I 
 have referred. Imitation, in a higher sense, as seen in parrot-talking, 
 belongs to the same principle. But in these cases it is more constitu- 
 tional, on account of the natural prating of the bird. It thus becomes 
 ingrafted upon its notes, and will therefore display itself as an offspring 
 of nature, and as a matter of habit, and without any extraneous prompt- 
 ing. What is thus acquired from man by the parrot and magpie, and 
 which has been supposed, even by Mr. Locke, to evince a Rational Fac- 
 ulty, is derived by other birds from other songsters, particularly by the 
 American mocking-bird and cat-bird, who appropi-iate the notes of many 
 other warblers. Now, there is nothing more in parrot-talking than in 
 these last examples, and the latter is just as much an evidence of a 
 rational faculty as the former. The examples go towards the illustra- 
 tion of our subject in showing how Instinct is adapted to the peculiari- 
 ties of organization in different animals, while man, through his Rational 
 Faculties, may originate an endless variety of vocal music, and construct 
 languages for himself (§ 241, b). 
 
 § 1078, c. Even the promptings of Instinct, which impel animals to 
 search after food, whether for present or future use, have their origin in 
 present sensations. What is prospective in this respect is just as impul- 
 sive as migration, and as little allied to the course of Reason. The 
 same physiological influences of hunger, in regard to immediate wants, 
 operate in the infiincy of man, though with none of that discrimination 
 which distinguishes the infant animal ; for the human infant will as 
 readily suck at all things else as at the breast. Its apparent instinctive 
 impulses go no farther than the movement of the mouth ; and that is all 
 the display of instinct it evinces, unless farther shown by its cries Avhen 
 hunger is unappeased. 
 
 Again : as soon as Reason obtains its development, it displays an end- 
 less variety of inventions for the sustenance of life, which are wholly irre- 
 spective of associations with the original physiological incitements, but 
 which must'be forever a recurring cause to the animal. Whatever simili- 
 tude may seem to exist between the acts of Reason and the acts of In- 
 stinct in procuring food, or in providing for the future, organic influ- 
 ences are interested in the latter as often as hunger returns ; and, so far 
 as the processes are dependent in animals upon the inscrutable constitu- 
 tion of Instinct, they are contradistinguished from all the analogous man- 
 ifestations in man by their undeviating uniformity in animals, and ac- 
 
 * Rare5''s sj'stem of horse -taming is a comprehensive illustration of the principle. All 
 horses j'ield at once, and alike, to the foot-strap, as would a machine. — 1861.
 
 896 INSTITUTES OF MEDICINE. 
 
 cording, also, to the species of animals, while, also, all the individuals of 
 a species pursue a common and uniform way. Thus, many species lay 
 wait to entrap their food, and although variously according to the na- 
 ture of the species, all the individuals of a species act exactly in a certain 
 way, while others pursue a different course, and neither takes forecast be- 
 yond the present sensation of hunger ; while in some species which sub- 
 sist on vegetable food, the principle operates seemingly after the sagacious 
 manner of Reason in providing for their future wants. 
 
 § 1078, d. And here we come upon another, and very broad distinc- 
 tion between the Soul and Instinctive Principle ; for, as admitted by all, 
 the greater the development of the brain in man, so, in a general sense, 
 are the manifestations of Eeason, and therefore a forecast in animals 
 in laying up food, if at all allied to Reason, should predominate in those 
 which have the greatest amount of brain ; and here, if in any respect, 
 there should be the greatest display of Reason. But it is just otherwise 
 with all the superior animals, who take no thought for the morrow, what 
 they shall eat ; while in the bee and ant, where there are only ganglia 
 for the nervous centres, there is an anticipation of the future in providing 
 for the young which surpasses any thing known of the human race. 
 What variety, too, in the structures which they rear for their progeny, 
 according to the particular species in each genus, but always the same 
 with each species. And then the food — just as methodically of a precise 
 kind as the act of providing it. The whole history of the instinctive acts 
 of the elephant or the lion may be written in an hour ; but Huber found 
 a good-sized book necessary for the amazing operations of the common 
 honey-bee. He described the doings of a hive, and that description tells 
 the precise history of all past and of all future hives. The diversified 
 acts of this insect, and according as it may be queen, male, or drone, seem 
 like the complex movements of some elaborate machinery, which, when 
 wound up, runs on in one precise way till it runs down. And still more 
 estranged from Reason, and utterly beyond its grasp, is the return of the 
 bee to its hive through miles of trackless air, and the unerring flight 
 of the carrier pigeon ; nor are any of the higher animals capable of this 
 amazing achievement, which, also, grows immediately out of the physio- 
 logical arrangements for acquiring food. 
 
 § 1078, e. The correspondence between the peculiarities of Instinct 
 and the mechanism in animal and organic life is so remarkably full and 
 pex'fect in its design, and so unlike any of the manifestations of the Hu- 
 man Mind in their connection with the organs and functions of either 
 division of life, that a glance at the former will contribute farther aid in 
 distinguishing the Soul from the Instinctive Principle, and in proving 
 the absolute existence of Instinct as a distinct essence of the brute crea- 
 tion. If we may any where detect the Rational Faculty among ani- 
 mals, it should be found in the phenomena that are relative to their 
 means and modes of subsistence. 
 
 Now it will be found that, in eveiy species of animal, the promptings, 
 of Instinct in the pursuit of food have a direct relation to the peculiari- 
 ties that exist in the organization of the stomach, and the modifications 
 of the special endowments of the gastric juice in each of the species (as 
 set forth in section 353), by which one species is enabled to convert flesh, 
 another nuts, another hay, &c., into one homogeneous substance called 
 chyme, and which, from man to the lowest tribes of warm-blooded ani- 
 mals, at least, is apparently alike in all, whatever the nature and the
 
 The Soul. — APPENDIX. — Instinct. 897 
 
 variety of the food. But the agreement between man and animals is 
 limited to that result in its connection with the digestive apparatus, and 
 as it relates to the maintenance of organic life. What is true of the 
 precise adaptations of Instinct to the organic conditions, and its invaria- 
 ble operation in one way, according to the nature of the animal, is in no 
 way true of the Human Mind ; for the latter operates, in this respect, 
 according to acts which involve the exercise of judgment, reflection, com- 
 parison, t&c, and very variously, also, according to individual suggestions 
 of Reason, Passion, love of sensual gratifications, the exigencies of dis- 
 ease, &c. 
 
 Since, therefore. Instinct has its special constitution conforming to the 
 organization of the stomach and the peculiarities of the gastric juice, we 
 shall see how far it is related in its peculiarities to other varieties in the 
 mechanism of organic life, by considering how all these varieties in every 
 species, respectively, have an equally direct reference as the peculiarities 
 of Instinct, to the special organization of the stomach, and special con- 
 stitution of the gastx'ic juice. If, therefore, such be the relation of the 
 whole mechanism of animals, both organic and animal, to the special 
 condition of the stomach and gastric juice in their adaptations to the 
 varieties of food in the several species, it is obvious that Instinct in all 
 the species, respectively, must be constituted with a corresponding refer- 
 ence to every part of the organic whole. Now, an intestine, claw, hoof, 
 tooth, or any bone of an unknown animal being given, we may construct 
 a skeleton, say from the bone, that shall be true to nature in all its parts. 
 We may thus proceed to cover it with muscles, provide it with claws or 
 hoofs, and special kinds of teeth, «&;c., and, lastly, we can tell from that 
 tooth, or claw, or hoof, or other bone, what was the structure of the di- 
 gestive apparatus, and to what kind of food the gastric juice was specif- 
 ically adapted, and what were the peculiar Instinct and habits of the 
 animal ; so special is the adaptation of all other parts of the organism, 
 both in animal and organic life, to the peculiarities of the stomach in 
 every species, and so exactly conformable are the Instincts and habits of 
 animals to all that vast range of physical peculiarities in the several 
 species respectively. 
 
 The foregoing is also true of man as it relates to organization. But 
 who could surmise from any part, or from the whole of his organism, 
 that he is endowed with Rational Faculties, or with any thing more 
 than what is common to brute animals ? Here begins, abruptly, a total 
 distinction between man and animals — nothing whatever in the mechan- 
 ism of either to denote the ending of one or the beginning of the other. 
 Nothing, indeed, but analogy, founded upon observation, enables us to 
 affirm with certainty the same principles of extinct species of animals. 
 Nothing but observation informs us of either the physical or mental func- 
 tions ; for neither could have been deduced from structure alone. And 
 yet analogy is so perfect a guide where the continuity of the chain is 
 unbroken, that no error can arise in scanning the Designs of Infinite 
 Wisdom, so far as they are submitted to human inquiry. But analogy 
 in relation to Instinct snaps in man. This might render it difficult, if 
 not impossible, to know the great fact, had all the species of quadruma- 
 nous animals become extinct before man began his observations in nat- 
 ural history. The subsequent discovery of the skeleton of a chimpanzee 
 would doubtless have been regarded as an unanswerable proof that there 
 had been, at least, other beings upon earth besides the human race who 
 
 L L L
 
 898 INSTITUTES OF MEDICINE. 
 
 had enjoyed the prerogatives of Reason, and so a descending analogy 
 imagined down to the polypi.* But, the chimpanzee is a thousand times 
 less endowed with Instinct than the honey-bee ; and we have seen that 
 the sense of instinctive promptings throughout all animal tribes is con- 
 cerned about objects which Reason regards as only tributary to those 
 immeasurably higher occupations of the Soul which have no relation 
 whatever to those of the Instinctive Principle. — Note Pp p. 1142. 
 
 § 1078,/. However the foregoing branch of our inquiry (§ 1078, e) 
 may be pursued, it will always result in the same uniform way. Con- 
 sider, for example, the correspondence between the Instincts of animals 
 and their weapons of offence and defence ; each species of animals, and 
 all the individuals of a species, acting defensively or offensively accord- 
 ing to the special weapons with which they are provided. These means 
 of preservation have a direct reference to organic life, and Instinct, there- 
 fore, is adapted to the nature of the means. The various provisions are 
 not only such as are actively employed, both for the purpose of procuring 
 food and for self-preservation, like the weapon of the sword-fish, claws, 
 the poison of serpents, &c., but others for the simple object of self-pro- 
 tection, such as horns, the quills of the porcupine, the armour of the 
 rhinoceros, the sting of bees, the galvanism of the electrical eel, the ink 
 of the cuttle-fish, &c. Again, certain animals, and many of them of 
 inferior orders, as some species of cockroaches, some of worms, often af- 
 fect the appearance of death when closely pursued ; and when this is 
 seen in one animal, it is, as in the preceding cases, common to all the 
 individuals of the species. Many other animals that keep near the 
 ground are protected by their colour, and the animal, when alarmed, lies 
 close. In all the cases there is a manifest unity of designs which con- 
 spire together for the well-being of organic life. "Whatever may be the 
 means of defence, of offence, of flight, or of whatever variety or modifi- 
 cation, they are adapted to all the mechanism in animal life, to special 
 sensation, &c., and according to the whole will be the special prompt- 
 ings of Instinct. — Note C p. 1113. 
 
 § 1078, g. Fear, therefore, operates in animals impulsively, while in 
 man it is the result of judgment, reflection, comparison, and his modes 
 of defence are suggested accordingly. Observe, also, another fact rela- 
 tive to fear, which equally separates Instinct from the Soul. The young 
 animal will turn from danger about as impulsively as the adult, while 
 the human infant will thrust its hand into the blaze of a candle sooner 
 than it will seize the nourishment that is simultaneously offered. In ani- 
 mals, indeed, the most exquisite sensitiveness to danger prevails, transcend- 
 ing even the promptings of hunger. Its predominance is designed alone 
 for the preservation of organic life, and such are their exposures, and so 
 limited their conceptions, that it is made to operate with great uniform- 
 ity and instantaneousness. In man, on the contrary, its impulses are 
 comparatively feeble and slow, and so far as it obtains, it aims at a va- 
 riety of objects which are determined by the decisions of Reason. The 
 principle, in animals, is evidently allied to that characteristic Avhich di- 
 rects their migrations, and the homeward flight of the bee. 
 
 The manifest dependence, in man, of a sense of danger, and his expe- 
 dients for self- protect! on, upon the Rational Faculties, has led to compar- 
 isons of certain Instinctive perceptions of danger in animals, with a view 
 to the identity of Instinct and Reason, of which one of the strongest is 
 often seen in the elephant on crossing a bridge, or embarking on a steam- 
 
 * Who will doubt this, now that the much-lauded work of Darwin On the Origin of 
 Soecies has made its apoearance? See d. 814. 7iote. — 1860.
 
 The Soul. — APPENDIX. — Instinct. 899 
 
 boat, as he first presses the bridge or the boat with a single foot to learn 
 their stability. But this example is peculiarly adapted to our purpose, 
 since Instinct is here constituted with a reference to the weight of the 
 animal, who would be otherwise exposed to frequent injuries; and the 
 associations that are indispensable to safety are early formed. But they 
 go no farther, and this particular demonsti-ation is seen only in animals 
 that may break a bridge or sink a boat. It is, therefore, only an instance 
 of the ordinary impulsive associations which are always in operation in 
 cases of danger, and is exactly similar to the careful tread of the smooth- 
 shod horse when about stepping upon ice, or the wariness of the fox and 
 the rat in eluding the trap, or the various expedients of the squirrel in 
 dodging the sportsman, or the cautious nibble of the fish, &c. The va- 
 rieties in these examples are almost as great as the species of animals, 
 and they all belong to the exquisite intuitive principle which warns them 
 of approaching danger. It is often seen, indeed, in the aspect of mutual 
 protection among animals of the same species, when it always operates 
 according to the nature of the species. The crow has his sentinel, and 
 the affi'ighted ant communicates its alarm by a peculiar touch of its 
 companion, which spreads with rapidity from one to another, till the 
 whole hive is quickly thrown into this paroxysmal movement. And 
 now, if this analysis be pursued through an obvious series of analogies, 
 it will be found that the habits of bees in relation to their queen, and 
 many other remarkable problems in the history of Instinct, are flllied to 
 the principle which I have just considered. 
 
 § 1078, h. Another shade of difference in the general principle occurs 
 in an example which has been presented by Metaphysicians to illustrate 
 the supposed identity of Instinct and Reason. It is that of a dog, Avho 
 has appeared, when making for a drifting boat, to lay out the plan of 
 first ascending the bank of a stream above the boat, that the distance 
 between himself and the object may compensate for the motion of the 
 water, which would otherwise carry him below his destination. I pre- 
 sent the example in its strongest light, and as implying all that can be 
 surmised of a rational process in animals. But, with all instances of a 
 similar nature, it falls within the common laws of the Instinctive Princi- 
 ple, which are just so far operative, according to the species of animal, 
 as shall subserve the exigencies of life. In the case of the dog, this ani- 
 mal is more or less addicted to the water (especially the individual in 
 question), and his Instinct is therefore adapted to the emergencies that 
 may attend that temporary mode of life. He early acquires, in conse- 
 quence, an impulsive apprehension of the effects of strong currents of 
 water, and is so far capable of forming associations as may be necessary 
 to his safety, or to his natural wants. The instance of the boat is one 
 of safety and of want, and is exactly parallel with that where all dogs 
 will elect a bridge of 500 feet in preference to swimming the width of a 
 dozen. The knowledge of the effects of a current of water exceeds but 
 little that of its quality of wetting ; and when, therefore, a dog is moved 
 by the desire of bathing, he neglects the bridge and takes to the water. 
 
 Various prejudices and misapprehensions relative to supposed instinct- 
 ive acts abound in the community, who are prone to the most favourable 
 comparison of the brute with his lordly associate. The rarity of appa- 
 rent evidences of Reason in brutes, and the enjoyment of what is thus 
 unexpected and wonderful, lead the multitude to seize upon what is ac- 
 cidental and carry it to the account of Instinct. An example of this,
 
 900 INSTITUTES OF MEDICINE. 
 
 which has often gone the round of the public, is that of the elephant and 
 the apple, where the tempting morsel, being just beyond the grasping 
 range of the animal's trunk, was made, by a forcible projectile blow, to 
 rebound within its reach from an opposite wall. This has been thought 
 to be but little inferior to a game at billiards. But it was simply an 
 act of irritation, the blow being designed in the same resentment as 
 when an angry man loses all reason and castigates a stone that has 
 caused him an injury.;— Note P p. 1121. 
 
 § 1078, i The Speculatist points to the care with which animals pro- 
 vide for their young, and the great resemblance between them and man 
 in parental attachments, as an evidence of the supposed identity of Rea- 
 son and Instinct. But I answer that this is much more seeming than 
 real, and that however the principle may have an ultimate reference to 
 the well-being of organic life in the infancy of man, it embraces in him 
 far loftier objects, and prompts to an endless variety of useful purposes 
 in the care of his progeny which have not the least connection with the 
 exigencies of life, but which, on the contrary, are relative to the culture, 
 the enjoyments, the morality, the Religion, the eternal welfare of the 
 Spiritual part. It follows them through all the stages and vicissitudes 
 of life, rejoices in their happiness, and grieves for their adversities. 
 When intercourse fails, every expedient is devised, from the tardy mes- 
 senger to the electric telegraph, to impart renewed expressions of affec- 
 tion, and fresh hopes of prosperity. And how is it on the part of the 
 offspring? Does not every heart beat responsively to the Divine com- 
 mand to " honour thy father and thy mother "?" And can there be a 
 broader distinction between the attachments of animals and of mankind 
 than what Scripture implies and what man pursues 1 The very attach- 
 ments which man contracts for favourite animals flow from the Divine 
 sentiment which is impressed upon his Soul. And then all that display 
 of sympathy and friendship among companions of mutual thoughts, or of 
 heartfelt kindness towards the faithful and trusty servant, or the univer- 
 sal characteristic known as the sentiment of humanity — where, I say, 
 shall we look for the dawning of these mental attributes in the constitu- 
 tion of Instinct ? And wherein are the instinctive movements of ani- 
 mals towards their offspring related to human affections? Simply for 
 the preservation of life, and thus incidentally for the perpetuation of the 
 species, as conclusively shown by the total and abrupt disappearance of 
 brute attachments as soon as the offspring can provide for and protect 
 themselves, and this, too, at ordained times according to the species of 
 animal. Nay more ; parents and offspring mutually abandon each other 
 at allotted times, and turn upon each other. The principle is seen in 
 full operation, and in its largest extent, in the bird while hatching her 
 eggs. She may be in expectation, though she may have had no more 
 experience in the final result than the bee on its return after its first 
 wandering from the hive ; nor is there any more similitude with the ope- 
 rations of reason in the one case than the other ; she will as readily sit 
 upon counterfeit eggs as her own till her time of " reckoning" is up, and 
 then abandon them. 
 
 § 1078, ^•. The same distinction (§ 1078, i) exists between the love of 
 the sexes in the human race and what is observed of the sexual rela- 
 tions in the brute creation, and is not less opposed than our other facts 
 to the assumed identity of Reason and Instinct. Like all else in relation 
 to the latter, the impulse is totally restricted to the perpetuation of or-
 
 The Soul. — APPENDIX. — Instinct. 901 
 
 ganic life. In the human species the same impulse is as a spark in a 
 blaze of fire. The principle of love takes in its scope the loftiest senti- 
 ments of Mind, and anticipates all the intellectual endearments of domes- 
 tic society, and yields a grateful tribute to its munificent Author. If 
 there be a low analogy, it is of the lowest grade, and is nearly lost in the 
 sublimity of its intellectual accompaniments. Nor can there be a paral- 
 lel suggested between Reason and Instinct more degrading to man, or 
 more unjust to his Maker, or more characteristic of a perverted mind, 
 than that which is so often drawn in respect to human and brute affec- 
 tions. Yet he who makes it has a better opinion of himself, and only 
 thinks so of the rest of his race. 
 
 § 1078, I. And this leads me to speak of the very remarkable distinc- 
 tion between the Soul and Instinctive Principle known as Conscience. I 
 employ the term in its popular acceptation, as meaning the ability and 
 the impulse of man to decide on the lawfulness or unlawfulness of his 
 own actions and affections, and to instantly approve or condemn them 
 according to their nature. Nothing like this has ever been observed in 
 animals. It is purely intellectual, and has a clear reference to the moral, 
 Religious, and social condition of the human race. It may be said, how- 
 ever, to be apparent in some animals, as when the dog, for example, mani- 
 fests a sense of wrong when he surprises the game in a manner opposed 
 to his instruction, or does other analogous acts. But this manifestation 
 happens only under the influence of those physical causes which led him 
 to act more habitually in a different manner. The sense of wrong does 
 not originate from the act, or on account of the act, but is excited by 
 the presence of his master, whom he associates with the suffering which 
 he endured when his Instinct was undergoing discipline, and thus re- 
 solves itself into a dread of punishment. It is therefore exactly analo- 
 gous to all the other functions of Instinct which I have indicated, and 
 forms the limit of associations of which animals are capable. — Note P. 
 
 § 1078, m. And what shall be said of that other principle, scarcely 
 less universal and impulsive than conscience — a love of Fame and a de- 
 sire to live in the memory of posterity ? The question becomes ridicu- 
 lous in its application to animals, and is hardly less so, in an abstract 
 sense, as it relates to man. But, as an incentive to laudable action, it is 
 a noble offspring of Reason, and as significant of the Soul's immortality 
 it rises into sublimity. 
 
 § 1078, n. And what of Religion ? What of the universal desire of 
 immortality ? What of a sense of dependence upon a Superior Being ? 
 It may be safely affirmed that animals have no other knowledge of their 
 own existence than what ax'ises from present sensations ; and should a 
 chimpanzee be seen bowing even to an idol, it would be a greater phe- 
 nomenon than the expostulation of Balaam's ass. 
 
 § 1078, 0. Even memorjj, as it belongs to animals, is nothing but an 
 association awakened by some present impression upon the senses. It is 
 indispensable, however, to many of their wants and habits, and hence is 
 so strongly pronounced in many species that they will recognize objects 
 after a separation for long intervals of time, particularly where strong 
 impressions had been made, as between the dog and his master, and wild 
 beasts and their former keepers. In man, on the contrary, memory is 
 often relative alone to acquirements which the mind has made through 
 its own processes of reflection, and they may be as vast and profound as 
 the elaborate inductions which led to the discovery of the universal law
 
 902 INSTITUTES OF MEDICINE. 
 
 of gravitation, and thence to the calculation of the existence of the planet 
 Neptune. Nor does memory, in man, require any extraneous aid, like the 
 apparently corresponding function in animals. It is a rational function 
 in one, independent of sense ; an instinctive one in the other, and depend- 
 ent upon sense. In one, it always involves an exercise of Reason, and 
 often a vast complexity of ideas ; in the other, it is simply relative to the 
 single impression which had been transmitted to the brain by some ex- 
 ternal cause, and which can be recalled only by renewed applications of 
 the same or analogous causes.* By extending the analysis in this man- 
 ner, it will be seen that it is all Soul in man, and all Instinct in animals. 
 
 § 1078, p. But the most curious problem in the history of Instinct is 
 its natural mutations in certain animals, and which carry with them an 
 abundant proof of the radical distinctions between that Principle and the 
 Soul, and that the former is designed for the mere purposes of organic 
 life. I shall therefore give to the subject a greater consideration than 
 would be otherwise expedient. 
 
 This characteristic is seen, especially, in animals that are subject to 
 metamorphosis, though in many of the instances the changes of organiza- 
 tion and the modifications of Instinct are far gi-eater than in others. The 
 strongest examples occur in insects, a large proportion of which have four 
 stages of existence : the egg, the larva, the puj^a, and the imago, with 
 corresponding instinctive habits in the last three. Where the metamor- 
 phoses are most remarkable, as in the foregoing examples, some of the 
 organs undergo mutations that require a change in the stimuli of life 
 which could not be realized without corresponding adaptations of In- 
 stinct. This is also more conspicuously illustrated by the difference in 
 the Avants and habits of those animals which at one period breathe in 
 the v/ater with gills, or analogous organs, and subsequently in the air 
 with lungs. 
 
 Now these metamorphoses are as much the exact result of determinate 
 laws, ingrafted upon an original constitution of life, as the development 
 of the human ovum, or the seed of a plant ; nor are they in any respect 
 more fluctuating or less circumscribed (§ 72, 1051) ; and so a correspond- 
 ing law obtains in respect to Instinct, through Avhich the promptings of 
 Instinct shall harmonize with those modifications of organic life that dis- 
 tinguish the several stages of metamorphosis. In all the cases, from the 
 plant to the insect, and fl'om the insect to man, the metamorphoses or 
 other developments, and modifications of life, take place in one uniform 
 way, according to the species of animal or plant. A potential whole, 
 embracing all the special conditions necessary to the progressive changes 
 from the ovum, through the larva and pupa to the fly, and in all analo- 
 gous instances, is as perfect in the most mutable tribes as in the ova of 
 the highest order of animals, or in the seeds of plants ; and, since there 
 can be no departure from a precise and uniform succession of develop- 
 ments in any of the species, I'espectively, we also learn that there is no 
 transmutation of species, nor even an introduction of varieties (§ 1051, 
 jmmordial cell). — Note Pp p. 1142. 
 
 In respect to the various physical agents required by animals subject 
 to metamorphosis, according to their several stages, the principle is alike 
 ingrafted upon the ovum, and equally so in the case of man, by which 
 his development is started by one kind of vital stimulus, and is farther 
 conducted through foetal life by another kind, while a variety obtain af- 
 ter independent life begins. It is a metamorphosis in all (§ 63-81). 
 
 * NoTK Hh p. 1138.
 
 The Soul. — APPENDIX. — Instinct. 903 
 
 This brings us to the particular application of our subject, the simple 
 subserviency of Instinct to the exigencies of organic life. Here it is, in 
 the well-marked metamorphic animals, that it is distinctly seen that all 
 its modifications keep \)a,ce, pari jyassii, with, the changes of organization, 
 and that the law is exactly coincident with that which respects the 
 changes of structure, and is designed alone to fulfil the necessities of the 
 latter. They equally spring from a common principle of mutation im- 
 planted in the germ. 
 
 § 1078, q. There remains to be considered the comparative independ- 
 ence of the Soul in the exercise of its highest functions ; when, also, cer- 
 tain anatomical facts between man and animals will be reviewed for the 
 purpose of contrasting them in yet other relations to the Soul and Instinct. 
 
 Although there be a co-operation of the brain with the Soul in all 
 acts of intellection, it does not follow from what has been said that the 
 Rational may not act in greater independence of the organ than the In- 
 stinctive faculty. Just otherwise, indeed ; for my argument to this ef- 
 fect is founded, in part, upon the distinctions which I have indicated be- 
 tween the Soul and Instinct, and upon what I am about to say of the 
 general coincidence between the brain of man and of the higiicst or- 
 ders of animals, though an opposite conclusion has been deduced from 
 this relation. But the inference as to the equal dependence of the oper- 
 ations of the Soul and Instinct upon a concurrent action of the brain or 
 its equivalent has also depended upon a neglect of the distinction in their 
 attributes, or an assumption that there is no difference. The analogy 
 in such a case would be sound and conclusive so far as it respects man 
 and the approximate animals. But our premises are indisputable, that 
 all the higher acts of intellection, everything which falls within the 
 province of Reason, have no existence in animals. It is the only thing, 
 indeed, which essentially distinguishes man from the brute, and would 
 be in itself conclusive against the somewhat prevailing doctrine that man 
 was once a member of the quadrumanous race. We have also seen that 
 Instinct is more comprehensive in many insects where a ganglion takes 
 the place of a brain, and far more allied in its operations to the plans 
 of Reason, than in the highest order of animals, and is often as mature 
 in the new-born as in the adult being ; and since, also, the organization 
 of the brain of the higher animals is greatly like that of man, but with- 
 out any of his intellectual functions, we must logically conclude that 
 what is so absolutely peculiar to the Soul, and, as generally granted, 
 allied to God Himself, acts in greater independence of the brain than 
 does simple Instinct. But, so inscrutable are its connections, as well 
 as those of Instinct, with the organ in which it resides, that I shall not 
 trespass beyond the limits which are prescribed by observation. Our 
 facts terminate abruptly at this point, and mystery begins. But we may 
 pursue the facts, and reason upon them as upon the most tangible evi- 
 dence. We will therefore interrogate other proof in support of my con- 
 clusions. — Notes Pp p. 1142, Qq p. 1145. 
 
 We have seen that every variety of cerebral structure, from its approx- 
 imation to man's in the higher animals to its disappearance in a scarcely 
 appreciable ganglion in the lower tribes, is attended throughout with un- 
 deviating and perfect manifestations of Instinct, though according to the 
 nature of the animal, while they are only dimly seen in the human spe- 
 cies. This, in respect to Instinct, is conformable with all analogy as it 
 regards other organs where the results depend upon anatomical structure
 
 904 INSTITUTES OF MEDICINE. 
 
 acting through the principle of Organic Life. There is every variety, 
 for example, in the organization of the liver, from its greatest elabora- 
 tion in man and the higher animals until we meet with it in the lower 
 orders as a bundle of tubes or a simple sac. Yet in all it generates a 
 product which is nearly the same, and which performs the same office 
 throughout. And so of the kidneys, salivary glands, stomach, &c. 
 
 So far the analogy is complete between Instinct and its organ and the 
 Principle of Life and all parts of the body which that Principle animates. 
 But Instinct, as we have seen (§ 1076, a-c), must not, therefore, be con- 
 founded with organic products. The analogy, indeed, goes Avith our 
 other facts in showing that it is the cause of certain results through the 
 instrumentality of the brain, or its equivalent, and the nervous system, 
 as the Principle of Life is the cause of other results in and through that 
 same system of organs and every other variety of structure. . 
 
 Coming to the brain of man, the foregoing analogy totally fails as it 
 respects the manifestations of Reason and Instinct. There is an endless 
 variety of the former, but scarcely a real exhibition of the latter. We 
 see all in the structure of the fully developed animal brain that can be 
 detected in the human, or with only the modifications that are incident 
 to approximate species, but a perfect blank as it respects the Rational 
 Faculties. The analogy, however, is complete in man's so far as the 
 brain subserves all that Instinct can discharge among the animal tribes, 
 and all that is relative to the latter in the contributions which the nerv- 
 ous system makes to organic life. The only difference here is the substi- 
 tution of the Intellectual for the Instinctive functions; and whatever re- 
 lates to the manifestations of Instinct, and all the influence of the passions 
 upon the organs of organic life, are demonstrative of the co-operation 
 of the brain with the Soul. But the moment we leave this ground, and 
 approach the abstract operations of the higher faculties of the Soul, there 
 is very little direct indication that the brain has any functional con- 
 nection with the processes, however much its integrity may be nec- 
 essary; and the only foundation for the conclusion that such con- 
 nection exists are the results of sensation and the analogy supplied 
 by Reason in its exercise of the voluntary and other Instinctive 
 functions of animals (§ 1078 «, &c.). 
 
 Again : we have seen that in the infancy of man the Mind is inoper- 
 ative, Avhile the Instinctive Principle of animals is nearly as active and 
 comprehensive in their earliest as in their latest stage of existence. We 
 have also seen that Instinct is susceptible of artificial impressions, resem- 
 bling education, in the infancy of animals, and only then. This distinc- 
 tion can proceed only from a radical difference between the Soul and 
 Instinct ; and the attendant final causes of that difference consist in the 
 special design of the Soul for Rational functions when tlie body is suffi- 
 ciently mature for any practical purposes, and of Instinct for the simple 
 uses of the body. The necessity of Instinct, it may be farther said, is 
 superseded in man not only by the endowments of Reason when it comes 
 into individual operation, but by its delegated offices before its develop- 
 ment takes place, while no such protective care, as a general fact, can 
 be extended by the Instinctive Principle to the new-born animal. Hence, 
 therefore, as there are no superfluities in Nature, Instinct is in full op- 
 eration at the birth of animals, when there is no display of it in the hu- 
 man race, nor is the Soul only slowly developed in its Rational faculties. 
 And thus do the physiological facts, the manifestations of Reason and 
 of Instinct, and the final causes concur together.
 
 The Soul. — APPENDIX. — Instinct. 905 
 
 And now comes up the remarkable anatomical fact, which goes also 
 to the same conclusions (although supposed to be in opposition to them), 
 that Instinctive acts are irrespective of the progressive stages of cere- 
 bral development, while those of the Human Mind await that develop- 
 ment. This corresponds, in respect to animals, exactly with what we 
 know of the general maturity of the functions of all other parts at all 
 stages of life, and with what we have seen of the objects of Instinct 
 and Reason, since the former must be in early operation for the exigen- 
 cies of Organic Life, while the Soul, in the complexity of its functions, 
 and according to its objects, is only ready to act when the brain shall 
 have acquired sufficient maturity for those endless physical impressions 
 which come through the medium of the senses, and from which the Soul 
 gathers its earliest treasures of knowledge. 
 
 Such, then, is the relative aspect in which must be regarded the cor- 
 respondence between' the progressive development and maturity of the 
 brain and the operations of Mind in early life ; the development or ma- 
 turity of the brain having as well a reference to the multifarious physi- 
 cal contributions from the Senses, as to their appropriation by the 
 Soul ; while, also, the admirable Design obtains of rendering the brain 
 complete in all its relations to the organs of Organic Life from the mo- 
 ment of birth, and, on the other hand, its endowment for the uses of the 
 Soul exactly progi'essive with those physical developments of other parts 
 that are indispensable to the objects of Reason at the different stages of 
 advancing life. The Design is inexpressibly sublime in its numei'ous, 
 yet distinct involutions as they relate to organic and animal life and the 
 uses of Reason. The Soul, therefore, may be, abstractly considered, in 
 as perfect a state in infancy as at any stage of life. 
 
 Thus it appears, that, besides the physical development of the brain 
 which is requisite for the impression of natural objects, that maturity 
 of the organ is, also, as a part of the design, a necessary medium through 
 which the Soul may appropriate the impressions. Having made these 
 advances, the Soul comes to act in more or less independence of sensa- 
 tion, and to multiply knowledge by its own efforts. Nevertheless, it is 
 peculiarly useful to my purposes that aberrations are seen of occasional 
 displays of Reason in early childhood which are surpassed at adult age 
 only by genius of the highest order. In some of these rare instances 
 there had been only the most slender antecedent relative knowledge ac- 
 quired through the medium of the senses, but the Soul itself originated 
 its own vast conceptions, carried them into a variety of practical appli- 
 cations without the instrumentality of foreign aid, and to an extent 
 where erudition, with all the appliances of sense and the facilities of 
 instruction, falls far short of equal achievements — as witnessed in the 
 institution of mathematical principles and processes. And here we 
 strengthen our position by the converse rule, since in none of the cases 
 has there been a ratio in the advances of Mind corresponding with the 
 advancing maturity of the brain, while in some the early intellectual 
 ability has settled down at adult age to a common mediocrity. In the 
 latter case it cannot be doubted that the progress of the brain has em- 
 barrassed the Rational Faculties. Again, there is every gradation in 
 Reason from the Hottentot to the highest order of genius. There are no 
 two individuals alike either in its compass or in the manner of its exer- 
 cise. How different is all this with Instinct, which directs every indi- 
 vidual of every species of animal in one uniform way, and no one of
 
 906 INSTITUTES OF MEDICINE. 
 
 them enjoys, througliout all generations, any different or greater endow- 
 ment than all the rest. 
 
 And thus do the contrasts between the Soul and Instinctive Principle 
 correspond with the anatomical contrasts, both as they relate to the brain 
 of man and of animals, and to the human brain and other organs in the 
 state of infancy, and with the coincidences in function, instinctive and 
 organic, between the brain of animals or its equivalent and other organs 
 at all stages of life. And here, too, should be brought into review what 
 has been said of the injuries which are inflicted upon the Mind and its 
 associate organ, and through those influences upon the whole organism, 
 by overtasking the Mind in early life, while no such injuries are sus- 
 tained, but the contrary realized, by a severe exercise of Instinct in the 
 infancy of animals (§ 563-5G8). — Note Pp p. 1142. 
 
 § 1078, r. It may be now well to inquire into what is meant by ideas, 
 and whether there be generally any definite conception of their nature, 
 and, by ascertaining the facts, endeavour to show by this method that 
 the earliest acquirements through the instrumentality of the senses 
 demonstrate the self-acting and originating endowment of Mind, and that 
 it is distinguished, at its very daAvning, from the Instinctive Principle, 
 by the characteristic of forming ideas of the nature of objects. This in- 
 quiiy, like the rest, belongs alone to the Physiologist. How, then, does 
 sensation give rise to what are recognized as ideas by Reason ? The 
 impressions transmitted to the brain through the organs of sense, or such 
 as may arise from internal causes, do not, certainly, constitute the ideas, 
 as is apt to be supposed ; and, according to my demonstration, the im- 
 pressions made upon the brain cannot, through any physical or chemical 
 influences upon the organ, elicit the ideas from the organ itself. The 
 impressions must, therefore, of necessity, call into action a Principle or 
 Agent by which the ideas are alone formed ; from which it appears that 
 the process, by which the Mind seizes and appropriates impressions trans- 
 mitted through the organs of sense, is similar to that by Avhich it multi- 
 plies and originates ideas. It is true, animals have the capacity of form- 
 ing ideas so far as they depend upon the promptings of sensation, and 
 upon impulsive associations with the past that may be awakened by re- 
 newed sensations of a more simple nature. But they stop there. They 
 are merely ideas of sensation ; while, on the other hand, the results of 
 sensation in man terminate in intellectual images which have no analo- 
 gies in the brute creation, and these are the essential final cause of the 
 human Soul. It is the Soul, therefore, which, mainly, does the work in 
 acts of intellection, while, in respect to the simple ideas of sensation, ex- 
 ternal objects, or internal causes like that of hunger, supply the materi- 
 als. This is enough for my purposes ; and it will be as vain to inquire 
 into the modus operandi of the Mind in its abstract operations, or in its 
 perception of external objects, or how impressions are made upon the 
 nerves of sense, or what their nature, or how they are transmitted by the 
 nerves to the brain, or how they call the Mind or Instinct into action, as 
 to interrogate the modus opei^andi of Creative Energy. 
 
 § 1078, s. In drawing to the close of our subject, we are naturally led 
 to inquire whether there be more than one species of the human race — a 
 question which is unusually agitated at the present day. 
 
 Taking the extremes of the race in physical and intellectual develop- 
 ment, it appears to have been definitively shown that there are no ana- 
 tomical characteristics which distinguish them as different species, but,
 
 The Soul. — APPENDIX. — Imtinct. 907 
 
 on the contrary, mark them as one. All the differences are susceptible 
 of ready explanation through the influences of climate, habits, &c., un- 
 less, perhaps, the black color of the African (§ 604-611). The Malpi- 
 ghian 7-ete is abandoned as fallacious, and the color of all the races is 
 now known to depend upon carbonaceous matter deposited upon the 
 surface of the true skin, differing only in degrees of intensity. The 
 greater tint of the Negro has been referred, in a very ingenious Essay by 
 Professor MuUer of Brussels, to the hot and arid climate which the dark- 
 est of that race inhabit. But, with all his experience in those regions, 
 he is mistaken in his important point that the newborn Negro is white ; 
 and his doctrine of the influences of deficient oxygen and dryness of the 
 air in occasioning the deposition and fixedness of the cutaneous carbon 
 is inapplicable to the North American Indian, whose skin is as dark in 
 his extreme Northern as Southern limits ; nor has a Northern climate 
 exerted a bleaching effect, in many generations, upon the Negro in 
 America. Muller's theory, therefore, of excess of carbon in the blood 
 from an inadequate supply of oxygen by the rarefied air of the tropics, is 
 invalidated by the exceptions before us. Nevertheless, peculiarities of 
 climate have, doubtless, given rise to all the shades of color, unless that 
 of the Negro form an exception (§ 610). A simultaneous lusus naturce of 
 a male and female black, as in the case of the ivhite Negro, may have given 
 origin to the race. (Vide Med. and Physiolog. Comm., vol. ii., p. 640.) 
 
 § 1079, a. Such are the conclusions (§ 1069-1078) to which the evi- 
 dence of anatomical and physiological facts have successively led ; nor 
 have I any doubt that others will see in the demonstrations that man is 
 an animal only in his physical being ; that in Mind he is far less allied 
 to the things of the earth than he is to their Author ; and will realize a 
 corroboration of their own conceptions, that the Soul and Instinctive 
 Principle are so far differently constituted as implied by the ultimate ex- 
 istence of one in an abstract condition, while the other shares the destiny 
 of organic life. They will see, I say, a new ground of belief in the im- 
 mortality of the Soul, and in the perishable nature of Instinct. And if 
 this be so, they will see in my premises and conclusions a contradistinc- 
 tion between God and Nature, and what is equivalent to a demonstra- 
 tion of the existence of a Creative Spirit, in which alone the Thinking 
 part of man can have had its origin. And, coming to other details in 
 relation to man, they will realize in the Mosaic declaration that " the 
 Lord God formed man of the dust of the ground, and breathed into his 
 nostrils the bi-eath of life, and man became a livmg Soul," an Inspiration 
 from Him Who " created man in His Own Image," and repose with 
 equal confidence in the assurance that, although " the dust sliall return 
 to the earth as it was, the Spirit shall return unto the God Who gave it." 
 They will abide in the emphatic distinctions between the dust, the 
 breath, and the Soul, and regard the Spirit as a special gift, a new Cre- 
 ation, and the body as referring to materials already in being, and which 
 were designed in their organic state, and kindled into life, to connect the 
 Spiritual part with the material world ; and they will also see in the lim- 
 itation of the statement as to the Soul of man what is the ultimate des- 
 tiny of Instinct, 
 
 Hence it follows, if Revelation be received as to the immortalitij of the 
 Soul and the death of Instinct, it must be received, also, as revealing a 
 fundamental distinction between them, and should operate as a perfect 
 barrier with all those veho uphold the Scriptures against the common
 
 908 INSTITUTES OF MEDICINE. 
 
 prejudice of identifying Instinct and Reason, as confounding the revealed 
 distinction, and therefore promoting infidelity in its aim at materialism 
 and annihilation. — Notes Pp p. 1142, qQ p. 1145. 
 
 § 1079, b. The foregoing subject has been pursued by the Author in 
 a long Article upon " Theoretical Geology," in the '■'■ Protestant Episcopal 
 Quarterly Review,'' New York, April, 1856, in which he has endeavoured 
 to defend, upon scientific, philological, and geological grounds, the literal 
 interpretation of the Mosaic Narratives of Creation and of the Noachian 
 Flood ; and, should he think that the spirit of the times will justify the 
 publication of the larger work to which he referred in the original edi- 
 tion of the Essay on the Soul and Instinct, and which is now completed, 
 he will submit it to the press. His main difficulty is the general concur- 
 rence of the Religious press in the revolutionary views of Theoretical 
 Geology, though, in saying this, nothing more is intended than a simple 
 representation of the facts. It is doubtful, therefore, whether a hearing 
 can be obtained — certainly not a publisher at his own risk. The Author 
 makes this statement in consideration of his former announcement that 
 such a work was on hand. — See Supplement, p. 923-928, § 1085. 
 
 The " Review of Theoretical Geology," to which reference is now 
 made (extending to 120 pages), is an epitome of the larger work, and is 
 believed by the Author, and by better judges, to be incontrovertible. 
 This is said, however, simply for the purpose of inviting a criticism which 
 may either discourage the Author in a farther attempt, or prove to him 
 an incentive to go on with his solitary work. He acknowledges, how- 
 ever, some encouragement in a critical review of Hugh Miller's posthu- 
 mous work on the " Testimony of the Bocks," which occupies five pages of 
 the Westminster Review for July, 1857, and which is remarkable for its 
 contrast with an otherwise apparently universal shout of applause.* 
 
 § 1080. Again : such is the nature of our premises, that, if the Soul 
 of man be immaterial, so is the Instinct of animals. There are, more- 
 over, no violent transitions in nature. The material existences, especial- 
 ly the organic, pass gradually, as it were, into each other. And so, it 
 cannot be doubted, it is Avith the immaterial, from brute to man, from 
 man to angels, from angels to God. 
 
 "Of sj'stems possible, if tis confessed 
 That Wisdom Infinite must form the best, 
 Where all must fall or not coherent be, 
 And all that rises, rise in due degree ; 
 Then, in the scale oi reasoning life, 'tis plain, 
 There must be somewhere such a rank as man ; 
 And all the question (wrangle e'er so long) 
 Is onlj' this : if God has placed him wrong?" 
 
 But we have also seen from our premises that, as soon as Instinct 
 shall have fulfilled its objects, it perishes with the life of the animal ; 
 since, especially, all its present uses are limited to the wants of the body. 
 Nor will its extinction aifect the analogy of which we predicate its im- 
 materiality, nor contradict in the least the immortality of the Soul. We 
 deduce the latter, apart from Revelation, not from the Soul's immaterial- 
 ity, but from some of the facts which contradistinguish it from Instinct, 
 that all its higher faculties have no relation to the uses of the body, and 
 from the analogy which subsists between them and the Attributes of the 
 Creator. We infer, also, the immateriality of the Soul, in part, from the 
 pame analogy ; though it is essential to this analogy that it be conceded 
 that the Omniscient, Omnipresent, and Omnipotent Being is as dififerent 
 
 * A protest against the geological and astronomical perversions of Holy Writ has just 
 been signed (1865) bj- two hundred eminent scientific men of Great Britain.
 
 TJie Soul. — ^APPENDIX. — Instinct. 909 
 
 from the inert matter of which He is the Author as their manifestations 
 are different from each other. And again, if these premises be admitted, 
 it follows that immateriality, or something totally distinct from matter, is 
 indispensable to the unlimited duration of the Almighty, and therefore 
 that it must be rendered equally so to the Soul. But the acknowledg- 
 ment of a Creator carries with it a full admission of His immateriality, 
 otherwise matter would be self-existent, and God and the Universe would 
 be on common gi'ound. The latter is replete with design, and that is 
 the most tliat could be affirmed of the former. Neither should depend 
 for its existence upon the other ; nor, as we have seen, can matter cre- 
 ate matter (§14 c). Ilaterialism, therefore, i?> pantheism — atheism. 
 
 It need not be repeated that the iymnateriality of Instinct is inferred 
 from its feeble analogies to the Soul, though not in the least to any man- 
 ifestations of those attributes which ally the Soul to its Maker.* 
 
 § 1081. It will have been seen that materialism, in its proper accepta- 
 tion, and the question as to the materiality of the Soul, are distinct from 
 each other, since the former denies the existence of the Soul as a sub- 
 stantive agent, while the latter admits it. My object has been to sub- 
 stantiate the existence, more than the ivimateriality of the Soul. But the 
 proof of the latter has constantly attended all that I have shown of the 
 self-acting nature both of the Soul and Instinctive Principle, which con- 
 tradistinguishes them from every known attribute of matter. The near- 
 est approximation, in the light of analogy, to what may be material, is 
 to be seen in the Principle of Organic Life ; and here the resemblance 
 consists in action alone. But the Principle of Life requires the opera- 
 tion of numerous physical causes to bring and maintain it in sensible 
 action. It is impossible, therefore, to adduce a single phenomenon of 
 the Soul or of Instinct that bears a resemblance to the manifestations of 
 matter. 
 
 § 1082. Our inquiry may be variously pursued, especially upon the 
 great basis of analogy. It is one of no little moment at the present day, 
 and materialism must abide its own facts and method of reasoning ; a 
 ground, however, which nothing can shake when presented according to 
 its ordination in nature. In the present case, the admitted facts are 
 co-extensive with all animal existences, and they are bound together in 
 the different races by close resemblances. Indeed, in each of the series 
 the facts differ only by shades. The evidence here is of the strongest 
 possible nature, not only on account of the universality of the facts, but 
 because they are founded in the unchanging character of organic beings. 
 
 Resting, therefore, in the conclusions which I have now expressed, 
 and anxious for their greater prevalence against a progressive and al- 
 ready widespread materialism, I have been led into this discussion in 
 the hope that it may remove some of the obscurities of the subject, and 
 also advance the great truths in Physiology and Medicine. The province 
 of the Physiologist extends beyond the mere physical relations of matter 
 and Mind. Of those relations he is the only expounder. But it de- 
 volves upon him, also, to seek in the depths of Physiology for the con- 
 stitution of Mind as distinguished from matter ; and thus, also, contrib- 
 ute towards a right faith in a future state of being. Wherever, indeed, 
 
 * We have seen, § 168, that Professor Miiller, in discussing the nature of the Vital 
 Principle, concedes that even this maj' be an immaterial substance, and that "there is 
 nothing in the facts of natural science which argues against its possibility, and its inde- 
 pendence of matter, though its powers be manifested in organic bodies — ii> matter."
 
 910 INSTITUTES OF MEDICINE. 
 
 he turns his inquiries into organic nature, he sees in the mechanism of 
 every part — individually and collectively as a harmonious whole — in 
 every function and product, separately and relatively — in the properties 
 by which they are carried on, and in the laws by which they are gov- 
 erned, the most perfect evidences of consummate Design. It is the 
 duty of the Physiologist to turn all this immense weight of proof against 
 those ci'ude doctrines of materialism, mental and medical, which have 
 had their origin either in the closet of the speculatist or in the laboratory 
 of the Organic Chemist. And thus, also, shall he secure from Mankind 
 that homage for Medicine which is due to " the Divine Art," and again 
 restore the Hippocratic axiom that " a philosophical physician is like a 
 god" (§ 235). 
 
 § 1083. Before concluding our subject I shall avail myself of the 
 proof which it supplies against the doctrine oi spontaneity of living beings, 
 now extensively prevalent in the scientific world, and against which I 
 have alleged many objections in the Medical and Physiolorjical Commen- 
 taries (vol. ii., p. 123-140), and again in the original Essay on the 
 '■'■Soul and Instinct,^' and in that upon "Theoretical Geology''^ (§ 1079, S), 
 and in these Institutes (§ 14 c, 170, 350f a-m). 
 
 As it respects the Soul and Instinctive Principle, Ave have now seen 
 that they ai'e substantive existences, and all organic beings are made up of 
 the common elements of matter. But there is no element known in the 
 inorganic kingdom which affords any of the manifestations which char- 
 acterize the Soul and Instinct, or any of the results of the organic mech- 
 anism. The latter, therefore, was endowed with new properties when 
 the elements were brought into organic union. To say that such prop- 
 erties were " slumbering in the elements," is a frivolous assumption 
 (§ 14 c, 175 d, 250J b, c, f-h), and necessarily involves the conclusion 
 (which has been probably intended) that the Soul, also, is equally in- 
 herent in the elements, which is the worst kind of materialism. But the 
 manifestations of the Soul and Instinct are, as we have seen, not only 
 totally different from those of every organic process, but cannot be gen- 
 erated by the material part. These principles, therefore, were as much 
 created as the elements of matter, and, as they exist in union with the 
 organized structure of man and animals, it is inferable that the structure 
 was created simultaneously, and by a common act, with the spiritual 
 part. Or, if the material elements were first combined, it would equally 
 follow that it was a direct Creative Act, since the Soul and Instinctive 
 Principle must have been created for the distinct purpose of being asso- 
 ciated with the material body. The rule, of course, applies, through the 
 analogies of structure, to the vegetable kingdom, and which it is equally 
 consistent to suppose was created in the form of plants as of seeds, or 
 as that man and mammiferous animals were created in a state of ma- 
 turity, according to my demonstratioif in the Essay on the " Soul and 
 Instinct" (p. 158-173).— Note Pp p. 1142. 
 
 I have also said in relation to the common opinion that intestinal 
 worms are of spontaneous origin, that, if this be admitted, it must be also 
 conceded by all that is sound in analogy, that the door is equally open 
 for any other animal, and for man himself The hypothesis is without 
 a plausible fact, while the ova of these parasites, and of such as are 
 found in the organization of the body, even in the foetus, may require, 
 in the natural external condition of the animals, a magnifying power of 
 some hundreds of times to render them visible. They may, therefore,
 
 The Soul. — APPENDIX. — Instinct. 911 
 
 be absorbed into the circulation, where their new mode of existence, as 
 Avell as in the intestinal canal, may so modify the condition of the ani- 
 mals that they shall lose all resemblance to their characteristics in the 
 external world. The animal and vegetable tribes abound with equally 
 remarkable aberrations, that arise from climate, domestication, and cul- 
 tivation alone. But more than this. From whence comes the elaborate 
 organization of these so-called parasites and their wonderful systems of 
 Design? How and from whence do they obtain, at their start into be- 
 ing, the seventeen or eighteen elements of which they are composed, and 
 . which are indispensable, in every species of animal and plant, to the be- 
 ginning of existence ? And should not this objection have been urged 
 against the pretended creation of the Acarus Crossii out of a simple so- 
 lution of silex in water (§ 350f , h) ? Is there any thing in Chemistry 
 that will expound the intimate union of such a number of elements into 
 compounds of the most exact nature, or these compounds, by any thing 
 known in physics, into systems of Design, and this for every species of 
 animal and plant, if you had all the elements to begin with 1 Or, take 
 oxygen, hydrogen, nitrogen, and carbon alone, the Chemist completely 
 fails to fabricate the most simple organic compound (§ 350, No. 39, par- 
 allel columns). But by no possible contingency can the seventeen or 
 eighteen elements have been assembled for a single individual plant or 
 animal ; and when all the species are regarded collectively, the supposi- 
 tion becomes palpably absurd. Nothing but Creative Power could have 
 gathered them together in a single instance. This disposes, also, of the 
 ^'parturient faculty of the earth" as it is called in the ''progressive devel- 
 opment" system of theoretical Geology. Nor can the pretence be set up 
 that the so-called intestinal parasites grow out of a previously organized 
 part, for they are perfectly independent beings, and have no attachments 
 to the intestine. Or, if attachments exist in other cases, they are precisely 
 upon common ground with parasite plants as it respects their original 
 independence. The doctrine which ascribes Mvguet "to the production of 
 a parasite plant within the epithelial cell" is open to the same objections 
 as apply to the spontaneity of animals, and is contradicted by all the 
 physiological, pathological, and therapeutical facts. It is alone worthy 
 of the most imaginative of the microscopical school, setting aside its per- 
 nicious tendencies in Religion* {Continued in ^ 1085.) 
 
 I can not but think, after all, that whoever regards the animalcule, 
 that can be discerned only through a high magnifying power, in all its 
 wonderful complexity of organization, seemingly existing in nothing, in 
 all its close analogies in composition and structure to man himself, and 
 often with a large development of the Instinctive Principle, and pon- 
 ders upon the same analogies as they are only less complex in worms, 
 and only still less in parasitic plants, and considers the stupendous De- 
 signs which each part, and all together in unison, fulfil for the growth and 
 well-being of each individual, and how there is no deviation in structure 
 and functions among all the individuals of the species respectively, must 
 concede the descent of the whole fi-om progenitors that had been brought 
 into being by an Intelligence higher than that which is enabled to ex- 
 plore the labyrinth and trace out the Designs (§ 1051), and that thus 
 informed, he must bow with reverential awe under the inspiration of 
 such contemplations. (See Index L, Article Design.) 
 
 * The Author is gratified to observe that the spirit of his arguments uponspoNTAXK- 
 OTJS GicNKKATioN, as expressed here and elsewhere, is adopted in Amer. Jour, of Science 
 and Art, May, 1859, and b}- the same writer as referred to in note at p. 1^6, § 360. 
 Comptes Renclus, 1859, contains conclusive experiments in favor of cukative rowKR. 
 ^1860.— Notes Ppp. 1142, Qq p. 1145.
 
 912 INSTITUTES OF MEDICINE. 
 
 THE EIGHTS OF AUTHORS. 
 
 § 1084. Upon all questions of priority that concern the advancement 
 of Science and Art, there is, doubtless, a general understanding that the 
 principle should not only be sacredly observed, but that, w^henever vio- 
 lated, there should be a common effort to repair the injury. This is alike 
 due to the individual, to the principle, and to the common good. Nor is 
 it less the privilege of the individual, who may have good reason to think 
 that the principle has not been extended to himself, to vindicate his 
 rights, and to appeal to that sympathy which forms the bond of union 
 among honourable men. It is a common cause, and not seldom demands 
 protection. 
 
 The Author of these Institutes (and it will soon appear that he acted 
 wisely) has sometimes thought it expedient to assert his claim of origin- 
 ality, in advance, to many doctrines promulgated in the work ; as, for 
 example, all that is most essential in the application of the Nervous 
 Power, or Reflex action of the nervous system to Pathology and Thera- 
 peutics, and to much of what is most important in the natural state of 
 the functions. This may be readily seen by consulting p. 106, § 222 b, 
 p. 107-116, § 224-234, p. 295-318, ^75^-493 tZ, p. 321-341, ^ 495- 
 514, p. 343-353, § 516-524, p. 465-467, § 714-719, p. 506, § 803-804, 
 p. 515-516, § 819 h, p. 661-663, § 894-896, p. 666-676, § 902 5-904, 
 p. 679-680, § 905 a, p. 690-691, § 906 g, p. 693-695, § 917-923, p. 
 698, § 931-935, p. 703-711, § 940-952, p.745,^990ia,5,&c., where all 
 the subjects relate to the reflex action of the nervous system, and present 
 the nervous power as an important vital agent in the various processes 
 of organic and animal life, in the production of disease, in the operation 
 of remedies, in all the results of bloodletting, in the changes which take 
 place in the secreted and excreted products — having also originally set 
 forth the agency of the nervous power in voluntary motion (Indexes, 
 Article Will), and as this power is the efficient cause of the modifica- 
 tions of organic results under the influence of mental emotions (Index 
 H., Article Mental Emotions, and references at p. 867, § 1067). Indeed, 
 as the reader will have seen, the foregoing doctrines relative to the reflex 
 action of the nervous power, operating as a vital stimulus, or vital dejwess- 
 ant, or vital alterative, as it may be modified in its nature by one cause 
 or another (§ 226-232, 481, 500, 891^^,894 &,990i«,^»), pervade this 
 work. The same doctrines are at the foundation of the Author's '■^Med- 
 ical and Physiological Commentaries," published in 1840, while the present 
 work was published in 1847. In the mean time he has also laboured to 
 inculcate them throughout his course of Medical Lectures in the Uni- 
 versity of New York — first on the Institutes of Medicine and Materia 
 Medica from the year 1841 to 1850, and subsequently, to the present 
 time (1857), on General Therapeutics and Materia Medica. 
 
 It may be worth saying, also, that the Author preserves the term 
 " sympathy," though always meaning by it, as he strictly defines, reflex 
 action of the nervous system, and this whether he employs the term " re- 
 mote sympathy" or "contiguous sympathy." The elements of sympa- 
 thy, as set forth in the work, are the nervous power and sensibility. All
 
 Bights q/^— APPENDiX.^ — Azdhors. 913 
 
 this will be readily seen by a reference to Indexes. Also, among other 
 general remarks of a similar import, the Author has the following : 
 
 " Notwithstanding all the laws of sympathy that are necessary to the 
 full interpretation of the remote effects of morbific and remedial agents 
 are as well established as any laws in physics, iheT/ have not been apjjUed 
 to these important objects ; but, on the contrary, those philosophers who 
 have contributed most to their critical exposition, overlook their patholog- 
 ical and therapeutical bearings, and cling to the doctrines of humoralism and 
 of the operation of remedies by absorption; nor have they applied, in the 
 least, the nervous power in a philosophical manner to an explanation of the 
 natural phenomena of sympathy" (p. Ill, § 234 a, 169 e 435 c, 906 g). 
 
 When the foregoing works were first published, it was in the midst of 
 a universal prevalence of the chemical and physical doctrines of life 
 and disease, and the Author stood alone in the field of Vital Physiology, 
 and in the application of the reflex action of the nervous system in re- 
 solving the great problems in Physiology, Pathology, and Therapeutics. 
 A few, however, had the quick sagacity to see its importance as presented 
 by the Author ; and since the decline of Organic Chemistry began, others 
 have entered upon the inquiry, and the most zealous have promulgated 
 as original with themselves many of the doctrines which belong to the 
 Author of these Institutes, especially such as are relative to the nervous 
 system. But the Author has relied upon his professional brethren for 
 ultimate justice: '■'■JJltimum et unicum remedium." '■'■Jus aliquando dor- 
 mitur, moritur nunquamy 
 
 But the Author has lately seen so great an indisposition, in certain 
 quarters, to allow him any credit for his labours, that he has concluded 
 to make this expostulation, which refers, particularly, to the following 
 dispute about the authorship of matters in which neither of the gentle- 
 men has any interest, but the writer alone of these Institutes. This rival 
 claim appears in an Article published by J. Adams Allen, A.M., M.D., 
 in the ^'■Medical Independent'^ for September, 1857, p. 381, Detroit, Mich- 
 igan. Thus : 
 
 " It appears from a late number of the London Lancet that M. Hall 
 (Marshall Hall) recognizes to a certain extent the priority of Dr. Camp- 
 bell. His words are these : 
 
 " 'I arrive at this conclusion: the idea and the designation of an ex- 
 ciio-secretory action belongs to Dr. Campbell, and his details are limited to 
 pathology and observation. The elaborate experimental demonstration 
 of reflex excito-secretory action is the result of the experimental labors 
 of M. Claude Bernard. My own claim is of a very different character, 
 and I renounce every other. It consists in the vast generalization of ex- 
 cito-motory action throughout the system. I trust Dr. Campbell will 
 be satisfied with my adjudication. There is the excito-secretory func- 
 tion as applied to pathology, an ample field of inquiry for his life's ca- 
 reer, and it is indisputably — ms own. He first detected it, gave it its 
 designation, and saw its vast importance.' " 
 
 Dr. Allen then continues : 
 
 " M. Hall thus far freely and fully admits the priority of Dr. Camp- 
 bell, and the latter gentleman bases his claim upon the date, May, 1850. 
 I shall undertake to show that this same doctrine was first publicly 
 announced and illustrated in my Lectures at the Indiana Medical Col- 
 lege in November, 1848, and thenceforth continuously during the con- 
 tinuance of my public teaching before the several classes of that College, 
 
 M M M
 
 914 INSTITUTES OF MEDICINE. 
 
 and also the Medical Classes of the University of Michigan until my con- 
 nection with that Institution 'expired by limitation' in 1854. My own 
 manuscript containing this doctrine was written in May or June, 1848" 
 — that is to say, mo7-e than one yea?- after the jyublicatioti of these Institutes. 
 
 " What I do claim is the great generalization that the excito-injiuence is 
 followed by a reflex change in which the effect is not a motion, hut a modi- 
 fication OF VASCULAR AND NUTRIENT ACTION. That this effect takes 
 place BY MEANS of the double nervous arc. a vast number of thera- 
 })eutic phenomena are thus explained." I preserve in the quotations 
 Dr. A.'s capitals and italics. 
 
 Now the whole of the foregoing doctrine is impressed upon the 
 Med. and Physiolog. Commentaries, and upon more than half of the 
 pages of these Institutes, and has been always taught extensively in 
 the Author's Lectures since 1841. In respect to the present work, 
 see, particularly, pages 106 to 111, 283 to 362, and the chapters upon 
 Remedial Action, Therapeutics, Counter-Irritation, Cathartics, Se- 
 cretion, and Excretion, Index II. 
 
 Dr. Allen claims, also, the application of the principle to Therapeu- 
 tics, and remarks that " in my course upon ' General Therapeutics' the 
 subject of ' Counter-Irritation' came under review," and concludes that 
 " the impression must be transmitted to the nervous centres, and thence re- 
 flected to the affected organ. In other words, the influence is primarily ex- 
 erted upon the cerehro-sjnnal system, and secondarily upon the internal afl'ected 
 organ. This is the gist of the whole matter, and the point consists in 
 the recognition of reflex cerebro-spinal action, which, in the instances ad- 
 duced, give rise to a molecular or integral change in the inflamed tissue, 
 and not a muscular contraction. The oral elaboration of this principle 
 was suggested by an idea [?] which does not even now appear to have 
 occurred to either M. Hall or Dr. Campbell, viz, : The motor effect is 
 merely secondary, and not a neassary part of the action of the nervous arc." 
 
 Here, also, the whole of the foregoing doctrine appears throughout 
 these Institutes, but not to the neglect of the sympathetic nerve- In the 
 long chapter upon '* Counter- LTitation'''' it will be seen that the Author 
 has employed nearly the language of Dr. Allen, as also in that upon 
 " liemedial Actio7i,'" with a great elaboration and extensive application of 
 the doctrine throughout the work ; which had been also antecedently 
 taught in his Lectures for seven consecutive years before Dr. Allen pro- 
 mulgated the same views. (Indexes, Reflex Action, Nervous Power). 
 
 To show still farther this partiality for the Author's Writings, or his 
 Lectures (then familiar to his large classes of students), he Avill quote 
 from Dr. Allen the following conclusions, which he also places in capitals: 
 
 "The effect is motory, if contractile fibre be present. 
 
 " The effect is secretory, if secretory organs be supplied. 
 
 " The effect is sensation, if sensitive neurine be reached. 
 
 "The effect is perception, or intellection, if the organ there- 
 of be in connection with the reflex nerve," 
 
 " The effect produced, then, depends tipon the structure and condition 
 of the organ reached^'' 
 
 " This influence is not confined to the mere increase of action, as the term 
 ExciTOR might perhaps suggest. The reverse may take place — the ex- 
 citor may rather become the dep)ressor. It would be as correct to say 
 the depressor-motory, the depressor-secretory, as to say the excitor-jc/em." 
 
 Now the Author of these Institutes not only dwells emphatically upon 
 the depressing and sedative influence of reflex nervous action, according to
 
 Rights of — APPENDIX. — Authors. 915 
 
 the nature of the remote causes and special conditions of disease (§ 224- 
 233f, 234 d, 455 d-J\ 481, 488^, 500 c, ec, 503, 514 b-h, 516 d, no. 13, 
 526 d, 847 g, 863 d, 891^ 1-, 894-895, 902 b-m, 904 a, 945, 947, 951 c, 
 966, 973-976, 990 J a, ^), and upon its operation according to the natural 
 structure and special vital constitution of organs, and their varying con- 
 ditions (p. 59, § 129 g-i, p. 61-69, § 132-150, p. 73, § 163, p. 109, § 229, 
 p. Ill, § 233|, p. 285, § 455 d-f, p. 313, § 487 h, p. 353-362, § 525-529, 
 p. 374-383, § 576-584, p. 415-417, § 649, p. 418, § 651 Z*, p. 421-423, 
 § 657-658, p. 523, § 827 c, p. 542, § 854 bb, p. 613, § 892^ b, p. 644-650, 
 § 893 c-2, p. 665-672, § 902-903 b, p. 746, § 990^ b, and the numerous ref- 
 erences in those sections) ; but the Author represents, also, the reflex 
 action as variously alterative in organic life, and this imputed attribute 
 pervades the Author's writings. He enforces, everywhere, the doctrine 
 that the reflex action of the nervous power is the modifying cause 
 through which all the changes are effected by morbific and remedial 
 agents in parts that are not immediately connected with the direct seat 
 of their action ; and, farther, that the principle is precisely the same 
 when the nervous power is brought into operation by direct influences 
 upon the nervous centres (as in the case of their diseases, or when the 
 Passions operate, or as the Will determines voluntary motion), as it is 
 when it is brought into operation in that indirect manner known as re- 
 flex action. Hence he has called the former direct nervous action. 
 
 Indeed, every one of the foregoing doctrines, in all their particulari- 
 ties, as quoted from the American Claimant, are taught, at great extent, 
 in the volume before us, as may be readily seen by consulting the refer- 
 ences made in this protest, and, more extensively, Indexes, Articles 
 Stkucture, Nervous Power, Sensation, Sensibility, Sympathy, Or- 
 ganic Functions, Remedial Action, Mind, Mental Emotions, Will. 
 — "*S'« quceris monwnentum, circumspice.^^ It may appear superfluous, 
 however, to have made these specific references in an article connected 
 with the work itself; but it is done to encourage those readers who 
 might not otherwise be inclined to ascertain the facts. 
 
 But the writer is more interested with the European Umpire, of 
 whom he has felt that he has much more reason to complain. 
 
 " Omne animi vitium tanto conspectus in se 
 Crimen habet, quanto major, qui peccat, habetur." — Juvenal. 
 
 That the Author's physiological and medical writings were generally 
 known in Europe many years before the pei'iod at which " Dr. Camp- 
 bell bases his claim" (1850), is evident from the distinguished honors to 
 which they had led in that Country before that period — that from the 
 Medical Society of Prussia as early as 1842 — that from the Medical So- 
 ciety of Leipsic in 1843 ; and the " Medical and Physiological Com- 
 mentaries" (of 1840) were published simultaneously in London and New 
 York ; and as to the United States, the Commentaries were early distrib- 
 uted throughout the land, and his Institutes of Medicine more than a year, 
 also, before Dr. A.'s Lectures were delivered ; and the Author's Lectures 
 at the University, which form the groundwork of his Institutes, had been 
 listened to annually by Medical Students from all quarters of the Union 
 since the year 1841. In 1848 the Author applied the doctrine of reflex 
 nervous action to a physiological demonstration of the substantive exist- 
 ence of the Soul and Instinctive Principle, which was then published 
 in pamphlet form, and in 1849 the work was extended and assumed
 
 916 INSTITUTES OF MEDICINE. 
 
 the shape of a book, and is now incorporated, in its essential parts, in 
 these Institutes. Aho, fully, in Ant]io}:^s Materia Medica, 1848, p. 176-180. 
 
 Nor is that all ; for the whole of this doctrine of reflex nervous action, 
 and of the operation of the nervous power as an alterative, an excitant of 
 the secretions and of vascular action (both direct and reflex), a depressant 
 and sedative (according to the nature of exciting causes), and the great 
 immediate cause of diseases and their cure — variously modifying organic ac- 
 tions — was set forth extensively and circumstantially in an '■'■Essay on the 
 Modus Operandi of Kemedies" in 1842, of which the Author distrib- 
 uted, at that time, a large number of copies in London, and addressed 
 four thousand copies to Physicians throughout the United States. The 
 Author not only sent a copy of the work to Dr. Hall, but dedicated it 
 to him (along with Prof J. Miiller and Dr. A. P. W. Philip) in connec- 
 tion with an '■^ Essay on the Philosophy of Vitality f and he may add that 
 he controverted, in the former Essay, doctrines of Dr. Hall (in '^Memoir 
 on Diseases and Derangements of the Nervous System, 1841"), which were 
 in direct opposition to those which are now in question (also, p. 296- 
 297, § 476 J, b). These Essays were subsequently bound up in the Third 
 volume of the " Medical and Physiological Commentaries," where the for- 
 mer may be readily consulted. But Dr. Philip had fully deduced from 
 his experiments the sedative as well as exciting influence of the nervous 
 system upon vascular action before Di*. Hall's experiments were made 
 (§ 492) — See Index II. — Hall, M. — for many other unpardonable criticisms. 
 
 As to M. Bernard, his experiments bearing upon the connection of the 
 nerves Avith the function of secretion, however much they may have 
 been varied and multiplied, were anticipated long before by those of 
 A. P. W. Philip, which are quoted extensively in these Institutes (p. 290- 
 321), and towards which Dr. Hall had no friendly disposition (p. 306- 
 308, and where the writer has controverted his views). The merit of 
 originality which belongs to the present writer, in relation to these ex- 
 periments, consists in their extensive application in illustrating the func- 
 tions of the nervous power as a vital agent, profoundly interested not 
 only as an " excito-secretory" power, and as a modifying cause of all 
 secreted products, nutrition, &c., when diverted from their natural stand- 
 ard, but in deducing from them a universal agency of the reflex action 
 of the nervous system, through " the double nervous arc," in the produc- 
 tion and cure of disease, and by which be laboured to explode the chem- 
 ical and physical doctrines as early as 1840. But, that the writer may 
 not be misapprehended, he will say that he endeavours to establish the 
 fact that secretion in animals, as in plants, is conducted by powers im- 
 planted in every part, bvit that it is constantly influenced physiologic- 
 ally, pathologically, and therapeutically, by reflex action of the nervous 
 system, as also by direct action (§ 227, 481). 
 
 The writer is very sensible that unaccountable coincidences often pre- 
 sent themselves in the development of new thoughts, and in the discov- 
 ery of hidden things, especially where enduring reputation may be won. 
 "C/i? mel, ibi apes.'''' — '■'■JJno tiene la fama,y otro carda la lanaP But the 
 reader, with these Institutes before him, will quickly find that much that is 
 claimed by Dr. Hall, and all that he has granted to Dr. Campbell, in the 
 foregoing quotation, and, therefore, all that Dr. Allen appropriates to 
 himself,* abounds in this volume, and, in fact, constitutes the life and 
 
 * "Unus utrique 
 
 Error ; sed variis illudit partibus." — Hohace.
 
 Rights (/—APPENDIX. — Authors. 917 
 
 soul (" <^w?y KoX "^vxrf) of the work, as it does, also, of the ^^ Commenta- 
 ries,^^ and of the Essay on the ^^ Modus 02}erandi of Bemedies ;" nor can the 
 reader fail of the conclusion that, were Dr. Hall's "adjudication," and Dr. 
 Allen's after-thought, founded in any justice, and were not the claimants 
 themselves the obnoxious parties, the pi'esent writer would have been long 
 ago convicted by them and by others of arrogant assurance and the gross- 
 est plagiarisms. Nevertheless, the Author is most happy to find that his 
 solitary position is becoming relieved, and that a practical dii-ection has 
 been given to his labours by others which cannot fail of carrying forward 
 the great doctrines at which he has toiled, and against manifold obstacles, 
 during his professional life. — Note X p. 112Y. 
 New York, September, 1857. 
 
 Postscript. — From what has been seen in the last preceding Article 
 (which was at first intended for publication without this Postscript), it 
 will not appear remarkable that the Author regards it as a duty to him- 
 self and to the cause of that Philosophy in Physiology and other 
 branches of Medicine which he has labored to introduce, that he should 
 set forth the principal details of what he considers himself the unques- 
 tionable Author. Prompted, therefore, by these and other obvious rea- 
 sons, he proceeds to assert his claim of originality to — 
 
 1. All that is relative, in principle, to Reflex Action of the Nervous Sys- 
 tem in Pathology and Therapeutics, including the application of antece- 
 dent experiments to determine the " Laws of Sympathy" and of the 
 "Vital Functions," as they respect the natural conditions, to all the 
 great problems in those branches of Medicine, so far as the Nervous In- 
 fluence is involved as a modifying cause ; and a systematic generalization 
 of the whole subject. The Laws of Reflex Action of the Nervous Sys- 
 tem, in their Physiological aspect, were understood, to a large extent, as 
 eai'ly as the time of Prochaska (§ 463 b, 476 h), and justice demands of 
 us that analogous contributions by Hippocrates shall be acknowledged 
 (§ 463 a), while, also, it will be seen through the foregoing references that 
 this most important subject, in philosophical and practical medicine, had 
 engaged the diligent attention of other eminent observers prior to the 
 grand discovery by Sir Charles Bell of the anatomical media (§ 464, &c.), 
 by the aid of which, and the labors of many others, the great Prussian 
 Physiologist reduced the laws of reflex action of the nervous system to a 
 masterly generalization. The Author of these Institutes had also given 
 his critical attention to the researches of Marshall Hall, and has express- 
 ed his opinion of their merits in many places, and summarily in § 463 h. 
 
 2. The doctrine of Modification of the Nervous Power by the Causes 
 which bring it into action, and according to the nature of each Cause, 
 whether mental or physical, I'emedial or morbific, external and internal, 
 and through which its Alterative influences are exerted in conformity 
 with its various modifications, respectively — regarding, therefore, the 
 Nervous Power as a Vital Alterative Agent and susceptible of an endless 
 variety of changes in hind from the influence of exciting causes ; being 
 thus rendered, in its extremes of change, either a vital stimulant or seda- 
 tive, exerting alterative effects, with corresponding results in both the sol- 
 ids and fluids. — The application of this philosophy equally to the cure 
 and production of diseases in all their gradations. (Index I. and II.) 
 
 3. The doctrine and demonstration of the operation oi Remedial Agents 
 and Morbific Causes by Refiex Action of the Nervous System, as, also.
 
 918 INSTITUTES OF MEDICINE. 
 
 through the foregoing modification of the Nervous Power (No. 2), and all 
 that is relative to the same action in Pathology and Therapeutics. 
 
 4. A distinct exposition of the modus operandi of Counter-irritants 
 through Reflex Action of the Nervous System, and their associate local i7i- 
 fluences ; exemplifying, also, by these agents, the modus operandi of all 
 other agents applied to the skin when they produce constitutional, or anyt 
 internal efiects, whether remedial or morbific — as in the case of cold, mer-> 
 cury, t&c. (Index II., Counter-irritants ; Causes, Morbific ; and Remedies). 
 
 5. A distinct exposition of the modus operandi of the Seton through 
 Reflex Nervous Action and local organic influences, as exemplifying all the 
 essential philosophy that is ever concerned in the operation of all reme- 
 dial and morbific agents, as set forth in the Author's Essay on the Modus 
 Operandi of Kemedies (1842), and in these Institutes (p. G79-681, § 905 a) 
 — being, however, only parallel with the author's demonstration of the 
 operation of Blisters and other Counter-irritants through the same causa- 
 tions. 
 
 6. The operation of Aticesthetics through Reflex Nervous Action, as con- 
 tained in this work. 
 
 7. Distinction between the agencies of Reflex Nervous Action in the mo- 
 dus operandi of the Author's group of Alteratives and among other denomi- 
 nations of Remedies (Index I. and II.) — an important consideration, by 
 which the gradual operation of Remedies through Reflex Nervous Action 
 is rendered clearly intelligible, as in the progressive influences of small 
 and frequently repeated doses of tartarized antimony, mercury, &c. (p. 
 344-345, § 516 d, No. 6, 889 m, 902 i-m, 904 hh). And so, also, of 
 the progressive operation of Morbific Causes, either physical or mental — 
 as in hydrophobia, sympathetic diseases, &c. (p. 421-422, § 657 a, b, p. 
 465-466, § 715, p. 661-663, § 894-896). The example of the Seton 
 illustrates the principle (No. 5). 
 
 8. All embraced in this work, and in the Medical and Physiological 
 Commentaries (vol. i., p. 124-384) upon the Influences and Modus Ope- 
 randi of Loss OF Blood (whether in General Bloodletting or Leeching), 
 which are interpreted by the Author upon purely Physiological Laws, 
 and mainly through Reflex Action of the Nervous System. 
 
 9. The Law of Adaptation, operating through Reflex Nervous Action 
 (Index I.). 
 
 10. The philosophy of the natural operation of the Will and Mental 
 Emotions through the direct development and action of the Nen'ous Power, 
 and its efiects as an Alterative agent when the latter operates in the cure 
 or production of disease, as embraced in this work. 
 
 11. Demonstration of the direct development and propagation of the 
 Nervous Poiver as an Alterative agent, or a simple Stimulant or Depressant, 
 in diseases of the nervous centres, «&c., and as concerned in Loss of Blood 
 along with Reflex Action, &c. 
 
 12. What is relative, in this work, to peculiarities of Stimcture in its 
 Vital constitution in different parts (p. 50-73, «&;c.), and their important 
 bearings upon Physiological, Pathological, and Therapeutical doctrines, 
 as it relates both to the direct action of remedial and morbific causes, 
 and their operation through Reflex Action of the Nervous System. 
 
 13. The proof and reasoning embraced in these Institutes, and in the 
 Medical and Physiological Commentaries, and other Avorks, in behalf of 
 Vital Solidism, as applied to Physiology, Pathology, and Therapeutics, 
 and in opposition to the Chemical hypotheses.
 
 Bights of— AVV'EE'DII..— Authors. 919 
 
 14. Special deduction of Vital Principle, and peculiar Laws of Organic 
 Beings, from their Composition, as embraced in this work (p. 23-49). 
 
 15. Special deductions from Nitrogen Gas, as contradistinguishing the 
 Organic from the Inorganic Kingdom, as contained in the Essay on 
 the Philosophy of Vitality (1842), and briefly in this work (p. 34-36, 
 § 62 a-lc). 
 
 16. Special deduction of the principles of Vital Solidisni, Physiological 
 and Pathological, from the development of the incubated Egg and the 
 physiology of Generation, as contained in the Essay on the Philosophy 
 of Vitality, and in these Institutes (p. 36-49, § 63-81). 
 
 17. Analysis and elaboration of the Properties of Life, as contained in 
 this work (p. 73-125). 
 
 18. The proof adduced in this work, and in the Medical and Physio- 
 logical Commentaries (vol. i., p. 1-119), of the existence and office of the 
 Vital Powers or Vital Properties, with a disproof in the latter work of the 
 supposed ideii^ty of the Nervous Power and Galvanism, with the variety 
 of proof herein contained of the wonderful attributes of the Nervous 
 Power, as one of the properties of the Vital Principle of Animals. 
 
 19. Exposition of Law of Vital Habit (p. 363-370, § 535-537). 
 
 20. All embraced in these Institutes and the Medical and Physio- 
 logical Commentaries in disproof of the Chemical and Physical hypoth- 
 eses as applied to Physiology, Pathology, and Therapeutics. 
 
 21. All herein and in the Medical and Physiological Commentaries 
 (vol. i., p. 385-712) in refutation of the Humoral Pathology. 
 
 22. Demonstration of the dependence of Digestion upon Vital Laws, 
 and to the exclusion of the Chemical, as contained in this work and in 
 the Medical and Physiological Commentaries (vol. ii., p. 79-122). 
 
 23. Demonstration embraced in these Institutes, and in the Medical 
 and Physiological Commentaries (vol. ii., p. 1-78), of the dependence of 
 Vegetable and Animal Heat upon Vital Laws, and against the Chemical 
 hypotheses. (p. 236, § 435 b). 
 
 24. Experiments relative to the Circulation in the Brain, showing that 
 the organ is depleted in Bloodletting (p. 824-828). 
 
 25. Demonstration of the dependence oi Absoiption and Circulation in 
 Plants and Animals upon Vital Laws (p. 817-824, § 1053-1055, and 
 passim). 
 
 26. Much of what herein relates to the Powers which circulate the 
 Blood, and in the Medical and Physiological Commentaries (vol. ii., p. 
 398-426). 
 
 27. The distinction between Inflammation and Fever, and what is most 
 essential in proving an active condition of the immediate instruments of 
 Inflammation, and the dependence of its different stages, and of all its 
 phases and products upon Vital Laws, as embraced in these Institutes, 
 and in the Medical and Physiological Commentaries (vol. ii., p. 141-214). 
 
 28. All herein relative to the philosophy of Venous Congestion and 
 Varix, and in Medical and Physiological Commentaries (showing that 
 venous inflammation is the pathological condition), and the proof of the de- 
 pendence of Tubercle and Scrofula upon Inflammation, and Cold as a 
 cause of Congestion, &c., in the several Appendixes to Venous Conges- 
 tion in Commentaries (vol. ii., p. 215-640). 
 
 29. Much of the Physiological bearing of organic changes incident 
 to different periods of Life upon practical medicine (p. 373-383, § 570- 
 584).
 
 920 INSTITUTES OF MEDICINE. 
 
 30. The uses and abuses of Morbid Anatomy as contained in this work 
 and in Medical and Physiological Commentaries (vol. ii., p. 641-677). 
 
 31. A generalization of the mutability of the Properties of Life, as 
 lying at the foundation of disease and of its cure, and of many natural 
 changes of organization at the different stages of life, of gestation, lacta- 
 tion, &c. Also, the doctrine of a substitution of pathological conditions by 
 llemedial Agents, thi'ough reflex nervous action, more favourable to the 
 law of recuperation than such as had been impressed by the truly mor- 
 bific causes, and their progressive nature ; and the physiological distinction 
 which the Author has drawn between remedial and morbific agents. — 
 See Index I., Vital Properties. — Index II., Kemedies ; Causes, Mor- 
 bific ; Therapeutics. 
 
 32. The demonstration of the operation oi Astringents upon Vital Prin- 
 ciples, and through reflex action of the nervous system (p. 370-378). 
 
 33. The demonstration of the operation of Tonics upon Vital Princi- 
 ples, and through reflex action of the nervous system (p. 57%-583, § SOOJ, 
 p. 676-679, § 904 c, d). 
 
 34. Attempted refutation of Theoretical Geology, and of Spontaneity of 
 Being, to which there are references at p. 908, § 1079 b, p. 910-911, 
 § 1083. 
 
 35. A critical exposure of the fallacies of the Medical Docti'ines em- 
 braced in the Writings of P. Cii. A. Louis, in Medical and Physiolog- 
 ical Commentaries (vol. ii., p. 679-815, 2xx^ passim). 
 
 36. A critical exposure of the fallacies contained in the Writings of 
 Liebig, so far as he has applied Organic Chemistry to Physiology, Pa- 
 thology, and Therapeutics (p. 147-178, p. 234-279, ixa^ passim). 
 
 37. K Therapeutical Arrangement of the Materia Medica upon Physio- 
 logical principles, and in the order of the relative therapeutical value of 
 the diflferent substances, and as applied to particular forms of disease. 
 
 38. All that is relative to the Substantive Existence and Physiology 
 of the Soul and Instinctive Principle, as embraced in this work, and 
 in the former Essay upon those subjects (See Index II, JSTote at p. 873). 
 
 39. Opinion that the Will exercises a controlling influence upon the 
 Intestine in Defecation, and as evincing a remarkable instance of Creative 
 Design, p. 325, § 500, e. 
 
 NoTE.^The foregoing specifications appeared in the Fourth Edition 
 of this work, and as the Author has seen no objections alleged that in- 
 validate any of the claims, but rather a general, or at least tacit, admis- 
 sion of them, and as they have been spontaneously republished in several 
 medical periodicals, he leaves them in this Ninth Edition without modi- 
 fication, but will add that, in regard to the term '■'■ excito-secretoi^j func- 
 tion^'' although an unimportant matter, and referring simply to the phys- 
 iological condition, he suggested the term itself in sections 514 h, 512, 
 902 g, and in many other places ; nor will he neglect saying in this con- 
 nexion that he attempted to show the influence of the sympathetic nerve 
 upon the action of the blood-vessels, and the operation of Counter-irri- 
 tants and of Leeching through reflex nervous action as early as the year 
 1834, in an article in the London Medico-Chirurgical Review. See p. 
 827, § 1056. The author has now taught the docti'ines of these 
 Institutes in the Medical Department of the University of tlie City 
 of ISTew York fpr twenty-six years. 
 New York, 18C7.
 
 SUPPLEMENT. 
 
 [The first parajTi'aph of the section with which this Supplement begins appeared 
 in the Fourtli Edition. All that follows belongs to the Fifth.] 
 
 COKKELATIO^r OF FORCES. 
 
 § 1085. An important omission was made in that part of our Ap- 
 pendix which relates to the progress of " physiological and patholog- 
 ical chemistry" (p, 779) in not havmg converted to our purposes the 
 doctrine of the " correlation of forces," to which organic chemistry, 
 in its discomfiture, is now appealing.* This fiction is equivalent to an 
 abandonment of the whole ground to the vital sohdist. It is a full 
 acknowledgment that the powers of nature, as they operate in the in- 
 organic world, are entirely inappHcable to living beings, and that the 
 assumption has become necessary that they are transmuted into some- 
 thing very difierent, but Avanting in every other shadow of proof than 
 such as rests upon mere analogies observed in the inorganic world, 
 and without any analogies between organic and inorganic beings. 
 The supposed transmutation is therefore claimed by the vital solidist 
 as his vital principle. But, curiously enough, the chemico-vitalist, in 
 accepting this assumption, contends, also, for a vital principle. Fi- 
 nally, if the vital force be a "transformation of heat," electricity, &c., 
 why is heat, electricity, &c., so conspicuously manifested as such in 
 living beings? Why not altogether converted into the supposed 
 "correlated force?" How will be reconciled with the supposed 
 " metamorphosis of heat into vital force" the prodigious elaboration 
 of absolute heat by that organic structure which is said to be the 
 medium through which "heat is transformed into vital force?" 
 Strange function this, which is simultaneously engaged in " trans- 
 forming heat into vital force" and generating heat under its usual 
 conditions ! We suppose that it will scarcely be contended that this 
 sensible caloric is also vital force, notwithstanding its complete sub- 
 mission to the vitahzing power of the whole organic being ; or, if this 
 consistency be maintained, the manifestations, by this product of or- 
 ganization, of all the usual effects of caloric, both upon dead and living 
 matter, equally consign the speculation to the same fate as is attend- 
 ing the physical forces in their less mystified application to the sci- 
 ence of life (^ 234^, h, 350, nos. 16, 17, 19, 20, 21, 37, 3761, 447^ 448), 
 On different occasions, and sometimes in the course of this work 
 (p. 180-190, § 350f e-m, p. 910-911, §1083),! have shown that it is 
 the tendency of this generalization of organic and inorganic na- 
 ture to lead to other violations of fundamental laws, of which one of 
 the most glaring is the doctrine of the spontaneity of living beings, 
 and, therefore, a fully implied denial of a Creative Power — by which 
 I mean a Power totally distinct from nature. The latter, it is true, 
 is often obtruding itself under the name of the former ; and this, I 
 apprehend, is what is intended to be implied by the common geolog- 
 * Much of the present work; is against the doctrine of "Correlation of Forces." 
 The subject is critically examined in the new edition of mv work on the Soul and In- 
 STiNCTiVK, Principlic", about to be published, 1870. — See IsTotk Ddd p. 1149.
 
 922 INSTITUTES OF MEDICINE. 
 
 ical expressions, "the developmental system," and "the progressive de- 
 velopment" of living beings, according to their rank in the scale of or- 
 ganization. Sometimes, indeed, this appears to be distinctly avowed, 
 and of which I shall present an example from a late geological work of 
 good repute to show the method in which the doctrine oi chance is tricked 
 out with the devices of "positive science," but in opposition to its 
 plainest facts and principles. Thus, it is said that, 
 
 " We are not told that the parturitive powers of the earth, when 
 they first began to be exercised, were very different from what they 
 are now. They may have been more rapid or more slow, but if it 
 Avas a real physical energy, governed by law, and not merely an arbi- 
 trary sign of a contra-natural power, it must, at least, have had a 
 harmony in its workings — such a harmony as would have required 
 that the widely varying among its diversified effects should bear some 
 ratio to the greater strength or longer duration in the cause. It 
 would not have brought out the full-formed, fuU-groMTi, and ripened 
 cedar of Lebanon in the same time it required for giving hirth to the 
 mushroom, JSTo intimation is giveii that the first groAvth, after the 
 instantaneous starting powei*, or the utterance of the creative Word, 
 was not as natural as any that followed. We are rather led to be- 
 lieve that this first growth gave the laAV to all subsequent production. 
 If the first plants or trees did not come from a previous organized 
 seed, the first seeds, at all events, grew out of the plant, and, as far 
 as the language gives tis any idea, in a similar manner, and by a 
 similar law, and in a corresponding time, or succession of times, to 
 that which regulated any subsequent seeding, or ripening, or fructifi- 
 cation of the parent organism." And, again, " There was a j^^'evious 
 nature in the eai-th, whether it had been in operation for twenty-four 
 hours or twenty-four thousand years. We may compare this to a 
 stream flowing on and having its regular current of law, or regulated 
 succession of cause and effect. Into this stream we may say there 
 was dropped a new pov'er — supernatural, yet not contra-natural, or 
 unnatural — varying the old flow, and raising it to a higher law and 
 a higher energy, yet still in harmony with it. New causations, or 
 new modifications of causation arise, and, after the successions and 
 steps required, be they longer or shorter, a world of vegetation is 
 the result of this chain of causation in the one period, and, through 
 an analogous, if not similar process, an animal creation arose in anoth- 
 er." — (The italics are mine.) — Professor Taylee Lewis' Six Days 
 of Creation, p. 206, 216. 1855. — See, also, Dabwin, p. 814, note.* 
 
 Such is the philosophy of the " typical" or " progressive develop- 
 mental system," or spontaneity of living beings. It is defective, how- 
 ever, in assuming that the same " parturitive powers of the earth" 
 which "gave birth" to the first plants and animals continue to ope- 
 rate now — and it is not true to the Sacred Record in affirming that 
 — " no intimation is given that the first growth after the instantane- 
 ous starting power, or the utterance of the creative Word, was not 
 as natural as any that followed," and then explaining away what is 
 affirmed of the first appeai'ance of the vegetable world, where it is 
 most distinctly stated, and in remarkable consistency with the creation 
 of man and animals in a state of maturity, that " the Lord God made 
 the earth and the heavens, and every plant of the field before it was 
 in the earth, and every herb of the field before it grew y for the Lord 
 * See Koi ts P p, page 1142, Q Q, page 1145, awA foot-note at p. 908.
 
 Correlation — supplement — of Forces. 923 
 
 God had not caused it to rain upon the earth, and there was not a 
 man to till the ground ;" thus, also, assigning the reasons. The au- 
 thor must, therefore, abide by his own authority. I may finally add 
 that an examination of this subject occurs in my Essay on Theoret- 
 ical Geology ^1 to which reference is made at p. 908, § 1079, b. 
 
 Organic nature is one of the greatest embarrassments with which 
 modern theoretical geology has been obliged to contend ever since 
 Dr. Buckland discovered that the trilobite is endowed with eyes, and 
 it has, accordingly, undergone many mutations as geologists have be- 
 come somewhat informed of the laws of living beings. Nevertheless, 
 such is the hidden nature of physiology, and not to be acquired by 
 any extent of anatomical knowledge without a long and laborious 
 study of the phenomena of living beings, and in their morbid as 
 well as natural aspects, the propensity remains to group the 'organic 
 world under the category of the inorganic. Examples of this nature 
 are common enough, but, to carry out still farther one of the objects 
 of the present section, I shall qiiote a paragraph from a work by the 
 distinguished Alexander Von Humboldt, who, according to President 
 Edward Everett, " owes his position in the intellectual Avorld to his 
 grasp of the whole domain of science and the majestic range of his 
 generalizations." In his generalization of the forces and phenomena 
 of nature, he undertakes, upon this scheme of philosophy as applica- 
 ble to inorganic beings, to bring the organic world within the domain 
 of that philosophy, a distinct enunciation of which occurs in his " As- 
 pects of Nature." 
 
 " Reflection and continued study in the domains of physiology and 
 chemistry," says this learned man, " have shaken my earlier belief in 
 a peculiar so-called vital force. In 1797, at the close of my work en- 
 titled ' Versuche,' etc., I already declai-ed that I by no means regard- 
 ed the existence of such peculiar vital forces as demonstrated. Since 
 that time I have no longer called peculiar forces what may possibly 
 only be the operation of the concurrent action of the several long- 
 known substances and their material forces." " I have said, in ' Cos- 
 mos,' ' The myths of imponderable matter and of vital forces peculiar 
 to each organism have complicated and perplexed the view of na- 
 ture.' " " Fai'ther on in the same volume I have said, ' In a physical 
 descrii)tion of the Universe, it should still be noticed that the same 
 substances which compose the organic forms of plants and animals 
 are also found in the inorganic crust of the Globe ; and that the same 
 forces or powers which govern inorganic matter are seen to prevail 
 in organic beings likewise, combining and decomposing the various 
 substances, regulating the forms and properties of organic tissues, 
 but acting in these cases under complicated conditions., yet xmexpect- 
 ed [unexplained ?], to which the very vague terms of vital phenom- 
 ena., operation of vital forces., have been assigned, and which have 
 been systematically grouped according to analogies more or less hap- 
 pily imagined." — p. 408-410. — Also, Instittites, p. 272, §> 447 g. 
 
 Such is the opinion of an imusually vigorous mind, and remarkably 
 enriched by an observation of nature ; and if it can be of any advan- 
 tage to the cause which he advocates, it is welcome to it. It is the 
 high authority in science which this philosopher has so justly ac- 
 quired, and the factitious importance which his opinion of organic life 
 derives from its incorporation in "the majestic range of his general-
 
 924 INSTITUTES OF MEDICINE. 
 
 izations" that have led, in part, to its introduction here. But it 
 should be considered that Von Humboldt was an unprofessional man, 
 without any recognition as a physiologist in the department of organic 
 nature, and that he was therefore rather less qualified to determine 
 the merits of the question than many others who had made it the 
 great topic of professional life, and least of all, was he entitled to em- 
 ploy his authority in speaking contemptuously of the doctrine which 
 imderlies the labours of Haller, John Hunter, Bichat, his own friend 
 John Mviller, and, I may add, of every man of note in medicine since 
 the days of Hippocrates. It should, moreover, be considered that this 
 degradation of man and other living beings formed an indispensable 
 element in our Author's plan of the generalization of nature. With- 
 out it, Cosinos could not have been written. " The view of nature" 
 would have been otherwise too much " perplexed." 
 
 Besides the disposition which I have always endeavoured to mani- 
 fest of afibrding the j^hysical school of organic nature the opportunity 
 of explaining their philosoi:)hy in their own unreserved way, I have 
 also in view, in the present case, my oft-reiterated proof that it is the 
 tendency of this generalization of the forces of nature to conduct its 
 projectors and advocates to still greater violations of physiological 
 laws, since those laAvs positively, enjoin an ascription of the "first 
 origin" of every existing species of animal and plant to a Supreme, 
 Intelligent, Creative Power. But, since this is ignored by the doc- 
 ti'ine which I am about to cite, there is necessarily an attendant im- 
 plication that man and other organic beings were " brought forth," in 
 the language of theoretical geology, " by the parturitive powers of 
 the earth ;" or, as explained physiologically, the properties impressed 
 upon matter include a certain number of a vital, " slumbermg," na- 
 ture (§ 135 d, 250f ci-f)j through which the requisite 17 or 18 ele- 
 ments were assembled together, for every species of animal and plant, 
 which then united them into an almost endless variety of precise ter- 
 nary, quaternary, &c., compounds, then arranged them into a miiltitude 
 of complex designs, developed reason and instinct, and ended by en- 
 abling man, and all mammiferous animals, and all unfledged birds, to 
 provide sustenance for themselves in their state of infancy (§ 32-57, 
 350| c-351, 1082, 1083. Also, Index I., Articles, Compositioti, Struc- 
 ture, Life, Vitalism and Solidism, Design, God and Nature, the orig- 
 inal Essay on the So^d and Instinct, p. 158-172, being an Appendix 
 on the foregoing subject, and the Essay on Theoretical Geology, 
 § 1079 i).* Plere is the intended paragraph from Cosmos, which lets 
 us farther into the philosophy of " positive science :" 
 
 " Geographical investigations regarding the ancient seat, the so- 
 called * cradle of the human race,' are not devoid of a mythical char- 
 acter." Our Author then quotes approvingly from his brother Will- 
 iam as follows: "'We do not know, either from history or from 
 authentic tradition, any period of time in which the human race has 
 not been divided into social groups. Whether the gregarious con- 
 dition was original, or of subsequent occurrence, tve have no historic 
 evidence to show. The separate mythical relations found to exist in- 
 dependently of one another in different parts of the earth appear to 
 refute the first hypothesis, and concur in ascribing the generation of 
 the whole human race to the union of one pair. The general prev- 
 alence of this myth has caused it to be regarded as a traditionary 
 
 * I have shown that man, mammiferous animals, and birds, must have been created, 
 ex necessitate rei, in a state of maturity both of mind and body. — See Note Pp p. 1142,
 
 Correlation — supplement — of Forces. 925 
 
 record transmitted from the primitive mau to his descendants. But 
 this very circumstance seems rather to prove that it has no historical 
 foundation, but has simjDly arisen from an identity in the mode of 
 intellectual conception, which has everywhere led man to adopt the 
 same conclusion regarding identical phenomena ; in the same manner 
 as many myths have doubtlessly arisen, not from any historical con- 
 nection existing between them, but rather from an identity in human 
 thought and imagination. Another e\'idence in favour of the purely 
 mythical nature of this belief is aiforded by the fact that the first 
 origin of mankind — a phenomejtion which is wholly beyond the sphere 
 of experience — is explained in perfect conformity with existing views, 
 being considered on the principle of the colonization of some desert 
 islatid or remote mountainous valley at ap>eriod xohen manhind had 
 already existed for thousands of years. It is in vain that we direct 
 our thoughts to the solution of the great pyrohlem of the first origin., 
 since man is too intimately associated with his own race and with the 
 relations of time to conceive of the existence of an individual inde- 
 pendently of a preceding generation and age. A solution of those 
 diflacult questions, which cannot be determined by inductive reason- 
 ing or by experience — whether the belief in this presumed traditional 
 condition be actually based on historical evidence, or whether mankind 
 inhabited the earth in gregarious associations from the origin of the 
 race — cannot, therefore, be determmed from any philological data, 
 and yet its elucidation ought not to be sought from other sources.' " 
 — Cosmos., vol. i., p. 355, Harper's edition. — My italics (p. 158, no. 5i). 
 We may not be surprised, therefore, that our Aiithor's generaliza- 
 tion of nature embraces Laplace's doctrine of the evolution of the 
 solar system, and as inculcated in the "Vestiges of Creation" (p. 186, 
 § 350| A-^), and now adopted, indeed^y many astronomers. The 
 subject is invested with a certain degree of physiological interest on 
 account of the constitution of the primary rocks, and the analogical 
 reasoning which may be thence carried to the spontaneity of living 
 beings from the assumed evolution of these rocks from a gaseous, 
 chaotic state, exclusively through the properties impressed upon mat- 
 ter. This I have endeavoured to expound in my Essay on Theoret- 
 ical Geology, and I recur to the subject now for the purpose of show- 
 ing the ha^-mony with which Cosmos has carried out the generaliza- 
 tion of nature, and of giving to its system all the advantages that can 
 inure from such consistency, or, on the other hand, of enabling it to 
 accept, as graciously, the penalties of any defects, and thus subserve, 
 in either case, some of the greatest truths and principles in nature and 
 Religion. The following extract embraces the doctrine : when speak- 
 ing of the origin of aerolites, he says, 
 
 " I would ask why. the elementary substances that compose one 
 group of cosmical bodies, or one planetary system, may not, in a great 
 measure, be identical ? Why should we not adopt this view, smce 
 we may conjecture "that these planetary bodies, like cdl the larger or 
 smaller agglomerated masses revolving round the sun, have been 
 thrown off from the once far more expanded solar atmosphere, and 
 been formed from vaporous rings describing their orbits round the 
 central body."— Cosmos, vol. i., p. 132.— Note Pp p. 1142. 
 
 It is not now my purpose to discuss the merits of the 3Iosaic His- 
 tory of Creation, as this is not the place, and, moreover, I have done
 
 926 INSTITUTES OF MEDICINE. 
 
 that in the Essay on Theoretical Geology. But it is appropriate to 
 remark that if the want of" experience'' disqualifies us for judging of 
 the " first origin of mankind," as intimated in one of the foregoing 
 quotations, and if Ave do not choose to accept the accomit of Revela- 
 tion as " historical," it is highly incumbent upon physiological science 
 to declare that the laws of nature utterly contradict the doctrine that 
 organic beuigs were evolved by those laws, and that they therefore 
 ])roclaim their dependence upon an Intelligent, Creative Power. In 
 the former case we have an ample amount of" experience," and if the 
 latter be admitted, all nature ceases at once to be mysterious (§ 4^ 
 5), and mystery associates itself with God alone. This doctrine of 
 " experience," it must be allowed, has been carried to the same sub- 
 ject by distinguished physiologists (§ 350f Z), but it is as applicable 
 to all the miracles and prophecies of the Old Testament, and to all 
 the most essential means upon which the authenticity of Christianity 
 depends, as to the origin of mankind ; and it Avould be quite as fatal 
 in science, and even in the ordinary pursuits of man, as it is to Relig- 
 ion. It is even possible that Humboldt would not have won laurels 
 in America had it not been for the inductive philosophy of Columbus. 
 Our Author appropriates in Cosmos the histoi'ical facts of the Old 
 Testament so fiir as they relate to simply human affairs, because it 
 alone informs us of that era of mankind, and this information was im- 
 portant to Cosmos ; and herein lies the distinction between that ex- 
 perience which is so readily accepted on the mere testimony of man, 
 and that in which man's agency is associated with Divine interposi- 
 tion, till it finally culminates in the distinction between experience 
 fmdi faith in their abstract relations.* A trust, therefore, in the mere- 
 ly historical facts of the Bible (for our Author has been defended 
 uj)onthis principle), is no propf whatever of a belief in Revelation, or 
 in its Author — no more so than the Jew's trust in the biography of 
 our Lord, as it respects His humanity, is a proof that he is a Christian. 
 It is not unusual, indeed, for the mere Pantheist to emjiloy the term 
 creator as a sort of compromise with the Theist, and even to make 
 professions of Christianity. But this has signally failed after the day 
 of novelty, and personal influence, and mutual admiration has ceased, 
 and the authors and actors have passed into history. Injustice is 
 sometimes done, as was remarkably the case with the Meligio-Medici, 
 for, although it abounds throughout with evidences of the highest 
 order of faith, yet its author incurred the charge of infidelity ; and 
 more than fifty years after his death, Avhen time had extinguished 
 animosities, Samuel Johnson thought it necessary to contribute the 
 Aveight of his mind and character to the just cause of rescuing the 
 Author's memory from this imputation, notwithstanding Browne had 
 made an able defence of himself. But it shows the strong course of 
 reason in its deliberations upon doctrines and professions. 
 
 Fmally, besides the great question of the identity of the forces and 
 laws of organic and morganic beings, the remaining object of the 
 present discussion has been equally in behalf of scientific interests, es- 
 pecially physiological ; for nothing can be more opposed to the " ex- 
 perience" upon which are founded the facts and principles in physi- 
 ology than the assumed or implied origin of living beings in the 
 forces which rule the inorganic world ; and coming to the intricate, 
 but methodical constitution of the primary rocks, the evidence of a 
 
 * He saj's in a letter to Varnhagen — " Possibly my ' Book of Nature' is not sufficient- 
 ly Christian for her Majesty," Victoria.—ZeWers, &c.
 
 Correlation — supplement — of Forces. 927 
 
 direct interposition of Creative Power in their formation is as palpa- 
 ble as in living beings, as manifested in the assembling of the numer- 
 ous elements which compose the crystalline constituents, and in the 
 methodical disposition of the three crystals in the bosom of each other 
 which make up all the granite of the globe ; or, if sometimes the three 
 be united with a fourtli, or that fourth replace one of the three in 
 other granitic rocks, the same methodical arrangement obtains ; all 
 of which, with other characteristics, concur in yielding the same kmd 
 of testimony of supernatural dependence as the composition and 
 structure of livmg objects, however probable it be in the former case 
 that there was a subordinate instrumentality of the forces and laws 
 impressed upon matter ; while, also, the nebular hypothesis, and ev- 
 ery other shape of the Plutonic doctrine, is absolutely contradicted by 
 the water w^iich enters into the composition of the primary rocks, by 
 the uniform absence of all traces of fusion among the crystals, and 
 especially, also, by the vast differences in temperature at which those 
 crystals, and that water, and the numerous metallic substances, im- 
 dergo condensation, besides an array of other facts whose introduc- 
 tion here Avould be inappropriate, but which I have considered exten- 
 sively in the Essay on Theoretical Geology. Here, therefore, is some- 
 thing for the senses, something from " experience," something demon- 
 , strable through the estabhshed facts and laws in chemistry and phys- 
 ics. Still, however, it is certainly to be expected that all who neglect 
 the facts which declare the "first origin" of man and other living be- 
 ings in an Intelligent, Creative Power, and refer their origin to the 
 powers of nature, will unhesitatingly ignore the corresponding facts 
 in their relation to the earth, and assemble the whole under a com- 
 mon generalization. A critical attention, also, to the writings of 
 those who sustain the nebular hypothesis will result in the conviction 
 that they are equally pledged to the doctrhie of the evolution of or- 
 ganic nature through the powers alone which appertain to matter. 
 
 Science, for its own sake, especially physiological science, should 
 be consistent with itself. Nor may we exclude from the interests of 
 the latter the cosmogony of the nebular hyjDothesis, for, as I have 
 shown, such is the elementary composition of the primary rocks 
 (seven elements for feldspar, ten for mica, and which, according to 
 the nebular hypothesis, must have existed, along wuth all other terres- 
 trial things, in a perfectly blended condition), and such the imiform- 
 ity and arrangement of the crystalline substances, and such, there- 
 fore, the ground for analogical reasoning, that were it conceded that 
 the main bulk of the earth was brought into its organized condition 
 by its own properties alone, it would be a vain attempt to refute the 
 doctrine of the spontaneity of living beings by any demonstrations 
 founded on their elementary composition and constituent parts. To 
 assume, as does the nebular hypothesis, and that of the spontaneity 
 of living bemgs, that the elements of matter were endowed with the 
 independent power of generating their organized conditions, is so 
 contrary to all experience (for the artificial production of crystals, or 
 as witnessed in natural progress, bears no proper analogy to the com- 
 plexity of the primary rocks), that it supposes a condition of things 
 which is equivalent to Creative Energy. It is an illusion, therefore, 
 to imagine that science divests itself of causes that elude its ambitious 
 grasp by assuming that " blind material forces" will explain the origin
 
 928 INSTITUTES OP MEDICINE. 
 
 of both living beings and the primary crystalline rocks, since, in either 
 case, it demands a condition of forces and laws which experience as- 
 sures us, and science admits, does not exist at present ; or, if it be 
 content with a simple expression of ignorance of the organizing 
 causes, from " want of experience," it is equally an admission that 
 terrestrial beings originated in causes which have no existence now, 
 and therefore not belonging to the constitution of nature. The plea 
 of a " want of experience" simply means that the causes which gave 
 origin to organic nature and the primary rocks ceased their operation 
 before the observations of men began. They have therefore no lon- 
 ger an existence; otherAvise, they would continue to operate, and 
 new animals and plants, if not granitic rocks, &c., would be present- 
 ing themselves. Science, therefore, in separating from Supernatural 
 Power convicts itself of inconsistency ; and the essential difference 
 between the supposed " parturitive power," and the co-operation of 
 Divine Power with the properties impressed upon matter, in ex- 
 pounding the problem before us, whether it respect the organization 
 of the earth or of living beings, consists in the neglect, in the former 
 case, of all the evidences of Design, and in a disposition to lean upon 
 the atheism of pantheism. But this in no respect compasses the ab- 
 stract object of the disciples of nature, for there still remains the 
 crushing fact that it is contrary to all " experience," to all that is 
 known of nature, to sujjpose that living beings, or the primitive 
 earth, emerged from the elements of matter without at the same time 
 supi^osing that some supernatural agency was concerned in the works. 
 In the one case, therefore, science stultifies itself, while, in yielding 
 to the agency of an Intelligent Creative Power, it simply obeys the 
 exigencies of the facts and the dictates of that reason which j^roftsses 
 to be a rude imitator of some of the Designs which challenge its faith 
 in a higher order of Reason (^ 350f /-z, I, 1079 h, 1083).* 
 
 The Glycogenic Function of the Liver. 
 
 § 1086. Among the subjects discussed in the Aj^pendix to this 
 work is the important one of the supposed glycogenic function of the 
 liver. Had this anomalous complication of functions, with all its 
 other attendant joeculiarities, been attributed to the liver only, it 
 would have been more diflicult to have arrived at the real facts in 
 the case. But the discoverer has recently not a little invalidated the 
 plausible experiments which had conducted him to his conclusions by 
 assigning this same function to the placenta " during the early period 
 of foetal life." This appears to have been a kind of corollary from 
 the imputed function of the fully-develoijed liver and its immaturity 
 during the early period of foetal life, but resting upon experimental 
 observation. That such a coincidence should exist between two or- 
 gans so differently constituted, and whose principal offices are so dis- 
 similar in the economy of life, may well raise our admiration ; and 
 this the more so, as the glycogenic function of the placenta is said to 
 disappear, along with its special anatomical provision, as soon as the 
 foetal liver has advanced to a maturer development. Nature, there- 
 fore, to be consistent in this remarkable scheme, should have allotted, 
 also, to "the transitory glandular or epithelial element of the pla- 
 centa," as to the mature liver, the vicarious function of secreting 
 bile; and hence, should the glycogenic function be established, and 
 * See NoTKs Pp p. 1142, Qq p. 1145.
 
 Cause of — supplement — Blood's fluidity. 929 
 
 the exact disappearance of the glandular element Avhen it is no longer 
 necessary to the exigencies of fcetal life, we may expect to hear from 
 the eminent physiologist that he has demonstrated the co-existence 
 of the tAVO hepatic functions in the placenta. But the original sup- 
 position relative to the liver was apparently encumbered with diffi- 
 culties, as was shown in sections 1031-1033, and the "vicarious" na- 
 ture of the supposed temporary office of the placenta Avoiild seem to 
 belong to the category of the " vicarious spermatozoa," as represent- 
 ed in section 83 b, or to what is perhaps more analogous in § 493 c. 
 
 The Cause of the Blood'' s Fluidity. 
 
 § 1087. It Avas a very ingenious, and so far as appearances went, 
 a plausible demonstration of Dr. Richardson's, in his prize essay, that 
 the blood owes its fluidity to the presence of ammonia. This is a 
 question, however, not to be determined by chemical exiDcriments, or 
 by any other outside of the living body. If experiments with j)ep- 
 sin, or the " digestive mixture," could not stand the test of organic 
 philosophy, nor even of experimental philosophy (p. 781, § 1029), 
 it was scarcely probable that those would long endure by which 
 the new doctrine of the blood's fluidity was very plausibly com- 
 mended to the attention of the physiological world ; and the only 
 ajsparent objection about it was, that it did not insist that the heart 
 and blood-vessels are stimulated into action by the solvent princij^le 
 of the blood. It may have been foreseen that such a theory would 
 imply great fluctuations beyond the standard frequency of the pulse, 
 according to the variable proportions of ammonia. But it is at 
 least certain that, whenever such experiments have been attempt- 
 ed upon this organic, living, complex fluid, whatever their nature, 
 they have been shown to be fallacious, and such has been the early 
 fate of this new hypothesis in the hands of Briick and Zimmermann, 
 the former particularly sustaining the Hunterian theory that the 
 fluidity is owing to a vivifying influence exerted upon the blood by 
 the sanguiferous organs, while the latter very justly supposes that 
 the coagulation of abstracted blood is due to chemical transforma- 
 tions. These transformations are prevented, while the blood is cir- 
 culating, by the influences of the blood-vessels which maintain its 
 vitality. When those influences are withdrawn, the oxygen and 
 other elements of the fluid pass very quickly under the operation of 
 chemical affinities, as set forth in section 54 a. I may finally add 
 that, when the various characteristics of the blood, such of them as 
 are represented in many parts of this work, as in sections 688 ee, 
 846, 847, 952, 953, are duly considered, it must be admitted that such 
 phenomena evince the dependence of the blood's fluidity upon a cause 
 appertaining to the constitution of the blood itself, while other ob- 
 vious considerations place it beyond doubt that so important a con- 
 ■dition of the pahulu^n vitm is not committed to the physical action 
 of any one of its constantly-fluctuating constituents ; for if ammo- 
 nia be truly one of them, it must be as liable to variations, at least 
 in proportions, as the serum, globules, etc., and the fluidity of the 
 blood, therefore, exposed to the same instability. Richardson's clever 
 observations have been accepted by other physiologists ; but they 
 are a part of the " experimental philosophy" of the day, whose facti- 
 tious analogies have been so extensively and powerfully arrayed
 
 930 INSTITUTES OF MEDICINE. 
 
 against the great laws of organic beings, and tlie subject is intro- 
 duced here as tributary to the objects of these Institutes. — See Hu- 
 moral Pathology, Index II. 
 
 THE MODUS OPERANDI OF REMEDIES. 
 
 § 1088 a. As principles and sound analogy, the great ends of sci- 
 ence and the basis of the healing art, are of very secondary mo- 
 ment Avith the speculative as "svell as the practical masses of man- 
 kind, a demand is apt to be made for specific demonstrations of 
 every problem that may arise in the vast range of observation. It is 
 not enough, for example, that it be shown of a thousand things that 
 they exert their morbific or remedial eftects through natural physio- 
 logical laws, and that when their influences extend to parts remote 
 from the seat of their application it is through the medium of the 
 nervous system. Each particular fact must be settled experimentally 
 as if it had no law govei'iiing its condition. This propensity must be 
 gratified, and it Avill doubtless end, also, in satisfying all that organic 
 nature is perfectly consistent, throughout its mutations, in all its laws 
 and principles. 
 
 The foregoing considerations lead me into a farther proof that cer- 
 tain substances, particularly arsenic and strychnine, Avhich are sup- 
 posed to exert their eftects by absorption, have been again shown to 
 be incapable of detection within the organism when administered in 
 poisonous doses. Two cases of this nature, where large quantities of 
 strychnine (two scruples in one of them), and six experiments upon 
 animals by poisoning with the same substance, are related by Dr. 
 Alfred S.Taylor in Guy's Hospital Reports (1856, vol. ii), in which 
 none of the poison could be detected in the blood or tissues. Another 
 case is related in the same Reports (1857, vol. iii), in which Prof. 
 Christison, and Dr. Maclagan of Edinburgh, and Prof Geoghegan of 
 Dublin, to Avhom parts of the body were sent, and Dr. Taylor, failed 
 of detecting the })oison. Here occurs, also, the case of Rev. Dr. Alex- 
 ander, who died from poisoning by arsenic, but in whom none of the 
 metal could be found. 
 
 Absorption by the Skin. 
 
 § 1088 b. Experiments, also, showing that the skin in its natural 
 condition absorbs nothing, even in a state of solution, continue to be 
 multiplied ; and yet we are constantly told in the books that remedies 
 applied to this organ produce their eftects by absorption into the cir- 
 culation. Let us have, therefore, some of the late, reiterated experi- 
 ments in reference to this question. Thus, it is stated m the report 
 on Physiology in the London Medico- Chinirgical Meview for Jan., 
 1857, that, 
 
 " The inferences regarding the absorption of saline or organic sub- 
 stances dissolved in water (in Duriau's experiments vdXh the Avarni- 
 bath) are based on the examination of the urine before and after the 
 use of the bath. Iodine and ferrocyanide of potassium, carbonate of 
 potash, sulphate of quinia, and other salts, were employed. The re- 
 action of the urine after the bath Avas always alkaline, even Avhen 
 nitric ac/fHiad been added to the bath. Potash and soda Avere the 
 only bases found in the urine — no trace of iodine, cyanogen, ttc. 
 
 "Poulet draAvs the folloA\Thg inferences from his experiments: 1.
 
 Modus operandi — supplement — of Remedies. 931 
 
 That the urine becomes alkaline after acid, as Avell as after alkaline 
 baths. 2. After friction of the skin with a solution of tartrate of an- 
 timony or extract of belladonna, &c., none of these substances Avere 
 found in the urine. 3. The skin absorbs, therefore, neither water (?) 
 nor substances dissolved in it, as long as the epidermis is entire. 
 
 " Kletzinsky's experiments likewise confirm the non-absorption of 
 salts through the healthy epidermis." — See Index 11.^ Articles Hu- 
 iiORAL Pathology, Skix, Cold, Counter-IrPvItants, Setox, Plas- 
 ters, Remedies. Also, Experiments, § 481-484, 494 h-e, 
 
 § 1088 c. It is worthy of remark, however, that experiments of the 
 foregoing negative character have little influence upon doctrines of 
 so much simplicity, and of such comprehensive and ready application 
 in pathology and therapeutics as humoralism and the operation of 
 remedies by absorption. It therefore continues, as ever, to be a pre- 
 vailing belief that, among other things, the numerous preparations of 
 mercury are absorbed both by the skin and the intestinal canal, and, 
 entering the circulation, not only thus accomplish their effects, but be- 
 come deposited in the tissues (§ 851). Thus lodged in the system, 
 they are supposed to inflict the manifold evils that are due to vicious 
 habits, or other foreign causes. But the most curious circumstance 
 attending this hypothesis, and which must not be omitted in this rec- 
 ord of " experimental philosophy," a practice has obtained extensive- 
 ly of immersing these subjects in iodine baths, for the purjiose of dis- 
 lodging the supposed offender. But the facts being against the phi- 
 losophy, at least as it respects the skin, and as iodine baths have been 
 said to effect the liberation of mercury from the system at long inter- 
 vals after the administration of the latter remedy, we may safely con- 
 clude that what has been asserted by Professor Lorinser, and others, 
 of a similar effect by the internal use of iodine, is equally a mistake, 
 especially when connected with the various facts which I have alleged 
 against the supposed absorption of mercury. 
 
 Nevertheless, it may be said that negative facts cannot contradict 
 the affirmative. But, in the first place, are the affirmative reliable 
 (§ 5^-6) ? Are not the senses apt to be deceived by preconceived 
 hypotheses ? Why, if many remedies of a very irritating nature op- 
 erate by absorption, do they not manifest their action upon the heart 
 as readily as upon organs that are incomparably less irritable (§ 829) ? 
 Is not this consideration alone an insuperable objection to the hypoth- 
 esis of absorption ? If it be answered that reflex actions of the nerv- 
 ous system excited by remedial agents should, in conformity with the 
 principles which I have advanced, be equally liable to aflfect the heart, 
 it would only evince an ignorance of the most obvious laws of the 
 nervous system, and which, in this aspect of their remarkable charac- 
 teristics, I have endeavoured to illustrate in former sections (§ 233| ; 
 500y, it, m, &c.). The wonderful endowment of the nervous system by 
 which it receives and reflects impressions upon particular parts and 
 avoids all other parts, according to the nature of the exciting cause 
 and other special circumstances, readily explains, and can alone ex- 
 plain, the phenomenon in question, especially considering its remark- 
 able frequency. And here I may add to what I have said of the op- 
 eration of ansesthetics through reflex action of the nervous system, 
 that the law of elective influence (§ 233|, 500 J, X;, &c.) explains com- 
 pletely the limitation of their effects to the organs of animal life, while
 
 932 INSTITUTES OF MEDICINE. 
 
 the doctrine of absorj^tion is contradicted by that limitation (§ 827 5, 
 1066), as is the doctrine in its broadest sense by local diseases. 
 
 Finally, the foregoing negative observations (§ 1088 a, h) are as 
 good, at least, as the affirmative ; and since, therefore, it is thus shown 
 that many remedies that have been supposed to always operate by 
 absorption do sometimes produce their effects upon various parts 
 without being taken into the circulation, and therefore by no other 
 conceivable method than that which I have indicated, the consistency 
 of the laws of nature is such as to assure us that the same remedies 
 always exert their eflects upon parts remote from their seat of appli- 
 cation through alterative influences of reflex action of the nervous 
 system, and that, if they be sometimes absorbed, the present and fore- 
 going considerations, as well as a multitude of others which occur in 
 this work, equally assure us that they are admitted in such small 
 quantities as to produce no efi'ect whatever, not even upon the very 
 irritable heart. (See Index II., Ai-ticles Remedies, Reflex Actio:n^, 
 Nervous Power, &c.) — Note Aaa p. 1146. 
 
 Transfusion of Remedies into the Circidation. 
 § 1088. d. The foregoing sections upon absorption will remind some 
 of our readers of an experiment performed a few years ago by Prof. 
 Buckheim, of uijecting a solution of about half an ounce of sulphate 
 of soda in two ounces of water into the jugular vein of two dogs 
 Avithout any efiect upon the intestine, while both animals were purged 
 freely by the same dose when administered by the mouth. The dem- 
 onstration is, of course, conclusive against the prevailing doctrine of 
 operation of cathartics by absorption, and jjroves that they exert 
 their direct efifects upon the mucous coat of the intestine, and by re- 
 flex action of the nervous system upon the muscular coat, and ujDon 
 all other parts that may feel their influence. In the present case 
 there is not only the assurance arising from the foilure of the injected 
 substance to excite the slightest action in the intestinal canal, but the 
 interpretation supplied by the exciting efiect of the nervous influence 
 Avhen reflected upon the intestinal muscular tissue through the direct 
 irritation of the mucous when the cathartic was swallowed ; since, no 
 action being manifested in the case of the injection, all the results 
 from swalloAving the agent must, of necessity, be referred to the same 
 causation that increased the peristaltic movements (§ 889 a). But 
 these are facts which lie in the depths of philosophical medicine. To 
 be duly appreciated there must have been a laborious study of the 
 profound laws in physiology, especially such as are relative to the 
 nervous system in its coimection with organic functions. In any 
 event, the experiments cannot fail of estabhshing the conviction that 
 remedies do not operate by absorption, and sustain my conclusions 
 as to the fallacious nature of this kind of " experimental philosophy" 
 (§ 830-837). Also, Index II., Articles, Cathartics; Oil, Castor; 
 Humoral Pathology.) 
 
 AbsorjJtion tliroucjli the Epithelial Cells of the Intestinal Tube, and 
 Lacteal Circidation. 
 
 § 1089. The folloAving observations, so far as they go, corroborate 
 the doctrines in this work (§ 275-294, &c.), and in the Medical and 
 Physiological Commentai-ies, upon the subject of endosmose and ex-
 
 Absorption by — supplement — Epithelial Cells. 933 
 
 osmose, and more particularly the manner in which substances are 
 taken up by the absorbents. 
 
 " Von Wittich," says the London Medico-Chirurgical Review for 
 July, 1857, "contributes an observation of great importance regard- 
 ing the question at issue (the passage of solid molecules through the 
 epithelial cells of the intestinal tube). A rabbit killed (by bleeding) 
 six hours after it had been bitten in the back by a dog, and thus de- 
 prived of the use of his posterior limbs, exhibited the chyliferous 
 vessels originating from the lower half of the ileum filled with an en- 
 tirely red fiuid. This redness was shown to be caused merely by the 
 admixture of the red blood-globules in a large proportion, not by that 
 of coloring matter. The corresponding part of the intestinal tube 
 contained mucus mixed with blood, after the removal of which the 
 mucous membrane manifested the ajipearance of fine red dots, which, 
 by means of a lens, were recognized as villi filled with blood. Yon 
 Wittich does not hesitate to explain this state of things by adopting 
 the view, that the blood-globules pass as such through the epithelial 
 cells and the parenchyma of the villi into the chyliferous vessels ; but 
 is of a similar opinion regarding the entrance of fat and other mi- 
 nutely divided solid substances into the absorbent vessels." He 
 found the same true, also, of the chyliferous vessels of the caecum. 
 
 The foregoing observations had been recently made by others, one 
 of whom I shall quote upon the particular question, for the sake of 
 other facts, as related in the Med. Chir. Bev. for January, 1854. 
 
 " Briicke states, as the result of his observations and experiments 
 (on man, swme, and other mammalia), that the cylindrical epithelial 
 cells of the mucous membrane of the intestmes, through which the 
 chyle i^asses on its way to the lacteal vessels, do not, as is generally 
 supposed, consist of a closed cavity surrounded by a complete mem- 
 brane, but that this cavity is isolated from the intestinal tube merely 
 by a thin layer of a mucilaginous substance. Briicke asserts also that 
 they possess a small opening on their opposite side, through which 
 the molecules of fat pass into the interior of the villi" (§ 295). And 
 he goes so far as to say that one of " the mechanical means for the 
 movement of the chyle is the muscular contractions of the intestinal 
 tube by which the chyle is pressed into the villi." Why not, then, 
 other tinngs " pressed in ;" and is not the analogy supplied by plants 
 of some application here? (§ 289-291, p. 166, §350, nos. 26^, 2V, the 
 parallel columjis, 826 a.) It is an important and sound conclusion, 
 however, and in which Von Wittich and Moleschott agree A^dth 
 Briicke, in opposition to the prevailing doctrine (§ 1054-1055), that, 
 "When the villi are filled, their muscular fibres contract, and the 
 fluid they contain is jiressed into the channels l}^ng between the mu- 
 cous and submucous membranes," and that, " from the lacteals with- 
 in the Avails of the intestmes the chyle is propelled by means of the 
 muscular contractions of the tubes into the vessels of the mesentery, 
 from Avhence it is pumped up by means of the respiratory actions 
 into the thoracic duct;" or rather, as I have endeavoured to show, 
 " pumped up" by the derivative or suction power of the right cavi- 
 ties of the heart. {Indexes., Cieculatioi^ of the Blood, Lacteals, 
 Veins.) 
 
 In all the discussions upon the foregoing subject Ave hear nothing 
 of the intestinal A^eins being concerned in the function of absorption,
 
 934 INSTITUTES OF MEDICINE. 
 
 although this is as mucli a matter of general belief as in Magendie's 
 day (269, 829). 
 
 Doubtless, the essential fact relative to the intestinal villi was well 
 ascertained by Mr. Cruikshank, in the presence of Mr, Hunter, whose 
 statement I quoted in the Med. and Physiolog. Comni. (1840), that 
 they had seen the villi distended with chyle, and had no difficulty in 
 f-eeiug the open orifices. I shall also repeat here, for pathological as 
 well as physiological purposes, a quotation which I made, in the arti- 
 cle upon Endosmose and Exosmose (vol. i.), from R. Jackson on 
 Febrile Diseases. Thus : " R. Jackson, in speakmg of the enlarged 
 blood-vessels of the villous coat of the intestmes (in yellow fever), 
 remarks that 'in some instances the mouths of the canals Avere visi- 
 ble at different x>oints in the interior surface, yielding a dark-coloured 
 liuid by pressure.' Again : ' The mouths of ducts — not blood-vessels 
 — were discovered on the interior of the colon, containing a dark-col- 
 oured fluid,' ' Proceedmg farther with the investigation, similar ca- 
 nals discharging a tar-like fluid into the interior of the stomach, more 
 especially near the i;pper orifice, were in like manner discovered in 
 almost all cases where black vomiting had been a consj^icuous symp- 
 tom of the disease. The appearances were noted, and they were oft- 
 en verified by inspection,' As to the open termination of the villi, 
 we are not insensible of our solitary position, since it is stated m the 
 British and Foreign Med. Revieio that ' almost every modern phys- 
 iologist has now abandoned the idea that the absorbents commence 
 by open mouths on the villous coat of the intestines,' This opinion 
 we are certainly bound to respect so far as it is supported hj any 
 facts, or is not contradicted by others," — Medical and Physiological 
 Commentaries., nt supra. — Also, Institutes § 275. 
 
 The Forces which Circidate the Blood. 
 
 § 1090, The foUowiug quotation is made from the British and 
 Foreign Med. Chirurg. Review of January, 1859, simply for the rea- 
 son that it sustams several of the principal conclusions set forth in 
 this Avork, and originally in the Medical and Physiological Com- 
 mentaries upon the important subject of the forces by which the 
 blood is circulated. See Index U., article Circidation of the Blood. 
 
 " Nelson considers the diastole of the heart as the effect of an act- 
 ive movement. He assumes that the heart muscles, imlike voluntary 
 muscles, are possessed of a double power — that of expansion as Avell 
 as of contraction. The distention of the ventricles, the Author says, 
 'is an active and inherent force,' The mechanical forces actmg on 
 the movement of the blood in the veins are: 1, That furnished by 
 the heart and arteries ; 2, That by the pleural vacuum of the thorax ; 
 and, 3, The expansive power of the auricle," These, however, are 
 only a part of the forces concerned, nor do I suppose that the expan- 
 sion of the thorax is much of an element, as I endeavoured to show 
 m the 3Iedical and Physiological Commentaries. 
 
 As to Oesterreicher's old experiment of placing a heavy weiglit upon 
 the heart of a frog and deducing from it the important conclusion that 
 the dilatation of the organ is not an active movement, and which con- 
 tinues to be quoted as an unquestioned authority, I show in the Com- 
 mentaries that the experiment proves exactly the contrary. — Med. and 
 Physiolofi. Comm., vol. ii., p. 399-402. Also, Notk Bb p. 1131. 
 
 New York, 185'J.
 
 INDEX I. 
 
 A. 
 
 A.BS3RBENTS, 
 
 consist of the lacteals and lymphatics ; 
 one for formative, the other for de- 
 structive purposes, p. 129, ^ 273. 
 See, also, Veins, Tissues, and Ab- 
 sorption. 
 Absorption, 
 
 description of the function, &c., p. 
 128-134, ^ 268-295. 
 
 comparative view of its physical philos- 
 ophy with that of digestion, animal 
 heat, bloodletting, humoralism, in- 
 flammation, &c., p. 99, () 192 ; p. 132, 
 133, i) 289-292; p. 197, ^ 362; p. 
 238, ^ 438 b-d ; § 556, <J 699 c ; p. 
 482, ^ 744 ; p. 484, ij 748 ; § 837, 
 >!» 823 ; § 841, () 863 e ; § 873, f) 906 
 a ; §90466, (} 909, 910, 1088-1089. 
 
 of unnatural agents, depends upon 
 morbid changes in irritability, p. 99, 
 ^ 192; p. 129-134, (> 277-295; p. 
 519-521, () 826-827 ; p. 677, () 904 c. 
 
 operates universally through the lym- 
 phatics, and without the aid of any 
 specific stimulus, p. 46, (J 74 a, but 
 requires a specific stimulus in the 
 lacteals. See Nutrition. 
 Aconite, Atropia, Strychni.v, Hydro- 
 cyanic Acid, Carbonic Acid Gas, 
 Nitrous Oxide Gas, Sulphuric 
 Ether, Tobacco, &c. 
 
 their effects upon organic life, and 
 mode of operation, p. 66, 67, ^ 143, 
 148-151 ; p. 318-321, () 493 (i-494 ; 
 p. 415-418, (} 648 c-652 c; p. 420, 
 ^ 654 a ; p. 522-525, () 827 6-828 c ; 
 p. 672-674, 4 904 6. 
 Adaptation, Law of, 
 
 propounded by the author in a series 
 of propositions, p. 45, i}73 a; p. 46, 
 ^ 74 a ; p. 58, 59, (J 129 ; p. 61-63, 
 <} 136-137 ; p. 65, 66, () 143 ; p. 67, 
 68, ^ 149-152 ; p. 69, () 156 b, and 
 references there ; p. 89, <J 188 a ; p. 
 90, ^ 188^ a-c; p. 93-95, ^ 188^ d 
 p. 98, () 191 a, b; p. 99, M92 ; p 
 101, 102, () 201-203 ; p. 107, ^ 226 
 p. 110, 111, i5> 233-233| ; p. 330, 331 
 () 500 nn,o; p. 350-361,^524^529 ; p 
 430-433, § 675 ; p. 531, <J 837 cc-839 
 p. 535-539, ^ 847-849 ; p. 542, <J 843 
 c, d ; p. 545, () 859 6 ; p. 553, ^ 870 
 aa; p. 555, () 872 a; p. 561, 562, ^ 
 888 a-d ; p. 565, 566, (} 889 p-k ; p. 
 570, 1^889 n; p. 580, 581, (^ 890^ e; p. 
 582-585, (i 890^-591 e; p. 586-588, 
 
 Adaptation, Law of — continued. 
 
 (j 891 g-l; p. 592, 593, () 891 J k; p 
 597, ij 892 c; p. 601, ^ 892 g ; p. 
 605, (j 892 m-p ; p. 607, i) 892 r ; p. 
 613, § 892^ 6, c ; p. 624, ^ 892§ d; 
 p. 629, ^ 892| s ; p. 632, ^ 892^ c ; 
 p. 633-642, ^ 892| a-i ; p. 644-650, 
 \ 893 c-i; p. 658-660, \ 893 p-r ; p. 
 662-664, § 895-899 ; p. 669, ^ 902 
 h, i ; p. 670, i) 902 m ; p. 679-683, 
 <^ 905 ; p. 684-688, ^ 905^ 6, c ; p. 
 692-694, <J 914-923 6; p. 698-709, 
 ^ 929-951. 
 
 Adhesion. See Inflammation. 
 
 Adult Age, 
 
 its physiological and moral character 
 istics, p. 380-381, ^ 579. 
 
 Affinity, Vital. See Vital Affinity. 
 
 Age, 
 
 its physiological and moral character- 
 istics, p. 373-383, ^ 574-584. 
 
 Alimentary Canal, 
 
 experiments to determine the Principle 
 uponwhich its Action depends, p. 315 
 
 Allotropism, 
 
 applied to illustrate the philosophy of 
 life, p. 99, ^91 d. 
 
 Alston, Dr. (1733) — shows that opium is 
 not absorbed, but acts through nerv- 
 ous system, p. 308, ^ 484, a, b. 
 
 Alvine Discharges, 
 
 in their relation to disease, p. 452-455, 
 ^ 694, 6941 . 
 
 Alkaloids of Cinchona, 
 their therapeutical uses, p. 593-607. 
 
 Alteratives, 
 
 all things such, moral and physical, 
 which are capable of changing the 
 existing condition of the vital states, 
 p. 542, () 854 c ; p. 662-665, ^ 895- 
 901. 
 in large doses or degrees their reme- 
 dial or morbific effects may be speedy 
 and profound ; in small and frequent- 
 ly-repeated doses or degrees, the 
 same effects may be only gradually 
 established, in conformity with the 
 fundamental plan of organic nature, 
 p. 89, 90, ^ 188-188^ 6; p. 107-110. 
 () 226-232 ; p. 122, (j 240 ; p. 210, (j 
 387 ; p. 214-217, () 393-399 ; p. 222- 
 227, () 409 c-411 ; p. 230-232, () 421- 
 424; p. 250, 251, () 441 c; p. 260- 
 265, (j 445-447 6 ; p. 272, 273, ^ 447 
 h; p. 280, ^ 449 d; p. 283-287, (j 452- 
 458 ; p. 290, <J 462, 463 ; p. 295, (J 
 476 a ; p. 323-332, ^ 498 /-500 ; p
 
 936 
 
 INDEX. 
 
 Alteratives — continued. 
 
 335-341, () 512-514; P. S^-^:, 345, 
 
 (J 516 d, No. 6 ; p. 364^369, () 546- 
 564 ; p. 423, «J 659, 660 ; p. 426, (J 
 666 ; p. 428, i) 672 ; p. 541, (^ 854 a, 
 h ; p. 542, (} 854 c-c ; p. 544, ^ 857 ; 
 p. 545, ^ 859 b ; p. 547, (} 863 d ; p. 
 547-550, () 863 b-c ; p. 552, ^ 867 ; 
 p. 554, () 871 ; p. 556, '557, ^ 873 ; p. 
 562, 6 888 e ; p. 567-569, ^ 889 l- 
 vim ; 'p. 577, ^ 890 o ; p. 579 ; p. 
 598-600, {) 892 d ; p. 662-665, ^ 895- 
 901 ; p. 666-670, ^ 902 c-m ; p. 679- 
 681, § 905 ; p. 703-711, ^ 940-952 ; 
 p. 724, ^ 961 a; p. 726, ^ 961 c-e ; 
 p. 732, 733, () 973-974. 
 Anaemia — a dogma in humoralism, ^ 487 
 
 k, 569 d, 836, 843, 961, 1007 6. 
 Analogies, 
 
 between Animals and Plants. See 
 Plants. 
 
 between semen and all other vital 
 agents, p. 44-49, () 72-80 ; p. 84, ^ 
 175 b; p. 331, () 500 o. 
 
 between the nervous power and all 
 other vital agents, p. 107-1 U,^ 226- 
 2331 ; p. 662, 663, ^ 896. See, also. 
 Nervous Power. 
 
 between Vital Principle and Mind and 
 Instinct, p. 84, ^ 175 b; p. 88, ^ 183, 
 184; p. 89, ^ 186; p. 98, ^ 191 c; 
 p. 112-125, ^ 234-246 ; p. 370, ^ 567, 
 568. 
 
 between Vital Properties, p. 97-99, ^ 
 190-191 ; p. 100, ^ 197-200 ; p. 102, 
 <} 203 ; p. 104, ^ 215 ; p. 105, () 220 ; 
 p. 107-110, § 225-232; p. 112, (J 
 234 i.. 
 
 remote, but illustrative, between the 
 Vital Principle and the " Imponder- 
 ables," p. 92-95, ^ 188^ d; p. 112- 
 122, (} 234-238. 
 
 between all Physical and Moral Causes, 
 in their relation to Life, p. 44-49, ^ 
 72-80 ; p. 62-68, ^ 136-152 ; p. 84, 
 ^ 157 i, c ; p. 92-95, ^ 188 J- d ; p. 96, 
 <J 189 c ; p. 97, ^ 190 ; p. 104, (} 215 ; 
 p. 107-111, ^ 225-2331 ; p. 113-122, 
 ^ 234-240 ; p. 250, 251, ^ 441 c ; p. 
 296, () 476 c ; p. 323-332, {) 500 ; p. 
 356-358, {)526d; p. 363-370, (/ 535- 
 568; p. 405-412, ^ 638; p. 543, ^ 
 857 ; p. 577, ^ 890 o ; p. 579, 580, ^ 
 890^ d; p. 597, ^ 892 c; p. 631, (} 
 8921 ; p. 645-647, ^ 893 c, d ; p. 
 662-665, 1^895-901 ; p. 669, i) 902 h; 
 p. 670, ^ 902 m ; p. 679-683, ^ 905 ; 
 692-694, ^ 914-923 b; p. 698-709, 
 iji 929-951. See, also. Remedial Ac- 
 tion and Vital Agents. 
 Analogies, False, 
 
 productive of error, p. 10, ^ 5^ a; p. 
 43, 1^ 67; p. 84, ii 175 c; p. 90-95, 
 <) 188 d ; p. 132, 133, <;> 289-292 ; p. 
 157-173, I) 350; p. 182, (} 350J g; 
 
 Analogies, False — continued. 
 
 p. 238-245, § 438 i-440 e; p. 518, 
 519, () 823, 824. 
 Analogy, 
 
 the great basis of science, p. 12, <) 5^ 
 /; p. 183, ^ 350 gg. 
 Analysis, Chemical, 
 
 its limits, p. 14, ^ 6 ; p. 15, <J 14 J ; p. 
 16, (J 15; p. 18, (J 18 d; p. 24, <^ 42 ; 
 p. 25, <J 44 ; p. 27-29, (} 53, 54 ; p. 
 221, 222, <) 409 b ; p. 228, <J 417 a. 
 Anastomosis, 
 
 its uses, p.53, «J 94 ; p. 54, 55, ^ 109-1 17. 
 Anatomy, 
 
 uses of, p. 3, (J 2 ; p. 50-73, ^ 83-163. 
 
 the basis of medicine, p. 3, ij 2 c ; p. 
 50-73, ^ 83-163. 
 
 teaches nothing, per se, in physiology, 
 pathology, or therapeutics, p. 3, ^ 2 
 c; p. 50, ^ 83 c; p. 59, 60, 6 131. 
 Anatomy, Morbid, 
 
 its uses, &:c., p. 456-463. 
 Animalcula, 
 
 their uses, p. 15, <J 14 b. 
 Animals, Food of, 
 
 of an organic nature, p. 16, i^ 17; p. 
 17-20, <) 18. 
 
 can not be indicated by chemical analy- 
 sis, p. 17-20, M8; P- 219-222, § 
 409; p. 235, ^ 433. See, also, 
 Plants. 
 Animal Functions, p. 280-362, § 450- 
 534. 
 
 consist of Sensation, Sympathy, Volun- 
 tary Motion, and the mental and in- 
 stinctive, p. 125, ^ 250. 
 Animal. Heat, 
 
 organic, and chemical, philosophy of, 
 p. 234-279, () 433-448. 
 
 chemical basis of, p. 238, (j 438 h-d , 
 p. 276, 277, M*'''^/ 
 
 organic basis of, p. 271, ^ 447/; p. 
 273, () 447 h; p. 662, 663, () 896. 
 See, also. Combustion, 
 Animal Kingdom, 
 
 dependent on the inorganic, p. 15, ^ 9 : 
 p. 16, {)Uc; p. 23, (j 35, 37 ; p. 24 
 () 41, 42 ; p. 25, ^3 ; p. 135-138, (, 
 300-303i. 
 
 dependent on the vegetable kingdom, 
 p. 15, ^ 10, 13, 14; p. 16, (^11; p. 
 135-139, ^ 300-303i. 
 
 its pecuhar properties^ p. 88, ^ 184 ; p. 
 106, ^ 223. See, also, Sensibility. 
 and Nervous Power, and Sensa- 
 tion and Sympathy, and Plants. 
 Animal Life, 
 
 founded upon organic life, p. 53, ij 98- 
 
 103; p. 54, (j 108, 110, 111 ; p. 55, 
 
 ij 114-117; p. 143-146, () 322-326. 
 
 See, also. Life, and Organic Life. 
 
 Animal Magnetism, 
 
 who its advocates are, p. 77, ij 167 /; 
 p. 187, {) 350| kk ; p. 534, ^ 844 ; and 
 British and Foreign Medioai, Rk
 
 INDEX. 
 
 937 
 
 Animal Magnetism — continued. 
 
 VIEW, Oct., 1846, p. 475-487. Also, 
 ibid., p. 428-458, or Medicine Relaps- 
 ing into the Dark Ages. 
 its deceptive nature, p. 77, ^167 /, 
 
 7iote. 
 how it may sometimes operate, p. 534, 
 
 ^ 844. 
 hearing, seeing, tasting, one or all, 
 show that perception is awake, and 
 that the skin, nerves, &c., equally 
 feel when cut, pricked, &c., or when 
 teeth are extracted ; while connected 
 speech evinces the fuU operation of 
 the will, judgment, reflection, per- 
 ception, memory, the understand- 
 ing. That is a test, as are, also, 
 the established laws in Physiology, 
 p. 77, note. Consult, likewise, the 
 physiological law as pronounced in 
 the harmonious and progressive de- 
 velopment of all the senses in in- 
 fancy, and Somnambulism, and Rea- 
 son. 
 firmness of purpose and mental ex- 
 citement will enable most people, 
 especially in health, to endure suf- 
 fering without complaint. The for- 
 mer operates through the will alone, 
 and does not diminish or prevent 
 suffering ; the latter by subduing 
 common sensibility, and thus remov- 
 ing and even preventing pain, as 
 seen in subsidence of toothache at 
 the approach of the dentist, and in 
 the subsequent little suffering inci- 
 dent, to the operation of extraction, 
 p. 77, note ; p. 124, ^ 243 ; p. 534, § 
 844; p. 588, 589, ^ 891 m. See, 
 also, Sensibility, Sensation, and 
 the Nervous Power. 
 
 Animals and Plants, 
 their fundamental distinction, p. 15, (} 
 11 ; p. 17-20, M8; p. 135-139, § 
 303-303i. See, also. Plants. 
 their Composition, p. 15, ^ 12. See 
 Composition. 
 
 Antimony, Taetakized. See Thera- 
 peutics, Remedial Action, Vital 
 Habit, Sudorifics, Emetics, and 
 E.xpectorants. 
 
 Antispasmodics, p. 590-593. 
 
 Appropriation, or Nutrition and Se- 
 cretion, 
 laws of, p. 217-227. 
 
 Argumentative Discussion, 
 some common ground necessary to, p. 
 401, ^ 632 b. See, also. Organic 
 Chemistry, its Recommendations. 
 
 Arsenic, p. 607-612. See, also, Inflam- 
 mation. 
 
 Ar'/eries, 
 experiments to determine the Principle 
 vpcn which the Action of the Heart and 
 
 Arteries — continued 
 
 Arteries depends, p. 295-301. See 
 Heart and Arteries. 
 experiments relative to the Arteries in 
 their connection with the Nervous Sys- 
 tem, p. 305-310.— Also, § 399, 485. 
 
 Arterial Tissue. See Tissues, anrt 
 Structure. 
 
 Assimilation, p. 134^207. 
 
 asafcetida. sco antispasmodics, auo 
 'E.xpectorants. 
 
 Astringents, p. 570-578. 
 
 Atheism, 
 
 author's refutation of, p. 16, ^ 14 c. 
 See, also. Design. 
 
 Atmosphere, 
 
 primary source of nourishment to 
 
 plants, p. 135-139, ^ 303-303|. 
 proves their creation before animals, 
 p. 136-138, () 303-303^ b, c. See, 
 also, Nitrogen, Animal Kingdo.m, 
 Animals and Plants, and Composi- 
 tion. 
 
 Atropia — how it affects the iris by reflex 
 nervous action, and analogous things, 
 p. 673, <J 904 6; p. 838, ^ 1057^. 
 
 Attraction, Capillary, 
 
 as applied to organic beings. See Ab- 
 sorption, and Capillary Action. 
 
 Authors, 
 
 their opinions, not themselves, the sub- 
 jects of criticism, p. 6, (J 4 6 ; p. 154, 
 155, § 349 d ; p. 515, ^ 819 b ; p. 540, 
 {) 851 c. 
 indicated as sources of authority, ibid. 
 their fallacious statements may form 
 their best refutation, and yield the 
 greatest light to truth, p. 17-19, (} 18 ; 
 p. 38-40, ^ Gif-h; p. 84-86. 6175 c , 
 p. 96, 9 189 b ; p. 132, 133, ^ 289 ; 
 p. 135-139, ^ 303-3031 ; p. 157-191, 
 ^ 350, 351 ; p. 199-202, ^ 364^376 ; 
 p. 220-222, ^ 409 b; p. 234^279, 
 passim ; p. 433, 434, <;. 676 i ; p. 514, 
 515, () 819, § 1028-1030, 1034, 1051. 
 
 Balsams, Expectorant, 
 
 when useful. See E.xpectorants. 
 Belladonna. See Narcotics, and Aco- 
 nite. 
 Bile, 
 
 its mode of production, p. 181, § 350J e. 
 Blisters. See Counter-irritants, and 
 
 Remedial Action. 
 Blood, 
 Author's theory of the powers by 
 
 which it is circulated, p. 208-217. 
 chemical views of, p. 18, § 18. 
 organic elaborations from, each one 
 specific, p. 18, ^ 18 d ; p. 24^4, ^ 
 40-62 ; p. 192, ^ 354 ; p. 216, ^ 398 ;
 
 'J38 
 
 INDEX. 
 
 Blood — continued. 
 
 p. 222, ^ 409 c ; p. 225, () 409 h, i ; 
 p. 227, ^411. 
 
 homogeneous, p. 24, ^ 42, note ; p. 25, 
 ^43. 
 
 composed of seventeen elements, p. 
 24, (J 42 ; p. 25, H3 ; p. 225, ^ 409. 
 
 rapidity of its chemical changes, p. 29, 
 i) 54 a. 
 
 rapidity of its organic changes, p. 233, 
 (J 427 ; p. 535, ^ 846 ; p. 537, ^ 847 
 c; p. 710, 711, {} 952. 
 
 decarbonization of, a vital function, p. 
 229, 230, I) 419, 420 ; p. 274-278, () 
 447^. 
 
 not medicated by unaided Nature, p. 
 531, § 839. 
 
 chemical theory of its Circulation, p. 157, 
 158, 159, (j 350, Nos. 3, 7, 8, 9 ; p. 
 208, 209, (J 383 a, b ; p. 329, ^ 500 n. 
 
 globules of, the ^'carriers of oxygen," p. 
 255, (J 441 /; p. 256, ^ 441^ d; p. 
 275-278, ^ 447i b, f. White, ^ 447i b. 
 
 shown by Kriemer that the nerves ex- 
 ert a remarkable influence upon the 
 blood, and applied by me to import- 
 ant principles in Pathology and Ther- 
 apeutics, p. 216, () 399 ; p. 310, ^ 485 ; 
 p. 445, (J 688 ee; p. 535, k 846 ; p. 
 709-711, <J 952 ; p. 730, ^ 969 c. 
 Bloodletting, 
 
 according to tissues affected, p. 72, 73, 
 i) 162. 
 
 A"jthor's theory of its modus operandi, 
 how far original, p. 691, () 906 g. 
 Bloodletting, General, p. 698-702. 
 
 GENERAL AND PRACTICAL OBSERVA- 
 TIONS UPON, p. 711-777. 
 
 general Extent of, p. 711-724. 
 
 in Congestive Forms of Disease, p. 724- 
 732. 
 
 in the Recognized Forms of Inflamma- 
 tion, p. 732-736. 
 
 in Simple Continued and Simple Inter- 
 mittent Fever, p. 736-741. 
 
 m the Cold Stage of Fever, p. 739-741. 
 
 in Apoplexy, p. 741-747. 
 
 general Experience, and Opinions re- 
 specting, <kc., p. 747-766. 
 
 171 the Diseases of Infancy, p. 766-768. 
 
 in the Diseases of Old Age, p. 768-770. 
 
 misapplied. Excessive, &c., p. 772-776. 
 
 general Conclusions as to Loss of Blood, 
 p. 776-777. 
 Bloou-Root. See Expectorants, and 
 
 Therapeutics. 
 Blood-vessels, 
 
 their essential office, p. 43, ^ 68-71 ; 
 p. 54, (J 109 b; p. 208-217, i) 382- 
 399 ; p. 219, () 407, 408 ; p. 223-227, 
 () 409 e-411 ; p. 289, ^61^ a. 
 
 their supposed chemical relations, p. 
 43, (J 67; p. 178-181, i) 350J ; p. 
 226, (J 409 ;". 
 
 the white, admit the red globules through 
 
 Blood-vessels — continued. 
 
 morbid changes of irritability, p. 99, 
 (J 192 ; p. 216, ^ 399 ; p. 310, ^ 485. 
 
 experiments by Buneva, Procter, and 
 
 Kriemer, showing the influence of 
 
 the nerves upon the, and variously 
 
 applied by me, ^ 399, 485, 846, 952. 
 
 Brain, 
 
 or its equivalent, the Ganglionic Sys- 
 tem, in the lower animals (see Nerv- 
 ous Power, and Cerebro-Spinal 
 System), 
 
 co-operates with the Mind, or with the 
 Instinctive Principle, p. 123, ^ 241 c. 
 
 and spinal cord, not necessary to foetal 
 life, as seen in the anencephalus ; 
 bet the sympathetic nerve is indis- 
 pensable as supplying the stimulus 
 to muscular tissue in organic life, per- 
 fecting organic compounds, &c. See 
 art. Sympathetic Nerve. 
 Brown, John — his doctrines, ^ 487 h, 
 
 890if, 1068 a. 
 
 C. 
 
 Calomel. See Cathartics, Therapeu- 
 tics, Vital Habit, Remedial Ac- 
 tion, and Alteratives. 
 
 Caloric. See Calorification. 
 
 an unexplained phenomenon of, p. 
 276-278, ^ 447^ /. 
 
 Calorification, 
 its philosophy investigated, p. 234-279, 
 (J 433-448. See Heat of Animals 
 AND Plants, and Combustion. 
 
 Camphor. See Antispasmodics. 
 
 Cantharides. See Counter-irritants. 
 
 Capillaries and Extreme Vessels, 
 the former reservoirs to the latter, p. 
 
 216, ^ 398 ; p. 483, () 746 a. 
 the latter, the main instruments of life 
 and disease, p. 42, ^ G7 ; p. 54, (J 
 109 ; p. 215-217, ^ 394-399 ; p. 218, 
 (J 404; p. 219, ^ 407 b; p. 226, i) 
 410 ; p. 227, HH ; p. 286, () 456 a; 
 p.289, H61; p. 322, ^498 c; p.479, ^ 
 741 b; p. 483, () 746 a ; p. 486, () 750 a. 
 See, also. Heart and Arteries. 
 
 Capillary Action, 
 physical views of, subversive of all 
 principles in Physiology and Medi- 
 cine, p. 215, ^ 394; p. 216, ^ 398 ; 
 p. 219, () 407 b ; p. 226, 227, ^ 410, 
 411 ; p. 483, <J 746 a ; p. 485, ^ 750 a. 
 that its nature is strictly vital is shown 
 by direct experiment, p. 127, i^ 263 ; 
 p. 134, i) 293 ; p. 216, 217, t) 399 ; p. 
 289, i) 461^ a; p. 295-310, ^ 476- 
 485 ; — is shown by the composition 
 of the blood and sap, p 23, (J 34, 35 ; 
 — is shown by the variety and exact- 
 ness of secreted products, and oth- 
 er phenomena, p. 23, ^37 ; p. 24, 25, 
 <J 41-46: p. 40, 41, ^65; p. 44, (j
 
 INDEX. 
 
 939 
 
 Capillary A ction — continued. 
 
 72; p. 222-227, ^09-411 ; p. 479, ^ 
 741 h ; p. 663, (j 896 ;— and is shown 
 by the light of analogy as reflected 
 from all sensible motions in organic 
 and animal life. See Capillaries, 
 Plants, Analogies, Nervous Pow- 
 er, Sympathy, and Absorption. 
 
 experiments by Buneva, Procter, and 
 Kriemer, showing the exciting in- 
 fluence of the sympathetic nerve upon 
 the large and small arteries, () 399 ; 
 and its effect on the blood, <^ 485. 
 Capillary Attraction. See Capillary 
 
 Action, &c. 
 Carbon, 
 
 its elimination from the blood, a vital 
 function, p. 236, 237, ^ 437. See, 
 also. Mucous Tissue. 
 
 theory of its combustion in the animal 
 organism, as it respects the genera- 
 tion of heat, p. 235, (j 434, 435 ; p. 
 238-248, () 438-440 ; p. 275-298, ij 
 447 C-447I-. 
 
 theory of its combustion in producing 
 the circulation of the blood, p. 157, 
 158, 159, (J 350, Nos. 3, 7, 8, 9 ; p. 
 208, 209, ij 383 ; p. 329, () 500 n. 
 
 theory of its combustion in producing 
 inflammation, p. 160, i) 350, No. 10 ; 
 p. 176, 177, <J350S a, 350 J e; p. 252, 
 1^441, c. 
 Carbonic Acid, 
 
 a food of plants, p. 136-139, (^ 303 a- 
 303§. 
 
 agency of light in its decomposition, 
 p. 93, <^ 188^ i; p. 163-167, () 350, 
 Nos. 64-77. 
 
 Its connection with respiration, p. 229, 
 6 418, 419 ; p. 274-278, l^ 447^ 
 
 its supposed connection with animal 
 heat. See Calorification. 
 
 does not excite heart's action, as sup- 
 posed by some, () 477 b, Exp. 1 . 
 Catalysis, 
 
 applied to organic processes, p. 43, <J 
 67 ; p. 178-181, () 350| a-350i e ; p. 
 226, ^ 409 ;. 
 
 conflict between, and the moving mole- 
 cule, or the rival doctrines of the 
 Laboratory, p. 226, (j 409 ;. See, 
 also. Protein. 
 Catechu. See Astringents. 
 Cathartics, p. 563-570. 
 
 physiology of their operation and in- 
 fluences, p. 339, () 514/; p. 547-550, 
 () 863 i; p. 563-570, ^ 889. See, 
 also. Remedial Action. 
 
 most appropriate time for their admin- 
 istration, p. 554, () 871 ; p. 570, (^ 
 889 n ; but the same rule does not 
 apply equally to emetics, p. 549, 550, 
 <J 863 d. 
 Causes, 
 
 their knowledge important, p. 4, ^ 3, 
 
 Causes — continued 
 
 4; p.- 80, () 169 d; p. 120, ^ 235, 
 236 ; p. 434, 435, i} 679, 680. 
 to be sought through their phenomena, 
 p. 10, 11, ^ 5| ; p. 80, () 169 ; p. 112 
 -121, ^ 234 c-237 ; p. 182, ^ 350i g , 
 p. 434, ^ 679 ; p. 456, 457, ^ 699. 
 undervalued by the ignorant alone, p 
 
 5, M *■ 
 Causes, Proximate or Pathological, p. 
 
 427-434. 
 Causes, Remote, of Disease, p. 414-427 
 Causes, Final, 
 have led to important discoveries in 
 medicine and astronomy. See De- 
 sign. Not acceptable to all, ibid. 
 Cells, 
 
 characteristic of organic structure, p. 
 42, ^ Q7 ■ p. 51, <J 84; p. 60, () 131. 
 supposed nucleus of, in ovum, p. 42, ^ 
 67; p. 44, <J 72; p. 812, () 1051. 
 Cerebro-Spinal System, 
 
 its Laws of Action, p. 292-295. 
 general Facts and Laws relative to, and 
 
 to the Ganglionic, p. 335-341. 
 pervades all parts, p. 54, i) 111-113. 
 important to complex organization, p. 
 
 54, (j 111-113; p. 58, ij 129. 
 designed especially for Animal life, p. 
 
 55, i) 112. See Nsrvous Power, 
 and Sympathy. 
 
 Chemical Physiologists, 
 
 school of, p. 6, ()^a,c ; p. 174-191, 
 1^350^51. 
 Chemical Compounds, 
 
 their simplicity, p. 23, ^38; p. 25, ^ 
 46 ; p. 26, ^ 49, 50. 
 Chemical and Physical Views of Life, 
 
 their moral and religious tendencies. 
 See Life, God and Nature, and 
 Vital Properties in the Elements 
 OF Matter. 
 Chemistry, 
 
 its proper vocation, p. 14, (Ji 6 ; p. 27, 
 <J 53 ; p. 26, ()A8; p. 207, ^ 376| b. 
 
 its home the Laboratory, p. 14, ij 6 ; p. 
 203, (^ 376i ; p. 227, (J 447^/. 
 
 contradistinguished from Medical Phi- 
 losophy, p. 8, ^ 5 ; p. 14, ^ 6 ; p. 19, 
 () \8 e; p. 21-.36, ^ 20-62 ; p. 149- 
 207, () 337-3761 ; p. 234-279, <J 433- 
 448. 
 
 usurps medical philosophy, p. 8, (J 5 , 
 p. 13, ^ 5i a; p. 202, 203, () 376}. 
 
 a problem for its solution, p. 281, ^ 450 
 e ; p. 330, § 500 nn. 
 
 why it fluctuates, p. 14, ^ 6. 
 
 its limits, p. 8, iji 5 ; p. 14, ij 6 ; p. 15, 
 ^Ub; p. 16, s^ 15; p. 18, <J 18 ; p. 
 24, M2 ; p. 25, (J 44 ; p. 27-29, ^ 
 53, 54; p. 161, () 350, No. 59; p. 
 202, 203, ^ 376^ ; p. 238, ^ 438 d. 
 
 THE Author's opinion of its value, p. 
 133, <J 292 ; p. 207, ^ 376| b. 
 
 as applied to Medicine illustrates forci-
 
 940 
 
 INDEX. 
 
 Chemistry — continued. 
 
 bly the universal maxim, nc sutor 
 ultra crepidam, p. 174-178, <J 350 J- 
 350|. 
 Chemistry, Medical, 
 
 now and sixty years ago, p. 8, § 5. 
 
 errors of, why successful, p. 10, 11, ^ 
 5^ c; p. 349 d ; -p. 202, ^ 376 i- ; p, 
 234, 235, <J 433. 
 
 admits, to the full extent, the princi- 
 ples of solidism and vitalism, p. 6, ^ 
 4i b, d; p. 19, ^8 c; p. 22, ^ 29 ; 
 p. 26, M9 ; P- 30-33, § 59, 60 ; p. 
 37, ^ 64 a; p. 157-173, ^ 350, Nos. 
 47-96 ; p. 189, <5 350| n. See, also. 
 Organic Chemistry, and Life in its 
 connection with physical views. 
 Chemistry, Organic. See Organic 
 
 Chemistry. 
 Childhood, 
 
 its physiological and moral character- 
 istics, p. 375-376, ^ 577. 
 Cholera Infantum, 
 
 treatment of, ^ 890 I, 1058 d. 
 Cholera, Malignant, 
 
 treatment of, () 630 e, 1058 d. 
 (Circulation of the Blood, 
 
 author's theory of, p. 207-217, J) 377- 
 399; p. 934, (J 1090. 
 
 chemical theory of, p. 157-163, ^ 350, 
 Nos. 3, 4, 5, 7, 8, 9, 10, 19 ; p. 175, 
 (J 350^ ; p. 208, 209, ^ 383 a, I ; p. 
 274, 6 447,^ a ; p. 329, ^ 500 n. 
 
 vicchanical theory of, p. 208, ^ 383 a ; 
 p. 210, ^ 387; p. 212, ^ 391. 
 
 animalcular theory of, p. 208, ^ 383 a.- 
 See, also Capillaries, and Capil- 
 lary Action. 
 Circulation, Capillary, 
 
 chemical thconj of, p. 157, 158, () 350, 
 Nos. 3, 7, 8, 9 ; p. 208, 209, () 383 ; p. 
 274, (J U7i a, No. 3 ; p. 329, <J 500 n. 
 
 physical views of, p. 99, § 192 ; p. 132, 
 133, () 289-292. 
 
 physiological experiments relative to. 
 See Heart, Arteries, and Plants. 
 Circulation, Portal, 
 
 author's theory of, p. 207, <J 379 ; p. 
 211, () 390 a; p. 214, ij 392 c. 
 Circulation, Venous, 
 
 author's theory of, p. 209-212, ^ 384- 
 392 a ; p. 214, ^ 392 d ; p. 934, «^ 1090. 
 
 and its bearing upon the pathology of 
 venous congestion. See Venous Con- 
 gestion, p. 500-513, and Venous 
 Tissue, and Veins. 
 Climate, 
 
 its physiological influences, p. 394-396, 
 ^ 615-621. 
 Colleges, Medical. See Medical Edu- 
 cation, and note there, Graduates, 
 Medical, and Defense of the Med- 
 ical Profession of the United 
 States. 
 
 Colocynth. See Cathartics, Theba- 
 
 peutics, and Remedial Action. 
 Combustion, 
 
 in Organic Chemistry, the cause oi 
 Animal Heat, p. 162, ^ 350, No. 17^ -, 
 p. 178, (J 3501 /; p. 238, ^ 438 b-d ; p. 
 239-247, I) 440, Nos. 1, 2, 3, 4, 5, 6, 
 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 
 19; p. 276-278, () U7k f. 
 
 the cause of the Vital Force or Vitali- 
 ty, p. 154, ^ 349 c ; p. 157-170, ^ 
 350, Nos. 3, 4, 6, 8, 15, 18, 18^, 19, 
 31, 32, 36, 37, 38, 39, 40 ; p. 177, 
 178, (} 350§ /; p. 254, ^ 441 e ; p. 
 274, ^ 447^ a. 
 
 the cause of all Organic Motions and 
 Results, p. 158-170, (J 350, Nos. 5, 
 6, 7, 8, 9, 10, 15, 19, 31, 32, 36, 37, 
 38, 39 ; p. 175, (} 350^ h-m ; p. 177. 
 178, l) 350§ d-f; p. 208, l^ 283; p. 
 254, (} 440, No. 10 ; p. 254, (^ 441 c. 
 
 the cause of Voluntary Motion, p. 155, 
 () 349 e ; p. 329, § 500 n. 
 
 the cause of the Circulation of the 
 Blood, p. 157-163, (j 350, Nos. 3, 4, 
 5, 7, 8, 9, 10, 19 ; p. 175, ^ 350 h-l ; 
 p. 208, 209, (} 383 a, b ; p. 274, ^ 
 447J a ; p. 329, (; 500 n. 
 
 the cause of Fever and Inflammation, p. 
 160, (J 350, No. 10; p. 175, ^350^ h-l; 
 p.l77, 178, ^3501 e,/; p.252,§Ulc. 
 
 the cause of Thought and Passions, 
 p. 155, (J 349 c. 
 
 the cause of Sleep, p. 329, ^ 500 n. 
 
 the cause of Respiration, p. 162, 163, § 
 () 350, Nos. 18, 18^^, 19, &c. ; p. 248, 
 252, § 441 b, c. 
 
 the cause of Mortification, p. 175, § 
 350i m. 
 
 and the cause of Death, p. 173, ^ 350, 
 No. 46 ; p. 243, ^ 440 cc, No. 12. 
 Composition of Organic Beings, p. 23- 
 49, () 32-82. 
 
 contrasted with that of mineral com- 
 pounds, p. 20-27, ^ 19-51. 
 
 its requisites, p. 15, ^ 14. 
 
 elementary and proximate, p. 23, ^ 33. 
 
 of animals, nearly the same in all, p 
 20, <J 18 c ; p. 25, () 45. 
 
 affected by disease, p. 25, § ii; p. 87, 
 {} 182 a. 
 
 mostly the same in animals and plants, 
 p. 23, ^ 34-36. 
 
 consists of about seventeen elements, 
 p. 23, (} 34-36. 
 
 consists mostly of four elements vari- 
 ously combined, p. 23, ij 37 ; p. 24, 
 HI ; P- 27, (J 52-; p. 222-225, \ 409, 
 Compounds, Mineral, 
 
 few only, p. 25, (} 46. 
 
 cause of their differences, p. 27 ^ 52, 
 53 A. 
 
 formed by the union of two elements, 
 or by the union of binary compounds 
 with another element, p. 23, () 38. 39
 
 INDEX. 
 
 941 
 
 Compounds, Mineral — continued. 
 their structure, p. 20, () 19. 
 their increase, p. 21, () 20. 
 how distinguished from organic beings, 
 p. 15, ^ 7-14 ; p. 20-22, ^ 19-30. 
 Compounds, Organic, 
 their variety contrasted with mineral, 
 
 p. 24, 25, {) 41, 46. 
 different in every part, p. 25, ^ 44 ; p. 
 
 27, ^ 53 5 ; p. 222-225, (j 409. 
 always the same in health in any giv- 
 en part, p. 25, <J 44 ; p. 27, ^ 53 i ; 
 p. 222-225, () 409 ; p. 227, HH. 
 always modified in one exact way in 
 any given state of disease, p. 222, 
 223, ij 409 ; p. 537, (j 847 d ; p. 538, 
 ^ 847/, g. See, also, Organic Com- 
 pounds. 
 CoNiUM — has no alterative virtue, p. 587, 
 
 ^891i; p. 681-683, (^ 905 6. 
 Congestion, Venous, p. 500-513, ^ 786- 
 818. 
 authofs theory and investigation of, 
 p. 500-513, (j 786-818. See, also, 
 Venous Tissue. 
 Constipation, Habitual, 
 how best overcome, p. 567-569, () 889 h 
 
 -889 mm. 
 or other attendant of indigestion often 
 gives rise to chorea, epilepsy, &c., 
 the philosophy explained, p. 323-332, 
 {) 500 ; p. 356-358, () 526 d. 
 Constitution, p. 383-385 ; p. 271-273. 
 Contagion, 
 limited by physiological laws, p. 418- 
 420, (} 652 c-653. 
 Contractility. See Mobility. 
 CoPAivA. See Genito-Ueinary Agents. 
 Copper, Sulphate of. See Emetics, 
 Astringents, Therapeutics, and 
 Remedial Action. 
 Counter-Irritants, p. 642-660, ^ 893 ; 
 p. 679-681, (J 905. 
 supply an illustration of remedial ac- 
 tion, p. 642-651, (} 893 n-i ; p. 679- 
 681, ij 905. 
 Creator, 
 an argument by the author in proof of, 
 p. 16, (J 14 c ; p. 81, () 170 a. See, 
 also, Design. — ^ 1085 ; Note Pp. 
 contradistinguished from Nature, p. 16, 
 9 14 c ,• p. 25, H3 ; P- 46, (j 7i a ; 
 p. 81. () 170 a ; p. 83, ^ 172 ; p. 86, 
 (} 175 d ; p. 124, (J 241 ; p. 183-189, 
 1^350 ?-i-m; p. 227, i^ 411. 
 faiih in a, necessary to philosophical 
 views of life, p. 317, (^ 493 a. See 
 Design, and Life, moral and relig- 
 ious tendencies of the Chemical and 
 Physical Views of . Also, p. 921-928. 
 Ckoup — blood-letting in, p. 375, (^ 576 e ; 
 
 p. 728, () 964 J; p. 846, ^ 1058 jo. 
 CuBEBs. See Genito-Urinary Agents. 
 Cupping, 
 
 its characteristic effects and uses, p. 
 702-703. 
 
 D. 
 
 Death, p. 401-404. 
 an extinction of the Vital Principle, 
 p. 30, ^ 58 ; p. 31, (J 59 ; p. 83, 9 
 174 ; p. 96, ^ 189 c. 
 
 "Debility," 
 often fatally mistaken for the failure 
 of the will to act upon the volunta- 
 ry muscles, p. 296, () 476 c ; p. 313, 
 <;> 487 gg, h ; p. 370-372, 9 569 ; p. 
 724-728, ^ 961-964; () 887; §785. 
 
 Decarbonization of Blood, 
 
 a vital function, p. 229, 230, () 419, 420 , 
 p. 274-278, (J 4474. 
 
 Decomposition, Vital, 
 
 balances nutrition, p.' 34, ^62b ; p. 53, 
 ^ 104 ; p. 129, ^ 273 ; p. 217, ^ 401. 
 governed by peculiar and established 
 laws, p. 34, ^ 62 b. See, also, Ap 
 PROPRiATioN, and Inflammation. 
 shows a radical difference between 01 
 ganic and inorganic beings, and the 
 laws of each, p. 34, ^ 62 b ; p. 217. 
 ^ 401. See, also, Putrefaction, and 
 Absorption. 
 
 " Defense of the Medical Profession 
 op the United States," p. 460^63, 
 () 709, and note. See, also, Medical 
 Education, and note there. 
 
 Design, 
 
 physiological proof of, p. 6, iji 4i i ; p 
 15, fU b ; p. 24, <J 40 ; p. 25, ^ 43, 
 46 ; p. 30, ij 57 ; p. 34-36, ^62; p. 
 37, () 64 ; p. 44, <;. 72 ; p. 46, .J 74 , 
 p. 51, ^83c; p. 53, ij 95 ; p. 55, ^ 
 117 ; p. 56, 57, ^ 121-125 ; p. 58, () 
 129 d ; p. 59, ^ 130 ; p. 61, i) 133 c ; 
 p. 62, () 136 ; p. 63, ^ 137 ; p. 65, <J 
 143 c ; p. 67-69, ^ 149-156 ; p. 81, 
 (J 169/; p. 85, ij 175 c; p. 87, ^ 180; 
 p. 88, {) 185 ; p. 93, () 188^ ; p. 97, 
 6 190 ; p. 98, (} 191 ; p. 99, ^ 192 ; 
 p. 100, {) 199 ; p. 102, /) 201 c ; p. 
 108, (J 228 a; p. 110, 111, ^ 232-233| ; 
 p. 122, ij 239, 240 ; p. 125, ^ 246 ; p. 
 130, ^ 180 ; p. 129, ^ 273 ; p. 135, 136 
 ^ 298, 303 a ; p. 137, 138, ^ 303^ b, c 
 p. 141, 9 307; p. 143-146, ^ 322-326 , 
 p. 148, 149, {) 336 ; p. 191, 192, ^ 353, 
 354 ; p. 209, ^ 385 ; p. 210, ^ 387 ; 
 p. 212, § 391 ; p. 216, () 398 ; p. 224, 
 ^ 409/; p. 227, Mil ; p. 230-232, 
 ^ 422-425 ; p. 234, () 433 ; p. 249, () 
 441 c ; p. 251, <^ 441 c ; p. 253, ^ 
 441 d ; p. 280, ^ 449 d ; p. 281, ^ 
 450 e ; p. 284, ^ 455 a ; p. 287, § 458 ; 
 p. 290, M64; p. 312, ^ 487^; p. 
 323-332, § 500 ; p. 335, <J 512 a ; p. 
 376, () 578 b ; p. 379, ^ 578 d ; p. 
 391, § 603 ; p. 402, ^ 633 ; p. 405- 
 412, () 638 ; p. 435, ^ 680 ; p. 472- 
 474, (} 732-733/; p. 519, (} 826 a; 
 p. 536-539, ^ 847. In all the fore- 
 going physiological evidences of De-
 
 942 
 
 INDEX. 
 
 Design — continued. 
 
 sign, the proof will be greatly multi- 
 plied by associating the processes 
 with the anatomical structure, in 
 the several instances respectively. 
 But the laws, processes, and results 
 are by far the most important. 
 Development of Organs, p. 37-^7, § 64 
 -74 ; p. 68, 69, ^ 153-159 ; p. 373- 
 380, ^ 574-578. 
 Diet, 
 importance of a careful regulation of, 
 in disease, p 61, 63, 67, I) 133, 137, d, 
 e, 151 ; p. 543, ^ 856 ; p. 600, iJ892 e. 
 See, also. Vis Medicateix Natur.<e. 
 Digestion, Physiology of, p. 147-207, 
 ^ 332-376i Also, p. 15, 16, () 10, 
 13, 14, 16, 17, 18 a; p. 134-147, (} 
 296-331. 
 chemical theory of, p. 167-170, ^ 350, 
 Nos. 29-34 ; p. 197-199, ^ 362-364i. 
 carries forward, not backward, organ- 
 ic compounds, p. 15, ^ 13, 14 ; p. 16, 
 ^ 16-18 ; p. 24, M2 ; p. 30, \ 59 ; 
 p. 33, (J 60 ; p. 135, {) 301 ; p. 143, 
 ^ 322 ; p. 196, () 360, 361 ; p. 201, 
 (J 374, 375. 
 Distribution, p. 207-217, () 377-399. 
 Diphtheria — mistaken for a local or hu- 
 moral malady, p. 450, ^ 689 I, note. 
 Disease, 
 its philosophy sought in the ovum, p. 
 
 47-49, () 75-80. 
 hereditary, philosophy of, p. 47-49, () 
 
 75-80 ; p. 424, () 661. 
 coincident in animal and organic life, 
 
 p. 55, (^ 117; p. 98, () 191 a. 
 influenced by relation of organs, p. 59, 
 
 () 129 g. 
 influenced by vital constitution of tis- 
 sues, p. 61, ^ 134 ; p 64, ^ 138, 141, 
 142 ; p. 67, (j 149-151 ; p. 69, ^ 158- 
 162. See, also. Venous Tissue, 
 and Sympathies of Tissues and 
 Organs. 
 npt to continue in an invade»ii tissue, 
 p. 64, ^ 141 h. See, also. Inflam- 
 mation. 
 disturbs the entire organ, p. 64, i) 
 
 141 b. 
 specific, extends from one to other tis- 
 sues, p. 64, ^ 141 b. 
 invades different parts of a tissue, p. 
 
 65, ^ 142, 143. 
 ils cure due to the mutability of the 
 vital properties, p. 3, i^ 2 i; p. 61, <J 
 133 e; p. 87, ^ 177-179; p. 119, (J 
 234 i; p. 122, () 239; p. 478, ^ 740 
 b. See, also. Therapeutics. 
 philosophy of its cure, p. 67, 68, ^ 150 
 
 -152 ; p. 662-665, () 895-901. 
 philosophy of its cure, in Organic Chem- 
 istry, p. 176-178, () 350 1 a. 
 force of, according to tissues aflected, 
 p. 72. <J 163. 
 
 Disease — continued. 
 
 illustrates physiological states, p. 73, 
 (J 163 ; p. 265, ^ 447 i ; p. 476, § 735 
 b. See, also. Age, Venous Tissue, 
 and Venous Congestion. 
 
 depends upon the mutability of the Vi- 
 tal properties, p. 3, ^ 2 i; p. 11, ^) 
 5i e ; p. 47-49, (> 74-80 ; p. 61, (J 133 
 c; p. 87, ^ 177-182 ; p. 98, ^ 191 ; 
 p. 121, ^ 237, 238 ; p. 352, () 524: d , 
 p. 514, ^ 819 a, No. 5. See, also, 
 Pathology. 
 
 consists, essentially, in changes of the 
 organic properties, p. 3, § 2 b ; p. 
 98, ^ 191 b. See, also, Pathology 
 
 analysis of, in plants and animals, p. 
 98, ^ 191 a. 
 
 establishes special susceptibilities, p. 
 3,^2 b; p. 63, (J 137d; p. 65, ij 143 ; 
 p. 67, ^ 149-152; p. 98, <) 191 b. 
 See, also. Pathology, and Thera- 
 peutics. 
 
 its effects conform to the causes, p. 
 105, (J 220 c. See, also, Remote 
 Causes of. 
 
 never occasions putrescency, p. 105, ^ 
 221. See, also, Humoralism, and 
 Digestion. 
 
 epidemic, according to the nature of 
 species, both of animals and plants, 
 p. 98, () 191 a. 
 
 affects the vital relations of all agents 
 p. 3, (J 2 b. See, also, establishes 
 special susceptibilities, as above. 
 
 mode of investigating, p. 73, <J 163 ; p. 
 437-442, () 685, 686 ; p. 561, ^ 888 a. 
 
 illustrative example of, in therapeu- 
 tics, p. 430^33, 4 675-676 a. 
 
 predisposition to, Author's philosophy 
 
 of, p. 87, <J 181 ; p. 368, § 559 ; p, 
 
 421, 422, ^ 657 a, b ; p. 426, ^ 666 ; 
 
 p. 429, 430, (j 674 d. 
 
 Disease, Remote Causes of, p. 414r-427, 
 
 ^ 644-666. 
 Disease, Proximate or Pathological 
 
 Cause of, p. 427-434, (j 667-676. 
 Discoveries, 
 
 recognition of their priority useful as 
 well as just, p. 93, ^ 188^ d ; p. 290, 
 (/ 462-164 ; p. 295, <) 476 a, b ; p. 
 308-310, ^ 484, 485 ; p. 319-321, 6 
 494 ; p. 341, ^ 51U b ; p. 559, 560, 
 () 883 b ; p. 595, ^ 892 a ; p. 614, () 
 892^ d ; p. 620-622, ^ 892§ a, b. 
 Dismemberment, 
 
 law of, p. 54, \ 108, 109 ; p. 56, ^ 122, 
 123. 
 Diuretics, 
 
 their uses, and illustrations of reme- 
 dial action, p. 630-633, ^ 892|. 
 Doctrines, Rival, 
 
 should be compared and contrasted, p. 
 6-8, () ii, 5; p. 19, (;> 18 e ; p 167 
 173, () 350 ; p. 189, 190, () 3503 n; 
 p. 191. ^ 351 ; p. 219, ^ 407 a; p
 
 INDEX. 
 
 943 
 
 Doctrines, Rival — continued. 
 
 238, (J 438 ; p. 246, <^ 440/; p. 277, 
 278, ^ 447^/; p. 514, <J 819 a, Nos. 
 1-7. 
 
 Doses of Medicine, &c., 
 the importance of accuracy in, p. 543- 
 545, ''i 857-860 ; p. 568, 569, ^ 888 
 m, mm; p 590, ^ 891 ; p. 598-604, 
 ^ 892 d-l. 
 
 Ducts, Living, 
 have no analogy in office with inert 
 
 tubes, p. 99, ^ 192. 
 their functions identified with the 
 capillary attraction of glass tubes, 
 sponges, and lamp-wicks, p. 99, ij 
 192 ; p. 132, 133, ^ 289-292. See, 
 also. Capillary Attraction, Capil- 
 lary Circulation, Absorption, and 
 Appropriation. 
 
 E. 
 
 Education, Medical, 
 
 in Europe and the United States, its 
 disproportion. See Medical Edu- 
 cation. 
 Effects, 
 
 causes of, important to know, p. 4, § 
 3-4 ; p. 80, ^ 169 d. 
 
 the foundation of philosophy, p. 10, ^ 
 5J ; p. 112-122, () 234-240. 
 
 evince their causes, p. 80, ^ 169 ; p. 
 112-121, <J 234-237. See, also, De- 
 sign. 
 
 the sources of knowledge, p. 2, 3, ij 2 ; 
 p. 50, 51, (J 83 c. 
 
 the iKiguage of disease and of all ex- 
 istences and causes, p. 112-121, ^ 
 234-237. See, also, Remote Causes 
 OF Disease. 
 Elaterium, p. 655, 656, ^ 893 n, and 
 Cathartics, and Remedial Action. 
 Elements of Organic Beings, p. 23, 
 § 34r-37 ; p. 33-36, .J 61, 62. 
 
 how combined, p. 23, (J 38, 39. See, 
 also. Nitrogen, and Vital Proper- 
 ties in the Elements of Matter. 
 Elements of Dead Organic Com- 
 pounds, 
 
 how maintained in union, p. 30, 31, ^ 
 59. See, also. Nitrogen. 
 Klements of Mineral Compounds, 
 
 how united, p. 23, ^ 38 ; p. 26, ^ 48, 
 49. 
 Electricity. See Galvanism. 
 Emetics, 
 
 physiology of their operation, and their 
 effects, p. 325, 326, <J 500 e, ee ; p. 
 336, 337, ^ 514 b, c ; p. 547-550, ^ 
 863 d; p. 667-669, ^ 902 e-g. See, 
 also, SuDORiFics, and Nervous 
 Power. 
 
 contrary to the general fact, p. 63, ^ 
 
 137 d, the stomach may be rendered 
 
 Emetics — continued. 
 
 by certain forms of disease more or 
 less insusceptible to their action, 
 as sometimes seen in croup, where, 
 too, there is a special modification of 
 inflammatory action in the mucous 
 tissue of the larynx ; and particular- 
 ly by narcotics, p. 61, ^ 134 ; p. 64, 
 <) 140 ; p. 374, ^ 576 d ; p. 554, <) 
 871, &c. 
 when given in small and repeated 
 doses in whooping-cough, so that an 
 emetic effect is determined by the 
 cough, the paroxysm is broken ac- 
 cording to the physiological influ- 
 ence of the nervous power as stated 
 at p. 337, ^ 514 c. Also, p. 323-332, 
 § 500 ; p. 548, 549, () 863 d ; p. 670, 
 ^ 902 m. 
 the examples reach far into the philos- 
 ophy of the operation of the nervous 
 power. See Remedial Action, and 
 Antispasmodics. 
 when employed in fever, often most 
 useful to administer calomel, with 
 or without jalap, two or three hours 
 before, p. 554, <J 871, &c. 
 
 Emotions. See Mental Emotions. 
 
 Emollient Poultices. See Poultices. 
 
 Emmenagogues, p. 628-629. See, also, 
 Genito-Urinary Agents, Ergot, 
 and Amenorrhcea. 
 
 Endosmose and Exosmose, p. 176, ^ 
 350^ n ; p. 219, § 407 b, 408 ; p. 320, 
 ^ 494 dd; p. 521-525, <J 827. See, 
 also. Gases. 
 
 Epsom Salts. See Cathartics, Thera- 
 peutics, and Remedial Action. 
 
 Ergot, 
 discovery of its uses, its importance to 
 mankind, &c., p. 620-628, ^ 8925. 
 
 Errhines, 
 
 their operation, p. 340, 341, ^ 5lil, m. 
 
 Error, 
 
 should be contrasted with truth, p. 2, 
 ^Ib; p. 6-8, (jih 5; p. 19, H8 e ; 
 p. 157-173, ^ 350 ; p. 189, 190, ^ 
 350| n ; p. 191, ^ 351 ; p. 219, (> 407 
 a ; p. 238, ^ 438 ; p. 246, (J 440 f; 
 p. 277, 278, () 447^ /; p. 433, 434, (, 
 676 b ; p. 463, () 709 ; p. 482, ^ 744 , 
 p. 514, (} 819 a, Nos. 1-7. 
 will be freely examined, p. 2, ^ 1 b. 
 its exposure necessary to truth, p. 2, ^ 
 
 lb; p. 6, (J 4 J; p. 515, (5.819 b. 
 involves argumentative discussion, p. 
 
 l,^lb;p.5,i)ib. 
 surrenders reluctantly, p. 2, ^ lb; p. 
 
 5, H ^ ; P- 268, ^ 447 d. 
 why preferred to truth, p. 202, ^ 376J , 
 
 p. 313, () 487 h. 
 itself, not the Author, the subject of 
 criticism, p. 6, (J 4 J ; p. 154, ^ 349 d 
 its Sources, AiUhorities, and Extent 
 should be known, p. 154, ^ 349 d
 
 944 
 
 INDEX. 
 
 Error — continued. 
 
 p. 185-189, ^ 350| M-m; p. 515, ^ 
 
 819 b. 
 engages the highest order of mind, p. 
 
 6, M *; P- 154, (} 349 d; p. 184, 
 
 185, ^ 3501 yt, U- ; p. 204, t) 376i a ; 
 
 p. 476, (J 733 k; p. 719, ^ 960 a. 
 often springs from a misappUcation of 
 
 facts, p. 10, 11, (J 51 ; p. 518, () 823. 
 often arises from-some absent fact, p. 
 
 10, (J 5i c. 
 springs from a mutilation of facts, p. 
 
 10, ^ 5i c; p. 518, ^ 823. See, also. 
 Organic Chemistry, Organic Heat, 
 and Physiology of Digestion. 
 
 leads to a disregard of consistency, p. 
 
 11, ^ 5i c; p. 519, ^ 824 a. See, 
 also, Organic Chemistry, its Rec- 
 ommendations. 
 
 hasty generalization, a source of, p. 
 
 10, <J 5i c. 
 relies upon the senses, p. 11, ^ 5^ c; 
 
 p. 111-121, ^ 234-237 ; p. 518, § 823. 
 ambition, a prolific cause of, p. 11, ^ 
 
 5^ d ; p. 202, ^ 376k 
 delights in false analogies, p. 10, ^ 5i 
 
 a; p. U,^5l c; p. 13,^5^; p. 157- 
 
 173, ^ 350, Nos. l-i6 ; p. 234-260, 
 
 (J 433-443 ; p. 274-278, ^ 447^ ; p. 
 
 518, 519, ^ 823, 824. 
 its most ingenious devices, p. 2, ij 1 J ; 
 
 p. 184, (} 3501 k. 
 one the parent of another, p. 762, ^ 
 
 1006 a. 
 coincidences in it^ nature, p. 762, 763, 
 
 ^ 1006 a. 
 liow best defeated, p. 176, ^ 350| a; 
 
 p. 191, (J 351 ; p. 515, ^819 b. 
 its refutation should contemplate ex- 
 tensive and permanent influences, 
 
 p. 174, ^ 350i 
 how far tolerant, p. 13, ij b\ a; p. 156, 
 
 () 350 a-c ; p. 185, ^ 3503 kk ; 204, ^ 
 
 376i a; p. 515, s^ 819 b. 
 who are its projectors, p. 516, (} 820 5. 
 its perseverance under defeat, p. 153, 
 
 <J 349 a ; p. 516, § 820 c. 
 an important cause of its prevalence, 
 
 p. 184, ^ 350i k; p. 515, § 819 b. 
 its exact distinction from truth, p. 166, 
 
 ^ 350, No. 28, and parallel columns, 
 
 p. 157-173. See Facts. 
 Excretion, 
 
 a function of organic life ; its nature, 
 
 &c., p. 227-234. 
 analogous to secretion, but differs in 
 
 its final cause, and does not give 
 
 rise to true organic compounds, ibid. 
 Excretions and Secretions, 
 
 as supplying symptoms, p. 450-455. 
 ExosMosE. See Endosmose. 
 Expectorants, p. 633-644, ^ 892|. 
 many of them being stimulant to the 
 
 extreme vessels, as well as to the 
 
 g^eneral organs of circulation, are 
 
 Expectorants — continued. 
 
 morbific in active fcnns of inflam- 
 mation, ibid., and Nervous Power. 
 
 few, only, useful as curative agents. 
 
 some of them, as sulphate of zinc, ex- 
 cite but little perspiration, ibid. 
 
 a mistaken view of the pathology of 
 phthisis pulmonalis, and an incon- 
 siderate use of the stimulating ex- 
 pectorants, important causes of the 
 great fatality of that disease, ibid., 
 and its hypothetical nature leads to 
 important errors in practice, ibid. 
 Experimental Observation in Medi- 
 cine, 
 
 nature of, p. 11, ^ 5i e, f ; p. 148, ^ 
 334; p. 518, "J 823. 
 
 imposes restraints upon art, p. 11, 12, 
 ^ 5^ e, f. See, also, Therapeutics. 
 Experiments to determine the Laws 
 OF THE Vital Functions, p. 295- 
 331, ij 476-494. 
 " Experimental Philosophy." See Med- 
 icine, vitiated by. 
 Extreme Vessels, 
 
 the main instruments of organic life. 
 See Capillaries and Extreme Ves- 
 sels. 
 Eye, 
 
 of subterranean fish, developed by light, 
 p. 46, (j 74. 
 
 its rudimentary state, p. 46, ^ 74. 
 
 Author's explanation of its develop- 
 ment, p. 46, <5i 74 ; p. 671, () 903. 
 
 action of light upon, analogous to that 
 of all other vital agents, p. 46, ^ 74 ; 
 p. 90-95, § 188i d. See, also, Anal 
 
 OGIES. ||, 
 
 Author's explanation of actioWof hght 
 in animal and organic life, p. 90-95, 
 ^ 188,V d. 
 
 F. 
 
 Facts, 
 importance of, p. 10, iJ5|; p. 515, iJiSlQfi. 
 in medicine, the phenomena of organic 
 
 nature, p. 10, <J 5| J ; p. 202, ^ 376J ; 
 
 p. 519, () 824 a. 
 who may apply them best, p. 10, ^ 5i 
 
 a ; p. 115, 116, i) 234 e, f; p. 119, I 
 
 235 ; p. 202, ^ 376^ ; p. 207, ^ 376J 
 
 b ; p. 247, § 440 h. 
 how employed by the vitalist, p. 10, ^ 
 
 5i a, b; p. 14, ij 6 ; p. 75, () 165 b; 
 
 p. 279, ^ 448 /; p. 330, § 500 nn ; p. 
 
 515, 1^819 b. 
 how far neglected by the Chemical 
 
 Physiologist, p. 10, ^ 5i a ; p. 14, ^ 6 ; 
 
 p. 202, 203, () 376^ ; p. 519, ^ 824 a. 
 
 See, also, Organic Chemistry, its 
 
 Recommendations, and Humoralism. 
 false conclusions from, prolific of error, 
 
 p. 10, ij 5| ; p. 202, 203, ^ 376^. See, 
 
 also. Error, Organic Chemistry 
 
 and Humoralism.
 
 INDEX. 
 
 945 
 
 Facts — continued. 
 
 often just otherwise, p. 10, ^ 5^ a; p. 
 19, ^ 18 e, A. C. ; p. 157-173, ^ 350, 
 Nos. 1-46 ; p. 189, 190, <J 350| n ; p. 
 191, () 351 ; p. 238, <^ 438 ; p. 246, ^ 
 440/; p. 277, 278, ^ 447^/; p. 433, 
 434, ^ 676 b ; p. 460, ^ 709 note ; p. 
 482, ij 744 ; p. 514, <^ 819 a, Nos. 1-3 ; 
 p. 518, () 823. 
 
 relative to organic beings, can not be 
 found in the laboratory, p. 10, ^ 5| J ; 
 p. 14, ^ 6 ; p. 202, <J 376^ ; p. 519, 
 <J 824 a. 
 
 each one too apt to be regarded ab- 
 stractedly, p. 10, (} 5i b. 
 
 should be compared, p. 10, ^ 5i b. See, 
 also, often just otherwise, as above. 
 
 the importance of one among many, p. 
 10, () 5i b. 
 
 when plausible, can not contradict es- 
 tablished ones, p. 10, ^ 51 b. See, 
 also, often just othenvise, as above. 
 
 mutilated to suit hypotheses, p. 10, (^ 
 bi c; p. 519, ^ 824 a. See, also, 
 often just otherwise, as above, and Or- 
 ganic Chemistry, its Recommend- 
 ations. 
 
 greatly neglected, p. 112, ^ 234 b. 
 
 between the physiologist and physical 
 philosopher of life, p. 115, ^ 234 e; 
 p. 519, 4 824 a. 
 
 how to employ them to the best ad- 
 vantage, p. 515, ^ 819 b. See, also. 
 Authors. 
 
 ••become old," p. 420, ^ 654 a. 
 Fermentation, 
 
 its cause and peculiarities, p. 28-31, ^ 
 54^59 ; p. 34-36, () 62. 
 
 inapplicable to physiological processes, 
 p. 167, ^ 350, Nos. 29, 78. 
 
 important in the Chemical and Humor- 
 al Pathology, p. 172, <J 350, Nos. 44, 
 45. See, also, IIumoralism. 
 Fever, p. 489^99. 
 
 description of, p. 489-497. 
 
 remote Causes of, p. 497-498. 
 
 pathological Cause of, p. 498-499. See, 
 also. Inflammation, distinguished 
 from Fever. 
 Fish, eyeless, 
 
 action of light upon, p. 46, () 74 a. See, 
 also, Light. 
 Fcetus, 
 
 the simplicity of its life, p. 53, ^ 103. 
 
 Author's philosophy of its develop- 
 ment, p. 36-49, () 63-80. 
 
 its animal and mental faculties pass- 
 ive. See Mind and Instinct. 
 
 early development of its nerves, like 
 that of the liver, kidneys, organs of 
 animal life, &c., consistent with 
 their dormant state, p. 234, § 455 a, 
 b; p 286, ^ 456 ; p 289, (J 46H a; 
 p. 342-353, i;. 516-524. 
 
 physiological distinction between the 
 
 
 
 Fcetus — conlinued 
 
 ova of mammiferous and oviparous 
 animals, p. 56, () 122. 
 Food, 
 
 of Animals, known only by experience, 
 p. 17-20, (J 18; p. 200, 201,^366,367. 
 
 can not be shown by chemistry, p. 17 
 20, (J 18 
 
 like physiology, pathology, and thera- 
 peutics, consigned to the laboratory. 
 p. 234, 235, () 433. 
 
 of Plants, chemistry may indicate 
 with great advantage, p. 20, (J 18 e. 
 
 importance of a right qiiality of, in dis- 
 eases, p. 250-252, (j 441 c; p. 543, () 
 856 ; p. 600, ij 892 e ; p. 615, ^ 892^ c. 
 Fomentations. See Poultices. 
 Forces of Nature, 
 
 prove a Creator, p. 16, ^ 14 c ; p. SI, 
 ^ 170. See, also. Design, and Na- 
 ture contradistinguished from 
 Creative Power, 
 fourcroy, 
 
 sixty years ago, p. 8, ij 5 ; p. 203, ^ 
 376i 
 Functions of Life, p. 125-372. 
 
 effects only, p. 86, ^76; p. 120, ^ 235 
 
 the great erds of life, ibid. 
 
 mistaken as the cause of life, ibid. See, 
 also, Life, Vital Principle, Vital 
 Properties, Nervous Power, Sym- 
 pathy, and Laws of Sympathy. 
 Functions, Organic, or Common, p. 126- 
 280. 
 
 peculiar, or Animal, p. 280-362. 
 
 of Relation, p. 280-362. 
 
 relation to the Mental Principlu 
 and Instinct, p. 362. 
 
 modifications of, arising from Age, 
 Temperament, Constitution, Sex, 
 Climate, Habits, &C , p. 373-397 
 
 G. 
 
 Galvanism and Electricity. 
 
 their modifications applied to illustrate 
 the philosophy of life and disease, p. 
 114, (J234<Z; p. 93-94, ^ 188 K 
 
 their extended application to the phi- 
 losophy of life, p. 93, 94, <J 188 d; p. 
 112-121, () 234-237; p. 323-332, ^ 
 500 ; i) 409 hh, 493 cc, 893 a, 893^. 
 Gamboge. See Cathartics, and Thera- 
 peutics. 
 Ganglionic or Sympathetic System, 
 
 general ^acts and Laws relative to, and 
 to the Cerebro- Spinal, p. 335-341. 
 
 its Laws of Action, and Propagation of 
 Impressions in it, p. 341, 342. 
 
 its Laws of Action in Involuntary Mo- 
 tions, p. 342-349. 
 
 laws of its Sensitive Functions, p. 350. 
 
 laws of its Organic Functions, p. 350- 
 353. See, also, Sympathetic Nerve.
 
 946 
 
 INDE^ 
 
 Gases, and Ethereal Vapor, 
 
 effects of their respiration disprove the 
 doctrines of Humoralism, p. 522, 
 523, ^ 827 b, c; (} 106Ga.— Note M. 
 iheir behavior in chemical physiology, 
 p. 175, 176, {) 350^ n-p. See, also, 
 Endosmose and Exosmose. 
 absorption of Carbonic Acid shown 
 physiologically to be improbable ; 
 and that its instant operation as a 
 destructive agent upon man and an- 
 imals is a farther proof, p. 522, 523, 
 i) 827 ; p. 672, (j 904 b. 
 Gastric Juice, 
 can be generated by nothing in Nature 
 but the mucous tissue of the stomach, 
 p. 62, ^ 135 a ; p. 141, ^ 307 ; p. 191, 
 192, () 353 ; p. 201, i) 374, 375. See, 
 also. Digestion, Physiology of, and 
 Mucous Tissue. 
 its manufacture, p. 197-199, () 362-364^. 
 Generation, p. 279-280, l^ 449. 
 its physiology, p. 36-i9, <;» 63-81. 
 illustrates the organic properties, p. 44, 
 
 <J 72 ; p. 97, \ 190 b. 
 proves a coincidence in the life of 
 plants and animals, p. 56, ^ 121- 
 123 ; p. 280, () 449 d. 
 Generation, Organs of, p. 55, (ji 118-121. 
 their influences in organic and animal 
 life, p. 56, () 120 ; p. 376-380, (J 578. 
 their importance in organic Design, p. 
 56, ^ 121-123 ; p. 280, () 449 d. 
 Genkration, Spontaneous, 
 
 how it happens, p. 178-184, ij 3503 a- 
 
 ZbQlg; p 186, 189,^350iM-350Jm. 
 
 disproved, p. 16, () 14 c. 
 
 inconsistent with Creative Pov/er, p. 
 
 81, 82, <^ 170.— Note Pp p. 1142, 
 
 Genito-Urinary Agents, p. 683-689, (j 
 
 905^. 
 Germ. See Ovum, and Seed. 
 Germinal Disk, 
 
 the potential whole, p. 41, ij 65. 
 Girtanner — he arrays an experiment 
 against 6000 others, p. 319, (J 494 b. 
 God and Nature, 
 
 confounded, p. 40, ^ 64 h ; p. 46, ^ 74 
 a ; p. 76, ^ 167 b ; p. 86, I) 175 d ; p. 
 178-189, () 350i a-3503 m. 
 confounded in the same way as the 
 vital force and chemical forces, or 
 as mind and matter, where there is 
 less motive for concealment, p. 154. 
 () 349 c ; p. 182, 183, (^ 350J gff ; p. 
 189, 190, () 350i n. See, also, Vital 
 Properties in the Elements of 
 Matter, and Problems. 
 contradistinguished, p. 16, i^ 14 c; p 
 25, ij 43 ; p. 46, i^ 74 a ; p. 81, () 170 
 a; p. 83, <J 172; p. 124, (j 241; p. 
 227, ^411. 
 the Latter the Interpreter of the For- 
 mer, p. 186, ^ 350J kk ; p. 227, ()4:\[; 
 p. 317, § 493 a See, also, Design. 
 
 Graduates, Medical, 
 their disproportion in Europe and the 
 United States, connected with a 
 greater disproportic n of Medical 
 Colleges, and other facts adduced 
 by the Author, evince the great 
 superiority of the American over the 
 European Medical Profession. See 
 Medical Education, and Defense 
 OF THE Medical Profession of the 
 United States. 
 
 Gratitude, 
 
 due from physicians to their enlighten- 
 ed predecessors. See Discoveries. 
 Also, Medical and Pk /siological 
 Commentaries, vol. ii., p. 676, 677, 
 ^ 801-815. 
 
 Granulations, 
 
 their office, p. 473, § 733 c. 
 
 Growth, 
 
 its philosophy souo-ht in the germ, p 
 
 37-47, ^ 64-74. 
 its subsequent progress, p. 68, 69, () 
 153-159 ; p. 373-383, (> 574-584. 
 See, also, Appropriation. 
 
 GUAIACUM, CoLCHICUM, CiNCHONA, CoE- 
 
 WEB, Alcohol, &c., 
 illustrate disease, specific action, &c., 
 p. 417, <} 650; p. 424, {) 662 a; p 
 430, (} 675, 676 a ; p. 488, () 756 a ; 
 p. 553, ^ 870 aa ; p. 562, {) 888 c ; p 
 587, ^ 892 c ; p. 676-679, (} 904 c 
 See, also. Remedial Action, As- 
 tringents, Alteratives, and Ai>- 
 aptation. Law of. 
 
 H. 
 
 Habit, Vital, 
 
 its physiological and moral laws ana 
 phenomena, p. 363-370, ^ 535-568. 
 Habits, or Usages, 
 
 their physiological influences, p. 396- 
 397, ^ 622-624. 
 Heart, 
 
 experiments to determine the Principle 
 upon which its Action and that of the 
 Vessels of Circulation depend, p. 295- 
 301. See, also. Distribution. 
 
 dilates actively, ij 262, 263, 392 d, 498 
 e, 516 d, no. 7, 637, 1090. 
 Heart and Arteries, 
 
 sympathize more than other parts with 
 local inflammations, especially acute, 
 p. 354, 355, (j 526 a. See, also, In- 
 flammation. 
 
 their sympathies not often inflamma 
 tory nor profound, ibid. 
 
 the extreme vessels more apt than the 
 heart and arteries to sympathize with 
 chronic inflammations, and with 
 other forms of disease, and thus to 
 result, sympathetically, in various 
 morbid conditions, ibid.
 
 94- 
 
 Heart and Arteries — continued. 
 
 the foregoing are important distinc- 
 tions, practically and philosophical- 
 ly, ibid. See, also, Blood-vessels 
 and Capillaries. 
 Heat, of Animals and Plants, p. 234- 
 279, i) 433-448. 
 
 external, resisted in the same way 
 as chemical agents, p. 30-33, ^ 59, 
 GO ; p. 258, ^ 442 d. 
 
 internal, how generated, p. 262-273, 
 ^ 445 /-447 h. See, also. Combus- 
 tion, and Organic Heat. 
 Hemorrhage, Spontaneocs, 
 
 its philosophy, advantages, &c , p. 572- 
 575; p. 770-772. See, also, Su- 
 
 DORIFICS. 
 
 Hellebore. See Cathartics, Thera- 
 peutics, and Emmenagogues. 
 
 HOMCEOPATHY, 
 
 what doses of any cathartic, or emetic, 
 will prove purgative, or produce 
 vomiting, or may be necessary to 
 affect diseases remote from the in- 
 testinal canal 1 The answer will be 
 a general test of the applicability of 
 the mathematical principle to the 
 graduation of remedial doses. A 
 common philosophy, in that respect, 
 pervades the Materia Medica, p. 67, 
 ^ 149-151 ; p. 541, 542, ^ 854 bb ; p. 
 543-544, /) 857 ; p. 545, ^ 859 ; p. 
 553, ^ 870 aa ; p. 558, ^ 878 ; p. 602- 
 605, ^ 892 i-m. 
 
 Hospital Reports and Precepts, 
 compared with private practice, <^ 621 
 a ; () 654 a ; p. 482, § 744 ; p. 457, f) 
 699 c ; p. 460-463, () 709 ; p. 573, (^ 
 890 d ; p. 603, 604, () 892 k ; p. 721, 
 <J 9G0 c; <J 1016; also. Essay on the 
 Writings of M. Louis, in Medical and 
 Physiological Commentaries, vol. ii , 
 p. 631-633, 679-815. 
 
 HUMORALISM, p. 514-540. 
 
 contradistinguished from Solidism and 
 Vitalism, p. 147, ^ 330 ; p. 516-518, ^ 
 821-822 ; p. 540, ^ 851 ; p. 550, 863 e. 
 
 has no physiological principle, p. 147, 
 <J 330 ; p. 558, <J 878. 
 
 author's physiological objection to, p. 
 534-540, <) 845-851. 
 HvMDRAL Pathology. See Humoralism. 
 
 Ui'BRIDS, 
 
 illustrate the philosophy of life, p. 44, 
 <5 72. 
 Hydrocvanic Acid, 
 its mode of operating, rapidity of its 
 effects, &c., p. 318-321, 9 493 d- 
 494 ; p. 523-525, § 827 d-928 c; p. 
 673, (i 904 b. 
 Hyoscyamus — illustrates enduring reflex 
 
 nervous action, p. 674. 
 Hypotheses, 
 
 the ground of, p. 10, I) 5i b; p. 202, () 
 376^ ; p. 518, 519, ^ 823, 824. 
 
 Idiosyncrasy, p. 383-385. 
 Ignorance, 
 
 opposes itself to knowledge, p. 112, ^ 
 234 6. 
 Imagination, 
 
 power of as a remedial agent, p. 534, () 
 844; p. 541, 542, ^ 854 bb ; p. 558. 
 i) 878. 
 Imponderables, 
 
 any number, p. 84, 1^ 175 bb. 
 
 agents, not the causes, in organic be- 
 ings, p. 46, ^ 74 ; p. 90-95, s^ 188^- , 
 p. 113, <J 243 c. 
 
 their analogies with the principle of 
 life, p. 113-121, ^ 234 c-237.. 
 
 applied to illustrate the philosophy of 
 life, p. 93, 94, ^ 188^ d ; p 112-121, 
 ^ 234-237 ; p. 323-332, ^ 500. 
 Indigestion, 
 
 often the slov/ result of a long series 
 of causes, p. 423, I) 659. 
 
 its train of maladies illustrate the laws 
 of sympathy. See Laws of, &c., and 
 Nervous Temperament. 
 
 renders the mind irritable, and weak 
 minds despondent. 
 Individuality, 
 
 of diseases and their phenomena, p. 4. 
 ^2e; p. 417, ^650. 
 Infancy, 
 
 its physiological characteristics, p. 373 
 375, ^ 576. 
 Infidelity, 
 
 its exposure, a duty of the Physiolo- 
 gist, p. 6, (J 4 b. See, also. Design, 
 and Nature contradistinguished 
 FROM its Author. 
 Inflammation, p. 464-489. — See Ind. Jl. 
 
 description of, p. 460-480. 
 
 remote Causes of, p. 480-481. 
 
 pathological Cause of, p. 482-489. 
 
 active and Passive, p. 486—489. 
 
 its philosophy, p. 99, ^ 192. 
 
 its vital nature shown by a fundament- 
 al law in pathology, p. 413, ^ 639 a ; 
 and by the analogy between the ad- 
 hesive process of, and the diseases 
 and reparation, ingrafting, &c., of 
 plants, and which is also illustrative 
 of the nature of each, of their de- 
 pendence upon modes of action as 
 nearly allied as are the modificatiorid 
 of their common properties and func- 
 tions of life, and of the near identity 
 of their properties and functions, ]>. 
 88, {) 185 ; p. 474-476, ^ 733 f-k ; p. 
 485, 486, i) 749-751. See, also, 
 Plants. 
 
 excited by dividing nerves, p. 289, <5 
 401. 
 
 its sympathetic or constitutional ef- 
 fects ; see above, and Fever. I add. 
 that the dependence of the " fever''
 
 948 
 
 INDEX. 
 
 Inflammation - -continued. 
 
 upon the local disease, and other 
 distinctions between true fever and 
 inflammation, are well shown by the 
 apparently opposite constitutional ef- 
 fects of poisonous doses of arsenic ; 
 as they may happen to produce in- 
 flammation in the gastro-mucous 
 membrane of one subject and not 
 of another. The difference proves, 
 also, that the poison does not operate 
 at large by absorption, but accord- 
 ing to its special effects upon the 
 stomach. See the principle, p. 665- 
 670, () 902 ; p. 679-681, ^ 905. Also, 
 HuMORALisM. — Note L p. 1120. 
 distinguished from Fever. I add to 
 the distinctions which I have set 
 forth in sections 141 b, 148, 675, 
 712-722, 757, 759, 764 a, 764 e, 770, 
 &c., that when inflammation is at- 
 tended by a chill, this phenomenon 
 generally happens only when the 
 disease is on the decline ; that is 
 to say, when suppuration is taking 
 place. In fever, on the contrary, 
 it denotes the stage of the most in- 
 tense morbid action. 
 chemical theory of, and of Fever, p. 1 60, 
 () 350, No. 10 ; p. 175, /) 350^ h-l ; 
 p. 176, 177, () 350§ a, 350§ e. 
 Inorganic Kingdom. See Kingdoms of 
 Nature, Organic Beings, Organic 
 Life, &c. 
 Instinct, 
 common to man and animals, p. 123, 
 
 () 241 a. 
 in animals, destitute of the rational 
 faculty, p. 123, () 241 a. See, also. 
 Mind, and Reason. 
 appertains to the soul in man, p. 123, 
 
 ^ 241 a. 
 the compound attributes of reason and 
 instinct in man, and the simple state 
 of instinct in animals, meet ■^vith 
 mutually illustrative analogies in the 
 relative conditions of the principle 
 of life in animals and plants, p. 123, 
 ^ 241 a; p. 88, <J 184, 185 ; p. 369, () 
 563 ; while other and greater phys- 
 ical coincidences between man and 
 animals, and the fundamental dis- 
 tinctions between them, destroy the 
 argument, based upon analogies, as 
 to the identity of the soul and the 
 instinctive principle, ibid. 
 endowed with understanding in ani- 
 mals, p. 123, () 241 b. 
 its affinity to the soul in certain attri- 
 butes, p. 123, ^ 241 c. 
 contrasted with reason, p. 123, 124, ^ 
 
 241 c. 
 its manifestations far greater in ani- 
 mals than in man, p. 123, ^ 241 c. 
 progressive in man, but little so in 
 
 Instinct — continued. 
 
 animals, p. 123, 124, () 241 c ; p 369 
 
 (J 563. 
 scarcely susceptible of cultivation ia 
 
 man, but remarkably so in many ani- 
 mals, ibid. 
 proof from, along with reason, of one 
 
 species of mankind, p. 123, (j 241 c, 
 
 note. 
 developed before reason, p. 123, <J 241 o, 
 its inferiority in man compared with 
 
 animals, compensated by reason, p. 
 
 123, ^241. 
 its inferiority in man designed to in 
 
 crease his moral responsibility 
 
 through the exercise of reason, 
 sufficient in man for the preservatiou 
 
 ofhfe. 
 Institutes of Medicine, 
 their objects, p. 2, ^ 2. 
 their consistency, a test of their truth, 
 
 p. 1,(J 1; p. 3, <J 2 c; p. 81, (^ 169/; 
 
 p. 331, (} 500 o; p. 405-il2, i; 638. 
 their foundation, p. 1, ij 1 ; p. 22, () 31. 
 conducted analytically, p. 1, i^ 1. 
 a connected chain throughout, p. 1, ^ 
 
 1 ; p. 405-412, (j 638. 
 
 should be studied progressively, p. 1, ij 1 • 
 now first attempted in their proper ob- 
 jects and natural relations, p. 1, <J 1 
 will be contradicted by collisions of 
 principles or facts, p. 1, ^ 1 ; p. 3, <J 
 
 2 c; p. 259, (J 442 e. See, also, 
 Theorif.s, Rival. 
 
 pervaded by the spirit of the Medical 
 AND Physiological Commentaries, 
 
 p. 2, H «• 
 should form one great symmetrical 
 whole, p. 3, iji 2 c ; p. 405-413, ^ 638, 
 639 a; p. 541, (j 852. 
 when founded upon any other than a 
 simple principle, the superstnicture 
 must be incongruous, chaotic, p. 2- 
 4, «J 2, 3 ; p. 173-178, <J 350i-350i. 
 See, also. Organic Chemistry and 
 Physiology, contracted. 
 fundamentally distinct from all other 
 inquiries, p. 5, (J 4 Zi ; p. 8, 9, iji 5 ; p. 
 14, ij 6; p. 19, i) \Q e; p. 157-182, 
 I) 350-3501 g ; p. 189, 190, ^ 350i n , 
 p. 191, (J 351 ; p. 246, () 440 /; p. 
 277,278, (}U7^f 
 Intestinal Canal, 
 potential whole of digestive system, p 
 41, (i 65. 
 Iodine, p. 612-620. Also, Therapeu- 
 tics, and Remedial Action. 
 Iris, 
 
 physiology of its contraction, and ap- 
 plication of in medicine, p. 328, 4 
 500 ;; p. 340, (} 5U k. 
 affected by the "Will, p. 349, <^ 519. 
 Irritability, 
 
 an important property of the Vital Prin- 
 ciple, p. 88, <^ 183 ; p. 89, ^ 188 a.
 
 INDEX. 
 
 949 
 
 rritability — continued. 
 
 eommon to plants and animals, p. 88, 
 ^ 184 a, 185. 
 
 receives the impressions from all 
 agents in the essential processes of 
 organic life, p. 89, ^ 188 a; p. 95, 
 
 96, {) 189. 
 
 variously adapted by special natural 
 modifications to vital agents, p. 43- 
 47, ^ 70-74 ; p. 62, 63, .J 136, 137 ; 
 p. 88, ^ 185 ; p. 89-99, (j 188-192 ; 
 p. 662-664, ^ 896-900. 
 
 its natural modifications in different 
 parts, &c., important in medicine, 
 p. 63, ^ 137 ; p. 64, ^ 141, 142 ; p. 
 66, ^ 143 ; p. 67, ^49, 150 ; p. 68- 
 73, (j 152-163 ; p. 89-99, ^ 188-192 ; 
 p. 210, <J 387 ; p. 503, 504, ^ 794-798. 
 
 naturally modified in each species of 
 animal and plant, germ, part, &c., p. 
 
 97, 98, (/ 190, 191. 
 
 its morbid changes, p. 63, <J 137 d; p. 
 65-68, ^ 143-152 ; p. 98, (J 191 b. 
 
 according to its natural modification 
 in a general, or local, sense, will be 
 the operation of natural, morbific, 
 and remedial agents, p. 61, ^ 133 i, 
 134 ; p. 62, 63, ^ 135-137 ; p. 64, ^ 
 138 ; p. 66-68, ^ 148-152 a ; p. 73, 
 (J 163 ; p. 97, 98, ^ 190, 191 ; p. 99, 
 ij 192. See, also, analogies in Sens- 
 ibility, p. 100-103, ^ 199-204. 
 
 its morbid changes alter the relations 
 and actions of all natural, morbific, 
 and remedial agents, p. 63, ^ 137 d ; 
 p. 65, {) 143 a-143 c ; p. 66, ^ 144- 
 147 ; p. 67, 68, <J 149-152 ; p. 73, ^ 
 163 ; p. 98, ^ 191 b ; p 541, 542, <J 
 854 bb. 
 
 its morbid changes generally increase 
 the susceptibility of organs to the 
 action of natural or remedial agents, 
 ibid, and p. 661-664, (J 894 i-900 ;— 
 though sometimes lessen the sus- 
 ceptibility, especially to agents of cer- 
 tain virtues, p. 365-368, () 551-560. 
 
 maybe increased through exalted sens- 
 ibility, p. 104, (J 110; p. 586-589, ^ 
 891 g-m. 
 
 its morbid changes allow the absorp- 
 tion of morbific agents, p. 99, ^ 192 ; 
 and admit the red globules into white- 
 blooded vessels, ibid ; and allow un- 
 digested food to pass the pylorus, 
 tbid. 
 
 a guard to the organism, p. 99, § 192. 
 
 belongs to all parts, p. 89, § 188 a. 
 
 described, p. 89-100, ^ 188-193. 
 
 necessary to motion, p. 89, ^ 188 a ; 
 p. 107, ^ 226; p. 110, <) 233. 
 
 and Sensibility receive the impressions 
 of all natural, morbific, and remedi- 
 al agents, p. 89-103, i) 188-204 ; p. 
 104, () 210; p. 107, ^ 226 ; p. 110, 
 ^ 233 ; p. 323-332, ^ 500. 
 
 Irritability — continued. 
 
 distinct from Sensioility, p. 99, ^ 193 ; 
 p. 104, () 110. 
 
 its natural modifications like those of 
 Sensibility, p. 98, (j 191 ; p. 100, ^ 
 200 ; p. 102, (j 203 ; p. 108, ^ 227 
 
 its artificial changes analogous to those 
 of the nervous power, p. 107, () 225 ; 
 p. 110, ^ 232. 
 
 its general relations to external ob- 
 jects, p. 398-400, <J 626-630. 
 Ipecacuanha. See Therapeutics, Re- 
 medial Action, Vital Habit, Emet- 
 ics, Expectorants, and Sudorifics. 
 Iron. See Tonics. 
 
 important in the chemical philosophy 
 of organic processes and results, p. 
 274-278, § 447^ 
 
 indigestible, and its sii])posed union 
 with the blood -globules in its in- 
 organic states a chemical fallacy, 
 Notes N, R, p. 1121, 1123; but ex- 
 tensively used upon that hypothesis ; 
 § 659 d, 836, 843, 1007 b. 
 
 K. 
 
 Kriemek — shows that the nervous influ- 
 ence atl'ects the condition of the blood, 
 p. 310, ^ 485; p. 710, ij 952. 
 Knowledge, 
 
 its limits and objects, p. 120, () 235 , 
 
 p. 185, () 350| k. 
 its accumulative nature, p. 206, ^ 3761 : 
 p. 719-720, () 960 a. 
 
 L. 
 
 Lacteals. See Absorption, Nutrition, 
 
 Tissues, and Structure. 
 Laws of Nature, 
 
 have no "exceptions," p. 120, 121, () 
 237 ; p. 131, ^ 285 ; p. 345, ^ 516 d, 
 No. 6 ; p. 383, () 584 ; p. 397, () 623. 
 See Nature, Organic Beings, Light, 
 Vital Properties, &c. 
 Le Gallois, 
 
 his experiments upon the nervous sys- 
 tem, p. 296-300, <J 476i-479. 
 Life, 
 
 a cause, p. 30, <^ 57-59 ; p. 83-88, <^ 
 175-185 ; p. 96, () 189 c ,• p. 120, ^ 
 236 ; p. 401, <J 631 ; p. 435, ^ 680 ; 
 p. 474, 475, ^ 733 /-i. 
 
 essentially the same in plants and ani- 
 mals ; see Plants. 
 
 its philosophy learned from a wide ob- 
 servation of Nature, p. 4, (J 2 c ; p 
 U,^6; p. 207, () 376i b. 
 
 "discovered in dead matter," p. 179, 
 1^ 3501 c. See, also. Vital Proper- 
 ties IN THE Elements of Matter. 
 
 its phenomena seen distinctly or con- 
 fusedly, p. 4, ij 2 e; p. 157-173, §
 
 950 
 
 INDEX. 
 
 Life — continued. 
 
 350 ; p. 189, 190, ^ 350| n; p. 276- 
 278, <J 447^/; p. 777, Pom/ret. 
 
 a knowledge of, requires habits of an- 
 alytical observation, p. 4, ^ 2 c ; p. 
 14, ^ 6 ; p. 313, () 487 h. See, also. 
 Observation. 
 
 Its study compared with that of botany, 
 p. 4, ^ 2 c. 
 
 simple in fundamental laws, complex 
 in its phenomena, p. 4, ^ 2 e ; p. 662 
 -664, l) 895-899. See, also, Adapt- 
 ation, and Design. 
 
 general Remarks upon, p. 111-122, ^ 
 234-240. 
 
 considered a metaphysical subtilty, p. 
 112, ^ 234; p. 482, ^ 744. 
 
 moral and religious tendencies of the 
 Chemical and Physical views of, p. 
 6, HM; P-8, ^5; p. 11, ^5lc; p. 
 13, ^5ka; p. 16, ^Uc; p. 46, (} 74 ; 
 p. 84-86, ^ 175 c, 175 d; p. 95, 96, 
 () 189 b ; p. 135, 136, (} 303 a ; p. 137, 
 138, ^ 3031 b, c; p. 141, ^ 307; p. 
 155, (j 349 e ; p. 178, ^ 350J a; p. 
 181-189, <j350i/-3503 m; p. 234, () 
 433 ; p. 458, 459, § 701, 704. See 
 Organic Life, and Plants. 
 LiFio, Animal, 
 
 connects us sensibly with external ob- 
 jects, p. 53, <J 10b ; p. 399, ^ 628. 
 
 requires repose, p. 53, <J 102. 
 
 not pronounced in the foetus, p. 53, ^ 
 103. See, also, Nerves, Sensibil- 
 iTV, Nervous Power, Sympathy, 
 and Organic Life. 
 
 " animal life " is employed in its popu- 
 lar sense, at p. 135, (J 301 ; p. 137, 
 ^ 303i a; p. 140, § 304. 
 Life, Organic and Animal, 
 
 their distinctions and relations, p. 53- 
 56, ^ 96-120. 
 
 diseases of, coincident, p. 55, ij 117. 
 Their relations to external objects, 
 p. 398-400, ^ 626-630. See, also. 
 Plants. 
 Life, Organic, 
 
 common to plants and animals, p. 53, 
 () 101 ; p. 280, (^ 449 rf ;— modified in 
 each, p. 54, I) 107 ; p. 88, () 185. 
 
 has no repose, p. 53, ^ 102. 
 
 necessary to animal life, p. 54, <J 108, 
 117. See, also. Plants, Organic 
 Life, Organic Properties, and Vi- 
 tal Principle. 
 
 its condition in the foetus. See Blood- 
 vessels. 
 Light, 
 
 discoveries in, p. 90-92, ^ 188^ d. 
 
 applied to illustrate the philosophy of 
 life, p. 46, (J 74 ; p. 90-95, () 188^ d ; 
 p. 112-117, ^ 234C-234/; p. 328- 
 331, <J 500 m-500 o ; p. 554, I) 872 a ; 
 p. 556, ^ 872 a ; p. 567, ^ 889 k ; p. 
 671, ^ 903, 
 
 Light — continued. 
 
 a vital agent, p. 46, ^ 74 ; p. 90-95, ^ 
 I88id; p. 134, <J 293; p. 137, i<i 303 c; 
 p. 164, ^ 350, No. 65 ; p. 28'., () 450. 
 
 analogous to all other vital agents, p. 
 46, 1^ 74 ; p. 90-95, ^ 188^ d ; p. 281- 
 283, ^ 450 d-A5l f; p. 328-331, ^ 
 500?n-500o; p. 671, ^ 903. See, 
 also, Analogies. 
 
 important in vital phOosophy, p. 92- 
 95, 088M ; P- 137, (} 303 e. 
 
 its component parts established, p. 92, 
 § 188^ d. 
 
 its visible, chemical,Tithonic, and phos- 
 phorogenic rays, p. 90, 92, ^ 188^ d. 
 
 its luminiferous rays act as a whole in 
 ordinary vision, but not so those or 
 the other rays upon inorganic com- 
 pounds, p. 92-95, ^ 188^ d ; p. 567, 
 ^ 889 k. 
 
 sought by the leaves of plants in dark 
 places, upon a principle of Design 
 corresponding with the attraction of 
 roots to appropriate means of nour- 
 ishment, ibid, and p. 166, 167, ^ 350, 
 Nos. 26^, 27, 77. 
 
 indispensable in vegetable life, p. 92- 
 95, ^ l8Sh d; p. 137, ^ 303 e. 
 
 chemical and vital theories of its ac- 
 tion, ibid. 
 
 if the union of carbon into organic 
 compounds by the leaf of plants be 
 due to organic influences, then are 
 the same influences the cause of 
 the immediately antecedent decom- 
 position of the carbonic acid gas ; 
 and if, also, the roots of plants de- 
 compound the carbonic acid which 
 they extract from the soil, and so 
 allowed by chemists, it follows, far- 
 ther, that light is not the decompos- 
 ing agent for the same phenomenon 
 in the leaf, p. 136, 137, ^ 303 b-e ; 
 p. 163-166, ^ 350, Nos. 64, 65, 66, 
 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 
 77, 26^, 27, 28. See, also, Mucous 
 Tissue, in its relation to carbon. 
 
 author^s theory of white light, p. 94, (^ 
 im^d; p. 566, 567, ^ 889 yt. 
 
 its velocity, undulations, and mode of 
 excitement, illustrative of the nerv- 
 ous pow-er, p. 114, () 234 e. 
 
 rate of its velocity, and of its undula- 
 tions, p. 114, ^ 234 c. 
 
 its modus operandi in physics un- 
 known, p. 115, (J 234 c,/. 
 
 its laws known, p. 115, ^ 234 c. 
 
 its undulations aid not our knowledge 
 of its laws, p. 115, (j 234 c. 
 
 develops the rudimentary eye, by its 
 action upon irritability, p. 46, ii 74 a. 
 
 comparison of its action upon irrita- 
 bility in producing organic results, 
 and upon sensibility in the proces.s 
 of vision, embarrassing! to chemis
 
 INDEX. 
 
 951 
 
 Light — continued. 
 
 trv, p. 46, ^74: a; p. 92-95, § 188^ d ; 
 
 p.' 281-283, ^ 450 e-451/,- p. 330, ^ 
 
 500 vn. 
 Liver, 
 developed Irom the intestinal Canal, 
 
 p. 41, 1^ 65. See Assimilation. 
 Loss OF Blood, Influences and Modus 
 
 Operandi of, p. 090-777. See 
 
 Bloo?31,etting. 
 Lobelia, 
 preferable to tobacco in strangulated 
 
 hernia, p. 717, <J 960 a. See, also, 
 
 Expectorants, and Therapeutics. 
 Lungs, 
 mucous tissue of, alone eliminates an 
 
 effete matter from venous blood, p. 
 
 62, () 135 a; p. 229, <) 418, 419 ; p. 
 
 274-278, ^ U7i. 
 experiments to Determine the Relation of 
 
 their Functions to the Nervous System, 
 
 p. 315. 
 Lymph. See Inflammation, and Blood- 
 letting, General. 
 Lymphatics. See Absorption, Tissues, 
 
 Structure, and Inflammation. 
 
 M. 
 
 Magnetism, 
 
 an imponderable substance. Why not 
 the vital principle, p. 113, (> 234 c; 
 p. 115, () 134 c. 
 
 its existence and laws known by its 
 effects, p. 113, <J 234 c. 
 
 applied to illustrate the philosophy of 
 life, p. 113, § 234 c. See, also. Gal- 
 vanism, Gravitation, Light, and 
 Imponderables. 
 Magnetism, Animal. See Animal Mag- 
 netism. 
 Mankind, 
 
 but one species of, proved by the same- 
 ness of reason and instinct in all, p. 
 123, ^ 241 c, note.— 'Note Fr p. IU2. 
 
 RACES of, p. 391-393. 
 Materia Medica, 
 
 objects of, p. 3, <J 2. 
 
 the organic, composed of three or four 
 eleipents, p. 25, ■Ji 47 ; p. 27, ^ 52. 
 
 each article of, has virtues peculiar to 
 itself, p. 27, i) 52 ; p.-417, ij 650 ; p. 
 545, ^ 860. 
 
 its members often embrace two or 
 more virtues, p. 555, <J 872 a ; p. 
 571, ^ 890 b ; p. 597, ^ 892 c ; p. 599, 
 i) 892 d. 
 
 redundant, yet the bad may have its 
 uses, p. 556, ^ 872. 
 
 remedial effects of, can be known only 
 from observation in diseased states 
 of man, p. 122, (} 240 ; p. 541, 542, 
 <J 854 ; p. 545, ^ 859. 
 
 Pereira's, the best, p. 676, ^ 904 c. 
 
 author's Arrangeiient of. p. 542, ^ 
 
 Materia Medica— conimucd. 
 
 854 c; p. 564, ■!> 889 c; p. 583, (J 891 
 a: p. 611, ^ 892i h; p. 634-646, ^ 
 892| 6-893 d ; p. 683-689, () 905^. 
 
 nature of its relations to Therapeutics, 
 p. 541, ^ 852 a; p. 662-665, ^ 895- 
 901. 
 Materialism, 
 
 disproved, p. 16, ^ 14 c; p. 84-86, y 
 175c-175d. See, also, Vital Prop- 
 erties IN the Elements of Matter, 
 Generation Spontaneous, Design, 
 and Nature Contradistinguished 
 from its Author. 
 Materialism, Medical, p. 86, ^ 175 d, 
 
 p. 95, ^ 189 b. 
 Matter, 
 
 author's proof from, of a Creator, p 
 IG, § 14 c. See, also. Design, Na- 
 ture Contradistinguished from 
 its Author, God and Nature Con- 
 founded, and Vital Properties in 
 the Elements of Matter. 
 
 its nature unknown, p. 80, ^ 169 a; p 
 117, () 234: g. 
 
 its properties immutable in kind but 
 through some change in the ar- 
 rangement of its compound or sim- 
 ple molecules, p. 99, () 191 d; p. 
 114, <J 234 d; p. 120, {) 237. 
 
 its final cause, p. 23-25, (} 34-43, 46 
 Mechanical Relations, 
 
 in organic beings, p. 59, ^129 k. 
 Medical Education and Practice ir 
 Europe and the United States,* 
 
 comparative view of, p. 13, i) 5^ a ; p 
 28, () 53 c; p. 43, ^ 64 ; p. 50, ^ 83 
 k; p. 60, (f 131 ; p. 86, () 175 d ; p. 
 133, <) 291 ; p. 136, ^ 303 a; p. 139, 
 ^ 303? ; p. 148, 9 334 ; p. 149, ^ 
 338 ; p. 154, 155, () 149 c-e ; p. 174- 
 182, () 350^-3501 /; p. 185-187, ^ 
 350J kk; p. 197-19^, () 362-364; p. 
 202, ^ 376L; p. 219, ^ 408; p. 220, 
 221,^09 6; p. 226, H09;; P- 233, 
 § 427 ; p. 334, 335, <;» 433 ; p. 338, ^ 
 438 b-d ; p. 239-247, () 440, Nos. 1- 
 19; p. 274-278, ^ 447^; p. 433, (, 
 676 b ; p. 457, ^ 699 c ; p. 458, ^ 
 701 ; p. 460-463, ^ 709, and note ; p. 
 482, ^ 744 ; p. 484, 485, () 748, 749 : 
 p. 488, (} 756 a; p. 515, ij 819 b ; p. 
 518, 519, (j 823-825 ; p. 540, () 851 
 a; p. 573, (J 890 d ; p. 584, 1^ 891 c. 
 p. 603, ^ 892 k ; p. 654, ^ 893 n ; p 
 690, ^ 906 a-d; p. 715-722, <J 960 
 a-d; p. 760, ^ 1005 /; ; p. 762, 763; 
 •J 1006 a. See, also, British and 
 
 * "About thiwj Medical Schools in the United 
 States, in which there is probably an annual av- 
 erage of 4500 students, 1300 of whom are yearly 
 graduated. (Population, 2C,000,000.) In France 
 with a population of 35,000,OC)0, there are but 
 three Medical Schools, which graduate only about 
 700 annually!" — Boston Medical and Surgicai 
 Journal Dec 2, 1846, y. 365.
 
 952 
 
 INDEX. 
 
 Medical Education — continued. 
 
 Foreign Medical Review, in advo- 
 .icy of Animal Magnetism, and the 
 ■'Water Cure," Oct., 1846, p. 428- 
 458 ; p. 475-485 ; and Author's In- 
 troductory Lecture on the Im- 
 provement OF Medical Education 
 IN THE United States, and Medi- 
 cal AND Physiological Commenta- 
 ries, vol. i., p. 257-273, 283, 300, 
 305, 309, 327, 384-440, 511-515 
 notes, 626-632, 682-690, 699-712; 
 vol. ii., p. 224-229, 324-327 note, 354- 
 377, 700-815.— Inst., Note W 1127. 
 Medical Profession of the United 
 States, Defense of, p. 460-463, () 
 709, and note there. 
 Mpdical Science, "The Progress of," 
 p. 13, {} 5^ a, b. See, also, Medi- 
 cine, Medical Education, Organic 
 Chemistry, and Humoralism. 
 Medicine, 
 
 philosophy of, p. 1, ij 1. 
 
 the necessity of consistency in its 
 principles and details, p. 1, i5> 1- 
 
 the vi^ork of observation, p. 3, ij 2 c ; p. 
 11, ij b\ e,f. 
 
 its elevated nature, p. 122, () 240 ; p. 
 186, (j 3501 kk ; p. 412, § 638. See, 
 also. Design.— Also, p. 361, § 530. 
 
 its ground-work simple, p. 4:, ^ 2 d, e ; 
 p. 40-49, ^ 65-80 ; p. 87, ^ 177-182 ; 
 
 ' p. 88, <) 185. 
 
 its detads complex, p. 109, ^ 232 ; p. 
 120-122, () 237-240 ; p. 405-412, ^ 
 638. 
 
 its difficulties, p. 11,12, <J5ie,- p. 121, 
 <J 237 ; p. 383, ^ 584 ; p. 397, ^ 623 ; 
 p. 545, ^ 859 b, and references there ; 
 p. 662-664, ^ 895-899. See, also, 
 Physicians and Surgeons. 
 
 its branches, a cemented chain, p. 3, 
 <J2(Z;p. 131,,^285; p. 405-412, ^ii 638. 
 
 the relations of its branches, ibid. 
 
 theories of, p. 5, <S> 4. 
 
 chemical, physiological, and chemico- 
 physiological schools of, p. 6, 7, ^ 
 4J a-e. 
 
 vitiated by Experiments under the dis- 
 guise of " Experimental Philosophy," 
 p. 11-14, I) 5i c-6; p. 17-19, () 18 
 b-e ; p. 26, -J 48 ; P- 28, ^ 53 c ; p. 
 50, ^8-d a, b ; p. 60, <J 131 ; p. 132, 
 133, ^ 289-292; p. 148, () 334; p. 
 164-170, () 350, Nos. 23^, 28, 29, 31, 
 39,44.45: p. 175, 176, ij 350i w, o; p. 
 177-182. () 350i/, 3502 a-g ; p. 197- 
 203, ^ 362-376^ ; p. 371, <J 569 b ; p. 
 434, ^ 676 b ; p 457, § 699 c ; p. 482, 
 ■) 744 ; p. 484, 485, (} 748, 749 ; p. 
 489, 490, ^ 757 a ; p. 509, <J 810 ; p. 
 515-519, () 819-825 ; p. 528, () 830 
 a-831 ; p. 541, 542, ^ 854 bb ; p. 
 573, ^ 890 d ; p. 603, 604, ^ 892 k ; 
 p. 711, I) 952 b; p. 715-722, <} 960 
 
 Medicine — continued. 
 
 a-d; p. 760, ^ 1005 k; p. 762, 763, 
 (} 1006 a; p. 765, <) 1006 g. 
 
 its relationship to chemical and me. 
 chanical philosophy, p. 8, ^ 5 ; p. 11, 
 5i c ; p. 202, 203, t) 376^ ; p. 434, ^ 
 676 b. 
 
 contradistinguished from chemical and 
 mechanical philosophy, p. 7, ^ 4^ d; 
 p. 8, 9, ^ 5; p. 8, ^5; p. 10, ()5i a; 
 p. 11, () 5i c, e; p. 14, ^ 6; p. 19, ^ 
 18 e; p. 21-36, ^ 20-62; p. 40-42, 
 {) 65, 66; p. 99-111, (J 188i-233J 
 p. 135-139, <) 303-3035 ; p. 149-203 
 (J 337-376i ; p. 234^279, ^ 433-448 
 p. 323-332, ^ 500 ; p. 362, ^ 530 ; p 
 376-380, <^ 578 ; p. 383, ^ 584 a; p 
 391. 392, ^ 602 d-606 ; p. 393, () 612 
 p. 397, (j 623 ; p. 398, () 626 ; p, 401 
 ^ 631 ; p. 405-412, ^ 638 ; p. 662, 
 663, ^ 895, 896. 
 
 its relative condition in Europe and the 
 United States. See Medical Edu- 
 cation. 
 
 its difficulties, intellectual nature, and 
 usefulness to mankind, compared 
 with Surgery. See Physicians and 
 Surgeons. 
 Medicine, " Specialities" in, 
 
 objections to, p. 721, 722, ^ 960 c, d. 
 Medicine and Surgery, 
 
 their comparative usefulness and dif- 
 ficulties, p. 614, ^892^. See, also, 
 Physicians and Surgeons. 
 Medicines. See Remedies. 
 Membranes. See Tissues. 
 Menstruation, 
 
 an excretory function, p. 62, ^ 135 a; 
 p. 233, 234, ^ 428-432. 
 
 not important in organic life, p. 234, ^ 
 428. 
 
 designed for impregnation, p. 234, ^ 
 428. 
 
 its suspension, per se, of little import- 
 ance to health, p. 234, ^ 432. 
 
 the influences of its suspension depend 
 upon the cause. See Emmena- 
 gogues, Ergot, and Uterine 
 Agents. 
 
 its institution, and effects of. See 
 Youth, p. 376-380. 
 Mental Emotions, and Passions. 
 
 how they operate, p. 89, <J 188 a ; p. 
 95, (} 188i d; p. 107, () 227; p. 108, 
 () 228 b; p. 109, «^ 230, 232 ; p. Ill 
 ij 2331 ; p. 326-330, ^ 500 /-500 n 
 p. 670, <) 902 /. 
 
 elect certain motor nerves, like the will 
 and physical agents, p. Ill, ^ 233| ; 
 p. 113, <J 243 c ; p. 326-330, ^ 500/- 
 500 71. 
 
 designed for moral and physical good, 
 p. 113, () 234: c. 
 
 morbific and curative, and analogous in 
 their influences with physical causes
 
 INDEX. 
 
 953 
 
 Mental Emotions, &,c. — continued. 
 
 anc' with tlte will, p. 92-95, ^ 188i 
 d; p. Ill, ^ 23:i; p. 113, l^ 234 c; 
 p. 296, I) 476 c ; p. 326-330, () 500 
 /-500 n ; p. 534, M44 ; p. 670, ^ 
 902 /. 
 
 chemical theory of, p. 155, ^ 349 e. See 
 Mind, and Instinct. 
 Mesmerism. See Animal Magnetism. 
 Metaphysicians, 
 
 regard the operations of the rr.ind ab- 
 stractedly from the brain, p. 123, ^ 
 241 c. 
 Metastasis, 
 
 its fallacy, p. 653-656, ^ 893 n. 
 Microscope, 
 
 useless and deceptive in important or- 
 ganic inquiries, p. 50, ^ 83 ; p. 60, (} 
 131 ; p. U3,^ 320; p. 219, H07 6; 
 p. 342, ^ 515; () 234/, 251, 409 e. 
 Mind, and its Properties, p. 122-125. 
 
 not a product of secretion, the only in- 
 dependent motive power, and capable 
 of being acted upon, p. 84, 85, ^ 175 c. 
 
 confounded with the chemical forces, 
 p. 182, 183, ^ 350| gg. See, also, 
 God and Nature, Vital Properties 
 in the Elements of Matter, and 
 Problems. 
 
 its analogies with the vital principle, p. 
 84, ^ 175 b ; p. 88, () 183, 184 ; p. 89, 
 ^ 186; p. 98, {) 191c; p. 112-125, (} 
 234 c-246. 
 
 its relation to the brain, p. 85, ^ 175 c ; 
 p. 98, ^ 191 c; p. 123-125, () 241- 
 246 ; p. 281, ^ 451 ; p. 332, (} 500 ;;. 
 See, also. Mental Emotions and 
 Passions, and Instinct. 
 
 its morbid states, p. 98, () 191 c. 
 
 its individuality, p. 84, ^ 175 ; p. 122- 
 125, () 241-246. 
 
 its "Plenipotentiaries" the Nervous 
 Power, p. 77-79, ^ 167 f. 
 
 its advancement in successive genera- 
 tions, p. 206, (J 376 { a; p. 719, 720, 
 ^ 960 a. 
 
 compared with instinct See Instinct. 
 
 chemical theory of, p. 155, () 349 e. 
 See Problems. 
 Mineral Compounds. See Compounds, 
 
 Mineral. 
 Minerals, 
 
 their most natural state, elementary, 
 p. 23, ^ 39. 
 
 their final cause, the existence and 
 welfare of organic beings, p. 16, <J 
 16 ; p. 23, ^ 34-36 ; p. 86, 87, ^ 176 ; 
 p. 135-138, <^ 300-303^. 
 Mineral Kingdom, 
 
 independent of the animal, and vegeta- 
 ble, p. 15, ^ 9-14 ; p. 137, 138, ^ 303:1 . 
 
 its final cause. See Minerals. 
 Mobility, 
 
 a property of life o )mmon to animals 
 and plants, p. 88 ^ 183. 184 a. 
 
 Mobility — continued. 
 
 a preferable term to contractility, p. 103, 
 § 205 b. 
 
 the cause of motion in organic beings, 
 p. 103, ^ 205-215 ; p. 107, ^ 226 ; p. 
 110, 111, ^ 233, 233| ; p. 284, ^ 455 
 a ; p. 286, ^ 456, 457 ; p. 289, ^ 461i 
 a ; p. 322-332, () 498-500. See, also, 
 Absorption, Blood-vessels, and 
 Powers which circulate the 
 Blood. 
 
 distinct from irritability, p. 103, () 206 ; 
 p. 110, <J 233. See, also. Irrita- 
 bility. 
 
 demonstrable in plants, p. 103, ^ 207 , 
 p. 134, ^ 293; p. 286, ^ 456 a; p. 
 322, ^ 498 c. 
 
 occasions sensible and insensible mo- 
 tions, p. 104, ^ 213. 
 
 excited ihrongh. irritability, p. 103, 104, 
 (} 208, 215; p. 107, ^ 226 ; p. 110, «J 
 233. 
 
 dormant in the seed and ovum, p. 30, 
 ^ 57 ; p. 56, {) 123 ; p. 104, () 212. 
 
 modified in animal and organic life, p. 
 61, ^ 133 b ; p. 62- 68, «J 135-155 ; p. 
 110, 1 1 1, ^ 233, 2331 ; p. 295, <J 475 ; 
 p. 296, § 476 c; p. 314, () 488; p. 
 323-332, ^ 500. See Motion. 
 Molecular Motion versus Catalysis, p. 
 
 226, ^ 409 ;. 
 Morbid Anatomy, 
 
 its practical and philosophical uses, p. 
 456-463, () 695-709. 
 Morbific Causes, 
 
 philosophy of their action, p. 47-49, y 
 75-80; p. 55, § 117; p. 59, <J 129 h, 
 p. 61, ^ 133 c; p. 63, § 137; p. 65, 
 5 142, 143 ; p. 67, 68. () 149-152 ; p. 
 69, ^ 156 ; p. 87, (> 177-182 ; p. 89, ^ 
 188; p. 107-110, ^226-232; p. Ill, 
 ^ 2331 ; p. 414, () 644, 645 ; p. 417, 
 () 650; p. 421, 422, (} 657; p. 423, 
 ^ 659 ; p. 424, ij 661 ; p. 425, () 664 ; 
 p. 426, ^ 666 ; p. 662-665, ^ 895-901. 
 
 their difference from remedial agents, 
 p. 542, <J 854. See, also. Remedial 
 Action, Vital Habit, and Thera- 
 peutics. 
 Morphia. See Narcotics, and Thera- 
 peutics. 
 Mortification, 
 
 vital theory of, p. 477, ^ 736 a-e. 
 
 mechanical theory of, p. 477, ^ 736 6, 
 e ; p. 484, 485, <J 748, 749. 
 
 chemical theory of, p. 175, i) 350^ m. 
 Motion, 
 
 indispensable to all organic beings, ex 
 cepting in the state of the c-erm, p 
 126-128. See, also. Germ.' 
 destructive of mineral compounds, p. 
 
 21, <J 24-26. 
 sensible and insensible, p. 103, <J 207. 
 how produced through sympathetic 
 sensibility, p. 101, ^ 201, 202 ; p.
 
 954 
 
 INDEX. 
 
 Motion — continued. 
 
 104, (j 209, 210 ; p. 282, ^ 451 ; p. 
 323-330, ^ 500. See, also, Laws of 
 Sympathy. 
 
 insensible the most important, p. 104, 
 (j 214 ; p. 227, ij 410, 411 ; p. 663, (j 
 896. See, also. Capillaries. 
 
 voluntary, how produced, p. 88, <J 188 ; 
 p. 104, ^ 215 ; p. 110, ^ 233 ; p. Ill, 
 ^ 2333 ; P- 127, I) 259 ; p. 128, (^ 
 266 ; p. 134, ^ 293-295 ; p. 323-332, 
 1^500. 
 
 spasmodic, readily induced in the vol- 
 untary muscles, and why, p. 284, ^ 
 455 ; p. 296, ^ 476 c ; p. 324-328, ^ 
 500 d-l; p. 357, 358, ^ 526 d; p. 
 404, ^ 637. • 
 
 how produced in organic life, p. 88, ^ 
 188 ; p. 110, ^ 233 ; p. Ill, \ 233^. 
 
 independent of the nervous system, p. 
 104, <J 215 ; p. 110, (J 233 ; p. 127, ^ 
 259 ; p. 284-289, ^ 454-461^ ; p. 
 663, 9 896. See, also. Experiments 
 
 TO DETERMINE THE LaWS OF THE Vl- 
 
 TAL Functions, p. 295-321, and 
 Laws of Sympathy, p. 335-362. 
 
 how produced through irritability, with 
 or without the agency of the nerv- 
 ous power, p. 89, 90, ^ 188, 188i ; 
 p. 95, () 189 ; p. 98, ^ 191 ; p. 103, 
 <;> 208 ; p. 107-111, () 226-2333 ! P- 
 323-332, <J 500 ; p. 356-358, (j 526 
 d ; p. 663, ^ 896. 
 
 toluntary and involuntary, their differ- 
 ence lies, mostly, in the nature of 
 the stimuli, and partly in modifica- 
 tions of mobility, p. 102, () 201 ; p. 
 104, ^ 215; p. 107, () 227; p. 110, 
 111, ^ 233, 2332 ; p. 296, ^ 476 c ,• p. 
 323-332, ij 500 ; p. 357, 358, l^ 526 d ; 
 p. 663, ^ 896. See, also. Mobility, 
 and Will. 
 
 the great intrinsic characteristic of the 
 organic kingdom, inertia that of the 
 inorganic, p. 21, ^ 24 ; p. 30, ^ 59 ; 
 p. 86, 87, (} 176. 
 
 interests us most, ibid. 
 
 dicmical Theory of, oxydation of the 
 blood and tissues, p. 158-162, ^ 350, 
 Nos. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 15, 
 16, 17; p. 208, ^ 283; p. 274, ^ 
 447^ a. 
 Motor Nerves. See Nerves. 
 Mucous Tissue, 
 
 proof from, by the Author, that the 
 elimination of carbon from the blood 
 IS a vital process. Combine the di- 
 rect facts and the analogies at p. 62, 
 ^ 135 a ; p. 201, <J 374, 375 ; p. 229, 
 i) 419 a-419 c. See, also. Carbon, 
 and Light, in its relation to carbonic 
 acid. 
 
 modified in its organic properties in 
 different parts of the body, and as 
 traversing different parts, shown by 
 
 Mucous Tissue — continued. 
 
 its natural products, and by the ef- 
 fects of natural, morbific, and reme- 
 dial agents, p. 62, 63, <J 135-137 ; p. 
 67, 68, i) 149-152. See, also. Re- 
 medial Action, and Therapeutics. 
 Mucus, 
 
 the laws which govern its formation. 
 See Secretion, p. 217-227. 
 
 its morbid states, p. 452. See, also, 
 Inflammation. 
 Muscles of Voluntary Motion, 
 
 experiments to determine the Principle or 
 which their Motion depends, and the 
 Relation they bear to the Nervous Sys- 
 tem, p. 310, <5 486. 
 
 comparative effects of Stimuli upon, aniX 
 upon the Heart, when applied to the 
 Brain and Spinal Cord, p. 311-315, 
 ^ 487-489. See, also, Motion, and 
 Will. 
 
 N. 
 
 Narcotics, p. 583-590, () 891 ; p. 715 
 721, (J 960 a, b. 
 
 an unimportant class of agents compai 
 ed with many curative means, ibid 
 
 their preference as means of relieving, 
 or preventing pain, to agents which 
 strike at disease and grapple with 
 Death, evinces a want of proper 
 medical philosophy, and of a proper 
 reference to the best interests of 
 mankind, ibid. See, also. Pain. 
 
 affect the nervous power so as to ren- 
 der it more or less insusceptible to 
 the action of other agents, p. 567, (/ 
 889 k; p. 672, ij 904 a, ij 891i k. 
 See, also, Nervous Power. 
 Nature, 
 
 its foundation simple, its phenomena 
 complex, p. 4, (J 2 c ; p. 662-664, (j 
 895-899. See, also. Adaptation 
 and Design. 
 
 contradistinguished from Creative Pow- 
 er, p. 16, H4 c ; p. 25, 'J 43 ; p. 46, 
 <J 74 a; p. 81, ^ 170 a,- p. 83, ^ 172; 
 p. 86, l^llbd ; p. 124, () 241 ; p. 227, 
 Mil; P- 317, 9 493 a; p. 376, (} 
 578 b; p. 393, (^612. 
 
 confounded with Creative Power, p. 40, 
 ^ 64 A ; p. 46, (J 74 a ; p. 76, i) \Q1 h ; 
 p. 86, () 175 d ; p. 178-189, i) 350| a- 
 350J m 
 
 the Interpreter of its Author, p. 186, ^ 
 350i kk; p. 227, ^ 411. See, also, 
 Design. 
 
 man her interpreter, p. 5, ^ 4 a. 
 
 the Conservator of Organic Beings ; 
 see Vis Medicatrix Naturae, and 
 Vital Principle. 
 
 the great fountain of rational enjoy- 
 ment, and the only foundation of 
 philosophy ; ut supra.
 
 INDEX. 
 
 955 
 
 Nature, Kingdoms op, p. 15, ^ 7, &c. 
 
 the organic, and inorganic, have, re- 
 spectively, their peculiar properties 
 and laws, p. 4, (J 3 ; p. 14, ij 6 ; p. 
 20-27, (J 19-51 ; p. 34-36, ^ 62. 
 
 phenomena of the organic more various 
 than of the inorganic, p. 4, (J 3 ; p. 
 14, ^ 6; p. 117, ^ 234: g; p. 331, ^ 
 500 0. 
 
 our knowledge of each depends upon 
 the nature or variety of the phenom- 
 ena, p. 4, (J 3 ; p. 80, (} 169 ; p. 111- 
 121, \ 234-237. 
 
 not mutually dependent, p. 15, ^ 9-14 ; 
 p. 16, (J 16, 17; p. 23, ^ 35, 37; p. 
 24, () 41, 42; p. 25, ^3 ; P- 135- 
 139, ^ 300-303|. 
 
 creation of the vegetable and animal 
 reversed, p. 135-138, () 303, 303|. 
 
 ■motion the great sensible attribute of 
 the constitution of the organic, vis 
 incrticB that of the inorganic, p. 21, 
 (J 24 ; p. 30, 9 59 ; p. 86, 87, (^ 176. 
 
 simple in their foundation, p. 4, <^ 2 e ; 
 p. 331, <J 500 o; p. 662-664, () 895- 
 899. 
 Nerves, 
 
 of what importance in foetal life, p. 43, 
 (Ji 69 ; p. 286, () 456 ; p. 289, <J 46U a. 
 
 their early development in the foetus, 
 like that of the liver, kidneys, and 
 organs of sense, &c., consistent with 
 their dormant state in the great plan 
 of Organic Design, as respects cere- 
 brospinal, p. 42, ^ 67-70 ; p. 284, <;> 
 455 a, b ; p. 286, (^ 456 ; p. 289, ^ 
 46U a; p. 342-353, (J 516-524. 
 
 sympathetic, necessary to the organic 
 and sphincter muscles in the life of 
 the foetus, ^ 46 li, 488J, 514 / g. 
 Also, Sympathetic Nerve. 
 
 not the source of motions or of any or- 
 ganic result, p. 43, ij 69 ; p. 46, (j 74 ; 
 p. 89, ij 188 c; p. 110, () 233 ; p. 389, 
 (^ 461 ; p. 296, 297, (^ 476^ b ; p. 317, 
 318, ^ 493; p. 324, ^ 500 c, d ; p. 
 475, ^ 733 h ; p. 483, () 746 c. See, 
 also. Capillary Action, Mobility. 
 
 an important distinction between their 
 trunks and expanded extremities, p. 
 280, () 450 b; p. 521, I) 826 d; p. 
 585, () 891 e. 
 
 their functions neglected, or perverted, 
 or ill considered, p. 112, ij 234 b ; p. 
 155, § 349 e; p. 162, 163, l^ 350, 
 Nos. 18, 19, 20 ; p. 177, ij 350f c; p. 
 193, <J 356 a; p. 283, (J 452 b; p. 
 296, ^ 476^ b; p. 317, 318, t) 493. 
 
 contribute to the perfection of animal 
 compounds, () 69, 22H, 224, 232, 233, 
 399, 405, 446 a, 455, 456 a, 461, 461^ 
 a, 485, 488i, 493 c-d, 512 rt-513, 516, 
 Nos. 8, 9, 746 c, 846, 902 a-m, 952 
 b-h. 
 Nekves, the Different Orders of, p. 
 
 Nerves — continued. 
 
 290-292. See, also, Cerebro-Spinai 
 AND Ganglionic Systems, and Syjt 
 pathetic Nerve. 
 Nerves, Motor, 
 
 their functions and laws of action, p. 
 102, () 202 ; p. 106, i} 224 ; p. 110, (^ 
 233 ; p. Ill, () 2333 ; p. 293, () 471 ; 
 p. 326, ^ 500 g; p. 330, () 500 nn ; 
 p. 335-353, ^ 512-524 ; p. 521, (j 826 
 d; p. 746, i) 990t b. 
 Nerves, Sensitive, 
 
 their functions and laws of action, p. 
 101-103,(^201-204; p. 281,H50e; 
 p. 292, () 472; p. 326, (J 500 g; p. 
 330, (} 500 nn; p. 335-353, (} 512- 
 524; p. 521, (j 826 d. 
 
 of true sensation, mostly cerebro-spi- 
 nal, p. 101, 102, () 201 ; p. 284, i) 455 a. 
 
 of sympathetic sensation, mostly the 
 ganglionic and pneumogastric, p. 101, 
 102, (J 201 ; p. 109, ij 230 ; p. 284, ^ 
 455 J; p. 746, 1^990^6. 
 Nervous Power, 
 
 a property of the vital principle, and 
 peculiar to animals, p. 88, (j 183, 184 ; 
 p. 110, ^ 232. 
 
 affords a demonstrative proof of the 
 existence of a vital principle, and of 
 its own existence as a property of 
 that principle, and that it operates 
 beyond the surface of organs, p. 42, 
 (^ 67 ; p. 746, ^ 990^ b. 
 
 enters largely, or its organs, into the 
 physical doctrines of life, p. 162, 163, 
 (j 350, Nos. 18, 18^, 19; p. Ill, 112, 
 ^ 234 a; p. 317, 318, ^ 493 ; p. 475, 
 ^ 733 h. 
 
 commonly regarded as the electric or 
 galvanic fluid, p. 88, (^ 184 b. 
 
 its action upon irritability, another 
 property, not more remarkable than 
 the control which the will exercises 
 over other properties of the mind and 
 the passions, p. 88, ij 184 b. 
 
 generated especially by the brain and 
 spinal cord, but also by the ganglia 
 of the sympathetic, p. 321, () 497 ; p. 
 323, ^ 499; p. 334, i) 507; p. 342- 
 346, () 515, 516; p. 349, () 520; p. 
 353, {) 524 d, Nos. 4-7. 
 
 the philosophy of its operation, and its 
 application to pathology and thera- 
 peutics, how far expounded by the 
 Author, p. 106,1^222; p. Ill, ^ 234a; 
 p. 162, 163, I) 350, Nos. 18, 19; p. 
 297, () 476i b ; p. 317, 318, (J 493 ; p. 
 320, ^ 494 dd ; p. 342, <J 514^ J ; p. 
 515, 4 819 b; p. 746, (, 990^ b ; and 
 throughout the philosophy of Reme- 
 dial AND Morbific Action, and of 
 the Operation of Loss of Blood. 
 
 its nature, useless to be known, p. 60, 
 ilUl, Milton : p. 88, ^ 184 J ; p. 1 17 
 9 234 5.
 
 956 
 
 INDEX. 
 
 Nervous Power — continued. 
 
 as with Light and Magnetism, not in 
 
 transitu, p 115, ^ 234 e. 
 like hght and electricity, brought into 
 operation by exciting causes, p. 115, 
 ^ 234 e. 
 acts upon irritability, p. 88, I) 184 h; p. 
 89, {) 188; p. 107, I) 226; p. 110, (J 
 233 ; p. 323-332, ^ 500. See, also, 
 Remedial Action. 
 how developed, p. 89, <J 188 ; p. 107, ^ 
 225-227; p. 114, () 234 e; p. 323- 
 332, (j 500. Also, Remedial Action. 
 excited directly and indirectly, p. 107, 
 ij 227; p. 323-332, ^ 500. Also, 
 Experiments to determine the 
 Laws of the Vital Functions, and 
 Remedial Action. 
 developed by agents applied to the 
 brain, spinal cord, and nerves, by the 
 will and passions, by internal phys- 
 ical causes, by external agents act- 
 ing upon all parts, and by disease 
 of all parts, p. 107-111, i) 227-233J ; 
 p. 333, i) 503 ; p. 334, () 507 ; p. 349, 
 (^ 520 ; p. 356-358, () 526 d ; p. 706, 
 707, () 947, and ut supra. 
 superadded to the animal kingdom, and 
 why, p. 54, 55, () 107-117 ; p. 106, ^ 
 223 ; p. 1 10, ^ 232 ; p. 284, 285, ^ 454, 
 455; p 475, <J 733 h. 
 operates in animal and organic life, p. 
 106, ij 223 ; p 110, () 233 ; p. Ill, ^ 
 233J ; p. 323-332, ^ 500 ; p. 483, ^ 
 746 c. 
 most important in the organic life of 
 animals, yet its greatest final cause 
 is relative to animal life, p 55, <) 
 113 ; p. 106, ^ 223 ; p. 127, <^ 259 ; p. 
 262, ^ 446 a ; p. 284, 285, () 454, 455. 
 in constant operation upon various 
 parts, p. 106, (;> 223 ; p. Ill, ^ 233| ; 
 p. 113, (J 234 c ; p. 115, ^ 234 e ; p. 
 335-341, ^ 512-514. 
 maintains harmonious action among 
 the viscera of organic life, p. 55, ^ 
 113 ; p. 106, ^ 223 ; p. 108, (J 228 a; 
 p. 110, <) 232; p. 284, M55. 
 when most obvious in its effect, in ani- 
 mal and organic life, p. 324, ^ 500 c, 
 d ; p. 332, ? 501 ; p. 662, 663, i) 896. 
 its important natural action mostly 
 limited to compound organs, and to 
 certain muscles in animal life, af- 
 fecting also the functions of the cap- 
 illary vessels in their various offices 
 of circulation, secretion, &c., and 
 capable of exerting the most power- 
 ful influences upon them. See ref- 
 ereyice.i above, and Nerves and Cap- 
 illaries. 
 but little operative in fcetal life, p. 43, 
 <J 69. See, also. Nerves, and Cap- 
 illaries. 
 0J^erates through motor nerves, p. 106, 
 
 Nervous Power — continued. 
 
 () 224; p. 290-292, () 462-471 ; p. 330.. 
 (j 500 nn. 
 
 indispensable to voluntary motion in 
 all animals, p. 104, (J 215 ; p. 110, i^ 
 233 ; p. 127, ^ 259, 260. 
 
 necessary to the action of muscles both 
 in animal and organic life, p. 325-327, 
 ^ 500 e-i; p. 338, 339, ^ 514/, g. 
 Also, Nerves, Sympathetic Nerve. 
 
 may respond through the same motor 
 nerves to impressions transmitted 
 through various sensitive nerves, p. 
 327, ^ 500 i. 
 
 indispensable to reflected motion, p. 
 102, <J 201 ; p. 107-111, ij 227-233| ; 
 p. 323-332, ^ 500 ; p. 404, ^ 637. 
 
 does not involve sensation, p. 106, <Si 223. 
 
 implanted in the brain, spinal cord, 
 ganglia, and nerves, or in the gan- 
 glionic system of inferior animals, p. 
 106, i) 224; p. 115, ^ 234 e ; p. 334, 
 () 507, and as aboi-e. 
 
 acted upon and altered in kind, &c., 
 p. 107, (j 225, 226. See, also. Reme- 
 dial Action. 
 
 a vital agent, p. 107, () 226, 227; p 
 323-332, i) 500 ; p. 359, $ 526 d ; p. 
 483, (} 746. 
 
 its operation and results analogous to 
 other vital agents, p. 107, 108, () 227, 
 228 ; p. 114-118, ^ 334 d-k ; p. 331, 
 ^ 500 ; p. 483, ^ 746 c ; p. 706-708, 
 ij 947, 949. See, also. Analogies. 
 
 excited through sympathetic sensibili- 
 ty, p. 108, ^ 227 ; p. 116, <) 234/; 
 p. 281-283, ^ 450 e, 451. 
 
 partakes of the virtues of the exciting 
 causes, under the influence of its 
 own nature, p. 108-110, ^ 227-232 ; 
 p. 333, () 503 ; p. 647, ^ 893 e. 
 
 its modus operandi, p. 107-111, <^227- 
 2333 ; p. 115, I) 234 e ; p. 125, 6 245 
 p. 296, () 476 c ; p. 323-332, ^ 500 
 p. 334, (J 509, 510 ; p. 357, ^ 526 d 
 p. 663, ^ 896; p. 703-711, ^940- 
 952. See, also, Remedial Action, 
 and Remote Causes of Disease. 
 
 exquisitely susceptible, p. 11, () 5i e ; 
 p. 108, 110, (} 228, 232 ; p. 323-332, 
 ^ 500, 501 ; p. 357, ^ 526 d; p. 706, 
 707, () 947. 
 operates according to the nature of 
 the existing and modifying causes, 
 p. 107, 109, 111, {) 227, 230, 233| ; 
 p. 296, (} 476 c; p. 301, 302, ^ 480, 
 481 ; p. 305, I) 482 ; p. 309-314, ij 
 484-489 ; p. 323-332, \ 500 ; p 334, 
 () 509 ; p. 405-412, (J 638 ; p. 662, 663, 
 () 896 ; p. 706, 707, () 947. See, also, 
 Remedial Action. 
 an important law of, in relation to or- 
 ganic life, and as distinguished from 
 the corresponding law in animal life, 
 p. 312, ^ 487 f
 
 957 
 
 Norvous Power — continued. 
 
 its effects in proportion to the sudden- 
 ness, as well as violence of its ac- 
 tion, p. 11, (J 5i e ; p. 298, ^ 476^ h ; 
 p. 300, ^ 479 ; p. 304, ^ A81 g ; p. 
 319, 320, I) 494; p. 334, 335, ^ 509- 
 511 ; p. 523, 524, ^ 827 d; p. 525, ^ 
 828 b ; p. 662, 663, <) 896 ; p. 703- 
 7il, (J 940-952; p. 726, ^ 961. 
 
 powerfully operative in inducing and 
 removing syncope, p. 304, 305, iJ481 
 ff, h, Exp. 18 ; p. 663, {) 896 ; p. 703- 
 709, () 940-95] ; p. 726, <5 961. 
 
 its influences, natural, morbific, or re- 
 medial, p. 106, () 222, 223 ; p. 107- 
 110, ij 226-232 ; p. 28't-287, ^ 454- 
 458 ; p. 331 , (^ 500 ; p. 483, ^ 746 c ; 
 p. 662-665, 1^ 896-901. See, also. 
 Remedial Action. 
 
 Its relative effect when developed by 
 disease of the nervous system, and 
 when by other causes acting upon 
 other parts, p. 334, ^ 508, 509 ; p. 
 356-358, () 526 d ; p. 592, ^ 892^. 
 See, also. Remote Causes of Dis- 
 ease, and Remedial Action. 
 
 its modifications illustrated by the 
 modifications of electricity, polar- 
 ized light, &c., p. 79, <j 168 ; and 
 ut supra. 
 
 its rapidity of action illustrated by the 
 motions of light, &c., p. 114, <) 234 e ; 
 p. 330, ^ 500 nn. 
 
 adapted- to the various exigencies of 
 life, p. 108, () 228 ; p. 127, ^ 259 ; 
 and as above. 
 
 influenced by slight variations in the 
 intensity, or nature, of the operating 
 causes, and by the precise part upon 
 which they operate, p. 108-110, () 
 228-232 ; p. 323-332, (} 500 ; p. 671, 
 072, ^ 904 a. Also, Remedial Ac- 
 tion. 
 
 how affected by disease, p. 109, ^ 229 ; 
 p. 662-664, () 895 900 ; and as above. 
 
 the cause of consRcutive diseases, p: 
 109, () 229 ; p. 285, ^ 455 ; p. 339, 
 (} 514: h. See, also, Pathological 
 Cause, Remote Causes, Remedial 
 Action, &c. 
 
 its connection with the Law of Adapt- 
 ation, p. 539, t) 848. 
 
 operates on the organic constitution 
 of the brain and nervous system, as 
 upon other parts, p. 109, ^ 230 ; p. 
 334, ^ 509. 
 
 operates, however, but little as a mor- 
 bific cause upon the nervous tissue, 
 p. 334, i) 508 ; p. 356-358, ^ 526 d. 
 
 mutable in its nature like the organic 
 properties, p. 108-110, () 227-232. 
 See Vital Properties, their mutabil- 
 ity, and Remedial Action. 
 
 its mutability, like that of the organic 
 properties, a main foundation of dis- 
 
 Nervous Power — continued. 
 
 ease and its cure, p. 333, § 503 
 See, also, partakes of the virtues, &c., 
 as above, and Vital Properties, &c. 
 
 does not generate motion, p. 110, {\ 
 233 ; p. 127, (} 259-261 ; p. 296, ^ 
 476^ b; p. 331, ^ 500 o ; p. 663, () 
 896. See, also. Experiments to 
 determine the Laws of the Vital 
 Functions. 
 
 maintains the balance of functions, p. 
 110, (J 232; p. 230, 231, ^ 4t22 ; p. 
 284, 285, § 455 ; p. 663, ^ 896. 
 
 in connection with the will, a remote 
 cause of voluntary motion, p. 110, ^ 
 233; p. Ill, ij 2331; p. 113, <J 234 c; 
 p. 284, ^ 455 a ; p. 288, ^ 459 d, e ; 
 p. 296, ^ 476 c ; p. 313, ^ 487 gg, h ; 
 p. 314, ^ 488, 488^ ; p. 324-332, <J 
 500 c ; p. 357, 358, ^ 526 d ; p. 370, 
 ^ 569 a. 
 
 its prolonged operation, natural, mor- 
 bific, and remedial, p. 110, 111, ^ 
 232, 233^ ; p. 285-287, ^ 455-458 ; 
 p. 333, ^ 506 ; p. 339, <) 514 g ; p. 
 344, 345, ^ 516 d. No. 6 ; p. 707, ^ 
 949. See, also. Remedial Action, 
 and Alteratives. 
 
 elects special motor nerves, in animal 
 and organic life, without apparent 
 reference to anatomical arrange- 
 ment, p. Ill, ^ 2331 ; p. 113, f) 231 
 c ; p. 327, 328, ^ 500 k. 
 
 its law of election adapted to the will, 
 remedial agents, &c., p. Ill, ij 233? ; 
 p. 287, {) 458 ; p. 328, ^ 500 /, m. 
 
 rendered insusceptible of development 
 by the will in paralysis, but suscep- 
 tible to other causes, p. 296, § 476 
 c ; p. 326-332, ^ 500/-/. See, also. 
 Narcotics. 
 
 rendered permanently stimulant to the 
 organs of circulation by local inflam- 
 mation, which thus influences the ef- 
 fects of loss of blood, p. 354, 355, ^ 
 526 a ; p. 732-736, () 971-980. 
 
 depressant or excitant in phlebitis and 
 venous congestion, p. 503, 504, <J 
 794-798 ; p. 507-510, () 806-816 ; p. 
 724-732, ^ 961-970 ; p. 735, 736, <J 
 978. 
 
 peculiarly modified in delirium a potu, 
 mania, hydrophobia, &c., p. 734, i) 
 975 c, 976 a, b. 
 
 especially oxcrtant in cerebral inflam- 
 mation and cerebral congestion, and 
 according, also, to the nature of oth- 
 er tissues, and the kind of inflam- 
 mation, p. 61, () 134 ; p. 64, ^ 140 , 
 p. 67, i) 150, 151 ; p. 70-73, tables . 
 p. 733-736, ^ 974-980 
 
 variously modified in spasmodic and 
 apoplectic affections, p. 356-358, 4 
 526 d; p. 590-593, i) 891^ ; p. 741 
 747, ^ 99')-990^.
 
 958 
 
 INDEX. 
 
 rvervous Tower— conliymed. 
 
 how productive of motion after appar- 
 ent death, and in decapitated ani- 
 mals, p. 338, ^ 5Ud; p. 357, 358, 
 ^ 526 d ; p. 404, <^ 637. 
 
 developed by narcotics with such in- 
 tensity, permanency, and organic in- 
 fluences, as to be more or less in- 
 susceptible to other agents. See 
 Narcotics. 
 
 is morbific or curative, according to 
 its modifications, p. 107-111, s^ 226- 
 233| ; p. 336, <) 5U b ; p. 672, ^ 
 904a. See, also, Remedial Action. 
 
 its development by Narcotics counter- 
 acted by pain, &c., p. 587-590, § 891. 
 
 its preternatural influences reach the 
 intimate organization of parts, read- 
 ily, slightly, and profoundly, p. 109, 
 •J 230, 231 ; p. 230, ^ 422 ; p. 286, ^ 
 455 ; p. 334, () 508, 509 ; p. 335-341, 
 <) 512-514 ; p. 354, 355, ^ 526 a; p. 
 662, 663, ^ 896 ; p. 724-726, ^ 961 a 
 -e ; p. 732-736, () 971-980. 
 
 always operative upon muscles of 
 mixed motion, and the exciting 
 cause, p. 325, ^ 500 e ; p. 339, | 
 514/, f. 
 little operative upon the voluntary 
 muscles, excepting when the will 
 operates, p. 110, ^ 233. 
 • illustrated by the " imponderables," p. 
 79, (} 168 ; p. 113-121, () 234 c-237 ; 
 p. 330, ^ 500 n. 
 
 spurious hypotheses of, p. Ill, 112, § 
 234 ; p. 317, 318, ^ 493. 
 
 illustrative of stupendous Design, p. 
 106-111, ^223-233i; p. 125, ^ 246 ; 
 p. 284, ^ 454 ; p. 287, § 458 ; p. 323 
 -332, ^ 499, 500 ; p. 662, 663, «J 896. 
 
 its agency in the production of animal 
 heat, p. 262-264, () 446 ; p. 663, <j 896. 
 
 its instrumentality in animal heat anal- 
 ogous to its connection with all oth- 
 er products of living beings, p. 54, 
 5.5, ^ 109 i, 113 ; p. 262, 263, (j 446 ; 
 p. 483, () 746 c ; p. 662, 663, ^ 896. 
 
 a knowledge, abstractedly, of its oper- 
 ation in health, of little practical im- 
 portance, but of the greatest moment 
 in disease ; ut supra. 
 
 hitherto not applied, in any intelhgible 
 sense, to the explanation of the laws 
 of sympathy, however those laws 
 may be known, or to any natural re- 
 sults, while it is totally obscured in 
 the philosophy of disease by the 
 chemical and physical doctrines, p. 
 106, ^ 222 b ; p, 264, ^ 447 c ; p. 283, 
 <J 451/,- p. 317, 318, ^ 493 ; p. 320, 
 ^ 494 dd ; p. 329, ^ 500 nn ; p. 342, ^ 
 514^ b ; p. 362, <} 530 ; p. 484, 485, 
 ^ 748, 749 ; p 515-518, ^ 819 i-824 ; 
 p. 661, i!i894a; p. 691, ^906^,909. 
 See, also. Organic Chemistry, (Jap- 
 
 Nervous Power — continued. 
 
 iLLARY Action, and Remedial Ac- 
 tion. Rights of Authors, p. 912. 
 
 shown, by experiment, that syncope 
 does not depend upon its failure to 
 affect the heart, &c., p. 305, ^ 481 A , 
 p. 706, 707, ^ 947, 948. 
 
 exerts a certain influence, as a vital 
 stimulus, upon the functions ana 
 products of animals, p. 262-268, ^ 
 446-447 d ; 483, 484, ^ 746 c. 
 
 presents a problem for Chemistry, p. 
 281, H50e; p. 330, (J 500 nn. 
 
 its functions, the Poetry of Nature ; 
 ut supra. 
 Nervous Systems, General Uses of, p 
 
 284-290. 
 Nervous Tissues. See Tissues, and 
 Structure. 
 
 not much subject to disease, p. 356- 
 358, (j 526 d. 
 Nitrogen, 
 
 a remarkable element of organic be 
 ings, p. 34-36. 
 
 a main cause of putrefaction and fer- 
 mentation, p. 34, ^ 62. 
 
 abounds in animals, p. 34, () 62 a, /. 
 
 occurs in most parts of plants, p. 35, ^ 
 62/, note. 
 
 a principle of dissolution, p. 34, ^ 62. 
 
 shown by the Author to prove a vital 
 principle, p. 34-36, ^ 62. 
 
 wanting, naturally, in inorganic com- 
 pounds, p. 34, {) 62 d, g. 
 
 feebly compatible with chemical com- 
 pounds, p. 34, 35, (^ 62 d-h. 
 
 not united with oxygen in the atmo- 
 sphere, p. 34, () 62 e. 
 
 most indifferent of all the elements, p. 
 
 34, (J 62 d. 
 
 maintains its connections in living or- 
 ganic compounds equally with the 
 other elements, p. 35, ^ 62/ 
 
 occasions transformations in dead or- 
 ganic and certain inorganic com- 
 pounds by the contact of water, p. 
 
 35, () 62 g. 
 
 in compounds of sudden transforma- 
 tion, heat, or mechanical violence, 
 is the predisposing, and water a re- 
 tarding, cause. 
 
 occasions the ready explosion of ful- 
 minating compounds, p. 35, i; 62 e. 
 
 another illustration in gun-cotton, &c. 
 
 one of its obvious final causes in or- 
 ganic beings is their ultimate disso- 
 lution ; and this explains the philos- 
 ophy of Tiedemann's statement, p. 
 28, 29, ^ 54 a ; p. 36, ^ 62 k. 
 
 Author'' s proof from, of the creation of 
 plants before animals, and against 
 the speculatists, p. 136-138, ij 303, 
 303i 
 
 NiTROGENIZED VEGETABLE FoOD, 
 
 its uses in Chemistry, p. 17-19, (j 18 ;
 
 INDEX. 
 
 959 
 
 Nilrogenized Vegetable Food — continued. 
 p. 219-222, () 409 a, b. See, also, 
 Protein. 
 Numerical Method and Organic Chem- 
 istry, 
 
 their parallel, p. 762, 763, (j 1006 a. 
 
 alike necessary " Instruments" in Med- 
 icine, p. 161, (J 350, No. 14, and as 
 above. 
 Nutrition, 
 
 laws of, p 40-45, ^ 65-73 ; p. 217-227, 
 () 400-411. 
 
 requires the blood, or sap, as a univer- 
 sal stimulus, while in each part it is 
 commonly promoted by specific stim- 
 uli, p. 46, \ 74 a; p. 62, 63, () 136, 
 137. 
 
 theory of, in organic chemistry, p. 180, 
 181, <^ 3501 e. 
 
 contradicts the chemical theory of, p. 
 219-227, H07-411. 
 
 its vast philosophy, 226-227, ^ 410, 41 1 . 
 Nutrition and Waste, 
 
 ends of organic life, p. 21, ij 20, 27 ; 
 p 34, ij 62 A; p. 53, ^ 104; p. 129, 
 ij 273. See, also. Absorbents. 
 Nux Vomica. See Aconite, &c. 
 
 O. 
 Oblivion, 
 
 Error its victim. Truth its vanquisher, 
 p. 203-207, (j 376.^, 376J a; p. 462, 
 note ; p. 690, (j 906/; p. 755, (J 1004 b. 
 Observation, 
 
 the importance oi minute and accurate, 
 in all physiological and medical in- 
 quiries, p. 1, 2, 1^ 1 ; p. 3, 4, ij 2 d, e ; 
 p. 10-12, (j bi; p. 14, ^ 6 ; p. 16, <^ 
 14 c; p. 34-49, () 62-81 ; p. 61-73, 
 () 133-163 ; p. 86, () 175 d ; p. 92-96, 
 () 188^ d-l89 c ; p. 99, () 192 ; p. 101, 
 102, ^ 201, 202 ; p. 106-122, ^ 222- 
 240 ; p. 127, 128, ^ 261-266 ; p. 132, 
 133, ^ 289-291 ; p. 139, () 303? ; p. 
 143-146, ^ 322-326 ; p. 152, 153, ^ 
 ^ 345-349 a ; p. 154, 155, () 349 c-e ; 
 p. 157-182, ^ 350-350J ff; p. 189, 
 190, ^ 350J n ; p. 197, () 363 ; p. 200, 
 201, ^ 366-375 ; p. 208-217, ^ 383- 
 399; p. 220-227, (} 409-411; and 
 so on. 
 Oil, Castor, 
 
 the introduction of, and of aloes and 
 rhubarb, among the group of Alter- 
 atives in the Author's Arrangement 
 of the Materia Medica, indicative of 
 their special influence in small and 
 repeated doses, p. 557, (} 873 b ; p. 
 p. 567-569, ^ 889 l-mm; p. 571, 572, 
 (J 890 b ; p. 636-642, (^ 8924 d-i ; p. 
 687, <J 905^ c. See, also. Altera- 
 tives. 
 
 author's opinion that it exerts a pecu- 
 liar alterative action upon the liver, 
 ill morbid states of that organ, ibid. 
 
 Old Age, 
 
 its physiological and moral character- 
 istics, p. 282, 283, ^ 581. See, also. 
 Death. 
 Opinions, 
 
 not their Authors, the subjects of criti- 
 cism. See Authors. 
 
 their want of independence, and arbi- 
 trary nature, characteristic of the 
 age, p. 155, <) 349 d; p. 174, § 350i ; 
 p. 176, ^ 350.^ q ; p. 202, ^ 376^ ; p. 
 203-207, (} 3761 a ; p. 235, ^ 433 ; p. 
 719, () 960 a; p. 762, 763, ^ 1006 a. 
 
 more independence of, in the United 
 States than in Europe, and why, p. 
 460, (J 709, and note. Also, Medical 
 AND Physiological Commentaries, 
 vol. i , p. 327; vol. ii,, p. 663-672. 
 
 when false, can not endure, p. 174, (j 
 .3501 ; p. 202-207, § 376^, 3761 a. 
 Opium, 
 
 possesses a factitious reputation as a 
 curative agent, p. 584, ij 891 c; p. 
 718, 719, ^ 960 a. 
 
 experiments showing it is not absorbed, 
 p. 302-310, 319, 333, 930. 
 
 its uses mostly limited to subduing 
 pain in the absence of acute inflam- 
 mation, moderating irritability, pro- 
 curing sleep, and restraining diar- 
 rhoea, p. 583-590, <i 891. 
 
 never to be employed for the relief of 
 pain when it may aggravate disease, 
 p. 587, 588, <J 891 k-m. 
 
 curative, only by allaying irritability, 
 and by thus preventing the deleteri- 
 ous action of exciting causes, or the 
 unfavorable action of cathartics, and 
 other irritating remedies, and thus 
 promoting their favorable action, 
 or by calming restlessness, and pro- 
 curing sleep, and thus giving a fa- 
 vorable determination to the whole 
 intervention of art, or to otherwise 
 unaided Nature, p. 554, (J 871, 872 
 a; p. 561, ^ 888 b; p. 585-590, ^ 
 891 f-s ; but for these purposes is 
 often inferior to cicuta, or hyoscy- 
 amus, especially where their fre- 
 quent repetitions are useful, as in 
 chronic irritability of the stomach, 
 irritable tumors and ulcers, cases of 
 phthisis attended by constipation, 
 &c., and where cicuta, upon the 
 ground of its sedative effect, has ac- 
 quired, in some of the cases, the 
 reputation of possessing positive 
 virtues of an alterative nature, ibid. 
 
 removes diarrhoea by quieting intesti- 
 nal irritability, while hyoscyamus 
 will not exert that effect upon the 
 intestinal mucous tissue in the same 
 morbid state, p. 61-63, ^ 134-137 ; p. 
 65, ^ 143 a, c; p. 67, () 149-151 ; p 
 73, ^ 163 ; p. 417, ^ 650 ; p. 427, ^
 
 960 
 
 INDEX. 
 
 Opium- —continued. 
 
 668-670 : p. 428, ^ 674 a ; p. 430- 
 
 433, 4 675, 676 a ; p. 543, i} 856 ; p. 
 
 553-557, (^ 870-874 ; p. 561, (} 888 h ; 
 
 p. 566, 567, ^ 889 k ; p. 570, ^ 889 n; 
 
 p. 571, 572, ^ 890 b; p. 575, 576, (} 
 
 890 A-, I; p. 577, 578, ^ 890 o; p. 
 
 583-590, ij 891 as; p. 592, 593, ^ 
 
 89H i; P- 718, ^ 960 a. 
 OEfJANic Analysis, 
 difficult in its elementary aspect, p. 16, 
 
 (J 15 ; p. 18, <J 18 d. 
 proximate, hypothetical, p. 14, <5 6 ; p. 
 
 27-29, ^ 53 ; p. 221, 222, (f 409 b ; p. 
 
 228, (} 417 a. See, also, Pkotein. 
 its artificial transformations, p. 28, ^ 
 
 53; p. 228, ^ 4\7 a. 
 elementary, the legitimate objects of, in 
 
 respect to science, p. 202, 203, () 376^. 
 OuGAMc Beings, 
 their general structure, p. 20, ij 19 ; p. 
 
 50-61, ^ 83-133. 
 their composition, p. 15, ij 12 ; p. 23- 
 
 49, ^ 38-80. 
 how distinguished from minerals, p. 
 
 15-22, ^ 7-30 ; p. 23-49, (J 38-80 ; p. 
 
 112-125, i) 234-246; p. 157-173, () 
 
 350. 
 their peculiar properties, p. 73-125, ij 
 
 164-246. 
 their peculiar functions, p. 125-372, <J 
 
 247-569. 
 their relations to external objects, p. 
 
 398^00, () 626-630. 
 generate motion, p. 21, '() 24; p. 31, ^ 
 
 59 ; p. 89, (j 188 a ; p. 345, 346, (J 516 
 
 d, No. 7. 
 their waste and renewal, p. 21, ^ 27 ; 
 
 p. 53, () 104 ; p. 129, ^ 273 ; p. 217, 
 
 <) 401 b. 
 their seventeen elements, p. 23, ^ 34, 
 
 35 ; p. 225, {) 409. 
 their four principal elements, p. 23, <J 
 
 37; p. 33, () 61, 62. 
 how their elements combine, p. 23, ^ 
 
 38, 39 ; p. 26, <J 48, 49 ; p. 30-32, (} 
 
 58, 59. 
 the vital power combines their ele- 
 ments, p. 30, ^ 58, 59 ; p. 36^7, ^ 
 
 63-74. 
 remarkable contrast in the number of 
 
 their compounds and those of the 
 
 globe, p. 24, 25, <J 41, 46 ; p. 227, -J 41 1. 
 their vis vita, succeeded by vis inertia, 
 
 p. 30, 31, () 59. 
 nitrogen gas, a remarkable element of, 
 
 p. 34-36, <J 62. 
 a knowledge and just appreciation of 
 
 their properties, functions, and laws, 
 
 indispensable in medicine, p. 4, 5, ij 
 
 3,4; p. 14, () 6. 
 why their general laws are determined, 
 
 p. 14, {) 6. 
 Organic Chemistry, 
 the extent of its power, p. 8, ^ 5 ; p. 
 
 Organic Chemistry — continued. 
 
 14, ^ 6; p. 15, ^ lib; p. 16, (J ly 
 p. 18, ^ 18; p. 24, ^2; p. 25, §44, 
 p. 27-29, § 53, 54 ; p. 29, § 54 6 ; p, 
 161, ^ 350, No. 59. 
 
 contradistinguished from Physiology 
 and Medical Philosophy, p. 7, (^ 4J 
 rf; p. 8, (J 5; p. 10, <J 5^ a; p. 11, ^ 
 51 c; p. 14, (J 6; p. 19, § 18 c ; p. 
 21-36, <J 20-62 ; p. 40-42, () 65, 66 ; 
 p. 92-111, ^ 188^ d-233l; p. 135- 
 139, § 303-3035; p. 149-203, () 337- 
 376^; p. 234-279, I) 433-448; p. 
 323-332, ^ 500; p. 362, § 530; p. 
 376-380, § 578 ; p. 383, § 584 a ; p. 
 391, 392, I) 602 d-606 ; p. 393, i) 612; 
 p. 397, (J 623 ; p. 398, ^ 626 ; p. 401, 
 § 631, and so on. 
 
 school of, p. 6, § 4.^ b. 
 
 decHning, p. 6, 7, Hj ^ ; P 203, () 376i. 
 
 inapplicable to medicine, p. 8, 9, () 5; 
 p. 13, ^5ib; p. 434, i) 676 b. 
 
 its foundation, p. 10, () 5i a, c ; p. 13, ^ 
 5i a; p. 154, ^ 349 c; p. 155, <J 349 
 e; p. 156, ^ 350, mottoes; p. 182, § 
 3501 g; p. 197, (} 362; p. 202, § 
 376^ ; p. 221, <) 409 b ; p. 235, <) 433 
 p. 238, § 438 ; p. 239-248, § 440^141 
 b; p. 274-278, § 447^ ; p. 456, (J 698 
 p. 519, (J 824 a. 
 
 its promises of usefulness, p. 8, 9, § 5 
 p. 12, § 5^ a. 
 
 extent of its objects, p. 197, § 362. 
 
 points out the means of sustenance, p. 
 17-20, (} 18 b-c ; p. 156, § 350, motto 
 d ; p. 235, (J 433. 
 
 may indicate the food for plants, p. 20, 
 •J 18 e. 
 
 applied to physiology, p. 7, § 4i J ; p. 
 13, -liSi; p. 14, § 6; p. 19, § 18 e; 
 p. 29, ^ 54 ; p. 38-40, § 64 e-k ; p. 
 152-203, § 345-376^; p. 226, (J 409 
 j; p. 234-248, () 433-441; p. 274- 
 278, {) 447^. 
 
 its summary exhibition by Mulder, p. 
 180-183, ^ 350J e-gg; p. 189, 190. 
 () 350J n. 
 
 its own statement of its ability and ob- 
 jects, p. 18, ^I8c; p. 161, (} 350, No. 
 59 ; and how far observed, p. 157- 
 178, § 350-350? ; p. 197, () 362 ; p. 
 202, § 376i 
 
 its moral and religious tendencies. 
 See Life. 
 
 the judgment of posterity upon, p. 9, ^ 
 5 ; p. 203, «J 3761 ; P- 434, § 676 b ; 
 p. 762, § 1006 a. 
 
 how far substituted for medical philos- 
 ophy, p. 8, § 5 ; p. 13, ^ 5^ b ; p. 
 174-178, ^ 3501-3503 ; p. 197, () 362 ; 
 p. 202, 203, (} 376i ; p. 234, 235, ^ 
 433 ; p. 456, § 698 ; p. 515, ^ 819 b. 
 
 how far tolerant, p. 13, ^ 5^ a ; p. 156, 
 <J 350, mottoes, a, b, c, d, e ; p. 185, ^ 
 350|U-; p. 515, § 819 />.
 
 961 
 
 Organic (chemistry — coiUinucd. 
 
 causes of its success, p. 11, ^ 5| c; p. 
 17, i) 18 c; p. 133, (J 292; p. 154, 
 155, (j 349 c, d; p. 202, () 376^ ;*p. 
 234, 235, ^ 433; p. 515, ^ 819 b. 
 See, also. Analogies, False. 
 
 its recommendations, p. 6, 7, ij ^\h, d ; 
 p. 8, 9, ^ 5; p. 11, ij 5i c; p. 13, ij 
 b\ b; p. 14, ^ 6; p. 17, (J 18c; p. 
 19, tjlQe; p. 26, () 48, 49 ; p. 28, () 
 53 c ; p. 30-33, ij 59 ; p. 36, ^ 62 i ; 
 p. 38-40, () 64 e-h ; p. 43, ij 67 ; p. 
 85, ^ 175 c; p. 132-134, (J 289-293 ; 
 p. 136-139, ^ 303-303^ ; p. 152-192, 
 9 345-352 ; p. 197, <J 363 ; p. 199, ^ 
 364^ ; p. 202, 203, (, 376, 376^ ; p. 
 220-222, ^ 409 ; p. 2^6, ^ 409 ; ; p. 
 234-260, ^ 433-445; p. 274-279, (} 
 447^^48 ; p. 434, ^ 676 b ; p. 456, ^ 
 698, p. 515, 6 819 i; p. 519, ^ 824 
 a; p. 763, ^ 1006 a, 
 
 the Author^ s Motives for investigating 
 its merits, p 7, ^ 4^ i, (Z ,• p. 8, (^ 5 ; 
 p. 13, ^ 5^ a; p. 148, <J 335 ; p. 154, 
 155, ij 349 ; p. 156, ^ 350, mottoes, a, 
 b, c, d, e; p. 173-178, () 350J-350i ; 
 p. 191, (j 351 ; p. 197, () 362 ; p 202, 
 () 376J ; p. 234, I) 433 ; p. 239, () 438 
 d; p. 241, ^ 440 J; p. 254, () 441 e ; 
 p. 265, ij 447 ^1 ,- p. 277, <J 447^/; p. 
 345, () 516 <Z, No. 6 ; p. 362, ^ 530 ; 
 p 456, (j 698 ; p. 515, ij 819 b ; p. 540, 
 <J 851 c ; p. 543, ^ 854 i6. 
 
 its advantages to medicine, p. 171-173, 
 {) 350, Nos. 41-46; p. 174-178, (/ 
 350^-350s. 
 
 Its confirmation or overthrow, p. 148, 
 ^ 335 ; p. 542, () 854 bb. 
 
 problems for its solution, p. 16, ^ 14 c ; 
 p. 85, I 175 c; p. 94, () 188^ d; p. 
 155, ^ 349 e;p. 281-283, ^ 450 d- 
 4:51 f; p. 330, (foOOnn; p. 377, 379. 
 Organic Chemistry and the Numerical 
 Method, 
 
 important " Instruments" in medicine, 
 p. 161, ^ 350, No. 14; p. 762, 763, § 
 1006 a. 
 
 their parallel, p. 762, 763, <) 1006 a. 
 Organic Chemistry and Physiology, 
 
 contrasted, p. 19, <;> 18 e; p. 157-173, 
 <J 350 ; p. 189, 190, 6 350? n ; p. 191, 
 « 351 ; p. 246, <J 440 /; p. 277, 278, 
 sS 447i/; p. 514, 515, ^ 819. 
 
 one destructive, the other formative 
 and conservative, p. 8, 9 5 ; p. 13, ij 
 5^ b ; p. 18, (} 18 c; p 24, (J 42 ; p. 
 33, 'Ji 60 ; p. 34-36, ^62; p. 37-40, 
 ^64; p 135, ^ 301. 
 Organic Compounds, 
 
 their four principal elements, p. 23, ^ 
 37 ; p 27, ^ 53 i ; p. 33, ^ 61, 62 ; p. 
 44, § 72. 
 
 always consist of three or more ele- 
 ments intimately combined, p. 16, (j 
 17; p. 227, Hll. 
 
 Pp 
 
 Organic Compounds — continued. 
 formed of ccmbustible substances, 
 
 proper, of supporters of combustion, 
 
 and nitrogen gas, p. 33, ij 61. 
 fonned out of a homogeneous fluid of 
 
 seventeen elements, p. 24, <J 42. 
 formed originally by plants, p. 15, ^ 
 
 10, 13 ; p. 135-138, ^ 298-303^. 
 when decompounded, how restored, p 
 
 15, § 13, 14. 
 
 mode in which their elements com- 
 bine, p. 23, § 37-39 ; p. 24, ^42; p. 
 
 26, (J 48 ; p. 27, ^ 51, 52, 53 b ; p, 
 44, § 72. 
 
 contradistinguished from mineral com- 
 pounds, p. 20-27, § 19-51 ; p. 221- 
 227, ^ 409 J-411. 
 
 progressively advanced, p. 24, ^ 42. 
 
 hold different ranks, p. 24, ^ 42. 
 
 different in every part, p. 25, ij 44 ; p. 
 
 27, <) 53 b; p. 222-225, (} 409. 
 variety of, p. 24, ij 41 ; p. 44, ij 72 ; p. 
 
 221-227, (J 409 i^ll. 
 
 not formed in the blood or sap, p. 24, 
 M2 ; p. 28, ^ 53 i, c ; p. 44, ^ 72 ; 
 p. 217, (J 401 b, 402 ; p. 218, ^ 404 ; 
 p. 219-227, ^ 407-411. See, also 
 Protein. 
 
 confounded by chemistry, p. 29, ^ 54 b. 
 
 uniform in health, p. 21, ^ 22 ; p. 24, () 
 42 ; p. 25, ^ 44 ; p. 26, () iS ; p. 27, 
 ^ 53 b; p. 44, ^ 72 ; p. 223-227, ^ 
 409/-411. 
 
 exactly variable in disease, p. 21, ^ 22 , 
 p. 25, §U; p. 87, ^ 182 a ; p. 105, ^ 
 220, 221 ; p. 435, () 680 ; p. 452, ^ 
 693 ;■ p. 473, <J 733 c ; p. 474, ^ 733 
 /; p. 478, 479, (} 739-741 ; p. 517, 
 518, ij 822 : p. 536-538, ^ 847 c-f 
 
 fundamental cause of their differences, 
 p. 27, (^ 52, 53 b. 
 
 their chemical analysis uncertain, p. 
 
 16, H5 ; p. 18, ^18 d; p. 26, ^ 48 ; 
 p. 27-29, ^ 53, 54. 
 
 their complexity, p. 24, ij 41, 42 ; p. 
 
 25, M3 ; p. 26, M9 ; P- 32, ^ 60 • 
 
 p. 44, ^ 72. 
 their putrefaction and fermentation, p. 
 
 28, § 5i; p. 30-32, ^ 59 ; p. 34-36, 
 ^62; p. 96, § 189 c. 
 
 their elements united hy vis vita, p. 
 30-32, ^ 58, 59 ; p. 33, ^ 60 ; p. 36, 
 (f62i; p. 37-44, (} 64-72. 
 
 when dead, vis inertice succeeds to vis 
 vita, p. 30, 31, ^ 59. 
 
 their artificial transformations, unnat- 
 ural, p. 28, 29, ^ 53 5-54 b ; p. 228, 
 § 417. 
 
 chemical influences upon, suppose 
 chemical decompositions and re- 
 combinations, p. 28. ^ 53 b ; p. 228, 
 
 their nature disturbed by any chemical 
 influence, p. 28, <J 53 J; p. 29, 30, ^ 
 56,57; p. 228, ^17 a. 
 P
 
 962 
 
 INDEX. 
 
 Organic Compounds — continued. 
 .when dead, their condition affected by 
 pre-existing \ital intiuences, p. 28, 
 
 their chemical decomposition rapid, p. 
 29, 30, f) 54 a, 56 ; p. 34-36, () 62. 
 
 their dissolution greatly owing to nitro- 
 gen gas, p. 34-36, <J 62. 
 
 their dissolution promoted by the com- 
 plexity of their elements, p. 36, (j 62 
 A, and by water or its elements, p. 
 35, (} 62 g. 
 Organic Force, Chemical Theory of, 
 
 oxydation of the blood and tissues, p. 
 157, 158, 159, (} 350, Nos. 3, 4, 5, 7, 
 8, 9 ; p. 274, (} 447^ a, No. 2. 
 
 the cause and the effect, p. 7, ^ 4i d; 
 p. 84-86, () lib c, d; p. 90, ^ 188^ 
 d; p. 154, 155, ^ 349 c, e; p. 254, I 
 441 e ; p. 274, ^ 44 7^ a. See Vital 
 Principle, and Vital Properties. 
 Organic Functions, 
 
 their general consideration, p. 126-280, 
 i) 251-449. 
 
 common to plants and animals, p. 125, 
 <) 249. 
 
 their designations, motion, absorption, 
 assimilation, distribution, o.ppropria- 
 tion, excretion, calorification, genera- 
 tion, p. 125, ij 249. 
 
 the most essential carried on by the 
 extreme vessels, p. 36^1, ^ 63-72. 
 See, also. Capillaries, Capillary 
 Action, and Circulation, Capil- 
 lary. 
 Organic Heat, 
 
 vital and Chemical Theories of, p. 234— 
 279, ^ 433-448. 
 
 its interpretation abandoned to chem- 
 istry, p. 234, 1^ 433 ; but is only one 
 among many corruptions in Physiol- 
 ogy, p. 235, {) 433. 
 
 Crawford's theory of, p. 235, ^ 434, 
 435 a. 
 
 Bichat's theory of, p. 236, ^ 437 a; p. 
 
 262, () 445 g ; p. 266, <) U7 d ; p. 
 
 270, ^ 447 d. 
 
 Hunter's theory of, p. 237, <J 437 b. 
 Philip's theory of, p. 237, <J 437 c ; p. 
 
 263, () 446 b. 
 
 Moore's theory of, p. 337, ^ 437 d. 
 Mailer's theory of, p. 237, () 437 e. 
 Tiedemann's theory of, p. 237, ^ 437/. 
 Carpenter's theory of, p. 237, ^ 437 g. 
 Edward's theory of, p. 237, ^ 438 a ; p. 
 248, () Ul b; p. 255, ^ 44U a ; p. 
 
 271, 272, ^447^. 
 
 Elliotson's theory of, p. 273, ^ 447 h. 
 
 Billing's theory of, p. 238, <^ 438 b. 
 
 Roget's theory of, p. 238, (J 438 c. 
 
 Distinction between Liebig's and the 
 last two, p. 238, ^ 438 d. 
 
 Liebig's theory of, as of all organic pro- 
 cesses and results, combustion, or 
 the union of oxygen with carbon and 
 
 Organic Heat —continued. 
 
 hydrogen, p. 239-248, ^ 440-441 h, 
 p. 252, ^ Ul c; p. 254, 2.55, <;> 441 c, 
 f; p. 260, ^445 b; p. 264, ^46 c. 
 p. 274-278, {) 447^. 
 conflict in the chemical statements of, 
 p. 239, 240, ^ 440 a, b; p. 252, ^ 
 441 c; p. 246, ^ 440/; p. 254, 255, 
 (j 441 e,f; p. 260, I) 445 b; p. 264, ^ 
 
 446 c ; p. 271, ^ 447 /, g ; p. 273, \ 
 
 447 h ; p. 274-278, ^ 447^ 
 
 theory of, regarding the conversion of 
 fluids into solids, p. 273, ^ 447 h, and 
 ut supra. 
 
 contingent aid required by the theo- 
 ry of combustion, p. 239-244, ^ 440, 
 Nos. 3, 7, 8, 9, 11, lU, 12, 13, 14; 
 p. 245, (J 440 e ; p. 247", () 440, No. 
 19 ; p. 248, i) 441 a-c ; p. 252, <J 441 
 c ; p. 254, (J 441 e ; p. 257, () 442 ; p. 
 264, () 446 c ; p. 274-278, () 447^ 
 
 not regulated by the quantity or qual- 
 ity of food, p. 239, 240, () 440 a ; p. 
 242-244, ^ 440 c, cc ; p. 248-253, (} 
 441 b-d. 
 
 chemical hypothesis of, founded mostly 
 upon facts and assumptions relative 
 to man, and man in health, p. 239, ^ 
 440 a, No. 3; p 243, 244, (;i440 cc, No. 
 12 ; p. 248, (^ 441 i ; p. 275, ^ 477^ b. 
 
 in its relation to the law regulating 
 the interchanges of caloric among 
 inanimate objects, p 244-246, <J 440 e. 
 
 chemical parallels of, with inorganic 
 processes, and artificial mecna 
 nisms, p. 177, 178, ^ 3501 ; p. 238 
 (} 438 b, c. 
 
 its supposed connection with exercise 
 p. 240, ^ 440 a. No. 8 ; p. 243, 244 
 ^ 440 cc. No. 12. 
 
 its supposed connection with alcoho 
 and cold water, p. 240, ^ 440 a, b. 
 
 why reduced and exalted by cold, p 
 
 245, 246, () 440 e. 
 
 its greater evolution from animal than 
 vegetable food, and from alcoho' 
 than water, and in their connection 
 with different climates, explaine«t 
 against organic chemistry, p. 240, § 
 440 b ; p. 245, <J 440 c ; p. 250-252, 
 (^ 441 c ; p. 257, (j 442 h ; p. 335, 336, 
 ij 512, 513 ; p. 394-396, ^ 617-b21. 
 
 chemical philosophy of, in relation to 
 meat, fat, tallow, wine, and oile, and 
 objections, p 67, 68, ^ 151, 152 ; p. 
 240-243, (j 440 a-c ; p. '^47, (} 440 *. 
 
 supposed dependence of upon clothing, 
 p. 239, <;» 440 a, No. 3 ; p. 241, ^ 440 
 bb. No. 9 ; p. 242, ^ 440 c ; p. 245, 
 
 246, 6 440 e; p. 249, 250, (/ 441 c; 
 p. 256, I) 441 J c; p. 257-259, ^ 442. 
 
 its uniformity in all warm-blooded non- 
 hybernating vertebrata, under all cir- 
 cumstances of heat, cold, food, cloth- 
 ing, &c., p. 242, ^ 440 c ; p. 245. 246.
 
 INDEX. 
 
 963 
 
 Organic Heat — continued. 
 
 (, 440 e ; p. 249, 250, (J 441 c ; p. 258, 
 
 259, <5 442 d, e. 
 
 more uniform ir warm-blooded verte- 
 brata than an" other product, p. 245, 
 () 440 e; p. 253, 9 441 d. 
 
 variable in cold-blooded animals and 
 insects, according to the external 
 temperature, their vital constitution, 
 and diseases, p. 252, ^ 441 c ; p. 255, 
 ^ 441^ a; p. 259, 260, ^ 443, 444. 
 
 generated by cold-blooded animals and 
 insects, p. 246, ^ 440 e. 
 
 less uniform in cold-blooded animals 
 than any other product ; see as above. 
 
 generated by the egg, p. 30, ij 57 ; p. 
 97, ^ 190 J; p. 256, () 44U d; p. 
 
 260, ^ 445 b. 
 
 generated by plants, p. 256, ^ 44H a; 
 p. 260-262, ^ 445. 
 
 a product of secretion, p. 263, ^ 446 ; 
 p. 273, ^ 447 A. 
 
 influenced by age and constitution, p. 
 68, 69, (J 153-156 ; p. 248, (J 441 b ,■ 
 p 255, ^ 44U a; p. 257, 258, ^ 442 
 a, b ; p. 259, 260, ^ 443-445 J ; p. 
 262, § 445 /; p. 271-273, <J 447 g", A ; 
 p. 275, ^ 447i b; p. 384, § 585 c, d, 
 586 ; p. 391, <. 603. 
 
 its vital nature shown by hereditary 
 constitution, p. 257, 258, ^ 442 b. 
 
 parallel in its production, between 
 the warm-blooded non-hybernating 
 mammalia (young and old), warm- 
 blooded hybernating mammalia, cold- 
 blooded animals, eggs, and plants, 
 and the coincident philosophy of, p. 
 245, 246, () 440 e; p. 248, ^ 441 b ; 
 p. 253, () 441 d ; p. 255-263, ^ 441 / 
 446 a ; p. 272, ^ 447 h ; p. 63, <) 137 
 e; p. 68, ^ 152. 
 
 amount generated by warm-blooded 
 animals depends upon the nature of 
 the species, and not at all upon any 
 given amount of food, clothing, de 
 gree of external temperature, &c. 
 p. 242-245, ^ 440 c-e ; p. 249, 250 
 ■51 441 c; p. 257-259, ^ 442-443. 
 
 Influenced by sympathy, p. 270, ^ 447 d 
 
 influenced by the nervous power, p 
 262-264, ^ 446. 
 
 greatly affected by disease, injuries 
 paralysis, &c., p. 259, () 443 b; p 
 264-270, ^ 447 a-d ; p. 272, § 447^, 
 
 exalted in disorganized states of the 
 lungs, p. 268, 269, <) 447 d. 
 
 influenced by climate, through the law 
 of vital habit, p. 256, ^ 441^ a-c ; p. 
 258, (i U2b, c ; p. 363, ^ 535-540 ; 
 p. 394-396, \ 615-621. 
 
 influenced by habits of exposure to cold, 
 by clothing, &c., through the law of 
 vital habit, p 257, 258, () 442 a-d. 
 
 its vital nature shown in plants by the 
 adaptation of tropical to cold cli- 
 
 Organic Heat— continued 
 
 mates, by the rapidity with which 
 the tropical may be made to endure 
 a frosty atmosphere, by the ever- 
 greens of northern latitudes, c&c, 
 ibid, and Vital Habit. 
 
 its relation to vital habit explains the 
 dissemination of animals from the 
 region of the Ark, p. 258, ^ 442 b, c ; 
 p. 363, (^ 537-540 ; p 364, () 544, 548 ; 
 p. 369, (J 562 ; p. 391, ^ 603 ; Which 
 is farther illustrated by transferring 
 plants from southern to northern 
 climates, ut supra. 
 
 its far more rapid reduction, or exalta- 
 tion, in disease, by a small loss of 
 blood, than by all other causes con- 
 joined, a proof of its independence 
 of combustion, p. 269, <J 447 d. See, 
 also. Loss OF Blood, and hyberna- 
 ting animals, as below. 
 
 its remarkable vicissitudes in hyber- 
 nating animals, and derivative proof 
 of its vital production, p. 253, () 441 
 d ; p. 255, 256, ^ 441^ a, b ; p. 264, 
 ^ 446 d. 
 
 supposed dependence of, upon the red 
 globules of blood, and objections, p. 
 255, ^ 441 /; p. 260, 261, A 445 b-e ; 
 p. 274-278, () 447f 
 
 generated according to the nature of 
 the part, p. 61, 62, (J 133 b, 134-136 ; 
 p. 67, () 150, 151 ; p. 97, 98, () 190, 
 191 ; p. 260, <) 445 a, b ; p. 268, 270, 
 ^U7 d. 
 
 why it sometimes rises just antece- 
 dently to death, p. 269, () 447 d. 
 
 why it rises after death, p. 266, 267, ^ 
 447 i. 
 
 has one provision for the lungs, and 
 another for " the rest of the body," p 
 276, 277, 4447^/. 
 Organic Kingdom. See the topics rela- 
 tive thereto. 
 Organic Life, 
 
 its laws sought in the ovum, p. 36-49, 
 ^ 63-81. 
 
 changes in, as constituted by tempera- 
 ment, domestication of animals, cul- 
 tivation of plants, and disease, have 
 their type in the ovum, p. 44-49, ^ 
 72-80. 
 
 resists chemical agencies, p. 29-33, () 
 55-60 ; p. 34, ij 62 c. 
 
 its organs, p. 54, <S> 105, 107, 111 ; p. 
 57, ^ 125. 
 
 its most essential organs, p. 40, § 65 ; 
 p. 42, <J 67 ; p. 54, ^ 109, 110 ; p. 55, 
 ^115; p. 56, 9 122; and are blended 
 in all parts, p. 54, () 109 b, 110; p. 
 55, ^ 113-117. See, also. Capilla- 
 ries, and Circulation, Capillary. 
 
 its great immediate office nutrition and 
 vital decomposition, p. 53, ^ 104 ; p 
 129, ^ 273.
 
 964 
 
 INDEX. 
 
 Organic Life — continued. 
 
 Its great final cause in respect to the 
 species, the development of the gen- 
 erative organs, and the production 
 of germs, p. 56, ^ 121. 
 
 its several functions, p. 54, i^ 105. See, 
 also. Organic Functions. 
 
 begins in plants, p. 15, () 10, 14; p. 
 16, (j 16, 17 ; p. 135, (J 298-301, 303 ; 
 p. 137, (j 303^ ; p. 201, ^ 374, 375. 
 
 never generates an inorganic sub- 
 stance for organic purposes, nor car- 
 ries backward, in the animal organ- 
 ization, an organic compound, p. 15, 
 ij 13, 14; p. 24, M2 ; P- 30, (^ 59; 
 p. 33, ^ 60 ; p. 135, () 301 ; p. 196, <J 
 360 ; p. 201, (j 374, 375. 
 
 its simplicity in plants in respect to 
 organization, p. 54, () 107; p. 58, (^ 
 129/; p. 135, ^ 202 ; p. 136, (J 303. 
 
 in plants the whole being, p. 55, ij 114 ; 
 p. 88, ^ 184, 185. 
 
 complexity of its organs in animals, p. 
 54-56, ij 111-120; p. 57, (^ 125; p. 
 13.5, () 302 a; p. 140-143, I) 304- 
 319. 
 
 its comprehensive system of connect- 
 ed Designs, p. 143-146, () 322-326. 
 See, also, Design. 
 
 how distinguished from animal life, p. 
 53, ^ 98-104 ; p. 54, ^ 106, 108, 110, 
 111; p. 55, ^ 112-117. See, also. 
 Life, Animal. 
 
 mdispensable to animal life, p. 54, <J 
 108, 110; p. 55, <J 115. 
 
 subordinate to animal life, in its com- 
 prehensive Design, p. 15, I) 10-14; 
 p. 55, I) 113. 114 ; p. 135, <J 298, 300. 
 
 gives rise to the same diseases in the 
 organs of animal as of organic life, 
 p. 55, ij 117. 
 
 the whole life of the foetus, p. 53, ^ 103. 
 See, also, Nerves. 
 
 has no repose but in the germ, p. 30, 
 (J 57; p. 53, ^ 102; p. 97, i) 190 b. 
 
 harmonious in its laws and phenome- 
 na, p. 1, ij 1 ; p. 3, ij 2, b, d ; p. 14, 
 ij 6 ; p. 41, ij 65 ; p. 44, (J 72 ; p. 47- 
 49, ^ 75-80 ; p. 55, § 117 ; p. 58, 59, 
 ^ 129; p. 61, ^ 133 c; p. 62, 63, ^ 
 135-137; p. 65, ^ 143 c; p. 67-69, 
 (^ 149-156 ; p. 81, ^ 169/; p. 85, ^ 
 175 c; p. 87, ^ 177-182 ; p. 88, 89, 
 i) 185-188 ; p. 90, (} 188^ a-d ; p. 93- 
 95, ^ I88id; p. 96-99, «J 189 c-192 ; 
 p. 101, 102, () 201-203 ; p. 103, ^ 
 205 a, 207, 208 ; p. 104, ^ 215 ; p. 
 105, ^ 220 a; p. 106-111, ^ 223- 
 233i; p. 120-122, § 237-240; p. 
 124, 125, () 243-246 ; p. 128, ^ 266 ; 
 p. 129, 130, ^ 273, 277-279; p. 131- 
 133, § 285-291 ; p. 135, ^ 300, 301 ; 
 p. 137, (} 303 e, 303| a ; p. 140-147, 
 ^ 304-330 ; p. 148, 149, ^ 336 ; p. 
 191, 192, ^ 351-353 ; p. 209, ^ 384, 
 
 Organic Life — continued. 
 
 385; p. 212, <J 392; p. 216, () 39i) , 
 p. 217, ^ 401 b; p. 222-234, <^ 409 c- 
 433 ; p. 271, ^ 447/; p. 272, 273, ^ 
 447 h; p. 279, <J 449 ; p 282, () 451 ; 
 p. 283, § 452 a, c ; p. 284-287, ^ 454 
 -458 ; p. 290, ^ 464, 465 ; p. 323- 
 332, cj 500 ; p. 405-412, <J 638 ; ana 
 so on. 
 
 contrasted with the condition of dead 
 matter, p. 23-73, () 34-163 ; p. 434, 
 435, () 680. See, also. Properties 
 OF Life, Functions, Age, Sex, and 
 Death. 
 
 its results always uniform under any 
 given combination of circumstances, 
 p. 120, 121, (J 237; p. 227, t) 411 ; p. 
 405-412, <J 638 ; p. 442, ^ 686 d; p. 
 489, (^ 756 ^<; p. 619, ^ 892 J- r. See, 
 also. Harmonious in its Laics, as 
 above; and Design, Therapeutics, 
 &c. 
 
 contradistinguished from chemical and 
 mechanical philosophy. See Or- 
 ganic Chemistry. 
 
 involves in animals the two properties 
 which are specifically designed for 
 animal life. See Vital Principle, 
 Vital Properties, Nervous Pow- 
 er, and Sensibility. See, also, 
 Life. 
 Organic Processes, 
 
 type of, in the germ, p. 36-49, ^ 63-81 
 
 proof of their universal vital nature 
 derived from the function of gener- 
 ation, p. 280, ^ 449 d. 
 Organic Properties, 
 
 common to plants and animals, p. 88, 
 ^ 183, 184 a. 
 
 modified in each department, p. 88, ij 
 185. See Vital Properties, and 
 Vital Principle. 
 Organism, 
 
 the universal body, p. 52, <J 89. 
 
 radiated, p. 53, i^ 93. 
 
 symmetrical as a whole, p. 53, ^ 95. 
 
 composed of two systems ; one rela- 
 tive to the individual, the other to 
 the species, p. 53, ^ 96, 97. 
 
 the animal founded on the organic, p. 
 53, {} 98-103 ; p. 54, (j 108, 110, 111 ; 
 p. 55, i) 114-117 ; p. 143-146, ^ 322- 
 326. 
 Organization, 
 
 beginning of in plants, p. 15, ^ 10, 14 a. 
 . rudiments of, p. 41, ^ 65 ; p. 46, () 74. 
 
 its simplicity in plants, p. 54, ^107; 
 p. 135, (J 302. 
 
 and vital properties, mutually depend- 
 ent, p. 16, <)\^c; p. 81, {) 170. 
 
 its most essential part, p! 54, iji 109 i. 
 Organized Structure. See Struct^ 
 
 ure. 
 Organs, Development of. See Devel- 
 opment.
 
 INDEX. 
 
 965 
 
 Organs of Animal Life, 
 
 their designation, &c , p. 54, ^ 106 ; p. 
 
 58, {) 127. 
 their subserviency to organic life, p. 
 
 54, 55, 9 111-117; p. 106, ^ 223 ; p. 
 
 108, {} 228 ; p. Ill, ^ 2335 ; P- 144- 
 
 146, ^ 323-326 ; p. 282-289, ^ 451 
 
 C-46H; p. 325, ^ 500 e; p. 332, ^ 
 
 501 c; p. 338, 339, ^ 5Uf,g. 
 act necessary to organic life, p. 54, ^ 
 
 108. See, also. Organic Life, and 
 
 Nerves. 
 Organs of Organic Life, 
 arrangement of, according to their 
 
 functions, p. 57, ^ 125. 
 compound, p. 52, 53, (i 89, 92. 
 their sympathetic relations, p. 58, ^ 
 
 129 c-f. 
 their relations liable to derangements, 
 
 p. 59, <) 129 g-i; p. 361, 362, i) 529. 
 
 See, also. Laws of Sympathy, and 
 
 Nervous Power. 
 their mechanical relations, p. 59, ^ 
 
 129 k. 
 indispensable to animal life, p. 54, () 
 
 108. 
 indispensable to each other, p. 54, ^ 
 
 109. 
 general nature of the relations be- 
 tween the organs of organic and of 
 
 animal hfe, p. 55, <J 111-117. 
 Ovum, 
 
 its state of life, p. 30, <J 57 ; p. 36-42, 
 
 <^ 63-66; p. 97, iJ190i; p. 104,9 212. 
 its principle of development, p. 37-40, 
 
 ^ 64-65. 
 vital Theory of its development, p. 41, 
 
 ^ 65. 
 chemical Theory of its development, p. 
 
 190, 191, ^ 350i n. 
 special circumstances attending its 
 
 condition and development, p. 56, ^ 
 
 122 ; p. 97, 4 190 b; p. 104, <) 212. 
 its vital modifications, p. 44, <J 72 ; p. 
 
 56, ^ 122, 123; p 97, § 190 b; p. 
 
 104, () 212. 
 how impressed in fecundation, p. 44, 
 
 45, <J 72-73 ; p. 97, ^ 190 b ; p. 104, 
 
 ^ 212. 
 its development a type of all organic 
 
 processes, p. 45, ^ 73 b ; p. 68, § 
 
 153-156 a. 
 its development supplies a type of all 
 
 diseases, p. 45, ij 72 ; p. 47-49, ^ 
 
 75-80. 
 transmits disease, p. 47, 48, <J 76-78. 
 potentially the future being, p. 40, () 65. 
 illustrates the general character of the 
 
 properties of life, p 41, § 72 ; p. 
 
 47-49, {) 75-80 ; p. 256, (fUlid. 
 illustrates the philosophy of hybrid an- 
 imals and hybrid plants, p. 44, 45, 9 
 
 72. 
 its common nucleus of a cell, p. 42, <5 
 
 67; p. 50, s*" 83 b; p. 60, ^ 131. 
 
 V u m — continu ed. 
 
 its peculiarities in different tribes, p. 
 56, ^ 122 ; p. 97, ^ 190 b. 
 
 oviparous and viviparous, distinctions 
 between, p. 45, ^ 73 a; p. 97, ^ 
 190 b. 
 
 organic life alone in operation during 
 its development, p. 53, ^ 103. 
 
 development of its nervous system, 
 organs of sense, and voluntary mus- 
 cles, like that of the liver, stomach, 
 &c., designed for independent life, 
 and the work of development de- 
 volves, therefore, upon the extreme 
 vessels, p. 42, ij 67 ; p. 54, 6 109 ; p. 
 284, ^ 455 a, b ; p. 286, <J 456 ; p. 
 289, ^ 46Ua ; p. 342-353, ^ 516-524. 
 
 its power of resisting external in- 
 fluences, p. 30, ^ 57 ; p. 56, ^ 123 ; 
 p. 256, iJ441H- 
 
 evinces great Design, p. 56, ^ 123 ; p. 
 
 97, ^ 190 b. See Nerves, their early 
 
 development, &c. 
 
 Oxvdation of the Blood and Body. 
 
 See Combustion, andORGANicHEAT. 
 
 Oxygen, 
 
 its relative connection with animals 
 and plants, p. 137-139, ^ 303^-3035. 
 
 its connection with respiration, p. 229, 
 ^ 419 ; p. 266, (} U7 d ; p. 268, () 447 
 d; p. 270, ^^1 447 e ,• p 274-278, () Ul^. 
 
 a test of the assumed dependence upon, 
 of motion and animal heat, p. 255, 1^ 
 441/. 
 
 its connection, in organic chemistry, 
 with the various processes and re- 
 sults of life. See Combustion, and 
 Physiology, in relation to the red 
 globules of blood. 
 
 Christison's observations upon in dis- 
 ease, p. 270, () 447 e. 
 
 its relative connection with the genera- 
 tion of heat and other products of 
 organic beings, p. 273, ^ 447 h 
 
 P. 
 
 Pain, 
 rarely a cause of disease, p. 588, ^ 891 
 
 does not affect organic actions in 
 health, p. 79, (} 167, note ; p. 588, 9 
 891 m. 
 
 should not be prevented, nor assuaged, 
 by means which may endanger life, 
 p. 584, () 891 c, d; p. 587, «J 891 k ; 
 p. 593, ^ 8911 k. See, also, Nar- 
 cotics. 
 Paralysis, 
 
 prevents the operation of the will by 
 embarrassing its action upon the 
 nervous power. See Will, Nerv- 
 ous Power, Narcotics, Motion, and 
 Analogies. 
 Past and Present, p. 203-207, ^ 376| a
 
 966 
 
 INDEX. 
 
 Pathology, 
 
 its general survey, p. 413-540, ^ 639- 
 851; comprehending J?cffio<e Causes, 
 p. 414-427, () 644-666 ; Proximate or 
 Pathological Cause, p. 427^34, <j 
 667-676; Symptoms, p. 434^55, <^ 
 677-694^ ; Morbid Anatomy, p. 456- 
 463, <J 695-709 ; Inflammation, p. 464- 
 489, ^ 710-756 ; Fever, p. 489-499, 
 <5 757-785 ; Venous Congestion, p. 
 500-513, 1) 786-818 ; Humoralism, p. 
 514-540, () 819-851. 
 objects and nature of, p. 3, ^ 2 ; p. 413, 
 
 414, ^ 639-642, p. 398, ^ 626. 
 to the physician the great final object of 
 physiology, p 3,<)2b; p. 413, <J 639 a. 
 reflects light upon physiology, p. 73, <J 
 
 163; p. 107-111, I) 225-233J. 
 the Chemical System of, p. 171-173, ^ 
 350, Nos. 41, 42, 43, 44, 45, 46 ; p. 
 174-176, () 350^ a-g; p. 251, 252, ^ 
 441c; p. 515, '5i819 6; p. 517, ij 821 c. 
 Pancreas, 
 developed from intestinal canal, p. 41, 
 () 65. See, also, Assimilation. 
 Passions. See Mental Emotions. 
 chemical theory of, p. 155, <5> 349 e. 
 See, also. Combustion. 
 Perception, 
 necessary to true sensation, p. 89, () 
 186 ; p. 100, ^ 196 ; p. 124, ^ 242 ; 
 p. 282, ^ 451 c. 
 not concerned in the function of sym- 
 >ithy, p. 54, 55, «J 111-117; p. 101, 
 102, ^ 201-203 ; p. 125, () 245, 246 ; 
 p. 282, () 451 ; p. 283, ^ 452. 
 Phenomena, 
 
 the foundation of philosophy. See Ef- 
 fects. 
 Philanthropy, 
 indispensable in medical pliilosophy, as 
 in the practice of medicine, p. 122, 
 () 240, &.C. 
 Philip, Wilson, 
 
 his Experiments to determine the Laws 
 of the Vital Functions, p. 110, ^ 233. 
 neglected, p. 112, (/ 234 h. 
 .statement of his, and analogous experi- 
 ments by others, and the author's in- 
 ductions from them, p. 290-321, § 
 462-494. 
 Philosophy, 
 
 portents of coming changes in, p. 7, I) 
 Ai b ; p. 8, 9. <S) 5 ; p. U, ^ 6 ; p. 174, 
 ^ 350i ; p. 203-207, ^ 376i ; p. 460- 
 463, ^ 709, note. See, also. Physi- 
 ology AND Organic Chemistry, con- 
 trasted. 
 neglected, p 112, (;> 234 b; p. 154, <J 
 349 d ; p. 202, () 376J ; p. 219, ^ 408 ; 
 p. 234, 235, () 433 ; p. 434, ^ 676 b ; 
 p. 457, ^ 699 c ; p. 482, (J 744 ; p. 
 484, {) 748 ; p. 515, ^ 819 b; p. 715- 
 721, (} 960 a. 
 lis limits, p. 185, ^ 850J k; p. 206, (> 
 
 Philosophy — continued. 
 
 376i a ; p. 317, () 493 a; p. 719, 720, 
 <J 960 a. See, also, Science. 
 trite and false, illustrated in the charac 
 ters of Pythagoras and Anaxagoras, 
 p 482, ^ 744. 
 false, illustrated by prevailing fabrics 
 in medicine, p. 174-178, () 350^- 
 350? ; p. 484, 485, ^ 748, 749 ; p 
 515-519, () 819 i-825. 
 Phlebitis. See Venous Congestion. 
 
 and Venous Tissue. 
 Phthisis Pulmonalis, 
 
 ar inflammatory disease, in all its 
 phases, and demanding loss of blood, 
 and a strictly antiphlogistic treat- 
 ment in its early stages, and ab- 
 stinence from meat in the more ad- 
 vanced, p. 457, (} 699 c ; p. 458, ^ 
 700 b ; p. 459, ^ 705 ; § 756 a; () 732 
 d; p. 546-551, () 862-864; p. 573, () 
 890 e; p 638-641, <;i 8924 g-i ; p, 
 765, 766, ^ 1007-1008. See, also, 
 Medical and Physiological Commen- 
 taries, vol. ii., p. 608-634 ; p. 74:3-746. 
 Physiologists, 
 their duty to their ov\ti science, p. 2, <) 
 lb; p. 8, (J 5 ; p. 122, ^ 240 ; p. 202, 
 ^ 376^ ; p. 207, ^ 3761 b ; p. 277, ^ 
 447^ /; p. 429. § 674 a ; p. 762, ^ 
 1006 a. 
 their proper vocation, p. 2-4, <J 2 ; p. 
 10-14, () 5i-6; p. 202. ^ 376^; p 
 207, (} 376| b ; p. 239, ^ 438 d ; p 
 279, () 448 ; p. 330, () 500 n; p. 429 
 § 674 a. 
 the proper ground for their inductions 
 p. 10, 11, s^ 5i ; p. 115, () 234 e; p 
 429, ^ 674 a ; p. 434, 435, (j 679, 680 
 See, also. Facts. 
 Physiological States, 
 
 inferred from morbid states, p. 61, <j 
 134; p 64, ^ 140; p. 73, ^ 163 ; p 
 107-111, () 225-2335; p. 265, ^ 447 
 a-c; p. 272, § U7 g ; p. 501-512, () 
 791-817. 
 inferred from the natural products, p. 
 
 62, ^ 135. 
 inferred from natural stimuli, p. 62, 6 
 136; p. 97. (} 190; p. 98, <) 191 a 
 p 100, ^ 199, 201, 
 inferred from the action of morbific 
 agents, p. 63, ^ 137; p. 64, () 142; 
 p. 66, (^ 143; p 67, () 149, 150; p 
 68-73. () 153-162; p. 98. () 191. 
 govern the morbid states, p. 67, ij 149 
 
 150; p. 107-111, (J 225-2333. 
 do not teach the morbid states, only aa 
 they are illustrated by the morbid, 
 p. 3, ^ 2 c, and as above. See, also, 
 Remeuies, their Capabilities and 
 Effects. 
 not taught by Anatomy, p 3. (J 2 c ; p. 
 50, (i 83 c; p. 59, ^ 131. See, also, 
 Morbid Anatomy.
 
 INDEX. 
 
 967 
 
 Physiology, 
 
 its general survey, p. 15-412, ^ 7-638. 
 
 objects of, p. 3, 1^ 2. 
 
 regards Nature according to her ordi- 
 nations, p. 3, 1^ 2 J; p. 11, iji 5 I e; 
 p. 12, (J Hf, ^ha; p. 330, <J 500 n. 
 
 schools of, p. 6, <S> 4^. 
 
 considered under seven divisions, p. 
 22, <;> 31. 
 
 not learned from anatomy, p. 3, ij 2 c ; 
 p. 50, <J 83 c; p. 59, (} 131. 
 
 its relations to pathology and therapeu- 
 tics, p. 1, n ; p. 2, 3, ^ 2; p. 55, ij 
 115-117; p. 58, {) 129; p. 61-70, (J 
 133-160; p. 98, ij 191 ; p. 102, l^ 
 202 ; p 107-122, I) 225-240 ; p. 131, 
 
 132, (j 284-288 ; p. 331, <J 500 c ; p. 
 398, ij 626 ; p. 405-413, '^ 638, 639 ; 
 p. 541, 9 852. 
 
 vitiated by experiments, p. 11-13, <J 
 5i e,/, 5^ a ; p. 14, ^ 6 ; p. 17, {) 18 
 e ; p. 26, ^8 ; P- 28, <) 53 c ; p. 132, 
 
 133, () 289-291 ; p. 148, (> 334, 335 ; 
 p. 173, <J 350i; p. 179-182, () 350| 
 c-g ; p. 196-198, (} 360-364 ; p. 200, 
 () 366 ; p. 202, () 376^ ; p. 485, (; 749 ; 
 p. 518, 9 823. 
 
 how far surrendered to Chemistry, p. 
 8, 9, ij 5 ; p. 13, () 5k a; p. 148, () 
 335 ; p. 155, () 349 d; p. 176, ^ 350J 
 q ; p. 202, <^ 376^ ; p. 235, 1} 433. 
 the qualifications of chemists for its 
 investigation, p. 7,^ H d ; p. 8, 9, ^ 
 5; p. II, () 5i c, d; p. 157-173, () 
 350, Nos. 3-46 ; p. 174-182, <J 350|- 
 350^ g ; p. 202, 203, (} 376^ ; p. 239, 
 (j 438 d. 
 its essential philosophy, as well as of 
 disease, supposed to reside in the 
 red globules of blood, p. 157-160, ^ 
 350, Nos. 1-10: p. 161-163, (} 350, 
 Nos. 15-19 ; p. 174-178, ^350^-350? ; 
 p. 208, () 383 a ; p. 251, 252, ^ 441 c ; 
 p. 254, 255, ^ 441 e, f; p. 26§, ^ 
 445 b ; p. 274-278, ^ 447^. 
 demonstrative proof of the error of the 
 grand doctrine in organic chemistry, 
 that motion and organic results de- 
 pend upon oxygen gas, p. 255, ^ 441 
 /; p. 318-321, H94. See, also, Com- 
 bustion. 
 
 Physiology and Organic Chemistry 
 Contrasted, p. 19, <J 18 e; p. 157- 
 173, () 350 ; p. 189, 190, !^ 350J n ; 
 p. 191. I) 351 ; p. 246, (J 440/; p. 
 277, 278, (j 447.} /; p 514, i, 819 o, 
 Nos. 1-7. See, also, Organic Chem- 
 istry, contradistinguished from, c^c. 
 
 Physiology, Summary Conclusion of, 
 OR its Unity of Design, p. 405- 
 412, (} 638. 
 
 Plants, 
 indispensable to animals, p. 15, ^ 13, 
 14; p. 17-20, () 18; p. 135-139, (j 
 293—303. 
 
 Plants — continued. 
 subsist on mineral substances, p. I.'-, 
 
 i) 11, 14; p. 10, ^16; p. 20, (J 18 e, 
 
 p. 135-139, ^ 298-303A. 
 their food originally from the atmos- 
 phere, p. 16, ij 16; p. 135-138, ^ 
 
 303-303^. 
 have greater organizing power than 
 
 animals, p. 15, <J 11 ; p. 24, <J 42 ; p. 
 
 105, i) 217 ; p, 135, () 298, 300. 
 their simplicity of life, p 55, ^ 114; p. 
 
 58, <J 129 /; p. 88, l^ 185 ; p. 135, () 
 
 302 ; p. 140, \ 304. 
 
 their organic properties, p. 88, ^ 183, 
 184; p. 93, () 188^ d ; p. 105, () 
 217. 
 
 their life essentially the same as that 
 of animals, p. 14, ^ 6 ; \>.\5,() 8-10, 
 12-14; p. 21, 22, i) 19-30; p. 23, 
 24, () 34-42 ; p. 26, i, 47-49 ; p. 27, 
 ^ 52, 53 ; p. 29, (J 54 a ; p. 30-36, I) 
 56-62 ; p. 44, (J 72 ; p. 45, (^ 13 b ; p. 
 48, >!> 77; p 49, MO ; P- 51, 52, ^ 
 84, 85 ; p. 54, (} 107-109 ; p. 55, «J 
 112-115; p. 56, «J 121-123; p. 58, ^ 
 129 /; p. 68, 69, () 153-157 ; p. 82, 
 ^ 170 a, 171 ; p. 83, ^ 172-174 ; p. 
 86, ^ 176; p. 88, ii 184 a, 185; p. 
 89, 6 188 a ; p. 90, ^ 188^ b, c ; p. 
 93-95, ^ 188^ d; p. 98, () 191 a; p. 
 103, ^ 207 ; p. 104, ^ 214 ; p. 105, I) 
 217 ; p. 127, () 261-264 ; p. 129, 130, 
 () 277, 278 ; p. 132-134, ^ 289-295 ; 
 p. 140, ^ 304; p. 163-167, () 350, 
 Nos. 64-77, and Nos. 262S 27, 51 : p. 
 207, 208, ^81; p. 224, 225, 1} 409 
 g-i; p. 226, 227, (/ 4l0, 411 ; p. 260 
 -262, ^ 445 a-f; p. 273, ^ 447 h ; p 
 280, () U9 d; p. 283, (} 452 a ; p 
 284, () 454, 455 ; p. 286, () 456 a ; p. 
 289, ^ 46U a; p. 345, 346, <) 516 d 
 No. 7; p. 391, 392, <J 603-606; p 
 395, () 618 b; p. 435, <J 680 ; p. 442 
 <5 686 d ; p. 474, 475, () 733 f-i ; p. 
 019, (j 892 r; p. 746, (, 990} b. 
 
 their creation before animals. Author's 
 proof of, p. 135, 136, I) 303 a; p. 
 137, 138, (1 303i b, c. 
 
 essentially independent of animals, p 
 15, (J 11-14; p. 16, () 16, 17; p. 135 
 136, ^ 303 a; p. 137, 138, I) 303^ b, c 
 
 the beginning of organic compounds, 
 p. 15, ij 10, 13, 14; p. 135-139, d 
 298-3035. 
 
 their manifestations of vital motion, p. 
 103, ^ 207; p. 134, ^ 293, 294; p 
 163-167, (} 350, Nos. 63-77. 
 
 illustrate coiitinuous sympathy, p. 58, ^ 
 129/,- p. 322, () 498 c ; p. 351, (J 
 524 a. No. 2. 
 
 the action of light upon, p. 46, «^ 74 a ; 
 p. 90-95, i) 188} d; p. 136, 137, ^ 
 
 303 d, e; p. 163-165, () 350, Nos 
 64-70. 
 
 their diseases, p. 93, ^ 188} d; p 98,
 
 968 
 
 INDEX. 
 
 Plants — continued. 
 
 ^ 191 a; p. 322, ^ 498 c; p. 474, 475, 
 ^ 733 f-i. 
 analogy traced between the process 
 of regeneration in inferior animals, 
 of the stag's horn, &c., and of rep- 
 aration, ingrafting, &c., of plants, 
 and the union of wounds by the ad- 
 hesive process, and the dependence 
 of the latter upon inflammation 
 through the coincidence in the sim- 
 ultaneous effusion of lymph around 
 the wall of an abscess, the forma- 
 tion of pus, the institution of the ul- 
 cerative process in the direction of 
 the surface, and the ultimate cica- 
 trization, and thence a close analogy 
 between the vital constitution of 
 plants and animals, and their morbid 
 states, through an example parallel 
 to an abscess, which is presented by 
 the stem of trees, when circum- 
 scribed disease is set up beneath 
 the surface, p. 88, ^ 185 ; p. 470, <J 
 729 a ; p. 471-476, <J 732-733 ; p. 
 479, (i 741 b. 
 
 Plants and Animals, 
 their fundamental distinction, p. 15, ^ 
 
 11-14 b; p. 17-20, () 18. 
 their composition, p. 15, i^ 12 ; p. 17- 
 20, iji 18 ; p. 23-28, ^ 34-53. See, 
 also. Plants, and Organic Life. 
 
 Pneumogastric Nerve, 
 appertains to organic life. See Nerv- 
 ous Power. 
 
 Pollen, 
 analogous to semen. See Semen, and 
 Ovum. 
 
 Poultices, Warm, 
 their uses, and mode of operating, p. 
 681-683. 
 
 Portal Circulation. See Circulation, 
 Portal. 
 
 Potash, Tartrate of. See Cathartics, 
 and Therapeutics. 
 
 Potash, Super-tartrate of. See Ca- 
 thartics, and Remedial Action. 
 
 Predictions — in medical philosophy, <^ 5^ 
 a, 131, 500/, 854 6^,896,971, 1006^. 
 
 Practice of Medicine, 
 how taught in Hospitals. See Hos- 
 pital Reports and Precepts. 
 
 Predisposition to Disease, 
 
 author's theory of, p. 47-49, ^ 75-81 ; 
 p. 87, (^ 181 ; p. 368, () 559 ; p. 420- 
 427, ^ 654-666 ; p. 429, 430, () 674 d ; 
 p. 669, 670, i) 902 i. 
 
 Pp.inciples, 
 importance of, p. 4, <J 3, 4; p. 331, ^ 
 
 500 ; p. 489, ^ 756 b. 
 consistency, a test of, p. 1, ij* 1 ; p. 3, 
 ) 2 c; p. 331, (} 500 o; p. 489, ^ 
 756 b. See, also, Vitalism and 
 Solidism, and Physiology and Or- 
 ganic Chemistry, Contrasted. 
 
 Principles — continued 
 
 in medicine, from their diversity and 
 discrepancy, form no test of the 
 rights of membership of the medical 
 profession, p. 77, note ; p. 515, ^ 819 
 b ; p. 529, ^ 835 ; p. 540, ^ 851 ; p. 
 558, ^ 878. 
 
 an introductory exposition of, p. 1-15, 
 ^1-6. 
 Problems, 
 
 one for Organic Chemistry, p. 281-283, 
 () 450 rf-451 /; p. 330, ^ 500 n. 
 
 another for Mental Materialism, p. 84, 
 85, ij 175 c ; p. 155, ^ 349 e ; p. 281, 
 ^ 450 e ; p. 329, <} 500 n. 
 
 another (or Atheism, p. 16, (} 14 c. 
 Profession, Medical, in Europe and 
 the United States, 
 
 their relative merits. See Medical 
 Education. 
 Properties of Life. See Vital Prop 
 
 erties. 
 Protein, 
 
 an important " instrument" in Organic 
 Chemistry, p. 17-20, () 18 ; p. 28, ^ 
 53 c ; p. 219-222, i) 409 a, b ; p. 7G3, 
 ^ 1106 a. See, also, Mulder's Re- 
 ply to Liebig, concerning Truth 
 AND Protein. London, 1846. 
 Proximate or Pathological Cause of 
 Disease, 
 
 general consideration of, p. 427-434. 
 
 founded upon physiological laws, which 
 exclude all chemical and humoral 
 doctrines from pathology and thera- 
 peutics, ^ 2, 6, 63, 74, 80, 117, 129 
 h, 133 c, 137, 143, 149-156, 163, 169 
 /, 177-182, 224-231, 233i, 285-295, 
 335, 3501, 360, 384-387, 393, 422- 
 424, 427, 447 b, 500, 514, 524 d, 527, 
 529 b, 549, 561, 573-630, 638, 638^, 
 639 a, 671, 674, 680, 686 b, 705, 733 
 e, f, 741, 745, 747-751, 768, 772 e. 
 
 * 785, 787, 792, 795, 801 e, 808, 822, 
 839, 847, 852-856, 858, 862, 863 d-h, 
 884, 889 a-f,n, 895-902, 905, 912. 
 Proximate Principles of Organic Com- 
 pounds, 
 
 their reputed nature, p. 29, ^ 54 b. 
 
 are chemical transformations, p. 18, 
 19, M8 ; p. 28, 29, ^ 53 6-54 a. 
 
 their true nature, p. 24, 25, ^ 42^14 ; 
 p. 27, 15. 53 ; p. 40-42, ^ 65-66. 
 Pulse, 
 
 in its relation to disease, p. 443- 
 448. 
 Pus, 
 
 depends upon inflammation. See In- 
 flammation, and Design. 
 Putrefaction, 
 
 its causes and pecuharities, p. 28- -31, 
 () 54-59 ; p. 34-36, (J 62. See, also. 
 Nitrogen. 
 
 its principal cause evinces that it is 
 not concerned in digestion nor in
 
 INDEX. 
 
 969 
 
 Putrefaction — continued. 
 
 any process of organic life, ibid 
 See, also, Digestion. 
 
 more philosophically the cause of the 
 explosion of gunpowder than of di- 
 gestion or of the waste of living 
 hodies, p. 35, ^ 62 c. See, also, 
 Digestion, Chemical Theory of, and 
 Physiology of, and Decomposition, 
 Vital. 
 
 incompatible with life, p. 10, (j n \ p. 
 105, () 221 ; p. 533, 534, ^ 843. 
 Sx.iHL and Junker define " life as a 
 state opposite to putridity." 
 
 rapid in dead animal compounds, p. 
 34, 4 62 c ; p. 96, () 189 c. 
 
 takes place under organic conditions, 
 p. 28, (j 54 a. 
 
 promoted mostly by nitrogen gas, p. 
 34-36, (j 62. 
 
 important in the philosophy of Organic 
 Chemistry and Humoralism, p. 167- 
 170, <;> 350, Nos. 29-39 ; p. 172, () 
 350, Nos. 44, 45 ; p. 179, (^ 3501 c; 
 p. 181, (j 350i e ; p. 199, 200, ^ 365 ; 
 p. 514, ^ 819 a, Nos 1, 2, 3 ; p. 517,. 
 ^ 821 c ; p. 529, () 835. 
 Pylorus, 
 
 admits the passage of solid food, &c., 
 through morbid changes of irritabil- 
 ity, p. 99, ^ 192. 
 
 Q. 
 
 QUINIA, 
 
 its therapeutical uses, with various 
 relative considerations, p. 593-607. 
 
 R. 
 
 Races of Mankind, 
 
 evince the influences of climate, &c., 
 without any remarkable physiologi- 
 cal, but greater moral, distinctions, 
 p. 391-393. 
 Reason, 
 
 its great characteristics, judgment and 
 reflection, p. 123, () 241 b; p. 124, ^ 
 241c. 
 
 the peculiar attribute of the soul, p. 
 123, <J 241 a ; p. 124, ^ 241 c. 
 
 contrasted with instinct, p. 123, 124, () 
 241 b, c. 
 
 its alliance to instinct, p. 123, 124, ^ 
 241 c. 
 
 as associated with instinct, a connect- 
 ing moral medium between man and 
 animals, p. 123, () 241 c. 
 
 the connecting link between man and 
 his Maker, p. 124, ^ 241 c. See, 
 also, Truth. 
 
 author's proof from, in connection with 
 'nstinct of the identity o mankind 
 
 Reason — continued. 
 
 in respect to species, p. 123, ^ 241 
 
 c, note. See, also, Instinct. 
 Reflex Action, 
 
 its general philosophy known in former 
 times ; its mechanism and physio- 
 logical laws lately determined, p 
 290, <J 462-465 ; p. 320, (j 494 di ; 
 p. 362, ^ 530. See, also, Nervous 
 Power, Sensibility, Sympathetic, 
 and Sympathy. 
 Relations, Sympathetic, 
 
 of a general nature, p. 58, <^ 129 ; p. 
 63, ^ 137 ; p. 64-66, () 140-143. See, 
 also. Sympathy, Ganglionic System, 
 and Nervous Power. 
 
 mechanical, p. 59, ij 129 k. 
 Remedial Action, or Modus Operandi 
 OF Remedies, 
 
 considered critically, p. 661-689. See, 
 also. Remedies, considered generally, 
 &c. 
 Remedies, 
 
 the cause of their differences, p. 27, (j 
 52 ; p. 68, (} 155. See, also. Anal- 
 ogies. 
 
 their specific relations to organs, p. 63, 
 {) 137; p. 66, ^ 143. See, also, 
 Adaptation, Law of. 
 
 their action accords with the existing 
 condition of the vital states, p. 3, ^ 
 2 b; p. 59, () 129 g-i; p. 66-69, «J 
 144-156 ; p. 73, (J 163 ; p. 98, <J 191 
 b ; p. 122, () 240 ; p. 437-442, (j 685- 
 686. See, also, Pathology, and 
 Therapeutics. 
 
 analogous in action to morbific causes, 
 p. 542, I) 854; p. 662-665, () 895^ 
 901 See, also, Remedial Action, 
 and Analogies. 
 
 their cApabilities, effects, and doses, to be 
 known only by their trial under vari- 
 ous conditions of human maladies, 
 and to be obtained only by a careful 
 reference to their virtues and to the 
 existing pathological conditions, p. 3. 
 <J 2 c ; p. 63, (J 137 d ; p. 65, ^ 143 c ; 
 p. 67, (} 150, 151 ; p. 122, (^ 240 ; p. 
 148, ^ 334 ; p. 417, <^ 650 ; p. 428, f, 
 671-674 a; p. 430-433, ^ 675, 676 
 a ; p. 434, () 680 ; p. 437-442, ^ 685, 
 686 ; p. 459, ^ 705 ; p. 464, <) 712, 
 713; p.486, <;»750 6,- p. 488, (J756i; 
 p. 528, {} 831 ; p. 541, 542, ^ 854 ; p. 
 543, 1^ 857 ; p 545, ^ 859 ; p. 547, ^ 
 863 d ; p. 565, i) 889 /, g ; p. 567- 
 569, i) 899 l-mm ; p 572-574, 9 890 
 
 d, e ; p. 575, 576, (j 890 h-l ; p. ^7. 
 578, 4 890 o-q; p. 580, 581, \ 890J 
 e-g; p. 584, ^ 891 d; p. 586-589, I 
 891 h-p; p. 590-593, 1^89 U; p 597- 
 600, ^ 892 c, d; p. 608-610, ^ 892i 
 c,d; p. 613, <J 892^i; p 615, ^892^ 
 
 e, f; p. 619, () 892i r ; p. 623, () 892§ 
 c ; p. 625, «J 892? /; p. 628, 629, ^
 
 9ro 
 
 INDEX. 
 
 Remedies — continued. 
 
 mn g-s ; P- 630, ^ 892| ; p. 633- 
 635, <) 892| a-c; p. 637-G39, ^ 892f 
 e-g; p. 645, ^ 893 c; p. 649, 650, ij 
 893 A, i; p. 652, 653, iji 893 m, ti; p. 
 057, 658, () 893 p ; p. 662, 663, <J 895- 
 897; p. 664, ^ 900; p. 679-683, ^ 
 905 ; p. 684-688, () 905.V ^f, c ; p. 692, 
 693, ^ 915-921 ; p. 698-700, () 929- 
 935 ; p. 702, 703, () 939-942 ; p. 707, 
 ^ 948, 949; p. 711-715, ^ 953-960; 
 p. 724, <) 961 a; p. 726, () 961 c, d; 
 p. 732-734, () 971-975, and so on. 
 the philosophy of their action con- 
 sidered generally, and under various 
 aspects, p. 3, ^ 2 i ; p. 27, ij 52 ; p. 
 44, i) 72 ; p. 45, ^ 73 ; p. 55, H17 ; 
 p. 59, {) 129 h; p. 61, () 133 c; p. 63, 
 \ 137 ; p. 65, § 143 ; p. 67, ^ 149- 
 152 ; p. 73, () 163 ; p. 87, <J 177-182 ; 
 p. 89, () 188 a; p. 98, <;. 191 a, b; p. 
 99, () 192; p. 101-104, ^ 201-204; 
 p. 100-111, ^ 223-2335 ; p. 321-335, 
 \ 495-511; p. 405-412, (} 638; p. 
 540, ^ 851 ; p. 662-665, ^ 895-901. 
 See, also. Remedial Action, con- 
 sidered critically. 
 do not operate by absorption, p. 301- 
 314, ^ 481-488^; p. 318-321, ^ 494. 
 See, also, Humoralism, Remedial 
 Action, Analogies, and Adapta- 
 tion, Law of. 
 fchown not to act upon any chemical or 
 physical principle by the variety of 
 agents which will remove a common 
 form of disease, as the intermittent 
 fever, or as iodine, mercury, quinia, 
 &c., will alike induce absorption of 
 lymph in indurated enlargements of 
 the hver, &c., p. 133, <J 291.; p. 603, 
 604, ^ 892 k, kk; p. 615, 616, ^ 892i 
 /; p. 677-679, () 904 d. See, also, 
 Absorption. 
 are constantly influenced by the order 
 of their app'ication, ut supra. See, 
 also, Therapeutics, and Adapta- 
 tion, Law of 
 action of, oftei depends upon the ef- 
 fects of antecedent and subsequent 
 remedies, ibid, &c. 
 can not be isolated from a consecutive 
 series, and each one studied in its ef- 
 fects by itself. See general Thera- 
 peutics, Bloodletting, and Reme- 
 dial Action. 
 Respiration, 
 physiology of, and its comprehensive 
 exemplification of remote sympathy, 
 p. 325-328, ^ 500 e-m. 
 in organic chemistry, the cause of all 
 motions, processes, and results, the 
 cause of itself, and the cause of 
 death, p. 173, k 350, No. 46. See, 
 
 also, Co.MBUSTION. 
 
 Respiration — continued. 
 the death of organic chemistry, p. 24y, 
 <^ 440 cc, No. 12. 
 
 Revelation, 
 its fundamental statements coincide 
 with the constitution and phenome- 
 na of nature, and their admission is 
 indispensable to the progress of 
 truth, and of science, p. 16, <J 14 c ; 
 p. 23, l) 34-36 ; p. 34, \ 62 c ; p. 46, 
 ^ 74; p. 49, Ml ; P- 86, (} 175 rf; 
 p. 135-138, ^ 303-303J ; p. 174-192, 
 () 350^353 ; p. 317, ^ 493 a; p. 401, 
 i) 632 b. See, also, Design- 
 
 Revulsion, 
 
 objections to the doctrine of, p. 653- 
 656, ^ 893 n. 
 
 RocHELLE Salts. See Cathartics, The- 
 rapeutics, &c. 
 
 Rdsii, Benjamin, 
 
 On Bloodletting in various forms of 
 disease, and at all ages, § 994, 999, 
 1010 6,1017 c. Note F F, p. 1135. 
 
 Saline Cathartics. See the several 
 Denominations. 
 
 Sap, 
 composed of the same seventeen ele 
 ments as blood, p. 23, (J 34-37 ; p. 
 24, ^ 41, 42. 
 its motion shown to be a vital process 
 by direct observation, and by the 
 variety of unique eliminations from 
 the sap, p. 24, ^ 41, 42 ; p. 134, () 
 293; p. 224-227, s*! 409 g--411. See, 
 also, Assimilation, Absorption. 
 Capillaries, and Plants. 
 
 Science, 
 must keep itself within the fundament- 
 al restraints of Revelation ; see 
 Revelation. 
 
 Sarsaparilla. See Alteratives, Io- 
 dine, and Remedial Action. 
 
 Scammonv. See Cathartics, and The- 
 rapeutics. 
 
 Schools of Medicine, 
 
 three : Physiological or Vital, Chemi- 
 cal, and Chemico-physiological, p 
 6, 7, ^ 4^ a-e. 
 the Physiological contradistinguish or- 
 ganic and inorganic Nature, p. 6, ^ 
 4i a ; the Chemical confound organ- 
 ic and inorganic Nature, p. 6, ^ 4^ J ; 
 the Chemico-physiological compro- 
 mise philosophy, p. 7, ^4^ c ; p. 197. 
 () 361. 
 
 Secretion, 
 the function upon which nutrition and 
 growth immediately depend ; better 
 designated as Appropriation, p. 217 
 -227, HOO-411.
 
 INDEX. 
 
 971 
 
 Secretion — continued. 
 
 chemical philosophy of, p. 168-170, <J 
 350, Nos. 31, 32, 37, 38, 39 ; p. 180- 
 182, <) 350J e,f. See,also, Combustion. 
 Seckktions and Excretions, 
 
 lernis applied to the products of the 
 functions, and used, at present, in 
 their morbid acceptation, and as 
 supplying symptoms, p. 450-455, i) 
 690-694i. 
 Skdatives, 
 
 their uses and mode of action, p. 583- 
 593, (} 891-89U ; p. 681-683, ^ 905 b. 
 See, also. Narcotics, Hydrocyanic 
 Acid, and Analogies. 
 Seisd, 
 
 its state of life, p. 30, ij 57 ; p. 97, ^ 
 190 6. 
 
 evinces great Design, p. 56, ^ 123 ; p. 
 97, ^ 190 b. See, also, Ovum. 
 Semen, 
 
 a vital stimulus, p. 44-46, ^ 72-73 ; p. 
 47-49, ^ 75-80 ; p. 97, ^ 190 i. 
 
 acts upon the ovum, p. 44, ij 72 ; p. 
 97. ^ 190 b. 
 
 transmits disease, p. 47-49, () 75-80. 
 
 its analogies with other vital agents, 
 p. 45, (} 73, 74 ; p. 97, ^ 190 b. 
 
 imparts constitutional peculiarities, p. 
 44, (J 72. 
 
 vicarious, p. 50, <J 83 b. See, also. Ovum. 
 Seneka, 
 
 its merits in croup, p. 638, ^ 892 1 /. 
 Senna, 
 
 objections to its common use ; see 
 Cathartics, and Therapeutics. 
 Sensation, 
 
 its philosophy, p. 89, ^ 186, 188 b ; p. 
 100-103, (J 194-204 ; p. 280-283, i) 
 450-451. 
 
 of three kinds, common, specific, and 
 sympathetic, p. 280-283, () 450-451. 
 
 common, the cause of pain, and uni- 
 versal, p. 100, <) 198 ; p. 281, () 450 d. 
 
 specific, the function of the senses, and 
 the fountain of knowledge, p. 100, 
 ^ 199 ; p. 281, () 450 e. 
 
 sympathetic, concurs with the nervous 
 power in producing the function of 
 remote sympathy, p. 101-103, () 201 
 -204 ; p. 107, 108, ^ 227 ; p. 282- 
 284, ^ 451-453 ; p. 290, 291, ^ 462- 
 467 ; p. 323-332, (/ 500. 
 
 sympathetic develops the nervous pow- 
 er, p. 101, {) 201 ; p. 107, ^ 227. 
 
 common and specific terminate in the 
 brain, and end in exciting percep- 
 tion, p. 100, I) 196, 199^ ; p. 101, ij 
 201 ; p. 280-282, (j 450 c-451 b. 
 
 common and specific require the exer- 
 cise of perception, p. 124, () 241 d ; 
 p. 281, () 450 e. 
 
 tympalhetic may terminate in any part 
 of the nervous system, does not af- 
 fect perception, but ends in exciting 
 
 Sensation — continued. 
 
 the nervous power, p. 101-103, § 201 
 -204 ; p. 107, 108, () 227 ; p. 124, (, 
 242 ; p. 281-287, (J 451-459 a; p 
 321, ^ 497 ; p. 323-332, ^ 500 ; p. 
 342, 343, () 515, 516 d, Nos. 3, 4 : p. 
 349, 1) 520-522 ; p. 353, ^ 524 d, Nos. 
 4, 5, 6. 
 
 common and specific may result in the 
 development of the nervous power 
 by exciting the mental emotions 
 along with perception, when the 
 emotion develops the nervous pow- 
 er, or sympathetic may be in simul- 
 taneous operation through nerves 
 of organic life, p. 101, ^ 201 a; p. 
 103, ^ 209 ; p. 341, ^ 514 m. See, 
 also. Pain, and Mental Emotions. 
 
 sympathetic is appropriated exclusively 
 to organic life in animals, since the 
 nervous power operates upon irrita- 
 bility in developing motion, and mo- 
 bility in its functions in animal life 
 is only a modification of the same 
 property in organic life, p. 89, ^ 188 
 a; p. 103, ^ 208; p. 110, ^ 2.33; p. 
 126, 127, ^ 258-260 ; p. 323-332, (> 
 500 ; p. 349, <J 519 ; p. 671, ^ 903. 
 See, also, Nervous Power. 
 
 common and specific depend mostly 
 upon cerebro-spinal nerves, p. 101, 
 102, 4 201. 
 
 sympathetic depends mostly upon the 
 sensitive fibres of the ganglionic 
 and pneumogastric nerves, p. 102, <! 
 201 c. 
 
 sympathetic is necessary to reflected 
 motion, but never operates when 
 motion is generated by causes act- 
 ing directly upon the nervous cen- 
 tres, p. 101, () 201 ; p. 107, 108, ^ 
 227; p. 671, (} 903, and ut cit. 
 
 what is its chemical rationale in con- 
 nection with Perception and Sympa- 
 thy, p. 85, (J 175 c ; p. 155, ^ 349 e ; 
 p. 281, ^ 450 ; p. 329, 330, () 500 ?! 
 Sensibility, 
 
 peculiar to animals, p. 100, (/ 194. 
 
 " organic" is irritability, p. 99, <) 193 ; 
 p. 101, ^ 201 a; p. 671, ^ 903. 
 
 the great inlet of knowledge, p. 100, (/ 
 195; p. 281, () 450 e. 
 
 receives and transmits impressions, p. 
 46, ()74:a; p 89, <J 188 i ; p. 93-96, 
 «J 188i rf-189 c; p. 100, ^ 195; p. 
 101-103, ^ 201-204; p. 281-283, ^ 
 45« e-451 ; p. 671, (J 903. 
 
 its organs, the nerves, p. 100, (j 196- 
 p. 280, ^ 450 b. 
 
 is of three kinds, p. 100, ^ 196 ; p. 280, 
 () 450 a. 
 
 common, belongs to all parts ; the 
 source of pain ; generally dormant 
 in organic life, but roused by dis- 
 ease, p. 100, ^ 198.
 
 972 
 
 INDEX. 
 
 Sensibility — continued. 
 
 specific, peculiar to the senses ; exqui- 
 sitely susceptible, but rendered ob- 
 tuse by disease, p. 100, t) 199 ; p. 
 281, § 450 e. 
 
 common and specific, relative to the 
 brain, or its equivalent, alone as their 
 center ; the sources of true sensa- 
 tion ; require the exercise of per- 
 ception, p. 89, () 188 b; p. 100, ^ 
 199^ ; p. 280, (J 450. 
 
 sympathetic, an element of remote 
 sympathy, p. 46, ^ 74 a. ; p. 89, ^ 
 188 a; p. 101-103, <;> 201-204; p. 
 104, <;i 209 ; p 282-284, ^ 451 c-453 ; 
 p. 671, ^ 903 ; is relative to the 
 brain, spinal cord, and ganglionic 
 system, as its centers, p. 101, 102,' 
 ^ 201 ; p. 287, ^ 459. See, also. 
 Sensation, sympathetic may termin- 
 ate, &c. ; effects of, reflected from 
 nervous centers, p. 89, <J 188 a ; p. 
 101, ^ 201 ; p. 108, <) 227 ; p. 223- 
 232, ^ 500 ; necessary to reflected 
 motion, ibid; resides especially in 
 the sympathetic and pneumogastric 
 nerves, p. 102, ij 201 c; p. 104, (^ 
 209 ; does not involve true sensa- 
 tion or perception, p. 101, ^ 201 b; 
 p. 103, () 204. 
 
 possesses modifications analogous to 
 those of irritability, p. 100, <J 200; 
 p. 102, ^ 203 ; p. 108, ^ 227. 
 
 common, low in the nervous centers, p. 
 107, (} 224. 
 
 less in trunks than nervous ramifica- 
 tions, p. 107, (J 224 ; p 347, § 516 d, 
 No. 11 ; p. 521, ^ 826 d. 
 
 its general relations to external ob- 
 jects, p. 53, 9 100 ; p. 398-400, (} 
 626-630. 
 Serous Tissue. See Tissues. 
 Serum. See Inflammation. 
 Seton, 
 
 philosophy of its operation applied to 
 the modus operandi of all morbific 
 and remedial agents, p. 679-681. 
 Sex, p. 393-394. 
 Sexual Organs, 
 
 their relations to organic life, &c., 
 p. 55, 56, ^ 118-121. See, also. 
 Youth. 
 Sleep, 
 
 how explained in materialism, p. 85, 
 H75c; p. 329, 330, (J 500 ?i. 
 
 awaking from disproves materialism, 
 p. 85, (} 175 c. 
 Soda, Sulphate of. See Cathartics, 
 
 and Therapeutics. 
 Soda, Muriate of. See Astringents, 
 
 and Remedial Action. 
 Solar Spectrum, 
 
 physiologically and chemically ap- 
 plied, p 92-95, ^ 188i d; p. 115, § 
 234 c 
 
 Solar Spectrum — contvmied. 
 its invisible rays, p. 91, ^ 188^ rf; p. 
 115, § 234 e. See, also, Analogies. 
 
 SoLIDIsM, 
 
 the basis of medicine, p. 1, ^ 1. See, 
 also. Vitalism and Solidism. 
 Soul, 
 created after structure, p. 81, ^ 170 a. 
 a stimulus of the brain, p. 85, ij 175 c. 
 that judgment, reflection, and percep- 
 tion, require, for their exercise, the 
 co-operation of the brain, is analogic- 
 ally inferable from the manifest con- 
 currence of the nervous system with 
 the will in voluntary motion, p. 281, 
 ^ 451 a. See, also, Mind, and Nerv- 
 ous Power. 
 Somnambulism, 
 subjects of, between the sleeping and 
 waking state ; speech incoherent ; 
 rational faculty dormant ; instinct 
 mostly, but feebly, operative. See 
 Animal Magnetism, Reason, and 
 Instinct. 
 "Specialities" in Medicine, 
 
 not founded in philosophy, p. G87, () 
 905i b; p. 721, 722, § 960 c, d. 
 Specific Action, 
 illustrated by remedial and morbific 
 agents, p. 417, (J 650 ; p 424, ^ 602 
 a ; p. 430, (j 675, 676 a ; p. 487-489, 
 (j 754-756 ; p. 542, (} 854 c ; p. 553, 
 \ 870 aa ; p. 562, ij 888 e ; p. 597, 
 () 892 c; p. 662-665, () 895-901 ; p. 
 676-679, <^ 904 c, d. See, also, Al- 
 teratives, and Analogies. 
 Spermatozoa, 
 
 the supposed germ, p. 42, § 67. 
 Sphincter Muscles, 
 held in contraction by the nervous 
 power, p. Ill, () 233.V; p. 339, ^ 
 514 5^. 
 illustrate the law of prolonged influ- 
 ence, ibul, and p. 344, 345. ^ 516 (^, 
 No, 6 ; p. 426, ^ 666 ; p. 670, <^ 902 k. 
 physiology of their contraction applied 
 pathologically and therapeutically, 
 ibid, and Remedial Action. 
 Spinal Cord, 
 its general physiological laws, p. 292- 
 295, (j 473-475 
 Sponge, Burned, Vegetable .^thiops, 
 and Cod's Liver Oil, p. 619, ^ 892^. 
 Spontaneous Generation. See Geneb- 
 
 ATiON, Spontaneous. 
 Squill. See Expectorants, Thera- 
 peutics, Emetics, Diuretics, and 
 Re.medial Action. 
 Stethoscope, 
 
 its advantages, p. 640, <^ 892i A. 
 Stimulants, 
 
 their uses, &c., p. 579-583. 
 Stimuli, Vital, p. 21, <;» 21 ; p. 62, ^ 136, 
 137; p. 90, 6 188i 
 everv part has its own, p. 62, ^ 136
 
 INDEX. 
 
 973 
 
 Stimuli, Vital — continued. 
 of one part offensive to other parts, p. 
 
 63, () 137. 
 certain natural ones acted upon and 
 
 appropriated to various uses, p. 90, 
 
 <;i 188^ c; p. 107-111, () 226-233i 
 their adaptation to parts, p. 62, ^ 136 ; 
 
 p. 63, § 137 c. See, also, Vital 
 
 Agents, and Analogies. 
 Stomach, 
 alone generates a digestive fluid, p. 62, 
 
 (j 135 a; p. 191, 192, <J 353; p. 229, 
 
 SS 419. 
 induction from, of the vital nature of 
 
 decarbonization of the blood, p. 229, 
 
 230, () 419, 420. See, also. Carbon, 
 
 and Mucous Tissue. 
 its peculiar product artificially pre- 
 pared, p. 197-202, § 362-376^ 
 Its variety of structure and compre- 
 hensive relations in the function of 
 
 assimilation, p. 140-147, (} 305-330. 
 formative not destructive, p. 15, ^ 13, 
 
 14; p. 16, () 16-18; p. 24, () A2 ; p. 
 
 30, (ji 59 ; p. 33, ^ 60 ; p. 135, ^ 301 ; 
 
 p. 143, {) 322 ; p. 196, ^ 360, 361 ; p. 
 
 200, () 374, 375. 
 chemical theory of its function of dis:es- 
 
 tion, g. 167-170, § 350, Nos. 29-34; 
 
 p. 197-199, () 362-364^. 
 its usual unaltered state after death, 
 
 adverse to the chemical theory of 
 
 digestion, ut supra. 
 Story, 
 his opinion of the times, p. 203-207, § 
 
 376J a. 
 Stramonium. See Aconite, &c. 
 Strength and Weakness, or Debility, 
 in what they consist, p. 370-372, ^ 569 ; 
 
 p. 312, 313, ^ ^87 g,h. 
 Structure, 
 its physical and vital characteristics, 
 
 p. 50-73, ^ 83-1.63. 
 important to be known in its sensible 
 
 and functional character, p. 51, (J 83 c. 
 its minuteness, unimportant to know, 
 
 p. 59, 60, ^ 131. 
 composed of Tissues, p. 52, § 85-88. 
 
 See, also, Tissues. 
 its vital characteristics, p. 52-73. See, 
 
 also, Tissues. 
 m plants and animals, how different, p. 
 
 54, 55, ^ 107-117; p. 134-140, ^ 
 
 293-304. See, also. Plants. 
 of organic beings, heterogeneous, p. 
 
 20, i} 29. 
 its ultimate intricacy, p. 59, <J 130. 
 created before life, p. 81, ^ 170. 
 Strychnia, 
 effects on the nervous system, see Ac- 
 onite, &c. 
 SunoRiFics, 
 tbe term objectionable, p. 250, 251, <J 
 
 441 c; p. 335-341, ^ 512-514; p. 
 
 547, () 863 d ; p. 550, ^ 863 e ; p. 630, 
 
 Sudorifics — co7itinued. 
 
 <;» 8925 h ; p. 661-664, ^ 894-900 ; p. 
 666-669, i) 902 b, i ; p. 678, § 904 d, 
 &c. ; p. 704, ^ 943 a, b, 944 a. 
 
 many agents, like hot water, &c., may 
 induce far greater diaphoresis than 
 the antimonials and ipecacuanha ; the 
 former excite the circulation, the 
 latter, like loss of blood, depress it, 
 and perspiration is in proportion ; 
 the former of no useful effect or in- 
 jurious, the latter profoundly cura- 
 tive, ibid. See, also. Remedial Ac- 
 tion, and Alteratives. 
 
 the author's philosophy of nervous in- 
 fluence places the phenomena of pete- 
 chial effusions of blood under the 
 skin during the operation of emetics 
 upon physiological grounds, as it 
 does, in the same way, the supposed 
 miracle, implied by the expression, 
 " a7id his sweat was, as it were, great 
 drops of blood falling down to the 
 ground.^' In this case the erno 
 tions were peculiar and violent, and 
 operated in their compound aspect, 
 according to the explanations which 
 occur at p. 631, ^ 892.f b, and ut 
 supra. See, also, Nervous Power, 
 Mental Emotions, Analogie.?, Cap- 
 illaries, Emetics, and Sweat. 
 Also, other facts and illustrations 
 relative to the secretion of blood by 
 the skin, piamater, &c., in Medical 
 and Physiological Commentaries, vol. 
 i., p. 371-384 {pathology of spontanC' 
 ous hemorrhage) ; p. 683-690, {en- 
 dosmose and exosmose) ; vol. ii., p. 
 546-566, (philosophy of spontaneous 
 hemorrhage.) 
 Suppuration, 
 
 a result of inflammation, instituted for 
 great final causes, p. 471-474, ^ 730 
 -733 ; p. 546-551, ^ 862, 863. 
 
 variable according to the exact condi- 
 tion of pathological states, p. 478- 
 480, (J 740, 741 ; p. 484, () 748 ; p. 
 536-539, ^ 847 c-848. 
 
 occurs, in a special product, upon mu- 
 cous surfaces without ulceration, 
 and farther illustrative of final caus- 
 es, p. 472, ^ 733 a. 
 Sweat, 
 
 an excreted product, p. 230, ^ 420-422. 
 
 considered in its relation to disease, p. 
 451, 452 ; and to physiological in- 
 fluences, see Sudorifics, and Ex- 
 cretion. 
 
 coincidence between, and mucus and 
 carbon, as products of organization, 
 p. 230, ^ 420. See, also, Mucous 
 Tissue. 
 Sympathetic Influences, 
 
 laws of, p. 55, <) 113, 115, 117; p. 58, 
 (} 120, 124 ; p. 57, ^ 125 ; p. 5S, 59.
 
 974 
 
 INDEX. 
 
 Sympathetic Influences — continued. 
 
 n29 ; p. 63-66, ^ 137-143 ; p. 67, 
 68, ^ 149-152; p. 106-111, ^ 222- 
 233J ; p. 321-341, ^ 495-514 ; p. 405 
 -412, ^ 638 ; p. 661-689, ^ 894-905^ ; 
 p. 692, 693, () 914-921 ; p. 698, 699, 
 (J 929-935 ; p. 702-711, () 939-952 ; 
 p. 746, (} 990^ a. See, also, Sympa- 
 thy. 
 
 depend, in part, upon the nature of 
 tissues, p. 64, <J 140-142 ; p. 67, () 
 150-152 ; p. 73, ^ 163. See, also. 
 Tissues. 
 Sympathetic Nerve, 
 
 pervades all parts, p. 54, 55, ^ 111, 
 113; p. 58, <J 129; p. 284-289, ^ 
 454-46 U. 
 
 its ganglia to be regarded as analogous 
 to brain, especially in inferior ani- 
 mals, and as contributing to gener- 
 ate the nervous power in the higher 
 orders, p. 55, H13 ; p. 321, iji 497 ; 
 p. 346, ^ 516 d, Nos. 8, 9 ; p. 349, 
 350, () 520-523 ; p. 353, ^ 524 d. 
 
 its prolongation through the chain of 
 ganglia consists truly of communi- 
 cating branches ; thus making the 
 ganglia so many intimately connect- 
 ed centers of sympathy ; ibid, &c. 
 
 its ganglia, plexuses, &c., the media 
 of contiguous sympathy, and more 
 or less of remote, in the higher ani- 
 mals, <) 473 c, 497, 516 d, Nos. 3, 4, 
 5, <J 520, 893 ;— the only centres of 
 sympathy in the inferior animals, ut 
 cit. ; ganglia shown to be centres of 
 sympathy by their resemblance to 
 brain ; — shovYn by the ramifications, 
 and the interchanges of their nerves ; 
 — shown by the absence of brain and 
 spinal cord in all but the higher an- 
 imals ; ut cit., and passim. 
 
 this nerve subserves the functions of 
 organic life, maintaining through re- 
 flex actions their harmonious rela- 
 tions, supplying an exciting and mod- 
 ifying influence, and thus also pro- 
 moting the secretions and exalting 
 the vital states of organic compounds, 
 and supplies the stimulus to muscu- 
 lar fibre in organic life, () 113-117, 
 22 H, 224-226, 2334, 259, 261, 264, 
 409 k, 455-46U, 473 c, 475^, 478 6, 
 4881, 489, 490, 493 cc, 497, 500 g, m, 
 514/, 516, Nos. 3,4, 5, 520, 523-524, 
 647^, 746 c, 893 a-e, 893^ 902 e-h, 
 904 Ob, 905 a, 939/, 942 6, 1059. 
 Sympathetic Relations, 
 
 such as are natural, ^ 129, 137., &c. 
 
 morbid, p. 59, ^ 129 i; p. 64-66, ^ 140 
 -143, 147. Adaptation, Law of. 
 Sy.mpathies, Morbid, 
 
 of the Inditidual Tissues ; see Tissues. 
 
 of the Compound Organs ; See Organs, 
 
 COMPQUND. 
 
 Sympathy, 
 
 its general consideration, p. 283-3C:i, 
 M52-530; p. 412, ^ 638^. 
 
 of three kinds, continuous, conlig^ious, 
 and remote, p. 321-335, () 495-511. 
 
 contiguous and remote depend upon the 
 nervous power, operating in its con- 
 nection with sympathetic sensibility, 
 ibid. See, also. Nervous Power, 
 and Sensibility, sympathetic. 
 
 continuous, common to plants and ani- 
 mals, p. 322, 323, () 498 ; p. 351, ^ 
 524 a, No. 2. 
 
 its main centers, in the higher ani- 
 mals, the brain and spinal cord, p. 
 323, () 499. See, also, Sympathetic 
 Nerve, and Nervous Power. 
 
 its physiological laws well settled, p. 
 Ill, \ 234 a. 
 
 not applied pathologically or therapeu- 
 tically, p. Ill, (J 234 a. See, also, 
 Humoralism, and Organic Chemis- 
 try. 
 
 its natural conditions neglected or rid- 
 iculed, p. 1 1 1, <;> 234 J ; p. 283, (j 452 b. 
 
 how far expounded by the Author ; see 
 Nervous Power, the Philosophy of 
 its Operation, &c. 
 
 admitted Laws of, and their applica- 
 tion, by the Author, to pathology and 
 therapeutics, p. 280-361, <J 450-530. 
 
 physiological Laws of, luminously ex- 
 pounded by the great Prussian Phys- 
 iologist, p. 341, i) 514^ b ; p. 362, ^ 
 530. 
 Symptoms, 
 
 the index of disease, p. 434-445. 
 
 certain special ones, p. 442-44.'5. 
 
 mode of investigating, p. 430-433, ^ 
 675, 676 a ; p. 437-4 12, ^ 685, 686 ; 
 p. 561, <J 888 a. 
 Syncope, 
 
 produced, not as supposed, by deficien- 
 cy of blood at the center of the cir- 
 culation, or by privation of nervous 
 influence, but by a strong determina- 
 tion of the nervous power upon all 
 the organs of circulation ; reproduced 
 by the antecedent enfeebled action 
 of those organs, p. 304, 305, (j 481 
 g, h; p. 703-709, () 940-951. 
 
 removed by the action of the nervous 
 power, or by irritating the heart me- 
 chanically, p. 89, {) 188 a; p. 107, 
 108, <J 226, 227 ; p. 705, § 945. 
 
 T. 
 Tables, 
 
 of Organs according to their relative 
 
 functions, p. 07, ^ 125. 
 of Tissues in their order of liability to 
 
 inflammation, p. 70, 71. 
 of Tissues as to force of disease, p. 72. 
 of Tissues inflamed, as to treatment, p 
 72, 73.
 
 INDEX. 
 
 975 
 
 Tables — contimied. 
 of the fluid products of secretion, p. 
 218, ^ 406. 
 
 Temperament, 
 physiological, pathological, and thera- 
 peutical considerations relative to, 
 p. 383-391, <J 585-603. Five, the 
 sanguine, melancholic, choleric, phleg- 
 matic, and nervous, ibid. 
 philosophy of, shown by impregnation, 
 p. 48, <J 76 ; p. 49, ^ 80. 
 
 Theories, Rival, 
 
 should be compared and contrasted, p. 
 6-8, ^ 4^, 5 ; p. 19, (^ 18 e ; p. 131- 
 133, () 281-295 ; p. 157-173, ^ 350 ; 
 p. 189, 190, (} 350i n; p. 191, (> 351 ; 
 p. 208-217, 9 382-399; p. 219-227, 
 () 408-411 ; p 238, () 438 ; p. 246, ^ 
 440/; p. 277, 278, ^ 447i/; p. 433, 
 434, ^ 676 b ; p. 456, 457, (/ 699 ; p. 
 463, i) 709 ; p. 482, -J 744 ; p. 484, ^ 
 748; p. 499, ^ 785; p. 500-504, ^ 
 786-797 ; p. 514, ^ 819 a, Nos. 1-7 ; 
 p. 662, () 896, &c. ; p. 690, ^ 906/; 
 p. 691, § 908-910. 
 
 Theory, 
 
 natural to the mind, p. 5, ij 4 a ; p. 10, 
 
 inculcated by the Creator, p. 5, ^ 4 a. 
 founded in Nature, p. 5, ij 4 a. 
 implies the greatest reference to facts, 
 
 p. 5, ^ 4 b. 
 should be studiously considered, p. 5, 
 
 Mi; P- 10. ^ 5; c. 
 undervalued by the ignorant alone, p. 
 
 5, ()4:b. 
 
 true, OT false, always guides the igno- 
 rant practitioner, p. 5, i^ 4 b. 
 how to make one, p. 10, i^ 5^ b, c. 
 
 THER.iPEUTICS, 
 
 considered in its various aspects, p. 
 
 541-777, ^ 852-1027. 
 the chemical system of, p. 176-178, ^ 
 
 350i. 
 Thought, 
 chemical theory of, p. 155, () 349 e ; 
 
 and corresponds with the chemical 
 
 theory of delirium and mania, p. 243, 
 
 ^ 440 c. 
 Time, 
 
 the arbiter of right, p. 622, ^ 892§ b. 
 Tissues, 
 of the animal body, p. 52, ^ 86. 
 their individuality important, p. 52, () 
 
 88 ; p. 61, () 133; p. 70, ^ 162; p. 
 
 416, <) 649 b-d. See, also, Venous 
 
 Tissue. 
 their distinctions physical and vital, p. 
 
 52, ^ 89 ; p. 61-73, <) 133-163. 
 their union, p. 52, <J 89-92. 
 a knowledge of important in medicine, 
 
 p. 50, ij 83; p. 61, ^ 132-134; p. 67, 
 
 (J 149-152 ; p. 69-73, ^ 160-163; p. 
 
 353-362, () 525-530 ; p. 468, () 722 c. 
 their respective modifications of life, 
 
 Tissues — cmitinued. 
 
 p. 61-64, () 133-138 ; p. 64, ^ 142, 
 p. 416, 417, () 649 b-d. 
 
 their special products, p. 62, ij 135 ; p. 
 141, () 307. 
 
 their special stimuli, p. 45, <J 73 ; p. 62, 
 ^ 136 ; p. 92-95, () 188^ d. 
 
 their relative liability to disease, p. 70- 
 72, ij 162. 
 
 their relative force of disease, p. 72, 4 
 162. 
 
 inflamed, their relative demands for 
 bloodletting, p. 72, ij 162. 
 Tissues, Sympathies of, 
 
 of the individual, p. 353-301. 
 
 of similar, p. 353-358. 
 
 of dissimilar, p. 359, 360. 
 
 of individual in their relation to each 
 other in Compound Organs, and with 
 Entire Organs, p. 360, 361. 
 Tobacco, 
 
 on the one hand, and Lobelia on the 
 other, "tried somewhat extensively 
 as substitutes for bloodletting in in- 
 flammatory affections," p. 715-718, 
 (j 960 a, g ; p. 515, ^ 819 b ; p. 527, 
 (J 829 ; p. 529, ^ 835 ; p. 540, ^ 851. 
 
 exemplifies the laws of vital habit, p. 
 364, (} 542-548 J ; p. 718, <) 960 a, note. 
 
 its use unwarrantable in strangulated 
 hernia, p. 716-718, ^ 960 a. 
 
 its limited use as a luxury admissible 
 in health only, p. 718, ^ 960 a, note 
 Tongue, 
 
 as supplying symptoms, p. 448-450. 
 Tonics, 
 
 general consideration of their uses, 
 mode of operating, &c., p. 579-583. 
 Truth, 
 
 how best ascertained and established, 
 p.2,^2b; p. 23S, () 438 d ; p. 463, 
 ^ 709 ; p. 515, ^ 819 b. See, also, 
 Error, and Facts. 
 
 its compass and nature, p. 11, ^ 5^ c. 
 
 its fundamental distinction from error, 
 p. 166, () 350, No. 28 ; p. 157-173, 
 189, 190. 
 
 can be sustained by itself alone, ibid. 
 
 man's ultimate love of, his greatest aj)- 
 proximation to his Maker, p. 124, <) 
 241 c. 
 Tubes, 
 
 organic and inorganic, have no resem- 
 blances in structure or function, p 
 99, ^ 192 ; p. 318, ^ 493 d. 
 
 U. 
 
 Ulceration. 
 
 its pathological character, &c., p. 470, 
 471, <J 729 a,b; p. 472^75, () 733 ; 
 p. 477, () 736 c, 737 ; p. 478, 4 740 a 
 Understanding, 
 
 a property of the mind and of the in- 
 stinctive principle, p. 123, ^ 241 h. 
 See Mind.
 
 976 
 
 INDEX. 
 
 Unity of Design. See Design. 
 Urea, 
 its importance in organic chemistry, p. 
 
 228, ^ 417. 
 Ukinaey Agents, 
 their general uses, influences, &c., 
 
 considered, p. 683-689. See, also. 
 
 Diuretics. 
 Urinary Organs, 
 product of, inorganic matter, p. 228, ^ 
 
 417 a. 
 contribute, by depurating the blood, to 
 
 the process of assimilation, p. 330, 
 
 1^421. 
 remarkable sympathy between, and the 
 
 skin, p. 330-332, ^ 422-424. See, 
 
 also. Nervous Power. 
 product of, very variable in health and 
 
 disease, p. 232, 233, ij 425-427. 
 but little subject to disease, p. 450, 451, 
 
 <^ 691. 
 adaptations to, of urinary agents, p. 
 
 683-689, ^ 905i 
 Urine, 
 its relations to disease, p. 450, ^ 691. 
 its spontaneous transformations occur 
 
 as readily as those of blood, p. 228, 
 
 ^ 417, &c. 
 morbid states of, sufliciently recognized 
 
 by inspection, p. 233, ^ 427 ; p. 451, 
 
 <J691. 
 Uterine Agents, 
 
 considered in their various therapeuti- 
 cal aspects, p. 683-689. See, also, 
 
 Emmenagogues, and Ergot. 
 Uva-Ursi. See Genito-Urinary Agents. 
 
 Vegetable Kingdom, 
 essentially independent of the animal, 
 p. 16, ^ 16, 17; p. 135-138, ^ 300- 
 303^. See, also, Plants, and Or- 
 ganic Life. 
 its importance to animals, p. 15, ^ 11- 
 14 ; p. 16, § 16 ; p. 135-138, ^ 300- 
 303i 
 
 Veins, 
 their ordained function in respect to 
 the circulation, their peculiar vital 
 constitution, their one and peculiar 
 vital stimulus, their extreme liability 
 to irritation and inflammation, as 
 well as direct observation, prove 
 that they take no part in the function 
 of absorption, p. 62, § 136 ; p. 63, § 
 137 6, c ; p. 128-134, ^ 269-295 ; p. 
 210, <^ 387; p. 527, 1^829. See, also. 
 Absorption Venous Tissue, Circu- 
 lation Venous, and Venous Con- 
 gestion. 
 function of their valves explained, p. 
 212, ^ 391. 
 
 Venous Congestion, 
 inquiry into its pathology, philosophy. 
 
 Venous Congestion — continued. 
 
 influences, treatment, &c., p. 500- 
 513, ^ 786-818 ; p. 724-732, () 961- 
 970; p. 756-759, ^ 1005. 
 
 constituted, essentially, by inflamma- 
 tion of the venous tissue, p. 503, ^ 
 794, 795. 
 
 coincident in its pathology with that 
 of phlebitis and varix, p. 503, 504, ^ 
 796, 797. 
 
 its influences upon the system difTereni 
 from those of inflammation of other 
 tissues, p. 507, 508, ^ 806 ; p. 724- 
 726, (j 961 a-t. 
 
 modifies the phenomena of idiopathic 
 fever and of other inflammatory af- 
 fections, and increases their danger, 
 p. 508, 509, ^ 809-811 ; p. 511, () 
 815, 816; p. 725, ^ 961 b. 
 
 insidious, p. 508, 509, (j 806-810 ; p. 
 724, () 961 a; p. 756-759, () 1005 a-h. 
 
 its prostration of the functions of ani- 
 mal life mistaken for " debility" of 
 organic life, p. 726, () 961 b. See, 
 also. Will. 
 
 illustrates the sway of theory in the 
 treatment of disease, p. 500, i) 789 ; 
 p. 501, () 790 b; p. 729, ^ 967; p. 4, 
 5, <J 4 a, b. See Venous Tissue. 
 Venous Tissue, 
 
 author's exposition of the peculiarities 
 of its vital constitution, and of their 
 bearing upon venous circulation, and 
 upon the pathology and treatment of 
 phlebitis, venous congestion, and 
 varix, and, also, of the influences of 
 its pathological conditions upon the 
 system at large, and upon coexisting 
 membranous inflammations, and 
 upon idiopathic fever, p. 62, ^ 136 ; 
 p. 63, {) 137 e ; p. 64, ^ 140, 141 a , 
 p. 67, ^ 149-151 ; p. 73, ^ 163 ; p. 
 209-212, ^ 387-390 ; p. 214, ^ 392 d, 
 393 ; p. 352, ^ 524 d ; p. 353, ^ 525 
 a; p. 354, 355, () 526 b; p. 416, ^ 
 649 b, c ; p. 424, 425, § 662 b, c ; p. 
 440, 441, ^ 686 b ; p. 444, 445, () 688 
 c, e ; p. 447, 448, ^ 688 i, k ; p. 450, 
 I) 689 b ; p. 453-455, ^ 694, 694i ; p. 
 468, (J 722 c ; p. 500-513, (} 786-818 ; 
 p. 724-732, ^ 961-970 ; p. 735, (} 978 ; 
 p. 756-762, () 1005. 
 Vis Medicatrix Nature, 
 
 what it is, and what its advantages, p. 
 87, ^ 177 ; p. 122, <J 239, 240 ; ]>. 
 457, ^ 699 c ; p. 470-475, () 729-733 
 /; p. 476, I) 735 a; p. 489, <J 757 a, 
 p. 492, 493, () 764 b, c ; p. 497, ^ 775 ; 
 p. 498, 499, ^ 784, 785 ; p. 531, () 839 , 
 p. 536, § 847 a; p. 541, ^ 853 ; p. 
 542. () 854 e ; p. 543-551, ^ 855-864 ; 
 p. 558, ^ 878 ; p. 662-664, ^ 895-899 , 
 p. 683, ^ 905 b; p. 435, ^ 680. 
 
 not recognized in the chemical and 
 humoral pathology, p. 169-173, (J
 
 INDEX. 
 
 97? 
 
 Vis Medicatrix Naturae — coidinucd. 
 
 350, Nos. 36-46 ; p. 176-178, 1) 350i ; 
 p. 540, ^ 851 a ; p. 550, ^ 863 e ; p. 
 661, mottoes. 
 
 does not institute, nor carry on, the 
 recuperative process in the blood, p. 
 535, 536, ^ 847 a-c ; p. 546, () 863 a. 
 Vis Inertia, 
 
 takes the place of Vis Vitce, p. 30, 31, 
 ■J 59 ; p. 105, <5 216. 
 Vision, 
 
 vital and Chemical Theories of, p. 93- 
 95, {} 188^ d. 
 Vital Affinity, 
 
 a property of the Vital Principle, and 
 common to plants and animals, p. 
 88, § 183, 184 a. 
 
 unites the elements of organic com- 
 pounds by associate action with the 
 other organic properties, p. 42, 43, § 
 67, 68 ; p. 89, ^ 187, 188 ; p. 104, {) 
 212 ; p. 105, ^ 217, 218 ; p. 135, ^ 299. 
 
 modified in plants and animals, p. 88, 
 ^ 185; p. 105, ^ 217. 
 
 susceptible of morbid changes, p. 47, 
 48, ^ 75, 76, 78 ; p. 105, <;> 220 ; p. 
 146. 147, (J 327-331 ; p. 535, 536, ^ 
 846, 847. 
 
 its morbid changes illustrated by, and 
 analogous to, its progressive natu- 
 ral modifications from the ovum to 
 old age, and such as result from the 
 slow influences of climate, cultiva- 
 tion, &c , p. 42, 43, ^ 67, 68-70 : p. 
 48, <;» 77 ; p. 68, 69. () 153-159 ; p. 
 363, (} 538 ; p. 364. ^ 548 ; p. 369, ^ 
 562 ; p. 376-380, ^ 578. 
 
 how opposed to chemical affmity, p. 30 
 -33, >J 59, 60. 
 Vital Agents, 
 
 whatever acts upon life, p. 21, ij 21 ; 
 p. 45, ^ 73 ; p. 46, ij 74 ; p. 62, 63, 
 ^ 136, 137 ; p. 90-95, i) 1881 ; &c. 
 
 act upon irritability in generating all 
 sensible and insensible motions, and 
 upon sensibility in the function of 
 sensation and in the transmission 
 of all influences from remote parts 
 to the nervous centers, whether 
 relative to animal or to organic life, 
 p. 21, ^ 21 ; p. 45, ^ 73 ; p. 46, t) 74 ; 
 p. 86, \ lib d; p. 89, ^ 188 ; p 95- 
 102. ^ 189-203 ; p. 107-111, ^ 226- 
 233J; p. 112, () 234 c; p. 114, ij 234 
 e ; p. 119, ^ 234 i ; p. 280-283, ^ 450 
 -451 ; p. 284-287, ^ 454-458 ; p. 289, 
 ^ 461 ; p. 296, <J 476 c ; p. 313, ^ 487 
 h; p. 323-341, (} 500-514; p. 398- 
 400, ^ 626-630 ; p. 405-412, (} 638 ; 
 p. 661-664, <;» 894-901 ; p. 692, 693, 
 ) 915, 920 ; p. 698, ^ 929-934 ; p. 
 707, ^ 949 ; p. 726, ^ 961 ; p. 732, 
 t^ 973 ; p. 746, ^ 990^ a. See, also, 
 
 A.'fALOGIES. 
 
 Fliilosophy of their operation, p. 47-49, 
 
 a Q 
 
 Vital Agents — continued. 
 
 i) 73-80; p. 89, () 188; p. 90-99, 9 
 188Jr-l93 ; p. 106-11 1, ^ 223-2333 ; 
 p. 296, ^ 476 c; p. 313, ^ 478 h ; p 
 321-335, {j 495-511; p. 661-664, <} 
 894-901 ; p. 692, 693, ^ 915, 920. 
 See, also, ilEiiEDiAL Action. 
 
 internal and external, p. 21, ^ 21 ; p. 
 45, (J 73 ; p. 62, -^ 136 ; p. 90, <J 188i ; 
 p. 106, 107, ^ 223. 226 ; p. llO, 111, 
 •J 233, 2331 ; p. 296, ^ 476 c ; p. 313, 
 § 487 A ; p. 398-400, ^ 626-630 ; p. 
 405-412, § 638. 
 
 how necessary to life, p. 21, ij 21 ; p. 
 30, <5 57 ; p. 45, ^ 73 ; p. 46, >J 74 a ; 
 p. 62, ^ 136 ; p. 63, ^ 137 d, e; p. 
 65, ^ 143 c ; p. 67, (} 150, 151 ; p. 90, 
 ^ 188i ; p. 106, 107, ^ 223, 226 ; p. 
 110, ^ 233 ; p. 285, ^ 455 c; p. 398 
 -400, () 626-630. 
 
 act and acted upon, p. 21, <J 25 ; p. 24, 
 M2; p. 90, (} 188 c; p. 108-110, (j 
 227-232 ; p. 134-144, d 296 322; p. 
 227, Hll- 
 
 do not act upon the structure, p. 95-97, 
 t) 189; p. 107-111, ^ 226-2.331; p. 
 1 12, ^ 234 c ; p. 282, ^ 451 b ; p. 330, 
 {) .500 n; p. 746, (J 990 1 a 
 
 their action conforms to the f:i)id of ir- 
 ritability and sensibility, p. 43-47, <J 
 70-74; p 62-69, (} 136-156; p. 97- 
 103, {} 190-204; p. 109, ^ 229; p. 
 110, () 233; p. 399, ^ 628, 630; p. 
 662-664, .;. 895-900. 
 
 include the morbific, p. 90, ^ 188 J b, 
 and as above. See, also, Analogies. 
 
 their most comprehensive relations to 
 organic states, p. 21, ij 21 ; p. 67, 68, 
 <;» 149-152; p. 120-122, ^ 237-240: 
 p. 398-400, ^ 626-630 ; p 405-412, 
 ^ 638 ; p 662-665, ^ 895-901. 
 
 their relations to life affected by dis- 
 ease, p. 3, (^ 2 J ; p. 47-49, ^ 75-79 ; 
 p. 59, (/ 129 g-i; p. 61, ^ 133 c; p. 
 63-68, ^ 137C-1.52 ; p. 73, H63; p 
 98, ^ 191; p. 108, 109, <J 227-230, 
 p. 120-122, ^ 237-240. See, also. 
 Remedial Action, Therapkutics, 
 general, and Adaptation, Law of. 
 
 analogies between the physical and 
 moral, p. 1 1 1 , (J 2335 ; p. 296, s^ 476 c , 
 p. 313, () 487 h ; 323-332, i) 500 ; p. 
 662-665,(^895-901.. See, also, Anal- 
 ogies. 
 
 each one has special virtues and ex- 
 erts special influences, p. 2\, () 21 
 25 ; p. 30, i)bl; p. 45-49, ^ 73-80 ; 
 p. 62-64, (J 135-140 ; p. 65-68, (^ 143 
 -152 ; p. 73, <J 163 ; p. 87, (j lid ; p 
 90, ^ 188^ a-c ; p. 92-95, /) 188i d ; p 
 98, ^ 191 ; p. 100, (J 198, 199 :"p. 101 
 -103, ^ 201-204; p. 104, ^ 215 ; p 
 107-111, ^ 226-2331 ; p. 119, 1} 235 
 p. 417, I) 6.50; p. 662-665, ^ 895-901 
 See, also. Remote Causes of Dis- 
 Q
 
 978 
 
 INDEX. 
 
 Vital Agents — continued. 
 
 EASE, Therapeutics, and Vital 
 
 Habit. 
 Vital Force, Chemical Theory of. See 
 
 Organic Force, Chemical Theory 
 
 OF. 
 
 Vital Functions, 
 
 experiments to Determine their Laws, 
 and their application by the Author to 
 physiology, pathology, and therapeu- 
 tics, p. 290-321, 6 462-494. 
 Vital Habit, 
 
 its laws and phenomena, physiological 
 and moral, p. 363-370, § 535-568. 
 Vital Principle, 
 
 has various properties, p. 83, <J 175 ; p. 
 88, § 183, 184. See, also, Vital 
 Properties. 
 
 has remarkahle analogies with the soul, 
 and with the principle of instinct, p. 
 84, ^ 175 b; p. 281, 282, (J 451. 
 
 illustrated by light, &c., p. 79, (J 168 ; 
 p. 84, f) 175 b; p. 114, 115, ^ 234, e, 
 f; p. 330, <J 500 nn. 
 
 a whole, p. 41, 42, ^ 65-67 ; p. 56, ^ 
 122; p. 82, () 171 ; p. 97, ^ 190 b; 
 p. 435, (J 680. 
 
 lecognized at all ages, p. 73, ^ 164. 
 
 recognized by all who deny its exist- 
 ence, p 6, 7, ij 4.V b, d ; p. 19, ^ 18 e ; 
 p. 30-33, (} 59, 60 ; p. 38-40, ^ 64 c- 
 h; p. 95, 96, (} 189 b; p. 157-173, () 
 350; p. 189, 190, ^ 350 J n; 626 b. 
 
 history of its vicissitudes with medical 
 philosophers, p. 73-79, ^ 164-168. 
 
 opinions respecting, p. 24, 4 42 ; p. 37 
 -41, (J 64, 65; p. 74-79, (} 165-167; 
 p. 132, 133, () 289, 290; p. 149-155, 
 <;» 337-349; p. 157-173, ^ 350; p. 
 189, 190, ^ 3501 n; p. 514, (} 819 a. 
 
 its existence and laws variously attest- 
 ed, and by adequate phenomena, p. 
 36-49, ^ 63-80 ; p. 75, ^ 165 b; p. 
 80, () 169 ; p. 84, i) 175 bb ; p. 111- 
 122, <J 234-240 ; p. 182, <J 350| g; p. 
 330, <;. 500 nn ; p. 398, ^ 626 b. 
 
 shown by elementary composition, p. 
 15, <) 10-14 ; p. 16, {} 16, 17 ; p. 20- 
 49, () 19-80; p. 79, (} 167^. 
 
 proved by nitrogen gas, p. 34-36, <) 62. 
 
 proved by its phenomena, p. 75, ^ 165 
 b ; p. 79, (J 168 ; p. 80, () 169 ; p. 84, 
 ^ 175 bb. 
 
 proved by the function of appropriation, 
 p 24, 25, (} 41-43 ; p. 227, ^411. 
 
 proved by the nervous power, p. 106- 
 111.^ 223-2335 ; p. 323-332, ^ 500 , 
 p 746, ^ 990^ b. 
 
 proved by -universal consent ; see 
 above, recognized by all who deny its 
 existence. 
 
 its nature unknown, as of all things 
 else, p. 79, ^ 168; p. 117, ^ 234: g ; 
 p. 152, (, 345 ; p. 428, 429, ^ 674 a; 
 p. 499, ^ 785. 
 
 Vital Pimciple — continued. 
 
 inseparable from living organic matte^, 
 p. 81, i) 170; p. 96, ^ 189 c. 
 
 created after structure, p. 81, ^ 170. 
 
 and organic matter mutually depend- 
 ent, p. 81, () 170; p 96, ^ 189 c. 
 
 indivisible, p 82, <J 171. 
 
 summary definition of its characteris- 
 tics, p. 82, (} 172. 
 
 fundamental cause of all phenomena 
 of organic beings, p. 24, ij 42 ; p. 30 
 -49, ^ 57-81 ; p. 73, ^ 164; p. 96, (f 
 189 c; p. 115, 6 234 e; p. 157-173, 
 (, 350, Nos. 47-97 ; p. 435, (; 680 ; p. 
 662-664, () 895-900, and so on. 
 
 combines the elements of matter in 
 plants, p. 15, ^ 11, 13 ; p. 30, ^ 58 ; 
 p. 83, I) 173; p. 135-139, ^ 298-3035. 
 See, also. Plants. 
 
 modifies and appropriates organic com- 
 pounds in animals, p. 15, ^ 11, 14 a; 
 p 83, <J 173 ; p. 143, 144, ^ 322 ; p. 
 196, () 360, 361. 
 
 re-arranges the elements of organic 
 compounds, p. 24, 25, (; 40-45 ; p. 
 30, <;i 58 ; p. 40-49, ^ 65-80 , p. 150, 
 ^ 339 a, b;p. 1 52, 1.' 3, ^ 345-349 a ; 
 p 227, ^ 411. 
 
 essentially the same in plants and ani- 
 mals, p 88, ^ 185. See, also. Plants, 
 and Organic Life. 
 
 on a par with magnetism and light, p. 
 75, () 165 b ; p. 79, (} 168 ; p. 80, f) 
 169 b; p. 81, 9 170 a; p. 84, () 175 
 bb; p. 99, ^ 191 d; p. 112-120, (} 
 234 c-237 ; p. 330, (^ 500 nn ; p. 746, 
 i) 990^ b 
 
 how far creative, p. 25, ^ 43 ; p. 37 • 
 40, «;> 64 c-h ; p. 81, ^ 170 ; p. 82, 83, 
 (^ 172 ; p. 149, i) 33G ; p. 169, () 350, 
 No. 84; p. 227, i) 411. See, also. 
 Nature, contradistinguished from 
 Creative Power. 
 
 resists chemical agencies, p. 30-33, ^ 
 57-60 ; p. 194, ^ 358 ; p. 196, ^ 360 
 See, also. Digestion. 
 
 the source of growth, p. 30, ij 57 ; p 
 36-44, ^ 63-72; p. 227, MH ; P 
 435, ^ 680. See, also. Plants. 
 
 develops the germ, p. 36-49, '^ 63-81 
 p. 97, () 190 b. 
 
 strongly pronounced in the ovum, p. 
 42, § 67 ; p. 44, ^ 71 ; p. 97, ^ 190 b 
 
 laws of, deduced from the ovum, p. 30 
 ^ 57, 58 ; p. 36-49, ^ 63-81 ; p. 97, 
 ^ 190 ft. 
 
 presides over organic processes and 
 results, p. 30, <5 58 ; p. 31-32, ^ 59 ; 
 p 37-49, ^ 64-80 ; p. 148-154, § 335 
 -349 e; p. 196, 197, 9 360, 361 ; p. 
 227, >;> 411 ; P- 273, <;. 447 A; p. 405- 
 412, <J 638 ; p. 435, ^ 680 ; p. 474, 
 475, ^ 733 f-i ; p. 662-664, f) 895- 
 900. 
 
 makes no demands on chemistry, p
 
 INDEX. 
 
 979 
 
 Vital Principle — continued. 
 
 15, (j 13, 14 ; p. 16, ^ 16-18 ; p. 24, 
 M2 ; p. 30-33, (j 59, 60 ; p. 42, (j 66, 
 67 ; p. 44, ^ 71 ; p. 84, () 175 bb ; p. 
 135, (J 301 ; p. 143, ^ 322 ; p. 194, 
 
 195, ^ 358, 359 ; p. 196, 197, ^ 360, 
 361 ; p. 201, <J 374, 375; p. 203, ^ 
 376^; p. 227, MH ; P- 276-279, ^ 
 447i /; p. 376-380, () 578 ; p. 405- 
 412, ^ 638 ; p. 160-162, ^ 350, Nos. 
 58-61. 
 
 generates Motion, and variously, p. 
 21, () 24 ; p. 31, ^ 59 ; p. 37-49, () 64 
 -80; p. 86, 87, ^ 176, 177; p. 103, 
 ^ 205, 208, 209 ; p. 107-111, ^ 226- 
 233j ; p. 323-332, ^ 500 ; p. 746, ^ 
 990^ a. 
 
 mutable in its nature ; see Vital 
 Properties. 
 
 its mutability the fundamental cause 
 of disease and its cure ; see Vital 
 Properties. 
 
 Its mutability designed for useful pur- 
 poses ; see Vital Properties. 
 
 formative not destructive, p. 16, ^ 16- 
 18 ; p. 83, ^ 172 ; p. 135, (J 301 ; p. 
 
 196, ^ 360; p. 227, ^11. 
 
 its nature altered in man since his 
 Creation, which proves the Mosaic 
 statement, p. 401, <J 632. 
 
 subject to extinction, p. 11, ij 5| e ; p. 
 30, 31, <J 68, 59 ; p. 83, ^ 174 ; p. 87, 
 <J 176 ; p. 96, <J 189 b, c ; p. 189, 190, 
 ^350 n; p. 401, ^ 631. 
 
 by its formative action its own de- 
 stroyer, p. 382, 383, <J 581-584 ; p. 
 401, 402, ^ 633. 
 
 a bond of union between mind and 
 matter, p. 116, 117, <^ 234/. 
 
 considered identical with the chemic- 
 al forces, p. 154, ^ 349 c ; p. 180- 
 182, <J 3501 e-gg ; p. 189, 190, ^ 3501 
 71. See, also. Vital Properties in 
 THE Elements of Matter, and 
 Problems. 
 Vital Properties, 
 
 elements or properties of the Vital 
 Principle, just as judgment, reflec- 
 tion, understanding, the will, &c., 
 are properties of tl|p soul, p. 88, ^ 
 183. 
 
 four are common to plants and ani- 
 mals, and are called organic, or com- 
 mon, viz., irritability, mobility, vital 
 affinity, and vivification, p. 88, <^ 184; 
 and two superadded to the life of 
 animals along with the nervous sys- 
 tem, and are called peculiar, viz., 
 sensibility and the nervous ■power, p. 
 88, () 183-185. See, also, the sever- 
 al Properties. 
 
 the common or organic co-operate more 
 or less together in organic process- 
 es, p. 42, 43, (} 67, 68 ; p. 89, () 187, 
 188 ; p. 103, <J 208, 209 ; p. 104. (} 
 
 Vital Properties — continued. 
 
 212; p. 105, () 217, 218; p. 135, ^ 
 299. 
 
 perform the functions which are as- 
 cribed, in a collective sense, to the 
 Vital Principle, and individually as 
 analyzed under each property; see 
 the several denominations. 
 
 the organic, essentially the same in 
 plants and animals, but specifically 
 modified or varied in each, as known 
 by coincidences in their composition, 
 structure, susceptibility to the action 
 of internal and external agents, 
 growth and nutrition, and all their 
 essential functions, and products, 
 diseases, reparation, generation. 
 &c., p. 15, ^ 9-14; p. 20-22, (} 20- 
 30 ; p. 23-25, ^ 34-45 ; p. 27, (j 51- 
 53 ; p. 28-45, ^ 54-73 ; p. 54-56, < 
 105-124 ; p. 68, () 155 ; p. 88. ij 185 ; 
 p. 89, () 188 ; p. 90, I) \8S\ a-d ; p. 
 93-95, 4 188i d; p. 97, 98, § 190, 
 191 ; p. 99, ^ 192 ; p. 103-105, ^ 205 
 -221; p. 118, ^234^; p. 120,121,^ 
 236-238 ; p. 125, ^ 249 ; p. 127, 128, 
 ^ 260-266 ; p. 134, ^ 293-295 ; p. 135 
 -138, ^ 298-303^ ; p. 140, (J 304 ; p. 
 163-167, ^ 350, Nos. 64-77, 26i, 27 ■ 
 p. 203, ^ 376i ; p. 224-229, <) A09 g- 
 419 a ; p. 260-263, § 445-446 ; p. 271 
 -278, ^ 447/-447i/,- p. 279, 280, (J 
 449 ; p. 284, 285, ^ 454-455 e ; p. 
 286, <) 456 a : p. 322, 323, H98 ; p 
 398-400, ^ 626-630 ; p. 473-476, () 
 733 e-k. 
 
 possess natural modifications in differ- 
 ent organs and tissues, and in the 
 conditions of the ovum, p. 30, () 57 ; 
 p. 43, ij 70 ; p. 44, <J 72 ; p. 46, <J 74 ; 
 p. 61-63, <} 133-137; p. 64, (J 138, 
 p. 67-73, <;> 149-162 ; p. 82, ^ 172 ; 
 p. 88, ^ 185 ; p. 97, 98, I) 190, 191 a ; 
 p. 100, {) 197-200 ; p. 102, ^ 203 ; p. 
 105, (J 217; p. 114, <) 234 d. See, 
 'also. Tissues, Venous Tissue, and 
 Analogies. 
 
 their definite character and permanen- 
 cy, p. 87, ^ 178-182 ; p. 120-122, () 
 237-239; p. 181, 182, ^ 3501 /, g ; 
 p. 662-665, ^ 895-901. See, also, 
 Vis Medicatrix Nature. 
 
 mutable in their nature, p. 3, () 2 b ; p. 
 11, ^ 5i e ; p. 47-49, (} 74-80 ; p. 61, 
 <5 133 c, 134; p. 68, 69, <J 153-156 ; 
 p. 87, ^ 176-182 ; p. 98, 99, § 191 b- 
 192; p. 105, () 220, p. 107-110, () 
 225-232; p. 121, 122, ij 237-240 ; p. 
 352, ^ 524 d ; p. 376-380, () 578 ; p. 
 405-412, <;. 638; p. 417, ^ 650; p 
 428, ^ 672 ; p. 435, <J 680 ; p. 478, 
 479, ^ 740, 741 ; p. 662-664, ^ 896- 
 900. 
 
 their mutability has corresponding 
 changes in the properties of the
 
 980 
 
 INDEX. 
 
 V^ital Properties — continued. 
 
 mind and instinct, p. 98, (j 191 c ; p. 
 123, 124, ^ 241 c ; p. 369, 370, () 564- 
 568 ; p. 374, (} 576 b ; p. 376, () 577 
 b; p. 377, i) 578 c; p. 380, 381, § 
 579 ; p. 382, () 581. 
 Iheir natural modifications in different 
 parts shown by natural stimuli, p. 
 46, ^ 7i a; p. 62, () 136; p. 97, <) 
 190 i-191 a; p. 100, I) 199, 201 ; — 
 bv natural products, p. 24, ^ 42 ; p. 
 50, ^ 83 ; p. 62, ^35; p 97, ij 190 ; 
 p 227, {) 411 ; p. 229, H19 ; P- 233, 
 234, () 428-432 ; p. 378, ^ 578 c ;— 
 by action of foreign agents, p. 61, <5 
 134 ; p. 63, ^ 137 ; p. 67, () 149-151 ; 
 p. 73, ^ 163 ; see, also. Remote 
 Causes of Disease, Tissues, Ven- 
 ous Tissue, Therapeutics, &c. ; — 
 by organization, p. 64, ^ 141 ; p. 88, 
 () 185; p. 100, 101, () 194-201; p. 
 106, () 223 ; p. 223-227, ^ 409-411 ; 
 — by morbific causes, p. 64, ^ 142 ; 
 p. 66, ^ 143; p. 67, () 149, 150; p. 
 68-73, § 153-162 ; p. 98, ^ 191 ; see, 
 also. Remote Causes of Disease, 
 &c. ; — by the development of organs, 
 p. 46, ^ 74; p. 68, 69, ^ 153-159 ; p. 
 87, ^ 178; p. 97, ^ 190 b; p. 375, ^ 
 577; p. 376-380, () 578 ;— by the 
 ovum, p. 42^5, ^ 67-73 ; p. 97, <J 
 
 190 b ; — by comparison of plants and 
 animals, p. 15, (} 10-14; p. 16, ^ 16, 
 17; p. 20, (J 18 e; p. 54, 55, ^ 107- 
 117 ; p. 56, <;» 121-123 ; p. 88, ^ 185 ; 
 p. 97, () 190 b, c ; p. 135-140, ^ 298- 
 305; p. 223-227, H09C-411; p. 474, 
 475, ^ 733 f-i ;— by the variety of 
 effects, p. 67, (} 149-151 ; p. 120- 
 122, <^ 226-240 ; p. 222-227, ^ 409 c- 
 411 ; p. 474, 475, ^ 733 f-i. 
 
 their natural modifications in different 
 species of beings, and in different 
 parts, have important final causes, 
 p. 15, ^ 9-14 ; p. 30, ^57; p. 42-46, 
 () 66-74 ; p. 61, ^ 133 b ; p. 62, (J 135, 
 136 ; p. 65, {) 143 c ; p. 67-69, () 150- 
 156; p. 87, ^ 180; p. 88, ^ 185; p. 
 93, 95, () 188^ ; p 97, 98. <) 190 b- 
 
 191 a; p. 99, ^ 192; p. 100-102, ^ 
 199-203 ; p. 104, () 212, 214 : p. 105, 
 (j 217 ; p. 352 () 524 d; p. 375, 376, 
 () 577 b; p. 376-381, ^ 578-579. 
 
 their mutability designed for useful 
 purposes, p. 3, <J 2 Z>; p. 61, () 133 c; 
 p. 63, «Si 137 c ; p. 68, 69, ^ 153-156 ; 
 p. 87, ^ 180 ; p. 120, § 237 ; p 352, 
 ^ 524 d; p. 376, «^ 578 b; p. 378, (J 
 578 c ; p. 435, () 680 ; p. 662, () 895. 
 
 their mutability the fundamental cause 
 of disease, p. 3, ^ 2 i; p. 11, 5^ e ; 
 p. 47-49, () 74-80 ; p.6\,() 133 c ; p. 
 87, ^ 177-182 ; p 98, I) 191 ; p. 121, 
 () 237, 238 ; p. 352, ^ 52id; p. 662- 
 604, ^ 895-900. 
 
 V^ital Properties -continued. 
 
 their mutability the ground-work o 
 cure, p. 61, (} 133 e; p. 89, ^ 177- 
 179; p. 119, ^ 234 i; p. 122, ^ 239; 
 p. 428, ^ 672 ; p. 544, 545, ^ 858 ; p. 
 546-551, () 862-864 ; p. 662-664, ^ 
 895-900. 
 
 their mutability the great cause of dif- 
 ficulties in medicine, p. 120, 121, 4 
 237 ; p. 662, ^ 895 ; p. 664, (} 899. 
 
 subject to extinction ; see Vital 
 Principle, subject to, &c. 
 
 a knowledge of their modifications, 
 natural and morbid, contrasted with 
 a knowledge of the undulations of 
 light, &c., p. 115, 116, (;> 234/. See, 
 also, Adaptation, Law of. 
 "Vital Properties in the Elements 
 OF Matter," 
 
 disproved, p. 16, <J 14 c. 
 
 how they are supposed to create man, 
 and other organic beings, p. 86, ^ 
 175 d; p. 160, 161, 170, ^ 350, Nos. 
 12, 13, 39 ; p. 178-184, I) 350i a-g ; 
 p. 186-192, ^ 350| kk-354:. 
 
 supposed to animate hydrogen, nitrogen, 
 oxygen, and carbon, and that these 
 are the special elements, which, with 
 the aid of heat, moisture, &c., create 
 organic beings, p. 181, 182, ^350% f. 
 Vital Properties and Functions, 
 
 modifications of , arisiiig from Age, Tern- 
 perament. Constitution, Sex, Climate, 
 Habit, &c., p. 373-397. 
 Vital Stimuli, Sedatives, and Altera- 
 tives. See Vital Agents, Altera- 
 tives, and Analogies. 
 Vitalism and Solidism, 
 
 the foundation of medicine, p. 1, iji 1. 
 
 deduced from the seed and ovum, p. 
 30, (^57; p. 36-49, ^ 63-81 ; ;). 56, 
 () 121-123 ; p. 97, ^ 190 b ; p. 279, 
 280, () 449. 
 
 their doctrines virtually conceded by 
 their opponents, p. 19, <S» 18 e ; p. 22, 
 (^ 29 ; p. 30-33, ^ 57-60 ; p. 38-40, 
 ^ 64 e-h ; p. 95, 96, ^ 189 b ; p. 152- 
 154, (J 345-349 c ; p. 157-173, ^ 350 ; 
 p. 189, 190, {) 350i| n ; p. 191, 9 351 ; 
 p. 478, 4790(5i 740 ; p. 514, ^ 819 a, 
 Nos. 4-7. 
 
 always consistent, p. 1, ^ 1 ; p. 40-49, 
 ^ 65-81 ; p. 81, () 169/; p. 94, 95, ^ 
 188^ d ; p. 147, ^ 330, 333 ; p. 235, 
 § 435 a; p. 331, i) 500 0; p. 405- 
 412, ^ 638 ; p. 413, ^ 639 a ; p. 541. 
 () 852 ; p. 662-665, ^ 895-901. See, 
 also. Analogies, and Nervous 
 Power. 
 
 admits of no unnecessary multiplica- 
 tion of causes, p. 81, ^ 169/; p. 154, 
 (^ 349 b; p. 194-197, ^ 358-361 ; p. 
 234, () 433; p. 264, 265, ^ 446 c, 
 447 a, b; p. 271, i) 447/; p. 276- 
 278, § 447^/; p. 331. (> 500 0; p
 
 INDEX. 
 
 9S1 
 
 Vitalism and Solidism — continued. 
 
 405-412, ij 638 ; p. 550, () 863 e ; p. 
 662, () 895 See, also. Organic 
 Chemistry and Physiology Con- 
 trasted. 
 contradistinguished from Humoralism, 
 p. 147, ^ 330; p. 516-518, (J 821, 
 822 ; p. 535-540, () 846-851 ; p. 550, 
 () 863 e ; p. 662-664, ^ 895-900. 
 
 "Vitality seen in Dead Matter," p. 
 179, ^ 350i c. See, also, Vital 
 Properties in the Elements of 
 Matter. 
 
 ViVIFICATION, 
 
 a property of the Vital Principle, and 
 
 common to animals and plants, p. 
 
 88, <J 183, 184 a; p. 105, 218-221. 
 with vital affinity, bestows life, p. 105, 
 
 ij 218. 
 belongs to the assimilating organs, and 
 
 to their subsidiary fluids, p. 105, § 
 
 219. 
 liable to morbid changes, p. 105, <J 220. 
 Voluntary Motion, 
 physiology of See Motion, Will, 
 
 Nervous Power, and Muscles of 
 
 Voluntary Motion. 
 Vomiting, 
 physiology of, p. 666-669, <^ 902 b-g. 
 
 W. 
 
 White Vitriol, or Sulphate of Zinc, 
 its uses, &c. See Zinc Sulphate, 
 and Re.medial Action. 
 Will, The, 
 
 its relation to motion, p 89, <J 186, 
 188 a; p. 95, ^ 188^ d; p. 97, i) 
 190 a ; p. 104, (} 215 ; p. 107, ^ 227 ; 
 p. 110, 111, ^ 233, 233^; p. 113, ^ 
 234 ; p. 124, 125, <J 243-246 ; p 210, 
 <J 486; p. 282, ^ 451 c; p. 284, ^ 
 454; p 288, () 459 d, e; p. 296, (^ 
 476 c ; p. 313, () 487 gg, h ; p. 314, 
 () 488^ ; p. 324-328, f 500 d-l ; p. 
 357, ^ 526 d. 
 
 nresides in animal hfe, p. 124, ^ 243 ; 
 p. 296, () 476 c ,• p. 313, ^ 487 gg,h; 
 p. 314, ^ 4881 ; p. 327, 328, ^ 500 k ; 
 p. 357, ^ 526 c. 
 
 scarcely reaches to organic life, p. 124, 
 ij 243 ; p. 282, ^ 451 c; p. 284, 285, 
 (j, 544-545 c ; p. 296, <J 476 c; p. 313, 
 ^ 487 gg, h ; p. 314, <J 488^ ; p. 324- 
 328, {) 500 d-l. 
 
 has no operation after removal of the 
 brain, p. 288, ^ 459 d, e ; p. 324, § 
 500 d; p. 357, () 526 d; and has 
 analogies to this in being wholly in- 
 operative in paralysis, and more or 
 less so in narcotization, and in its 
 failure to act as usual upon the mus- 
 cles of locomotion, or in protruding 
 the tongue, in febrile diseases, and 
 which is so often mistaken for " de- 
 
 Will, The — continued. 
 
 bilily," p. 296, () 476 c; p. 313, t, 
 487 gg, k ; p. 370-372, ^ 569 ; p. 
 481, <;i 743 ; p. 483, (J 746 c ; p. 498, 
 ^ 780; p. 724, ^ 961 a; p. 751, i) 
 999 b. 
 the analogies in its effects with those 
 of external and internal physical 
 agents prove the distinct nature of 
 mind, as do, also, perception and 
 the passions, and are fatal to men- 
 tal materialism, p. 85, «S> 175 c; p. 
 93-95, <J 188^ d; p. 97, () 190 a; p. 
 104, (J 215 ; p. 107-1 1 1, <J 226-233^ ; 
 p. 113, () 234 c ; p. 124, 125, ^ 243- 
 246 ; p. 282, ^51 c ; p. 284, ^ 454 • 
 p. 288, () 459 d, e ; p. 296, (J 476 c * 
 p. 313, ^ 487 gg, h ; p. 314, ^ 488^ ; 
 p. 323-332, <J 500. See, below. Its 
 elective power, <^c. 
 a distinct element of the mind and in- 
 stinctive principle, p. 97, ^ 190 a; p 
 296, () 476 c; p. 326, () 500 n; p. 
 
 357, ^ 526 d ; p. 369, () 563. and ibid. 
 a stimulus to the brain, like the nerv- 
 ous power to that and to other parts, 
 p. 124, § 244; p. 282, () 451 c; p. 
 288, (J 459 d, e ; p. 296, ^ 476 c ; p. 
 326, 327, 328, () 500 h, k. See, also, 
 Nervous Power. 
 
 being shown to prove the distinct na- 
 ture of mind, and its possession of 
 special attributes or properties, I 
 thus prove, also, by the analogies 
 between the mental properties and 
 the properties of life, the distinct 
 nature of a Vital Principle with its 
 several properties as its elements ; 
 as above and below, and p. 83, 84, ^ 
 175, Vital Properties, and In- 
 stinct. 
 
 its modus operandi, p. 125, () 245 ; p. 
 296, ^ 476 c ; p. 324-328, ^ 500 d-l ; 
 p. 357, <J 526 d. 
 
 controls other properties of the mind, 
 and the passions, p. 88, () 184 b ; p. 
 124, 4 243. 
 
 its elective power in animal life analo- 
 gous to that of the passions and 
 physical agents in organic life, p. 
 110, 111, iji 233,2331; p. 113,1^234; 
 p. 125, ^ 245, 246 ; p. 327, 328, 9 
 500 k. 
 
 its philosophy in developing voluntary 
 motion the same as when motion is 
 developed by the nervous power in 
 organic life, whether physical agents 
 or the passions be the remote causes 
 in the latter case, p. Ill, ^ 233? ; p. 
 114, () 234 e ; p. 125, ^ 245, 246 ; p. 
 281, 282, (J 451 a ; p. 296, ^ 476 c ; p 
 324-328, ^ 500 d-l. 
 Worms, 
 
 how they produce C(mvulsioris, p. 35(>- 
 
 358, ^ 526 d.
 
 982 
 
 INDEX. 
 
 Wounds, 
 
 their union by the first intention depends 
 upon inflammatory action, p. 471, 
 472, ^ 732 d-f. 
 
 union of, has close analogies in the re- 
 generative and reparative processes 
 of animals and plants, and the dif- 
 ferences of the latter reconciled 
 with the inflammatory nature of the 
 former, p. 474, 475, ^ 733 /-A. See, 
 also, Plants. 
 
 do not heal uniformly where several 
 tissues are involved, as in the stumps 
 of amputated limbs, on account of 
 their difference of organization and 
 vital constitution, p. 61, ^ 132-134 ; 
 p. 64, () 138-141 ; p. 67, ^ 149 ; p. 
 69, ^ 158 ; p. 70, ^ 162, table 1 ; p. 
 73, ^ 163. 
 
 VOUTH, 
 
 its relations to childhood, p. 376, ^ 578 
 a, b. 
 
 its prominent characteristic, the full 
 development of the organs of gener- 
 ation, p. 377, (J 578 b. 
 
 distinguished by many physiological 
 changes, and corresponding suscep- 
 tibilities to morbific and remedial 
 agents, p. 27, ^ 52 ; p. 68-70, ij 153- 
 160 ; p. 412, <) 686 d; p. 377-380, § 
 578 c, d. 
 
 the period of the institution of the 
 menses, and of the secretion of se- 
 men ; the latter shows by analogy, 
 as to object and time, that the former 
 is a secreted product, while its ob- 
 ject and time of institution show 
 that it has no general relation to or- 
 ganic life, and that, contrary to the 
 prevailing belief, its suspension, per 
 se, is of little moment in morbid con- 
 ditions, p. 233, 234, () 428-432 ; p. 
 377-380, l^ 578 c, d. 
 
 distinguished by changes in the moral 
 emotions which correspond with 
 
 Youth — continued. 
 
 the vital developments, p. 380, ^ 
 578 d. 
 
 the coincident changes in the moral 
 and physiological constitution, at 
 this and other periods of life, illus- 
 trate, each by itself and by analogy, 
 the mutability of the vital and intel- 
 lectual properties, p. 68, 69, () 153- 
 159 ; p. 374, ^ 576 b-d ; p. 375, 376, 
 ^ 577 b-d; p. 380, ^ 578 d ; p. 381, 
 ^ 579 b. See, also. Vital Proper- 
 ties, their mutability, &c.. Ovum, and 
 Plants. 
 
 the period of life when the development 
 of special functions displays the con- 
 stitution of the nervous power, the 
 natural oflice of this power in the 
 organic and animal economy, its in- 
 direct and unceasing development 
 and reflection upon every part of the 
 being by the organic progress of the 
 generative organs, in the fulfillment 
 of its natural oflices and as a morbif- 
 ic and curative agent, its direct ex- 
 citement by mental emotions and 
 passions, and how the principle ot 
 life is a bond of union between the 
 corporeal and the intellectual part ; 
 ibid, and Nervous Power, Moral 
 Emotions, Analogies, and p. 384- 
 292, ^ 454-470 ; P. 361, 362, <5 
 530. 
 
 offers problems to chemical physiciA)gy, 
 p. 377, 379, I) 578 c, d. See, also. 
 Problems. 
 
 Zinc, Sulphate of, 
 its uses and special influences as an 
 emetic and astringent, p. 547-549, () 
 863 d; p. 553, () 870 a; p. 571, (j 
 890 b ; p. 577, 578, () 890 o ; p. 582, 
 <;» 890^ h; p. 63, ^ 137 d; p. 65, ^ 
 143 c; p. 67, ^ 150, 151; p. 365- 
 368, ^ 549-558 ; p. 566-568, ^ 889 
 k, I; p. 582, ^ 890i g.
 
 INDEX 11. 
 
 A. 
 
 Acclimation, 
 
 philosophy of, p. 364-366, <J 544-556 ; 
 p. 425, ^ 664, 44U h 1047- 
 
 the same philosophy concerned in the 
 exemption from repeated attacks of 
 intermittent and yellow fevers, &:c., 
 as respects small-pox, measles, scar- 
 latina, &c. Nevertheless, the sub- 
 jects of the former must continue to 
 reside in the malarious climates, or 
 the original susceptibility will return, 
 p. 364-366, () 544-556 ; p. 425, ^ 664. 
 665. Self-limited Diseases, Index 
 II. 
 
 It is more owing to abstemious habits 
 than to any peculiarity of Constitu- 
 tion that the Negro escapes yellow 
 fever, &c., more than the white pop- 
 ulation, who may be equally accli- 
 mated. The indulgences of the lat- 
 ter render them more susceptible of 
 the morbific action of the essential 
 predisposing cause, and act as excit- 
 ing causes when the system is pre- 
 disposed to the disease. The reverse 
 of this happens with the malignant 
 cholera, since in that affection, vege- 
 table food, excepting the simplest kind 
 (and fruits also), is the principal ex- 
 citing cause. Mulattoes are said by 
 some to be more liable to yellow fever 
 than the Negro, and, where that is 
 observed, it is because their habits 
 are more luxurious ; not because, as 
 has been assumed, they are impreg- 
 nated with the blood of the white man. 
 It is a full, not an empty stomach, that 
 aids in breeding pestilence, p. 251. 
 Absorption, see /nc/.i. Hum. Pathol.,//. 
 Adaptation, Law of. See Lidex I. 
 Age, Adult, 
 
 begins at the age of twenty to twenty- 
 five years, and reaches to about sixty 
 years, p. 380, (/ 579 a — from the end 
 of Youth to the end of Manhood there 
 are but few changes of organization 
 or in the vital endowments, but the 
 Passions are now in greatest opera- 
 tion, and supply a fruitful evidence of 
 the existence of a self-acting Princi- 
 ple, distinct from the bodily structure, 
 and of its influences in laying deeply 
 the foundations of disease. Never- 
 theless, some new predispositions to 
 disease spring from the organic con- 
 stitution peculiar to this age, espe- 
 
 Age, Adult — continued. 
 
 cially in the female, p. 381, <J 579 b; 
 p. 865-868, () 1067. Also, Mental 
 Emotions, and Remedial Action, 
 subdivision Mental Emotions, Index 
 
 n. 
 
 Age, Old, 
 
 divided into three stages, extending from 
 sixty to eighty-five years and upward, 
 p. 382, () 580 — changes in organiza- 
 tion are now taking place through 
 which the Organic Properties are in- 
 flicting death upon themselves, though 
 morbific causes operate with a dimin- 
 ished intensity, corresponding with 
 the waning activity of Organic Life ; 
 the Passions are comparatively power- 
 less, and the Mind is gradually going 
 with the Organic Functions. Rem- 
 edies are, therefore, less energetic, 
 nature less recuperative, and, for like 
 reasons, art must be prompt and effi- 
 cient in proportion to the exigencies 
 of declining nature, p. 382-383, ij 581 
 Zi-584 ; p. 401-402, ij. 633 ; p. 768-770, 
 ^ 1014-1017. 
 
 Age, Stages of, 
 
 the periods which mark the times when 
 the greatest physiological changes 
 take place, with corresponding fluc- 
 tuations in disease and in mental 
 characteristics — all depending upon 
 natural modifications or mutations of 
 the Vital Properties and Functions, p. 
 373,1^574,575. Also, Vital Proper- 
 ties, Index I. ; Infancy, Childhood, 
 Youth ; Age, Adult ; Age, Old, //. 
 
 Alcohol — not absorbed, p. 172, no. 94. 
 
 Aloes, 
 its physiological and therapeutical in- 
 fluences, p. 366, ij 556 6 ; p. 547, ^ 863 
 d ; p. 566, <J 8i9 i ; p. 568, ^ 889 m, p. 
 856-857, (j 1063. 
 
 Alteratives, Modus Operandi of — con- 
 tinued from Index 1. 
 made a distinct group by the Author, 
 and why, p. 835-837, (J 1057^ — their 
 basis of arrangement, ibid. 
 Nevertheless, all remedies, and all mor- 
 bific causes, act as Alteratives, and 
 bring about the changes in the solids 
 and fluids (when not exclusively rela- 
 tive to the direct seat of action), either 
 through operation of reflex or direct 
 nervous influence, when the nervous 
 power is modified according to the 
 special virtues of every agent, whether 
 physical or mental, and thus establish-
 
 984 
 
 INDEX II. 
 
 AlterativeSjModus Operandi of — continued. 
 es changes in conformity with the vir- 
 tues of each, p. 107-112, <^ 227-234; 
 p. 303, () 481 d; p. 323-336, ^ 499-512 ; 
 p. G6 1-663, (^ 894-896 ; p. 665-670, () 
 902 a-7n ; p. 679-681, § 905 a. Also, 
 Sympathy, Sensibility, Sensation, 
 Sympathetic Influences, Nervous 
 Power, Index I.; Remedies; Causes, 
 Morbific ; Nervous Power, Reflex 
 Action of Nervous System, Mental 
 Emotions, Remedial Action, sicb- 
 division Mental Emotions, Secre- 
 tion and Excretion, Counter-Irri- 
 tation, Blood-letting, Index II. 
 u difference in the operation of reflex 
 action of the nervous system, as 
 brought about by the Author's group 
 of Alteratives and remedies of other 
 denominations, when the latter arc 
 employed for only a present or an 
 interrupted eflcct , and the same is 
 true of Morbific Causes, as their ef- 
 fects may be suddenly or gradually 
 produced, p. 05, i^i 123 b, c ; p. 66-67, 
 ^ 148 ; p. HI, 1^ 233.V, 233 J ; p. 285- 
 288, ^ 455 d~f,]). 333, <> 503-506 ; 
 p. 339-340, () 514 g-k ; p. 344-345, 
 () 516 d, No, 6; p. 365, ^ 551 ; p. 
 366, «5 556; p. 416^17, ^ 649 c ; p. 
 420-424, <^ 654-661 ; p. 426, >^ 626 ; 
 p. 497, ^ 777 ; p 532, ^ 841 ; p. 547, 
 (J 863 d; p. 55l,() 887; p. 568-569, 
 ^ 889 m, mm, p 646-649, ^ 893 c-h ; 
 p. 661-663, \ 894-898 , p. 668-670, 
 (j 892 g-m; p. 679-681, \ 905 a; p 
 849-851, ^ 1059; p. 891, () 1077. 
 
 Amenorrhcea. See Menstruation, In- 
 dex I. 
 generally consequent upon morbid states 
 of the digestive organs, and resulting 
 from the alterative action of reflex 
 nervous influence, as, also, when oc- 
 casioned by exposure of the feet to 
 cold. In the former case, is not the 
 principal evil nor often of much im- 
 portance. Cure the primary affec- 
 tions, and the uterine symptoms will 
 commonly subsidy without the true 
 emmenagogues, or, at least, these 
 agents will then act far more effi- 
 ciently, and with greater safety. In 
 the latter case, a pediluvium will often 
 re-establish the function, which shows 
 how readily the nervous influence 
 will produce and remove disease, and 
 how it is modified by exciting causes, 
 and goes with a multitude of corre- 
 sponding facts in demonstrating the 
 operation of morbific and remedial 
 agents through the alterative action 
 of reflex nervous influence, p 233- 
 234, i) 428-432 ; p. 629, ^ 892f r ; 
 p 684-687, 'Ji 895i A. Also, Nervous 
 Power, Index I. and II. ; Reflex 
 
 Amenorrhoea — continued. 
 
 Action of Nervous System, Index 
 II. 
 Amylene, 
 
 peculiar effects of, on inhalation, p. 863- 
 864, <J 1066 b. 
 
 illustrates different kinds of Sensibility, 
 ibid. Also, Sensibility, Sensation, 
 Index I. 
 Anaesthetics. See Gases, Index I. 
 
 philosophy of their operation through 
 alterative action of reflex nervous in- 
 fluence, p. 862-864, () 1066. Also, p. 
 522-524, ^ 827 b-e ; p. 674-675, () 
 904 b; p. 931, () 1088 c— Kote M. 
 Anatomy, Morbid, 
 
 all deviations of which it is cognizant 
 are owing to antecedent changes of a 
 vital nature, and which constitute the 
 essence of disease, p. 456, ^ 695, 696. 
 
 its importance greatly overrated, and 
 the consequences, p. 456-457, "Ji 697- 
 699; p. 460-463, (^ 709,; p. 604, ^ 
 892 k. Also, Examination of the 
 Principal Writings of P. Ch. A. 
 Louis, M.D., in Medical and Physi- 
 ological Commentaries, vol. ii., p. 679- 
 815. 
 
 cannot help us to a knowledge of pa- 
 thological conditions during life, but 
 through certain results ascertained at 
 former times, p. 458-459, (^ 702-703 ; 
 p. 510, ^13 a. 
 
 comes in at the close of life, p. 457-458, 
 ij 700-702 ; p. 459, (} 704. 
 
 must rely upon symptoms, remote causes, 
 and effects of remedies, for a knowl- 
 edge of disease under treatment, p. 
 489, ^ 705 a. 
 
 abortive in idiopathic lever, p. 489-490, 
 (} Ibl a. 
 
 its legitimate objects, p. 458-459, ^703, 
 705 ; p. 460, ij 707. Also, Compar- 
 ative Merits of the Hippocratic 
 AND Anatomical Schools, in Medi- 
 cal and Physiological Commentaries, 
 vol. ii., p. 641-677. 
 Animal Heat.. See Organic Heat, In- 
 dex I. and //. 
 Animals, 
 
 fundamentally distinguished from 
 Plants, p. 815, ^ 1052 a. Also, An- 
 imals AND Plants, Index I. 
 
 hybrid, why incapable of procreating, p. 
 816, (j 1052 b. 
 Animals and Plants — continued from 
 Index I. 
 
 Animals subsist upon organic com- 
 pounds, Plants upon the elements of 
 matter — a distinction confirmed by 
 microscopic observation of the most 
 inferior, p. 815-816, () 1052 a. Also, 
 Plants, Index I. 
 Antimony, Tartarized, 
 
 its prodigious power in developing and
 
 INDEX II, 
 
 98^ 
 
 Antimony, Tartarized — continued. 
 
 modifying the nervous influence, and 
 as an alterative agent through reflex 
 action of the nervous system, p. 532- 
 533, <J 841 ; p. 557, <J 873 ; p. 668, 
 § 903 g ; p. 675-676, () 904 bb ; p. 833, 
 <i 1057 h. Also, (^ 524 a, No. 1, 964 
 d. Also, Alteratives, Index II. 
 
 its action illustrated through lawr of Vi- 
 tal Habit, p. 365, 366, ^ 549-556 a. 
 
 its administration determined by its ef- 
 fects upon the stomach — against ab- 
 sorption, p. 530-533, ^ 837 6-841 ; 
 p. 557, (J 873 ; p. 675-676, l^ 904 66. 
 
 eflects of, compared with analogous 
 ones of other agents, p. 547, ^ 863 d; 
 p. 557, <J 873 ; p. 637, <J 892A e ; p, 
 728, <;» 964 d; p. 849-851,^ 1059. 
 
 its lavif of operation in small alterative 
 doses, p. 344-345, ^ 516 c?, No. 6 ; p. 
 AZ\,^ 675 ; p. 675, i) 904 bb\ p. 851, 
 (j 1059. Alteratives, Index II. 
 
 its results as an expectorant, p. 639, <^ 
 892A ej. 
 
 its fatal eflfects in small doses, p. 728, 
 <J 964 d; p. 846-847, ^ 1058 p. 
 
 like arsenic, iodine, &c.,inhealthno ef- 
 fects in its smallest therapeutical 
 doses, and thus, like those, by its con- 
 trasted eflects in disease, denotes the 
 increased susceptibility of organs in 
 their morbid states, illustrates the doc- 
 trines of Vital Solidism, and disproves 
 the Chemical hypothesis of therapeu- 
 tical action, p. 59, ^ 129 h, i; p. 63, 
 (} 137 d; p. 6.5-66, (} 143 c-145 ; p. 
 67-68,1^149-152; p. 170-173, <!i 350, 
 Nos. 40, 41, 42, 43, 44, 45, parallel 
 columns; p. 176-178, <J 350^ a-f; 
 p. 541-542, <J 854 66; p. 607, § 892i 
 6; p. 612, 1^ 892^ a. 
 Antispasmodics, 
 
 the group introduced to illustrate the 
 philosophy of the modus operandi of 
 morbific and remedial agents through 
 reflex action of the nervous system, 
 p. 590, ^ 89U a ; p. 592-.593, ^ 89U 
 k. Also, Remedies, and Remedial 
 Action, Index II 
 
 afford relief by modifying the reflex 
 nervous influence, rendering it seda- 
 tive instead of irritating, or changing 
 more essentially its nature, according 
 to the nature of its exciting cause, 
 and thus rendering it more profound- 
 ly alterative, p. 592-593, >J891i k. 
 
 Case of epilepsy stated, to show how in 
 this aflection the nervous influence is 
 sometimes developed in a direct man- 
 ner by disease of the nervous centres, 
 and at other times how the point of 
 departure is from some distant part, 
 when reflex action of the nervous sys- 
 tem is brought into operation, and 
 how, in either case, convulsions en- 
 
 Antispasmodics — continued. 
 
 sue as the result of the development 
 and operation of the nervous power — 
 leading to a parallel between the fore- 
 going results and the reflex action of 
 the nervous system as instituted by 
 Antispasmodics, and showing, also, 
 how the nervous influence is of an 
 exciting nature in the former case, 
 and how it is rendered depressing in 
 the latter, and upon which the relief 
 depends — and the same rule obtains 
 with Opium and other Narcotics when 
 they relieve Spasms, p. 592-593, ^ 
 891 A:. Also, Nervous Power, Sen- 
 sibility, Sympathy, Sympathetic In- 
 fluences, Index I. ; Reflex Action 
 of Nervous System, Remedial Ac- 
 tion, Remedies ; Causes, Morbific ; 
 Whooping-cough, Index II. 
 
 Although Narcotics relieve spasm in 
 iha foregoing manner, they also, un- 
 like the simple Antispasmodics, so 
 modify the reflex nervous influence 
 as to render it morbific — thus present- 
 ing a compound aspect of its modi- 
 fied condition, through which as a 
 sedative it may relieve spasm, but si- 
 multaneously exert a perniciously al- 
 terative effect upon other parts ; or 
 this latter may be such as to counter- 
 act the sedative influence, when no 
 relief of spasm will ensue, p. 593, ^ 
 891^ k. Also, the foregoing Refcr- 
 eiices. 
 
 greatly misapplied in the treatment of 
 convulsions from teething, wounds, 
 worms, &c., and in hysteria, chorea, 
 epilepsy, congestive asthma, &c. — 
 particularly from neglecting their re- 
 mote causes and complications, and 
 addressing them to the symptom rath- 
 er than the pathological conditions, 
 p. 590-592, () 89 H b-h; p. 593, ^ 
 891 k. 
 
 feebly endowed with curative virtues, 
 p. 592, IJ89U 1. 
 Apoplexy, 
 
 bloodletting in, and the principles by 
 which it should be regulated, p 741- 
 746, <^ 990; p. 848, iJ1055 u. 
 
 sanguineous, depends upon capillary 
 hemorrhage arising from congestion, 
 p. 740, <;i 990 6, c, m. Also, Medical 
 and Physiological Convmentaries, vol. 
 i., p. 371-384, Article Pathology of 
 Cerebral Hemorrhage ; and vol. ii., p. 
 546-550, Article Spontaneous Hemor- 
 rhage. 
 
 its treatment often embarrassing and 
 empirical, p. 741-745, () 990 b-q. 
 
 determines a pernicious nervous influ- 
 ence upon the great organs of life, 
 p. 742, i) 990 d-i; p. 745-746, (J 
 990 i.
 
 986 
 
 INDEX II. 
 
 Arsenic, (Arsenious Acid &c.) 
 
 destitute of a tonic virtue, p. 607, <J 892^ 
 a ; p. 608-609, () 892i c. 
 
 inferior to cinchona as a febrifuge, but 
 next in value, and has done less mis- 
 chief, ibid, and p. 610-611, <5> 892^ 
 
 its'inodus operandi, Note L p. 1120. 
 
 in therapeutical doses produces no ap- 
 parent effect upon the healthy body, 
 showing, like Iodine, Tartarized An- 
 timony, &:c., in their small doses, how 
 the relations of the system to the ac- 
 tion of remedies is changed by dis- 
 ease, and hence the fallacy of reason- 
 ing from the effects of remedies upon 
 the healthy system to its morbid 
 states, p. 607-608, ^ 892i a, b. Also, 
 p. 63, (^ 137 d ; p. 65, i) 143 c ; p. 67, 
 ^ 149-151 ; p. 68, () 152 b; p. 122, 
 () 240 ; p. 465-466, (} 715 ; p. 482, 
 ^ 744 ; p. 541-542, ^ 854 bb ; p. 545, 
 ^ 859 b; p. 612, <J 892^ a; p. 623, 
 ^ 892t c— Note L p. 1120. 
 
 its accidental superiority to Cinchona in 
 Autumnal intermittent fever, while 
 not so in the Vernal, and why, p. 
 608-609, () 892i c; p. 597-598, <) 
 892 c. 
 
 when preferable to Cinchona, p. 609, 
 <) 892i d-g. 
 
 equally useful in intermitting inflamma- 
 tion, intermitting headaches, periodic 
 tic douloureux, p. 611, ^ 892 /, g; 
 and in chronic cutaneous diseases, p. 
 611-612, i) 892i h, I. 
 
 its morbific effects in therapeutical 
 doses, in morbid states of the body, 
 p. 608, (J 892i b. 
 Asthma, 
 
 treatment of, p 337, <^ 514; p. 591, ^ 
 89H/,- p. 848, () 1058 2v. 
 
 employed to illustrate the substantive 
 existence and self-acting nature of 
 the Soul, p. 886-887, ^ 1077. 
 Astringents, Modus Operandi of, 
 
 supposed to act upon physical princi- 
 ples, p. 570, <) 890 a. 
 
 when employed internally, they operate 
 upon vital principles, either locally, or 
 through reflex action of the nervous 
 system, corresponding in this respect 
 with other remedies — and illustra- 
 tions, p. 570-578, ^ 890. Also, 
 Remedies, Remedial Action, Re- 
 flex Action of Nervous System ; 
 Causes, Morbific, Index II. ; Nerv- 
 ous PovfER, Index I. and II. 
 
 but more than other remedies are cura- 
 tive in some diseases by direct action 
 upon the surfaces, being then a sim- 
 ply local remedy, <J 890 b. 
 
 applied to outward surfaces, some op- 
 erate mechanically, (J 890 c. 
 
 much abused in hemorrhages, dysen- 
 tery, &c., p. 572-575, () 890 d-k. 
 
 Astringents, &c. — continued. 
 
 Also, p. 507, () 805 ; p. 509, (j 812 ; 
 p. 550, <} 863/; p. 770-772, ^ 1018- 
 1019. 
 
 their abuse arises from the physical 
 doctrines of their operation and of 
 hemorrhage and of secreted products, 
 p. 573-574, (J 890 d-ee, o. Also, 
 He.morrhage, Spontaneous; Secre- 
 tion and Excretion, Index II. 
 
 the symptom the thing considered, p. 
 572, 1) 890 d ; p. 590-591, ij 89U b-f. 
 variety of means having no astringent 
 virtue — ipecacuanha, tartarized anti- 
 mony, bloodletting, cold — will often 
 arrest hemorrhages and other mor- 
 bid products more efficiently and use- 
 fully, and prove the philosophy of the 
 operation of astringents upon parts 
 distant from the seat of their appli- 
 cation through alterative action of the 
 reflex nervous influence, ibid. 
 
 no two exactly alike in effects, and re- 
 quire discrimination, p. 578, ^ 890 p. 
 
 of very limited uses, <J 890 q; but in- 
 flict great injuries in various mala- 
 dies, p. 572-576, (J 890 d-n. 
 Authors, Rights of, 
 
 the Author recurs to this subject (p. 912) 
 for the purpose of saying that when- 
 ever he is under obligations to others, 
 he has expressed it in the Text of the 
 Institutes, as, for example, in rela- 
 tion to the laws of the nervous sys- 
 tem, at p. 283, i) 452 b ; p. 290-321, 
 ^ 463-494; p. 336-353, (j 514-524; 
 p. 362, () 530 ; but, in the Medical and 
 Physiological Commentaries, where 
 the Author is constantly interested 
 with the labors and opinions of a mul- 
 titude of writers, he has endeavored 
 to do them full justice, not only in 
 the Text, but by marginal references, 
 cf which there are nearly five thou- 
 sand in the first two volumes. — Note 
 Xp. 1127. 
 
 B. 
 
 Becquerel and Rodier, 
 
 their work on " Pathological Chemistry 
 
 in its Application to the Practice of 
 
 Medicine,'" and its advantages, p. 800, 
 
 () 1035. 
 their opinions of animal sugar, ursmia, 
 
 urea, diabetes, &c., p. 785-787, ^ 
 
 1031 b. 
 belong to the School of Vitalists, p. 800, 
 
 i) 1035. 
 Bernard, Cl., 
 
 experiments on nervous system, p. 792, 
 
 () 1032 d; p. 804, ^ 1039. 
 produces diabetes mellitus by pricking 
 
 the medulla oblongata, p.792,§ 1032 d. 
 alleges the production of sugar by the
 
 INDEX II. 
 
 987 
 
 Bernard, CI. — continued. 
 
 liver, &c., and Author's opinion, p. 
 783, <J 1031 a ; p. 785-786, () 1031 b; 
 p. 790, () 1032 b ; p. 793, ^ 1032 d. 
 Bile — continued from Index I., 
 
 none of its constituents detected in the 
 
 blood, p. 783, () 1031 b. 
 its morbid appearances regarded in the 
 light of symptoms, p. 452-455, ^ 694. 
 not rendered "green" by calomel and 
 acids in the living body, p. 454, ^ 694. 
 its production considered in connection 
 with different cathartics, and as il- 
 lustrating their alterative influence 
 through reflex action of the nervous 
 system, and the modification of the 
 nervous power according to the nature 
 of the cathartic, and how the nervous 
 power is the immediate remote cause 
 of the variable phenomena relative to 
 the secreted product, p. 366, () 556 b; 
 p. 554-556, <J 872 ; p. 563-564, ^ 889 
 a ; p. 566, ^ 889 i ; p. 568-569, ^ 889 
 771, mm ; p. 668-669, ^ 902, g ; p. 834, 
 <J 1057 /; p. 854, (} 1061 ; p. 856-857, 
 ^ 1063 b ; p. 859, () 1064. Also. Se- 
 cretion and Excretion, Index II. 
 Blisters. See Counter-Irritants, In- 
 dex II. 
 Blood — continued from Index I. 
 
 analysis of, allowed by Chemistry to be 
 incapable of yielding any reliable re- 
 sults, p. 780-782, <;> 1029-1030. 
 nothing to be learned from its analysis 
 
 as to disease, ibid. 
 circulation of, ascribed to oxygen gas, p. 
 208,^383; p. 818-819, i^ 1054— con- 
 tradicted by circulation of in Plants, 
 p. 820-823, i) 1054-1055. 
 nothing can make healthy blood but the 
 healthy action of the solids, p. 192, () 
 354 ; p. 535-539, (j 847-848. 
 occupies from one to two minutes in 
 going the round of the circulation, 
 p. 672, (J 904 J; p. 863, () 1066 b. 
 Bloodletting, General — continued from 
 Index I. See Loss of Blood, Index II. 
 varied from effects of Leeching, p. 698- 
 
 702, (J 929-938. 
 considered under five stages, p. 698-702: 
 1 st, earliest impression is exerted upon 
 all the bloodvessels, p. 698, (^ 930; 
 p. 711, ^ 953. 
 2d, the vessels undergo a vital con- 
 traction, p. 698, (} 931 ; p. 711, ^ 
 953. 
 3d, contraction of larger series con- 
 curs with the smaller in developing 
 reflex nervous influence, which in- 
 creases in an increasing ratio the 
 contraction of the latter, p. 698, ^ 
 932 ; p. 703, () 940. 
 4th, the heart becomes affected by the 
 same reflex action of the nervous 
 system which is excited by the 
 
 Bloodletting, General — continued. 
 
 vital influences attending the con- 
 traction of the general vascular 
 system, while, also, the nervous in- 
 fluence becomes early and rapidly 
 developed in a direct manner by the 
 contraction of the cerebral vessels — 
 thus establishing the compound in- 
 fluence oi direct and reflex nervous 
 action, p. 698, () 933 ; p. 703, ^ 940- 
 942 a ; p. 707, <J 948-949 ; p. 709, 
 ^ 951 c,d. Also, Nervous Power, 
 Index I. and II. ; Reflex Action 
 OF the Nervous System ; Reme- 
 dial Action, subdivision Mental 
 Emotions. 
 5th, the influence upon the heart (4th) 
 reacts through the nervous centres 
 upon the capillary vessels, and, by 
 thus increasing the changes in the 
 vascular system, especially in that 
 of the brain, increases in a still more 
 rapid ratio the foregoing compound 
 influence of the nervous power, 
 when syncope hastens on as a con- 
 sequence, p. 693, <J 920 ; p 698-699, 
 ^ 934-935 ; p. 701, ^ 937 6-938 b; 
 p. 703-707, (J 940-949 ; p. 709, ^ 
 951 c, d; p. 824-828, (J 1056. 
 failure of heart's action not in the least 
 owing to " deficiency of blood in the 
 organ" or "diminution of cerebral 
 action," but wholly the result of reflex 
 and direct action of the nervous sys- 
 tem, p. 699, ^ 935 a ; p 703-712, ^ 
 942-952, and ul supra — with a quali- 
 fication after syncope ensues, p. 705- 
 706, () 945. 
 in producing syncope, how connected 
 with gastro-intestinal irritation, and 
 with the depressing emotions, p. 668- 
 669, ^ 902 g, h ; p. 703-704, ^ 943- 
 944 a — all depending upon reflex or 
 upon direct nervous influence. See 
 Nervous Power, and Remedial Ac- 
 tion, subdivision Mental Emotions, 
 and Mental Emotions, Index II. 
 illustrated by remedies for syncope, and 
 by examples, p. 705, ^ 945 ; p. 706, 
 «J 946 ; p. 712, () 955 b; p. 726-731, 
 <^ 961 c-970 ; p. 733-736, <J 974-980. 
 reflex nervous influence, as also direct, 
 begins at the earliest contraction of 
 the small bloodvessels, especially of 
 the nervous centres, p. 703-704, 4 
 940-944. 
 blood excluded from the vessels by their 
 vital, not a physical contraction, p. 
 692, ^ 912 ; p. 699, ^ 935 c; p. 707, 
 ^ 949; p. 711, ^ 953. Also, Inflam- 
 mation, Index II. 
 hypotheses of its operation mostly me- 
 chanical, p. 691, ^ 909, 910. 
 effects of, disprove the doctrine of a 
 passive condition of the bloodvessels
 
 988 
 
 INDEX II. 
 
 Bloodletting, General — continued. 
 
 in inflammation and venous conges- 
 tion, p. 485-486, ij 750 ; p. 488, i) 766 
 b; p. 505, (} 801 ; p. 700, <^ 935 d; p. 
 724-730, () 961-970 ; p. 740, ij 988 a. 
 
 objections to, contrasted with other 
 means as substitutes, p. 372, i) 569 e ; 
 p. 396, () 621 a; p. 544, ^ 857 ; p. 558, 
 5 878 ; p. 579, () 890i a ; p. 584, () 
 891 e ; p. 602-604, (; 892 i~l ; p. 638, 
 ^ 8924/; p. 715-722, i) 959-960 ; p. 
 751-752, ^ 999 c; p. 754, () 1002/; 
 p. 756-757, ^ 1005 b-g ; p. 759-760, 
 \ 1005/ k; p. 760, <) 1005 A- ; p. 763- 
 766, <J 1006 c-1008 ; p. 857-861, ^ 
 1063-1065 J; <J892(/-^-; p. 872, P.S. 
 
 philosophy of its operation subordinate 
 to other considerations, p. 691, ^ 907. 
 
 illustrates the modus operandi of other 
 remedies, p. 691, () 908. 
 
 eflfects of, upon the blood, p. 710, () 952. 
 
 its effects depend upon a great variety 
 of circumstances, which should en- 
 gage the attention of the Physician, 
 p. 430-433, (i 675 ; p. 444-445, () 688 
 e, ec; p. 700-701, ^ 935 e-938 ; p. 
 704, 1^ 943-944; p. 709-711, (J 951 c 
 -952; p. 713-714, () 956-958 b; p. 
 724-731, () 961-970; p. 741-745, § 
 990 ; p. 756-759, <) 1005 a-h ; p. 765- 
 766, ^ 1007 b-d. 
 
 of its proper extent, p. 711-715, () 953- 
 959. 
 
 general rules to be observed, p. 711- 
 714, <J 954-958 ; p. 748-753, ^ 992- 
 1001 ; p. 756, ^ 1004 rf; p. 766-777, 
 <) 1027. 
 
 rules not to be observed, p. 713, (> 955 d ; 
 p. 715, ^ 959 ; p. 720, ^ 960 a ; p. 728, 
 ^ 965 a; p. 774-778, « 1024-1026. 
 
 in embarrassing cases, p. 375, ^ 576 e ; 
 p. 641-642, (J 892-1 i ; p. 712-713, () 
 955 b-e; p. 714, i^"'957 ; p. 726-728, 
 ^961c-964c; p. 729, ^ 967 ; p. 734- 
 735, <^ 976 6-977 ; p. 741-745, ^ 990 
 as ; p. 765-766, <) 1007 b-1008 ; p. 
 871-872, i) 1068 d. 
 
 svncope not a test of the proper extent 
 ' of, p. 715, (} 959 ; p. 726-730, <^ 961- 
 969 — but will sometimes remove se- 
 vere inflammation through the power- 
 ful alterative efl;ect of reflex nervous 
 influence, p. 704, ^ 943 b ; p. 709, ^ 
 951 b-d. 
 
 proposed substitutes for, such as tobacco, 
 aconite, belladonna, veratrum viride, 
 dry cupping, &c., p. 711, () 954 b; 
 p. 715-721, «J 960 ; p. 860, ^ 1065 a. 
 
 causes of objections to, p. 722, <5i 960/; 
 p. 729, (} 967; p. 752, ^ 1000, 1001. 
 
 general bloodletting the proper method 
 in all active ijiflammations of internal 
 organs, p. 713, ij 956 ; p. 729, i) 965 b, 
 966 ; p. 736, i) 979, 980. 
 
 its tolerance promoted in inflammations 
 
 Bloodletting, General — continued. 
 
 by a stimulating nervous influence 
 exerted upon the sanguiferous system, 
 and more so in inflammation of the 
 brain than of other organs, being di- 
 rect in the former case and reflex in 
 the latter, p. 508, (^ 806 ; p. 732-734, 
 ^ 973-975 ; p. 735, () 977 ; p. 736, ^ 
 979, 980. 
 
 hence is it that inflammation of the brain 
 generally requires a greater loss of 
 blood than other parts, p. 508, ij 806 ; 
 p. 696, () 925 c ; p. 733-736, ^ 974 b- 
 979 ; p. 748-749, ^ 992 ; p. 774-776, 
 <) 1024 a-^; p. 872. ^ 1068 d; p. 824- 
 828, () 1056 ; p. 847, (J 1058 q. 
 
 borne to a great extent in hydrophobia, 
 on account of the above nervous in-* 
 fluence, p. 734, <? 976 a. 
 
 often imperfectly borne in mania and 
 delirium tremens, p. 734, () 976. 
 
 in pneumonia, p. 572-575, ^ 890 c-h ; 
 p. 602, () 892 ? ; p. 638-639, (/ 892|- g ; 
 p. 638-642, <) 892A/-? ; p. 738, () 984 
 b ; p. 749, (j 992 d"; p. 750, ^ 995 ; p. 
 757-760, () 1005 h-k; p. 770, (J 1017c ; 
 p. 846, ^ 1058 ; p. 870, ^ 1068 c. 
 
 in apoplexy, embarrassing on account 
 of a prostrating nervous influence, 
 p. 741-747, (j 990-990i. 
 
 in dysentery, and an opposite practice, 
 p. 573, 1) 890 : p. 575, ^ 890 h ; p. 747, 
 () 991 b; p. 842, (^ 1058/— Notk Gg. 
 
 in erysipelas, p. 759-760, ^ 1005 j. 
 
 in purpura hemorrhagica, p. 754, ^ 10C2 
 d, e. — III Croup, (^ 576 e, 964 d. 
 
 in venous congestion and congestive fever, 
 p. 724-731, (j 961-970.— Note Ff. 
 
 why its effects are modified by venous 
 congestion, and why Physicians, in 
 such cases, are deterred from its ap- 
 plication, p. 724-726, ij 961 a-e. 
 
 to a small extent, often produces syn- 
 cope in congestive fever, but may be 
 soon borne in ample amount, and 
 why, p. 726-729, (j 961 c-965, 968; 
 p. 735, ^ 978, 979 — previous stimula- 
 tion may be necessary ; p. 727, <J 
 964 a, b — well borne as soon as reac- 
 tion takes place, p. 730, (Ji 969 — 
 leeches improper in such cases, and 
 why, p. 729, () 966. 
 
 well borne in venous congestion of the 
 brain, and for the same reason as in 
 cerebral inflammation, p. 507-508, 
 ij 806 ; p. 730, ^ 969 b; p. 733-734, 
 <^ 974 c-975 b. 
 
 its depressing effecfs in congestive 
 fevers, at the first bleeding, owing to 
 the depressing influence of reflex 
 nervous influence propagated over the 
 sanguiferous organs by the affected 
 veins, p. 503-513, (j 795-818 ; p. 724- 
 726, <!i 961 a-e; p. 729-730, \ 967- 
 969. Also, p. 444-445, <J 688 d-cc.
 
 INDEX II. 
 
 989 
 
 Bloodletting, General — continued. 
 
 fatal, in supposed but mistaken cases of 
 
 venous congestion, p. 730, "^ 970 a, b. 
 in yellow fever, p. 747-748, (J 991 6-992 
 
 a, c ; p. 749-750, <J 993-994 ; p. 751, 
 
 <J 999 ; p. 753-754, I) 1003 a-c ; p. 
 
 869, () 1068 b. 
 in typhus fever, p. 754, <J 1002 d ; p. 755, 
 
 () 1004 &. 
 in jail fever, p. 754, ij 1002 /^and pu- 
 trid fevers, ibid. 
 in intermittent fever, p. 63, <^ 137 c, (Z ; 
 
 p. 65, (j 143 6, c ; p. 424, () 662 6 ; 
 
 p. 430-433, ij 675 ; p. 553, i) 870 aa ; 
 
 p. 570, ij 889 71 ; p. 597-598, ^ 892 c ; 
 
 p. 600, (J 892 (Z ; p. 605-606, ^ 892 
 
 ■m-;),- p. 608-610, () 892i c, d; p. 
 
 737-739, (J 983-985 ; p. 740, ^ 989 ; 
 
 p. 754-755, () 1003 ; p. 756-757, () 
 
 1005 a-g; p. 829, ^ 1057 i. 
 in plague, p. 755, ^ 1002 rf, e. 
 
 in reduced and emaciated subjects, p. 
 765-766, <) 1007 b-d. 
 
 in simple continued fevers, p. 491-495, 
 (J 762 i-768 a; p. 736, (J 981. 
 
 in the cold stage of fever, and how it 
 operates, p. 739-740, (} 986-988. 
 Also, p. 430-433, ^ 675 ; p. 548-550, 
 () 863 d. 
 
 most useful, in fevers attended by reac- 
 tion, just as the subsidence of the 
 hot stage begins, and why, p. 430- 
 433, ^ 675 ; p. 547-549, <) 863 d ; p. 
 570, <S» 889 n ; p. 739-740, ^ 887-889. 
 
 in Infancy, p. 767-768, ^ 1009-1013. 
 
 in Old Age, p. 768-770, § 1014-1017. 
 
 under no controlling influence by cli- 
 mate or season in any country or at 
 any epoch, and what Hippocrates de- 
 scribes are perfect portraits of our 
 own diseases, p. 761-762, ^ 1005 b- 
 
 1006 a; p. 868-870, () 1068 a, b. 
 large abstractions of blood, when ap- 
 propriate, lead to speedy convales- 
 cence, and restoration of bodily vigor, 
 p. 747-759, (^ 891-1005 ; p. 765-766, 
 \ 1007-1008; p. 870-872, <J 1068 
 c, d. 
 
 when appropriate, the earlier the better, 
 and decisively at once, p. 642, ij 892-i 
 i; p. 711, (j 954 b; p. 712, «J 954 c"^- 
 p. 713, 1^ 955 e; p. 714, <^ 957; p. 
 729, l) 968 ; p. 749, ^ 992 d ; p. 750, 
 <5 997; p. 751, ^ 999; p. 870-872, 
 ^ 1068 c, d. 
 
 repeated and small abstractions of blood, 
 where free bloodletting is necessary, 
 although large in the aggregate, are 
 often fruitless, p. 714, ^ 958 b ; p. 
 728-729, ^ 965 b ; p. 751-752, ^ 999- 
 1000. 
 
 when excessive, may maintain or pro- 
 duce inflammation, and why, p. 697, 
 ^ 927 b ; p. 708, (^ 950 ; p. 733, ^ 
 974 b; p. 773-774, (^ 1023 a, i— for 
 
 Bloodletting, General — continued. 
 
 which Leeches may be a remedy, p. 
 774, <J 1024 a. 
 
 " morbid irritation and excessive reac- 
 tion from loss of blood," p. 772-776, 
 ^ 1020-1026 — the latter misappre- 
 hended, which is often dependent on 
 too small a loss, or on remaining in- 
 flammation, <J 1021-1024 — supposed 
 examples of, ^ 1023 a, c-g. 
 
 its advantages and safety denoted by 
 spontaneous hemorrhages — Nature's 
 remedy, and a lesson to man, p. 507, 
 ^ 805 ; p. 546-551, ^ 862-863 ; p. 
 572-575, ^ 890 d-g ; p. 641-642, ^ 
 8924 i; p. 770-772, (} 1018-1019. 
 
 experience and opinions of distinguish- 
 ed Physicians, ancient and modern, 
 as to bloodletting in inflammatory, 
 congestive, and febrile diseases, p. 
 747-776, f) 991-1026. 
 
 admissions of eminent Physicians as to 
 their neglect of the remedy, p. 756- 
 761, () 1005 a-k — contrasted with the 
 abuse of other remedies, p. 372, <J 
 569 e; p. 395, ^ 621 a; p. 572-570, 
 () 890 c-n; p. 579, ^ 890^- a ; p. 581, 
 ^ 890i /; p. 584, i) 891 c; p. 590- 
 591, § 8911r a-f; p. 603-604, () 892 
 k; p. 637-639, ^ 892^ c, f; p. 715, 
 718, ^ 960 ; p. 763-766, ^ 1006 c- 
 1007; p. 856-861, (} 1063-1065. 
 
 the head and shoulders of the patient, 
 if possible, should be always elevated 
 during the operation, as one of the 
 important means of regulating the 
 extent of the remedy, and there may 
 be risk without this precaution, p. 
 705, {} 945 ; p. 758, 1} 1005 h ; p. 872, 
 ^ 1068 d. 
 
 eifects of, diflferent in General Bloodlet- 
 ting, Cupping, and Leeching, p. 691, 
 •J 911 ; p. 713, (^ 956 ; p. 729, ^ 966. 
 
 eflfects of, as manifested in Leeching, 
 p. 692-698, ^ 912-928 ; p. 729, ^ 966. 
 Also, Leeching, Index II. 
 
 eflTects of, as manifested in Cupping, p. 
 702, () 937. Also, Copping, Index II. 
 
 general conclusions as to Bloodletting, 
 p. 776-777, ^ 1027. Also, p. 872, P.S. 
 Blood, Circulation of. See Circula- 
 tion OF Blood, Index II. 
 Blue Mercurial Pill — continued from 
 Index I., 
 
 its uses, and analogies with Calomel, 
 p. 840, () 1058 c ; p. 848, ^ 1058 s, v ; 
 p. 850, () 1059. 
 Brain, 
 
 Author's experiments upon, to determine 
 the quantity of blood circulating in the 
 brain, and to show that, as in other 
 parts, it may be reduced by Blood- 
 letting, and the provision through 
 which this reduction is effected, p. 
 824-828, () 1056.
 
 990 
 
 INDEX II. 
 
 Brain, Inflammation of, 
 
 treatment of, p. 507-508, ^ 806 ; p. 651, 
 ^ 893 k ; p. 696, <) 925 c ; p. 733-736, 
 <> 974 c-979 ; p. 748, ^ 992 b, c ; p. 
 774-776, i) 1024 a-g ; p. 824-828, ^ 
 1056; p. 847, ^ 1058 q; p. 872, ^ 
 1068 d. 
 
 develops a powerfully exciting nervous 
 influence in a direct manner, and 
 thus sustains the organs of circula- 
 tion against the depressing influence 
 of loss of blood, but which is common 
 to inflammations of other parts in an 
 inferior degree when the influence is 
 through reflex nervous action, p. 507- 
 508, 4 806 ; p. 732-734, (} 973-975 ; 
 p. 735, ^ 977 ; p. 736, i) 979, 980— 
 and to this stimulating nervous in- 
 fluence upon the bloodvessels is due 
 the incumpressihility of the pulse in 
 inflammations, p. 445, ^ 688 ec — and 
 to its modified condition the hardness 
 is owing, as also the changes which 
 the blood undergoes, ^ 485, 500 m, 
 688 d-ee — while, also, the influence 
 is so variously determined as to occa- 
 sion intermission of the heart's action, 
 various inequalities in action of the 
 radial arteries, p. 512, (j 390 I — and 
 illustrates the philosophy of animal 
 heat, p. 265-266, ^ 447, 447 d. Also, 
 Nervous Power, Index I. and II. ; 
 Reflex Action of Nervous System, 
 Mental Emotions, and Remedial 
 Action, subdivision Mental Emo- 
 tions, Index II. 
 Brain, Venous Congestion of, 
 
 treatment of, proceeds upon the same 
 plan as for inflammation of the brain 
 and congestive fevers, p. 374—375, () 
 576 d, e ; p. 504, ^ 798 ; p. 505, i) 801 
 b,c; p. 696, ^ 925 b, c; p. 724-731, 
 ^ 961-970. 
 
 owing to the natural constitution of the 
 venous tissue, congestion and active 
 inflammation of the veins, contrary 
 to what happens in inflammation of 
 other tissues, develops a prostrating 
 nervous influence, by which blood- 
 letting is often imperfectly borne at 
 its first application, except cerebral 
 congestion, which develops much of 
 the stimulating nervous influence that 
 is incident to inflammation of other 
 tissues, p. 61-63, () 133 b-\Zl c ; p. 
 64. () 140 ; p. 67, ^ 149-151 ; p. 503- 
 505, <J 794-801 ; p. 507-508, ^ 806 ; 
 p. 509-511, (j 811-815; p. 724-730, 
 061-969; p.733-734, §974c-975a. 
 Brown-Sequard, 
 
 his experiments on the nervous system 
 modify those by Sir C. Bell in relation 
 to spinal nerves, p. 802-804, (j 1037- 
 1039. 
 
 observations upon the iris, p. 806, (j 1042. 
 
 Calomel, 
 
 considered as an alterative in all its 
 doses, p. 838-850, (j 1058-1059. 
 
 its effects, where most strongly pro- 
 nounced, p. 839, <J 1058 h — and its 
 extensive sway, p. 839-840, (j 1058 J 
 — powerfully alterative, p. 564, ^ 889 
 c; p. 839, (j 1058 b. 
 
 must be considered in connexion with 
 other remedies, p. 841, ^ 1058 e. 
 
 its best combinations, p. 838-839, () 
 1058 a. 
 
 its effects, according to doses, p. 543— 
 544, {) 857 ; p. 840, () 1058 d ; p. 850, 
 <J 1059 : p. 576, <) 890 /. 
 
 does not impart a green color to intes- 
 tinal fluids, p. 454, () 694 b. 
 
 in malignant cholera, p. 841, ^ 1058 d — 
 in cholera infantum, p. 841 , ^ 1058 d — 
 in dysentery, sporadic and epidemic, 
 p. 842-848, <J \ObSf—m fevers, p. 843, 
 <5i 1058 g — in scarlet fever, p. 843, ^ 
 1058 h — in measles and small-pox, 
 p. 844, (^ 1058 t — in whooping-cough, 
 p. 844, <^ 1058 k — in jaundice, p. 844- 
 845, <J 1058 / — in erysipelas, p. 845, 
 ^ 1058 m — in acute rheumatism, and 
 acute gout, p. 846, ^ 1058 7m — in 
 pneumonia, p. 846, <J 1058 a — in croup, 
 
 p. 846, ^ 1058 p in inflammation 
 
 of brain, Y>. 847, ^ 1058 q — in inflam- 
 mation of serous tissues, p. 847, () 
 1058 r — in wflammation of kidneys, 
 p. 847, ^ 1058 i — in inflammation of 
 eyes, p. 848, () 1058 t — in apoplexy, 
 p. 848, {) 1058 u — in epilepsy, p. 848, 
 \ 1058 V — in asthma, p. 848, () 1058 w 
 — in chorea, p. 844, v 1058 x — in de- 
 lirium tremens, p. 849, ^ 1058 y — in 
 puerperal fever, p. 849, ^ 1058 z. 
 Cantharides. See Countee-Irritants, 
 Index II., 
 
 their morbific effects show that remedies 
 operate by substituting pathological 
 conditions of a transitory nature for 
 others more profoundly morbid, p. 
 63, ^ 137 rf; p. 65, () 143 a-c ; p. 67, 
 () 149-151 ; p. 542-543, (^ 854 c-857 ; 
 p. 645-646, ij 893 c, d; p. 652, ^ 893 /. 
 
 their remedial and morbific eff'ects, ex- 
 ternally or internally applied, demon- 
 strate the operation of remedies and 
 morbific causes upon parts beyond 
 their direct seat of action through 
 alterative effects of reflex nervous 
 influence, p. 646-652, (} 893 e-m; 
 p. 679-681, (J 905 a. Also, Reflex 
 Action of Nervous System, Reme; 
 dies; Causes, Morbific, Index II. 
 Also, p. 850-851, () 1059. 
 
 in producing inflammation of the bladder 
 without injuring the stomach, and as 
 the stomach may subsequently become
 
 INDEX II. 
 
 991 
 
 Cantharides — continued. 
 
 diseased through a morbific reflex ac- 
 tion of the nervous system determined 
 by the vesical inflammation — shows 
 how many morbific causes, such as 
 miasmata, cold, iStc, may exert all 
 their direst effects upon the skin and 
 mucous tissue without deranging 
 those organs, but that the impression 
 may develop a morbific reflex action 
 of the nervous system that shall insti- 
 tute disease in other parts, which may 
 then call into action a reflex influence 
 that will light up disease in the skin, 
 or mucous tissue, or other parts — 
 thus, also, showing how mercury ad- 
 ministered by the stomach, or applied 
 to the skin, will, without affecting 
 those organs sensibly, establish in- 
 flammation in the mouth and salivary 
 glands, and, by the same inductive 
 philosophy, how remedial agents ap- 
 plied to the same organs, do also, 
 through the alterative action of the 
 reflex nervous influence, establish 
 salutary pathological changes in dis- 
 eased parts remotely situated, and 
 without manifesting any action upon 
 the stomach or skin, p. 59, I) 129 A ; 
 p. 63, () 137 d; p. 65, () 143 a-c; p. 
 66-67, ^ 148-151 ; p. 101-102, () 201- 
 203 ; p. 332-334, (J 502-506 ; p. 339- 
 340, (} 5Ug,h; p. 347-348, <J 516 d, 
 No. 13 ; p 351-352, t) 524 c ; p. 367- 
 368. () 558 a; p. 416-417, ^ 649 c; 
 p. 421-423, ^ 657-658, 660 ; p. 426, 
 ^ 666 ; p. 429-430, () 674 d ; p. 465, 
 ^ 714 ; p. 522-523, () 827 b,c; p. 539, 
 ^ 848 ; p. 862-864, () 1066. 
 demonstrate, like Arsenic, Tartarized 
 Antimony, Iodine, &c., the modus 
 operandi of remedial and morbific 
 agents through alterative influence 
 of reflex nervous action, and the fal- 
 lacy of the doctrine of absorption, and 
 how remedies operate by that medium 
 through increased susceptibility of 
 parts morbidly affected, and accord- 
 ing to peculiarities in the natural 
 constitution of tissues, and how they 
 prove remedial or morbific according 
 to their just application, and upon a 
 common principle — by the failure of 
 the vesicating plaster to affect any 
 internal organ in its healthy state 
 excepting the bladder, while it will 
 overthrow inflammations of all other 
 internal parts, or will aggravate the 
 same disease if not duly applied, but 
 will exert no such effects when ad- 
 ministered internally excepting upon 
 the bladder. See last preceding' refer- 
 ences. Also, <J 1059, 1088. 
 
 Casein. See Milk, Index II. 
 
 Castor Oil. See Oil, Castor, Index II. 
 
 Cathartics — continued from Index I., 
 
 their curative and morbific effects upon 
 disease spring from irritation of the 
 alimentary mucous tissue, by which 
 the reflex action of the nervous system 
 is brought into alterative effect upon 
 morbid parts, and according to the 
 nature and dose of the cathartic, and 
 involve, also, continuous sympathy, 
 p. 101-102, () 201-203; p. 107-110, 
 ^ 227-232 ; p. 303, (i4:81 d; p. 322- 
 324, ^ 498-500 c; p. 339, () 514: f; 
 p. 563-567, § 889 a-k ; p. 661-663, 
 4 894-896; p. 835-841, <J 1057^- 
 1058; p. 851-859, ^ 1060-1064. 
 Also, Nervous Power, Index I. and 
 II ; Sympathy, Sensation, Sensi- 
 bility, Index I. ; Reflex Action of 
 Nervous System, Remedial Action, 
 Therapeutics, Index II, () 1088 d. 
 
 no two alike in eflTects, p. 964, § 889 c. 
 Also, p. 27, (i 52; p. 63, (> 137 b-d ; 
 p. 64-65, {) 138-143 c; p. 67-68, (J 
 149-152 b; p. 73, <) 163; p. 400, () 
 630 rf; p. 417, (f 650; p. 418-420, () 
 652 c-653 d ; p. 424-425, <) 662-663 ; 
 p. 545, ^ 860 ; p. 547-550, <J 863 d ; 
 p. 838-843, I) 1058 a-f, p. 851-862, 
 ^ 1060-1065. 
 
 each modifies the nervous influence in 
 a way peculiar to its own virtues, and 
 Calomel and Blue Pill, rendering it 
 most usefully alterative, are arranged 
 first in order in the Author's Materia 
 Medica and Therapeutics, p. 564, ^ 
 889 c; p. 838-843, § 1058 a-f. Also, 
 Nervous Power, Index I and II. ; 
 Alteratives, Remedial Action, In- 
 dex II. 
 
 may produce their curative efl^ects with- 
 out purging, p 564, ij 889 b. 
 
 the evacuations the least important ot 
 the effects, yet often a necessary re^ 
 suit of that irritation of the intestinal 
 mucous tissue which is required to 
 establish a powerful development of 
 reflex nervous influence, p. 564-565, 
 () 889 b-f. 
 
 the principal objects contemplated, p. 
 566, (;» 889 h. 
 
 special relation of alimentary canal to 
 nervous system goes to corroborate 
 the Author's doctrine of operation of 
 remedial and morbific agents through 
 reflex action of nervous system, p. 
 565-566, ij 889 g. 
 
 peristaltic action increased through in- 
 fluence of reflex action of nervous 
 system upon the muscular coat of in- 
 testine, which exemplifies the essen- 
 tial philosophy of their remedial and 
 morbific effects upon other parts, p. 
 107-112, (J 227-234; p. 284-285, (} 
 455 a-f; p. 323-341, ij 499-514 ; p. 
 347-348, ^ 516 d, No. 13; p. 361, ()
 
 992 
 
 INDEX II. 
 
 Cathartics — continued. 
 
 529 ; p 563-564, () 889 a, b ; p. 565- 
 566, l^ 889 /, g; p. 592-593, <^ 89U 
 k; p. 661-664, () 894-900; p. 665- 
 671, i) 902 a-l; p. 679-681, ^ 905 a. 
 
 some affect different parts of intestine 
 unequally, according to their special 
 virtues and to the difference in struc- 
 ture and vital constitution of differ- 
 ent portions of the canal, p. 566, i; 
 889 i; p. 856-857, § 1063 b. Also, 
 p. 59, i) 129 g-i; p. 61-73, ^ 133- 
 163 ; p. 98, ^ 191 i— but is not the 
 principle which should determine 
 their choice, p. 566, § 889 i. 
 
 their combinations, proportions of each, 
 addition of other things, dose, time 
 of exhibition, and relation to other 
 remedies, very important, p. 566-570, 
 ^ 889 k-n. Also, p. 339-340, () 514 
 h ; p. *3-544, i) 857 ; p. 548-549, ^ 
 863 d; p. 648-651, () 893 g-k ; p. 
 657, () 893 p; p. 696, ^ 926 ; p. 838- 
 849, I) 1058 a-z. 
 
 often cumulative in effect, important, 
 and illustrated, p. 667-569, ^ 889 
 l-mm. 
 
 mode and philosophy of overcoming 
 habitual constipation through pro- 
 gressive and alterative influence of 
 reflex nervous action, and contrast, 
 p. 568-569, <;i 889 771, mm. Also, p. 344 
 -345, (} 516 d, No. 6 ; p. 532, ^ 841 ; 
 p. 365, () 551 ; p. 646-649, ^ 893 c-h : 
 p. 667-669, () 902,/, g; p. 679-681, 
 \ 905 a. 
 
 the most appropriate time for exhibi- 
 tion, and why, p. 570, ^ 889 n. Also, 
 p 547-549, (j 863 d ; p. 740, ^ 989. 
 
 three principal objects contemplated, p. 
 566, ^ 889 h. 
 Cath.^rtics, Saline, 
 
 their therapeutic and morbific effects, 
 and relative value, p. 853, ^ 1061. 
 
 overrated, and as " refrigerants" falla- 
 cious, ibid. 
 
 example of their usefulness in combina- 
 tion with Rhubarb, p. 555, () 872 a. 
 Causes, Morbific, 
 
 operate upon the same principle of al- 
 terative influence of reflex action of 
 nervous system as remedial agents, 
 and more or less according to differ- 
 ences in the vital constitution of dif- 
 ferent parts, and their existing pre- 
 ternatural susceptibilities, p 3, ^ 2 c ; 
 p. 55, {} 117; p. 59, (J 129 h; p. 61, 
 5 133 c; p. 62-73, <;> 135 a-l 63; p. 
 87, () 177-182 ; p. 89, I) 188 : p. 101- 
 102, () 201-203; p. 107-112, (^ 226- 
 234 b; p. 131-132, ^ 285-288; p. 
 265, {) 447 b; p. 285-286, <J 455 d- 
 456 ; p. 323-341, t) 499-514; p. 365- 
 366, () 551-556 ; p. 373-390, <J 574- 
 601; p. 399, ^ 630; p. 415-418, () 
 
 Causes, Morbific — continued. 
 
 649-651 ; p. 421-423, l) 657-658 ; p. 
 424, (;> 661 ; p. 426, i) 666 ; p. 445, <> 
 688 ee; p. 451, i) 691, 692 ; p. 465- 
 467, () 714-719 ; p. 475, ij 733 h ; p. 
 478-479, ^ 740-741 ; p. 483-484, ^ 
 746 c ; p. 525-527, () 827 c-828 e; p. 
 530-533, 837 b-SU ; p. 538-539, ^ 
 847 g--848; p. 541-542, 854 a-d; 
 p. 547, <) 863 d ; p. 554, ^ 871 ; p. 
 563-564, ^ 889 a ; p. 565, ^ 889 g ; 
 p. 569, i) 889 mm ; p. 571-572, ^ 896 
 b ; p. 574-576, <^ 890 ce-n ; p. 580, 
 ^ 890tr e; p. 592-593, () 89H k ; p. 
 644-651, {) 893 c-i ; p. 657-658, ^ 
 893 0, p ; p. 661-663, ^ 894-896 ; p. 
 665-670, i) 892 a-m ; p. 679-681, ^ 
 905 a ; p. 802-804, I) 1039 ; p. 862- 
 864, () 1066 ; p. 501-512, ^ 792-817. 
 
 their operation at the beginning devel- 
 opment of the ovum supplies a key to 
 the essential philosophy of disease, 
 as the development of the ovum does, 
 also, to that of physiology, p. 47-49, 
 <J 75-80. 
 
 reflect light upon pathological condi- 
 tions, p. 414, () 642 a ; p. 424, () 662 
 a-c, p. 396, ^621 b. 
 
 two kinds, predisposing, and exrciting 
 or occasional, which are bofir exter- 
 nal and internal, physical and mental, 
 p. 414-415, (J 645-648. 
 
 the predisposing, general and specific, 
 p. 415, ^ 648. 
 
 the predisposing, most important as lay- 
 ing the foundation of disease, p. 414, 
 ^ 645 b. 
 
 the exciting, develop disease after the 
 predisposition is formed, p. 414, ^ 
 645 c. 
 
 the predisposing often also the exciting 
 cause, such as all animal and vege- 
 table poisons, &c. Many internal 
 causes, physical and mental, may be 
 either predisposing or exciting, or 
 may act as both. Also, numerous 
 external causes that are more or less 
 intermingled with the atmosphere, 
 and which are essentially predispos- 
 ing and generally require the subse- 
 quent operation of exciting causes for 
 the development of disease, may be 
 both predisposing and exciting, of 
 which kind are concentrated mias- 
 mata, p. 414, () 645 c; p. 418, () 652 
 c; p. 420-421, ^ 654-656; p. 423, ^ 
 659-660. 
 
 like remedial agents, exert their first ef- 
 fects locally, and thence upon other 
 parts through the alterative influence 
 of reflex action of the nervous system, 
 p. 415-416, 1^ 649 a, b ; p. 421-423, 
 \ 657-658 ; p. 520, () 826 c ; p. 592, 
 (} 89U g, k; p. 849, (^ 1059 ; p. 930, 
 ^ 1088 ; Remedies, Remedial Ac-
 
 INDEX II. 
 
 993 
 
 Causes, Morbific — continued. 
 
 TioN, Index II. ; Nervous Power, 
 Index I. and II. ; Sympathy, Sensi- 
 bility, Vital Properties, Index I. 
 
 all such as are of a miasmatic nature, 
 and cold and analogous causes, do not 
 induce disease in parts which are the 
 direct seat of their action, but in oth- 
 er parts by reflex action of the nerv- 
 ous S3'stem, or subsequently upon 
 their direct seat of action by reflex 
 influences propagated by the primary 
 derangements, p. 59, ^ 129 h; p. 63, 
 <i 137 d; p. 65, () 143 a-c ; p. 66-67, 
 ^ 148-151 ; p. 332-334, ^ 502-506 ; 
 p. 339-340, ^ 514 g, k ; p. 347-348, 
 <!i 516 fZ, No. 13 ; p. 351-352, ^ 524 
 c; p. 367-368, () 558 a; p. 416-417, 
 ^ 649 c ; p. 421-424, () 657-660 ; p. 
 426, () 666 ; p. 429-430, <^ 674 d ; p. 
 465, «J 714 ; p. 522-523, (J 827 i, c ; p. 
 539, () 848 ; p. 862-864, «J 1066. 
 
 their impression is made either upon 
 sympathetic sensibility or irritability 
 through the medium of their direct 
 seat of action, when, in either case, 
 the morbific influences are propagated 
 to other parts by an alterative influ- 
 ence of reflex action of nervous sys- 
 tem, which is also true of remedial 
 agents, p. 66-67, (> 148-151 ; p. 89- 
 90, {) 188-188^ d, &c. ; p. 101-103, 
 () 201-204; p. 106-109, <) 222-230; 
 p. 280-282, ^ 450-451 ; p. 284-287, 
 ^ 455-459 ; p. 323-362, i) 499-530 ; 
 p. 415-417, ^ 649 a-c; p. 421-423, 
 <} 657-658 ; p. 661-663, <^ 894 6-896 ; 
 p. 665-670, () 892 a-ni ; p. 679-681, 
 (j 905 a ; p. 520, () 826 c ; p. 849, (^ 
 1059 ; p. 930, t) 1088. Reflex Ac- 
 tion OF Nervous System, Index II. ; 
 Nervous Power, Index I. and II. 
 
 influenced by special endowments of 
 different tissues and parts of tissues, 
 by their varying susceptibilities, by 
 age, constitution, habits, and by many 
 morbific causes which simply predis- 
 pose the body to be acted upon by 
 some other predisposing cause of 
 more profound operation, but the 
 former of which without the latter 
 would be inoffensive, and yet not un- 
 frequently add to the violence of the 
 disease, as witnessed in epidemic 
 measles, and other epidemics, p. 59, 
 () 129 h, i; p. 61-73, ^ 133-163; p. 
 366-367, () 556 a-d; p. 372-397, (j 
 573-625 ; p. 399, ^ 628, 630 ; p. 415- 
 416, () 649 a-c; p. 418, (^ 851 b; p. 
 423-425, <J 659-663 ; p. 428, i) 671 ; 
 p. 503-512, () 795-817 ; p. 524, (J 827 
 e, 689/, 961 a 970 c. 
 
 eflfects of, according to one or more, 
 each one or according to the number, 
 ccEleris paribus, producing special in- 
 
 R 
 
 Causes, Morbific — continued. 
 
 fluences that result in particular forms 
 of disease, and so of remedies, p. 27, 
 i)b2\ p. 400, ^ 630 d; p. 417-420, 
 i} 650-653 ; p. 423-425, i) 659-663 ; 
 p. 545, ^ 860 ; p. 547-550, (^ 863 d. 
 
 one, generally the most important, and 
 commonly indispensable to any given 
 form of disease, as in malignant chol- 
 era, plague, yellow fever, all cases of 
 poisoning, all resulting from remedial 
 agents, &c., p. 418, () 652 b ; p. 419- 
 420, <J 653 ; p. 423, i) 659 ; p. 545, <J 
 860. 
 
 since, therefore, the same cause is always 
 necessary to the production of any 
 specific form of disease, and there is 
 no resemblance between the miasm 
 which is allowed by all to sometimes 
 generate yellow fever, plague, &c., 
 and the morbid products of living or^ 
 ganization, it is impossible that these 
 diseases should be contagious ; and, 
 for the same reason, small-pox, mea' 
 sles, and scarlet fever can never be 
 propagated but by contagion, however 
 the body may be predisposed by other 
 causes to the more ready and profound 
 action of their virus, p. 419-420, (^ 653. 
 Also, Self-limited Diseases, Index 
 II 
 
 operate according to the structure and 
 vital constitution of parts, and as they 
 may be diverted from their natural con- 
 dition. See Structure, and Reme- 
 dies, references under this clause, In- 
 dex II. 
 
 manifest their effects at intervals corre- 
 sponding more or less with their na- 
 ture, p. 420-423, ^ 654-659 ; p. 426, 
 () 666 a ; p. 631-632, i) 892i b, c. 
 
 the predisposing, often obscure, p. 423, 
 ^ 659. 
 
 there may be a long series of predis- 
 posing causes, each one progressively 
 aflfecting the organic states, but with- 
 out any special marks of disease, when 
 some exciting cause, innocent in per- 
 fect health, may give rise to a sudden 
 explosion of morbid symptoms, p. 65- 
 66, ^ 143 b, c ; p. 423, () 659 ; p. 426, 
 ^ 666. 
 
 the effects of morbific causes, physical 
 and mental, like those of a remedial 
 nature, owing to the mutability of the 
 properties of life, p. 87, () 177-182 ; 
 p. 120-122, (} 237-240 ; p. 414, ^ 642 
 b ; p. 542, () 854 c, d. Also, Vital 
 Properties, Index I. 
 
 hereditary predisposition equivalent to 
 remote predisposing causes, p. 424, ^ 
 661 ; p. 560-561, (J 886. 
 
 one disease becomes apredisposingcause 
 of the same or of other diseases in other 
 parts, or may act simply as an exciting 
 R R
 
 994 
 
 INDEX II. 
 
 Causes, Morbific — continued. 
 
 cause when the latter are predisposed 
 by other causes, or may be both to- 
 gether, and more or less according to 
 the peculiarities attending the vital 
 constitution of different parts, and by 
 its disturbing influence of that reflex 
 action of the nervous system by which 
 all parts are constantly maintained in 
 harmonious relation to each other, and 
 in one universal concerted action ; and, 
 as diseases thus spring up, one after 
 another, through the natural and for- 
 ever operating law of reflex nervous 
 action, they react upon and mutually 
 aggravate each other, while, through 
 the same natural operation of the nerv- 
 ous influence, a blow may be simul- 
 taneously struck at the whole by a 
 single remedy, as by bloodletting or 
 a cathartic, p. 59, () 129 A, i; p. GI- 
 GS, I) 133-152 ; p. 75, i) 165 b ; p. 89, 
 I 188 a; p. 101-102, () 201-203; p. 
 95, (} 189 ; p. 107-122, () 226-240 ; 
 p. 282, i) 451 e,f; p. 284-286, ^ 455- 
 456; p. 323-361, <;> 499-529; p.415,i<) 
 647 ; p. 422, <;. 660 ; p. 424-425, (} 662 ; 
 p. 428, ^673; p.450, H89/; p.465- 
 467, (, 714-719 ; p. 483, (^ 746 c; p. 
 497,1^779; p. 506, (^ 803,804; p. 508 
 -512, ^ 807-817 ; p. 561, ^ 886, 887 ; 
 p. 592, >J 891i k; p. 661-663. <J 894- 
 897 ; p. 665-670, () 902 a-m ; p. 679- 
 681, 1^ 905 a ; p. 703-709, ^ 940-951. 
 
 stimulants, irritants, and sedatives, give 
 rise to analogous conditions of disease, 
 though modified by the nature of each 
 cause, p. 480, f) 743 ; p. 487-489, ^ 
 756 ; p. 497-498, ^ 779-780 ; p. 510 
 -512, () 813-817; p 523, () 827; p. 
 708, () 950 ; p. 733, ^ 974 b; p. 773- 
 775, ^ 1024 ; p. 829, ^ 1057 a. 
 
 their modus operandi, and of remedial 
 agents, through reflex action of the 
 nervous system, illustrated by a Scton, 
 p. 679-681, <;. 905 a. 
 
 may extinguish the susceptibility to their 
 action, p. 364-366, 1) 544-556 ; p. 425, 
 ^ 664. Also, Sm.4LI--pox, Lidex II. 
 
 may establish a permanent predisposition 
 to disease, p. 425-426, (:) 665. Also, 
 Predisposition, Index II. 
 
 the predisposing, important to be known, 
 p. 424-425, ^ 662 ; p. 487-488, ^ 756 ; 
 p. 509, <J 811; p. 510, ^813*,- p. 545, 
 5 859 b; p. 560-561, <S> 886. 
 
 do not operate upon all exposed in 
 times of epidemics, and why, p. 394, 
 1^615,616; p. 397, ^ 623-625 ; p. 415, 
 (^ 648 b ; p. 425, ^ 663. 
 
 prcdisposilion, in what it consists, p. 426 
 -427, <^ 666. Also, Predisposition, 
 Index II. 
 Cause, Pathological. See Pathologi- 
 cal Cause, Index II. 
 
 Cell, Primordial, (See Cells, Index I.), 
 
 differs in organization in each species 
 of animals and plants, as shown by 
 microscope, p. 812-814, (j 1051. 
 
 wanting in low organic beings, p. 813- 
 814, ^ 1051 b. 
 
 shown to be radically different in ani- 
 mals and plants by the difference in 
 the means of their subsistence, p. 15, 
 <^ 1 1 ; p. 135-138, (^ 298-303i ; p. 815, 
 (Ji 1052. Also, p. 44, ^72. 
 Cerebro-Spinal System. See Index I., 
 
 and Nervous System, Index II. 
 Chemical Physiologists — continued 
 from Index I., 
 
 their unavoidable inconsistencies, con- 
 tradictions, admissions, and perver- 
 sions of Nature demonstrate the ab- 
 sence of all relationship of Organic 
 Chemistry to Physiology, Pathology, 
 and Therapeutics, ^.2,1) \b ; p. 6-14, 
 (^ 4i-6 ; p. 19, (^ \S e; p. 24, () 42 ; 
 p. 30-32, 'J 57-59 ; p. 33, ij 60 ; p. 
 38-40, () 64 e-h ; p. 43, (J 67 ; p. 86, 
 (J 175 d; p. 95-96, ^ 189 b; p. 132- 
 133, «J 289-292; p. 139, ^ 303f ; p. 
 149, ^ 338-339 a; p. 152-155, (> 345 
 -349 ; p. 156-173, ^ 350, the parallel 
 columns ; p. 174-191, ^ 350^-350|-; 
 p. 196-203, {) 360-376^ ; p. 234-236, 
 ^ 433-436; p. 237-261, <} 437^- 
 445 d ; p. 274-279, (} 447^-448 ; p. 
 482, ^ 744 ; p. 484-489, <) 747-756 ; 
 p. 514-540, () 819-851 ; p. 690-691, 
 I 906-910; p. 779-782, ^ 1028- 
 1030; p. 794-799, ^ 1033 6-1034. 
 Also, Organic ChemIstry, Index I. 
 and II. 
 Chemistry, Medical — continued from 
 Index I, 
 
 continues to offer its testimony in be- 
 half of rational medicine, p. 779-782, 
 ^ 1028-1030. Also, p. 433-434, <j 
 676 b ; p. 762, «;» 1006 a. 
 
 why incapable of yielding any light to 
 the different branches of Medicine, 
 p. 8, 1^5 ; p. 157, () 350, mottoes, h, 
 i, k; p. 191, ^ 351 ; p. 202-203, ^ 
 3764 ; p. 207, ^ 376f b ; p. 798, ^ 
 1034. 
 
 where Fourcroy left it seventy years 
 ago, as admitted, p. 9, (J 5 ; p. 202, ^ 
 3761 ; p. 781, ^ 1029. 
 Childhood, 
 
 extends from the age of two and a half 
 to fifteen or seventeen years in males, 
 and fourteen to seventeen in females, 
 p. 375, (} 577 a — its physiological and 
 mental characteristics, ^ 577 b — which 
 give rise to new diseases or to new 
 modifications of infantile, with illus- 
 trations, () 577 c — and corresponding 
 results from remedies, ^ 577 d. 
 Chloroform, Action of. See Anaes- 
 thetics, Index II.
 
 INDEX II. 
 
 995 
 
 Chorea, 
 
 treatment of, p. 590, () 891^ h, d; p. 848, 
 ij 1058 e. Also, Antispasmodics, /«- 
 dex II. 
 Cinchona and its Alkaloids, 
 
 introduction into practice, p. 593-595, ^ 
 892 a. 
 
 exemplify what are called specific vir- 
 tues, but which are often manifested 
 only when preceded by other reme- 
 dies that may be more curative, or 
 will be morbific without the latter ; 
 since the " specifics" possess tonic as 
 well as febrifuge virtues, and the for- 
 mer will transcend the latter if the 
 . pathological conditions be not brought 
 into a proper relation to the febrifuge 
 virtue ; while, also, they are specific 
 only in the same sense as coffee and 
 the cold dash are specifics for poison- 
 ing by opium, p. 595-596, ^ 892 aa. 
 Also, p. 67, (} 149-151 ; p. 422-425, 
 <J 662 a-c ; p. 430-433, (^ 675 ; p. 
 508-511, () 807-816; p. 547-550, <J 
 863 d ; p. 553-556, ^ 870 «a-872 a ; 
 p. 571-572, (} 890 b; p. 581, «J 890^ 
 c; p. 596-598, <J 892 b, c; p. 605- 
 607, ^ 892 m-r ; p. 737-738, «J 984. 
 
 a great practical error to suppose that 
 Cinchona cures intermittents by its 
 tonic virtue, since it will aggravate 
 all other fevers, at least in their early 
 stages, and all inflammations and con- 
 gestions that are not the consequence 
 of the same causes that produce inter- 
 mittents, p. 553, ^ 870 aa ; p. 605- 
 607, ^ 892 m-r ; p. 608-609, () 892^ c. 
 
 exemplify, with other things, the im- 
 portance of ascertaining the remote 
 predisposing cause of disease, p. 417- 
 418, <J 548-551 a; p. 424-425, () 662 a- 
 c. Also, Causes, Morbific, Index II. 
 
 their modus operandi not obscure, as 
 reputed, but through remote sympa- 
 thy or alterative influence of reflex 
 action of nervous system, p. 596-597, 
 (j 892 d; p. 676-679, () 904 c, rf— il- 
 lustrated by the modus operandi, 
 through remote sympathy, of the cold 
 dash and coffee as antidotes for poi- 
 soning by opium, p. 338, ^ 514 <Z ; p. 
 592-593, {) 89H k; p. 737-738, ^ 
 984 b. Also, Sympathy, Sensibil- 
 ity, Sensation, Nervous Power, 
 Index I. Nervous Power, Reflex 
 Action of Nervous System, Reme- 
 dial Action, Index II. 
 
 only one of a vast variety of means that 
 will arrest intermittent fever, and de- 
 rived from the three kingdoms of Na- 
 ture, as well, also. Mental Emotions 
 — thus showing their modus operandi 
 through alterative influence of reflex 
 nervous action, or oi direct in the case 
 of the Passions, and the consequent 
 
 Cinchona and its Alkaloids — continued. 
 substitution of more favorable patho- 
 logical conditions according to the 
 nature of the remedy, p. 597, <5i 892 c. 
 Also, p 69, () 149-151 ; p. 87, (j 177- 
 182 ; p. 107-110, ^ 227-232 ; p. 426, 
 <J 666 ; p. 430-433, ^ 675-676 ; p. 473 
 -474,11 733 e ; p. 542, ^ 854 c-e ; p. 
 545, ^ 860 ; p. 547-550, <;. 863 d ; p 
 061-670, ^ 894-902 ; p. 704, ^ 943 b 
 -944 « ; p. 707, ^ 947 ; () 892 b, 892^ 
 V, 951 c. Remedial Action, subdi- 
 vision Mental Emotions, Index II. 
 
 two methods of treatment by, the mod- 
 erate and excessive, one regarding 
 the recuperative law, the other rely- 
 ing wholly upon the drug, and their 
 results considered, p. 596-604, <J 892 
 Z>-i-.— Notes K p. 1119, L p. 1120. 
 Circulation of the Blood — continued 
 from Index I. See Veins, Index II. 
 
 a right estimate of the powers which 
 carry on the circulation import&nt in 
 philosophical and practical medicine, 
 p. 208, (^ 382 ; p. 214-215, «J 393-396 
 — prevailing errors in regard to it 
 prolific of evil, p. 208, ^ 383 ; p. 215, 
 (j 394. 
 
 Author assigns seven elements, which 
 concur harmoniously together, p. 209, 
 (J 384 ; p. 934. i) 1090. 
 
 Author shows an exquisite vital consent 
 of action of veins with the arteries 
 through reflex influence of cerebro- 
 spinal and ganglionic systems, "not 
 less so than the iris with the retina" 
 — excluding the mechanical doctrine, 
 p. 210, «;> 389 ; p 215, i) 394, 395 ; p. 
 216,(^399; p. 286, ^56 a, J ; p. 340, 
 (J 514 k ; p. 827, § 1 066, p. 503, § 794. 
 
 venous circulation determined princi- 
 pally by derivative power of the right 
 cavities of the heart, and the arterial 
 through the pulmonary veins by the 
 left cavities ; but a propelling power 
 of the arterial capillaries is indispens- 
 able, assisted also by the muscular 
 power ofthe veins, p. 210-211,1^388, 
 389,390 6; p. 212-213, ij 392; p. 215, 
 () 396 ; p. 503, ^ 794 ; p. 934, <J 1090. 
 
 objections answered, p. 211, <J 389, 390 
 b; p. 214, () 392 c. 
 
 Author shows that the suction power 
 of the heart is indispensable to the 
 portal circulation, and to that of the 
 lymphatics, lacteals, thoracic duct, and 
 umbilical vein, p. 211, (;» 390 a; p. 214, 
 ^ 392 c, d — and shows that the valves 
 of the veins are always open unless 
 there be a reflux of blood, p. 212, <;> 391 . 
 
 the action of the capillary arteries, and 
 the influence of the nervous system 
 upon them, and upon the veins, shown 
 by their natural phenomena and by 
 Exp. by BuNivA and Procter, p.
 
 996 
 
 INDEX II. 
 
 Circulation of the Blood — continued. 
 
 216, 6 394-399 ; p. 227, MH ; P- 
 485, «^ 750 a, and p. 827, ^ 1056. 
 Also, Medical and Physiological Com- 
 mentaries, Article Powers which 
 Circulate the Blood, vol. ii , p. 
 398-426, where the foregoing sub- 
 jects are elaborated ; and j4§ticle The- 
 ories OF Inflammation, p. 141-207. 
 
 Coffee, 
 
 its modus operandi through alterative 
 action of reflex nervous influence as 
 an antidote for poisoning by opium, 
 and illustrated by analogous effects 
 of cold dash through the same influ- 
 ence, p. 338. i^bUd; p. 592-593, () 
 89 U k; p. 737-738, ^984 6. 
 
 Cold, Shower Bath, &c., 
 
 employed to illustrate the reflex action 
 of the nervous system in the produc- 
 tion and cure of diseases, whatever 
 part may be the seat of the direct ac- 
 tion of remedial and morbific agents, 
 and to show how readily and vari- 
 ously the nervous influence is modi- 
 fied in its nature, and how, as render- 
 ed thus alterative of organic actions, 
 it readily lights up diseases, or proves 
 the direct efficient means of cure — 
 being equally true of mental emotions 
 according to their nature as of phys- 
 ical causes, p. 107-112, <^ 227-234 b ; 
 p. 230, () 422 , p. 245, <J 440 e ; p. 
 253, 1^ 441 d; p. 323-324, (> 499- 
 500 c; p. 338, ^ 514 d; p. 339-341, 
 ^514 g-m ; p. 359, ^ 527 b ; p. 360, 
 ^527d; p.416-417, ^649 c; p. 421 
 -422, ^ 657 ; p. 661-663, () 894-896 ; 
 p. 670-671, ^ 902 m ; p. 880, (^ 1074. 
 Also, Skin ; Causes, Morbific, In- 
 dex II; p. 580, § 8901 d- 
 illustrates, also, from its want of astrin- 
 gency, and difficulty of its absorption, 
 the modus operandi of Astringents 
 through alterative influence of reflex 
 action of nervous system, p. 533, ^ 
 842 ; p. 572, () 890 b. Also, last pre- 
 ceding references, and Ipecacuanha, 
 Index II. 
 
 COLOCYNTH, 
 
 its therapeutical and morbific eflfects, p 
 856, () 1063. 
 Combustion, Spontaneous, 
 
 of the human body, p. 863, <J 1066 a. 
 Constipation, Habitual, 
 
 most successfully treated by small and 
 frequently-repeated doses, and not by 
 full and rarer doses, of cathartics — 
 the reflex nervous influence being 
 mildly maintained in the former case, 
 while it is abrupt and violent in the 
 latter, p. 366, () 556 b, and references 
 there ; p. 567-569, ^ 889 l-mm. Also, 
 Alteratives, Cathartics, Exer- 
 cise, Index II. 
 
 Consumption. See Phthisis Pulmona- 
 
 Lis, Itidex II. 
 Contagion — continued from Index I, 
 
 subject to the law of limitation in re- 
 spect to causes of a specific nature — 
 showing that yellow fever, plague, 
 small-pox, measles, and scarlet fever 
 can not b^ alike produced, in either 
 case, by vegetable miasmata and by 
 the morbid products of living organi- 
 zation. And so, upon the same prin- 
 ciple, nothing will change, in a sound 
 constitution, an inflammation of the 
 common kind into a specific form, un- 
 less as when a specific virus is applied 
 to a wound or an ulcer, and also un- 
 less some specific predisposition, like 
 the scrofulous diathesis, be implanted 
 in the constitution (which is equiv- 
 alent to a specific remote cause) ; and 
 each one of the specific causes will 
 produce a particular, and generally 
 well-marked species or variety of the 
 disease. And so of yellow fever, in- 
 termittent fever, plague, &c., p. 27, 
 ^ 52 ; p. 418-420, () 652-653. Also, 
 Causes, Morbific, Index II. 
 Convulsions, 
 
 contrary to the opinion of Marshall Hall, 
 that " all convulsive aflfections arc 
 diseases of the true spinal or excito- 
 motory system ;" they are commonly 
 owing to simple irritation propagated 
 from distant parts both upon the brain 
 and spinal cord, and the consequent 
 reflection of an irritating nervous in- 
 fluence upon the voluntary muscles. 
 Hence a division of the gum, or of a 
 nerve or tendon, or a warm poultice 
 to them, or an enema, may at once 
 put an end to the trouble, p. 357-358, 
 ^ 526 d; p. 590-591, ^ 89H b; p. 
 592-593, () 89U k. 
 
 questions of this nature not to be de- 
 termined by experiments which do 
 not refer to the nervous system as a 
 whole, p. 287-290, <J 458-46H; p. 
 292, () 473 a ; p. 296, <) 476 c ; p. 
 303, ^ 481 e, f. Also, Mental Emo- 
 tions, Index II. 
 
 nevertheless, diseases ot the brain and 
 spinal cord are apt to give rise, both 
 by direct and reflex action, to great 
 disturbances in the organs of organic 
 life, and the Passions, through the 
 intercommunication of the cerebro- 
 spinal and sympathetic systems, may 
 produce convulsions, as in hysteria ; 
 though not so diseases of the nerv- 
 ous centres, unless they result in ef- 
 fusion or disorganization, p. 334, () 
 508. 
 
 how relieved by Antispasmodics through 
 reflex action of the nervous system. 
 See Antispasmodics, Index II.
 
 INDEX II. 
 
 997 
 
 Cotton Wool, 
 
 a sedative, and curative of inflammations 
 and ulcers, p. 833, () 1057 k. 
 Counter-Ieritants, 
 
 belong to Author's eighth order of Anti- 
 phlogistics, and consist of Vesicants, 
 Rubefacients, Suppurants, Escharot- 
 tcs, Potential Cauterants, Actual Cau- 
 terants. Other groups belong to this 
 order of Local Applications, p. 642- 
 644, () 893 a, b. 
 
 vesicants the most important, but mostly 
 limited to the genus Cantharis, p. 644, 
 «J 893 c. 
 
 all may operate upon internal parts 
 through alterative influence of reflex 
 action of nervous system ; but many 
 of them are commonly local only in 
 their effects. Whenever they exceed 
 the limit of local action, it is through 
 reflex nervous influence, and this in- 
 fluence, especially in the case of vesi- 
 cants, instead of being curative, may 
 produce or aggravate disease, accord- 
 ing to existing susceptibilities and the 
 natural endowment of tissues and or- 
 gans, and throw the whole body into 
 universal commotion — by which is 
 exemplified the close analogy between 
 remedial and morbific agents, and, as 
 demonstrated (articles Cantharidcs, 
 Seton, Cold, &c.. Index II.), that reme- 
 dies do not operate by absorption, but 
 through alterative action of the nerv- 
 ous influence, and according to the 
 nature of the remedy or mental emo- 
 tion and the existing susceptibilities 
 of organs that may arise from disease, 
 &c , p. 338, I) 514 d; p. 359-360, (} 
 527 b ; p. 592, i; 89U 9 ; V 642-659, 
 () 893 a-q ; p. 679-681, ^905 a; p. 
 850, ^ 1059 ; ^ 1088. Reflex Ac- 
 tion OF Nervous System, Remedies ; 
 C.iusEs, Morbific ; Mental Emo- 
 tions, Structure, Index II. ; Nerv- 
 ous Power, Index I. and II. 
 
 introductory review of problems relative 
 to the operation of other remedies 
 through alterative action of reflex 
 nervous influence to facilitate an 
 understanding of the same modus 
 operandi of Counter-irritants, which 
 opens widely a view of the Author's 
 principles relative to vital solidism, 
 and direct and reflex action of the 
 nervous system in the production and 
 cure of disease, p. 645-646, ^ 893 c, d. 
 
 their immediate effect strictly morbific, 
 variously modifying the nervous in- 
 fluence, and imparting to it an alter- 
 ative condition which may be either 
 i curative or morbific according to ex- 
 isting susceptibilities, &c., p. 646- 
 658, ^ 893 c-p. Also, the foregoing 
 references to Index. 
 
 Counter-irritants — continued. 
 
 the artificial inflammation produced by 
 the vesicating plaster either in the 
 skin or the bladder readily subsides, 
 and thus, also, through its develop- 
 ment and modification of reflex nerv- 
 ous influence, it institutes such path- 
 ological changes in diseased internal 
 organs as to lead to their speedy cure 
 — thus illustrating the morbific nature 
 of positive remedial action and its dis- 
 tinction from the effects of more pro- 
 foundly morbific causes, that remedies 
 cure by substituting new and transi- 
 tory pathological conditions, and the 
 great recuperative law of Nature ; and 
 which is farther shown by the manner 
 in which the plaster of Cantharides 
 will arrest erysipelas, and the oil of 
 turpentine relieve scalds, p. 646-647, () 
 893c-e; p. 652, (^893/; p. 682, ^905b. 
 
 the foregoing quick subsidence of the 
 artificial inflammations illustrates, 
 also, the principle involved in the 
 spontaneous subsidence of the self- 
 limited diseases ; for, however pro- 
 foundly their morbific causes may 
 operate, they carry with them the 
 virtues which administer to the re- 
 cuperative law, and are on common 
 ground with remedial agents when 
 these give rise to inflammation, p. 
 544-545, ^ 853 ; p. 850, () 1059. 
 Also, Remedies, Remedial Action ; 
 Diseases, Self-limited, Index II. 
 
 their curative and morbific effects upon 
 deep-seated parts refute the doctrine 
 of the operation of remedies by ab- 
 sorption, and confirm the Author's 
 doctrine of the alterative influence 
 of reflex action of nervous system, p. 
 338, ^ 514 d; p. 347, ^ 516 d, Nos. 
 12, 13; p. 642-647, <) 893; p. 679- 
 681, <J 905 a; p. 850, <J 1059 a, 1088. 
 
 the cutaneous effusions to which they 
 give rise not instrumental, p. 648, ^ 
 893 /; also. Sweat, Index II. — nev- 
 ertheless, full vesication, like active 
 purging, is often indispensable ; and 
 there is a great difference in the results 
 of simple Rubefacients and vesication 
 by Canthandes, ibid., and p. 564, <J 889 
 b; p. 565, <J 889/ — which difference 
 is owing, in part, to the difference in 
 the virtues of the remedies, and in 
 part to the difference in time, as seen 
 particularly in vesication by Canthar- 
 ides and scalding water, and in the 
 difference in results in the treatment 
 byoneortheotherofacute and chronic 
 inflammations — and by the whole of 
 which is illustrated the philosophy 
 which concerns the vast difference 
 between a sudden and gradual devel- 
 opment of reflex nervous influence
 
 998 
 
 INDEX II. 
 
 Counter-irritants — continued. 
 
 of a deleterious nature, as seen, in 
 the former case, in the fatal effects 
 of blows upon the epigastric region, 
 the shock of surgical operations, and 
 the violent passions, hydrocyanic acid, 
 tartarized antimony, a large abstrac- 
 tion of blood, p. 648, I) 893 g-; p. 650- 
 
 651, i) 893 I. Also, p. 296, ^ 476 c, 
 476^ i; p. 298-299, ij 476i ^-477 a ; 
 p. 300, I) 479; p. 304, (^ 481 g; p. 
 319-320, <) 494 ; p. 334-336, ^ 509- 
 511 ; p. 523-524, <) 827 d; p. 525, () 
 828 b, c ; p. 661-663, ^ 894-896 ; p 
 703-711, ^ 940-952 ; p. 726, (^ 961. 
 
 opposed to the sudden and violent op- 
 eration of counter-irritants, &c., as 
 last considered, is the gradual and 
 persistent development of reflex nerv- 
 ous influence as manifested by small 
 and frequently repeated vesications, 
 and by setons and issues, in treating 
 chronic inflammations — the decision 
 being in favor of the first remedy, p. 
 648-649, <J 893 g, h; p. 679-681, ^ 
 905 a — it being the same, also, in the 
 case of small and repeated leechings, 
 p. 696-697, ^ 926, 927 a. Also, Al- 
 teratives, Leeching, Lidex II. 
 
 the extent and part of the surface vesi- 
 cated, and the intensity of the artificial 
 inflammation, and the time of applica- 
 tion, as it respects antecedent means, 
 are, as with other remedies in their 
 appropriate use, important considera- 
 tions, p. 649-652, ^ 893 i-n. 
 
 comparison between the physiological 
 effects of scalding water, cantharides 
 plaster, rubefacients, and moxa, p. 
 650-651, ^ 893 i. 
 
 the vesicating piaster generally too small, 
 and may be useful only from a determ- 
 ination of a powerfully alterative in- 
 fluence of reflex action of the nervous 
 system, obtained by vesicating a very 
 large surface, p. 651, ^ 893 k; p. 847, 
 () 1058 q. 
 
 in acute inflammations, and often in 
 chronic, bloodletting, cathartics, &c., 
 important as preliminary remedies, 
 and vesicants should be the last in 
 the series, p. 657-658, () §93 p; p. 
 765-766, (J 1007 6-1008 ; p. 847, ^ 
 1058 q. 
 
 how managed in cerebral inflammation, 
 p. 651, ^ 893 k ; p. 847, () 1058 q. 
 
 with certain exceptions, the nearer vesi- 
 cants are applied to the region of dis- 
 ease the better, nor does it appear to 
 be of any great moment what tissue 
 of an organ may be affected, p. 651- 
 
 652, () 893 k-m. 
 
 Utility of vesicants in hemorrhage from 
 important organs, p. 659, <^ 893 r. 
 Also, Hemorrhage, Index II. 
 
 Counter-irritants — continued. 
 
 vesication by Cantharides sometimes 
 followed by a bad condition of the 
 skin, but only so in special and se- 
 vere forms of disease, p. 657, <^ 893 
 o; far greater evils result from their 
 premature application, and where 
 bloodletting, &c., should be the rem- 
 edies, p, 657-658, ^ 893 p. 
 
 unfavourable conditions for their use, p. 
 657-658, () 893 o, p. 
 
 analogy between counter-irritation and 
 leeching, p. 648-649, (/ 893 g, h ; p. 
 659, (j 893 q ; p. 696-697, ^ 926, 927 
 a. Also, Leeching, Index II. 
 
 many other local remedies not belong- 
 ing to the group of Counter-irritants 
 operate more or less upon the same 
 principle of alterative influence of re- 
 flex action of nervous system, such 
 as iodine, mercurial plaster, veratria, 
 aconite, camphor, &c., p. 659, ^ 893 
 q. Also, Plasters, Aconite under 
 Sedatives, Index II. 
 
 the doctrines of 7netastas2S and repul- 
 sion examined through the analogous 
 vital endowments of tissues of the 
 same kind, and in connexion with 
 counter-irritation — the doctrines hav- 
 ing led to a great abuse of remedies 
 — the whole illustrating the capri- 
 cious alterative influences of reflex 
 action of the nervous system when 
 directed by malpractice, p. 652-656, 
 <) 893 n. Also, Structure ; Causes, 
 Morbific ; Remedial Action, Lidex 
 II. ; Nervous Power, Index I. and 
 II Also, p. 351, "J 524 J, c. 
 Croton Oil, Modus Operandi of. See 
 
 Oil, Croton, hidcx II. 
 Croup, 
 
 illustrates diflerences in the vital con- 
 stitution of parts, p. 61-62, <J 134, 
 135. 
 
 its disappearance in early life owing to 
 changes in the constitution of tissues, 
 p. 374, ^ 576 d^; p. 376, <J 577 e 
 Also, Structure, Index II. 
 
 treatment of, by bloodletting, &.C., p. 
 375, ^ 576 e ; p. 638, <) 892^. /; p. 
 696, ^ 925 b ; p. 76.6-778, ( 1009- 
 1013 ; p. 846, § 1058 p, 964 d^ 
 Cupping, 
 
 intermediate in efi'ects between general 
 bloodletting and leeching, but most 
 allied to the former, since it does not 
 institute the specific changes of the 
 latter in the divided vessels, p. 702- 
 703, () 939. 
 
 deficient in that special reflex nervous 
 influence which belongs to leeching, 
 and in that important abruptness and 
 decision of the same influence which 
 forms the great advantage of general 
 bloodletting, and can therefore rarely,
 
 INDEX II. 
 
 999 
 
 Cupping — continued. 
 
 if ever, supersede the other methods, 
 p. 702-703, 1) 939 e,f. Also, Gener- 
 al Bloodletting, Leeching, Nerv- 
 ous Power, Index II. 
 
 diiference from leeching farther shown 
 by the blood flowing from larger ves- 
 sels, and will not flow without cup- 
 ping-glasses, while patients have died 
 of hemorrhage from a single leech- 
 bite, p. 694, {) 922 ; p. 702, ^ 939. 
 
 most useful in early life, as the quan- 
 tity of blood abstracted is greater in 
 the ratio of size, p. 696, <J 925 b ; p. 
 703, ^ 939 / 
 
 D. 
 
 Darwin, Ch. — On the Origin of Species 
 
 by Natural Selection, p. 814, note. 
 Death — continued from hidex I., 
 
 physiology of, p. 401, ^ 631 ; p. 402- 
 404, () 634-637; Note C p. 1113. 
 
 when natural, the result of progressive 
 changes incident to organic functions, 
 p. 401-402, ^ 633. Also, Structure, 
 Childhood, Youth, Index II. 
 
 life maintained after apparent death, p. 
 403, i;»637; p. 805, <^ 1041. 
 
 rise of heat after apparent, p. 266, ^ 
 U7 d. 
 
 reflex action of nervous system often 
 occurs after apparent death, and oc- 
 casions movements of the voluntary 
 muscles, p. 403, <) 637; p. 805, () 
 1041. 
 
 alternate contraction and dilatation of 
 iris from light after, p. 806, () 1041 ; 
 p. 875-876, () 1072 a. 
 "Debility" — continued from Index I., 
 
 doctrine of, and its fatal tendencies, p. 
 313, () 487 h ; p. 371-372, () 569 b-e 
 p. 396, t) 621 a; p. 480-481, () 743 
 p. 486-489, (i 752-750 ; p. 499, <J 785 
 p. 511, () 815; p. 715-721, () 959- 
 960 b; p. 722, () 960 g; p. 729, ^ 
 967; p. 730-731, l) 969 c-970 b; p. 
 735-736, ^ 977-990 ; p. 749, «;> 992 c ; 
 p. 751, () 999 c ; p. 753, ^ 1001 b ; p. 
 756-757, (, 1005 b-h ; p. 759-760, () 
 1005 ;, k ; p. 764, ^ 1006 /-1007 b ; 
 p. 856-861, <J 1063-1065; p. 868- 
 869, () 1068 a,b; ^ 887; ^61*. 
 Defecation, 
 
 Author's opinion that the Intestine is 
 under the controlling influence of the 
 Will, and that in Defecation the 
 Will brings it into action in concert 
 with the determination of the nerv- 
 ous influence upon the abdominal, 
 levator, perinaeal, and sphincter mus- 
 cles — supplying a remarkable in- 
 stance of Creative Design in the crit- 
 ical nature of rendering a portion of 
 the intestine a voluntary part, and as- 
 
 Defecation — continued. 
 
 sociating its action with that of the 
 other muscles that are engaged in 
 defecation, p. 325, () 500 e ; p. 326, () 
 bOOh. Also, p. HI, (J 233 J; p. 113, 
 ^ 234 c ; p. 330, () 500 n ; and Will, 
 Intestine, Index I. and II. 
 Delirium Tremens, 
 
 supplies an unusual example of the 
 modifying effects of disease, accord- 
 ing to the nature of its remote cause, 
 upon the operation of loss of blood, 
 as it respects its influences upon the 
 nervous system, especially when con- 
 trasted with its effects in cerebral in- 
 flammation and congestion, p. 734, ^ 
 976 b; p. 849, () 1058 y. Also, 
 p. 673, note; Brain, Inflamma- 
 tion OF, Index II; p. 425, i) 662 c. 
 Diabetes, 
 
 produced by pricking floor of fourth 
 cerebral ventricle, p. 792, ^ 1032 d. 
 
 the only disease in which sugar is said 
 to be found at large in the blood, and 
 this questioned by many Chemists, p. 
 786, i) 1031 ; p. 789, ^ 1032 b. 
 
 blood in, said by Chemists to be per- 
 fectly natural, p. 786-787, i) \Q^\ b. 
 
 vegetable food in, said to be conducive 
 to the disappearance of saccharine 
 matter from the urine, p. 784, <J 1031 b. 
 Diarrhcea, and Cholera Infantum, 
 
 their principles of treatment, p. 567, (j 
 889 k ; p. 571-572, «J 890 b ; p. 575- 
 576, ^ 890 h-l; p. 577-578, ^ 890 
 o-q; p. 841, () 1058 d. 
 Digestion in Animals and Plants, or 
 Assimilation, 
 
 the principal element of assimilation in 
 animals, p. 147, () 332. 
 
 assimilation, common to plants and an- 
 imals, p. 125, <^ 249. 
 
 the function by which the properties of 
 life are communicated to dead mat- 
 ter, p. 134, i) 296. 
 
 chemical changes arrested in stomach, 
 p. 134, ij 297 ; p. 135, ^ 301 ; p. 150, 
 «J 339 h. 
 
 food of animals organic, of plants inor- 
 ganic, p. 15, ^ 1 1-14 ; p. 20, (jlS c; 
 p. 135, (j 300 ; and Index I and 11, 
 Plants, Plants and Animals. 
 
 the animal dependent on the vegetable 
 kingdom, but reciprocally useful to 
 each other, p. 15, <) 9-14; p. 135- 
 136, () 303 ; p. 137, () 303i a-c— 
 plants the providers — animals the 
 consumers, p. 15, ^ 14 ; p. 137, () 
 303i a. 
 
 assimilatin'' organs very simple in 
 plants, pT 135-137, ^ 302-303. 
 
 food of plants mostly from atmosphere, 
 and comments upon, p. 135-137, <J 
 303. 
 
 office of roots and leaves, and light and
 
 loao 
 
 INDEX II. 
 
 Digestion in Animals, &c. — continued. 
 darkness, p. 136-137, (^ 303 c-e; p. 
 138-139, <) 303^-303f. 
 
 something of nitrogen, and oxygen, p. 
 136-137, ^ 303 a-303i b; p. 138, ^ 
 303^, and of iron, Notes N, R. 
 
 carbonic acid gas, food of plants, and 
 proportion of in atmosphere, how it 
 got there, and other comments, and 
 its relation to oxygen, p. 135-138, (} 
 303 a-303^. 
 
 Liebig's identification of functions of 
 living with the physics of dead plants, 
 p. 13J, () 303i 
 Digestion (in Animals) — continued from 
 Index I., 
 
 digestion, respiration, and calorification, 
 the main intrenchments of Organic 
 Chemistry, p. 147, ^ 333. 
 
 comparative view of reasoning from re- 
 sults of experiments upon animals to 
 physiological and morbid conditions 
 of man, and chemical experiments 
 upon dead matter with the same in- 
 tentions, p. 148, () 334, 335. 
 
 the three schools have different theories 
 of, p. 6-7, () 4^ ; p. 149, ^ 337. 
 
 Liebig's doctrine of Chymification, and 
 method of reasoning, p. 149-150, ^ 
 338-339 a; p. 154-178, () 349-350|-. 
 Also, p. 239-279, () 440-448. 
 
 Conclusions from Dr. Beaumont's ex- 
 periments, and tabular view of, p. 150, 
 () 339 b ; p. 200, () 366. 
 
 Spallanzani, Hunter, Fordyce, Tiede- 
 mann, their vital doctrines of, p. 150- 
 
 152, <^ 340-344. 
 
 Front's and Carpenter's reasoning upon, 
 
 p. 152-153, ^ 145-148. 
 Roget and Wagner doubtful about it, p. 
 
 153, (J 348. 
 
 Mulder's application of Chemistry, p. 
 179-183, ^ 350J a-g. 
 
 opinion of the " Manchester Literary 
 and Philosophical Society^'' rendered 
 in favour of Author's views, p. 156, 
 ^ 350. 
 
 the parallel columns, p. 19, ^ 18 e; p. 
 156-173, () 350; p. 182, i) 350J gg ; 
 p. 189-190, () 350i n; p. 277-278, ^ 
 447^ b. 
 
 organs of, in animals, complex and va- 
 rious, with a corresponding variety in 
 functions and gastric juice, and food, 
 p. 140,1^304-306; p. 191-192, (;. 353; 
 p. 223-226, (} 409 e-j. 
 
 how to make up an unknown animal 
 from any given part, as a tooth, or 
 bone, &c., p. 144-145, () 323-324— 
 all the parts referring to the digestive 
 organs and special nature of the gas- 
 tric juice, and the kind of instinct 
 also, p. 145, <} 325; p. 193, <J 356. 
 
 varieties as to stomach, salivary glands, 
 liver, and organs of mastication, p. 
 
 Digestion (in Animals) — continued. 
 
 140-141, () 306, 309-311 ; p. 192, <5 
 353. 
 
 prerogatives of the stomach, and its dis- 
 tinctions from all things else, p. 145, 
 ^ 325; p. 148-149, () 336; p. 193, () 
 356; p. 191-196, <;. 353-360. 
 
 Chemistry inconsistent with itself in 
 assuming that its agencies disturb 
 those organic compounds in chymifi- 
 cation which had been elaborated for 
 the purpose of receiving in the stom- 
 ach the first impress towards restor- 
 ing their organic endowments, and 
 since also any chemical change would 
 be a restoration of the compounds to- 
 wards that condition of which the 
 vegetable kingdom takes charge, p. 
 196, ^ 360, 361. Also, p. 15, ^ 13, 
 14 ; p. 16, () 16-18 ; p. 24, {)A2; p. 
 30, ^ 59 ; p. 33, (J 60 ; p. 135, (} 301 ; 
 p. 143, <J 322 ; p. 201, () 374, 375. 
 
 physiological endowment of the pyloric 
 orifice, p. 141-142, () 313. 
 
 gastric juice the principal assimilating 
 agent, and what the Vitalists and 
 Chemists say of it, p. 140-141, ^ 307 ; 
 p. 150-152, () 340-344 ; p. 152-153, 
 <) 345-348; p. 157-173, () 350, Nos. 
 6, 7 X 54 ; 8 X 55 ; 1 1, 12 X 58 ; 25- 
 27 X 71-76 ; 29 X 78, 79, parallel col- 
 umns ; p. 193-199, ^ 356-364^^. 
 
 uses of bile, saliva, &c., p. 142, ^ 314- 
 316. 
 
 chemical substitutes for gastric juice, p 
 197-203, <;> 363-3761^; p. 781,1)1029 
 p. 784, () 1031 b. 
 
 Chemistry allows that " we are wholly 
 ignorant of the proximate metamor- 
 phosis of albuminous bodies in the 
 stomach during digestion ;" and that, 
 " although hypotheses are not want- 
 ing regarding the mode of action of 
 Pepsin, we know nothing of its na- 
 ture,'' p. 781, ^ 1029. 
 
 lacteals, thoracic duct, progress of chyle 
 to the lungs, globules in chyle, &c., 
 p. 142-143, ^ 317-321. 
 
 progress of assimilation through its va- 
 rious stages to its consummation in 
 the capillary vessels (the main instru- 
 ments of life and disease), and in all 
 its magnificent varieties, yet always 
 the same in every individual of each 
 species of animals and plants, yet 
 more or less different in each, p. 143 
 144, () 319, 322 ; p. 192-193, <) 354- 
 356 ; p. 221-227, (> 409 i-411. 
 
 illustrations of the foregoing varieties 
 in organization, products, &c., and 
 their uniformity in each species, and 
 in all parts of each, drawn from indi- 
 vidual animals and plants, p. 223- 
 226, () 409 c-j. 
 
 the whole of the foregoing united, and,
 
 INDEX II. 
 
 1001 
 
 Digestion (in Animals) — continued. 
 
 along with the laws of reflex action 
 of the nervous system, by which all 
 are maintained in one everlasting har- 
 mony of functions, constitutes a more 
 sublime edifice of Design than all else 
 in the world of matter, p. 146, () 326. 
 Also, p. 54-55, (J 107-117; p. 106- 
 112, ^ 222-234 b; p. 284-287, () 454- 
 458. 
 
 physiology of assimilation applied path- 
 ologically — gastric juice changed by 
 gastric disease, which, as well as the 
 influence of the disease, affects the 
 condition of the blood, though Chem- 
 istry cannot tell us how ; and Humor- 
 alism defeated in practice, the Vital 
 Solidist resolves the problem and de- 
 monstrates the art of making healthy 
 blood, p 146-147, () 328-330 ; p. 534 
 -537, ^ 845-847 c; p. 540, ^ 851 b; 
 p. 780, <J 1029 ; Notk R p. 1123. 
 Disease — continued from Index I., 
 
 conceded that Chemistry reflects little or 
 no light upon it, p. 433-434, (^ 876 b ; 
 p. 762, () 1006 a ; p. 779-782, <J 1029, 
 1030. 
 
 remains without essential change at all 
 times and in all climates, p. 401, ^ 
 632 b; p. 761, (} 1005 /-1005^ a, b; 
 p. 764-765, () 1006/, g-; p. 868-872, 
 () 1068. 
 
 produced by morbific causes in parts that 
 are not their direct seat of operation 
 through alterative influence of reflex 
 action of nervous system ; and so of 
 cure by remedies, p. 323-341, () 500- 
 514 m. Also, Causes, Morbific ; 
 Remedies, Remedial Action, In. II. 
 
 depends also upon the natural consti- 
 tution of parts. See Causes, Mor- 
 bific, first subdivision. Index II. 
 
 produced and cured by Mental Emotions 
 through direct development of nervous 
 influence. See Mental Emotions, 
 Remedial Action, subdivision Men- 
 tal Emotions, and Nervous Power, 
 Index II. 
 
 disease of one part becomes the cause 
 of disease in another part through 
 alterative influence of reflex nervous 
 action ; and disease of one part super- 
 vening as a sympathetic result in an- 
 other part may reflect, after the man- 
 ner of Counter-irritants, through re- 
 flex action of nervous system, a salu- 
 brious influence upon the primary 
 affection, p. 340, ^ 514 h; p. 351- 
 352, <^ 524 c; p. 679-681, ^ 905 a; 
 also, Counter-Irritants, Index II. 
 — but which art cannot imitate by 
 internal remedies, though attempted, 
 p. 654-656, () 893 n; p. 856-861, <^ 
 1063 6-1065 — or, as it subsides in 
 the secondary affection, it may again 
 
 Disease — continued. 
 
 return to its primary seat — the whole 
 exemplifying the reflex nervous in- 
 fluence as a curative or morbific cause, 
 and its development and modification 
 according to the varying states of the 
 organs, p. 333, <^ 503 ; p. 351-352, <J 
 524 a-c ; p. 360-361, (;> 528 ; p. 421- 
 422, «J 657 a ; p. 423, ^ 660 ; p. 473- 
 474, (} 733 e; p. 506, ^ 804 ; p. 679- 
 681, (} 905 a, 89H A-, 893 n, 902 b. 
 
 analysis of a case of fever, complicated 
 with inflammations and venous con- 
 gestions, showing how to investigate 
 disease, and trace out the consecutive 
 derangements that are superinduced 
 by morbific influences of reflex nerv- 
 ous action, p. 438-442, ^ 686 b-d. 
 Also, Sy.mptoms, Index II. 
 
 important in leading to a knowledge of 
 physiological states and of the proper- 
 ties and laws of organic beings, p. 265, 
 ()U7b; p.413,i^639 6; p. 798, 1)1034, 
 and references there. 
 Diseases, Self-limited, 
 
 illustrate the recuperative tendency of 
 Nature, and the uses of remedies, p. 
 544-545, <) 858. 
 
 treatment of, mostly expectant, but 
 when complicated with local inflam- 
 mation the constitutional affection is 
 so brought under their influence, 
 through reflex action of nervous sys- 
 tem, as to admit of active treatment, 
 p. 59, (} 127 h, I ; p. 61, <;» 134 ; p. 63, 
 ^ 137 b, c; p. 65, ^ 143 c; p. 67-68, 
 () 149-152 ; p. 69, () 156 b ; p. 73, ^ 
 163; p. 430-433, () 675-676 a; p. 
 508-509, ^ 809-811 ; p. 531, () 839; 
 p. 538, ^ 847 §-, h ; p. 539, «;» 848 ; p. 
 544-545, (J 858 ; p. 553, () 870 aa ; 
 p. 597-599, (J 892 c, d; p. 732, ^ 970 
 c; p. 733-736, ^ 973 b-980. Also, 
 Law of Adaptation, hidex I. 
 
 their causes impress a curative disposi- 
 tion which cannot be improved by re- 
 medial agents ; thus showing also, as 
 in the case of Counter-irritants, the 
 principle upon which remedies oper- 
 ate, p. 531, (} 839 ; p. 544-545, ^858, 
 861. Also, Counter-Irritants,Can- 
 tharides. Index II. 
 
 the principle through which their causes 
 extinguish the susceptibility of the 
 system to their repeated operation is 
 the same as involved in acclimation, 
 with the difference that the acclimated 
 must continue to live under the influ- 
 ence of the morbific causes, or the 
 susceptibility to their action will re- 
 turn, p. 364, (} 543-548; p. 421. ^ 
 654 b ; p. 425, () 664. Also, p. 170- 
 173, Nos. 40-45, parallel columns. 
 Disgust, 
 
 determines vomiting by first propagat-
 
 1002 
 
 INDEX II. 
 
 Disgust — cojitmued. 
 
 inn- the nervous influence upon ♦he 
 mucous coat of the stomach, upon 
 which it acts after the manner of 
 emetics, when the process of reflex 
 nervous action is instituted as in the 
 case of emetics ; and when vomiting 
 arises from tickling the throat, or a 
 fall, or sailing, &c., it is the result of 
 a double process of reflex action of 
 nervous system, but is otherwise like 
 that from disgust — and employed by 
 the Author to interpret tlie modus 
 operandi of remedial and morbific 
 causes, physical and mental, through 
 direct or reflex action of the nervous 
 system, and to illustrate the substan- 
 tive existence and self-acting nature 
 of the Soul, p. 324-328, i) 500 c-dd, 
 k; p. 340, i) 514 k-m ; p. 547-550, 
 i) 863 d; p. 889-890, ^ 1077. Also, 
 Joy and Anger, Love, Grief, Fear, 
 Jealousy, Hope, Shame, Yawning, 
 Sneezing, Sea-Sickness, Mental 
 Emotions, Reflex Action of Nerv- 
 ous System, Remedial Action, sub- 
 division Mental Emotions, Index 
 II.; Nervous Power, /«(/.Z a«(^/Z 
 
 Distribution. See Circulation. 
 
 Diuretics, 
 proper, are feebly endowed with cura- 
 tive virtues ; while other and the most 
 useful means for dropsy, such as 
 bloodletting, cathartics, may be far 
 more diuretic through their profound 
 influences upon disease; by which, 
 also, is illustrated the inflammatory 
 nature of dropsical affections, p. 630- 
 633, (} 892i. Also, p. 364, () 545 ; 
 p. 419-420, (} 653 ; p. 421, «^ 654 b ; 
 p. 563-564, (J 889 a, b ; p. 665-669, 
 i5> 902 a-i; and Iodine, Index II. 
 the philosophy of their operation through 
 alterative influence of reflex action of 
 the nervous system, and how the 
 nervous influence is variously modi- 
 fied and rendered variously alterative, 
 as in the case of other remedies, and 
 as denoted by corresponding effects 
 of fear and other mental emotions, p. 
 230-233, () 422-427 ; p. 630-632, ij 
 892J b, c. Also, Joy and Anger, 
 Love, Grief, Mental Emotions, Re- 
 flex Action of Nervous System, 
 Remedial Action, subdivision Men- 
 tal Emotions, Index II. ; Nervous 
 Power, Index I. and II. 
 
 Dropsy, 
 
 its pathology, inflammation, p. 630, (j 
 
 () 892i b. 
 requires a variety of treatment, accord- 
 ing to its stage and complications, p. 
 617, ^ 892i k; p. 632-633, ^ 892| 
 c-e. 
 no essential difference in the pathology 
 
 Dropsy — continued. 
 
 of what is called active and passive, 
 p. 633, <J 892i g. 
 
 Dysentery, 
 
 its antiphlogistic treatment, and objec- 
 tions to Astringents in, p. 573, <J 890 
 (/, e; p. 575, *;» 890 h; p. 747, ^ 991 
 b; p. 842, ^lOoSy;- Note Go p. 1138. 
 
 E. 
 
 Elaterium, 
 
 employed, along with other cathartics, 
 to illustrate the doctrine of revulsion, 
 through its profound development of 
 a morbific reflex nervous influence, 
 and the misapplication of Cathartics 
 upon the principle of counter-irrita- 
 tion, p. 655-656, () 893 n ; p. 722, ^ 
 960 g; p. 856-862, ^ 1003-1065. 
 Emetics — continued from Index I, 
 
 their therapeutical as well as physiolog- 
 ical effects take place through reflex 
 action of the nervous system, the lat- 
 ter of which, like the increased peri- 
 staltic action arising from cathartics, is 
 a simple concurring element of other 
 alterative influences of the same ac- 
 tion reflected upon other parts ren- 
 dered susceptible by disease, p. 107- 
 1 10, <;i 227-230 ; p. 323-324, (J 500 c ; 
 p. 326-328, 1) 500 h-k ; p. 333, ij 504 ; 
 p. 336-337, <J 514 a-c ; p. 532-533, 
 ^ 841 ; p. 547-550, () 863 d ; p. 661- 
 663, (j 894-896 ; p. 666-669, () 902 c- 
 i ; p. 675-676, \ 904 bb ; p. 876-877, 
 ^ 1072 a ; p. 879-880, ij 1074 ; p. 886 
 -891, i^ 1077. Also, Ipecac, hid. IL 
 
 modify the reflex action of the nervous 
 system according to the nature of the 
 exciting cause, whether physical or 
 mental, and upon which modification 
 the special nature of the alterative in- 
 fluences depends, p. 547-550, ^ 863 
 d ; p. 664, \ 900 ; p. 667-669, ^ 902 
 e-i. Also, preceding references, and 
 Alteratives, Cathartics, Disgust, 
 Sea-Sickness, Mental Emotions, 
 Remedial Action, subdivision Men- 
 tal Emotions, Index II. ; Nervous 
 Power, Index I. and II. 
 Emmenagogues, 
 
 arranged in the Author's Therapeutical 
 System of the Materia Medica under 
 the general denomination of Uterins 
 Agents, which are distinguished by a 
 variety of virtues in relation to the 
 uterine system in its morbid or pre- 
 ternatural states, p. 628, <J 892| q ; p. 
 684-687, () 895i b. 
 
 inadmissible in inflammatory and irrita- 
 ble states of the uterus, tbid. 
 
 amenorrhoea apt to be a sympathetic 
 consequence of abdominal derange-
 
 INDEX II. 
 
 100:5 
 
 Emmenagogues — continued. 
 
 merits, and maintained by them ; but 
 this morbific effect of reflex nervous 
 influence is also apt to be overlooked, 
 and the uterine afliiection to be regard- 
 ed as the principal malady, while the 
 evils that may arise immediately from 
 the latter, though comparatively un- 
 important, depend mostly upon its 
 morbid disturbance, and little upon 
 the failure of the discharge, p. 233- 
 234, (} 428-432 ; p. 628-629, <5> 892f 
 r; p. 684-687, ^ 895i b. 
 remedies should be addressed to the 
 primary derangements, while, also, 
 emmenagogues may or may not be 
 expedient, but probably means of a 
 local nature — so that a variety of 
 treatment is necessary in the multi- 
 farious conditions attending amenor- 
 rhoea, p. 545, <) 859 b, and references 
 there; p. 616-617, () 892i /, k; p. 
 628-629, () 892-1 r-t ; p. 684-687, ^ 
 895^ b. Also, Amenorrhcea, Index 
 II. 
 
 Emotions. See Mental Emotions, Re- 
 medial Action, subdivision Mental 
 Emotions, Joy and Anger, Grief, 
 Hope, Love, Disgust, Fear, Jeal- 
 ousy, Shame, Index II 
 
 Endermic Remedies. See Remedies, 
 Endermic, Index II. 
 
 Endosmosis — continued from Index I, 
 admitted to be sustained only by " scanty 
 facts," p. 797, ij 1034. Also, Anes- 
 thetics, hidex II 
 
 Epilepsy, 
 
 the convulsions of. dependent on reflex 
 action of nervous system, or upon 
 direct and reflex, according to the 
 nature of the cause which develops 
 the nervous influence, how counter- 
 acted by Antispasmodics through the 
 same agency ; how the whole inter- 
 prets the modus operandi of remedial 
 and morbific causes, physical and 
 mental, through the same alterative 
 processes of nervous action, and the 
 treatment, p. 591, () 89H e; p. 592- 
 593, () 89H fc; P- 848, <J 1058 v. Also, 
 Reflex Action of the Nervous 
 System, Antispasmodics, Remedies ; 
 Causes, Morbific ; Remedial Ac- 
 tion, Mental Emotions, Bloodlet- 
 ting, Lidex II. ; Nervous Power, 
 Index I. and II. 
 
 Epispastics. See Counter-Irritants, 
 Index II. 
 
 Ergot, 
 
 its introduction into practice accom- 
 panied by all the important qualifica- 
 tions in its use, p. 620-622, () 892| 
 a, b ; p. 625, <J 892f /, g — encountered 
 opposition, ibid., and p. 626, ^ 892| /. 
 its primary action upon the stomach, 
 
 Ergot — continued. 
 
 and, through reflex nervous influence, 
 upon the uterus — illustrative of the 
 modus operandi of all remedial and 
 morbific agents — and its reputed de- 
 leterious eflfects upon the nervous 
 centres by absorption due to other 
 causes, generally to reflected nervous 
 influence excited by the uterus and 
 determined with violence upon those 
 centres, p 623, () 892f c ; p. 626-627, 
 ^ 892-| /. Also, Epilepsy, Antispas- 
 modics, Nervous Power, Index II. 
 
 excites the uterus in its impregnated 
 state to contraction in numerous ani- 
 mals, as well as the human subject, 
 p. 624, ^ 892|- d— but only then, and 
 often fails unless parturition has be- 
 gun, or when the organ is rendered 
 susceptible by morbid states, as in 
 cases of hydatids and menorrhagia, 
 showing, like numerous other things, 
 the mutability of the properties of life, 
 and, like Arsenic, Iodine, Tartarized 
 Antimony, that the action of remedies 
 depends greatly upon a morbidly in- 
 creased susceptibility of the parts dis- 
 eased, and that no safe conclusions 
 can be drawn from experiments with 
 remedies upon healthy subjects as to 
 their influences upon morbid states, 
 ibid. Also, Arsenic, Remedies, Al- 
 teratives, Reflex Action of Nerv- 
 ous System, Index II. ; Nervous 
 Power, Index I. and II. 
 
 reasons for thinking it not reliable for 
 producing abortion, p. 624-625, § 
 892| d. 
 
 circumstances under which its use is 
 desirable or admissible in cases of 
 labor, p. 620-622, () 892| a, b; p. 
 625-627, <^ 892 /-n. 
 
 employed, also, to restrain uterine hem- 
 orrhage, for expulsion of placenta, 
 polypi, hydatids, and in puerperal 
 convulsions, ibid. 
 
 its want of astringency, and in some- 
 times arresting other hemorrhages 
 than uterine, illustrates, like Cold, 
 Ipecacuanha, and Counter-irritants, 
 the modus operandi of Astringents 
 through reflex action of the nervous 
 system, p. 627-628, () 892|- o. Also, 
 Astringents, Cold, &c.. Index II. 
 
 fatal to some small animals — illustrating 
 distinctions in vital constitutions, p. 
 622, '!) 8931; c. Also, p. 61-63, <J 133- 
 137; p. 88, (J 185; p. 98, ^ 191 a. 
 Erysipelas — complex pathology of, and 
 treatment of, <J 630 e, 689 I, 814, 970 
 c, 1005 j, 1058 m. 
 
 employed to show that remedies operate 
 by substituting one pathological con- 
 dition for another, p. 642-646, () 893 
 a-e; p. 652, ^ 893 I; p. 872, P.S.
 
 1004 
 
 INDEX II. 
 
 Erysipelas — continued. 
 
 Also, Counter-Irritants, Remedies, 
 Therapeutics, Index II ; §905 b. 
 
 Exciting Causes. See Causes, Mor- 
 bific, Index II. 
 
 Excito-Secretory Action, as resulting 
 FROM Reflex Action of the Nerv- 
 ous System. See Secretion and 
 Excretion, Generalization of Re- 
 flex Action of Nervous System, 
 Index II. 
 
 Excretion. See Secretion and Excre- 
 tion, Index II. 
 
 Exercise, 
 
 its modus operandi consists especially 
 in instituting through muscular action 
 a salutary reflex nervous influence 
 upon various organs, but particularly 
 upon the stomach, intestines, and 
 liver, while, also, these organs are 
 rendered the source of the same 
 nervous development and its determ- 
 ination upon themselves by the me- 
 chanical influences of jolting ; hence 
 the superior advantages of running 
 for overcoming habitual constipation, 
 p. 543, () 855 ; p. 580, () 890^ d; p. 
 670-671, <J 902 in. Also, Constipa- 
 Tio.v, Habitual ; Friction, Respira- 
 tion, Heat, Cold, Skin, Phthisis, 
 Food, Whooping-Cough, Altera- 
 tives, Reflex Action of Nervous 
 System, Index II. 
 
 Expectorants — continued from Index I, 
 the name objectionable, as diverting at- 
 tention from the pathological states, 
 and thus leading to errors in practice, 
 p. 633-634, () 8924 a; p. 641, § 8924 
 I ; p. 739, <) 984 c. 
 Alteratives adapted to Pulmonic Inflam- 
 mation substituted for, in Author's 
 Therapeutical Arrangement of the 
 Materia Medica, and Bloodletting 
 ranked as the first in importance, 
 and Tartarized Antimony the second, 
 p. 634, I) 892| b ; p. 641, () 892* i. 
 the substances distributed into four non- 
 stimulating, fifteen stimulating, one 
 stimulating and narcotic, one sedative 
 and narcotic, and three stimulating 
 and antispasmodic, p. 635, § 492J c. 
 the several expectorants proper stated, 
 and reasons for their order of arrange- 
 ment, serving also as an example of 
 the principles upon which the arrange- 
 ment of other groups is founded, p. 
 635-641, (f 892 c-i. 
 sustain special relations to the pulmo- 
 nary mucous tissue in its morbid states 
 — illustrating the diflTerence in the 
 vital constitution of the same tissue 
 in different organs, and that remedies 
 operate through increased irritability 
 arising from disease, and according 
 to the precise modes in which they 
 
 Expectorants — continued. 
 
 may develop and modify the reflex 
 action of the nervous system, through 
 which their eflects are exerted, p. 634 
 -637, § 8924 b-d. Also, p. 62-64, () 
 136-140 ; p". 65, 66, <^ 143 ; p. 67, ^ 
 149-151 ; p. 73, i) 163 ; and Reme- 
 dies, Remedial Action, Reflex 
 Action of Nervous System, Se- 
 cretion AND Excretion, Index II. ; 
 Nervous Power, Index I. and II 
 
 all of them capable of useful or injurious 
 effects, but two only ever wanted in 
 acute pulmonic inflammation, the oth- 
 ers in chronic conditions alone, p. 634 
 -635, <J 892| b, c. 
 
 why Squill is ranked before two of the 
 non-stimulating, p. 635-636, () 8924 c. 
 
 the best eflfects, especially of the non- 
 stimulating, may or may not result 
 in expectoration, which shows the 
 alterative principle upon which reme- 
 dies operate, p. 637, () 892 d, e Also, 
 Alteratives, Index II. 
 
 the utility of bloodletting and tartarized 
 antimony in acute pulmonic inflam- 
 mation, p. 641-642, <J 892-| i. Also, 
 Pneumonia, Index II. 
 
 resolution, not expectoration, is wanted, 
 if possible, in ail cases of active pul- 
 monic inflammation , and as cough 
 depends upon a variety of pathological 
 conditions, it is a very slender guide 
 to the treatment, which should be de- 
 termined by all the symptoms as sig- 
 nificant of their exact cause or causes, 
 and it may be then found that some- 
 thing else than Expectorants are the 
 appropriate remedies, p 636-642, ^ 
 8924 d-i. Also, p. 428, () 674 a; p. 
 437-442, § 684-686 ; p. 456-460, ^ 
 695-708 ; p. 479-480, ^ 741 a, b ; p. 
 541-542, § 854 bb ; p. 548-550, () 863 
 d; p. 551-554, <!i 867-871 ; p. 572- 
 579, § 680 d-n ; p. 587, ^ 891 ^; p 
 663-665, § 897-901 ; p. 738-739, «J 
 984 c-985; p. 759, ^ 1005;; and 
 Whooping-Cough, Phthisis Pul- 
 monalis, Index II. 
 
 secreted products are a secondary result, 
 symptoms only, however much they 
 may be Nature's means of cure, and 
 may be produced by remedies of op- 
 posite virtues through their variously 
 modifying effects upon the reflex ac- 
 tion of the nervous system, and may 
 arise as well from an increase as a 
 diminution of disease, whether it occur 
 naturally or be the result of remedies, 
 p. 634, \ 8924 a ; p. 637, () 8924 d. 
 Also, p. 546-551, § 862-864, and 
 Secretion and Excretion, Reflex 
 Action of Nervous System, Reme- 
 dial Action, Index II. ; Nervous 
 Power, Index I. and II.
 
 INDEX II. 
 
 lOOo 
 
 Ether, Sulphuric. See AnjEsthetics, 
 Index II. 
 
 Fear, 
 
 demonstrates the direct development 
 and profound operation of the nerv- 
 ous influence upon the secretions, 
 contradicts all chemical and physical 
 hypotheses of operation of remedial 
 and morbific agents, and goes to es- 
 tablish the substantive existence and 
 self-acting nature of the Soul ; what 
 but the nervous influence will expound 
 the torrent of sweat, the copious flow 
 of urine, the thumping heart, the pro- 
 truded eyeballs, the ghastly and pallid 
 countenance, while convulsions and 
 purging sometimes enhance the aston- 
 ishing spectacle — all of which, too, 
 often follow upon loss of blood and 
 the operation of an emetic, and all the 
 phenomena in all the cases equally 
 due to direct or reflex action of the 
 nervous system — and also observe 
 that the sweat, the urine, the intesti- 
 nal fluids, as supplied by Fear, are 
 simple elements of the more profound 
 manifestations of the nervous system 
 in its universal excito-secretory func- 
 tion, while the corresponding results 
 from loss of blood and emetics illus- 
 trate the manner in which the nerv- 
 ous system is instrumental in chang- 
 ing the character of the secreted pro- 
 ducts, according to the manner in 
 which the nervous influence is modi- 
 fied by morbific and remedial agents, 
 p. 230-232, () 422-424 ; p. 324, () 500 
 c; p. 331, ^ 500 o; p. 332, () 501 c; 
 p. 334, {) 508-510; p. 341, -^ 514 m; 
 p. 534, § 844; p. 630-631, ^ 892 J ; 
 p. 666-669, ^ 902 b-i ; p. 703-705, () 
 943-944 b; p. 708-710, (} 951-952; 
 p. 866, () 1067 a; p. 877, () 1072 b; 
 p. 880, <^ 1074; p. 891,^077. Also, 
 Mental Emotions, Remedial Ac- 
 tion, subdivision Mental Emotions, 
 Reflex Action of Nervous System, 
 Secretion and Excretion, Loss op 
 Blood, Bloodletting, Generaliza- 
 tion of Reflex Action of Nervous 
 System, Cold, Skin, Kidney, Joy 
 AND Anger, Grief, Hope, Lovk, 
 Jealousy, Shame, Disgust, Weep- 
 ing, Laughing, Sea-Sickness, Index 
 II. ; Nervous Power, Index I. and II. 
 
 Fever, 
 
 farther distinctions between, and inflam- 
 mation — the former universal, the lat- 
 ter local — the increased heat and in- 
 creased excitement in fever owing to 
 the malady at large in the system, 
 that of inflammation to a local cause 
 
 Fever — continued. 
 
 developing a stimulating reflex action 
 of the nervous system which is greatly 
 expended upon the heart and arteries, 
 after the manner of anger, when that 
 passion develops the nervous influence 
 in a direct manner — has none of the 
 morbid products of inflammation, 
 while in the latter the constitutional 
 symptoms yield as soon as the local 
 malady gives way — begin in diflferent 
 modes ; no chill in inflammation, un- 
 less preceding the formation of an 
 abscess, and no such paroxysms, as 
 to their nature and definite intervals, 
 as in fever, unless in the analogy 
 supplied by phthisis pulmonalis — may 
 subside suddenly, unlike inflammation 
 — pulse and blood differently affected, 
 p. 64-65, (i 141-143 c ; p. 66-67, i) 
 148 ; p. 429, ^ 674 c , p. 367, ij 557 
 a; p. 444-445, (^ 688 d-ee ; p. 465- 
 467, <J 714-718 ; p. 489-490, i, 755 ; 
 p. 493, ^ 764 c ; p. 495, l^ IIQ ; p. 
 496, ^ lib ; p. 497-498, (^ 779-785 ; 
 p. 733-736, {) 974-980. Also, Ln- 
 flammation. Index I. and II. 
 
 many varieties of, and corresponding 
 names, p. 490, () 758. 
 
 is not contagious, p. 419-420, (^ 653; 
 p. 537, I) 847 d, e; p. 869, ^ 1068 b, 
 note. Also, Contagion, Index II. 
 
 compounded of paroxysms when con. 
 tinued beyond a day, p. 493-496, (} 
 765-772. 
 
 ephemera a simple type of, and descrip- 
 tion, p. 490-493, <;> 759-764. 
 
 has three stages, cold, hot, and crisis, or 
 sweating, &c., p. 430-433, I) 675 ; p. 
 491-493, () 763-764 c. 
 
 cold or formative stage, the period of 
 most intense morbid action, p. 491, ^ 
 {} 764 a ; p. 739-740, I) 986-989. 
 
 hot stage manifests the recuperative 
 tendency, and the crisis still greater, 
 p. 430-433, I) 675 ; p. 492-493, ^ 764 
 b-e ; p. 548-549, () 863 d ; p. 740, () 
 989. 
 
 secreted products advance the crisis, p. 
 450-452, () 690-693 ; p. 453-454, ^ 
 694 b, Nos. 2, 3 ; p. 471-474, (> 732- 
 733 e; p. 493, () 763 c~c ; p. 546-551, 
 () 862-864 ; p. 740, ij 989. 
 
 access, symptoms of, p. 492, ^ 764 a. 
 
 when the paroxysms take place, and in 
 obedience to a law of the constitution, 
 p. 494-496, ^768-771; p. 570, «;» 889 71. 
 
 difficult to understand the cause of defi- 
 nite intermissions, but nothing like it 
 in inflammations, p. 495, ^ 770. 
 
 irregularities in paroxysms, p. 494-496, 
 ^ 768-772. 
 
 analogies between continued, remittent, 
 and intermittent, p. 493-495, I) 76^ 
 768 ; p. 496, ^ 773, 774.
 
 1006 
 
 INDEX II. 
 
 Fever — continued. 
 
 natural duration of, p. 496, <J 774 ; p. 
 545-546, ij 861. 
 
 vegetable miasmata the predisposing 
 causes, p. 497, ^ 777 — also, among 
 the causes of inflammation, ^ 779 — 
 and of venous congestions, p. 510- 
 512,1^813-817. Also, Causes, Mor- 
 bific, and Predisposition, Index II. 
 
 pathological cause of, increased action, 
 but more especially a change in kind 
 — not "debility" nor " vitiated blood," 
 and illustrated by other things, p. 65, 
 ^ 114 6, c, p. 66, (} 148 ; p. 376-380, 
 <) 577 c-578 ; p. 464-467, ^ 712-719 ; 
 p. 498, ^ 781-785. Also, Patholog- 
 ical Cause, Index II. ; Debihty, 
 Index I 
 
 relapses of, and why, and not a new 
 fever, p. 495, () 769 ; p. 598-604, () 
 892 d-k. Also, Predisposition, 
 Vital Habit, Index II. 
 
 gives rise to inflammations, either as a 
 predisposing or exciting cause, or 
 both together, p. 438-442, () 686 b, c ; 
 p. 497-498, ^ 779-780. 
 
 special analysis of, and principles of 
 treatment, illustrative of the philoso- 
 phy of disease and operation of reme- 
 dies, and mode of investigating dis- 
 ease, p. 430-433, ^ 675-676 ; p. 438- 
 442, <) 686 b-d. Also, p. 65-66, () 143 
 c; p. 67-68, () 150-152 ; p. 73, () 163 ; 
 p. 430-433, () 675 ; p. 553-556, () 870 
 aa-872 ; p. 570-574, ^ 890 ; p. 596- 
 604, (} 892 b-kk; p. 609-611, ^ 892i 
 d-f; p. 648-652, <^ 893 g-m ; p. 713- 
 714, ^ 955 e-958 b ; p. 724-732, <J 961 
 -970 ; p. 739-740, ^ 986-989 ; p. 843, 
 ^ 1059 g. 
 Fever, Intermittent, 
 
 description of, p. 491-497, {} 761-775. 
 
 treatment of, under its various condi- 
 tions, the best and the worst, and 
 suggestive principles, p. 63, <S> 137 c, 
 d ; p. 65, () 143 b, c ; p. 430-433, ^ 
 675-676 a; p. 505, () 801 c; p. 508- 
 509, (J 809-811 ; p. 512, ^ 817; p. 
 535-539, (} 847; p. 548-551, i) 863 
 d-g; p. 552-553, ^ 868-870 aa; p. 
 570, () 889 n ; p. 597-607, ^ 892 c-r ; 
 p. 609-611, ^ 892J d-h; p. 724-732, 
 § 961-970; p. 736-739, ^ 981-985; 
 p. 740, <;> 989 ; p. 754-755, ^ 1003 ; 
 p. 757-759, <J 1005 h. 
 Fever, Jail, 
 
 treatment of, by bloodletting, p. 754, () 
 1002/ 
 Fever, Puerperal, 
 
 experience of eminent Physicians as to 
 its prompt and decisive treatment by 
 bloodletting, p. 756-757, i) 1005 b-g. 
 Also, p. 72, Table III. 
 
 question as to cathartics in, p. 849, () 
 1058 2. Also, p. 63, (} 137 d; p. 64, 
 
 Fever, Puerperal — continued. 
 
 (} 140; p. 67, I) 150-151; p. 73. § 
 165. — Opium, in. Note H p. 1117. 
 
 Fever, "Putrid," 
 
 treatment of, by bloodletting, p. 754, "J 
 1002/. 
 
 Fever, Scarlet, 
 
 treatment of, p. 843, () 1058 h. 
 
 Fever, Typhus, 
 
 pathology of, and treatment by blood- 
 letting, § 892 ? ; §1002 d, e; p. 755, 
 ^ 1004 b. Also, stimulants ^ 984 a.* 
 
 Fever, YELLovir, and Pestilential, 
 bloodletting in, p. 747-748, ^ 991 b- 
 992 c; p. 749-750, I) 993-994; p. 
 751, () 999 ; p. 753-755, ^ 1002-1004; 
 p. 869, ^ 1068 Zi; Note Ff p. 1135. 
 not contagious, p. 27, ij 52 ; p. 418-420, 
 ^ 652-653 ; p. 537, <) 847 e ; p. 869, 
 ^ 1068 b. Also, Contagion, hidex II. 
 
 Fibrin, 
 
 its formation as a coat upon blood ab- 
 stracted in inflammations, in preg- 
 nancy, cStc. — denoting, also, a greater 
 fluidity of the blood than natural, p. 
 445, ij 688 ee; p. 710, () 952 b, c. 
 Also, Pulse, Index II. 
 remarkable changes to which it is liable 
 during venesection, p. 710, ^ 952 b-f 
 — showing that no conclusions can 
 be drawn as to the relative quantity 
 of lymph in inflammatory diseases, 
 p. 711, (J 952 h. Also, p. 535-536, 
 i) 846-847 c. Also, Pulse, Index II. 
 " cannot be chemically exhibited in a 
 
 pure state," p. 780, <J 1029. 
 Simon's vital exposition of, p. 800-801, 
 <^ 1035. 
 
 Fomentations, 
 
 their modus operandi i;i relieving pain 
 and diseases. See Poultices, Heat, 
 Warm Bath, Index II. 
 
 Food — continued from Index I., 
 
 by simple contact with the stomach, 
 will, like wine, &;c., often light up 
 warmth on a cold surface, and invigo- 
 rate the muscles by the same stimu- 
 lating influence of reflected action of 
 the nervous system, and, like the 
 physiology of Respiration, and the 
 interchange of action between the 
 skin and kidneys through the same 
 medium, and like the same causation 
 which expounds the various efl'ects of 
 cold air upon internal organs, supplies 
 an elementary principle through which 
 the modus operandi of remedial and 
 morbific agents beyond the direct seat 
 of their operation may be readily un- 
 derstood to depend upon alterative in- 
 fluences of reflex action of the nervous 
 system, and through modifications of 
 that action, according to the nature 
 of the causes, whether physical or 
 mental, by which it is excited, p. 68, 
 
 ' Also, Bloodletting in, Notes S p. 1124, Ii p. 1139.
 
 INDEX II. 
 
 lOO: 
 
 Food — continued. 
 
 (}152a; p. 245, ^ 440 c ; p. 250-251, 
 § 441 c ; p. 262-263, t) 446 a ; p. 335- 
 336, ^ 512 a, b ; p. 339, () 514 h ; p. 
 565, ^ 889 ^ ; p. 579-580, () 8904 rf. 
 Also, Exercise, Friction, Heat, 
 Cold, Phthisis, Amenorrhcea, 
 Whooping-Cough, Reflex Action 
 OF Nervous System ; Causes, Mor- 
 bific ; Remedies, Remedial Action, 
 Index II. ; Nervous Power, Index 
 I. and II. 
 
 how its odor, &c., Influences the mind, 
 and contradicts the chemical and 
 physical doctrines of modus operandi 
 of remedial and morbific agents, and 
 establishes Author's theory of direct 
 development of nervous influence by 
 the Passions, and its profound in- 
 fluence upon the Secretions, p. 866, 
 ^ 1067 a ; p. 877-878, () 1072 6-1073 
 a; p. 879-882, (} 1074-1075. Also, 
 Fear, Joy and Anger, Jealousy, 
 Disgust, Love, Mental Emotions, 
 Remedial Action, subdivision Men- 
 tal Emotions ; Brain, Inflamma- 
 tion of; Secretion and Excretion, 
 Index II. ; Nervous Power, Index I. 
 and II. 
 
 what is above said of the contact of food 
 with the stomach resolves the paradox 
 of the "vomited pill of opium," and of 
 the " scarlet efflorescence," as set forth 
 at p. 673, <J 904 b ; though we may 
 bring to the aid of our interpretation 
 what is said of Idiosyncrasy at p. 384, 
 ^ 585 b. Also, Opium, Supposito- 
 ries, Heat {enemas). 
 
 some kinds poisonous to some, but salu- 
 brious to most others, owing to the 
 development of a morbific reflex action 
 of the nervous system, p. 384, <^ 685 b. 
 Also, Opium {the pill and " scarlet 
 efflorescence"), Skin (eruptions). In- 
 dex II. ; Nervous Power, Sympathy, 
 Forces, Correlation of, p. 921, "J 1085. 
 Friction, 
 
 operates through reflex nervous action 
 in relieving disease, and exemplifies 
 the modus operandi of other agents 
 applied to the skin, p. 670-671, | 902 
 m. Also, Skin, Cold, Heat, Exer- 
 cise, Food, Respiration, Phthisis, 
 
 ■ Whooping-Cough, Kidney, Index II. 
 Functions of Life — continued from In- 
 dex I, 
 
 common to animals and plants — 1, mo- 
 tion — 2, absorption — 3, assimilation — 
 4, distribution — 5, appropriation — 6, 
 excretion — 7, calorification — 8, gener- 
 ation, p. 125, i;> 249. 
 
 peculiar to animals — 1, sensation — 2, 
 sympathy — 3, voluntary motion — 4, 
 other mental and instinctive functions, 
 p. 125, ^ 250. 
 
 Functions of Life — continued. 
 
 common functions — motion, p. 126- 
 128, () 253-267— absorption, p. 128 
 -134, ^ 268-295; p. 817-824, (J 
 1053-1055 — assimilation (includ- 
 ing physiology of digestion), p 134 
 -207, () 296-373i— distribution (in- 
 cluding the powers which circulate 
 the blood), p. 207-217, () 377-399 ; 
 p. 817-824, () 1053-1055— appro- 
 priation (nutrition and secretion), 
 p. 217-227, <;» 400-411— excretion, 
 p 227-234, (} 4:l2-4r32— calorifica- 
 tion, p. 234-279, () 433-448 ; p. 807 
 -812, () lOA3-l050—!rencratwn, p 
 279-280, H19 ; p. 816-817, ^ 1052 
 b,c. 
 
 peculiar functions — sensation, p. 280 
 -283, () 450-451 — sympathy (reflex 
 action of the nervous system), p. 
 283-362, H52-530. Also, Reflex 
 Action of Nervous System, Sym- 
 pathy, Index II.; Nervous Pow- 
 er, Index I. and II. 
 
 functions relative to the mind and in- 
 stinct, p. 362, ^ 531-534; p. 876- 
 911, i} 1069-1083. 
 
 G. 
 
 Galvanism — Electricity. See I}idex I. 
 
 Gases and Fumes. See Humoral Pa- 
 thology, Anesthetics, Index II. ,- 
 Gases, Index I. 
 
 Gereralization of Reflex Action of 
 the Nervous System, 
 as the medium through which all reme- 
 dial and morbific agents exert their 
 effects upon parts beyond their direct 
 seat of action, and as universally en- 
 gaged in the excito-secretory action, 
 not only as a simple excitant, but, 
 what is far more important, as the 
 modifying cause of all deviations from 
 their natural standard, with the few 
 exceptions that attend the perfectly 
 local action of escharotics, vesicants, 
 &c., but which modify all the secre- 
 tions beyond their direct seat of opera- 
 tion through reflex action of the nerv- 
 ous system, including, also, the cor- 
 responding effects of the nervous in- 
 fluence as developed by the Passions. 
 See Medical and Physiological Com- 
 mentaries, vol. i., p. 568-574 (1840), 
 and many other places to the same 
 effect; Reflex Action of the Nerv- 
 ous System, Remedial Action, Rem- 
 edies ; Causes, Morbific ; Thera- 
 peutics, Secretion and Excretion, 
 Mental Emotions, Remedial Ac- 
 tion, subdivision Mental Emotions ; 
 Sympathy, subdivision Remote and 
 Contiguous, Index II. ; Nervous 
 Power, Index I. and II.
 
 1008 
 
 INDEX II. 
 
 Generalization, &c. — continued. 
 
 of which the following are some of 
 the illustrations of the foregoing 
 imputed eflects of direct and reflex 
 action of the nervous system : 
 Cathartics, Emetics, Bloodletting, 
 Loss of Blood, Leeching, Antispas- 
 modics, Counter-irritants, Seton, 
 Alteratives, Narcotics, Sedatives, 
 Expectorants, Diuretics, Astrin- 
 gents, Tonics and Stimulants, Mer- 
 curial Remedies, Anccsthctics, Ela- 
 terium; Antimony ,Tartarized ; To- 
 bacco ; Oil, Croton ; Hydrocyanic 
 Acid, Plasters ; Hydrophobia, Vi- 
 rus of , Predisposition to Diseases; 
 Self-limited Diseases, Co?ivulsions, 
 Phthisis, Asthma, Inflammation ; 
 Brain, Inflammation of; Amenor- 
 rhea, Hysteria, Whooping-Cough, 
 Sea- Sickness, Humoral Pathology, 
 Sphincter Muscles, Heart, Skin, 
 Cold, Heat, Warm Bath, Food, 
 Exercise, Friction, Respiration, 
 Defecation, Metastasis ; Stomach, 
 Blows upon ; Sweat, Urine, Hyber- 
 nating Animals, Joy and Anger, 
 Hope, Fear, Love, Jealousy, Grief, 
 Shame, Disgust, Laughing, Weep- 
 ing, Yawning, Roosting, Sneezing, 
 Soul and Instinct, Index II. ; Will, 
 Index I. and II. 
 Generation, Spontaneous, or Sponta- 
 NElTY of Being — continued from In- 
 dex I, 
 advocated by Physiologists, p. 86, ^ 175 
 
 d; p. 188-189, ^ 350 Z, m. 
 facts and arguments against, p. 910-911, 
 () 1083. Also, Generation, Index I. 
 a doubtful exception to the laws of the 
 organic function, p. 817, ^ 1052 c. 
 Genito-Urinary Agents, 
 
 introduced to illustrate the principles 
 on which the Author's Therapeutical 
 Arrangement of the Materia Medica is 
 based, p. 684, () 905^ a, b; p. 687-889, 
 <J 905i c. Also, p. 634-636, ij 892| b, c. 
 present a large variety of remedial vir- 
 tues, which are mostly relative to the 
 genito-urinary organs, and thus illus- 
 trate what is meant by specific action, 
 being addressed directly to these or- 
 gans, and not regarding their diseases 
 as sympathetic of derangements of 
 other parts, however much they may 
 be so, p. 687-689, () 905^ c. Also. 
 p. 62-64, () 135-138 ; p. 65, 1:j 143 «; 
 p. 66, ^ 143 d ; p. 545, <J 859 J , p. 
 584-585, iji 891 rf; p. 592, ^ 89U z,- 
 p. 623, l^ 892^ c ; p. 634, ^ 892| b. 
 Geology, Theoretical, 
 
 the Author's work upon, p. 908, (^ 1079 b. 
 
 GONORRHCEA, 
 
 its principles of treatment, p. 576, ^ 890 
 m ; p. 689, () 905^ c. 
 
 Grief, 
 
 demonstrates Author's theory of the 
 operation of remedial and morbific 
 causes through the medium of direct 
 and reflex action of the nervous sys- 
 tem, contradicts the chemical and 
 physical hypotheses, and goes to con- 
 firm Author's demonstration of the 
 substantive existence and self-acting 
 nature of the Soul, p. 326-327, (> 500 
 /, I, ] ; p. 331, i) 500 o ; p. 341, ^ 514 
 VI ; p. 534, <J 844 ; p. 630-631, (} 892i ; 
 p. 703-705, ^ 943 a, 944 b ; p. 709, ^ 
 951 c ; p. 866, ^ 1067 ; p. 877, <^ 1072 
 b; p. 880, ^ 1074. Also, Mental 
 Emotions, Remedial Action, sub- 
 division Mental Emotions, Secre- 
 tion and Excretion, Food, Joy and 
 Anger, Love, Fear, Jealousy, Hope, 
 Shame, Disgust, Laughing, Weep- 
 ing, Yawning, Roosting, Sneezing, 
 Soul and Instinct, Index II. ; Will, 
 Index I. and II. 
 
 Granulation, 
 
 evinces great Design, and involves pro- 
 found physiological laws, p. 472-475, 
 (} 733 c-f. Also, Inflammation, In- 
 dex II 
 
 H. 
 
 Hall, Marshall, and the Author. 
 
 his opinion of the cause of voluntary 
 motion, p. 77, <^ 167/. Also, Will, 
 Mental Emotions, Index II. ; Nerv- 
 ous Power, Index I. and II. 
 
 experiments on nervous system adverse- 
 ly to A. P. W. Philips, p. 306-310, ^ 
 483 i-484 — proving to have been a 
 repetition of Alston's, p. 309, No. 4. 
 
 advocates the chemical and humoral 
 hypotheses of operation of remedies 
 and secretion, but is contradicted by 
 his own experiments, p. 308, ^ 483 c ; 
 p. 342, <J 5l4i b. See, also. Medical 
 and Physiological Commentaries, vol. 
 iii.. Essay on Modus Operandi of 
 Remedies (1842), in which occurs the 
 example of the Seton, as presented 
 at p. 679-681, () 905 a of these Insti- 
 tutes ; and vol. i., p. 569-574 (1840), 
 where appears a distinct and anatomi- 
 cal exposition of the reflex action of 
 the nervous system as applied by the 
 Author to Pathology and Therapeu- 
 tics, and where he presents it in array 
 against the humoral pathology, and as 
 being all that is ever concerned in the 
 modus operandi of remedies and of 
 morbific causes (and in the example 
 of the Seton also) beyond their direct 
 seat of action — the Author being in 
 advance of the one, and, unfortunate- 
 ly, not sufficiently submissive for the 
 rest, to the chemical and humoral doc-
 
 INDEX II. 
 
 1009 
 
 Hall, Marshall — continued. 
 
 trines of the day. It may be added, 
 also, that in either of the above refer- 
 ences to the Commentaries will be 
 found, quite elaborately set forth, 
 "the gist of the whole matter," 
 Institutes, p. 814. 
 
 affirms that the sympathies in organic 
 life are owing to the mutual influences 
 of organs among each other, p. 308, 
 () 483 c. 
 
 believes "that the "spinal marrow, ex- 
 clusive of the cerebrum, is the source 
 of animal life" — and that " the irrila- 
 bilily of the muscles of organic life 
 depends probably on the ganglionic 
 sijstem," p. 296, ^ 476 1^ b. Also, p. 
 88, () 183, 184 a; p. 89, <) 188 a; p 
 100-102, () 194-202 ; p. 284-290, () 
 455-46 H. Also, objections to, in 
 Essay on Modus Operandi of Reme- 
 dies in^Iedical and Physiological 
 Commentaries, vol. iii (1842). 
 
 supposes " all convulsive affections to 
 be diseases of the true spinal or cxci- 
 to-motory system," and Author's ob- 
 jections, p. 357, () 526 d ; p. 467-468, 
 •J 719. Also, Convulsions, Hysteria, 
 Whooping-cough, Index II. 
 
 his contributions toward the laws of re- 
 flex action of nervous system, p. 290, 
 (^ 463 b. 
 
 supposes organic actions to depend upon 
 the nervous system, and not upon 
 properties inherent in all parts, p. 217, 
 () 399. Also, Vital Properties, Or- 
 ganic Life, Index I. 
 
 his experiments showing the circulation 
 of the blood independently of the sym- 
 pathetic system, p. 127, (j 233. 
 
 his opinion upon bloodletting as to rule 
 of practice, and Author's objections, 
 p. 712-713, () 955 d; p. 715, ^ 959 a. 
 Also, extended objections to, in Med- 
 ical and Physiological Commentaries, 
 vol. i., p. 216-233, p 239-271 (1840) 
 
 his opinion as to tolerance of loss of 
 blood, and Author's objections, p. 728 
 -729, ij 965. Also, critical objections 
 to, in Medical and Physiological Com- 
 mentaries, vol. i., p. 239-271 (1840). 
 
 his opinion as to "excessive reaction 
 from loss of blood," and Author's ob- 
 jections, p. 469, (J 722 d ; p. 772-776, 
 <^ 1020-1026. Also, critical objections 
 to, in Medical and Physiological Com- 
 mentaries, \o\.\.,]i 239-271. 
 Habit, Vital, 
 
 so designated and investigated by the 
 Author through a long chain of anal- 
 ogies, embracing the results attendant 
 upon natural, morbific, and remedial 
 agents, and of the mind, p. 363-370. 
 
 relates to the modifications of functions, 
 and the variations of their results as 
 
 S s 
 
 Habit, Vital — continued. 
 
 arising from the repeated or continued 
 operation of causes, and lies at the 
 foundation of some of the most im- 
 portant and comprehensive laws in 
 Medicine, p. 363, () 535 ; p. 364-369, 
 () 542-563 ; p. 532-533, '^ 841 ; p. 
 567-569, () 889 l-mm; p. 585, t) 891 
 /,- p. 648-649, § 893 g, h ; p. 675- 
 676, <J 904 b. 
 
 belongs to both plants and animals, p. 
 363, <) 536-538. 
 
 philosophy of, in organic and animal 
 life, p. 363-370, ^ 539-568 
 
 illustrated by effects of natural, reme- 
 dial, and morbific agents, p. 257-258, 
 ^ 442 b, c ; p. 364-369, () 542-563 ; 
 p. 425, ^ 064 , p. 532-533, ^ 841 ; p. 
 567-569, <) 889 /-?n77i , p 585, I) 891 
 /,- p. 648-649, (} 893 g,h; p 675- 
 676, {) 904 b; p 809, i) 1047 Also, 
 Acclimation, Index II. 
 
 manifested by the Mind and Instinctive 
 Principle, p 369-370, ^ 564-568 ; p. 
 894-895, () 1078 b. 
 
 illustrates the instability of the vital 
 properties, p. 363, ^ 541. Also, Vital 
 Properties, Index I. 
 
 generally results in diminished irrita- 
 bility, but may be the reverse, and 
 either practically important, v/ith il- 
 lustrations, p. 366-367, ij 556 a-d ; 
 p. 532-533, 1^ 841 ; p. 567-569, (} 889 
 l-mm; p. 585, iji 891 /". 
 
 always relative to impressions, niore or 
 less durable, upon the vital, mental, 
 or instinctive constitution, p. 363, (J 
 540 ; p. 894-895, ^ 1078 b. 
 
 liable to obtain under the repeated or 
 continued operation of almost all 
 agents capable of affecting the vital 
 or mental properties, p. 364, i) 543. 
 
 through which miasmata, tobacco, crude 
 food, &c., cease to be injurious, p. 364, 
 <S) 544. Also, Acclimation, Index II. 
 
 or may obtain from one apphcation of 
 particular causes, so as to render them 
 inoperative afterward, p. 364, (ji 545. 
 
 lessens or increases the susceptihility 
 of organs to the action of remedies, 
 p. 364, ^ 546 ; p. 532-533, () 841 , p. 
 542, <;. 854 c, d; p. 66.5, <J 901. 
 
 demonstrates the operation of remedies 
 and morbific causes by alterative in- 
 fluence of reflex action of the nervous 
 system, p. 364, (J 547 ; p. 532-533, (^ 
 841 ; p. 649, ^ 893 h. 
 
 its effects generally most prominent in 
 organic life when causes are long in 
 operation — a law of great practical 
 bearing, p. 364, (J) 548 a, b 
 
 not much applicable to food and other 
 perfectly natural stimuli — showing 
 Design ; though some kinds liable to, 
 p. 364-365, i) 548^^ a, b. 
 s
 
 1010 
 
 INDEX II. 
 
 Habit, Vital — continued. 
 
 follows, in respect to morbific and reme- 
 dial agents, the law which governs the 
 relative duration of disease when pro- 
 duced by remedies and truly morbific 
 causes, p. 365, <^ 549-554 ; p. 366, ^ 
 555; p 542, 1^854 c-rf, p. 665, (^901. 
 Also, Cantharides, Counter-Irri- 
 TANTs, Index II 
 
 illustrated by the tolerance of frequently- 
 repeated and increased doses of medi- 
 cines, and its subsidence on their sus- 
 pension for a short time, p. 364, <^ 543 ; 
 p 365, {} 551, 552 , p. 532-533, i) 841 , 
 p 569, ^ 889 mm ; p. 649, ^ 893 h. 
 
 its effects vary according to the exact 
 nature of its causes, p 366. <J 553. 
 
 allied to the principle which lies at the 
 foundation of disease and its cure, p 
 
 366, ij 555 , p 542, <J 854 c-f 
 liable to be influenced by accidental 
 
 causes, and to thus affect the treat- 
 ment of disease, with examples, p 
 
 367, ^ 556 rf-557. 
 
 embraces the cumulative effect of reme- 
 dies, and predisposition to disease, 
 with illustrations, p. 368, <^ 558 a, b, 
 559 ; p 568-569, 6 889 m , p 669- 
 670, ^ 902 I ; p. 675-676, <J 904 b 
 A'so, Predisposition, Remedies, In- 
 dex II. 
 
 relates to the tenacity of many diseases, 
 p 368, 1^ 560 — and to many acquired 
 natural habits of the constitution, () 
 561 — and to luxuries and customs, (} 
 539 a, 543, 548^ b, 562— and to the 
 periodical desire of food, and many 
 little usages, (} 563 — and to the culture 
 of the mind, or of any mental faculty 
 at the expense of others, and to its 
 enjoyments, and to the senses, and 
 to the voluntary muscles, <^ 543, 564- 
 567 — and to analogies between cer- 
 tain special injuries in organic life 
 and o/ the mind, p 370, <5i 568 ; p. 
 894, (J 1078 i 
 Heart See Heart and Arteries, In- 
 dex I., 
 
 constantly influenced, and tlie arteries 
 also, in all diseases, by reflex action 
 of the nervous system, and the pulse 
 is felt simply for the purpose of ascer- 
 taining the extent and nature of these 
 influences, and of thus arriving at the 
 nature and extent of the remote affec- 
 tion, while, also, the heart and arteries 
 do not often fall under the alterative 
 influence of the reflex action so far as 
 to produce disease — employed by the 
 Author, along with many other anal- 
 ogous things, to illustrate the reflex 
 action of the nervous system as the 
 immediate cause of diseases and their 
 cure through its alterative influences 
 upon the organic states, beyond the 
 
 Heart — continued. 
 
 direct seat of operation of remedial 
 and morbific causes — the nervous in- 
 fluence being rendered variously al- 
 terative, or simply stimulating or 
 sedative, according to the nature of 
 the causes by which it is brought 
 into any increased or preternatural 
 operation, p. 301-310, () 480-485 ; p. 
 355-356, (} 526 a, b ; p 443-448, <j 
 687^-688; ^ 714, 715, 961 a. 
 its highly irritable nature employed by 
 the Author to prove that remedies do 
 not operate by absorption, since the 
 most powerful, when swallowed, act 
 mostly upon other parts, and do not 
 often affect the heart, except by re- 
 ducing diseases upon whose morbif- 
 ic reflex nervous influences the dis- 
 turbances of the heart depend, <) 500 
 m, 687i, 694J, 826 cc, 829, 893 c, 
 p, 904 C--905 a, 973-»5, 1024. 
 
 Heat — continued from Index I., 
 applied to the surface, or intestinal canal, 
 by stomach or rectum, and, wliether 
 dry or moist, illustrates, like Cold, 
 the operation of remedies and mor- 
 bific causes through alterative in- 
 fluence of reflex action of the nervous 
 system, and supplies, in its varieties, 
 whether dry or moist, and the different 
 temperatures, from 98° to 120° Fah., 
 a critical illustration of the modifica- 
 tions which the reflex influence un- 
 dergoes, and through the manner in 
 which it impresses organs favorably 
 or unfavorably, according to their ex- 
 isting susceptibilities, and according 
 to the degree or kind of heat ; illus- 
 trates, also, the modus operandi of 
 remedial and morbific agents through 
 the same alterative reflex nervous in- 
 fluence, and equally according to the 
 nature and intensity of the agents, 
 and that, although closely allied, our 
 remedies may be curative or morbific 
 according to their exact nature and 
 dose, p. 246, () 440 c; p 253, l)Aild; 
 p. 351, i) 524 a ; p. 589, (J 891 p ; p. 
 681-683, ^ 905 a. Also, Warm 
 Bath, Cold, Skin, Friction, Food, 
 Exercise, Respiration, Cathartics, 
 Emetics, Index II. 
 operates in raising the temperature of 
 the surface as a stimulus of organic 
 actions, and without the agency of 
 the nervous system, but will not so 
 influence the reflex action of the 
 nervous system as to raise the tem- 
 perature of internal organs, nor will 
 cold reduce it unless it impair their 
 functions — a remarkable evidence of 
 Design when contrasted with theman- 
 ner in which Croton oil, and leeching 
 the anus, will develop a powerful re-
 
 INDEX II. 
 
 1011 
 
 Heat — continued. 
 
 flex nervous influence through the 
 mere propagation oi continuous sym- 
 pathy along the mucous tract of the 
 intestine, p. 249-250, s^ 441 c; p. 
 256-259, ^ 44H-442 c; p. 809-812, 
 <J 1046-1050. Also, Organic Heat, 
 Index I. and 11. ; Hybernating Ani- 
 mals ; Oil, Croton; Leeching, Sup- 
 positories, SvMPATHY, subdivision 
 continuous, Index II. 
 simple warm water, as an enema, among 
 a multitude of analogies in these In- 
 stitutes, by its development of a stim- 
 ulating reflex action, and its determ- 
 ination of an exciting effect upon the 
 muscular coat of the intestine and ab-* 
 dominal muscles, shows that if Croton 
 Oil, or other cathartic, be added to the 
 water, the alterative eflects of the lat- 
 ter upon remote diseases is through 
 the same reflex influence, now modi- 
 fied by the nature of the added cathar- 
 tic, and carried by the iVuthor to the 
 interpretation of all remedial and mor- 
 bific agents beyond their direct seat of 
 operation through alterative influences 
 of reflex action of nervous system, 
 ibid., and Suppositories, Opium {the 
 J3J//,&c.),Reflex Action OF Nervous 
 System, Remedial Action, Index II.; 
 Nervous Power, Sympathy, Lidex I. 
 and II. 
 
 Heat, Animal. See Organic Heat, hidex 
 I. and II. 
 
 Hemorrhage, Spontaneous, 
 
 philosophy of, practically very important 
 — not owing to ruptured vessels, but 
 morbid vascular action, p. 507, ^ 805 ; 
 p. 509, <J 812 ; p. 533, () 842 ; p. 572, 
 i)Q^Oa-h; p. 694, .J 922 ; p. 738-739, 
 ^984c-985; p. 770-772,'^ 1018-1019. 
 Also, Medical and Physiological 
 Commentaries, Article Pathology of 
 Cerebral Hemorrhage, vol. i., p. 371- 
 384 ; Article Spontaneous Hemor- 
 rhage, vol. ii., p. 546-550. 
 if what the Author has said of the phys- 
 iology of Bloodletting and Leeching 
 be founded in nature, it is obvious 
 that the foregoing comparative safety 
 of spontaneous hemorrhage must de- 
 pend upon a comparatively milder 
 development of the nervous influence 
 when Nature institutes the loss of 
 blood, p. 694, ^ 922 6— and the inter- 
 pretation is farther confirmed by the 
 comparatively slight prostration that 
 results from the drain in malignant 
 cholera, prolonged diarrhoea, abscess- 
 es, mennorrhagia, &c., with such as is 
 brought about by the continued use of 
 the mildest purgatives, 
 nature's mode of cure, and often suc- 
 cessfully in such quantities as cannot 
 
 Hemorrhage, Spontaneous — continued. 
 be iniitated by art, and in such ad- 
 vanced stages of disease that blood- 
 letting is inadmissible, p. 471-472, () 
 732 ; p 507, ^ 805 ; p. 550. ^ 863/; 
 p. 573-575, {) 890 e-/, p 770-772, 
 ^ 1019; NoTEsFFp. 1135,Iip. 1139. 
 
 Nature, therefore, concurs with expe- 
 rience in protesting against the use 
 of Astringents to restrain this natural 
 means of cure, unless proceeding to 
 an alarming excess, p. 573-575, (} 
 890 a-h; p. 771-772, <J 1019 g, h. 
 Also, " Debility," Index I. and II. 
 
 nevertheless, when practicable, as in 
 the early stages of disease, and if the 
 hemorrhage proceed from an import- 
 ant organ, the pathological condition 
 should not be left to Nature, but Art 
 should interfere with its direct Anti- 
 phlogistics, especially Bloodletting, 
 Tartarized Antimony, and Vesicants, 
 and this particularly in pulmonary 
 hemorrhage. See foregoing refer- 
 ences, and Expectorants, Astrin- 
 gents, Pneumonia, Index II. 
 
 all preternatural eff*usions are designed 
 for useful ends, and form some of the 
 most remarkable examples of Design. 
 If they take place within cavities or 
 the structure of organs, it is still the 
 same, nor does Nature depart from 
 any great law for the sake of special 
 exigencies, p. 471-476, () 732 i-733 ; 
 p. 546-547, ii 862-863 rf; p. 550-551, 
 \ 863 e-864. 
 Hiccough, 
 
 introduced to illustrate the coincidences 
 which attend the operation of the 
 nervous influence, whether brought 
 into action by the mind or by physical 
 causes — presenting an example of a 
 paroxysm brought on by a sense of 
 choking, which was evidently the re- 
 sult of reflex nervous action induced 
 by gastric derangement, and which 
 had the efi*ect of exciting through 
 mental sympathy the same condition 
 in three others that antispasmodics 
 failed of removing, but which was 
 overcome in all the cases by a mustard 
 emetic — thus illustrating, as in hys- 
 teria, the modus operandi of an emetic 
 in arresting the paroxysms through 
 the development of another series of 
 reflex actions and the introduction of 
 movements in other associated mus- 
 cles, though most successfully in the 
 mental cases whose causes were more 
 transient — and illustrating the differ- 
 ence in the modes in which antispas- 
 modics and emetics relieve spasmodic 
 affections through the agency of reflex 
 action of the nervous system, and the 
 differences among other things to the
 
 loi; 
 
 INDEX II. 
 
 Hiccough — continued. 
 
 same effect (as may be seen in the 
 references below) — and illustrative 
 of the delicate shades in variety in 
 which mental emotions modify the 
 nervous influence, and how, through 
 their medium, the mere disgust aris- 
 ing from the thought of taking an 
 emetic will develop the nervous in- 
 fluence so as to stop a paroxysm of 
 hysteria without vomiting, and con- 
 trasted with the effect of an emetic 
 in overcoming the same, and vv'ilh 
 the united effect of disgust in other 
 cases as brought on by the recollection 
 of a former occurrence of the same 
 nature — while the whole, in all its 
 wonderful relations to the mind in 
 its endless variety of demonstrations 
 upon the organic mechanism through 
 its direct development and diversified 
 modifications of the nervous influence, 
 and the perfect correspondence in these 
 respects with the effects of physical 
 agents applied to the nervous centres, 
 or as they may be affected by disease, 
 and thusdevelopthe nervous influence 
 in a direct manner, or as other physical 
 causes give rise to reflex action, and, 
 in all the cases, modify the nervous 
 influence in a manner analogous to 
 the various mental emotions, not only 
 reflect a flood of light upon the modus 
 operandi of all morbific and remedial 
 agents, but, through the foregoing 
 analogies between the mental and 
 physical causes, declare the substan- 
 tive existence and self-acting nature 
 oftheSoM/,p. 337-338, ^ 514 c. Also, 
 Hysteria and Hiccough, Convul- 
 sions, Whooping-Cough, Antispas- 
 modics, Emetics, Disgust, Fear, 
 Mental Emotions, Soul and In- 
 stinct, Remedial Action, Reflex 
 Action, Index 11. ; Nervous Power, 
 Sympathy, Index I. and II. 
 
 Hope, 
 
 " cheer up the patient, and he is sure 
 to do well," or, as Hippocrates has it, 
 " he docth the best cures in whom 
 most trust" — who can mistake an an- 
 tagonistic substantive cause — some- 
 thing more than imaginary — acting in 
 opposition to itself, when grief, dis- 
 appointment, despondency, despair, 
 lay deeply the foundations of disease, 
 but rarely too deeply for the mastery 
 of Hope — who can mistake a common 
 substantive, self-acting agent, known 
 as the Soul, which develops and jnodi- 
 fies, according to the nature of each 
 emotion, another agent known as the 
 nervous power, or nervous influence 
 (no matter which), upon whose altera- 
 tive efl'ccts, and as it may bo rendered 
 
 Hope — continued. 
 
 morbific or curative by the Spiritual 
 part, all the astonishing variety de- 
 pends ; and who so unjust to his rea- 
 son as not to concede an exact analogy 
 between the modus operandi of these 
 and other emotions, and of all physical 
 causes, whether morbific or remedial, 
 and thus embrace the operation of the 
 whole under a common philosophy — ■ 
 or, reasoning from the latter to the 
 former, equally concede the instru- 
 mentality of the nervous influence in 
 the former case, and its development 
 by an agent of the same substantive 
 existence as the physical causes, p. 
 
 ' 107-111,15.227-2331; p. 324, ^ 500 c; 
 p. 326, () 500 g; p. 327, ^ 500;; p. 
 333, ^ 503 ; p. 534, «J 844 ; p. 661- 
 664, ^ 894 5-900 ; p. 667, <J 904 c ; 
 p 865-868, ^ 1007; p. 879-882, ^ 
 1074-1075; p. 886-891, () 1077. 
 Also, Mental Emotions, Grief, Joy 
 AND Anger, Love, Jealousy, Weep- 
 ing, Shame, Disgust, Fear, Food, 
 Hunger, Thirst, Respiration, Ex- 
 ercise, Skin, Cold, Heat, Convul- 
 sions, Antispasmodics, Seton ; 
 Causes, Morbific ; Remedies, Ca- 
 thartics, Emetics, Remedial Ac- 
 tion, Soul and Instinct, Index II. 
 
 Humboldt — generalizations, p. 923-926. 
 
 Humoral Pathology — See Humoralism, 
 Index I.) 
 inconsistent opinions of its intelligent 
 Advocates, p. 156-173, parallel col- 
 timns ; p. 514-515, parallel columns ; 
 p. 519, ij 825 ; p. 520, () 826 c ; p. 754, 
 I 1002/; p. 755,^ 1004 c. 
 Author's motives for the inquiry, p. 515, 
 
 illustrates propensity for simple views 
 in Medicine, p. 516, <) 820 c. 
 
 an old affair, p. 516, () 820 c. 
 
 the doctrine stated, p. 516-517, ^ 821 b. 
 
 its eleven special points, which are pro- 
 posed to be investigated and examined 
 in order, p. 518-519, ^ 823-824. 
 
 arguments in behalf of, drawn fromyeast, 
 putrid herrings, spoiled sausages, pu- 
 trid urine, putrid cheese, putrid brain, 
 and cold meat, p. 172-173, Nos. 44, 
 45, parallel columns ; p. 517, () 821 c ; 
 p. 528, () 832-835. 
 
 argument from " hereditary impurities" 
 and "impoverished blood," p. 52'J, (J 
 836. 
 
 argument from remedies injected into 
 circulation, p. 529-530, ^ 837 a, b ; 
 p. 677, '^ 904 c ; p- 932, (j 1088 d. 
 
 argument from Astringents and Tonics, 
 p. 533, {) 842. 
 
 general argument from putridity, p. 533, 
 ^ 843. 
 
 curious inductions from injcclionr. of
 
 INDEX 11. 
 
 1013 
 
 Humoral Pathology — continued. 
 
 morbific matters into the circulation, 
 and examined, p. 527-528, () 830-831. 
 action of poisons inserted in wounds, 
 aorainst Humoralism, with examples, 
 and other illustrations, p. 319-321, ^ 
 494 b-e ; p. 525-526, ^ 828 a-c, and 
 references there ; p. 526, () 828 d. 
 Also, Hydrophobia, Virus of, Index 
 II. 
 
 deleterious agents and remedies not ab- 
 sorbed, unless they first inflict disease 
 upon the absorbing vessels, and then, 
 if at all, but sparingly, and quickly 
 carried off by kidneys, p. 99, () 192 ; 
 p. 129-134, *;. 277-295 ; p. 230, <J 422 
 b; p. 519-521, (i 826-827,1088-1089. 
 
 their absorption disproved by the refusal 
 of the absorbents to admit bile, intes- 
 tinal acids, and all other things that 
 may undergo fermentation in the in- 
 testine, urine, &c., p. 62-63, <J 136- 
 " 137; and ut supra. Also, Absorp- 
 tion, Index I. Also, p. 932, ^ 1089. 
 
 false conclusions from the absorption of 
 nitrate of silver, acetate of lead, &c., 
 since they become soon converted in- 
 to inert compounds in the alimentary 
 canal, p. 530, ^ 837 c. 
 
 how do sulphuric acid and acetate of 
 lead arrest the night-sweats of pul- 
 monary phthisis^ Ask the Chemist 
 what is their condition when he mixes 
 them with blood, p. 530, <J 837 c ; p. 
 . 577, ^ 890 0. 
 
 many poisons applied to wounds produce 
 no effect upon surfaces, and inflict 
 their constitutional effects, in the for- 
 mer case, through alterative influence 
 of reflex action of nervous system, 
 unless violently forced into the torrent 
 of blood ; and here the Author ad- 
 monishes against confounding experi- 
 ments upon nerves with those upon 
 their expanded extremities, p. 520- 
 521, ij 826 d; p. 525, ^ 828 a. 
 
 contrast between effects of poisons as 
 applied to different surfaces and as 
 inserted in wounds, p. 520-521, ij 
 826 d. 
 
 eminent Chemists do not agree in the 
 least in regard to absorption of some 
 important remedies, and others are 
 receding, p. 520, () 826 ; p. 779-782, 
 ^ 1028-1030 ; p. 783-784, <J 1031 b; 
 p. 787, ^ 1032 a; p. 794, ^ 1033 a. 
 
 absorption of morbific and remedial 
 agents disproved in those instances 
 where their effects are enduring or 
 long delayed, as the hydrophobic vi- 
 rus, miasmata, mercurials, by the fre- 
 quent renewal of the blood, p. 520, ^ 
 826 b ; p. 677, () 904 c. 
 
 absorption of violent agents disproved 
 by their failure to act upon the highly 
 
 Humoral Pathology — continued. 
 
 irritable heart when they act with vio- 
 lence upon other organs, p. 527, () 829. 
 
 if admitted that the causes of disease 
 and means of cure be absorbed (whose 
 nature is sufficiently material), it be- 
 longs to Vital Solidism alone to ex- 
 plain their modus operandi, () 284, 
 827/, 904 c, 1033 b. 
 
 v;hat mental emotions say to it, p. 534. 
 (} 844. Also, Mental Emotions, the 
 several individual Passions, Skin, 
 Cold, Heat, Food, Friction, Exer- 
 cise, Phthisis, Whooping-Cough, 
 Seton, and other analogous things. 
 Index II. 
 
 Andral's doctrine of primary changes in 
 the blood refuted by a fundamental 
 law, p. 535-538, () 846-847. 
 
 nothing can make healthy blood but 
 the healthy action of the solids, 
 and, did the blood take the initiatory 
 step in disease, there could be no re- 
 covery, p. 535-539, ^ 846-847, 
 
 a great fundamental law in a universal 
 adaptation of blood and secreted pro- 
 ducts, however morbidly changed, to 
 all parts of the organism respectively, 
 by which they are rendered inoffensive 
 to the respective parts, p. 62-63, <J 136 
 -137 c ; p. 536-.539, (} 847 e-850. Al- 
 so, p. 62-63, () 136, 137, Adaptation, 
 Law of. Index I. A\?o, p. 146 § 328. 
 
 dependence of all morbid products, in 
 each instance, upon special physio- 
 logical changes, fatal to Humoralism, 
 p. 479, iji 741. Also, Secretion and 
 Excretion, Index II 
 
 Author resolves the whole chaos of the 
 Humoral Pathology into a system of 
 grand Designs, through the applica- 
 tion of the natural organic functions, 
 and alterative influence of direct and 
 reflex action of the nervous system, 
 and which he has equally applied to 
 all the problems in Pathology and 
 Therapeutics, and to all the philoso- 
 phy involved in the modus operandi 
 of morbific and remedial agents, both 
 physical and mental, p. 519-521, ^S 
 826 a, b, d; p. 523, <J 827 b, c; p. 
 525-527, () 828-829 ; p. 530, ^ 837 
 b ; p. 532-533, ^ 841 ; p. 534, (J 844 ; 
 p. 538, 539, ^ 847 g, 848. See Medi- 
 cal and Physiological Commcntancs, 
 vol. i., p. 569-574 (1840), where occurs 
 a distinct and anatomical exposition 
 of the reflex action of the nervous sys- 
 tem, which the Author there arra3's 
 against the doctrines in Humoralism. 
 Also, Institutes, Pathology, Reflex 
 Action OF Nervous System; Causes, 
 Morbific ; Remedies, Remedial Ac- 
 tion, Therapeutics, Seton, Coun- 
 ter-Ireitants, Mental Emotions.
 
 1014 
 
 INDEX II. 
 
 Humoral Pathology — continued. 
 
 the individual Passions, Exercise, 
 Food, Suppositories, Bloodletting, 
 Leeching, Skin, Cold, Heat, Fric- 
 tion, Convulsions, Respiration, 
 Cathartics, Emetics, &;c.. Index II.; 
 
 contradicted by physiological laws, () 
 284, 285, 639, 674-676, 822, 829, 
 835, 839, 847-851, 863 e, 889 a-f, n. 
 
 supposed absorption of certain gases 
 and fumes refuted, and shown to 
 operate through reflex action of the 
 nervous system, p. 320, (} 494 dd ; p. 
 521-525, () 827 ; p. 862-864, (} 1 066— 
 Liebig's hypotheses of, p. 175-176, 
 ^ 350^ n-p. Also, Anesthetics, 
 Hydrocyanic Acid, Index II. 
 
 miasmata produce disease through alter- 
 ative influence of reflex action of the 
 nervous system, p. 522-524, () 827 
 b-e. Also, Predisposition, Causes, 
 Morbific; Hydrophobia, Virus of ; 
 Seton, Alteratives, Anesthetics, 
 and the preceding references to In. II. 
 
 morbific blood should produce no local, 
 but universal disease, p. 539, ij) 847 A. 
 
 a great and prevailing error to confound 
 the altered states of the blood with the 
 pathology ofdisease, or with the causes 
 of disease, which is owing as much to 
 morbid influences of the solids as are 
 the morbid products of the liver, or of 
 otherparts — beingon common ground 
 in all the cases as merely efl^ects or 
 f ymptoms, and all referable to altera- 
 tive influence of direct or reflex action 
 of the nervous system beyond the di- 
 rect seat of operation of any physical 
 agent, p. 478-480, () 740 ; p. 551, ^ 
 839 ; p. 535-539, ij 847. Also, Se- 
 cretion AND Excretion, Index II. 
 
 reasons why the blood cannot be medi- 
 cated, p. 531-533, () 838-841 ; p. 535 
 -539, () 846-847; p. U7, § 330. 
 
 illustrations from Tartarized Antimony 
 and other remedies, p. 530, () 837 c ; 
 p. 531-532, <J 840, 841 ; p. 533, (;- 842. 
 
 its special objects in the treatment ofdis- 
 ease, and the difference in the practical 
 habits of the Hunioralist and the Vital 
 Solidist, p. 356, i) 526 c ; p. 540, ^ 851 ; 
 p. 550, ^863 e 
 Hunger, 
 
 like the exciting cause of Respiration, 
 a Seton, Cold, &c., incapable of being 
 "absorbed" — associated with the 
 physiology of respiration and the in- 
 fluences of food in developing a reflex 
 action of the nervous system, to illus- 
 trate the modus operandi of morbific 
 and remedial agents upon parts beyond 
 their direct scat of operation through 
 an alterative influence of the reflex 
 action corresponding with the nature 
 of the exciting causes — the analogies 
 
 Hunger — continued. 
 
 being, that in respiration the point of 
 departure for the reflex nervous in- 
 fluence is the mucous tissue of the 
 lungs, and that of food, in the examples 
 presented, and of hunger, the mucous 
 tissue of the stomach, while all the 
 remote influences of either are con- 
 ducted through the nervous system, 
 but with the difference that the reflex 
 action of the nervous system, in the 
 case of respiration and food, is natural 
 and salutary, while in that of hunger, 
 when prolonged, it is morbific — and 
 the analogies between the examples 
 of food and hunger are farther con- 
 tinued in their equal development of 
 reflex action of the nervous system 
 and in the co-operation of mental 
 emotions that develop a direct nerv- 
 ous influence, which, in one case, 
 falls upon the salivary glands with a 
 salutary effect, while it is morbific in 
 the other, and by which is also illus- 
 trated the modifications which the 
 nervous influence undergoes accord- 
 ing to the nature of the causes which 
 bring it into operation. See Food, 
 Thirst, Reflex Action of Nervous 
 System, Remedial Action, Mental 
 Emotions, the individual Passions, 
 Skin, Cold, Heat, Disgust, Seton, 
 &c., Index II. ; Nervous Power, 
 Sympathy, Index I. and II. 
 
 Hybernating Animals, 
 
 employed to illustrate the philosophy of 
 animal heat as a secreted product, and 
 in connexion with reflex action of the 
 nervous system, p. 249, <^ 441 c; p.« 
 253, i) 441 d; p 255-256, () 44U a; 
 p. 257, () 442 a ; p. 262-263, <) 446 a ; 
 p. 264-265, () 446 d, 447 a ; p. 332, 
 ^500o. Also, Organic Heat, /nrfez 
 I. and II. 
 show how intense cold, or merely prick- 
 ing, may develop in animals of a pecu- 
 liar constitution a reflex nervous in- 
 fluence that shall prove a stimulus to 
 organic functions, and speedily exalt 
 the temperature of the entire body 
 from 39° to 97° F.— and thus show- 
 ing, also, that animal heat is on com- 
 mon ground with other secretions, p. 
 249, {j 441 c ; p. 253, (/ 441 d ; p. 262- 
 263, ^ 446 a ; p. 264-265, i) 446 d, 
 447 a. Also, Heat, Cold, Skin, Index 
 II ; Vital Properties, Index I. 
 
 Hybrid Animals — continued from Index 
 I, 
 why incapable of procreating, p. 86, ij 
 1052 h. 
 
 Hydrocyanic Acid,Nux Vomica, Strych- 
 nia, 
 exert their destructive effects through 
 reflex action of the nei^'ous system, *
 
 INDEX II. 
 
 1015 
 
 Hydrocyanic Acid, &c. — continued. 
 
 to which they impart a pernicious 
 modification ; and compared with 
 other things, p. 176, (j 350^ -p; p. 
 296, <;. 176 c; p. 298, () 476^ h; p. 
 318-320, () 493 rf-494 dd; p. 323- 
 324, i) 500 c ; p. 334, (^t 509 ; p 368, 
 ^ 558 a, b; p. 481, «^ 743; p. 521, () 
 826 d; p. 523, <J 827 c, <f; p. 525- 
 526, ^ 828 a-c ; p. 672-675, i) 904 i ; 
 p. 706, () 946 i. Also, Remedial 
 Action, Reflex Action, Antispas- 
 modics, Index II. ; Nervous Power, 
 Sympathy, Index I. and II. 
 
 when fatal in man, indistinguishable in 
 the blood or organization, p. 672, ^ 
 904 b. 
 Hydrophobia, Virus of, 
 
 its morbific effects propagated from bit- 
 ten part through alterative influence 
 of reflex action of the nervous system, 
 to which it imparts a pernicious modi- 
 fication ; and compared with other 
 things, p. 66-67, (} 148 ; p. 333, (> 503, 
 506; p. 344, iji 516 rf. No. 6 ; p. 356, 
 ^526c; p. 368-369, 1^ 558-561 ; p. 
 421-423, {) 654 J-659 a; p. 520, i) 
 826 b; p. 523, t) 827 b, c; p. 525, ^ 
 828 a; p. 526, <) 828 d; p. 661-663, 
 (J 894-896 ; p. 666-670, I) 902 b-m ,■ 
 p. 679-681, ^ 905 a. Also, Medical 
 and Physiological Commentaries, vol. 
 i., p. 494-513; p. 569-574 (1840), 
 where the alterative influence of reflex 
 action of the nervous system is fully 
 applied to this problem. This opinion is 
 confirmed by observations made many 
 years after the Author's exposition. 
 
 the disease admits of a great loss of blood 
 on account of a powerfully stimulating 
 nervous influence determined upon 
 the vascular system, p. 733-734, ^ 
 974 c-976 a. Also, Inflammation ; 
 Brain, Inflammation of ; Blood- 
 letting, Index II. ; Nervous Power, 
 Index I. and II. 
 
 the only morbid animal poison that is 
 not a new formation, and its morbific 
 power limited to the canine and feline 
 tribes, though all animals are liable to 
 its profound influences. The disease 
 supposed by many to occur spontane- 
 ously in man, p. 421, <^ 654 b. Also, 
 Medical and Physiological Comment- 
 aries, vol. i., p. 498-506. 
 Hysteria and Hiccough, 
 
 depend upon reflex action of the nervous 
 system, which commonly has its point 
 of departure in the former affection 
 from the uterine system, and in the 
 latter from the mucous tissue of the 
 stomach, though an emotion of the 
 mind may determine both, even on 
 witnessing this affection in others, as 
 in yawning, through its direct devel- 
 
 Hysteria and Hiccough — tontinuci^. 
 
 opment of the nervous influence — 
 relieved by emetics, which, by intro- 
 ducing a new development of reflex 
 action of the nervous system, and 
 directing its influence upon other 
 muscles, breaks up the paroxysm — 
 showing, also, how readily simple 
 irritations of the nervous centres will 
 produce convulsions, whether through 
 direct development of the nervous in- 
 fluence by mental emotions, or by re- 
 flex action of the nervous system, as 
 in teething, intestinal troubles, dtc, 
 while diseases of the brain and of the 
 spinal cord do not often give rise to 
 them unless they result in effusion or 
 disorganization, p. Ill, (^ 233| ; p. 
 326, ^ 500 g-, p. 337-338, «J 514 c, rf; 
 p. 358, () 526 c. Continued under 
 Hiccough, Index II. Also, Convul- 
 sions, Antispasmodics, Whooping- 
 CouGH, Mental Emotions, hidex II. 
 
 I. 
 
 Idiosyncrasy, 
 
 depends, particularly, upon a special 
 modification of irritability, through 
 which certain medicines, or certain 
 doses of medicine, some kinds of food, 
 and certain mental emotions, and other 
 things (all on common ground), will 
 act with violence, or prove morbific, 
 when they would exert no effect upon 
 others — all depending upon their de- 
 velopment of a morbific influence of 
 direct or reflex action of the nervous 
 system, and going with the rest of our 
 subjects to illustrate the philosophy 
 of life, the modus operandi of all mor- 
 bific and remedial causes, physical 
 and mental, through the agency of 
 direct or reflex nervous influences, 
 and, as it respects the mental causes, 
 to substantiate the substantive exist- 
 ence and self-acting nature of the 
 S.oul, p. 384, ^ 585 b; p. 631-632, ij 
 8921 b, c. Also, Opium (the ''fill," 
 and " scarlet efflorescence''') ; Causes, 
 Morbific ; Food, Mental Emotions, 
 Soul and Instinct, Fear, Index II,- 
 
 Ignorance in Medicine, 
 
 confessions of, when excusable and 
 laudable, i) 904 c, 905J. 
 
 Imagination — continued from Index I., 
 on common ground with the mental 
 emotions as it respects its influence 
 in organic life, and the prolific parent 
 of a great variety of modifications of 
 the latter — exemplifying the appa- 
 rently endless variety in contrasts 
 and near affinities in the modified 
 conditions of the nervous influence 
 as developed by one emotion or an"
 
 1016 
 
 INDEX II. 
 
 Imagination — continued. 
 
 other, according to its nature, inten- 
 sity, concurring causes, &c., p. 631- 
 632, ^ 892i b, c — and to what is there 
 said, it may be worth adding that I 
 know an individual who is purged by 
 the disgust at the supposed neces- 
 sity of taking a cathartic. Also, 
 Mental Emotions, the individual 
 Passions, Bloodletting, Remedial 
 Action, Soul and Instinctive Prin- 
 ciple, Index II. ; Nervous Power, 
 I?idex I. and II. 
 Infancy, 
 
 extends from birth to end of first denti- 
 tion, p. 373, () 576. a — its various 
 charcLCteristics, physical and mental, 
 (} 576 b, c — diseases of, correspond 
 with mutations in structure and other 
 physiological characteristics, and ex- 
 amples, p 576 d — and require corre- 
 sponding modifications of treatment, 
 with illustrations, p 375, () 576 e ; p. 
 766-768, <) 1009-1013. Also, Age, 
 Index II 
 
 its numerous peculiarities, in connex- 
 ion with those which are incident to 
 Youth, illustrate the changes which 
 organs undergo in their vital consti- 
 tution, and exemplify the Author's 
 doctrines relative to Irritability and 
 the changeable nature of the Proper- 
 ties of Life, and invite the ingenuity 
 of the. Chemical Interpreter, p. 374- 
 375, () 576 c-f; p. 376-380, <J 578. 
 Also, Irritability, Vital Proper- 
 ties, Vital Principle, Organic Life, 
 Index I. ; Structure, Index II. 
 Infants, Cholera of. See Diarrhoea, 
 
 Index II. 
 Inflammation — continued from Index I., 
 
 distinct from Idiopathic Fever, and how 
 distinguished, p. 64-65, (f 143 e; p. 
 63-67, ^ 148 ; p. 70-73, the Tables; 
 p. 367, i) 557 a ; p. 444-445, () 688 
 d-ee ; p. 464, () 712 ; p. 466, ^ 716 ; 
 p. 489-490, () 757, 759 ; p. 491-492, 
 ^ 764 a; p. 493, (} 764 e; p. 495, () 
 770 ; p. 497-499, «J 779, 780, 784 a, 
 785. Also, Fever, Index II. 
 
 nevertheless, is generally confounded 
 with fever, p. 464, ^ 713. Also, 
 Fever, Lidex II. 
 
 the distinction herein made between 
 Inflammation and Fever, embraced 
 in part under both articles, and also 
 other distinguishing characteristics in 
 Medical and Physiological Comment- 
 aries, Articles Inflammation and Ve- 
 nous Congestion, vol. ii., the Author 
 claims as peculiar to himself, p. 464, 
 () 710 b; p. 489, (; 757. 
 
 its general characteristics, p. 469, (J 725 
 -728. Also, p. 444-445, (} 688 d-ec. 
 
 its four principal Btages, formative, sup- 
 
 Inflammation — continued. 
 
 purativc, ulcerative, restorative, the 
 last three being results of the recu- 
 perative disposition, or "termina- 
 tions," as they are called, p. 470-475, 
 ^ 729-733— take place in all parts 
 under common laws, p 471, ^ 732 d 
 — illustrated by a deep-seated abscess, 
 showing great Design, p. 472-474, ij 
 733 ; p. 546, (^ 862. 
 involves reparation, p. 474, ij 733 / — 
 which is analogous to regeneration, 
 p. 474-475, ^ 733 — but controverted 
 by physical theorists, p. 475, ^ 733 
 
 its termination in resolution during the 
 formative stage, which it is the great 
 aim of art to efiect, p. 470, <^ 729 a; 
 p. 476, (j 735 ; p. 638, 639, 640, i) 8924 
 g ; p. 642, ^ 892| i. 
 
 the suppurative stage the next most fa- 
 vorable termination of, p. 471, () 730 ; 
 p. 472, I) 733 a, b. 
 
 secretions of lymph, scrum, mucus, &c., 
 may take the place of suppuration, but 
 are analogous in principle, p. 471, () 
 732 — all acting as depletory means, 
 thid., and p. 546-548, (^ 862-863 d. 
 
 what Nature contemplates besides, in 
 effusions of lymph and pus, p. 472, (j 
 732 c-733 c. 
 
 called adhesive stage when lymph takes 
 the place of suppuration, which, in 
 wounds, constitutes " healing by first 
 intention," p 471, ^ 732 c, d — objec- 
 tions answered to its dependence upon 
 inflammation, p. 475, <Si 733 g-k. 
 
 adhesive process occurs within the struc- 
 ture of all organs through a general 
 law, and although often a greater evil 
 than the disease which it is designed, 
 in part, to relieve, Nature has still 
 provided means for its removal, p. 
 471, <;> 723 d. 
 
 ulceratiofi more or less attendant on 
 suppuration, and its objects and laws, 
 p. 471, ^ 730 ; p. 472, (} 733 b. 
 
 granulatwn, a consequence of inflam- 
 mation, belongs to reparation, is pro- 
 moted by suppuration, and involves 
 profound physiological laws, p. 471. 
 () 730 ; p. 472-475, ^ 733 c-f, and 
 references there. 
 
 irregularities of its stages, p. 476-480, 
 {) 734-741. 
 
 an irregularity in being diffuse, as in 
 erysipelas and phlebitis, p. 476, <J 
 735 b. 
 
 in its different stages being accelerated 
 or protracted, which is often true in 
 the latter respect of the formative 
 and restorative, p. 477, <J 737. 
 in the products of the second stage, 
 when pus, or lymph, or serum de- 
 viate from their natural standard,
 
 INDEX II. 
 
 1017 
 
 Inflammation — continued. 
 
 and from certain peculiarities in the 
 nature of particular tissues, or as 
 arisinof from specific forms of dis- 
 ease, p. 471, () 730, 732 ; p. 478, ^ 
 739. 
 mortification the greatest irregularity, 
 and, like resolution, commonly hap- 
 pens in the formative stage — the 
 result of a profound alteration of 
 the properties and actions of life, 
 and not dependent upon stagnation 
 and coagulation of blood, as com- 
 monly supposed, p. 477, ^ 736 b ; 
 p. 484, () 748 — and dead parts re- 
 moved from the living through the 
 vital process of ulceration, and not, 
 as generally alleged, by the vis a 
 tergo, or a mere solution, p. 477, ^ 
 736 c. 
 all the varieties in pus, lymph, mucus, 
 serum, &c., depend (^catcris paribus) 
 upon precise pathological conditions, 
 respectively, p. 478-479, <^ 740-741. 
 Also, p. 222-227, ^ 409 c-411 ; p, 
 228, {) 415 ; p. 436, () 682 b; p. 452, 
 ^ 693 ; p. 479, () 741 a ; p. 531, (} 838 
 -840; p. 536-539, ^ 847 c — which 
 contradicts all chemical and humoral 
 hypotheses, ibid. — nor is pus owing, 
 as supposed, to a degeneration of blood 
 or of tissues, p. 479, ^ 741 a. 
 its tendency to confine itself to the tissue 
 in which it springs up, and deeply 
 founded in physiological laws that 
 relate to the different tissues, p. 64, 
 ^ 141 b; p. 354, ^ 526 a; p. 480, 'J 
 741 c; p. 652-653, () 893 n. Also, 
 Structure, Index II. 
 its remote causes, p. 414-427, <) 644- 
 
 666 ; p. 480-481, (J 742-743. 
 may be produced by sedatives, even loss 
 of blood, as well as by stimulants, di- 
 rect irritants, &c., p. 480-481, <) 743 ; 
 p. 512, <) 817 ; p. 523, (j 837 ; p. 708, 
 () 950 ; p. 733, ^ 974 b ; p. 773-775, 
 (j 1024; p. 829, () 1057 a. Also, 
 Causes, Morbific, Index II. 
 its precise character, even in the common 
 form, depends mostly upon the nature 
 of the remote cause, in sound consti- 
 tutions, or when two or more operate, 
 upon their united properties, or will 
 be modified by hereditary predispo- 
 sitions, idiosyncrasies, &c., and its 
 various modifications as produced by 
 diflTerent kinds of mechanical injuries, 
 and their different modes of treatment 
 employed to illustrate the principle 
 that every morbific and remedial agent 
 produces modifications of the vital 
 states peculiar to its own virtues, p. 
 417-418, () 650-652 c ; p. 468-469, 
 <^ 722 h, c; p. 641, ^ 8924 i ; p. 664, 
 \ 900; p. 669, (^ 902 h; p. 671-672, 
 
 Inflammation — continued. 
 
 SS 904 a. Also, p. 61-67, I) 133-151, 
 and Causes, Morbific ; Remedies, 
 Index II. 
 
 its varieties, common and specific — as 
 induced by cold and wounds, forming 
 an example of the first, and by all 
 natural and morbid animal poisons, 
 and all poisons of the Materia Medica, 
 and hereditary predispositions, of the 
 la.st, p. 419-421, i) 653 6-655; p. 
 424, {} 661 ; p. 468, <^ 721 ; p. 641, i) 
 892| I. 
 
 is either acute or chronic, but. whichever 
 it be, the general principles of treat- 
 ment are the same, though modified 
 in its details, p. 469, ^ 723. Also, 
 Bloodletting, Counter-Irritants, 
 Expectorants, Index II. 
 
 nevertheless, there are numerous grada- 
 tions between acute and chronic, and 
 between common and specific, each 
 series, respectively, approximating 
 each other in some of the modifica- 
 tions, and showing that they all belong 
 to a common family, p. 468, I) 722. 
 
 active and '^passive," shown to be essen- 
 tially the same condition, requiring 
 the same principles of treatment, 
 though generally supposed to be in 
 opposition, p. 486-489, i) 753-756. 
 
 intermittent, depends upon the causes 
 of intermittent fever, requires the 
 same general treatment as the com- 
 mon form, with probably the ultimate 
 use of Cinchona, or Arsenic, p. 424, 
 (J 662 b; p. 487-488, <;» 756 a, b; p. 
 605-606, <^ 892 p ; p. 609, () 892^ c ; 
 p. 611-612, <^ 892i h, i ; p. 615-616, 
 (j 892^/; p. 737-739, <;> 894-895. 
 
 rheumatic, like the intermittent, demands 
 the direct antiphlogistic remedies, and 
 perhaps ultimately other remedies 
 suited to their specific forms, such as 
 Colchicum, and certain acrids, p. 488 
 -489, f) 756 a, b ; p. 561, ij 888 b ; p. 
 737-739, () 984-985. 
 
 scrofulous, another specific form calling 
 for the same general treatment as the 
 two preceding, but more particularly 
 for special remedies like Iodine, Ba- 
 rytes, and, like the rest, illustrate the 
 philosophy of remedial action, &c., 
 p. 488-489, (J 756 a, 6 ; p. 561, § 888 
 b; p. 615, ^ 892)r e; p. 619-620, <J 
 892^ u; p. 664-6"65. (} 900-901 ; p. 
 737-739, ^ 984-985. Also, Spe- 
 cifics, Index II. 
 
 its immediate instruments the terminat- 
 ing series of the arterial system, p. 
 226-227, 1) 410, 411; p. 355. i) 528 a ; 
 p 483, <^ 746 a — and why the serous 
 vessels admit the red globules, p. 99, 
 ^ 192 — the nervous system locally 
 interested in the results, but in other
 
 1018 
 
 INDEX II. 
 
 Inflammation — continued. 
 
 respects acts only as an exciting cause 
 of inflammation by direct or reflex ac- 
 tion, p. 475, ^ 733 h ; p 483-484, ^ 
 746 c. Also, Reflex Action of the 
 Nervous System. Index II ; Nerv- 
 ous Power, Sympathy, Index I. and 
 II. 
 
 its proximate or ■pathological cause con- 
 sists of two fundamental elements — 
 1st, an increased action of the vessels ; 
 2d, and by far the most important, a 
 change in kind, ^ 747, 750-751, 910, 
 953 d, e. Also, () 384, 399, 410, 485. 
 
 involves the whole philosophy of all 
 other diseases, p. 482, <^ 745. 
 
 the prevailing mechanical doctrine of, 
 which supposes a passive relaxation 
 of the vessels, and stagnation of blood, 
 considered, p. 484-485, ij 748, 749. 
 
 always a local disease, while fever affects 
 the system universally, p. 65, () 143 
 a,b; p.66, H48; p. 417-418, ^^ 650; 
 p. 422, <;> 657 b ; p. 464, ^ 712 ; p. 489- 
 491,(^1757-760; p. 498, ^ 784. Also, 
 other distinctions in first subdivision. 
 Also, Fever, Index II 
 
 nevertheless, inflammation is often com- 
 plicated with fever at the invasion of 
 the latter, and may be its exciting, 
 though not its predisposing cause, 
 and fever rarely exists long without 
 giving rise to inflammation, of which 
 it may be either an exciting cause in 
 organs already predisposed, or may 
 be the predisposing as well as excit- 
 ing cause, p. 227, HI 1 ; P- 355, ^ 526 
 a ; p. 464, <^ 71 1-713 ; p. 481, ^^i 743 ; 
 p. 498, () 784 ; p. 506, ^ 803, 804 ; p. 
 508-509,(^809-811; p. 510, (J 813. 
 
 the general arterial excitement and heat 
 of skin attendant on inflammation and 
 fever, but which is often absent in 
 both, and always more or less inter- 
 mitting in the latter, have led to their 
 supposed unity, p. 464, 465, <5> 713- 
 714. Also, references in first sub- 
 division, and Fever, Index II. 
 
 the constitutional excitement of local 
 inflammation is owing to remote sym- 
 pathy, while that of fever arises from 
 the disease at large throughout the 
 system — the exciting influence of the 
 reflex action of the nervous system, 
 in the former case, being determined 
 especially upon the heart and arteries, 
 while, also, the same phenomenon is 
 most strongly pronounced in inflam- 
 mation of the brain, when the devel- 
 opment of the nervous influence is 
 direct, as in the case of the Passions, 
 but instituting, as a consequence, 
 circles of reflex action, p. 227, i!> 41 1 > 
 p. 355, (j 526 b ; p. 46.5-468, () 714- 
 719 ; p. 804-805, ^ 1040, and refer- 
 
 Inflammation — continued. 
 
 cnccs there. Also, Brain, Inflam- 
 mation OF ; Joy and Anger, and the 
 other individual Passions, Fever, first 
 subdivision. Index II. 
 
 no "general" inflammation, and the 
 term "inflammatory fever" hypothet- 
 ical and objectionable, p. 466, () 716. 
 
 farther, the foregoing exciting and alter- 
 ative influence of reflex action of the 
 nervous system upon the general 
 circulatory system, and its local de- 
 termination upon individual parts, is 
 the cause of consecutive inflamma- 
 tions, while each one as it comes for- 
 ward in the progressive series joins in 
 the development of the morbific reflex 
 action, and thus also mutually aggra- 
 vate each other, and multiply the ratio 
 of the consecutive derangements — 
 and these disturbances of the never- 
 ceasing, ever-changing reflex action 
 will depend greatly upon the activity 
 of disease, and upon the importance 
 of the organs and the nature of the 
 tissue affected, though not always so, 
 p. 227, Hi 1; p. 355, (5)526 o; p. 465- 
 
 466, ^ 715 ; p. 467-468, () 718, 719 ; 
 p. 506-509, (5)806-811; p. 511, (^815; 
 p. 679-681, (J 904 a; p. 724-727, ^ 
 961 ; p. 730, ^ 969; p. 731, ^ 970 c; 
 p. 732-734, {} 973-975 ; p. 804-805, 
 ^ 1040, and references there. Also, 
 Structure, Reflex Action; Causes, 
 Morbific, Index II. ; Nervous Pow- 
 er, Sympathy, Index I. and II. 
 
 such is the correspondence among the 
 foregoing influences and derange- 
 ments, that a modification may be 
 given to the reflected nervous in- 
 fluence by a single remedy, as Blood- 
 letting and Tartarized Antimony (and 
 in fever also, and as complicated with 
 inflammation), that will overthrow all 
 the extensive lesions, p. 65-66, (J 143 c, 
 and references there ; p. 66-67, 1) 148 ; 
 p. 465-466, (J) 715, and re/crcwccs there; 
 p. 498, (J 784 b, and references there ; 
 p. 731-732, ^ 970 c. 
 
 produces, also, through the foregoing 
 sympathetic influences, other forms 
 of disease, which concur in modifying 
 the reflex nervous influence, and this 
 often depending upon the special vital 
 constitution of tissues and organs, p. 
 
 467, (^ 718. Also, Structure. 
 
 the development and modification of the 
 reflex action of the nervous system, 
 and its influence upon one part or an- 
 other, depends, more or less, not only 
 upon the special vital constitution of 
 tissues and the relations which they 
 bear to compound organs as one or 
 another may be the seat of inflamma- 
 tion, and more or less so as it respects
 
 INDEX II. 
 
 1019 
 
 Inflammation — continued. 
 
 the determination of the morbific in- 
 fluence upon different parts, but its 
 influence when resulting from ve- 
 nous inflammation is a strong exem- 
 plification of the special modes in 
 which the alterative influence of re- 
 flex nervous action is modified by the 
 nature of a tissue when affected by a 
 common form of disease, and serves 
 to illustrate the great fact that every 
 cause, both physical and mental, that 
 may bring it into operation, imparts 
 to it a special modification peculiar to 
 its own virtues, p. 444-446, ^ 688 c,f; 
 p. 506-509, 'J 806-811; p. 511, (j* 815 ; 
 p. 724-726, <J 961 ; p. 730, <^ 969; 
 p. 731, () 970 c; p. 732-734, (} 973- 
 975. Also, Structure, Index II. ; 
 Nervous Power, Index I. and II. ; 
 Vexous Congestion, Venous Tissue, 
 Index I. 
 
 develops a reflex action of the nervous 
 system which imparts to the pulse its 
 peculiar characteristics of hardness 
 and incompressibility, and the pecu- 
 liar modification of the nervous in- 
 fluence as instituted by inflammation 
 is farther manifested in its production 
 of those changes of vascular action 
 that lead to the buffing and cupping 
 of abstracted blood, while, on the 
 other hand, this protean power may 
 be almost instantly made to change 
 its shape and establish a totally new 
 order of things under the loss of blood 
 or a mental emotion, p. 227, ij 411 ; 
 p. 355, i) 526 a ; p. 444-445, ^ 688 
 a-f; p. 708-710, ^ 951-952 b; p. 
 804-805, () 1040, and references there. 
 
 develops an exciting nervous influence 
 which sustains the system under the 
 loss of blood, though o<^some tissues, 
 and in their connexion with compound 
 organs, more than others, while the 
 loss of blood so modifies the alterative 
 influence of the reflex nervous action 
 (and upon which all the phenomena 
 of Bloodletting depend) as to speedily 
 change the whole condition, p. 732- 
 736, () 973-980. Also, p. 70-73, the 
 Tables ; p. 227, <J 411 ; P- 355, () 526 
 a ; p. 444-^46, () 688 d ; p. 506-509, 
 ^806-811; p. 511, ^815; p. 709- 
 710, () 952 ; p. 724-734, (} 961-976 ; 
 p. 735-736, ^ 978-980 ; p. 804-805, 
 ^ 1040, and references there. Also, 
 Bloodletting, Loss of Blood, 
 Reflex Action, Antispasmodics ; 
 Brain, Inflammation of ; Struc- 
 ture, Index II. ; Nervous Power, 
 Sympathy, Index I. and II. ; Venous 
 Congestion, Venous Tissue, Index I. 
 
 when affecting the brain, the exciting 
 nervous influence is greater than of 
 
 Inflammation — continued. 
 
 other organs, and here, too, the nerv- 
 ous influence is developed in a direct 
 manner, and the motor nerves are 
 alone concerned ; but as soon as felt 
 by other organs, they react upon the 
 nervous centres, and give rise to cir- 
 cles of reflex action, p. 671, ^ 903; 
 p. 733-734, () 974 c-975. Also, Ve- 
 nous Congestion ; Brain, Inflam- 
 mation of ; Mental Emotions, the 
 individual Passions, Index II. 
 
 when affecting any important organ in 
 small-pox, measles, and scarlet fever, 
 it gives rise to such alterative in- 
 fluences of the reflected nervous ac- 
 tion as enables the system to bear 
 the remedies that would be necessary 
 when the same disease occurs inde- 
 pendently, and which might be other- 
 wise fatal, p 59, {) 129 h, i ; p. 61, () 
 134 ; p. 63, 9 137 b-e ; p. 65, () 143 c ; 
 p. 67, ^ 150-151 , p. 69, <J 156 b; p. 
 . 73, H63 ; p 227, MH ; P- 355, ^ 
 526 a ; p. 538-539, ^ 847 g--849 ; p. 
 542-543, (J. 854/; p. 544-545, «J 858 ; 
 p. 804-805, <) 1040, and references 
 there. 
 
 all the foregoing influences of reflex 
 action of the nervous system are 
 examples of that alterative action as 
 brought into operation by all remedial 
 and morbific causes, physical and 
 mental, whenever they act upon parts 
 beyond the seat of their direct opera- 
 tion, though variously modified accord- 
 ing to the nature of the exciting cause, 
 and are the medium through which all 
 the remote changes in the solids and 
 the fluids (the blood included) are 
 brought about, p. 483-484, ^ 746 c ; 
 p. 679-681, () 905 a. Also, Blood- 
 letting, Loss OF Blood, Cathar- 
 tics, Emetics, &c. ; Causes, Mor- 
 bific ; Remedies, Therapeutics, Re- 
 medial Action, Secretion and Ex- 
 cretion, Reflex Action of Nervous 
 System, Mental Emotions, the in- 
 dividual Passions, &.C., Index II. 
 
 founded wholly upon the physiological 
 states, 1^ 749-751. Patholog. Cause. 
 Inflammation, Pathological or Proxi- 
 mate Cause of, 
 
 supplies the whole philosophy of other 
 diseases, p. 482, <^ 745. 
 
 its immediate instruments the extreme 
 arterial capillaries, the nerves and ab- 
 sorbents participating, p. 483, ^ 746. 
 Also, p. 220-227, H09 J-41 1 ; p. 355, 
 ^ 526 a. 
 
 irritability and mobility increased, p. 
 484, (} 747. Also, p. 89, M88 ; p. 
 103-104, ^ 205-215 ; Organic Life, 
 Vital Properties, Vital Principle, 
 Index I.
 
 1020 
 
 INDEX II. 
 
 Inflammation, &c. — continued. 
 
 constituted by an active contraction and 
 dilatation of arteries and veins, but 
 more especially by a change in the 
 natural kind, and an increased circu- 
 lation and volume of blood, p. 209- 
 210, ^ 384-387 ; p. 214-215, () 392- 
 39G; p. 216, ^ 399; p. 305-310, ^ 
 483-485; p. 485-48G, <) 750-751; 
 p. 503, () 794 ; p. 792-793, () 1022 d; 
 p 803-804, <^ 1039, 910, 935 c, d. 
 
 mechanical theory of, which supposes 
 passive relaxation of vessels, and 
 stagnation and coagulation of blood, 
 but which is contradicted by facts, p. 
 484-486, <;» 748-751. Also, Medical 
 and Physiological Commentaries, vol. 
 ii.,p. 141-214. 
 
 Hunter's opinion of, p. 484, ^ 747. 
 
 Magendie's opinion of, p. 482, i) 744. 
 
 active and '^passive" shown to be essen- 
 tially the same, p. 486-489, (} 752- 
 756. 
 Inflamm.\tion, Treatment of, 
 
 discussed under the several practical 
 subjects, Bloodletting, Cathartics, 
 Tonics and Stimulants, individual 
 Remedies, &c., Index 1. and II. 
 
 Table, indicative of the variety in the 
 vital constitution of different tissues 
 and compound organs, and of parts 
 of a continuous tissue, illustrated by 
 their relative liability to inflammation, 
 and by the efliects of some remedial 
 agent, as bloodletting, upon the va- 
 rious tissues of organs, p. 70-73, ^ 
 160-162 — and another of the relative 
 liability of different tissues of the same 
 nature remote from each other to sym- 
 pathize together in their diseases, re- 
 spectively, through reflex action of the 
 nervous system, p. 353, (^ 525 a — and 
 another showing the relative liability 
 of different tissues, respectively, when 
 morbidly affected, in any one part, to 
 continuous sympathy in their several 
 parts, p. 354, <J 526 a, and in connex- 
 ion with Tables at p. 70-73 — all 
 serving as an important basis of an 
 extended philosophy in Physiology, 
 Pathology, and Therapeutics. Also, 
 Structure; Sympathy, Continu- 
 ous, Index H. ; Nervous Power, 
 Sympathy, Index I. and II. 
 Instinct. See Soul and Instinctive 
 Principle, Index II. ; and Instinct, 
 Index I. 
 Intestine, 
 
 contrary to opinions before entertained, 
 this organ is subjected very greatly 
 to the control of the Will ; and that 
 it is closely allied to the respiratory 
 and sphincter muscles in being also 
 under the influence of reflex action of 
 the nervous system, and liable to a 
 
 Intestine — continued. 
 
 temporary suspension of that influence 
 by an act of volition ; and that the whole 
 intestine is subject to this compound 
 influence, though perhaps the lower 
 more than the upper part, is evident 
 from what is said in the text, and as 
 will be more apparent from consider- 
 ing how completely a strong desire 
 for defecation may be resisted till the 
 increased reflex nervous action is fully 
 overcome by counteracting nervous 
 influence determined by the Will upon 
 the intestinal muscular tissue — being 
 a very remarkable instance of the ac- 
 tion of the Will in Organic Life, and 
 forming, in connexion with its asso- 
 ciate action upon other muscles con- 
 cerned in defecation, an impressive 
 example of Design, p. 325, ^ 500 e ; 
 p. 326, () 500 h; p. 867, <^ 1067 a— 
 while, also, it appears that the stomach 
 is partially liable to influences of the 
 Will, as seen in spontaneous vomit- 
 ing, p. 327, ^ 500 j — and in its control 
 over sea-sickness, p. 889-890, § 1077. 
 Also, Mental Emotions, Reflex 
 Action of Nervous System, Anti- 
 spasmodics, Sea - Sickness, Fear, 
 Index II. ; Will, Nervous Power, 
 Index I. and II. Also, p. 349. () 519. 
 
 different portions of, according to the 
 special vital constitution of each part, 
 when affected by disease, or when 
 certain cathartics operate, develop dif- 
 ferently, and occasion different reflex 
 influences of the nervous system, and 
 require modifications of treatment as 
 the same disease may affect one part 
 or another, and reasons assigned for 
 the rapid development of a curative 
 or morbific reflex action of the nerv- 
 ous system when cathartics operate, 
 p. 467, () 718 ; p. 565, () 899 ; p. 856- 
 857, ^ 1063 b. Also, p. 62-67, ^ 135- 
 151; p. 70, Table II. 
 Iodine, 
 
 its introduction into practice, p. 614, (} 
 892i d. 
 
 exemplifies, like arsenic, tartarized anti- 
 mony, &c., the fallacy of reasoning 
 from the effects of remedies upon the 
 healthy system to its morbid states, 
 since it produces its effects only upon 
 very special conditions of the latter, 
 and thereby, as with the effects of all 
 , other remedies, demonstrates the mu- 
 tability of the properties of life, and 
 their greater susceptibility when mor- 
 bidly affected, and goes with the rest 
 in supplying interesting problems for 
 cAcniicaZ interpretation, p. 612, i5i892i. 
 Also, p. 3, (J 2 b; p. 120-122, ^ 237- 
 240 ; p. 352, ^ 524 d ; p. 435, ^ 680 ; 
 Arsenic; Antimony, Tartarized;
 
 INDEX II. 
 
 1021 
 
 Iodine — continued. 
 
 Remedies, Therapeutics, Lidex II. ; 
 Vital Properties, Index I. 
 some of its imputed evil effects rarely if 
 
 ever witnessed, p. 612, ^ 892^ a. 
 often as efficient when applied exter- 
 nally as internally, while, in the for- 
 mer case, it must be in the region of 
 the affected organ — thus showing, as 
 in the case of counter-irritants, &c., 
 that its operation, when employed in- 
 ternally, is not by absorption, but in 
 both cases alike by alterative influence 
 of reflex action of the nervous system, 
 p. 613, <) 892^ c; p. 619, ^ 892^ t. 
 Also, Counter-Irritants, Sedatives 
 {Aconite), Alteratives, Index II. ; 
 Nervous Power, Sympathy, Index 
 I. a7id II ; p. 930-931, () 1088 b, c. 
 adapted only to bronchocele, and not to 
 other affections of the thyroid gland, 
 p. 613, -J 892^ c. 
 its uses in scrofula, &c., depend much 
 upon other appropriate treatment, p. 
 615, () 892^ e; p. 619, <J 892^ s, ii. 
 examples of its curative effects in ob- 
 stinate chronic indurations of liver, 
 spleen, uterus, lymphatic glands, &c., 
 p. 615-616,^892^/. Also, Leeching, 
 Index II. 
 is stimulating, and, if inflammation be 
 active, and especially of any important 
 organ, it should be reduced by general 
 bloodletting before employing iodine, 
 and leeching is often useful in indo- 
 lent conditions, p. 615, <J 892^ c; p. 
 619-620, () 892^ m— and a neglect of 
 which in early phthisis cuts off" the 
 chance of recovery, <S» 892^ e. 
 its uses in skin diseases, secondary 
 
 syphilis, &c., p. 617, <J 822i g-i. 
 in amenorrhcea of scrofulous subjects, 
 and how it relieves, p. 685-686, () 905^ 
 b. Also, Amenorrhcea, Index II. 
 in chronic rheumatism and gout, ill- 
 conditioned ulcers, &c., p. 617-618, 
 ^ 892^ l-p. 
 useful in dropsies complicated with or- 
 ganic disease, by relieving the latter, 
 but not in other cases, p. 617, <J 892^^ 
 k; p. 630, i!>892J a. 
 fucus vesiculosus, burnt sponge, cod- 
 liver oil, how did they get into prac- 
 tice] p. 619, <J 892^ r. 
 Ipecacuanha, 
 
 its virtues illustrated through its salutary 
 effects in its largest and smallest doses 
 upon various conditions of disease — 
 illustrates, along with Cold, Opium, 
 &c., the modus operandi of Tonics 
 and Astringents through alterative 
 influence of reflex action of nervous 
 system — and employed to show the 
 importance of addressing remedies 
 not only to thp exact pathological 
 
 Ipecacuanha — continued. 
 
 conditions, but to those particularly 
 which may have established and 
 maintain sympathetic derangements, 
 p. 533, ^ 842 ; p. 554-555, () 872 a ; 
 p. 557, ^ 873 a ; p. 572, () 890 bb ; p. 
 573, ^ 890 d ; p. 576-578, «J 890 l-o ; 
 p. 634, <;» 892| g; p. 641, ^ 8924 i; 
 p. 851, ^ 1059. Also, Alteratives, 
 Astringents, Cold, Opium, Ergot, 
 Index II. 
 as an alterative in small doses, p. 557, (J 
 873 ; p. 851, (} 1059. Also, as above, 
 and Antimony, Tartarized; Alter- 
 atives, Index II. 
 its action in emetic doses quickened by 
 the union of the sulphate of copper or 
 of zinc, which arises from the sudden 
 increase of gastric irritability effected 
 by the minerals — involving a principle 
 which reaches far into the practical 
 details of other remedies, both in their 
 combinations and consecutive order 
 of application, p. 567-568, (J 889 /. 
 Also, p. 63, (j 137 d, e ; p. 65-66, ^ 
 143 c, d; p. 67, i) 149-151 ; p. 73, () 
 163 ; p. 367, (J 556 c ; p. 566-569, ^ 
 889 k—m. 
 unlike Tartarized Antimony, is accumu- 
 lative in its small therapeutical doses, 
 and requires a different mode of ad- 
 ministration, p. 557, (J 873 a ; p. 567- 
 568, ^ 889 I. Also, p. 365-368, ^ 549 
 -558 ; p. 532-533, <) 841, and Anti- 
 mony, Tartarized ; Cold, Altera- 
 tives, Index II. Also, Emetics. 
 in some constitutions, and whether in- 
 haled in small quantities or taken by 
 the stomach in a grain or less, pro- 
 duces asthmatic breathing through 
 exciting influence of reflex action of 
 nervous system — the coincidences 
 showing how all remedial and morbific 
 agents exert their effects through the 
 same medium, and illustrative of the 
 modus operandi of Anaesthetics, ut 
 supra, and An.^esthetics, Antispas- 
 modics, Reflex Action of Nervous 
 System, Sympathy, Index II. ; Nerv- 
 ous Power, Index I. and II. 
 Iris — continued from Index /., 
 
 of extirpated eye, affected by light, p. 
 
 806, ^ 1042. 
 the physiology of its movements applied 
 by the Author to an interpretation of 
 the modus operandi of remedial and 
 morbific agents through alterative in- 
 fluences of reflex action of the nervous 
 system, p. 340, <^ 514 k — and in illus- 
 trating the substantive existence and 
 self-acting nature of the Soul, p. 875- 
 876, () 1072 a. Also, Atropia. p. 673 
 Irritability — continued from Index /., 
 Dr. Carpenter arraigned upon, p. 95- 
 96, ^ 189 b — and upon development
 
 1022 
 
 INDEX II. 
 
 Irritability — continued. 
 
 of the Ovum, p. 39-40, <^ 64 g — and 
 Digestion, p. 153, () 34S — and Ab- 
 sorption, p. 133, ^ 291 — and upon the 
 opinion that the " tendency to decom- 
 j)Osition after death bears a very elosc 
 relation with the activity of the changes 
 which take place in the part during life,'" 
 p. 39, ^ 64 g — and upon " vital prop- 
 erties in the elements of matter" in 
 connexion with " transcendentalism," 
 p. 85-86, ^ 175 d; p. 182, () 350|/, 
 note. 
 
 Jalap, 
 
 often subdues excited states of the gen- 
 eral circulation during its direct ac- 
 tion, is the most decisively antiphlo- 
 gistic of all the cathartics, and the 
 safest of the active purgatives — and 
 its most useful combinations, with 
 some suggestions as to remedial ac- 
 tion, p. 547-550, ^ 863 d ; p. 686, ^ 
 905^ b; p. 851-853, () 1060. 
 Jealousy, 
 
 a passion not without its contributions to 
 the Author's philosophy of the modus 
 operandi of remedial and morbific 
 causes, physical and mental, through 
 alterative influence of either direct or 
 reflex action of the nervous system, 
 and going with the rest to illustrate 
 the modifications of the nervous in- 
 fluence according to the nature of its 
 exciting cause, and aiding in Author's 
 demonstration of the substantive ex- 
 istence and self-acting nature of the 
 Soul, p. 95, <^ 188^ d; p. 107-111, <^ 
 227-233J; p. 324, () 500 c; p. 326, 
 <) 500 g; p. 327, ^ 500;; p. 333, (} 
 503; p. 631, (J 892 J 6; p. 661-664, 
 (J. 894 b-900; p. 709, ^ 951 b-d; p. 
 865-866, {) 1067 ; p. 879-882, ^ 1074- 
 1075; p. 886-891, <^ 1077; p. 901, <J 
 1078 I. Also, Mental Emotions ; 
 Brain, Inflammation of ; Remedial 
 Action, subdivision Mental Emo- 
 tions, Fear, Love, Hope, Joy and 
 Anger, Shame, Disgust, Laughing, 
 Weeping, Yawning, Sneezing, Res- 
 piration, Sphincter Muscles, Ex- 
 ercise, Food, Friction, Skin, Cold, 
 Phthisis, Whooping -Cough, Anti- 
 spasmodics, Opium, Convulsions, 
 Bloodletting, Reflex Action of 
 Nervous System, hidex II. ; Nervous 
 Power, Sympathy, Index I. and II. 
 
 illustrates the manner in which, like 
 compounded remedies, a compound 
 Passion will so modify the reflex ac- 
 tion of the nervous system as to afi*ect 
 the secretions in a different manner 
 from either of the individual agents. 
 
 Jealousy — continued. 
 
 and which furnished a theme for 
 Sappho, p. 631, () 892i b. Also, p. 
 90-95, {) 188^ d; Shame, Secretion 
 AND Excretion, Index II. 
 
 Joy AND Anger, 
 
 the Passions which destroy life sudden- 
 ly by a sudden and violent determina- 
 tion of the nervous influence upon the 
 brain, and, through that organ, upon 
 the heart, &c., after the manner of 
 blows upon the epigastrium — demon- 
 strate Author's theory of the opera- 
 tion of remedial and morbific agents 
 through alterative influence of reflex 
 action of nervous system — contradict 
 the physical hypotheses — and con- 
 tribute in establishing demonstration 
 of the substantive existence and self- 
 acting nature of the Soul,p. 95, iji 188'^; 
 p. 107-111, () 227-2331 ; p. 284-286, 
 (} 455-457 ; p. 298, <J 476^ h ; p. 300- 
 302, ^ 478-480 ; p. 326-329, ^ 500 
 f-n; p. 334-335, ^ 507-511 ; p. 362, 
 ^ 634 ; p. 670, <) 902 I; p. 704, «J 944 
 a ; p. 707, ^ 947 ; p. 709, <J 951 b-d ; 
 p. 865-868, () 1067; p. 879-881, ^ 
 1074; p. 887, () 1077. Also, Stom- 
 ach, Blows upon, and the several 
 references to yl?i«c/es under Jealousy, 
 Index II. 
 consider, also, their milder operation — 
 how Joy lights up every feature, glad- 
 dens the heart, and invigorates diges- 
 tion ; or Anger thumping at your side, 
 but diflferently from Fear, injecting the 
 face, while Fear blanches it, protrud- 
 ing the fiery eyeballs, though not after 
 the manner of Fear, and imparting 
 herculean strength to the muscles, 
 while Fear paralyzes, and compare 
 with what is said of the development 
 and modification of the nervous in- 
 fluence, both direct and reflex, by 
 physical agents, under Article Gen- 
 eralization OF Reflex Action op 
 Nervous System, Index II. Also, 
 p. 324, (j 500 c ; p. 326, ^ 500 g ; p. 
 865-868, ' 1067 ; p. 879-882, (j 1071- 
 1075. 
 
 K. 
 
 Kidney, 
 
 effect upon, in producing saccharine 
 urine, by pricking medulla oblongata, 
 p. 792, I) 1032 d. 
 
 its diseases, treatment of, p. 450, 451, 
 <J 691 ; p. 847, ^ 1058 s. 
 
 the reciprocal sympathies between the 
 skin and kidneys, in their natural 
 condition, through reflex action of 
 the nervous system, evince the great 
 liability of the nervous influence to 
 disturbances frop slight causes, and.
 
 INDEX II. 
 
 1023 
 
 Kidney — continued. 
 
 like tiie physiology of respiration, 
 supply a key to the whole philosophy 
 of the operation of remedies and mor- 
 bific causes upon all parts beyond the 
 seat of their direct etlects through 
 alterative influence of reflex nervous 
 action — while, also, the torrent of 
 urine which is often generated by the 
 contact of cold air with the surface, 
 and its sudden expulsion from the 
 bladder by the cold dash or by the 
 warm bath, supply a simple element 
 of the universal instrumentality of the 
 reflex nervous influence in inducing 
 disease and of changing the condition 
 of morbid states, and of the secreted 
 products, according to the manner in 
 which the nervous influence may be 
 modified by remedial and morbific 
 agents — and taking along, also, the 
 exactly corresponding effects of Fear, 
 Loss of Blood, &c., in suddenly aug- 
 menting the urine and perspiration, 
 and in inducing purging and convul- 
 sion of muscles, we reach the certain- 
 ty that these effects of the latter are, 
 equally with the former, owing to the 
 exciting and alterative influences of 
 that same protean power, and that it 
 may be brought into direct operation 
 as well by causes acting directly upon 
 the nervous centres as when it involves 
 both orders of nerves, p. 107-111, ^ 
 227-233f ; p. 230-233, ^^ 422-427 ; 
 p. 284-287, \ 455-459 ; p. 290-291, 
 \ 462-470 ; p. 295-321, ^ 476-494 ; 
 p. 321, ^ 496, 497; p. 631-632, () 
 892f ; p. 651-653. (} 894-896; p. 
 665-676, <J 902-904; p. 679-681, i} 
 905 a. Also, Reflex Action of 
 Nervous System, Mental Emo- 
 tions, Fear, and the other individ- 
 ual Passions, Weeping, Skin, Cold, 
 Heat, Warm Bath, Respiration, 
 Convulsions, Spasmodic Affec- 
 tions, Whooping-Cough, Food, Loss 
 OF Blood, Bloodletting, Secretion 
 and Excretion. Index II. ; Sympa- 
 thy, Nervous Power, Index I. and 
 IL 
 not a " strainer," as commonly supposed, 
 p. 222-227, H09C-411 ; p. 230-233, 
 ^ 422-427 ; p. 318, (J 493 d; p. 631^ 
 632, ^892f ; p. 788, ^ 1032 a; p. 801, 
 (j 1036 ; p. 910-911, (} 1083, and con- 
 firmed particularly through the last 
 preceding references, 
 its modified action, as denoted by fluc- 
 tuations of the urine, generally owing 
 to diseases of other organs, especially 
 of the digestive, and induced by reflex 
 action of the nervous system, which 
 disturbs its functions without induc- 
 infj absolute disease, when the urine 
 
 Kidney — continued. 
 
 should be regarded as a symptom only, 
 like that of the pulse, or the morbid 
 aspects of the tongue, through which 
 some knowledge is obtained of the 
 nature and force of disease in other 
 parts, p. 232-233, (j 426, 427. Al- 
 so, Pulse, Tongue, Amenorrhcea, 
 Urine, hidex II. ; Menstruation, 
 Index I Also, p. 847, () 1058 s. 
 
 Kiestine, 
 
 declared, on authority, to be a "pure 
 illusion," p. 787, i; 1032 a. 
 
 L. 
 
 Lactation, 
 
 exemplifies the natural instability of the 
 properties of life, which, in being de- 
 signed for useful ends, becomes the 
 occasion of diseases and of their cure, 
 p. 3, (J 2 h ; p. 61, ^ 133 c ; p. 68-69, 
 (^153-156; p. 87, <J 180; p. 120-122, 
 (j 237-240 ; p. 352, ^ 524 d ; p. 376- 
 380, § 578; p. 662, () 895. Also, 
 Vital Properties, Organic Life, 
 Index I ; Youth, Infancy, Vomit- 
 ing, Pregnancy, Index II. 
 
 alterative influence of reflex action of the 
 nervous system, excited by the uterus, 
 the efficient cause, ibid., and p. Ill, ij 
 233J; p. 351,1^524*. Also, Metas- 
 tasis and Repulsion, Index II 
 
 considered in connexion with the vital 
 and mechanical doctrines of secretion, 
 and as a proof from analogy, along 
 with the now admitted absence of the 
 constituents of the bile in the blood, 
 that the kidney is not a " strainer," 
 and in its relation, also, to the sup- 
 posed production of sugar by the liv- 
 er, p. 783-793, ^ 1031-1032. Also, 
 the preceding references, and refer- 
 ences under Kidney and " Strain- 
 age," Index II. 
 
 diverted from its natural state, and the 
 milk altered by mental emotions 
 through direct propagation of the 
 nervous influence, p. 788, ^ 1032 a, 
 and Mental Emotions ; Brain, In- 
 flammation of ; Remedial Action, 
 subdivision Mental Emotions ; the 
 individual Passions, Secretion and 
 Excretion, Reflex Action ,IndexII. 
 
 proof derived from, that sugar does not 
 exist in the blood, p. 785, ij 1031 b ■ 
 p. 790, () 1032 b. 
 Lacteals, (See Absorption, Index I.) 
 
 circulation in, depends upon suction of 
 the heart and their own action, p. 211, 
 ^ 390 a; p. 214, () 392 c, d. 
 
 exclude the bile, and all intestinal prod- 
 ucts excepting chyle, unless diseased, 
 and why — and, for like reason, exclude 
 remedial agents, and not liable to in-
 
 1024 
 
 INDEX II. 
 
 Lacteal s — continued. 
 
 flammation like the Lymphatics and 
 Veins — all evincing great Design, p. 
 99, ^ 192; p. 129-131, (} 277-284, 
 and references there ; p. 356, () 526 c ; 
 p 632, ^ 892i c. Also, Lymphatics, 
 Veins, Index II. Also, p. 933, () 1089. 
 
 allusion to, in connexion with the ana- 
 tomical relations of the intestinalcanal 
 to the nervous system, and Author's 
 doctrine of the operation of Cathartics 
 through alterative influence of reflex 
 action of the nervous system, p. 565. 
 have terminal orifices, p. 933, ^ 1089. 
 
 Liebig's and Carpenter's mechanical 
 doctrine of the function of absorption, 
 p. 132-133, {) 289-292. 
 Lactic Acid, 
 
 not found in the blood, and physiological 
 conclusions, p. 784, <St 1031 b. 
 Laughing, 
 
 excited in a direct manner through the 
 Will and Mental Emotion, showing 
 how the latter sometimes conspires 
 with the former in determining the 
 nervous influence upon the voluntary 
 muscles, and may be excited through 
 reflex action of the nervous system, 
 as an ultimate result, by tickling the 
 feet, and may then prove fatal — illus- 
 trative of the modus operandi of reme- 
 dial and morbific causes, physical and 
 mental, through alterative influence of 
 direct and reflex nervous action, and 
 of the substantive existence and self- 
 acting nature of the Soul, p. 323-328, 
 ^ 499-500 m ; p. 707, <5 947 ; p. 709, 
 ^ 951 b-c; p. 880, () 1074 ; p. 887, ^ 
 1077. Also, Mental Emotions, Joy 
 AND Anger, and other individual Pas- 
 sions ; Brain, Inflammation of ; 
 Reflex Action, Index II. ; Sympa- 
 thy, Nervous Power, Index I. aiidll. 
 Lead, Acetate of, 
 
 arrests hemorrhage of lungs, uterus, 
 &c., and colliquative sweats, through 
 alterative influence of reflex action of 
 nervous system, since, if absorbed, it 
 would be rendered inert by conversion 
 into another salt, or, if otherwise, the 
 quantity of a grain at a dose, diluted 
 by the mass of blood and other fluids, 
 would not be felt, p. 530, I) 837 c ; p. 
 
 577, <;> 890 0. 
 
 the modus operandi of Astringents and 
 of other remedies illustrated in the 
 foregoing manner, and by other reme- 
 dial influences of the acetate of lead, 
 and by comparison with other Astrin- 
 gents and with other things, p. 577- 
 
 578, () 890 0. Also, Astringents, 
 Index II. 
 
 Leeching, 
 
 the philosophy of its effects divided into 
 seven stages, p. 692-698, <^ 914-928. 
 
 Leeching — continued. 
 
 1st, as in general bloodletting, the first 
 essential effect consists of a con- 
 traction of the capillary bloodves- 
 sels ; but in leeching there is an 
 antecedent vital impression of a 
 very peculiar nature produced up- 
 on the extreme vessels to which 
 the leeches are applied, () 915. 
 
 2d, an immediate vital contraction of 
 these vessels, arising in part from 
 the foregoing specific impression, 
 and in part from the direct abstrac- 
 tion of their natural stimulus, ^ 916. 
 
 3d, then follows, by continuous sym- 
 pathy along the vessels (or continu- 
 ous influence, as the Author prefers, 
 p. 322, ^ 498 a), and through reflex 
 action of the nervous system, p. 
 321, () 496, a propagation of the 
 foregoing changes to the entire 
 system of extreme and capillary 
 vessels throughout the body, and 
 why, <J 917. 
 
 4th, the larger vessels, sooner or later, 
 participate through the foregoing 
 influences (3) in the contraction, 
 ^ 918. Also, Sympathy, Continu- 
 ous, Index II. 
 
 5th, simultaneously, and at an early 
 stage, the heart is brought under 
 - the influence of the reflex action 
 of the nervous system, which in- 
 creases in a rapid ratio, p. 693, ij 
 919 ; p. 698, () 933. 
 
 6th, during the progress of the fore- 
 going influences and changes they 
 become more or less compounded, 
 the reflex nervous influence which 
 is propagated from the extreme to 
 the larger vessels and the heart in- 
 stitutes reflex influences upon the 
 extreme vessels, while these, in 
 being thus impressed, institute an 
 increased amount of the reflex in- 
 fluence upon the heart and larger 
 vessels, which increases still farther 
 the contraction of the small vessels, 
 and this complex or double circle of 
 sympathies continues to advance 
 till the heart becomes overpowered 
 in its action, and syncope takes 
 place, p. 693, () 920, and references 
 there. 
 
 7th, the specific artificial impression 
 instituted by leeches at the place 
 of their impression continues to 
 exert a powerful development of re- 
 flex action of the nervous system, 
 which is determined with the fore- 
 going effect (2-6) upon the heart 
 and arteries long after the blood 
 has ceased flowing, and, for this 
 reason, the system may be more 
 prostrated by much smaller quan-
 
 INDEX II. 
 
 . 1025 
 
 Leeching — continued. 
 
 tities of blood taken by leeching 
 than by general bloodletting, and 
 syncope may ensue some hours 
 after the blood has ceased flowing, 
 p. 693, ^921 a-c, and references 
 there. — Note Dd p. 1132. 
 direct and reflex action of fhe nervous 
 system the essential cause of all the 
 effects, ibid., and p. 703-711, ^ 940- 
 952 — and which is distinctly shown 
 by the effect of a single leech in re- 
 lieving ophthalmia, or pleurisy, or 
 amenorrhcea, &c., when applied to 
 the skin, since there is no vascular 
 connexion between the skin and the 
 internal parts, and the quantity of 
 blood too insignificant to affect' the 
 volume of the circulating mass. See 
 Bloodletting, General, Index 11. 
 che eff'usion of blood is owing to the 
 specific change instituted by leeches 
 in the vital condition of the extreme 
 vessels, being analogous to the pro- 
 cess of secretion, and differing totally 
 in that respect from the results of 
 cupping, although in the latter case 
 larger and far more numerous vessels 
 are divided, and then require the aid 
 of an exhausting receiver, p. 694, (j 
 922 a ; p. 702, () 939 b, c. 
 hence it is evident that cupping-glasses 
 should not be applied in leeching, and 
 for other reasons, p. 702, ^ 939 d. 
 a remarkable diflference, also, betv?een 
 the effects of leeching and of spon- 
 taneous hemorrhage, which is also 
 analogous to a secretory process, and 
 may amount to many pounds without 
 much impairing the strength or in- 
 ducing syncope — owing to a differ- 
 ence in the development of the reflex 
 action of the nervous influence in the 
 two cases, p. 694, () 922 b. Also, 
 Hemorrhage, Spontaneous, Index 
 II. 
 other special influences may be obtained 
 through the medium of special vital 
 relations which one organ may bear 
 to another, while the auxiliary part 
 will not only co-operate in the develop- 
 ment of salutary alterative influences 
 of reflex action of the nervous system, 
 but may itself be thus relieved of dis- 
 ease more efifectually than by any oth- 
 er means — as seen in hepatic conges- 
 tion, when, if leeches be applied to the 
 anus, or septum nasi, the artificial 
 change which is there established is 
 propagated continuously along the 
 mucous tissue of the intestine and 
 up the duct of the liver into the laby- 
 rinth of the organ, while, also, the 
 liver is not only thus relieved and 
 brought to institute salutary reflex 
 
 Tt 
 
 Leeching — continued. 
 
 action of the nervous system, but the 
 continuous impression upon the intes- 
 tinal mucous tissue institutes other 
 usefully alterative influences of reflex 
 action, and after the manner of Croton 
 oil applied to the tongue, or of sup- 
 positories, p. 694-695, i) 923 a-d 
 Also, p. 64, ij 141 b; p. 322-323, I) 
 498 ; p. 343, ^ 516 rf, No. 2 ; p. 344- 
 345, (J 516 d, No. 6 ; p. 349, ^ 520; 
 p. 350, ^ 523, No. 7 ; p. 351, i) 524 a, 
 No. 2 ; p. 355-359, ^ 526 b, c ; p. 526, 
 ^ 828 d ; p. 563-564, ^ 889 a ; Oil, 
 Croton; SapposiTORiEs; Sympathy, 
 Continuous ; Alteratives ; Anti- 
 mony, Tartarized, Index II. 
 for uie foregoing and other reasons, it 
 may be most useful to apply leeches 
 to a part remote from the seat of dis- 
 ease, while in a larger proportion of 
 cases the application should be made 
 near or directly to the aflected part, 
 p. 694-695, <J 923-924— and the me- 
 chanical doctrine of revulsion not to 
 be thought of, p. 695, () 924. Also, 
 Metastasis and Revulsion, Coun- 
 ter-Irritants, Reflex Action of 
 Nervous System, Index II. 
 again, the best influences will sometimes 
 follow the application to a distant part 
 between which and the seat of disease 
 there are apparently no particular nat- 
 ural relations, as to the feet in amen- 
 orrhcea, and the septum nasi in cerebral 
 affections, p. 694-695, <} 923 ^>-924. 
 operates, in part, upon principle con- 
 cerned in Counter- Irritation, when 
 the reflex nervous influence is de- 
 veloped by the irritation of the skin, 
 p. 659, ^ 893 g ; p. 696-697, ^ 926, 
 927 a — and the philosophy considered 
 of the salutary effects of frequent and 
 small abstractions of blood by leeches 
 in chronic inflammation — being, be- 
 sides the influences peculiar to loss 
 of blood, and by leeching, analogous 
 to the philosophy concerned in small 
 and repeated vesications in the same 
 conditions of disease, and closely allied 
 in principle to the continued operation 
 of small and repeated doses of altera- 
 tive medicines, p. 648-649, (; 893 g-, h. 
 Also, p. 649, () 893 h; Counter-Ir- 
 ritation, Alteratives ; Antimony, 
 Tartarized, Index II. 
 useful when applied over indolent tu- 
 mours, and often when not of an in- 
 flammatory nature, both by changing 
 the morbid action, and particularly by 
 establishing a susceptibility in the 
 tumours to the local or constitutional 
 action of other remedies, as Iodine, 
 Mercury, Vesicants, &c. , p. 659, i^ 893 
 q; p. 684, 905^ b; p. 616, ^ 892i/,
 
 1026 
 
 INDEX II. 
 
 Leeching — continued. 
 
 often useful only after general bloodlet- 
 ting, in chronic inflammations, which 
 demand the sudden and special phys- 
 iological influences of the latter reme- 
 dy to overcome the obstinacy of morbid 
 habit, p. 298, <) 476i h ; p. 658, ^ 893 
 ;>; p. 697, ^927 a; p. 711,^953. Al- 
 so, Bloodletting, General ; Habit, 
 YiTAh, Index II. — but often beneficial 
 in certain mild, though chronic cases, 
 without the general remedy, <S» 927 b. 
 
 should neverprecede general bloodletting 
 when the latter may be more useful, 
 as in all cases of severe inflammations, 
 p. 696, () 925 ; p. 713-714, () 956-958 ; 
 p. 729, ^ 966 ; p. 733, <^ 974.* Also, 
 p 642, ^ 892A i ; p. 658, () 893 p; p. 
 871-872, () 1068 d; Bloodletting, 
 General ; Inflammation, Index II. 
 
 most sensibly felt in Infancy, and may 
 then be sufficient when general blood- 
 letting would be indispensable at a la- 
 ter age, as the susceptibility to reme- 
 dial action is then greatest, and a lar- 
 ger volume of blood is abstracted in 
 the ratio of size, and quickly. &c., p. 
 696, <) 925. Also, p. 67, ^ 150-151 ; 
 p. 375, ^ 576 e — but never in the cere- 
 bral inflammations and congestions of 
 that age, p. 696, 1) 925 c ; p. 733-734, 
 ^ 974 c-975 b. Also, Brain, Inflam- 
 mation of; Inflammation, Infancy, 
 Index II. 
 
 injurious as an early remedy in the grave 
 forms of visceral congestions and in- 
 flammations, p. 729, ^ 965 b, 966. 
 
 the nature of its influences considered 
 when excessive, having some pecu- 
 liarities which difier from the inju- 
 rious influences that arise from the 
 excessive use of general bloodletting, 
 p. 697-698, ^ 927 b. Also, Blood- 
 letting, General, Index II. 
 
 may be a remedy for inflammation in- 
 duced by excessive general bloodlet- 
 ting, p. 698, ^ 928 ; p. 774, ^ 1024 a. 
 Also, Bloodletting, General, Index 
 II. 
 
 like general bloodletting, more salutary 
 than spontaneous hemorrhages even 
 of large extent, when the remedies 
 may be adopted, on account of, in the 
 former case, the specific influence in- 
 stituted in the extreme vessels of the 
 bitten part, and the consequent special 
 modification of the nervous influence, 
 and, in the latter, the suddenness of 
 its development, p. 298. ^ 476^ h ; p. 
 693-694, <) 921-922 ; p. 702, <) 939 ; 
 p. 770-772, () 1018, 1019. Also, 
 Hemorrhage, Spontaneous ; Stom- 
 ach, Blows upon ; Joy and Anger, 
 Index II. 
 
 the most unfavorable cases for, and 
 
 Leeching — continued. 
 
 where general bloodletting is import- 
 ant, p. 729, ij 966. 
 
 unlike general bloodletting, leeching 
 may be superintended by the unpro- 
 fessional, as the quantity of blood 
 abstracted is generally comparatively 
 small, is slowly taken away, and the 
 results slowly manifested, though in 
 Infancy these considerations do not 
 obtain as at later years, p. 696, () 925 
 b; p. 714, () 958 i. 
 Lehmann, 
 
 his admissions that Medicine has nothing 
 to hope from Chemistry, p. 779-782, 
 () 1029-1030. 
 
 l)is opinion of Vital Physiologists, p. 
 795-799, <^ 1034. 
 
 avows that " there is no essential dif- 
 ference between organic and inor- 
 ganic bodies," ibid. Also, Mijlder, 
 Index II. 
 
 his opinion upon the production of ani- 
 mal sugar, &c., p. 783-795, l^ 1031- 
 1033. 
 
 affirms that the component parts of the 
 bile are not found in the blood, in 
 which he agrees with Miilder and 
 Kane, p. 180, () 350f e; p. 783, (} 
 1031 b — and from which, and other 
 facts, the Author reasons to other 
 secretions, p. 784-793, ^ 1031 b- 
 1032. 
 Leucorrhcea, 
 
 its principles of treatment, p. 576, ^ 890 
 n; p. 688, ij 905^ c. 
 
 best special remedies for, Cantharides 
 internally. Nitrate of Silver externally, 
 p.688, ^905ic. 
 Light — continued from Index I, 
 
 how it produces sneezing through a 
 compounded series of reflex actions 
 of the nervous system, and employed 
 by Author to illustrate the modus 
 operandi of remedial and morbific 
 agents through alterative influences 
 of the same medium, p. 340-341, ^ 
 514 I. Also, Iris, Odors, Disgust, 
 Mental Emotions. &c., Index II. 
 Liver — continued from Index I., 
 
 does it produce sugar 1 p. 783-794, ^ 
 1031-1033. 
 
 objections to hypothesis of double func- 
 tion, p. 789, 790, ^ 1032 a. 
 
 supposed effect upon, by pricking me- 
 dulla oblongata, p. 792, ^ 1032 d. 
 
 allowed not to be a " strainer," p. 783, 
 ^ 1031 b. Also, " Strainage," Index 
 IL 
 Loss OF Blood, (Bloodletting, Ind. II.) 
 
 when appropriate, promotes the salutary 
 effects of all other remedies, prevents 
 their morbific effects, and should there- 
 fore, when employed, precede all oth- 
 ers, and often even to the extent of its
 
 INDEX II. 
 
 1027 
 
 Loss of Blood — continued. 
 
 repetition, p. 367, ^ 556 c ; p. 375, () 
 576 c ; p. 550, () 863/; p. 552, ^ 868 b ; 
 p. 572-574, () 890 d-f; p. 641-642, 
 § 892| ; p. 658, ^ 893 jo ; p. 713-714, 
 ^ 956-958 ; p. 729-730, ^ 968-969 ; 
 p. 733-734, ^ 974-975 ; p. 736, 1) 979 ; 
 p. 739, ^ 985. Also, Bloodletting, 
 Leeching, Index II. 
 
 its management in Croup, ^ 5*76 6, 964 d. 
 
 leeching may succeed, in Infancy, in grave 
 inflammations and congestions of all 
 organs excepting the brain, and in the 
 latter case general bloodletting should 
 be practised, and why, p. 696, ^ 925 ; 
 p. 733-734, 1^974-975; p. 767, ^ 1009 
 b, c. 
 
 the philosophy of its effects wholly refer- 
 able to alterative influences of direct 
 and reflex action of the nervous sys- 
 tem, p. 690-711, () 906-952. Also, 
 Bloodletting, Leeching, Index II. 
 
 affects profoundly the secretions and the 
 blood itself through alterative influence 
 of reflex action of the nervous system 
 exerted upon the capillary vessels, as 
 may also a mental emotion, p. 703- 
 711, ^ 940-952 — which should be 
 connected with that condition of the 
 same influence that so alters the ac- 
 tion of the sanguiferous vessels in 
 inflammations as to impart the hard- 
 ness and incompressibility of pulse, 
 and buffiness and cupping of blood 
 which its loss removes, p. 444-445, 
 ^ 688 a~f; p. 804-805, (} 1040. Also, 
 Bloodletting, Mental Emotions, 
 Fear, and the other individual Pas- 
 sio7is, Pulse, Secretion and Excre- 
 tion, Inflammation, Remedial Ac- 
 tion, Index II. ; Nervous Power, 
 Sympathy, Index I. and II. 
 
 its effects through the nervous system 
 illustrated by the Passions and other 
 things, p. 666, I) 902 c ; p. 667-669, 
 § 902 e-i ; p. 704, () 944 a ; p. 706- 
 709, () 946 J-951. Also, various cita- 
 tions under last general references. 
 
 when death is brought on immediately 
 by the ordinary operation of blood- 
 letting, or as it follows leeching, or 
 the passions, it is wholly owing to 
 the prostrating influence of direct 
 and reflex action of the nervous sys- 
 tem upon the great organs of life, p. 
 693-694, <J 921-922 ; p. 703-705, () 
 942 i-944 b; p. 706-709, ^ 947-951. 
 Also, Joy and Anger, Index II. 
 
 like sudden mental emotions, blows upon 
 the epigastrium, shocks from surgical 
 operations, hydrocyanic acid, &;c., a 
 small loss of blood may determine the 
 nervous influence with so much vio- 
 lence upon the brain itself as to extin- 
 guish life suddenly ; as seen in blood- 
 
 Loss of Blood — continued. 
 
 letting after the brain has sustained 
 a shock of the nervous influence, and 
 through that shock all other organs, 
 in cases of falls, p. 709, <J 951 b-d. 
 Also, Stomach, Blows upon ; Hy- 
 drocyanic Acid, Index II. ; Nervous 
 Power, Index I. and II. 
 
 if syncope take place, reanimation is 
 established by stimulants, cold air, 
 snapping drops of cold water upon 
 the face, 6ic., through their develop- 
 ment of an exciting reflex action of 
 the nervous system, p. 338, () 514 d; 
 p. 705, <) 945. Also, Cold, Skin, 
 Heat, Food, Index II. 
 
 Author's tabular arrangement of the dif- 
 ferent tissues and organs, and parts 
 of continuous tissues, illustrating the 
 difference in their vital constitution 
 by their relative liability to inflamma- 
 tion, the relative danger of the disease. 
 and the relative proportion of loss ot 
 blood that may be required, as the 
 disease may affect one part or another. 
 p. 69-73, 1} 160-162. Also, Struc- 
 ture, Index II. 
 
 proposal of pricking the heart in per- 
 sisting cases of syncope originally 
 made by the Author, in Medical and 
 Physiological Commentaries, vol. i. 
 p. 178, note {184:0); Institutes, p. 705, 
 (J 945. 
 
 its operation expounded by Author in 
 Medical and Physiological Comment- 
 aries, altogether through direct and 
 reflex action of the nervous system — 
 Article Bloodletting, p. 121-362, 
 vol. i. ( J 840). Also, ibid., p. 568-572, 
 where the mechanism and the doc- 
 trine of reflex nervous action is specif- 
 ically set forth as the Author's engine 
 against the Humoral Pathology. 
 
 first recorded quantities of blood ab- 
 stracted, p. 755, () 1004 c. 
 
 why Hippocrates has not stated quan- 
 tities, p. 756, {) 1004 d. 
 Love, 
 
 like every other passion, has its own 
 special way of developing and modi- 
 fying the nervous influence, and di- 
 recting it upon special parts with 
 well-marked effects, while its local 
 influences of a direct nature generate 
 a reflex action of the nervous system 
 less productive of agreeable results — 
 contradicts the chemical and humoral 
 doctrines in physiology and disease, 
 and goes with the rest in sustaining 
 the Author's interpretation of the mo- 
 dus operandi of remedial and morbific 
 agents, p. 95, § 188^ ; p. 107^108, ^ 
 227-228; p. Ill, (J233f ; p. 326-328, 
 § 500 g-m; p. 335-336, (/ 412-513 ; 
 p. 417, (J 649 c ; p. 631, <J 892f b; p
 
 1028 
 
 INDEX II. 
 
 Love — continued. 
 
 709, (^ 951 6, c ; p. 891, (^ 1077. Also, 
 Mental Emotions, Jealousy, and 
 the other individual Passions, Dis- 
 gust, Shame, Friction, Yawning, 
 Sea- Sickness, Remedial Action, 
 Seton, Index II. 
 
 considered in its distinction between 
 man and animals, p. 900-901, <J 1078 
 i,L 
 Lungs, 
 
 the philosophy and treatment of their 
 various maladies, p. 633-642, <) 8924. 
 Also, Pneumonia, Bloodletting, 
 Counter-Irritants, Inflammation, 
 Index II. 
 Lymph, 
 
 as a morbid product, depends upon in- 
 flammation, and designed for useful 
 ends, and analogous to suppuration 
 in principle, p. 471-475, () 732-733. 
 Also, p 546-547, () 862-863. 
 
 Becquerel and Rodier's, and Simon's 
 opinion of its dependence on vital 
 laws, p. 800-801, \ 1035. 
 Lymphatics, (See Absorption, Index I.) 
 
 circulation in, dependent on same causes 
 as in Lacteals, which see, Index II. 
 
 termination of, in mesenteric veins, led 
 Magendie to the inference that the 
 veins perform the office of absorption, 
 which is contradicted, also, by Design 
 in relation to the general functions of 
 the absorbent and venous systems, p. 
 128-129, () 269-273 ; p. 527, ^ 829. 
 Also, p. 62, <J 136 ; p. 63, <) 137 b, c ; 
 p. 210, ^ 387; and Circulation of 
 Blood, Lidex II. ; Veins, Lidcx I. 
 
 absorb nothing but what is natural to 
 them, not even pus, p. 99, ^ 192; p. 
 129-131, ^ 227-284, and references 
 there ; p. 632, () 892J c, 1088-1089. 
 
 participate in the ulcerative process, p. 
 129, {) 272 ; p. 472-473, ^ 733 b-d; 
 p. 483, (j 746 b, &c. 
 
 like the veins, particularly liable to dif- 
 fuse inflammation, and supplying in 
 cither case a good illustration of con- 
 tinuous sympathy, p. 356, () 526 c ; 
 p. 526-527, () 828 d, e. Also, Veins ; 
 Sympathy, Continuous, Index I. and 
 II. ; Lacteals, Index II. ; Venous 
 Congestion, Venous Tissue, Index I. 
 
 M. 
 Magendie, 
 
 his mistake in supposing that the veins 
 perform the office of absorption, p. 
 128-129, () 269-273 ; p. 527, <^ 829. 
 Also, p. 62, <J 136 ; p. 63, <J 137 b, c ; 
 p. 210, () 387, and Veins, Index I ; 
 Circulation of Blood, Index II. 
 
 his opinion of "Vitality" and Inflamma- 
 tion, p. 482, (J 744; p. 509 () 810. 
 
 Mankind, Unity of — continued from In- 
 dex I, 
 briefly considered, p. 906-907, () 1078 s. 
 Also, Races of Mankind, Index I. 
 Materialism — continued from Index I, 
 the chemical and functional doctrines of, 
 p. 882-885, ^ 1076 ; p. 894, note. 
 Materia Medico — continued from Index 
 
 farther illustrations of the principles 
 upon which the Author has founded 
 his Therapeutical Arrangement of, 
 p. 830-831, ij 1057 c; p. 835-838, (j 
 1057i; ji. 851, () 1060; p. 853, ^ 
 1061 ; i) 1062, 2 b, 854-860, 892^ h. 
 Measles, 
 
 like small-pox, scarlet fever, and mumps, 
 a self-limited disease, and cannot be 
 placed in a better condition for the 
 recuperative law than is done by its 
 own cause, and, like the other affec- 
 tions, illustrates the close analogy 
 between morbific and remedial agents, 
 p. 544-545, ^ 858 ; p. 844, () 1058 z— 
 and what, also, is generally true of the 
 former in regard to their laws, is about 
 the same in respect to measles. See 
 the Articles. Also, Contagion, 
 Miasm ; Causes, Morbific ; Reme- 
 dies, Therapeutics. 
 Medical Science, Progress of — contin- 
 ued from Index /., 
 
 what is apt to be so denominated, p. 795, 
 ^ 1033 b. 
 
 its future prospects at the hands of 
 Chemistry, p. 8-10, ij 5 ; p. 14, iji 6 ; 
 p. 203-204, {) 367i ; p. 779-782, <J 
 1028-1030. 
 
 in its present state, intolerant of those 
 who look upon Nature less super- 
 ficially, p. 12-13, (jb^a; p. 795-799, 
 ^ 1034 — which explains the remote 
 cause that has compelled the Article 
 on the " Rights of Authors," p. 912 
 -920. 
 Medicine — continued from Index I, 
 
 sudden revolutions in, p. 795, () 1035 b. 
 Medicines, Combinations of. See Reme- 
 dies, Index II. 
 Memory — loss of, Note Hh p. 1138. 
 
 different in man and animals, p. 901- 
 902, () 1078 a. 
 Menorrhagia, 
 
 commonly a sympathetic result, like 
 amenorrhcea, of abdominal diseases, 
 though more frequently than the lat- 
 ter, and the whole condition generally 
 more important, and greater advan- 
 tages are bestowed by astringents in 
 one case than by emmenagogues in 
 the other, while either equally require 
 the main treatment to be addressed 
 to any existing predisposing disease. 
 See Amenorrhcea, Emmenagogues, 
 Astringents; Causes, Morbific,-
 
 INDEX II. 
 
 1029 
 
 Menorrhagia — continued. 
 
 Hemorrhage, Spontaneous; Ergot, 
 Loss OF Blood, Uterus, Index II. 
 
 Menstruation. See Index I. 
 
 Mental Emotions, 
 
 see a subdivision, Mental Emotions, 
 under Remedial Action, where the 
 references to this subject are numer- 
 ous, and present a variety of physio- 
 logical, pathological, and therapeutical 
 problems, illustrative of the Author's 
 doctrine of their action through the 
 direct development of the nervous in- 
 fluence, and of developments of reflex 
 action of the nervous system as con- 
 sequences of the impressions made 
 upon parts remote from the nervous 
 centres by the antecedent direct de- 
 velopment ; and also the numerous 
 references under the several subdivis- 
 ions of Reflex Action of the Nerv- 
 ous System, and of Nervous Power 
 {Index II.), where the analogies with 
 the foregoing are clearly and variously 
 established — each and all of which, 
 certainly their united force, must ere 
 long sweep away those chemical and 
 physical doctrines, which, though 
 promulgated by Genius of the highest 
 order in the walks of Chemistry, and 
 to which mankind are under profound 
 obligations, have, for that very reason, 
 vitiated all Medical Science, and ren- 
 dered its practice an empirical art. 
 See Shame, Grief, Disgust, Joy and 
 Anger, Hope, Fear, Jealousy, Love, 
 Weeping, Micturition, Laughing, 
 Yawning, Roosting, Sneezing, 
 Mind, Soul and Instinctive Prin- 
 ciple, Chemical Physiologists, In- 
 dex II. ; Organic Chemistry, Index 
 I. and II. 
 bear a strict analogy in effects with those 
 of disease, injuries, and physical irri- 
 tations of the nervous centres, which 
 develop the nervous influence in a 
 direct manner, and are then alone 
 interested with the system of excito- 
 motory nerves or fibres of compound 
 nerves, and farther establish their 
 analogy with the Mental Emotions 
 through the reflex actions of the nerv- 
 ous system that supervene as conse- 
 quences of the impressions upon dis- 
 tant parts by the direct development, 
 and other resulting circles of complex 
 reflex actions — whose results declare 
 their dependence upon something, that 
 they are precisely the same in all the 
 cases, and that, therefore, they are 
 equally due to a common cause, and 
 equally so when physical agents act- 
 ing upon the skin give rise to exactly 
 the same phenomena, and that since 
 neither the external physical causes 
 
 Mental Emotions — continued. 
 
 nor the brain, nor spinal cord, are 
 transmitted to the affected parts, it is 
 quite logical to suppose that the 
 Mental Emotions are restrained from 
 wandering away from those nervous 
 centres upon which they institute their 
 primary action, and that, if there be 
 any thing of a substantive nature in 
 a blister, or in the stick which inflicts 
 a blow upon the head, and upon which 
 all the distant effects depend, it is 
 equally certain that a substance quite 
 as real, and quite as distinct from the 
 nervous centres, occasions the corre- 
 sponding results of the mental emo- 
 tions, and therefore, also, through the 
 same efficient medium — all of which 
 is elaborately apparent in the follow- 
 ing sections, p. 101-102, ^ 201-202 
 p. 107-108, () 227; p. 109, ^230; p 
 111, '^233J; p. 289, M61 ; p. 296 
 476 c; p. 302, <^ 481 b; p. 315-310 
 (J 492 ; p. 321, (} 496, 497 ; p. 323- 
 330, I) 500 a-n ; p. 333, (, 503-505 
 p. 336-337, (} 514 b ; p. 338-339, ^ 
 514 d~h; p. 347-348, (/ 516 d. No. 13 
 p. 416-417, (J 649 c; p. 592-593, ^ 
 891iZ:; p. 631-632, (^ 892f 6 ; p. 061 
 -663, ^ 894 i-896 ; p. 666-668, (/ 902 
 b-g ; p. 670, () 902 / ; p. 675-676, <) 
 904 b; p. 679-681, ^ 905 a; p. 704, 
 () 944 a ; p. 707, ^ 947-949 ; p. 709, 
 (} 951 b, c; p. 865-868, ^ 1076; p. 
 874-881, () 1071-1075 ; p. 876-877, 
 () 1072 a ; p. 886-890, () 1077. Also, 
 the foregoing Articles. 
 
 as Mental Emotions, therefore, often 
 give rise to alterative influences of 
 reflex actions of the nervous system, 
 they differ in those respects from the 
 Will, whose displays of the nervous 
 influence terminate in the voluntary 
 muscles, and without exerting any 
 other effect than that of simple mo- 
 tion, and it is alone interested in 
 excito-motory nerves or fibres of that 
 denomination. See Will, Index I. 
 and II. ; Nerves, Motor ; Nerves, 
 Sensitive; Nervous Power, /?!rfcx/. 
 
 do not operate upon the brain or other 
 organs in the metaphysical manner 
 as commonly supposed of all the attri- 
 butes of the mind, nor according to the 
 doctrine of Chemistry, but in no other 
 conceivable way than as appertain- 
 ing to a substantive self-acting agent 
 exciting the nervous influence and 
 determining it upon other organs, or 
 upon the nervous centres themselve? , 
 according to the exact analogies sup- 
 plied by all physical causes, and like 
 those, also, modifying the nervous in- 
 fluence according to the nature of the 
 individual emotions — the effects of the
 
 103U 
 
 INDEX II. 
 
 Mental Emotions — continued. 
 
 Will through the same causation con- 
 curring in this demonstration, p. 107- 
 lll.'J 226-233f ; p. 266, i^ 447 (Z ; p. 
 289, M61 ; p. 296, <^ 476 c; p. 298, 
 ij 476^ h; p. 300, () 479; p. 301, (j 
 480 ; p. 302, (^481 6 ; p. 304, (> 481 
 g; p. 306-308, () 483 b; p. 324, (j 
 600 c, d; p. 335, <;i 511 ; p. 402-403, 
 ^ 634-635 ; p. 534, <J 846 ; p. 706- 
 709, ij 947-951 ; p. 631, <J 892i 4; 
 p. 661-662, i) 894 b; p. 745-746, ^ 
 990i ; p. 865-868, «J 1067 ; p. 878- 
 882, ij 1074-1075 ; p. 887, () 1077. 
 
 since, therefore, according to the fore- 
 going references, the Meiital Emotions 
 and the Will develop the nervous in- 
 fluence by their direct action upon the 
 brain, and without the intervention of 
 sensitive nerves, and since, also, the 
 nervous influence, when thus devel- 
 oped by the Passions, brings about 
 precisely the same morbid and cu- 
 rative results as when other things 
 operate through reflex action of the 
 nervous system, it supplies as full a 
 demonstration against any chemical 
 doctrine that may be carried analog- 
 ically from the supposed positive and 
 negative condition of atoms in the 
 galvanic battery to the double nervous 
 arc ; foregoing references, and Will, 
 Index I. and II. 
 
 not only induce and remove disease like 
 all morbific and remedial agents of a 
 physical nature, but, like physical 
 causes, it is one of their most obvious 
 characteristics to determine the nerv- 
 ous influence with such a modifying 
 effect upon the instruments of organic 
 processes as to increase or diminish, or 
 to change the natural condition of the 
 secretions, p. 266, i) 447 d ; p. 289, § 
 461 ; p. 296, (j 476 c ; p. 302, (j 4:81 b ; 
 p. 631-632, ^ 892i b. Also, Fear, 
 Jealousy, and the other individual 
 Passions, Food, Cold, Kidney, Skin, 
 Remedial Action, subdivision Men- 
 tal Emotions, Index II. 
 
 having established the strict analogies 
 between the morbific and remedial 
 effects of the various Passions and 
 all physical agents, and that they are 
 all exerted through the medium of the 
 nervous system, and according to the 
 particular nature and intensity of each 
 one, and that they constantly operate 
 not only in a direct manner through 
 the excito-motory nerves alone, and 
 according to direct physical impres- 
 sions upon the nervous centres, and 
 according to their nature, but that the 
 Passions, like the physical impres- 
 sions, through their effects upon or- 
 gans distant from the nervous cen- 
 
 Mental Emotions — continued. 
 
 tres, give rise to alterative influences 
 of reflex action of the nervous system 
 according to the nature of each one, 
 and since none but the Materialist 
 will assume that they operate in any 
 chemical or physical manner, we ar- 
 rive at the incontrovertible conclusion 
 that all the analogous effects of reme- 
 dial and morbific agents of a physical 
 constitution are not only carried on 
 through the same causation, but that 
 they are equally destitute of all relation 
 to physics and chemistry, ut supra, 
 and the individual Passions, Blood- 
 letting, Loss of Blood ; Brain, 
 Inflammation of, Index II. 
 an apparently endless variety of prob- 
 lems are presented by the Passions 
 in their independent influences, and 
 which become greatly complicated by 
 their relations to foreign causes, by 
 the variety of ways in which they are 
 brought into operation, by the manner 
 in which they modify the condition of 
 organs so as to predispose them to the 
 morbific action of foreign causes, or, 
 again, defeat or promote the salutary 
 effects of remedies, or as they are 
 directly morbific or remedial them- 
 selves, and according to the nature 
 and intensity of each, or by their pro- 
 duction through mental sympathy, as 
 in laughing, weeping, and even hic- 
 cough, or in that analogous but inde- 
 finable influence propagated from one 
 to another, as witnessed in yawning, 
 micturition, &c., but all of which are 
 perfectly resolvable through the Au- 
 thor's doctrine of alterative and vari- 
 ously modified influence of direct and 
 reflex action of the nervous system, 
 evince their subjection to laws as 
 peculiar as are all the phenomena (p. 
 112-121, (j 234 c-237 ; p. 514, No. 7, 
 parallelcolumns) ; and here the Author 
 will extend the example which occurs 
 at p. 866-867, (j 1067, in relation to 
 the influence of Fear upon digestion, 
 and suppose that one of the individuals 
 should reject the food from the stom- 
 ach, in which case the emotion would 
 simply render the nervous influence 
 an irritant to the mucous tissue of the 
 stomach, while the mechanical irrita- 
 tion of the food would develop, in con- 
 junction with the gastric irritation by 
 the passion, the reflex nervous action 
 which determines the act of vomiting ; 
 and the analogy in substantive remote 
 causes, and the sameness of the imme- 
 diate exciting cause of the paroxysm 
 become abundantly manifest in the 
 fact that the mind itself may subse- 
 quently reproduce the act by calling
 
 INDEX II. 
 
 1031 
 
 Mental Emotions — continued. 
 
 up a recollection of the event, and as 
 described at p. 324, () 500 c ; p. 547- 
 548, ^ 863 d ; p. 666, () 902 c, and 
 under the Article Disgust. See, 
 also. Hiccough, Hysteria, Imagina- 
 tion, Fear, Joy and Anger, Jeal- 
 ousy, Love, Shame, Sea-Sickness, 
 Weeping, Laughing, Sneezing, 
 Roosting, Whooping-Cough, Phthi- 
 sis, Food, Cold, Heat, Skin, Seton. 
 
 their influences, and the eflfects of the 
 Will, employed by the Author in de- 
 monstrating the substantive existence 
 and self-acting nature of the Soul and 
 Instinctive Principle, p. 876-881, ^ 
 1071-1075. Also, Will, Index I. 
 and II. 
 
 how regarded in their relations to the 
 higher powers of the mind, p. 877- 
 881, (i 1072 J-1075. 
 
 from all which it appears that every 
 consideration relative to the Mental 
 Emotions — their very nature, the 
 variety of their effects in organic life, 
 physiological, pathological, and thera- 
 peutical, the rapidity with which they 
 may institute the changes, the manner 
 in which they modify the operation of 
 physical agents, the anatomical me- 
 dium through which they exert their 
 effects, denote the total absence of 
 any connexion with the laws which 
 govern the conditions of dead matter, 
 while the complete analogies of their 
 effects with those of physical causes, 
 and the multitudinous variety of means 
 which will arrest some given condi- 
 tions of disease, and often with great 
 instantaneousness, and in common 
 with mental emotions, show that the 
 physical causes, by this correspond- 
 ence with mental emotions, are equally 
 independent of chemical and physical 
 laws ; and their united force bears an 
 overwhelming testimony in corrobora- 
 tion of what is so abundantly substan- 
 tiated by the phenomena of the men- 
 tal causes; nor is there a principle or 
 a fact promulgated by Chemistry of 
 practical application at the bedside of 
 the sick, p. 296, <J 476 c ; p. 302, (/ 
 481 b; p. 377-380, (^ 578; p. 547- 
 548, ^ 863 d; p. 664, (; 900 ; p. 666, 
 () 902 c ; p. 667-669, <J 902 e-g ; p. 
 679-681, () 905 a; p. 707, () 947 ; p. 
 709, (/ 951 b; p. 866-868, ^ 1067; 
 p. 889-890, <^ 1077. Also, the indi- 
 vidual Passions, Skin, Cold, Seton, 
 Counter- Irritants, Respiration; 
 &c.. Index 11 Also, p. 95, ^ 188^ rf. 
 
 their development of the nervous in- 
 fluence by their action upon the brain, 
 and their operation upon distant parts 
 through that influence, as also of the 
 
 Mental Emotions — continued. 
 
 Will, wholly peculiar to the Author, 
 p. 106, <J 222 b; p. 296, () 476 c, and 
 ut supra, and Reflex Action of the 
 Nervous System, Remedial Action, 
 subdivision Mental Emotions ; Au- 
 thors, Rights of. Index II. 
 
 Mercurial Pill, Blue. See Blue Pill, 
 Index II. 
 
 Mercurial Remedies, 
 
 whether applied to the skin or taken in- 
 ternally, produce their constitutional 
 effects through alterative influence of 
 reflex action of the nervous system, 
 both in their largest and smallest 
 doses, and when their operation is 
 slowly progressive illustrated by nat- 
 ural processes, as contraction of the 
 sphincter muscles, respiration, &c., 
 and by effects of cold applied to the 
 surface, seton, tartarized antimony, 
 &c. — displaying, also, the strict anal- 
 ogy in effects between remedial and 
 morbific agents, and that the former 
 operate by substituting pathological 
 conditions more favorable than those 
 of the latter to the recuperative law, 
 since, when the full constitutional 
 effects of mercury induce inflamma- 
 tion of the parotids, and mouth, and 
 the " mercurial fever," the gravest 
 forms of various diseases disappear 
 as a consequence, and, therefore, 
 when they subside under milder in- 
 fluences, it is still in consequence of 
 milder degrees of analogous chan- 
 ges, p. 66-67, () 148 ; p. 338-339, () 
 514 d-h ; p. 344-345, () 516 d. No. 6 ; 
 p. 524, (} 827 e; p. 526, () 828 d; p. 
 541, ^ 853-854 b; p. 542-543, ^ 854 
 c-857 ; p. 567-569, <J 889 l-mm ; p. 
 645-647, (J 893 c-e ; p. 661-663, () 
 894 i-896 ; p. 664-672, ^ 900-904 ; 
 p. 678, ^ 904 rf ; p. 679-681, ^ 905 a; 
 p. 850, ^ 1059. Alteratives ; An- 
 timony, Tartarized; Cantharides; 
 Hydrophobia,Virus of ; Skin, Cold ; 
 Oil,Croton; Suppositories, Leech- 
 ing, Index IL P. 930-931, ij 1088 b, c. 
 their constitutional effects promoted by 
 other cathartics and by loss of blood, 
 which raise the irritability of the in- 
 testinal mucous tissue and of the 
 system at large, through which the 
 influences of the mercurial agent are 
 promoted, p. 367, () 556 c. Also, p. 
 63, \ 137 d, e; p. 65-66, ^ 143 c, d; 
 p. 67, ^ 149-151 ; p. 73, () 163, and 
 Ipecacuanha, Index II. 
 
 Mercury, Chloride of. See Calomel, 
 Index II. , 
 illustrates the modus operandi of Astrin- 
 gents by its comparative effects in 
 cholera infantum with those of the 
 latter in diarrhoea, &c., p. 576, ^ 890 I,
 
 1032 
 
 INDEX II. 
 
 Metamorphosis, 
 
 philosophy of, p. 902, ^ 1078 p. 
 Metaphysicians — continued from Index 
 I., 
 
 should take for their basis, in intellectual 
 philosophy, the physiological facts 
 which demonstrate the substantive 
 existence and self-acting nature of 
 the Soul. See Soul and Instinctive 
 Principle, Index II. 
 
 identify the Soul and Instinctive Princi- 
 ple, p. 895, (J 1078 b; p. 889, (J 1078 h. 
 Metastasis, Revulsion, and Repulsion, 
 
 have been interpreted upon no intelligi- 
 ble principle, but which depend upon 
 alterative influences of reflex action 
 of the nervous system — illustrating 
 the practical consequences of unsound 
 doctrines, p. 351-352, () 524 h-d; p. 
 652-656, ^ 893 n; p. 695, ^ 924. 
 Also, Counter-Irritants, Elate- 
 EiuM, Lactation, Mumps, Uterus. 
 Miasm, Vegetable, 
 
 the cause of the numerous varieties of 
 fever, and often of inflammations and 
 venous congestions, and modify the 
 character of each according to the 
 particular modes of vegetable decom- 
 position and recombination of the ele- 
 ments as brought about by varying 
 temperatures, climate, season as to 
 moisture and dryness, and other 
 chemical influences, p. 417-418, (} 
 650; p. 424, <J 662; p. 480-481, ^ 
 743 ; p. 490, i) 758 ; p. 493-494, (J 
 765-767 ; p. 496, I) 773 ; p. 497-498, 
 () ni-im ; p. 510-512, (j 813-817. 
 Also, Causes, Morbific ; Remedies, 
 Remedial Action, Index II 
 
 is generally the predisposing cause on- 
 ly, but may be also the only exciting 
 cause, p. 420, () 654 a; p. 421-422, 
 () 654 c-657 a ; p. 497, ^ 779. 
 
 does not produce disease in the surfaces 
 upon which it operates, unless through 
 reacting influences of the reflex law 
 of the nervous system, and through 
 which, also, as in the case of cold, the 
 morbific influences are propagated 
 upon all other parts from the surface 
 upon which the primary impression 
 is made, p. 221-222, ^ 657 a; p. 426, 
 () 666 a. Also, Causes, Morbific ; 
 Hydrophobia, Virus OF ; Skin, Cold, 
 Seton, Sphincter Muscles, Whoop- 
 iNG-CouGH, Alteratives; Antimony, 
 Tartarized ; Predisposition, &c., 
 Index II Also, ^ 89U ?, 1088 I, 
 
 like the virus of small-pox, measles, &c., 
 may establish a permanently protec- 
 tive influence against repetitions of 
 the same disease — intermittent and 
 yellow fevers, for example — but with 
 the difierence that the susceptibility is 
 more likely to return in the case of the 
 
 Miasm, Vegetable — continued. 
 
 fevers unless the subjects continue to 
 reside under the influence of their 
 predisposing causes, p. 364, () 544, 
 545 ; p. 365-366, <) 550-555 ; p. 368, 
 () 559, 560 ; p. 370, () 566 b; p. 425, 
 ^ 664. Also, Small-pox ; Diseases, 
 Self-limited ; Vital Habit, Accli- 
 mation, Index II. 
 
 cannot produce disease — such as yellow 
 fever, plague, malignant cholera, dys- 
 entery, &c. — that may be communi- 
 cable, nor can a contagious disease be 
 generated in others by any other cause 
 than the animal product which arises 
 from each disease respectively — a fun- 
 damental law which is without excep- 
 tion, p. 27, (^ 52 ; p. 419-420, ^ 653 ; 
 p. 842-843, () 1058/. 
 
 its morbific action promoted by various 
 causes which increase the suscepti- 
 bility of the system, with illustrations 
 from Cathartics, Bloodletting, &c., p. 
 524, (^827e; <J961a; ^970c; and 
 Remedies, Acclimation, Index II. 
 
 often predisposes the system to the ma- 
 lign action of other morbific causes, 
 renders the consequent diseases more 
 dangerous and complicates their treat- 
 ment, as the malignant cholera, small- 
 pox, measles, scarlatina, and increases 
 their epidemic character, ^ 630 e ; § 
 652 b; p. 420, (} 654 a; p. 425, ^ 
 663 ; p. 510-511, () 813-816 ; p. 553, 
 (J 870 aa ; p. 604-606, ^ 892 m-p. 
 
 illustrates the philosophy of Vital Habit, 
 p. 364, () 543-548 ; p. 365-366, ^ 550 
 -554 ; p. 368, ^ 559, 560 ; p. 370, ^ 
 566 b. 
 
 may establish the predisposition quickl}^ 
 and although the subject pass imme- 
 diately from its farther influence, an 
 explosion of disease may follow at 
 once as a consequence, or only after 
 weeks or months, p. 420, (} 654 a ; p. 
 421, ^ 655 c, d. Also, Hydrophobia, 
 Virus of ; Predisposition, Altera- 
 tives, Index II. 
 Micturition, 
 
 its phenomena as arising from mental 
 sympathy, and in connexion with 
 those of Fear, noises, &c., illustrative 
 of the remarkable effects of mental 
 emotions in organic life through the 
 nervous influence, and of its diversi- 
 fied modifications according to the 
 precise nature of the emotion, p. 534, 
 () 844 ; p. 630-632, <^ 892f ; also. 
 Jealousy, Mental Emotions — and 
 when regarded in connexion with the 
 corresponding cflTects of cold applied 
 to the surface, and of cathartics, 
 bloodletting, &c., an identity of a 
 common proximate cause is estab- 
 lished, only, in the case of the men-
 
 INDEX II. 
 
 1033 
 
 Micturition — conlimied. 
 
 tal emotions the nervous influence is 
 developed in a direct manner, and in 
 which the excito-motory nerves are 
 primarily interested, while in the 
 other cases the sensitive nerves take 
 the initiatory step, and reflex action 
 is the consequence — all concurring 
 together in advancing the Author's 
 doctrine of the modus operandi of 
 morbific and remedial agents, physi- 
 cal and mental, through alterative in- 
 fluences of direct and reflex action of 
 the nervous system. See Remedies ; 
 Causes, Morbific ; Remedial Ac- 
 tion, Mental Emotions, &c., Index 
 II. 
 Migration, 
 
 its want of analogies with the acts of 
 reason employed to demonstrate the 
 distinction between the Soul and In- 
 stinctive Principle, p. 896, <;> 1078 d; 
 p. 898, (^ 1078 q. 
 Milk, 
 
 its production originally dependent upon 
 alterative influence of reflex action of 
 the nervous system, whose point of 
 departure is the uterine system, p. 
 231-232, ^ 424; p. 351, (^ 524 b. 
 Also, Kidney, Secretion and Ex- 
 cretion, Weeping, Food, Fear, 
 Cold, Uterus, Organs of Genera- 
 tion, Index II. ; Youth, Nervous 
 Power, Index I. and II. 
 
 rendered "morbid" by mental emotions, 
 through alterative influence of nervous 
 power, p. 788, ij 1032 a. 
 
 " we analyze healthy and morbid milk, 
 and yet we are ignorant of the sub- 
 stances whose admixture we term 
 casci«," p. 780, H029._ 
 
 disquisition as to the origin of its sac- 
 charine matter, p. 785, ^ 1031 ; p. 
 788-791, <J 1032 a, h. 
 Mind — continued from Index I, 
 
 its influence upon the action of remedial 
 agents, p. 865-868, ^ 1067. Also, 
 Mental Emotions, the individual 
 Passions, Index II. ; Will, Index I. 
 and II. 
 
 its phenomena far more multifarious 
 than of inorganic nature, and more, 
 therefore, is known of the former 
 than of the latter, p. 182, () 350i g. 
 Also, p. 84, () 175 bb; p. 112-121, ^ 
 234 J-237 ; Soul and Instinctive 
 Principle. Mental Emotions, the 
 individual Passions, Index 11. ; Will, 
 Index I. and II. 
 
 subject to the law of Vital Habit, and 
 under complex influences, p. 369-370, 
 ^ 566-568 ; p. 894-895, ^ 1078 b. 
 
 suffers permanently from premature 
 education, but not so with Instinct, 
 and throutrh reflex nervous influence 
 
 Mind — continued. 
 
 from too much or improper food in 
 early life, p. 370, § 568 ; p. 894-895, 
 •J 1078 b. Also, Infancy, Childhood, 
 Youth, Food, Uterus, Vomiting. 
 
 what constitutes Ideas, and employed 
 to illustrate the substantive existence 
 and self-acting nature of the Soul, p. 
 906, (J 1078. 
 
 its modus operandi inscrutable, ibid. 
 
 contrast -between, and Instinct, in the 
 infancy of man and animals, p. 892- 
 895, '!i"l078fl, ^>,- p. 904-906, «;. 1078 7. 
 
 contrasted with the Instinctive Princi- 
 ple as they respect the relative varie- 
 ties in the main central portion of the 
 nervous system, p. 896, <J 1078 d; p. 
 897-898, I) 1078 e; p. 903-906, (} 
 1078 q. 
 
 various other contrasts and analogies 
 between. See Soul and Instinctive 
 Principle. 
 
 the brain, or its equivalent, co-operates 
 with, in all intellectual and instinctive 
 acts, but more so in the latter case, 
 p. 894, () 1078 b; p. 903-906, (} 1078 q. 
 
 identified by metaphysicians with In- 
 stinct, p. 895, ^ 1078 b; p. 899, ^ 
 1078 h. 
 
 the doctrines of Materialism in relation 
 to, p. 882-886, {) 1076 ; p. 894, note. 
 Morbid Anatomy. See Anatomy, Mor- 
 bid, Index II. 
 Morbific Causes. See Causes, Moe- 
 
 BiFic, Index II. 
 Mortification — continued from Index I., 
 
 results from a profoundly morbid condi- 
 tion of the formative stage of inflam- 
 mation, when not owing to direct vio- 
 lence as variously inflicted, p. 447, ^ 
 736 a, b. 
 
 dead parts removed from living through 
 the vital process of ulceration, p. 477, 
 <J 736 c. 
 
 imputed, in inflammations, by the pre- 
 vailing physical doctrines, to stagna- 
 tion and coagulation of blood, p. 484- 
 485, ^ 748, 749. 
 Motion — continued from Index I., 
 
 after apparent death, in voluntary and 
 involuntary muscles, and the philoso- 
 phy of, p. 403-404, ^ 637 ; p. 805, ^ 
 1041. 
 
 dependent upon properties implanted in 
 all parts, p. 806, (J 1 042. Also, Vital 
 Properties, Organic Life, Index I. 
 Mucus, 
 
 Table of parts by which it is produced 
 according to their physiological dif- 
 ferences, with corresponding varieties 
 in the product, p. 218, (; 406. Also, 
 p. 61, (} 133 a, b; p. 62-63, ^ 135- 
 137. 
 
 its varieties depend in its morbic^ as well 
 as natural states upon the physiologi-
 
 1034 
 
 INDEX II. 
 
 Mucus — continued. 
 
 cal peculiarities of different parts of 
 the mucous tissue, and their exact 
 modifications in disease, p. 436, <J 682 
 b; p. 452, (} 693; p. 455, () 694i. 
 
 denotes a greater intensity of inflamma- 
 tion, and greater danger, and calls for 
 more vigorous yet cautious practice 
 when intermixed with blood, p. 572- 
 576, (j 890 c-n. 
 
 its redundancy generally denotes inflam- 
 mation, and it is then equivalent in 
 principle to suppuration, with which 
 it often alternates, and with lymph, 
 in some parts of the mucous tissue, 
 p. 452, «J 693 ; p. 471, ^ 732 a. 
 
 is increased, or diminished, or altered 
 from its natural condition through 
 reflex action of the nervous system 
 in all parts beyond the seat of the 
 direct operation of foreign causes, 
 and more or less so upon their direct 
 seat of action through reverberated 
 nervous influences ; and affected in 
 the foregoing manner by the passions 
 or other causes acting directly upon 
 the nervous centres through direct 
 development of the nervous influence, 
 and through reflex action when the 
 changes are induced by disorders of 
 other and distant parts, p. 422-423, () 
 658; p. 465-467, 1^715-719; p. 478- 
 479, (j 740-741. Also, Bile, Lacta- 
 tion, Weeping, Food, Kidney, Skin; 
 Water, Hot ; Antimony, Tartau- 
 IZED ; Fear, Mental Emotions, &c.. 
 Index II. 
 
 a peculiar modification of, diagnostic of 
 pneumonia, p. 436, <J 682 b. 
 
 operates as a depletive means, but far 
 less so than most other products of 
 morbid processes, excepting from the 
 lungs, being also a result of the recu- 
 perative law, p. 471, i) 732 b ; p. 546- 
 551, ^ 862-863 ; p. 633-634, ^ 892| 
 a ; p. 635-640, ^ 8924 h. 
 Mucous Tissue — continued from Index I, 
 
 the important part, in one of its arrange- 
 ments, upon which remedial agents 
 make their impressions, and from 
 which emanate those modified condi- 
 tions of reflex action of the nervous 
 system through whose variously diver- 
 sified alterative influences, according 
 to the nature of the agent, &c., bring 
 about all their changes in parts re- 
 motely situated, and constantly, also, 
 through reacting nervous influences 
 upon the tissue which is the direct 
 seat of remedial or morbific action, 
 and the philosophy of all of which 
 may be found in the physiology of 
 respiration, where the point of depart- 
 ure for the reflex action of the nerv- 
 ous system is the same tissue in the 
 
 Mucous Tissue — continued. 
 
 lungs, and where the exciting cause 
 is of such an insensible nature that 
 it is diflacult to decide upon its real 
 character, and also farther coincident 
 with other natural processes, as may 
 be seen through the references under 
 the Articles subjoined, p. 66-67, I) 
 148; p. 359, () 527 a, b; p. 361, ^ 
 529 b; p. 415-417, () 649 a-650 ; p. 
 421-422, () 657-658 ; p. 530, () 837 b 
 p. 542, () 854 c, d ; p. 545, () 860 ; p 
 547-550, <J 863 d-e ; p. 554, () 871 
 p. 561, ^ 888 c; p. 563-566, <J 889 
 a-i; p. 567-569, () 889 l-mm; p 
 571, <^ 890 b; p. 575-576, ^ 890 ^-w 
 p. 628-629, {) 892^ q-t ; p. 634-641 
 ^ 8924- b-i; p. 687-688, ^ 905^ c 
 Also, Respiration, Sphincter Mus 
 CLEs, Youth, Skin, Cold, Heat 
 Counter-Irritants, Seton, Exer 
 cisE, Ulcers, Iris, Phthisis, Sea- 
 Sickness, Heart, Kidney, Stomach 
 Emetics, Vomiting, Disgust, Odors 
 Cathartics ; Hydrophobia, Virus 
 of; Roosting, Yawning, Antispas- 
 modics, Reflex Action, Remedial 
 Action, &c.. Index II. ; Nervous 
 Power, Sympathy, Index I. and II. 
 Table, referring to the different modifi- 
 cations of its organic conditions in 
 different parts, and indicative of their 
 relative liability to inflammation, p. 
 70, Table H. — another, showing its 
 relative liability to that disease com- 
 pared with other tissues. Table I. — 
 another, showing the relative danger 
 when aflfected with high inflammation 
 as it forms a component part of differ- 
 ent organs, and as the same disease 
 may affect other tissues in their com- 
 pound relations, p. 72, Table HI. — 
 another, showing the exigencies for 
 bloodletting in high inflammation, ac- 
 cording to its last foregoing relations, 
 and comparatively with other tissues 
 in their connexion with compound 
 organs, Table IV. 
 the difference in the vital constitution 
 of its different parts where it occurs 
 continuously, as from the mouth to 
 the lungs, and from the mouth to the 
 anus, variously illustrated by the cor- 
 responding variety in its products, by 
 the natural changes in some of its 
 parts, by the differences in effects 
 that arise from remedial and morbific 
 agents, whether acting immediately 
 upon its surface, or through alterative 
 influences of reflex action of the nerv- 
 ous system, or through direct develop- 
 ment of the nervous influence by the 
 Passions, and according to the special 
 modifications of disease ; and the va- 
 riety in its vital constitution farther
 
 INDEX II. 
 
 1035 
 
 Mucous Tissue — continued. 
 
 shown as the tissue occurs in parts 
 remote from each other, and as it 
 sympathizes in remote parts through 
 reflex action, p. 61-66, ^ 134-143 ; 
 p. 67, () 149-151 ; p. 70, Table II. ; 
 p. 107-111, ^ 227-2331; p. 374, ^ 
 576 d ; p. 415-41 7, ^ 649 a-c ; p. 436, 
 '^ 682 b ; p. 452. (J 693 ; p. 522-523, 
 <^ 827 b-d ; p. 547-550, i) 863 d ; p. 
 555, i) 872 a ; p. 566, (j 889 i ; p. 571, 
 ^ 890 b; p. 575-576, ^ 890 ^-n; p. 
 634-641, ^ 892|- b-i; p. 661-663, () 
 894 6-896 ; p. 666-672, () 902 a-904 ; 
 p. 840-841, t) 1058 d, c; p. 854, ^ 
 1061 ; p. 856-857, ^ 1063; p. 862- 
 864, (J 1066. 
 
 Table showing its relative liability with 
 that of other tissues to sympathize 
 continuously in their several parts, 
 p. 354, <J 526 a. Also, Sympathy, 
 Continuous, Index II. 
 
 Table showing its relative liability com- 
 pared with other tissues to morbid 
 sympathies, through reflex action of 
 the nervous system, in organs remote 
 from each other, p. 353, ^ 525 a. 
 
 its own sympathies in parts remote from 
 each other, and with other tissues, () 
 512. 514/, 523, no. 7, 527 a-529, 689 
 I, 889, 892% b-i, 902 e, 904 bb. 
 
 MiJLDER, 
 
 applies catalysis in expounding secreted 
 ■ products, in which he does not agree 
 with LiEBiG, p. 178-182, ^ 350t a-f; 
 p. 226, i) 409 ;. 
 
 decides that the component parts of the 
 bile and of other secretions are not to 
 be found in the blood, and that we 
 have "no knowledge whether the bile 
 proceeds from the blood or from the 
 secreting organ," p. 180-182, <J 350f e. 
 Also Lehmann, Index II. 
 
 maintains that there is no essential 
 difference between living and dead 
 matter, p. 179-182, ^ 350i c-f ; also, 
 Lehmann, Index II. — and yet he does 
 not, p. 189-190, i) 350} n, parallel 
 columns — but believes with Dr. Car- 
 penter and others that Carbon, Oxy- 
 gen, Hydrogen, and Nitrogen are en- 
 dowed with life, p. 178, ij 350| a; p. 
 181-182,(^3501/. 
 
 upon the Soul, p. 183, ^ 350f gg. 
 
 MiJLLER, 
 
 the chief expositor of the physiological 
 laws of reflex action of the nervous 
 system, p. 341-342, (j bU^b; p. 362, 
 <J 530. 
 
 nevertheless, fails of applying them 
 pathologically and therapeutically, is 
 at fault, like Marshall Hall, in his 
 physiological attributes of the nervous 
 influence, adopts the physical doctrine 
 of Absorption, and, like Dr. Hall, 
 
 Miiller — continued. 
 
 patronizes the Humoral Pathology, 
 p. 283, l) 452 b ; p. 320, ^ 494 dd. 
 
 Mumps, 
 
 occasions inflammation of the testes and 
 mammse through alterative influences 
 of reflex action of the nervous system, 
 and exemplifies the disposition of tis- 
 sues of analogous organization and 
 function to sympathize with each 
 other, and is an example of the me- 
 tastasis of Authors, p. 59, (J* 129 i; 
 p. 351-352, () 524 b, c; p. 353-354, 
 () 525 ; p. 652-653, () 893 n. Also, 
 Metastasis, Inflammation ; Causes, 
 Morbific ; Reflex Action, &,c.. In- 
 dex II. ; Nervous Power, Sympathy, 
 Index I. and II. 
 
 N. 
 
 Narcotics — continued from Index I. See, 
 also. Opium, Index I. and II. 
 
 limited in a group to such as relieve pain 
 and induce sleep, p. 583, (j 891 a, b. 
 
 greatly overrated, p. 584, i) 891 c ; p. 715 
 -720, () 960 a; Note H p. 1117. 
 
 considerations relative to their injurious 
 tendencies, and the neglect of more 
 important means, ibid. 
 
 very deficient in curative virtues, and 
 illustrations, p. 584, i^i 891 d. 
 
 their modus operandi like that of all 
 other remedies and of all morbific 
 causes — that is to say, when their 
 effects extend beyond their direct seat 
 of operation, it is through alterative 
 influences of reflex action of the nerv- 
 ous system — supplying examples, al- 
 so, of the remarkable manner in which 
 the nervous influence is variously mod- 
 ified and rendered alterative according 
 to the nature of the causes by which 
 it is brought into action, p. 107-111, 
 {} 227-233} ; p. 309-310, (j 484 b, Nos. 
 5, 6; p 321-341, () 496-514 m; p. 
 567, <J 889 k; p. 585, ^ 891 e ; p. 
 589-590, (^ BQl 0, p; p. 592-593, () 
 89HA-; p. 661-663, (J 894-896; p. 
 665-675, i) 902-904; p. 679-681, <^ 
 905 a. Also, Antispasmodics, Index 
 
 n. 
 
 an example derived from Aconite applied 
 to the skin in its sudden relief of neu- 
 ralgia of the sciatic nerve, to show its 
 operation through alterative influence 
 of reflex nervous action, p. 838, () 
 1057^. 
 
 analogy between the sedative effect ex- 
 erted upon the nervous influence by 
 Narcotics when developed by reflex 
 action, and as developed in a direct 
 manner by certain Emotions of the 
 Mind, p. 296, I) 476 c; p. 302, ^ 481
 
 1036 
 
 INDEX II. 
 
 Narcotics — continued. 
 
 b ; p 589-590, ^ 891 p ; p. 592-593, 
 (^ 89H A- ,■ p 670, () 902 /. Also, Hic- 
 cough, Hysteria, Axtispasjiodics, 
 Mental Emotions, Opicm, Food, 
 Index II. ; Nervous Power, Index I. 
 and II. 
 
 the variety in their virtues, respectively, 
 of much practical advantage, p. 585, 
 «J89I/. 
 
 their effects generally increase, at first, 
 by frequent repetition, but subse- 
 quently decrease, though may be a 
 good deal maintained by substituting 
 one for another during their continued 
 use, ibid., and <S> 981 s. 
 
 directly sedative, as shown by their less- 
 ening morbid sensibility and irritabil- 
 ity, and by the manner in which they 
 counteract spasmodic affections, p. 
 590, ^ 891 q; p. 592-593, <» 89H k; 
 p. 828-833, {) 1057 a-i. 
 
 their greatest use, to produce sleep and 
 relieve restlessness, though in this 
 they may fail, or aggravate the trou- 
 ble, when other means would be effi- 
 cient, p. 586, i) 891 g, h ; p. 715-721, 
 § 960 a, b. 
 
 their next great use, to relieve morbid 
 states of irritability, through which 
 opium arrests diarrhoea, &c., with 
 practical illustrations, p. 572, () 890 a; 
 p. 576, ^ 890 / ; p. 587, <} 891 i. 
 
 next in order comes paiii. for which they 
 are mostly esteemed, and most abused 
 — the symptoms commonly demanding 
 very different remedies, such as loss of 
 blood, blisters, warm bath and foment- 
 ations, p. 587-589, ^ 891 k-p ; p. 715- 
 721, ^ 960 a, b. 
 
 their effects often counteracted by a pe- 
 culiar stimulating nervous influence 
 developed by pain, so that quantities 
 are often admissible that would be 
 fatal in health, p. 590, ^ 891 r— and 
 again by a very different modification, 
 as in the delirium of drunkenness, p. 
 590, 1^ 891 r; p. 734, i) 976 b. 
 
 the less important the part, the safer will 
 they be, in a general sense, or where 
 disease is not profound, p. 587-589, 
 () 891 k-p. 
 
 less morbific in chronic than acute dis- 
 eases, where, also, they are most suc- 
 cessful, ibid. 
 Nauseants, 
 
 a subdivision of Author's group of Seda- 
 tives, p. 830, ^ 1057 rf. 
 
 prolific in examples of the operation of 
 remedial and morbific agents through 
 alterative influence of reflex action of 
 the nervous system, of which Croup 
 supplies one of the most obvious, 
 where no amount of Tartarized Anti- 
 mony or Ipecacuanha will moderate 
 
 Nauseants — continued. 
 
 the symptoms till nausea takes place, 
 when immediately a melioration often 
 sets in, and advances rapidly when 
 vomiting ensues — and, as the latter is 
 admitted to depend upon reflex action 
 of the nervous system, it goes with the 
 former fact in showing that the dis- 
 ease is equally overcome by the same 
 influence determined upon the mucous 
 tissue of the larynx — while, also, the 
 mineral and vegetable substance, in 
 alike subduing the disease, demon- 
 strates, like a thousand other analo- 
 gous cases, the absurdity of the chem- 
 ical and everj' other physical rationale, 
 p. 336-337, ij 514 b, c ; p. 365-366, ^ 
 551-554; p. 486, () 750 b; p. 532- 
 533, (J 841 ; p. 666-670, () 902 b-m; 
 p, 675-676, <J 904 b. Also, Antimony, 
 Tartarized ; Alteratives, Disgust, 
 Mental Emotions, Index II. 
 
 Negro, 
 
 his color, and that of other races, con- 
 sidered, p. 393, <J 610 ; p. 907, (} 1078 s. 
 Also, Races of Mankind, Index I. ; 
 Medical and Physiological Comment- 
 aries, vol. ii., p. 640. 
 
 Nervous Power — continued from Ind. I. 
 its existence, attributes, and functions, 
 (whateverit maybe, or if a better name 
 can be substituted), as well as of the 
 Organic Properties, more demonstra- 
 ble than any thing relative to mere 
 physics, p. 76, (J 167 a; p. 79-81, <J 
 167^-169/; p. 84, (^ 175 b ; p. 85- 
 87, () 175 d-177 ; p. 88, i) 184 b, 185 ; 
 p. 95-96, 6 189 b; p. 111-121, (^ 234- 
 237 ; p. 326-331, ^ 500 g-o. 
 although its existence as an agent is 
 variously demonstrable, as above, it 
 is sufficiently so by considering that 
 all motions have a positive exciting 
 cause — the lining membrane of the 
 heart and bloodvessels is stimulated 
 by the blood, the retina by light, the 
 mucous tissue of the alimentary canal 
 by food and bile, &.c. — therefore the 
 analogies prove that the muscles of 
 respiration, the iris, the sphincter 
 muscles, and all other muscles, must 
 have an analogous cause, and when 
 the variety in the results is consider- 
 ed, as arising from mental as well as 
 physical causes, the great fallacy of 
 the chemical rationale becomes glar- 
 ingly apparent — and so of the Soul 
 and Instinctive Principle, p. 62, <^ 136. 
 Also, p. 107-122, 1) 226-240. and fore- 
 going references, and Soul and In- 
 stinctive Principle, Index II. 
 nevertheless, the Author expresses him- 
 self as entirely opposed to all specula- 
 tions as to the nature of such a power, 
 and it is wholly unimportant whether
 
 INDEX II. 
 
 1037 
 
 Nervous Power — continued. 
 
 it be conceded that some other un- 
 known influence (ahvays excepting 
 the chemical rationale) is exerted at 
 the extremities of the excito-motory 
 nerves, since, whatever it may be, it 
 will in no respect affect the Author's 
 application of the physiological laws 
 of the nervous system in resolving 
 the great problems in Pathology and 
 Therapeutics, p. 117-118, () 234 g; 
 p. 330, ^ 500 nn; p. 878-879, () 1073 a 
 — but, in accepting this part of the 
 alternative, it must be made to explain 
 in some intelligible manner the end- 
 less variety of effects that ensue upon 
 the operation of natural, morbific, and 
 remedial agents, physical and mental 
 (many of which are incapable of being 
 absorbed), according to the nature of 
 each one, and shown to be of some 
 practical use in medicine, but which 
 is perfectly resolved by the Author's 
 doctrine of special modification of the 
 nervous power by the several causes 
 respectively. The iexmpower is sanc- 
 tioned by long usage and by late emi- 
 nent writers, as Liebig, for example, 
 when speaking of the functions of the 
 nervous system (p. 158-171, Nos. 51- 
 62, 65, 69, 70, 72-74, 79, 81, 87-91, 
 ■parallel columns) ; but the present 
 writer prefers the term nervous in- 
 fluence (as he says oi continuous sym- 
 pathy, p. 322, ^ 498 a), which ex- 
 presses his meaning exactly, and is 
 exempt from all hypotheses, p. 88, ^ 
 184 6,- p. 107-110, <J 227-232; p. 112, 
 § 234 b ; p. 302, () 481 b ; p. 305, ^ 
 482; p. 309-314, H84-489; p. 323- 
 332, I) 500 ; p. 333, <) 503 ; p. 334, ^ 
 509 ; p. 405-412, (^ 638 ; p. 530, ^ 
 837 b; p. 547-550, ^ 863 d; p. 661- 
 663, () 894 J-896 ; p. 665-670, § 902 
 a-m; p. 706-709, <) 947-951. 
 operates upon the minute structure of 
 organs, whether vascular, muscular, 
 &c., and both by reflex and direct 
 action, as it may be excited in one 
 case through sensitive nerves, or in 
 the other by causes acting directly 
 upon the nervous centres, and through 
 which action upon their organic states 
 all the secreted products, and all the 
 other natural conditions, are increased 
 or diminished, or turned from their 
 natural conditions, or again restored, 
 in all parts beyond the seat of the 
 direct operation of all causes which 
 disturb its natural action — all organs 
 being rendered preternaturally sus- 
 ceptible of the influences of the nerv- 
 ous system by their morbid state; and 
 where it is not directly affirmed that 
 all the foregoing results are due to 
 
 Nervous Power — continued. 
 
 influences of reflex or direct action of 
 the nervous system upon the organic 
 states, it is so by an obvious implica- 
 tion, for brevity's sake, founded upon 
 the Author's universal application of 
 the foregoing principle — and, farther, 
 the nervous influence may prove a 
 simple excitant or depressant, or, what 
 is far more important, and distinctly 
 and variously shown by unequivocal 
 demonstration, and which can be ex- 
 pounded by no other philosophy, and 
 which is fundamental in the Author's, 
 it may, according to the nature of the 
 causes, physical and mental, that bring 
 it into preternatural action, undergo 
 as great a variety of modifications as 
 there are special virtues in the several 
 causes, remedial or morbific, rendering 
 it variously alterative, and from which 
 results through the influences exerted 
 by this protean agent upon the instru- 
 ments of action the endless variety of 
 changes that occur in the solids and 
 fluids remote from the direct seat of 
 operation in the case of all physical 
 agents, and always so in the case of 
 the Passions or other causes affecting 
 the nervous centres, and even in the 
 case of the direct seat of action the 
 changes in the direct seat are apt to 
 be consequent upon reflex actions 
 coming either through the appropriate 
 nerves of the part, or depend upon re- 
 flex actions excited by remote organs, 
 p. 61, l^ 133 c; p. 63, () 137 d; p. 65, 
 <J 143 c; p. 66-67, () 148 ; p. 101-102, 
 () 201-203; p. 106-118, () 222-234; 
 p. 125, {) 245 ; p. 215, () 395 ; p. 226- 
 227, () 410-411 ; p. 230-233, ^ 422- 
 427; p. 250, H4lc,- p. 262, H46a; 
 p. 264-270, () 446 (Z-447 d ; p. 286, () 
 456 a, b ; p. 301-302, () 481 ; p. 305- 
 310, () 483-485; p. 323-336, ^ 499- 
 512 ; p. 337, 338, § 514 c, d ; p. 339- 
 340, ^ 514 h; p. 344-345, ^ 516 d, 
 No. 6 ; p. 347, ^5l6d, No. 10 ; p. 348, 
 ^ 516 d, No. 13; p. 351, ^ 524 a; 
 p. 356-358, ^ 526 d ; p. 359, ^ 527 
 a, b; p. 421-423, () 657-658 ; p. 451- 
 452, (J 692 ; p. 486, ^ 750 b ; p. 483- 
 484, (J 746 c ; p. 506, ^ 803. 804 ; p. 
 546-550, ^ 862-863/; p. 563-566, (J 
 889 a-^; p. 585, ij 891 e; p. 589-590, 
 ^891;>,- p. 592-593,^5 89 H A- ; P-612 
 -613, ^ 892J a, b; p. 631-632, ^ 892i ; 
 p. 637, ^ 892| d, e ; p.642'648, ^ 893 
 a-g; p. 661-663, i) 894-896 ; p. 666- 
 672, ^ 902 6-904 a ; p. 679-681, ^ 905 
 a; p. 692-69.5, 1^ 915-924; p. 697- 
 701, ^ 927-928 ; p. 703-710, ^ 940- 
 952; p. 831-833, '5l057/-yt; p. 862- 
 864, (J 1066 ; p. 865-868, ^ 1067 ; p. 
 875-877, ^ 1072 a; p. 886-891, ^
 
 1038 
 
 INDEX II. 
 
 Nervous Power — continued. 
 
 1077. Also, Reflex Action, Men- 
 tal Emotions, Remedial Action. 
 exalts the condition of all organic com- 
 pounds, solid and fluid, including the 
 blood ; a law profoundly concerned 
 in pathology and therapeutics, ^ 226, 
 232, 399, 405, 446 a, 461, 485, 488^, 
 512, 733 h, 746 c, 846, 902, 952. 
 explanatory specifications of the mechan- 
 ism through which the nervous power 
 operates in its function of reflex action, 
 for the purpose of applying it to the 
 interpretation of the modus operandi 
 of all remedial and* morbific agents 
 upon parts beyond the seat of their 
 direct operation, and also of its limita- 
 tion in other cases to the motor nerves, 
 and as the cause of all the physiologi- 
 cal changes in the solids, and of all 
 increased or otherwise modified secre- 
 tions in parts not the immediate sub- 
 jects of other agents through its va- 
 rious influences upon the instruments 
 of organic processes, and of its modi- 
 fications according to the nature of its 
 exciting causes, as well, also, for prov- 
 ing the substantive existence and self- 
 actingnature of the Soul and Principle 
 of Instinct, p. 101-102, (} 201-202; 
 p. 106, ^ 224-227; p. 112, «;. 234 i; 
 p. 116-117, ^ 234/; p. 282, (} 451 d; 
 p. 285-287, ^ 455 d-459 a ; p. 290- 
 295, ^ 462-475i ; p. 300, <;> 479 ; p. 
 309-310, ^ 484 b, Nos. 5 and 6 ; p. 
 321, ^ 496, 497 ; p. 323-328, ^ 499 a 
 -500 m; p. 331-341, () 500 0-514 n ; 
 p. 344-345, <J 516 (i, No. 6 ; p. 348, 
 \ 516 d, No. 13 ; p. 416-417, <J 649 c; 
 p. 421-423, () 657-658 ; p. 465-466, 
 () 715 ; p. 483-484, ^ 746 c ; p. 592- 
 593, <^ 8911 k; p. 661-663, () 894- 
 896 ; p. 665-670, <^ 902 a-n; p. 679 
 -681, <^ 905 a; p. 703-710, ij 940- 
 952; p. 873-881, ^ 1069-1075; p. 
 886-891, () 1077; (} 111-113, 224, 
 488^, 524 d, no. 7, 89U g, 893 a. 
 nevertheless, the Author endeavors to 
 show that the functions of organs in 
 the organic life of Animals are carried 
 on, like the analogous ones in Plants, 
 by properties inherent in all parts, and 
 that the nervous power or nervous 
 influence contributes nothing more 
 toward the functions of the nutritive 
 and other secretory vessels than that 
 of exerting a modifying, or exciting, 
 or depressing influence upon them, 
 through which the products are per- 
 fected in their character, or increased 
 or diminished ; but these instruments 
 of life are constantly liable to preter- 
 natural influences of the nervous 
 power, and of an endless variety, and 
 there is no function in the natural 
 
 Nervous Power — continued. 
 
 state of the body, no condition of dis- 
 ease, no action of remedies, in which 
 the nervous influence does not par- 
 ticipate (p. 54-55, ij 109 i-117; p 
 284-287, () 454 c-459 ; p. 2^9, () 461 ; 
 p. 483-484, {) 746 c), while organs in 
 their compounded condition are more 
 manifestly under its perpetual har- 
 monizing influence through the im- 
 pressions made upon their minute 
 structure — it being, therefore, the 
 Author's doctrine that the nervous 
 influence is merely an exciting or 
 modifying cause of the organic func- 
 tions, and whenever he speaks of that 
 influence as a cause of certain effects, 
 or objects to its application as a cause 
 of any of the processes of life, he 
 
 » always means in the former case that 
 it influences the processes of life, and 
 in the latter that these processes are 
 carried on by causes or properties 
 inherent in all parts, p. 23, ^ 34-38 ; 
 p. 24, ^ 41, 42; p 54, ^ 109 b; p. 66- 
 67, () 148;.p. 75-76, ^ 167a,- p. 110, 
 ^ 233 ; p. 222-227, i} 409 c-411 ; p. 
 284-286, () Ab^^bl ; p. 289, (^ 460- 
 46H; p. 294, (J 475; p. 295-296, (J 
 476 b; p. 313-315, (} 488-489; p. 
 317-318, <J 493 ; p. 421-423, () 657- 
 658; p. 483-484, (;> 746c,- p. 353, no. 7. 
 Vital Properties, Organic Life, 
 Index I. ; Respiration, Sphincter 
 Muscles, &c.. Index II. ij 990^ a, b. 
 is the agent through which the Will and 
 Mental Emotions operate. See Will, 
 Index I and II. ; Mental Emotions, 
 and the individual Passions, Index II. ; 
 Nervous Power, Lulex I 
 but there is an essential difference in the 
 influence of the nervous power upon 
 organs that are less interested, or not 
 at all, in the essential processes of 
 organic life, where, as in voluntary 
 motion, respiration, contraction of the 
 sphincter muscles, peristaltic move- 
 ments, the nervous power is the only 
 immediate stimulus which brings the 
 muscles into action ; though here, 
 also, the motions are accomplished 
 by inherent powers, p. 110, (^ 233, 
 and many of the preceding references. 
 Also, Vital Properties, Nervous 
 Power, Index I ; Sphincter Mus- 
 cles, Respiration, Iris, Cathartics, 
 Index II. 
 its development direct when the Will or 
 Mental Emotions operate, or any dis- 
 turbances affect the nervous centres, 
 and indirect when the exciting in- 
 fluences proceed from other parts 
 through sensitive nerves or fibres, 
 and the transmitted impression de- 
 velops the nervous influence — consti-
 
 INDEX II. 
 
 1039 
 
 Nervous Power — continued. 
 
 tuting reflex action of the nervous 
 system or remote sympathy — both 
 orders of nerves or fibres of compound 
 nerves being always engaged in the 
 latter case, while in the former, when 
 the Will and Passions operate, the 
 excito-motory nerves or fibres are 
 alone concerned, and the influence 
 alone centrifugal, unless the Passions, 
 as is common, and diseases of the 
 nervous centres, &c., institute im- 
 pressions upon distant parts that are 
 reverberated upon the nervous cen- 
 tres, when the nervous influence, al- 
 though direct at its incipient move- 
 ment, may establish a complex circle 
 of reflex actions, and undergo modifi- 
 cations of its alterative influence, not 
 only according to the nature of its 
 primary exciting cause, but according, 
 also, to that of the particular natural 
 constitution of different parts, and 
 any present modified condition of 
 parts upon which its influences may 
 fall, since, also, any preternatural 
 condition of an organ, whether ren- 
 dered temporarily so by disease, or 
 only temporarily disturbed by the 
 nervous influence (as in sneezing 
 from a strong light impinging upon 
 the retina, p. 327, (J 500 i ; p. 333, ^ 
 504 ; p. 340-341, () 514 /), is equiva- 
 lent to influences propagated in a like 
 manner by the action of remedial and 
 morbific agents, and will modify the 
 nervous influence in a corresponding 
 manner ; and upon this reflected in- 
 fluence and its modifications depend 
 the diseases of organs that grow out 
 of each other, and the nature of the 
 affections as they may spring up con- 
 secutively, and in connexion with the 
 constitutional nature ofdifferent parts, 
 or as they may conspire together in 
 aggravating or relieving the condi- 
 tions of each other, p. 59, () 129 h, i; 
 p. 61-63, () 133-152 ; p. 73, <;» 163 ; 
 p. 101-102, () 201-202; p. 107-119, 
 <J 224-234 ; p. 232-284, ^ 451-453 ; 
 p. 285-286, (J 455 ; p. 296, (} 476 c ; 
 p. 321, () 496, 497; p. 323-328, () 
 499-500 /; p. 331-334, (/ 500 o-510 ; 
 p. 347-348, (} 516 d, No. 13, 517; 
 p. 429-430, () 674 d ; p. 526, (} 828 d; 
 p. 539, f) 848 ; p. 592, I) 89H f^ ; P- 
 642-648, <) 893 a-g ; p. 661-663, (} 
 894-896 ; p. 665-676, (J 902 a-904 6; 
 p. 679-681, ^ 905 a; p. 692, (} 914- 
 921 ; p. 698-699, () 930-935 ; p. 703- 
 710, ^ 940-952 ; p. 745-746, ij 990^ ; 
 p. 831-833, ^ 1057 f-h; p. 838, ^ 
 10571; p- 865-868, ^ 1067; p. 874- 
 881, ^ 1071-1075; p. 886-891, () 
 1077. 
 
 Nervous Power — continued. 
 
 " exhaustion of," an hypothesis without 
 foundation, p. 805, ^ 1041. 
 
 when remedies properly applied (as with 
 morbific causes) develop the alterative 
 action of the nervous influence, it is 
 not commonly by exciting disease in 
 parts which are the direct seat of their 
 operation, but when this result ensues 
 it is mostly through reflex action of 
 the nervous system directed upon the 
 seat of their operation — though prom- 
 inent exceptions occur in the case of 
 Counter-irritants, p. 66-67, <^ 148 ; p. 
 336,(} 5U b-h; p. 416-417, ^J 649 c ; 
 p. 421-423, () 657-658 ; p. 483-484, 
 I 746 c ; p. 522-523, ^ 827 b, c ; p. 
 862-864, <^ 1066. Also, Miasm, Skin, 
 Cold, &c.. Index II. 
 
 considered in its slowly progressive 
 operation through reflex action of 
 the nervous system, when brought 
 into effect by agents belonging to 
 Author's group of Alteratives, and 
 analogous means, both physical and 
 mental — the same being also true of 
 the slowly progressive operation of 
 morbific causes, p. 1 1 1, <J 233^, 233f ; 
 p. 285-286, () 455 d-f; p. 333, (J. 503- 
 506 ; p. 339, () 514 g-; p. 344-345, i) 
 516 d, No. 6 ; p. 365, (j 551 ; p. 366, 
 () 556 ; p. 416-417, () 649 c; p. 420- 
 424, (} 654-661 ; p. 532, ^ 841 ; p. 
 547, (j 863 d; p. 551, ^ 877; p. 568- 
 569, () 889 m, mm ; p. 646-649, <J 893 
 e-/i ; p. 661-663, <J 894-896 ; p. 668- 
 670, () 902 g-m ; p. 675-676, § 904 6 ; 
 p. 679-681, ij 905 rt. Also, Sphincter 
 Muscles, Alter.\tives; Hydropho- 
 bia, Virus of ; Small-pox, MijTsm, 
 Predisposition, Index II. 
 
 may operate profoundly with morbific, 
 but little with remedial effect, long 
 after the exciting cause is withdrawn, 
 p. 66-67, () 148. 150 ; p. Ill, i^i 233^, 
 2331 ; p. 285-286, i) 455 d-f; p. 333, 
 () 503-506 ; p. 339-340, ^ 514 g, h; 
 p. 344-345, (J 516 d. No. 6; p. 364, 
 i) 545 ; p. 365, (^ 549, 550 ; p. 368, ij 
 558, 560; p. 416-417, ^ 649 c ; p. 
 420-424, (J 654-661 ; p. 425-427, ^ 
 664-666 ; p. 532, ^ 841 ; p. 542, ^ 
 854 c-e ; p. 668-669, ^ 902 g ; p. 707 
 -708, ^ 949. 
 
 the incorporation of the cerebro-spinal 
 and ganglionic systems in all parts 
 renders them all the constant subjects 
 of direct and reflex nervous influence ; 
 but in the natural state of the body 
 this influence is not strongly pro- 
 nounced, excepting in certain in- 
 stances, as respiration, the contrac- 
 tion of the sphincter muscles, the 
 motions of the iris, of the stomach 
 and intestine, and of the heart ; but •
 
 1040 
 
 INDEX II. 
 
 Nervous Power — continued. 
 
 otherwise mostly so when morbific 
 and remedial agents and the mental 
 emotions operate, p. 55, () 111-117; 
 p. 58-59, {) 129 a, i; p. 61, <) 133 c; 
 p. 62-67, () 136-151 ; p. 87, ^ 177; 
 p. 88, «J 184-185 ; p. 101-102, ^ 201- 
 202; p. 106-112, ^222-234; p. 116- 
 117, ^ 234/ g; p. 253, (J 441 d; p. 
 262-268, (J 446 a-447 d ; p. 284-290, 
 (} 454-4611 c; p. 296, () 476 c; p. 
 323-341, ^ 499-514; p. 344-345, () 
 516 <Z, No. 6 ; p. 348, ^ 516 d, No. 13 ; 
 p. 350-353, (j 524 ; p. 354-362, i) 526 
 -530; p. 508-509, i^i 807-81 1 ; p. 537 
 -539, <J 847 e-848 ; p. 563-565, ^ 889 
 a-g; p. 592-593, () 891i k; p. 642- 
 650, <;> 893 a-i ; p. 657, () 893 p ; p. 
 661-681, () 894-905; p. 692-709, ^ 
 914-951 ; p. 745-747, () 990^ a, b; 
 p. 804, () 1040 ; p. 865-868, (J 1067 ; 
 p. 874, () 1071 ; p. 877-881, ^ 1072 b- 
 1075; p. 886-890, () 1077, 89H g- 
 
 other strongly marked examples of reflex 
 action of the nervous system, and of 
 an alterative nature, occur in natural 
 mutations of the body from Infancy 
 to Youth, and others in other natural 
 conditions to which the system is in- 
 cidentally liable, as in gestation and 
 lactation. See Youth, Lactation, 
 Uterus, Organs of Generation, 
 Milk, Index II. 
 
 the entire dependence of respiration 
 upon reflex action of the nervous in- 
 fluence coincides with the dependence 
 of the act of vomiting upon the same 
 causation, and carried by the Author 
 through a chain of analogies consist- 
 ing of the various modifications of 
 respiration, of vomiting as produced 
 by emetics of various kinds, by loss 
 of blood, by tickling the fauces, by 
 tobacco applied to the soles of the 
 feet, by pregnancy, by shock of falls, 
 by mental emotions, &c., and the di- 
 vers influences and results according 
 to the nature of the cause, and other 
 coincidences supplied by the iris, 
 sphincter muscles, skin, cold, sup- 
 positories, tetanus, &c., which de- 
 pend upon other modifications of the 
 nervous influence through reflex ac- 
 tion, and the analogies supplied by the 
 will in voluntary motion — all carried 
 to the interpretation of all the eflTects 
 of active emetics and cathartics, both 
 remedial and morbific, and by the 
 same analogies, their effects, when 
 they fall short of vomiting or purging, 
 or other prominent results that arise 
 from larger doses, through alterative 
 influences of reflex action of the nerv- 
 ous system, upon parts beyond the 
 seat of their direct operation, and 
 
 Nervous Power — continued. 
 
 against the chemical and physical 
 doctrines of operation through ab- 
 sorption — and all this chain of analo- 
 gies applied to the modus operandi 
 of all other remedial and morbific 
 causes, physical and mental, while 
 the same interpretation of all the 
 others is sustained by other special 
 demonstrations in immediate connex- 
 ion with a large number of the several 
 things respectively, p. 66-67, ^ 148 ; 
 p. 110, () 232 ; p. 323-341, (j 499-514 
 m ; p. 344-345, (^ 526 d, No. 6 ; p. 347 
 -348, (} 516 d, No. 13 ; p. 421-423, ^ 
 657-658 ; p. 526, ^ 828 d ; p. 532- 
 533, <J 841 ; p. 542-543, t) 854 c-f; 
 p. 547-550, <^ 863 d ; p. 563-566, ^ 
 889 a-g ; p. 568-569, () 889 m, mm ; 
 p. 592, <;> 89H k; p. 631-632, ^ 892f 
 b; p. 661-663, <J 894-896; p. 666 
 -672, <) 902 i-904 b; p. 679-681, 
 <J 905 a; p. 703-710, ^ 940-952; 
 p. 831-833, () W57 f-g; p. 838, <j 
 1057^. Also, Stomach, Nauseants, 
 Skin, Cold, Shower Bath, Tetanus, 
 Disgust, Syncope, and the several 
 Articles under Generalization of 
 Reflex Action of the Nervous 
 System, Index II. 
 
 examples of its effects in subduing vio- 
 lent inflammations, augmenting and 
 altering the natural secretions, and 
 of variously and suddenly modifying 
 the condition of morbid fluid products, 
 and the condition of the blood, when 
 brought into operation by Mental 
 Emotions, p. 296, () 476 c ; p. 230- 
 232, () 422 6-424 ; p. 335-336, ^512 
 a, b ; p. 630-632, f) 892i b ; p. 709- 
 710, () 951 i-952 ; p. 865-868, ^ 1067 ; 
 p. 877-878, (i 1072 b. Also. Milk, 
 Sweat, Urine, Food, Weeping, 
 Mental Emotions, Index II. ; Su- 
 DORiFics, Index I. 
 
 is the exciting cause of all diseases 
 which spring up as consequences of 
 each other ; but the secondary aflfcc- 
 tions, one or more, may be very dif- 
 ferent from the primary, depending, 
 in part, upon the peculiar constitution 
 of difl*erent tissues, or parts of a tissue, 
 p. 62-68, ^ 135-152 ; p. 109, ^ 229 ; 
 p. 339-340, <^ 514 h ; p. 465-469, ^ 
 715-722; p. 483-484, <J 746 c. Also, 
 Causes, Morbific ; Inflammation, 
 Skin, Tobacco, Seton, Index II. 
 
 expounds the philosophy of Metastasis 
 and Revulsio7i. See Metastasis, 
 Index II. 
 
 may operate upon the organic constitu- 
 tion of the nervous centres, and thence 
 upon the heart, stomach, &c., with a 
 suddenly fatal effect, through reflex 
 action of the nervous system, as with
 
 INDEX II. 
 
 1041 
 
 Nervous Power — continued. 
 
 blows upon the epigastrium, surgical 
 operations, hydrocyanic acid, &c., or 
 directly through its sudden and violent 
 determination upon the brain, as in 
 the case of joy and anger, when it 
 may act by suddenly destroying the 
 life of the brain, and also farther ex- 
 emplified by the sudden determination 
 of syncope, and the consequent sudden 
 interruption of pleurisy, &c., through 
 direct and reflex action of the nervous 
 system, and equally acts upon all other 
 parts of the nervous system, p. 107- 
 111,^ 226-2334 ; p. 296, <J 476 c ; p. 
 298, () 476^ h ; p. 300, <^ 479 ; p. 301, 
 (J 480; p. 302, <;.481 b; p. 304, H81 
 g; p. 306-308, () 483 b ; p. 320, () 494 
 del ; p. 324, ^ 500 c, d ; p. 334-335, 
 ^ 509-511 ; p. 402-403, ^ 634-635 ; 
 p. 534, () 844 ; p. 704, <;. 943 a-944 a ; 
 p. 707, () 947; p. 709, () 951 b-d ; p. 
 831-833, (} 1057 f-ff; p. 858, () 1057^ : 
 p. 862-864, () 1066 ; p. 865-868, ^ 
 1067; p. 878-881, >;. 1074-1075; p. 
 887, <J 1077. Also, Jov and Anger, 
 Mental Emotions; Serpents, Virus 
 OF ; Stomach, Blows upon ; Pain, 
 Oxygen, Opium, Sedatives (Aconite), 
 Neuralgia, Antispasmodics , Brain, 
 Inflammation of ; Bloodletting, 
 Loss of Blood, Lidcx II. ; Will, 
 Index I. and //.—Note Q p. 1122, 
 its opposite influences upon the sensi- 
 bility of nerves through reflex action 
 of the nervous system the cause and 
 cure of pain (when not the direct result 
 of causes operating locally) and accord- 
 ing to the nature of the means by which 
 it is brought into operation, whether 
 by morbific causes, or sedatives, loss 
 of blood, &c., and equally relieved 
 through the same influence by men- 
 tal emotions, and according to their 
 nature, p. 296, ^ 476 c ; p. 302, () 481 
 b ; p. 323-324, (} 500 c ; p. 584-585, 
 <J 891 d, c; p. 587-590, ^ 891 k-s ; 
 p. 592-593,.^ 891^ k; p. 831-832, 
 <) 1057/; p. 838, () 1057^: p. 862- 
 864, ^ 1066. Also, Pain, Sedatives 
 (Aconite), Neuralgia, Antispasmod- 
 ics, Bloodletting, Poultices, /?!rfca; 
 // 
 hoplied through alterative influence of 
 reflex action of the nervous system 
 to the modus operandi of Cinchona, 
 Loss of Blood, and of other things of 
 whose mode of operation we are said 
 to be ignorant, and in connexion with 
 illustrations drawn from the modus 
 operandi of a Seton, and where, also, 
 under the several references, the or- 
 ganic influences of remedial agents 
 through the instrumentality of nerv- 
 ous action and the philosophy which 
 
 Uu 
 
 Nervous Power — continued. 
 
 concerns their substitution of transi. 
 tory pathological conditions for the 
 more profound, is summarily present- 
 ed, p. 596-597, () 892 6, c ,• p. 676-68 1 , 
 ^ 904 c-905 a. Also, p. 67, (j 149- 
 151 ; p. 73, l) 163 ; p. 108-110, 4 227 
 -232 ; p. 542, ^ 845 c-e ; p. 554, ^ 
 871 ; p. 592-593, <J 891Jr k; p. 661- 
 663, ^ 894-896 ; p. 664^665, i) 900- 
 901 ; Bloodletting, Remedies, Re- 
 medial Action, Index II. ; Nervous 
 Power, Index I. 
 influences very profoundly the functions 
 of secretion and excretion, whether 
 brought into preternatural action by 
 physical agents, or loss of blood, or 
 mental emotions, and is always the 
 cause of the redundances that may 
 arise and the changes they may un- 
 dergo in parts beyond the seat of the 
 direct action of physical causes, and 
 all other causes through its modifying 
 influences upon the immediate instru- 
 ments, ^ 113, 224, 226, 399, 446 a, 
 461, 485, 489, 493 cc, 512, 524, no. 7, 
 ^ 657-658 ; p. 631-632, <J 892J ; p. 
 668-669, (J 902 g, h ; () 893 J ; <S> 943 
 a, b; Secretion and Excretion, 
 Bile, Sweat, Milk, Weepino, Fear, 
 Jealousy, Skin, Kidney, Cold, Heat; 
 Water, Hot ; Food, Tea, Emetics, 
 Bloodletting, Loss of Blood, Men- 
 tal Emotions, Index II. ; Sudorifics, 
 Index I. 
 exerts the same influence in the produc- 
 tion of animal heat as upon other se- 
 cretions, p. 262-270, '^ 446-447 ; p. 
 807-808, <J 1044-1045. Also, p. 68, 
 () 152 a ; p. 245, ^ 440 c ; p. 250-251, 
 (^ 441 c; p. 335-336, I) 512 a, h; p. 
 339, 4 514 h; p. 365, ^ 889 g; p. 
 579-580, () 890^ d ; Organic Heat, 
 Index I. ; Hybernating Animals, 
 Tea, Index II. 
 employed by the Author to expound the 
 dependence of the first act of respira- 
 tion through reflex action of the nerv- 
 ous system, whose centripetal source 
 is the skin. See Reflex Action of 
 the Nervous System ; also. Skin, 
 Syncope, Index II. 
 is the immediate cause of syncope as 
 arising from loss of blood, and of 
 subsequent restoration, and supplies 
 analogies for the Author's doctrines 
 in relation to the nervous influence 
 as connected with Pathology and 
 Therapeutics. See Syncope, Loss 
 OF Blood, Mental Eimotions, Index 
 11 
 exerts its effects, in modifying the con- 
 dition of the solids and fluids, upon 
 the capillary vessels, and in develop- 
 ing muscular motion upon the indi- 
 U
 
 1042 
 
 INDEX II. 
 
 Nervous Power — continued. 
 
 vidual fibres, &c., p. 54, <) 109 b; p. 
 220-227, ^ 409 b-All ; p. 355, <) 526 
 a; p. 804-805, (^ 1040. Also, Causes, 
 Morbific ; Remedies, Remedial Ac- 
 tion, &c.. Index II.; Nervous Pow- 
 er, Vital Properties, Organic Life, 
 Index I. 
 
 hardness and mcomprcssihility of pulse, 
 and buffing and cupping of blood, in 
 inflammations, depend upon its modi- 
 fying influence upon the sanguiferous 
 organs, while the loss of blood, or a 
 mental emotion, will quickly change 
 its influence and render it subversive 
 of those conditions, p. 444-445, <J 688 
 a-f; p. 708-710, § 951-952 b; mis- 
 taken for Galvanism, § 409 hh, k, 
 493 cc; 893 a; 500 X-, 7h, nn, o; 893^. 
 Note Y, p. 1130. 
 
 direct and reflex, employed as the prin- 
 cipal basis in demonstration of the 
 substantive existence and self-acting 
 nature of the Soul and Instinctive 
 Principle, p. 873-881, ij 1069-1075; 
 p. 886-891, t) ion. 
 
 determines the act of roosting and of 
 sleeping in the erect posture, and in 
 a manner analogous to its action upon 
 the sphincter muscles, p. 890-891, <5> 
 1077. Also, Sphincter Muscles, 
 Alteratives, Suppositories, Grief, 
 Hope, Index II. ; p. 325, (} 500 dd. 
 
 recent observations upon, confirming 
 important principles in these Insti- 
 tutes, p 803-808, {) 1039-1045. 
 
 is not a movable substance, i?j transitu 
 from part to part, but, like the prin- 
 ciple of Light, is every where diffused 
 through its appropriate medium, and, 
 like that principle, is brought into op- 
 eration by exciting causes, and with 
 every variety of effect according to 
 the nature of the causes, nor is there 
 any greater difficulty in understand- 
 ing its imputed modifications than the 
 polarization of light, or any other at- 
 tributes which the Author assigns it 
 than such as appertain to Light, p. 80, 
 ^ 169 b, d; p. 84, () 175 b, bb ; p. 88, 
 (^ 184 b; p. 1 14-120, ^ 234 c-235 ; p. 
 330, i) 500 nn; p. 334, (j 507; p. 670, 
 ij 902 k. 
 Nervous System. See Nerves; Nerves, 
 Motor ; Nerves, Sensitive, Index I. 
 
 anatomical account of, and of its uses, 
 and precautions to be observed in ex- 
 periments upon — with a reference to 
 Author's application of direct and re- 
 flex action of, to the modus operandi 
 of all morbific and remedial agents 
 beyond the seat of their direct opera- 
 tion, embracing in this application the 
 natural interchange of actions among 
 all parts which is carried on through 
 
 Nervous System — continued. 
 
 reflex actions of the nervous system, 
 and for applying the same to the 
 propagation of disease from one part 
 to another, and for resolving the op- 
 eration of Mental Emotions and the 
 Will through direct development and 
 instrumentaHty of the nervous in- 
 fluence, and as more fully set forth 
 in other places, p. 284-362, <^ 454- 
 530; p. 661-681, (j 894-905; p. 692 
 711, {) 915-952. 
 
 perfects or ammalizes the constitution 
 of all organic compounds, solid and 
 fluid, including the blood ; a law pro- 
 foundly concerned in pathology and 
 therapeutics. iS'ee this at p. 1038. 
 
 is the medium through which all parts 
 of the organic system are maintained 
 by its reflex actions in harmonious re- 
 lations, and, although in constant op- 
 eration among all parts, its manifest- 
 ations are not strongly pronounced 
 except in particular functions, as in 
 respiration, the motions of the heart 
 and intestines, the motions of the 
 iris, &c., or as brought into action by 
 special causes, as in deglutition, and 
 when its reflex action starts the urine 
 as excited by cold, or the milk at the 
 time of parturition, or by Mental 
 Emotions when its displays are very 
 various and strongly manifested, and 
 by the Will ; but is brought into pre- 
 ternatural operation by all morbific 
 and remedial agents, and is the im- 
 mediate exciting cause of diseases 
 and their cure in all parts beyond the 
 seat of the direct action of morbific 
 and remedial agents, and of diseases 
 that ensue upon each otlier ; and, if 
 our Chemical friends continue to ap- 
 ply the laws of the science which they 
 cultivate to the modus operandi of re- 
 medial and morbific agents, they must 
 accept the absurdity of supposing that 
 all the foregoing natural results of the 
 nervous influenceg are equally chemi- 
 cal, and deny to organic actions (that 
 is, Nature) all participation in the 
 work of cure, p. 54-55, <S> 111-117; 
 p. 58-59, () 129 a, ? ; p. 61, () 133 c; 
 p. 62-67, () 136-151; p. 87, <) 177; 
 p. 88, ^ 184-185 ; p. 101-102, (} 201- 
 202 ; p. 106-112, ^ 222-234 ; p. 226, 
 ^ 409 k ; p. 295, ^75^ P- 253, (j 441 
 d ; p. 262-268, () 446 a-447 d ; p. 284 
 -290, 9 454-46 U c ; p. 296, ^ 476 c ; 
 p. 301,H81 b; p. 318-341,(5 493 cc- 
 514 ; p. 344, (} 516 d. No. 6 ; p. 348, 
 <^ 516 rf. No. 13 ; p. 350-353, «;» 524 ; 
 p. 354-362, () 526-530 ; p. 465-469, 
 () 715-722; p. 508-509, i) 807-811 ; 
 p. 537-539, iji 847 e-848 ; p. 563-565, 
 (} 889 a-g; p. 592-593, ^ 89H /t; p.
 
 INDEX II. 
 
 1043 
 
 Nervous System — continued. 
 
 642-650, <J 893 a-i; p. 657, ^ 893 ;?,• 
 p. 661-681, (} 894-905; p. 692-709, 
 / § 914-951 ; p. 745-747, () 990^ a, b ; 
 p. 804, (J 1040 ; p. 865-868, i) 1067 ; 
 p. 874, () 1071 ; p. 877-881, () 1072 b 
 -1075; p. 886-890, ^ 1077,^^8911^. 
 
 all remote effects of the Mental Emo- 
 tions, and of the Will, and of physical 
 agents applied to the nervous centres, 
 and of all diseases of those centres, 
 and of the nerves, are consequences 
 of the nervous influence, developed at 
 first in a direct manner, though all but 
 the Will are generally followed by re- 
 flex actions, p. 107, i) 227 ; p. 109, ^ 
 230; p. 670-671, () 902 Z-903; p. 
 733-734, (} 973-975. Also, Mental 
 Emotions, Sympathy (experiments). 
 Index II. ; Will, Index I. and II. 
 
 experiments upon, mostly by A. P. W. 
 Philip, to determine the " Laws of 
 the Vital Functions," in the relations 
 it bears to the Heart and Vessels of 
 Circulation, p. 295-310, <J 476-485; 
 p. 311-315, <J 487-489— and to the 
 Voluntary Muscles, p. 310-315, ^ 486 
 -489 — and to the Alimentary Canal, 
 p. 315, ^ 490, 491— and to the Lungs, 
 p. 315, ^ 491 ; with practical applica- 
 tions by the Author to Pathology and 
 Therapeutics, and introduced for the 
 sole purpose of applying them to the 
 interpretation of the effects of all mor- 
 bific and remedial agents beyond the 
 seat of their direct action, and of the 
 Passions, through alterative influences 
 of reflex action of the nervous system 
 in the former case, and of primarily 
 direct and secondarily reflex in the 
 latter, and of the naturally concerted 
 actions among all parts, their disturb- 
 ances of each other, &c., ibid., and 
 throughout a greater part of the work. 
 
 the varieties of sympathy or reflex action 
 as conducted through the medium of 
 the nervous system, and various phys- 
 iological illustrations, p. 321-335, () 
 495-511 — and the physiological laws 
 of sympathy or reflex action of the 
 nervous system introduced for the 
 purpose only of applying them as 
 stated in the preceding subdivisions, 
 p. 335-362, ^ 512-530. 
 
 generalization of its laws as applied by 
 the Author to interpret the modus 
 operandi of morbific and remedial 
 agents, both physical and mental, as 
 aforesaid, and from which arise all 
 the changes in the solids and fluids 
 as a consequence of the alterative in- 
 fluence exerted by the nervous action 
 upon the various series of capillary 
 vessels, and showing specifically that 
 this action, both direct and reflex, is 
 
 Nervous System — continued. 
 
 the fundamental cause not only of 
 increased secretions so far as the 
 function does not depend upon other 
 stimuli, but of the various modifica- 
 tions which the secretions undergo in 
 disease, according to the nature of the 
 cause by which the nervous influence 
 is excited, whether physical or mental, 
 p. 230-231, H22-423; p. 289,^61; 
 p. 631-632, ^ 8921 ; p. 668-669, ^ 
 902 g, h ; p. 704, (} 943 a, b. Also, 
 Fear, Jealousy, Weeping, Tea, 
 Food ; Water, Hot ; Secretion 
 and Excretion, Mental Emotions, 
 Remedial Action, Index II ; Nerv- 
 ous Power, Sympathy, Index I. and 
 II. 
 
 exerts the same influence in the produc- 
 tion of animal heat as upon other se- 
 cretions, only in the former case it is 
 simply an excitant, while in the latter 
 it increases, diminishes, and modifies 
 their condition in an endless variety 
 of ways, according to the nature of 
 the exciting causes, p. 262-270, i) 
 446-447 ; p. 807-808, i) 1044-1045. 
 Also, p. 68, (} 152 a ; p. 245, ()UOe; 
 p. 250-251, (} 441 c; p. 289, ^ 461 ; 
 p. 335-336, (j 512 a,b; p. 339, () 514 A; 
 p. 365, <) 889 g ; p. 483-484, () 746 c ; 
 p. 579-580, (J 8901 d- Also, Organic 
 Heat, Index I ; Hybernating Ani- 
 mals, Index II. 
 
 Brown-Sequard's interesting and inge- 
 nious discoveries in relation to spinal 
 cord, p. 802-803, () 1037. 
 
 acts as a whole in its natural state so 
 far as the great nervous centres are 
 engaged in developing motion or 
 otherwise influencing or modifying 
 actions and their results in organic 
 and animal life, however much cer- 
 tain parts may hold a predominating 
 power, and the great sympathetic 
 system derives a concurrent action 
 from the cerebro-spinal, and there- 
 fore experiments made upon isolated 
 portions with a view to their inde- 
 pendent functions are liable to falsify 
 Nature, p. 11-12, (^ 51 e-f; p. 54-55, 
 (} 110-117; p. 287-289, () 459-461 ; 
 p. 292, () 473 a ; p. 293, I) 473 c ; p. 
 296-298, <;> 467^^ a-h ; p. 303, (} 481 
 e-f; p. 306-308, ^ 483 b, c ; p. 357- 
 358, <J 590-591. 
 
 mistakes in regard to reflex action from 
 confounding results of experiments 
 on trunks of nerves with those upon 
 their expanded extremities, p 338, ^ 
 514 d; p. 347, ^ 516 d, No. 10, p. 
 520-521, <J 826c, d. Also, Medical and 
 Physiological Commentaries, vol. i., 
 p. 507, 563-566. 
 
 an intimate connexion established be-
 
 1044 
 
 INDEX II. 
 
 Nervous System — continued. 
 
 tween the organs of organic and ani- 
 mal life by the intercommunication of 
 the cerebro-spinal and ganglionic sys- 
 tems and the consequent interchanges 
 of reflex nervous action, p. 54-55, () 
 110-117; p. 107, ^ 224; p. 110, i; 
 232 ; p. 284-287, () 454-459 ; p. 341 
 -353, () 514^-524 — and hence the 
 convulsions of the voluntary muscles 
 which ensue upon intestinal irritation 
 and upon spasm of the stomach, and 
 various other resulting consequences 
 of a reciprocal nature, p. 347-348, 
 Nos. 11-13, &c. ; p, 642, () 893 a. 
 
 subject, like all other organs, to a determ- 
 ination of direct and reflex nervous 
 influence upon its own organization 
 when developed by the Passions, or by 
 inflammation, or injuries, or mechani- 
 cal or other physical irritations of the 
 nervous centres ; but its own afiec- 
 tions in this respect are of diflScult 
 analysis, p. 109, ^ 230 ; p. 356-358, 
 9 526 d ; p. 709, <;> 951 c ; p. 831-832, 
 () 1057/, g. Also, Neuralgia, Opium, 
 Sedatives, Antispasmodics ; Brain, 
 Inflammation of ; Mental Emo- 
 tions, Joy and Anger, and the other 
 individual Passio7is, Anesthetics, 
 Oxygen, Pain; Serpents,Virusof ; 
 Hydrocyanic Acid; Stomach, Blows 
 UPON ; Nervous Power, Index II. 
 
 the nervous influence may be determ- 
 ined with such sudden violence upon 
 the brain as to instantly extinguish life, 
 though doubtless, also, the same in- 
 fluence is propagated simultaneously 
 upon all the organic viscera, p. 107- 
 111, (^ 226-233J; p. 298, () 476|- h; 
 p. 300, H79 ; p. 301, <^ 480 ; p. 304, 
 H81 g- ; p. 306-308, ^ 483 b; p. 320, 
 ^ 494 dd ; p. 324, () 500 c, d ; p. 334- 
 335, ^ 509-511 ; p. 402-403, () 634, 
 635 ; p. 534, (^ 844 ; p. 709, ^ 951 c ; 
 p. 865-868, ^ 1067; p. 879-881, ^ 
 1074-1075; p. 887, ^ 1077. Also, 
 Joy and Anger ; Stomach, Blows 
 UPON, Index II. 
 
 a great misapprehension of Marshall 
 Hall's in supposing "all convulsive 
 affections to be diseases of the true 
 spinal or excito-motory system," and 
 that " the spinal marrow, exclusive of 
 the cerebrum, is the source of animal 
 life," and that " the trritabibty of the 
 muscles of organic life depends, prob- 
 ably, on the ganglionic system," and 
 his mistake in contradicting an im- 
 portant experiment by A. P. Wilson 
 Philip, p 296-297, (} 476^ b; p. 306- 
 308, ij 483 b, c ; p 357-358, ^ 526 d ; 
 p. 467-468, ^ 719. Also, p. 11-12, 
 () 54 e,f; p. 54-55, () 110-117; p. 
 287-290, (J 458-46 H ; P- 292, () 473 
 
 Nervous System — continued. 
 
 a ; p. 296, () 476 c, 476J- b ; p- 298- 
 299, ^ 476 ;t-477 a ; p. 300, ^ 479 ; 
 p. 303, () 481 e,f; p. 357-358, ^ 526 
 d; p. 590-591, ^891i; p. 592-593, § 
 891i k; and Convulsions, Hysteria, 
 Mental Emotions, Index II. — nor 
 does the Author acquiesce in his doc- 
 trine that " the Soul sends forth emis- 
 saries and plenipotentiaries ichick con- 
 vey its sovereign mandates along the 
 voluntary nerves to muscles subdued 
 to volition," p. 77, () 167 f. 
 
 diseases of the brain and spinal cord are 
 apt to give rise to great disturbances 
 in organs of organic life, but not to 
 convulsions unless efiusion or disor- 
 ganization happen, but which are com- 
 monly dependent on simple irritations 
 of the nervous centres, p. 334, ^ 508 ; 
 p. 357-358, ^ 526 d; p. 590-591, <) 
 89 H J; p. 592-593, ^891 H-; P- 733 
 -735, ^ 974 c-976. 
 
 its painful affections, when situated in- 
 ternally, occasioned and relieved by 
 alterative influences of reflex nervous 
 action upon the sensibility of the 
 nerves, and through the same in- 
 fluence when dissipated by mental 
 emotions, and according to the nature 
 of the means by which it is brought 
 into operation, p. 584^585, ^ 891 rf, e; 
 p. 587-590, ^ 891 k-s ; p. 592-593, 
 () 1057|-. Also, Sedatives {Aconite). 
 Opium, Poultices, Antispasmodics, 
 Bloodletting, Nervous Power, /n< 
 dex II. 
 
 is constantly charged with the nervous 
 power or nervous influence, or what- 
 ever name may be most acceptable, 
 which is not m transitu, a movable 
 substance, but, like the principle of 
 light, is every where diffused through 
 its appropriate medium, and, like that 
 principle, is brought into operation by 
 exciting causes, while, also, the polar- 
 ization of light supplies some analogy 
 to the Author's supposed modifications 
 of the nervous influence according to 
 the nature of the causes by which it is 
 brought into preternatural operation, 
 p. 114-115, <.234c. 
 
 it has been seen in a preceding subdivi- 
 sion that it is exceedingly difficult to 
 determine by experiments the special 
 functions of any part of the brain or 
 of particular nerves or fibres as they 
 may influence the organic functions, 
 and doubtless, in a general sense, the 
 phenomena as manifested in health 
 and disease are entitled to a large 
 ground of reliance, p. 115-119, ij 234 
 7-235; p. 309-310, (J 484 b. No. 5; 
 p. 413-414, ij 640 ; p. 434, ^ 679 ; p. 
 . 442, (^ 686 d; p. 541-542, I) 854 b;
 
 INDEX II. 
 
 1045 
 
 Nervous System — continued. 
 
 and in respect to the question before 
 us we may appeal to what was accom- 
 plished by our predecessors (deny it as 
 we may), in inferring the existence 
 and many of the laws of reflex action 
 of the nervous system from natural 
 phenomena alone, p. 290, i) 463 a, b ; 
 p. 295-296, § 476 b ; which brings us 
 to the Author's immediate object — 
 that of having inferred different series 
 of excito-motory nerves or fibres of 
 compound nerves for the fulfilment 
 of several special functions, one, for 
 example, for common sensation, an- 
 other for specific, a third for sympa- 
 thetic, another for voluntary motion, 
 another for the glandular organs, &c., 
 p. 100-103, <J 197-204; p. 280-283, 
 ^ 450-451 ; p. 330, () 500m«; though 
 it cannot be satisfactorily inferred 
 from the simple phenomena in health 
 or disease whether there be any spe- 
 cial excito-motory nerves or series of 
 fibres destined for influences upon 
 the glandular or other fluid products, 
 p. 230-232, (J 422 6-424 ; p. 335- 
 336, () 512 a, b; p. 630-632, () 892i 
 b ; and an experiment by Claude 
 Bernard of pricking the floor of the 
 fourth cerebral ventricle discredits 
 ail analytical conclusions upon the 
 question of excito-secretory nerves, 
 but very greatly so upon many others 
 of a specific nature, p. 792-793, ^ 
 1032 rf, and, doubtless, about the only 
 reliable amount of experimental in- 
 quiry as to the influence of the nerves 
 upon the secretions was supplied by 
 A. P. W. Philip, as published in the 
 London Philosophical Transactions 
 for 1815 and 1817, and of which a 
 summary abstract relative to our sub- 
 ject occurs at p. 314-315, ^ 489 ; p. 
 317-318, ^ 493 a-d. Also, p. 264, ^ 
 446 c ; p. 289, () 460, 461 ; and Hy- 
 
 BERNATING AnIMALS, IndcX II. 
 
 its mechanism and laws of reflex action 
 upon which is founded the Author's 
 physiological demonstration of the 
 substantive existence and self-acting 
 nature of the Soul and Instinctive 
 Principle, p. 873-874, ^ 1070-1071— 
 and physiological examples of the re- 
 flex action, and of the Will in its sim- 
 ply direct action, and of the Mental 
 Emotions in their operation through 
 direct development of the nervous in- 
 fluence and the subsequent institution 
 of reflex actions, and the application 
 of the whole to the foregoing object, 
 and to the explosion of the doctrines 
 in materialism, p. 874-892, i) 1072- 
 1077 ; p 904-906, ^ 1078 g-r. 
 
 relative structure and other physiological 
 
 Nervous System — continued. 
 
 conditions of the main central part in 
 the infancy of man and animals, as 
 implied by their intellectual and in- 
 stinctive habits, respectively, p. 892- 
 895, !^ 1078 «, 6 ; p. 904-906, () 1078 q. 
 a concurrence of action between the 
 main central portion and the Soul 
 and Instinctivie Principle, p. 892, ^ 
 1078. 
 the central part of, less subservient to 
 the Soul than to the Instinctive Prin- 
 ciple, p. 894, ij 1078 b ; p. 903-906, 
 <J 1078 q. 
 its varieties in the principal central por- 
 tion employed to distinguish the Soul 
 from the Instinctive Principle, p 896, 
 (} 1078 d; p. 897-898, t) 1078 e; p. 
 903-906, ^ 1078 q. Also, Soul and 
 Instinctive Pkinciple, Index II. 
 
 Neuralgia, 
 its sudden relief by Aconite when applied 
 along the course of an affected nerve 
 demonstrative of the modus operandi 
 of remedies through alterative in- 
 fluence of reflex action of the nervous 
 system, and of the modification of that 
 influence according to the nature of 
 the exciting cause, and that the nerv- 
 ous influence may be determined with 
 alterative effect as well upon the or- 
 ganic constitution of any part of the 
 nervous system as upon other organs, 
 and, farther, shows that pain is relieved 
 by that influence, p. 838, i) 1057^. 
 Also, Antispasmodics, Opium, Seda- 
 tives, Index II. 
 
 Nitric Acid, 
 
 applied as a pediluvium, subverts syph- 
 ilis and hepatic diseases, and increases 
 the secretion of bile, through alterative 
 influence of reflex action of the nerv- 
 ous system, p. 530, ^ 837 c — while 
 " our astonishment is great that the 
 bile is not more frequently affected 
 by the various medicinal agents put 
 into the stomach" — but far less so 
 than that the highly irritable heart 
 should escape, were there any found- 
 ation for the doctrine of operation by 
 absorption, p. 527, (} 829. Also, Sul- 
 phuric Acid ; Lead, Acetate of ; 
 Silver, Nitrate of ; Opium, Cold, 
 Index II. 
 
 Nitrous Oxide Gas, 
 
 employed, in connexion with oxygen 
 and other things, to show, in part, 
 upon chemical grounds, that anaes- 
 thetics are not absorbed, but that they 
 produce their constitutional eflfects 
 through alterative influences of reflex 
 action of the nervous system — the 
 philosophy being the same as in res- 
 piration when the reflex action is ex- 
 cited by an inappreciable irritation of
 
 1046 
 
 INDEX II. 
 
 Nitrous Oxide Gas — continued. 
 
 the pulmonary mucous tissue, p. 522- 
 523, ^ 827 b-d ; p. 862-864, ^ 1066. 
 Also, RespiratioiV, Emetics, Stom- 
 ach, Oxygen, Index II. ; Nervous 
 Power, Index I. and II. 
 
 Nux Vomica. See Hydkocvanic Acid, 
 Index II. 
 
 O. 
 
 Odors, 
 
 the physiology of vomiting from, &c., 
 through reflex action of the nervous 
 system, employed by the Author in 
 illustrating the modus operandi of all 
 morbific and remedial agents through 
 alterative influences of direct and re- 
 flex nervous action , and for the same 
 purpose, also, and to show how an 
 endless variety of impressions from 
 slight causes and upon various.parts, 
 and from various causes incapable of 
 absorption or chemical action, and 
 coming from mental as well as phys- 
 ical sources, will institute, through 
 complex circles of reflex actions, a 
 common ultimate effect, such as vom- 
 iting, or other results, and how, when 
 instituted by mental emotions, the 
 impression which is primarily made 
 upon a distant part will institute reflex 
 actions that result in violent manifest- 
 ations — all of which is exemplified in 
 t'le case of offensive odors in their 
 production of vomiting, whose pri- 
 mary impression is made upon the 
 olfactory nerve, and thus transmitted 
 to the brain, from whence the nerv- 
 ous influence is propagated upon the 
 mucous tissue of the stomach, which 
 It irritates after the manner of an 
 e.nctic, when this impression is re- 
 turned to the nervous centres and 
 chence reflected upon the abdominal 
 muscles and muscular coat of the 
 stomach, the former of which are 
 thrown into convulsive action and 
 the action of the latter violently re- 
 versed — and again, when a strong 
 light gives rise to sneezing, whose 
 primary impression is made upon the 
 retina, when the nervous influence is 
 reflected from the brain through ex- 
 cito-motory fibres of the nasal branch 
 of the fifth pair of nerves upon the 
 Schneiderian membrane, which it irri- 
 tates after the manner of snuff", when 
 this impression is returned to the 
 nervous centres through sensitive 
 fibres of the same nasal branch, and 
 thence reflected with convulsive effect 
 upon the abdominal muscles, but in a 
 diflferent manner from the odor — and 
 again, as an offensive spectacle gives 
 
 Odors — continued. 
 
 rise to vomiting, the rationale being 
 the same as that for the odor, with 
 the difference that in the case of the 
 spectacle the primary impression, as 
 in the case of sneezing, comes through 
 the optic nerve — or yet again, as when 
 the mind itself will occasion vomiting 
 by calling up the recollection of the 
 odor or the spectacle, when the mind 
 is the only agent concerned, but the 
 remaining process the same as in the 
 other cases — these analogies, with 
 numerous others supplied by other 
 affections of the mind, and along with 
 their morbific and curative effects, 
 being then carried by the Author to 
 vomiting as produced by blows upon 
 the head or epigastric region, or by ir- 
 ritating the fauces, or drinking warm 
 water, or by undigested food, or as 
 arising from irritations of the uterus 
 or kidney, &c., and all considered in 
 connexion with the morbific and cura- 
 tive effects upon internal organs of 
 cold applied to the surface or as it 
 increases the secretion of urine, and 
 many other analogous things — and 
 the demonstration supplied by all the 
 analogies, which, in all the foregoing 
 cases, inevitably turns upon direct and 
 reflex action of the nei"vous system, 
 applied to the interpretation, through 
 the same rationale, of all the analogous 
 eflfects which flow from the operation 
 of all other morbific and remedial 
 agents of a tangible nature; and ulti- 
 mately employed in demonstrating the 
 substantive existence and self-acting 
 nature of the Soul and Instinctive 
 Principle, p. 324, <J 500 c; p. 327- 
 328, ^ 500 i-m; p. 340-341, ^ 514 
 f:-m; p. 522-524, (f 827 b-d ; p. 530, 
 (^ 837 b; p. 534. ^ 844; p. 631-632, 
 ^ 892 J b ; p. 666-670, () 902 b-vi ; p. 
 703-705, () 940-945 ; p. 707, ^ 947 ; 
 p. 709-710, () 951-952; p. 865-868, 
 ^ 1067; p. 888-890, ^ 1077. Also, 
 Generalization of Reflex Action, 
 Index II. 
 
 their presence in the secretions supplies 
 no ground for the doctrine of remedial 
 action by absorption, p. 520, (} 826 b ; 
 p 523-524, {) 827 d. 
 Oil, Castor, 
 
 its special action upon the liver as an 
 alterative, and its great advantages, 
 p. 555, () 872 ; p. 568-569, () 889 7?! ; 
 p. 834, {) 1057 /,- p. 853, (J 1060. 
 
 as an adjuvant to Calomel and Blue Pill, 
 one of the best, p. 834, <i 1057 I; p. 
 839, {) 1058 a; p. 845-846, <^ 1058 
 777, n; p. 847, (^ 1058 q ; p. 848, <5 
 1058 t; p. 853, () 1060. 
 
 as a remedy, in small and repeated doses,
 
 INDEX II. 
 
 1047 
 
 Oil, Castor — continued. 
 
 for habitual coijstipation, p. 366, () 
 556 b; p. 555, () 872 ; p. 568, () 889 
 m ; p. 834, <^ 1057 /. Also, Altera- 
 tives, Index II. 
 
 best cathartic in scarlet fever, p. 843, <S> 
 1058 h. 
 
 should be exhibited in carefully regu- 
 lated doses throughout the progress 
 of many diseases, and at the advanced 
 stages of all, and for its gradually al- 
 terative effect, p. 555, ^ 872 ; p. 568- 
 569, ^ 889 m ; p. 834, () 1057 I. 
 
 possesses a soporific virtue, p. 834-835, 
 ^ 1057 /. 
 
 time for its administration compared 
 with other cathartics, p. 570, ^ 889 
 n ; p. 835, () 1057 /. 
 
 injected into the circulation, and why its 
 effects in that case, or in other similar 
 examples, prove nothing in behalf of 
 the supposed operation of remedies by 
 absorption, p. 529-530, <^ 837 a, b ; p. 
 675-676, <) 904 b ; p. 677, (} 904 c. 
 Oil, Croton, 
 
 its operation, as a cathartic, when sim- 
 ply applied to the tongue, or intro- 
 duced into the rectum, in the quantity 
 of a drop, illustrates the principle of 
 continuous sympathy (or, as the Au- 
 thor prefers, continuous influence, p. 
 322, I) 498 a), the impression being 
 propagated, as in leeching the anus 
 or septum nasi, continuously along 
 the mucous tract, being equivalent to 
 the direct passage of a cathartic, or 
 any other irritation, while, also, the 
 impression thus produced upon the 
 tissue establishes an alterative reflex 
 action of the nervous system, modified 
 according to the nature of the exciting 
 cause, and which is the common result 
 of continuous sympathy, p. 58, <J 129 
 f; p 322-323, t) 498 a-g ; p. 343, () 
 516 d; p. 344-345, No, 6 ; p. 526, () 
 828 d. Also, Medical and Physiologi- 
 cal Commentaries, vol. i., p. 494-513; 
 p. 569-574 — and the logical mind will 
 readily perceive that this is analogous 
 to the reflex actions that are generated 
 by impressions made by Mental Emo- 
 tions upon the mucous tissue of the 
 stomach and intestine, when they give 
 rise to vomiting and purging, and ap- 
 ply the whole to the interpretation of 
 morbific and remedial agents upon 
 parts beyond the seat of their direct 
 effect to alterative influences of reflex 
 nervous action, while, also, the coin- 
 cidences in effects between the phys- 
 ical and mental causes will as readily 
 lead to the conclusion that all the 
 morbific and remedial effects of Men- 
 tal Emotions are equally as those of 
 the physical causes owing to the same 
 
 Oil, Croton — continued. 
 
 versatile nervous influence. See 
 Odors, Fear, Disgust, Mental 
 Emotions, Index II Also, ^ 1088 i-rf 
 for like reason, when cathartics fall 
 rather short of developing the full 
 reflex influence that is necessary to 
 the cathartic effect, chewing a little 
 Rhubarb will often speedily and ef- 
 fectually determine the result See 
 Cathartics, Index II. 
 the foregoing principle is exactly the 
 same as when reflex actions are in- 
 stituted and progressively increased 
 in force by inflammation of any part 
 when propagated continuously from 
 an isolated point, p 343, <S» 516 d; p. 
 526, () 828 d ; p. 563-564, ^ 889 a. 
 
 Opium — continued from Index /., 
 
 " it is very singular that a pill of opium, 
 administered by the stomach at night, 
 will be vomited up in the morning, 
 after having producedils narcotic effect" 
 — explained by the Author through its 
 development, by simple contact with 
 the stomach, of an alterative reflex 
 nervous action — as is also the " very 
 minute quantity which always pro- 
 duced in a Physician a scarlet efflo- 
 rescence over the whole surface of the 
 body" — the former having its close 
 analogy in the constitutional results of 
 the first contact offood with the stom- 
 ach, and the latter in the eruptive affec- 
 tionsconsequentupon intestinal disor- 
 ders, along with analogous examples 
 supplied by Strychnia, Hydrocyanic 
 Acid, Hyoscyamus, Atropia, and To- 
 bacco — carried to the interpretation of 
 the modus operandi of all morbific and 
 remedial agents upon parts beyond the 
 seat of their direct operation through' 
 alterative influences of reflex action 
 of the nervous system, p. 672-674, <^ 
 904 b. Also, Sedatives, Food, Skin 
 (eruptions of). Suppositories, Nar- 
 cotics, Nervous System, Lidex II. 
 conclusions from experimental applica- 
 tions of, made to the nervous centres, 
 stomach, and skin, that its eflfects are 
 produced in all the cases by alterative 
 influence of direct or reflex action of 
 the nervous system, and introduced 
 for the purpose of applying the same 
 philosophy to the modus operandi of 
 all other remedial and morbific causes, 
 whether physical or mental, and U- 
 show that the nervous influence ncu 
 essarily undergoes modifications in 
 its nature according to the nature of 
 its exciting causes, p. 301-303, <J 481 ; 
 p. 306, Exp. 21 ; p. 309-310, ^ 484 b, 
 Nos. 5, 6. Also, p. 107-109, (> 227- 
 230 ; p. 592-593, ^ 891M; P- 670- 
 675, .;» 902 /-904 b.
 
 1048 
 
 INDEX II. 
 
 Opium — continued. 
 
 experiments with, by Volkmann and 
 others, showing the distinction be- 
 tween the trunks of nerves and their 
 expanded extremities, and how the 
 skin is rendered by narcotization and 
 other causes a very sensitive source 
 of convulsions, and introduced by 
 Author to expound the modus ope- 
 randi of bhsters, setons, mercury, 
 iodine, miasms, and other agents ap- 
 pHed to the skin through alterative 
 influences of reflex nervous action, 
 p. 308-310, ^ 484-485 ; p 319, () 894 
 d; p 338, ^ 514: d; p. 348, <) 516 d, 
 No. 13. Also, Skin, Cold, Seton, 
 Counter-Irritants, &c.. Index II. 
 
 in producing no astringency, but in re- 
 straining colliquative sweats, check- 
 ing the secretions of the liver, kidneys, 
 &c., illustrates the modus operandi of 
 true Astringents through alterative 
 influence of reflex action of nervous 
 system, p 422-423, {) 658 ; p. 577, «J 
 890 o; p 592-593, ^891^- k. Also, 
 Silver, Nitrate OF, Lead, Acetate 
 of; Sulphuric Acid, Cold, Ipecac- 
 uanha, Ergot, Index II. ; <S> 890 b. 
 
 overcomes spasms by developing a coun- 
 teracting reflex nervous influence, p. 
 592-593, (^ 89U- /c. Also, Antispas- 
 modics, Coffee, Cold, Skin, Index II. 
 
 relieves pain, situated internally, through 
 sedative influence of reflex action of 
 nervous system upon the sensibility 
 of the expanded nerves, which is 
 equally true, also, of all other seda- 
 tives of active virtues, of loss of blood, 
 &c., and of mental emotions through 
 their direct development and modifica- 
 tion of the nervous influence, p 587- 
 590, ^ 891 k-s; p. 592-593, i) 891 k; 
 p. 831-832, ^ 1057 f, p. 838, ^ 1057A. 
 Also, p. 520-521, <J 826 rf; and Seda- 
 tives (^co?n<c), Bloodletting, Poul- 
 tices, Remedial Action, Antispas- 
 modics, Index II i Nervous Power, 
 Index I. and II 
 
 in relieving pain or spasms depending 
 upon wounds, and locally applied, 
 may act mostly like warm poultices 
 by simply diminishing the sensibility 
 and irritability of the part, and thus 
 arresting the morbific reflex nervous 
 action, but also by generating a coun- 
 teracting reflex nervous influence, p. 
 592-59-3, (J 89U A:; p. 682-683, ^ 
 905 b 
 
 commended above all other remedies, 
 and contrasted with Bloodletting, p. 
 584, ^ 891 c, d; p. 718-719, § 859 b. 
 Also, Opium, Index I , for its special 
 uses. 
 
 compounded with Ipecacuanha, the re- 
 flex nervous influence is so modified 
 
 Opium — continued. 
 
 that the secretions of the liver and 
 kidney are less restrained, and sweat- 
 ing promoted, besides other well- 
 known peculiarities of action, which 
 illustrate the manner in which the 
 nervous influence is modified accord- 
 ing to the particular virtues of the 
 cause, physical or mental, by which 
 it is brought into operation, p. 592- 
 593, () 89H k. Also, Jealousy, In- 
 dex II ; Nervous Power, Index I. 
 and II. 
 Organic Analysis — continued from Index 
 /. 
 
 allowed by Lehmann to be unreliable, 
 p. 779-782, «^ 1029-1030. 
 
 quantitative, surrounded by diflSculties, 
 ibid. 
 
 qualitative, opposed by insuperable ob- 
 stacles, p. 782, (} 1030. 
 
 of the blood and tissues, impossible, p. 
 780, 781, {) 1029, 1030. 
 
 fruitless in morbid conditions by its own 
 admissions, p. 782, <J 1030. 
 Organic Beings — continued from Index 
 I, 
 
 the fundamental distinction between 
 Animals and Plants certified by the 
 microscope, p. 815, () 1052. 
 
 a question as to their origin, p. 182-191, 
 ^ 350f g-n ; p. 910-911, ^ 1083. 
 
 their relation to external objects, and 
 how the connexion obtains, p. 398- 
 400, <) 626-630— and what the differ- 
 ence in this respect between Animals 
 and Plants, p. 399, § 628. 
 
 die, nothing else, p. 401, ^ 631. 
 Organic Chemistry — continued from In- 
 dex I., 
 
 what Lehmann thinks of its prospects 
 and of the past, p. 779-782, i) 1029, 
 1030. 
 
 allows that Physiology and Pathology 
 have but little or nothing to hope from 
 it, p 779-782,^ 1029, 1030. 
 
 allowed to be unavailable in practical 
 medicine, p. 795, () 1033 b 
 
 confesses its "weakness and incapaci- 
 ty,^' p 782, (J 1030. 
 
 apologizes for its failure, p. 779-782, ^ 
 1029. 1030. 
 
 as applied to digestion, admitted by 
 distinguished advocates that there is 
 something more than Chemistry in it, 
 p. 152-153, <J 345-348; p 160-161, 
 Nos. 12-15 X 58-60; p 163-164, 
 Nos. 21X65; p. 168-170, Nos. 34- 
 38x83-87i; p. 171, Nos 41 X 93, 
 parallel columns. 
 
 a cause of its supposed connexion with 
 Medicine, p. 798, <) 1034 
 
 its complaint against Vitalists, p, 796- 
 799, () 1034 
 
 charges Physicians with greater homage
 
 INDEX II. 
 
 1049 
 
 Organic Chemistry — continued. 
 
 than it thinks it deserves, and lays 
 something of the blame of its failure 
 to their confidence in its promises, p. 
 781, «;) 1030; p. 808, <J 1034. 
 the Author greatly indebted to it, p. 207, 
 ^ 376J b; p. 801, () 1035. 
 Org.^nic Heat — continued from Index I. 
 Also, Combustion, 
 farther observations upon, confirming 
 the Author's former demonstrations 
 of its independence of chemical laws, 
 p. 807-812, <5 1043-1049. 
 experimental demonstration by Brown- 
 Sequard of being liable to sudden in- 
 fluences in circumscribed parts by re- 
 flex action of the nervous system, sus- 
 taining the present writer's opinion 
 of its being a secreted product, and, 
 like all other secretions, subject to 
 influences by direct and reflex nervous 
 action, p. 807, <J 1044 a. Also, p. 68, 
 ^152 a; p. 245, H40 e ; p. 250-251, 
 4 441 c ; p. 262-270, <^ 446-447 ; p. 
 335-336, ^ 512 a,b; p. 339, ^ 514 A; 
 p. 365, ^ 889 g ; p. 579-580, ^ 890^ d. 
 Also, Hyb«rnating Animals, Index 
 IL 
 liable to local exaltations by direct devel- 
 opment of nervous influence from in- 
 juries or other aflTections of the nerves, 
 p. 259, <J 443 b ; p. 264-270, () 447 a-d 
 — the causation being then exactly 
 the same as when the gastric juice 
 and the pulmonary mucus are in- 
 creased in quantity by the nervous 
 shock incident to a division of the 
 pneumogastric nerve, p. 289, <S> 461 ; 
 p. 293, () 473 a, No. 2. Also, Brain, 
 Inflammation of ; Mental Emo- 
 tions, the individual Passions, Sym- 
 pathy {Experiments to determine, i^c.). 
 cannot be one theory to explain the phe- 
 nomena of heat in health, and another 
 for disease, p. 271, ^ 447/. 
 different in different parts, according to 
 the vital constitution of each, extend- 
 ing even to plants, p 260, i^ 445 a-b; 
 p.270,H47rf; p.808,<)1045. Also, 
 p. 61, H33 a, b; p. 62-63, () 135-137 ; 
 p. 97-98, <J 190, 191. 
 Dr. Kane's experience relative to, sus- 
 taining the Author's philosophy of its 
 dependence upon vital laws as set 
 forth in the Medieal and Physiological 
 Commentaries, vol. ii., p. 1-78, and, in 
 continuation, in these Institutes, p. 
 234-279. 
 
 influenced by constitution, p. 809, (^ 
 1047. Also, p. 68-69, <^ 153-156 ; 
 p. 248, () 441 b; p. 255, () 44H a; 
 p. 257-258, i) 442 a, b ; p. 259-260, 
 ^ 443-445 b ; p. 262, ^ 445/; p. 271 
 -273, § 447 g. h ; p. 275, ^ 447^ b ; 
 p. 384, <J 585 c, cZ, 585 ; p. 391, <^ 603. 
 
 Organic Heat — continued. 
 
 influenced by habit of exposure and 
 by Chmate, p. 809, () 1047. Also, 
 p. 256, § 441+ a-c; p. 257-258, (J 
 •442 a-d ; p. 363, () 535-540 ; p. 
 394-396, () 615-621. 
 influenced by Mental Emotions, p. 
 271, () Ulf. Also, Fear, Shame, 
 Mental Emotions, Index II. 
 less dependent upon food than other 
 secreted products, p. 810-812, ^ 
 1048-1050. Also, p. 245, 246, ^ 
 440 c; p. 248-262, H41 c-U5 g. 
 suddenly exalted upon the surface by 
 contact of food with the stomach, 
 through reflex action of the nervous 
 system. See Food, Shame, Love, 
 Fear, Index II. 
 arctic and tropical, compared as it 
 respects food, p. 810-812, <^ 1048- 
 1050. Also, p. 248-252, ^ 441 c. 
 in its relation to clothing, fire, alcohol, 
 fat, blubber oil, p. 809-812, ^ 1047 
 -1050. Also, p. 239-243, ^ 440 
 a-c; p. 245, 246, () 440 e; p. 247, 
 () 440 t ; p. 256, () Ull' c; p. 257- 
 259, <^ 442. 
 tea, the great arctic resource for the 
 generation of heat under the pro- 
 longed influence of cold, p. 811, ^ 
 1049. 
 Organic Life — continued from Index I, 
 recent experiments, showing the distinc- 
 tion between the properties of organic 
 life and the nervous power, and sus- 
 taining the Author's philosophy upon 
 this subject, p. 803-804, () 1039 ; p. 
 805-806, 1^ 1041. Also, Vital Prop- 
 erties, Vital Principle, Index I.; 
 Iris, Index II 
 Organic Products, Morbid, 
 
 each variety has always a special path- 
 ologicalcause, conforming in principle 
 with the natural products, and when 
 not the result of direct local action of 
 physical agents, every change depends 
 upon alterative influences of either 
 direct or reflex action of the nervous 
 system exerted upon the instruments 
 of organic processes, and equally so 
 from the operation of Mental Emo- 
 tions as from external and internal 
 exciting causes of a physical nature, 
 (J 53 ; ^ 109 6 ; ij 1 13 ; (^i 224 ; (} 226 ; 
 () 409 d; p. 226, () 409 fc; p. 228, ^ 
 415; p. 230-233, ^ 422 i-427 ; p. 
 285-287, () 455 b-458 ; p. 289, ^ 431 ; 
 p. 296, {) 476 c; p. 302, ^81*; p. 
 436, () 682 b ; p. 452, () 693 ; p. 478- 
 479, (J 740-741 ; p. 483-484, ^ 746 c; 
 p. 531, (J 838-840 ; p. 536-539, ^ 847 
 c-h ; p. 630-632, I) 892| b ; p. 666- 
 672, () 902 i-904 b; p. 679-681, () 
 905 a ; p. 703-710, <J 940-952. Also, 
 Secretion and Excretion; Reme-
 
 1050 
 
 INDEX II. 
 
 Organic Products, Morbid — continued. 
 
 DIAL Action, subdivismi Mental 
 Emotions ; Feak, Jealousy, Food, 
 Tea, Kidney, Skin, Cold, Weeping, 
 Sympathy (the Experiments upon 
 Brain and Spinal Cord), Index II. ; 
 Nervous Power, Index I. and II. 
 
 Organs, 
 
 the philosophy concerned in their devel- 
 opment and other natural changes, 
 from the embryo to old age, as, also, 
 the essential philosophy of their dis- 
 eases and their cure, p. 36-49, (} 63- 
 80; p. 66, i) 144-147; p. 68-69, ^ 
 153-159; p. 373-380, 'Ji 576-578 ; p. 
 401-402, <J 633 ; p. 679-681, () 905 a. 
 Also, Uterus, Organs of Genera- 
 tion, Lactation, Pregnancy, hidcx 
 II. ; Youth, Nervous Power, Index 
 I. and II. 
 
 Organs of Generation, 
 
 supply an endless variety in the in- 
 fluences which they exert through 
 their development of natural, mor- 
 bific, and remedial conditions of re- 
 flex action of the nervous system, 
 both in an independent sense and as 
 compounded with other nervous in- 
 fluences that spring from attendant 
 mental emotions, and serving as a 
 fruitful source of interpretation of the 
 effects of morbific and remedial agents, 
 and of the no less wonderful manner 
 in which the nervous influence is 
 propagated through particular excito- 
 motory nerves as it may be developed 
 in all the cases by certain physical 
 impressions, or by passion, and as the 
 will may often interpose its modify- 
 ing mandates, or, again, as the reflex 
 nervous power may be developed alone 
 by the independent influence of the 
 generative organs, and thus brought 
 into unusual and unintermitting op- 
 eration upon the universal organism 
 (after the manner explained in sections 
 under Alteratives and Sphincter 
 Muscles, Index II.), and rendered 
 the essential cause of the physical 
 and moral changes which mark the 
 transition of Childhood into Youth, 
 yet intermingling this organic in- 
 fluence of reflex nervous action with 
 those transitory ones that have a 
 common parentage through the men- 
 tal emotions that are incident to the 
 same organic influence, and display- 
 ing themselves in a great variety of 
 familiar ways — and, finally, as they 
 manifest their ascendency in the 
 pregnant female by directing the re- 
 flex nervous action with nauseating 
 effect upon the stomach, and, as par- 
 turition approaches, increase its alter- 
 ative influence already established up- 
 
 Organs of Generation — continued. 
 
 on the mammary glands, and, through 
 a perpetual determination of that in- 
 fluence upon them, maintain an un- 
 ceasing secretion of milk, now and 
 then disturbed by mental emotions, 
 till the uterine organs, returning to 
 their wonted function of menstrua- 
 tion, generally cease to propagate the 
 requisite influence to tiie nervous 
 centres — all of which is applied to 
 the interpretation of the modus oper- 
 andi of remedial and morbific agents, 
 physical and mental, through other 
 but exactly analogous influences of 
 the same reflex or direct action of the 
 nervous system, and against the chem- 
 ical and other physical hypotheses, p. 
 56, () 120, 121 ; p. 61, ^ 133 c; p. 87, 
 ^ 177; p. 111,(^2331; p. 114-115,^ 
 234 e; p. 1 17-120, <J 234 §--235; p. 231 
 -232, ^ 424 ; p. 330, |J500 nn ; p. 335- 
 336, () 512 a, b ; p. 352, ^ 524 d ; p. 
 397, ^ 625^. Emotions, Altera- 
 tives, Antimony, Lactation, Milk, 
 Weeping, Sphincter Muscles, To- 
 bacco, Love, Fear„Jealousy, Kid- 
 ney, Skin, Roosting, Index II. 
 Osborne, Dr. — on neglect of blood-letting 
 
 in pneumonia, p. 761, () 1005 k. 
 Ovum — continued from Index I., 
 
 its development exactg from leading 
 Chemical Physiologists an admission 
 of its dependence upon a Vital Prin- 
 ciple, and a concession of the whole 
 ground of Vital Solidism, p. 38-39, (J 
 64 e-g — nay, more, to the extent of 
 transcendentalism, p. 40, ^ 64 A ; p. 
 85-86, (jllbd. 
 
 embraces the potential whole of meta- 
 morphic animals, and which deteian- 
 ines all their changes — applied to dis- 
 tinguish the Instinctive Principle from 
 the Soul, p. 902-903, (J 1078 — and 
 the same principle, independently of 
 other facts, confutes the hypothesis 
 of a " primordial cell," p. 812-815, i^i 
 1051 i-1052. 
 Oxygen — continued from Index I., 
 
 considered farther in its supposed causa- 
 tion of the circulation of the blood, p. 
 817-823, ^ 1054-1055. 
 
 employed, upon chemical principles, 
 along with other considerations, to 
 show that AnsEsthetics produce their 
 effects through alterative influence of 
 reflex action of the nervous system — 
 their modus operandi being the same 
 as concerned in the function of respi- 
 ration, where the reflex action is ex- 
 cited by an inappreciable irritation of 
 the pulmonary mucous tissue, while 
 in the case of Ansesthetics the in- 
 fluence is profound, and of such a 
 peculiar nature as to determine the
 
 INDEX 11. 
 
 1051 
 
 Oxygen — coiitinued. 
 
 nervous influence upon the expanded 
 nerves and no other parts, and impart 
 to it a modification capable of abolish- 
 ing, temporarily, common sensibility, 
 p 522-523, {) 827 b-d; p. 862-864, 
 ^ 1066. Also, p. 1 1 1, ^ 233J ; p. 214 
 -216, (J 234 e-g ; p. 330, I) 500 n ; p. 
 661-663, ^ 894-896; p. 679-681, ^ 
 905 a; and Neuralgia, Opium, Anti- 
 spasmodics, Pain, Sedatives {Aco- 
 nite), Skin, Kidney, Cold, Respira- 
 tion, Emetics, Stomach, Index 11. ; 
 Nervous Power, Youth, Index I. 
 and II. 
 
 Pain — continued from Index /., 
 
 a very nnreliable symptom, often leading 
 to mistakes in practice, p. 584, ^ 891 c; 
 p. 587-589, i) 891 k-p ; p. 718-721, (} 
 960 a. Also, Opium, Index II. 
 
 illustrates, by the requisite variety of 
 treatment, the modifications of in- 
 flammation that arise from differences 
 in its remote causes, p. 418, ^ 652 c; 
 p. 468, i) 722 a-c ; p. 469-470, ^ 725 ; 
 p. 587-589, () 891 k-p. 
 
 occasioned and relieved, when not the 
 direct result of causes operating local- 
 ly, by alterative influences of reflex 
 action of the nervous system, operat- 
 ing either directly upon the common 
 sensibility of the nerves or indirectly 
 by exciting or relieving disease, and 
 according to the nature of the means 
 by which it is brought into operation, 
 and equally relieved, also, through the 
 same medium by mental emotions and 
 according to their nature, and in gen- 
 erally not affecting the senses, a plain 
 distinction is thus supplied between 
 common and specific sensibility, and 
 in other ways between sctisibility and 
 irritability, p 89, i) 183 a-c, &,c. ; p. 
 100-102, ij 197-203 ; p. 280-282, () 
 450-451 ; p. 338, i) 514 (/ ; p. 587- 
 590, ij 891 k-s; p. 592-593, ^ 89U k; 
 p. 831-832, 1057/; p. 838, () 1057^ ; 
 p. 862-864, ^ 1066. Also, Opium, 
 Narcotics, Warm Bath, Poultices, 
 Index II. ; Nervous Power, Index I. 
 and II. 
 
 when relieved in superficial parts by the 
 direct local action of sedatives, such 
 as opium, &c , or when traumatic 
 spasms subside under the influence 
 of hot fomentations, it is mostly by 
 subduing local sensibility and irrita- 
 bility, when, in the case of the spasm, 
 the exciting nervous influence sub- 
 sides as a consequence, just as infan- 
 tile convulsions are relieved by lancing 
 a gum or by removing irritating matter 
 
 Pain — conttnued. 
 
 from the alimentary canal ; though 
 in many of the cases a sedative reflex 
 nervous action is instituted which is 
 reflected upon the part through excito- 
 motory fibres coming directly to the 
 part, or through more indirect chan- 
 nels, as is commonly more or less the 
 case with all remedies when they sub- 
 due diseases of parts upon which their 
 • direct effect is exerted, p. 66-67, ij 148; 
 p. 421-423, ^ 657-658 ; p. 682-683, 
 \ 905 b. Also, Pathological Cause, 
 Index 11. 
 if it affect the action of the heart, it is 
 through some mental emotion it pro- 
 duces, p. 78-79, note; p. 588, ^ 791 m. 
 Parallel Columns, 
 
 their argumentative uses, p. 19, <J 18 e; 
 p. 156-173, (J 350 ; p. 182, ^ 350j gg\ 
 p. 189-190, ^ 3501 n ; p. 200, ^ 366 ; 
 p. 246-247, <^ 440 /; p. 277-278, ^ 
 447^; p. 514-515, ^ 819. Also, 
 Medical and Physiological Com- 
 mentaries, vol. iii.. Article Examina- 
 tion of Reviews, p. 91-96. 
 Paris, 
 
 his opinions of Organic Chemistry, p. 
 433-434, 1) 676 b; p. 762, ^ 1006 a. 
 his opinion of spasmodic affections and 
 their means of relief, p. 590, ^ 891^ b. 
 Parturition, 
 
 conducted through reflex action of the 
 nervous system, having its point of 
 departure in the mucous tissue of the 
 uterus, and acting mostly upon its 
 muscular tissue, while its natural 
 action upon the perineal muscles is 
 suspended during the paroxysm — 
 remarkable for its intermissions, and 
 inducing convulsions, &c., and for its 
 immediately subsequent determina- 
 tion upon the mammary gland as an 
 exciting cause of lactation — and ap- 
 plied in advancing the Author's doc- 
 trine of the modus operandi of all 
 morbific and remedial agents through 
 alterative influence of reflex nervous 
 action beyond the seat of their direct 
 operation, while, also, the manner in 
 which the milk is liable to be affected 
 in quality and quantity by mental 
 emotions brings them under the same 
 rule of interpretation, p. 56, () 120, 
 121; p. Ill, <J 2331 ; p. 114-115, <5 
 234 e; p. 117-120, ^ 234 ^-235; p. 
 231-232, () 424 ; p. 330, () 500 nn; p. 
 335-336, <i 512 o, i ; p. 352, (> 524 d ; 
 p. 686, (} 905i b Also, Uterus, Lac- 
 tation, Pregnancy, Youth, Kidney, 
 Skin, Cold, Ergot, Fear, Weeping, 
 Bile, Mucus, Respiration, Reflex 
 Action, &c.. Index II. , Youth, Index 
 I. and II. — Also, Note A p. 1111. 
 illustrates the mutability of the proper-
 
 1052 
 
 INDEX II. 
 
 Parturition — conthmcd. 
 
 ties of life, like many other natural 
 changes, shows its foundation in use- 
 ful Design, and that hence arise dis- 
 ease and its cure, p. 61, ^ 133 c; p. 
 82-83, ^ 172 ; p. 86-88, () 176-185 ; 
 p. 665, ^ 901. Also, Vital Proper- 
 ties, Organic Life, Index I., and 
 references in foregoing subdivision. 
 Passions. See Mental Emotions, and 
 Remedial Action, subdivision Men- 
 tal Emotions, and the individual 
 Passions, Index II. 
 Pathological Anatomy. See Anatomy, 
 
 Morbid, Index II. 
 Pathological or Proximate Cause ; 
 also, Proximate Cause, Index I., 
 
 the essential condition of disease, as 
 resulting from remote causes, and the 
 immediate cause of the symptoms, p. 
 427, <;> 667, 668 ; p. 428, ^ 674 a. 
 
 consists simply of changes of the natural 
 states, and is therefore strictly a mor- 
 bid physiological condition, p. 3-4, i^ 2 
 b-d; p. 131-132, ^ 285-288 ; p. 265, 
 ^ 447 b; p 413, ^ 639 ; p 428-430, 
 ^ 674 ; p. 398, l^ 626 ; p. 498-504, () 
 785-79S*-and the essential Art of 
 Medicine lies in the principle of im- 
 parting to morbid states some more 
 favorable pathological condition that 
 may subside spontaneously in the 
 shortest time — the principle being 
 distinctly illustrated by such remedies 
 as produce artificial diseases, as the 
 inflammation of the parotid glands 
 and mouth induced by mercury and 
 the mercurial fever which denotes 
 morbific influences upon other parts 
 rendered susceptible by disease, and 
 also by the spontaneous subsidence 
 of the artificial disease, and the sim- 
 ultaneousdisappearance of the natural 
 ones (and so in slighter degrees of the 
 mercurial influences), and as farther 
 
 * shown by analogous circumstances 
 attending Vesicants, Cantharides, 
 &c., p. 08, (^ 152 ; p 541-543, i} 852 
 -856 ; p. 662-665, <^ 896-901 ; 1059 ; 
 Remedies, Vesicants, Cantharides, 
 Therapeutics, Index II — (^ 746. 
 
 although it consist essentially of some 
 change in the properties of life, it 
 may be assumed, for convenience, to 
 ^ consist of some of the physical results 
 appertaining to the instruments of 
 disease, where such results are com- 
 monly present, as in inflammation 
 and venous congestion, p. 428-429, *J 
 674; p. 484, <J 747; p. 485-486, (^ 750 
 -751; p. 498-499, <J 781-785; p. 500 
 -506, i) 786-802. Pros. Cau.se, Ind. 1. 
 
 its precise nature depends greatly upon 
 the exact nature of the remote causes, 
 whether simple or complex, quick or 
 
 » Also, § 3 ft, 73-80, 129, 130, 1S7, 143, 150-152, 
 5TG rf, 5TS c, '/, 741 ft, 764 c, S47, 801 \ /,; 8!)6, 900, 
 320, 455(;, 52Ga, ft, 597-601, 674". 718. 7G3(r, 703, 
 
 Pathological Cause — continued. 
 
 slow in operation, &c., and upon the 
 natural constitution of diflerent parts, 
 their natural mutations, and other 
 permanently acquired conditions, p. 
 61-73, ^ 133-163 ; p. 374-375, ^ 576 
 d, e ; p. 376-380, (J 578 ; p. 418, s'' 
 651-652; p. 423-424, (J 659-662 ; p. 
 427-428, <J 669-672; () 526 /;. Causes, 
 Morbific ; Remedies, Index II. 
 
 depends upon the natural mutability of 
 the properties of life, which is design- 
 ed for useful purposes, p. 61, () 133 c; 
 p. 82-83, 1^172; p. 86-88, <^ 176-185; 
 p. 665, ^ 901 Also, Pregnancy, 
 Lactation, Organs of Generation, 
 Uterus, Kidney, Skin, Cold, Lidcx 
 II. ; Youth, Index I. and II. ; Vital 
 Properties, Organic Life, Index I. 
 
 may exist in a predisposing condition 
 and not of actual disease, and this 
 from an instant of time to a series of 
 months and even years, and should 
 disease arise in the part upon which 
 the primary impression is made, it is 
 apt in most cases, especially in the 
 prevailing forms of disease, to be the 
 result of morbific influences of reflex 
 action of the nervous system excited 
 either by the primary impression or 
 by some remote disease to vi'hich it 
 had given rise through antecedent in- 
 fluences of the reflex nervous action, 
 p. 59, ^ 129 h; p. 65, <J 143 c ; p. 66- 
 67, M48 ; p. 332-334, ^ 502-506 ; 
 p. 344, {) 516 d, No. 6 ; p. 351-352, 
 ^ 524 c ; p. 359, I) 527 b ; p. 360, () 
 527 d; p. 368-369, ^ 559-563; p. 
 416-417, (J 649 c, p. 420-423, ^ 654 
 -660 ; p. 426, ^ 666 ; p. 429-430, ^ 
 674 rf; p. 465, (} 714 ; p. 522-523, ^ 
 827 b,di p. 539, (} 848 ; p. 670-671, 
 <J 902 7n; p 862-864, <J 1066. 
 
 where sympathetic diseases follow as 
 consequences of a primary affection, 
 or where they grow consecutively 
 out of each other, there may be great 
 diversity in their pathological condi- 
 tions, which often depends much upon 
 the respective peculiarities of different 
 tissues or parts of one and the same 
 continuous tissue, p. 61, ^ 153 a, h; 
 p. 62-68, i) 135-152; p. 109, ^229; 
 p. 339-340, l^bUh; p. 450, () 689 / ; 
 p. 465-469, () 715-722; p. 731, (} 970 c. 
 Also, Causes, Morbific ; Canthar- 
 ides, Predisposition; Hydropho- 
 Bi.*, Virus of ; Serpents, Virus of; 
 Hydrocyanic Acid, Joy and Anger, 
 Hope ; Stomach, Blows upon ; 
 S.MALL-Pox. Index II. 
 
 a comprehensive illustration of its phi- 
 losophy drawn from an analysis of 
 fever, p 430-433, ij 675, 676. Also, 
 p. 490-496, -J 759-774— and farther 
 
 165, 156, 447 ft, 500, 512-516, 524 r/, 526 ft, d, 530, 
 902, 1105, 172, 177, 179, 191 ft, 237-240, 285, 3031, 
 795.
 
 INDEX II. 
 
 1053 
 
 Pathological Cause — continued. 
 
 illustrated by a critical analysis of 
 symptoms, remote causes, &c., p. 438 
 -442, (} 686 b-d— and by the philoso- 
 phy of the operation of a scton in its 
 morbific as well as curative aspects, 
 p. 679-681, (} 905 a. 
 
 its philosophy sought for in the ovum, 
 p. 47-49, ^ 75-80 ; p. 227, ^ 411. 
 
 as remedies operate only by introducing 
 new pathological conditions, every 
 disease from its beginning to its ter- 
 mination, whether in health or in 
 death, consists of a succession of 
 pathological causes, p. 428, ^ 672 ; 
 p. 430-433, () 675, 676 ; p. 473-474, 
 ^ 733 e ; p. 542-543, () 854 c-857 ; 
 p. 551-554, ^ 867-871 ; p. 683-665, 
 ^ 897-901. Peox. Cavse, Index 1. 
 
 should determine the treatment, p. 65- 
 67, ^ 143 c-151 ; p. 73, () 163 ; p. 424 
 -425, <J 661-662 ; p. 428, <^ 694 a ; p. 
 437-442, () 684-686 ; p. 456-460, ^ 
 695-708 ; p. 479-480, (} 741 a, b ; p. 
 486, <^ 750 b ; p. 487-489, ^ 756 ; p. 
 498-499, (i 785 ; p. 505, <) 801 ; p. 
 510, () 813 b; p. 541-542, () 854 bb ; 
 p. 545, ^ 859 b ; p. 548-550, () 863 d ; 
 p. 551-554, § 867-871 ; p. 560-561, 
 4 886-888 ; p. 597-600, (^ 892 c, d ; 
 p. 603-604, (J 892 k ; p. 606, <J 892 p ; 
 p. 609-610, <) 892i d; p. 613, <;> 892^ 
 c; p. 615-617, () 892k f-k ; P- 636- 
 642, I) 8924 d-i ; p. 663-665, <) 897- 
 901 ; p. 724-728, «^ 961 ; p. 729-732, 
 <^ 966-970 ; p. 732-736, () 971-980. 
 
 the aggregate symptoms determine the 
 precise nature of the pathological 
 cause, p. 430-433, <) 675-676; p. 
 434, ^ 679 ; p. 435, <J 681 a; p. 437- 
 442, () 685-686 ; p. 447-448, () 688 i ,• 
 p. 457-460, <^ 700-708 ; p. 560-562, 
 ^ 884-888 d — while reliance on indi- 
 vidual symptoms is a fruitful source 
 of malpractice, and a sure index of 
 defective knowledge, p. 436, <^ 682 
 a, b; p. 447-448, ^ 668 i ,• p. 511, ^ 
 815; p. 560, () 884; p. 572-576, () 
 890 d-n; p. 587, () 891 k; p. 636- 
 641, ^ 892-1 d-i; p. 724-725, «J 961 
 a, b; p. 759-760, ^ 1005 ;. Also, 
 " Debilitv," Index I. and II. 
 Pathology — continued from Index I, 
 
 allowed to have derived but little or no 
 light from Chemistry, p. 781, (} 1030. 
 Also, Pathological Cause, Index II. 
 
 reflects important light upon natural 
 physiological conditions, and its prac- 
 tical knowledge, as well as of Thera- 
 peutics, is indispensable to any just 
 views in Physiology, p. 14, ^ 6 ; p. 
 59, () 129 h, i; p. 61, (} 133-134; p. 
 63, () 137 d; p. 65, () 143 ; p. 67-68. 
 <^ 149-152 ; p. 73, ^ 163 ; p. 265, (} 
 447 b ; p. 413-414, <J 639-640 ; p. 
 
 Pathology — continued. 
 
 539, () 848 ; p. 798, ^ 1034, and refer- 
 ences ; p. 503, () 795 ; p. 272, () 447 g-. 
 Pathology, Humoral. See Humoral 
 
 Pathology, Index II. 
 Pepsin, 
 
 admitted by Chemistry to be probably a 
 fiction, p. 784, () 1031 b — and "knows 
 nothing of its nature," p. 781, <J 1029 
 — though lately a triumph of the la- 
 boratory, p. 197-202, ^ 362-376. 
 Philip, A. P.W. — continued from Index I., 
 
 his importyint " Experiments to determine 
 the Laics of the Vital Functions'" — 
 introduced for the purpose of illus- 
 trating the modus operandi of mor- 
 bific and remedial agents through al- 
 terative influence of reflex action of 
 the nervous system, and of the opera- 
 tion of the Mental Emotions and the 
 Will through the direct development 
 of the nervous influence, and that this 
 influence is the immediate exciting or 
 modifying cause, through its action 
 upon organic structure, of all the 
 changes that arise in the solids and 
 fluids beyond the seat of the direct 
 operation of natural, morbific, and 
 remedial agents, and as attendant on 
 loss of blood, and on mental emotions, 
 p. 295-321, (^ 476-494. Also, Gener- 
 alization OF Reflex Action of the 
 Nervous System, Index II. 
 
 his experiments farther confirmed, p. 
 804, {) 1039— and his priority, p. 916, 
 (J 1084. 
 
 does not apply his experiments patho- 
 logically or therapeutically, but in- 
 clines to the chemical and physical 
 doctrines, p. 295, (^ 476 a ; p. 309- 
 310, () 484 a, No. 5 ; p. 314, ^ 488 ; 
 p. 317-318, ^ 493 a-d. 
 Philosophy, Experimental. Also, Phi- 
 losophy, Index I., 
 
 should imitate Nature, and illustrated 
 by examples to the contrary, p. 8-14, 
 {) 5-6; p. 132-133, ^ 289-291; p. 
 161-172, Nos. 15, 29, 31, 32, 44, 45, 
 parallel columns; p. 175-176, ^ 350^ 
 n-q; p. 177-178,^3501/; p. 179- 
 182, () 350J c-g; p. 195-203, () 359- 
 376^-; p. 219-220, ^ 408-409; p. 
 238, ^ 438 h, el seq. ; p. 279, () 448 f; 
 p. 287-289, «J 459-401 ; p. 319, <J 494 
 b; p. 320, ^ 494 dd ; p. 323-324, <J 
 427 ,- p. 371, <) 569 b ; p. 482, () 744 ; 
 p. 517, (J 821 c ; p. 521, <) 826 d; p. 
 527-528, () 830 a-831 ; p. 529-531, 
 § 837 a-cc ; p. 715-722, ^ 960 a-c. 
 
 in the department of Chemistry, as ap- 
 plied to Physiology and Pathology, 
 its future proceedings and results 
 had been, and continue to be, antic- 
 ipated by the Author, p. 6-7, <J 4i 
 b ; p. 9, § 5 ; p. 202-203, (/ 3764 ; p".
 
 1054 
 
 INDEX II. 
 
 Philosophy, Experimental — continued. 
 
 236, ^ 435 c; p. 779-782, ^ 1028- 
 1030. 
 Phlebitis, 
 
 employed to illustrate the pathology of 
 venous congestion, p. 501-505, () 792 
 -801; p. 507-509, () 806-811— and 
 which concur together, by the coinci- 
 dences in their phenomena, and the 
 sameness of treatment, in showing 
 that the alterative influence of reflex 
 nervous action is alike modified in a 
 peculiar manner by both affections, 
 p. 507-508, <^ 806. Also, Venous 
 Congestion, Venous Tissue, Index I. 
 Phthisis Polmonalis, — (Also, Index I. 
 
 relieved by open air and exercise through 
 complex influences of reflex action of 
 the nervous system, the point of de- 
 parture for the air being mostly the 
 skin, and the voluntary muscles for 
 the exercise — the primary curative 
 influence being exerted especially 
 upon the digestive organs, which be- 
 come a source of salutary reflex nerv- 
 ous influence upon the lungs — and 
 farther explained, p. 543, ^ 855 ; p. 579 
 -580, 890i d; p. 670-671, ^ 902 m. 
 Also, Exercise, Disease (5th sub- 
 division). Ulcers, Hope, Laughing, 
 MiTNTAL Emotions, Mind, Skin, Cold, 
 Index II. 
 
 employed, along with other diseases, to 
 show the fallacy of the chemical ra- 
 tionale of animal heat, and that this 
 product is of analogous origin with 
 the secreted fluids, and, like them, 
 constantly liable to influences of direct 
 and reflex nervous action, and from 
 mental as well as physical causes, p. 
 264-272, «J 446 rf-447 g. 
 
 colliquative sweats of, arrested by Ace- 
 tate of Lead and Sulphuric Acid, 
 through alterative influence of reflex 
 action of the nervous system, and the 
 analogy carried to the modus operandi 
 of other Astringents, and of all other 
 remedies, p. 530, <^ 837 c ; p. 557, ^ 
 890 0. Also, Lead, Acetate of ; 
 Sulphuric Acid; Silver, Nitrate 
 OF ; Astringents, Ipecacuanha, 
 Cold, Index II. 
 
 certain facts and principles which denote 
 the appropriate treatment to be anti- 
 phlogistic, p. 471, () 732 b; p. 550, ^ 
 863/; p. 507, (} 805 ; p. 573-574, ^ 
 S90 d-f, o; ^ 836; p. 872, P.S., 
 Notes F p. 1114, Mm p. 1141. 
 Physicians, 
 
 Organic Chemistry imputes to them a 
 fanatical reliance upon it, p. 781, <J 
 1029; p. 808, () 1034. 
 Physiologists, (See Chem. Phvs.) 
 
 afiirnied on high authority that " it is 
 a doctrine generally accepted at the 
 
 Physiologists — continued. 
 
 present day that the glandular organ 
 exerts a catalytic action on the ele- 
 ments of the blood as it traverses the 
 organ," p. 791, (;» 1032 c— but will this 
 explain all the analogous millions of 
 distinct organic products out of main- 
 ly four elements, yet intimately com- 
 bined with twelve or fourteen more in 
 the blood and sap of all Animals and 
 Plants, and their ternary and quater- 
 nary combinations, and their endless 
 variety in disease, and as the glandular 
 products, particularly, are affected by 
 the passions — considering, too, that 
 Plants begin with the elements of 
 matter? p. 23-26, <» 37-48 ; p. 27-28, 
 () 51-53 b; p. 221-227, <^ 409 i-411. 
 Also, Mental Emotions, Fear, and 
 other individual Passio7is, Milk, Bile, 
 Urine, Weeping, Sweat ; Water, 
 Hot ; Kidney, Skin, Uterus, Partu- 
 rition, Index II. ; Nervous Power, 
 hidex I. and II. ; Sudorifics, Index 
 I. 
 Placenta, 
 
 glycogenic function of, p. 928, () 1086. 
 Plague, 
 
 treatment of, by bloodletting, p. 755, ^ 
 1004 c. 
 
 not contagious, p. 418-420, ^ 652-653. 
 
 supplies the first recorded instances of 
 the quantities of blood abstracted, p. 
 755, ^ 1004 c. 
 Plants — continued from Index /., 
 
 their fundamental distinction from Ani- 
 mals confirmed in the lowest rank of 
 the two kingdoms, p. 815, () 1052 a. 
 Also, Sap, Circulation of. Index I. 
 and II. 
 
 absorption and circulation in, and Dr. 
 Hales' experiments upon, and with 
 a reference to the circulation of the 
 blood, p. 817-824, (j 1053-1055. 
 Also, Sap, Circulation of. Index I. 
 and II. 
 
 present a reputed departure from a fun- 
 damental law of generation, p. 817, (^ 
 1052 c. 
 Plasters, 
 
 mercurial, anodyne, iodine, &c., and irri- 
 tating, operate upon deep-seated parts 
 after the manner of Cantharides and 
 Seton through uninterrupted influence 
 of reflex action of the nervous system, 
 modified according to the nature of the 
 remedy, p 66-67, ij 148 ; p. 107-111, 
 «;i 226-233.? ; p. 339, () 514 g, h; p. 
 344-345, i) 516 d. No. 6; p. 348, ^ 
 516 d. No. 13; p. 659, () 893 q ; p. 
 661-603, () 894-896; p. 664-676, 
 () 900-904 b; p. 679-681, (j 905 a; 
 p. 838, () 1057i. Also, Counter- 
 Irritants, Tobacco, Alteratives, 
 Sphincter Muscles, Index II.
 
 INDEX II. 
 
 1055 
 
 "Plastic Power" and " Organic Force," 
 
 employed in Organic Chemistry as con- 
 venient substitutes for the term Vital 
 Principle, p. 784, ^ 1031. Also, Vital 
 Principle, Index I; p. 398, ^ 626 b. 
 Pneumonia, 
 
 its treatment, especially by Bloodletting 
 and Tartarized Antimony, p. 602, ^ 
 892 I ; p. 638-642, ^ 892|- f-i ; p. 
 749, ^ 992 d; p. 750, ^ 995 ; p. 757- 
 760, ^ 1005 h-k; p. 770, ^ 1017 c; 
 p. 846, () 1058 o; p. 870, <J 1068 c. 
 
 Bloodletting in, opposed by Louis, and 
 other distinguished French savans, 
 and the resulting mortality, p. 760, 
 <^ 1005 k — and the contrast in the 
 United States, ibid. Also, p. 872, P.S. 
 
 diagnostic symptoms of, p. 436, <J 682 b. 
 
 may be attended with a good pulse and 
 other deceptive symptoms, p. 447- 
 448, (j 688 t. 
 
 an example of the rapidity with which 
 the alterative influence of reflex nerv- 
 ous action will change the condition 
 of the blood in small abstractions, p. 
 710, ^ 952 b. 
 
 the system sustained under large ab- 
 stractions of blood by a powerful ex- 
 citing nervous influence developed 
 by the inflammation, being reflex in 
 pneumonia, and direct in cerebral in- 
 flammation, p. 733-734, t) 974 a-975 ; 
 p 748-749, <J 992 b-d. Also, Brain, 
 Inflammation of, Index II. 
 
 " typhoid," examples of successful and 
 adverse treatment, p. 757-759, 1) 1005 
 h; p. 760, () 1005 k. Also, p. 751- 
 752, <^ 999 c. 
 
 " bilious,''' treatment by bloodletting in 
 the Minorca epidemic, and its success 
 contrasted with its neglect, p. 757- 
 759, ^ 1005 h, i. Also, p. 872, P.S. 
 Portal Circulation, 
 
 proves the dependence of venous circu- 
 lation upon the suction power of the 
 heart, p. 211, <^ 390. Also, Circula- 
 tion OF THE Blood, Index II. 
 Potash, Tartrate of, 
 
 in connexion with jalap, a valuable 
 compound, p. 845, <J 1058 m ; p. 853, 
 (} 1060. 
 Potash and Soda, Tartrate of, 
 
 possesses advantages over other saline 
 cathartics, p. 555, ^ 872 a; p. 853- 
 854, <J 1061. 
 Poultices, Hot, and Hot Fomentations, 
 
 their importance in conservative surgery, 
 p. 682-683, () 905 b. 
 
 relieve superficial inflammation by di- 
 rectly modifying irritability (p. 89, ^ 
 188), and remove any resulting dis- 
 turbance of internal organs mostly 
 through the simple subsidence of the 
 stimulating reflex nervous influence 
 to which the inflammation had given 
 
 Poultices, Hot, &c. — continued. 
 
 rise, and relieve the pain of superficial 
 parts by diminishing sensibility in a 
 direct manner (p. 100, ^ 198 ; p. 671, 
 ^ 903), though doubtless, in part, in 
 either case, through a sedative reflex 
 nervous influence reverberated upon 
 the part — and relieve primary dis- 
 eases, pain, &c., of internal parts 
 wholly through sedative influence of 
 reflex action of the nervous system, 
 p. 592-593, ^ 891^ A-,- p. 681-682, <J 
 905 b ; p. 838, () 1057^. Also, p 66- 
 67, (} 148 ; p. 338, ^ 514 d ; p. 351- 
 352, <^ 524 b'd; p. 421-423, ^ 657- 
 658; p. 483-484, ^ 746 c ; Opium, 
 Sedatives, Seton, Index II. 
 
 Predisposing Causes. See Causes, Mor- 
 bific, Index II. 
 
 Predisposition to Disease — continued 
 from Index I., 
 when owing to present influences, con- 
 sists of some inappreciable change in 
 the organic properties, corresponding 
 in a general sense with the special 
 virtues of the morbific causes, and 
 which may remain for a short or for 
 a long time without manifesting any 
 functional derangement, when, at last, 
 it may have acquired such a degree of 
 intensity as to explode suddenly in 
 absolute disease, or may require ex- 
 citing causes for its full development 
 — though often before the irruption 
 takes place there are many obscurely 
 marked symptoms that denote its ap- 
 proach — while, also, the predisposi- 
 tion is always at first formed, when 
 owing to external causes, in one of 
 the surfaces with which they come 
 in contact, and in which they may or 
 may not produce disease, and from 
 which it is propagated over other 
 parts through alterative and uninter- 
 rupted influences of reflex action of 
 the nervous system, p. 47-49, <J 75- 
 81 ; p. 65, (J 143 ; p. 66-67, ^ 148 ; 
 p. 426-427, <J 666. Also, p. 107-112, 
 I) 227-234 b ; p. 230, ^ 432 ; p. 245, 
 ^ 440 e ; p. 253, (^Uld; p. 323-324, 
 (j 499-500 c; p. 339-340, ^514 g-k; 
 p. 344-345. ^ 516 tZ, No. 6 ; p. 348, 
 <J 518 ; p. 351-352, <} 524 c ; p. 359, 
 ^ 527 b ; p. 360, <^ 527 d; p. 368-369, 
 ^ 559-562; p. 378-380, ^ 578 c, d; 
 p. 385, ^ 591 ; p. 416-417, <;. 649 c ; 
 p. 420-427, ^ 654-666 ; p. 429-430, 
 ^ 674 d; p. 481, (Ji 743 ; p. 483-484, 
 ^ 746 c; p. 490, () 760; p. 491-492, 
 <^ 674 a, b; p. 497, () 111 ; p. 553, ^ 
 827 c; p. 661-663, <;. 894-896; p. 669 
 -670, ^ 902 i; p. 670-671, (J 902 m ; 
 p. 679-681, ^ 905 a; p. 880, (; 1074. 
 Also, Hydrophobia, Virus of ; Skin, 
 Cold, Sphincter Muscles, Seda-
 
 1056 
 
 INDEX II. 
 
 Predisposition to Disease — continued. 
 
 TivEs {^Aconite), Suppositories, Se- 
 TON, Plasters ; Causes, Morbific ; 
 Alteratives, Index II. 
 
 may be produced not only by external 
 causes, but by a variety of internal, 
 both physical and mental — the nerv- 
 ous influence, either direct or reflex, 
 being equally instrumental in all the 
 cases, p. 414-415, ij 646-647; p. 423 
 -424, () 659-660. Also, p. 55, ^ 117 ; 
 p. 58-59, (^ 129 ; p. 65, ^ 143 b ; p. 106 
 -111, ^ 222-2331 ; p. 332, () 501 ; p. 
 339-340, () 514 h; p. 465-466, <^ 715. 
 Also, Mental Emotions, the indi- 
 vidual Passions; Causes, Morbific, 
 Index II. 
 
 should disease be set up in the part upon 
 which morbific causes make their di- 
 rect impression, it may be the direct 
 eflTect of the agent, or more commonly 
 the result of alterative influences of 
 nervous action reflected upon the part 
 either as a consequence of the primary 
 impression or as instituted by some 
 supervening disease in other parts — 
 observing the same rule in this respect 
 as remedial agents, p. 66-67, ij 148 ; 
 p. 333, () 502-506 ; p. 339-340, ^^ 514 
 h; p. 347-348, <Si 516 rf, No. 13; p. 351 
 -352, ^ 524: b-d; p 416-417, <J 649 c; 
 p. 421-424, § 657-660 ; p. 426, ■;> 666 ; 
 p. 429-430, § 674 rf,- p. 465, ^ 714; 
 p. 483-484, <^ 746 c; p. 522-523, (j 
 827 b, c ; p. 539, ^ 848 ; p. 862-864, 
 ^ 1066. 
 
 or is inherited — when the predisposing 
 causes have operated upon ancestors, 
 and this predisposition being equiva- 
 lent to a knowledge of the predispos- 
 ing causes is assumed as a predis- 
 posing cause, p. 424, ^ 661 , p. 561, 
 <;. 886. 
 
 may continue after disease has subsided, 
 as seen in fever, dyspepsy, &c.,when 
 great prudence is apt to be necessary 
 to avoid relapses, t). 425-426, () 665 , 
 p. 495, () 769 ; p. 598-604, ^ 892 d-k, 
 and ut supra, and IIabit, Vital; 
 Fever, Index II. 
 
 a knowledge of its remote causes oflen 
 very important for detecting the true 
 nature of the pathological, and for 
 directing the treatment, p. 361, () 529 
 b ; p. 414, (i 644 ; p. 423-425, <J 659 
 -662 ; p. 480, <J 742 ; p. 487-488, <J 
 756 ; p. 497, ^ 776 ; p. 509, <j 811 ; 
 p. 510, ^ 813 a,b; p. 545, () 859 b; 
 p. 553, ^ 870 aa ; p. 559-561, <^ 883 b 
 -886; p. 589, ij 891 0, p 639-641, 
 (J 8924 ^-i; p. 723, ^ 960 h. 
 
 has often but one cflScient and indis- 
 pensable remote cause, as in small- 
 pox, measles, malignant cholera, fe- 
 vers, 6lC., but there may be many 
 
 Predisposition to Disease — continued. 
 
 antecedent ones which predispose the 
 system to be acted upon by the essen- 
 tial one, and render the disease more 
 malign, often more prevalent, and 
 modify the treatment — and while the 
 miasmata upon which fevers depend 
 have their action promoted and in- 
 creased in intensity by a variety of 
 subordinate causes that are incapable 
 of producing the disease, the same 
 miasmata are prolific in predisposing 
 the system to the action of more 
 specific causes, as the self-limited 
 diseases, the malignant cholera, &c., 
 and often lay the foundation of indi- 
 gestion, or complicate rheumatism, 
 pneumonia, puerperal fever, &c. — or 
 the complicating influences may de- 
 pend upon hereditary peculiarities, 
 p. 65, ^ 143 a-c; p. 67, () 149-151 ; 
 p. 418, () 652 b ; p. 420, ^ 654 a ; p. 
 424-425, (} 662-663 ; p. 438-442, ^ 
 686 ; p. 489, ^ 756 b ; p. 509, ^811; 
 p. 510, (J 814 ; p. 511, <) 816 d; p. 
 538, 4 848 ; p. 544-545, <^ 855 ; p. 
 553, ^ 870 aa ; p. 597, § 892 c ; p. 
 723-725, (} 960 6-961 ; p. 756-757, 9 
 1005 b-j. Also, Causes, Morbific, 
 Index II. 
 
 Pregnancy, 
 
 illustrates the natural mutability of the 
 properties of life, which, although 
 designed for useful ends, is rendered, 
 in the great plan of organic beings, 
 the foundation of all the changes that 
 arise from the operation of physical 
 causes, morbific and remedial, and of 
 the mental emotions, and derides all 
 chemical hypotheses, p. 87, () 180; 
 p 352, (f 524 d; p. 378, () 578 c; p. 
 434-435, <} 680; p. 471, <^ 732 d. 
 Also, Youth, Infancy, Uterus, Or- 
 gans of Generation, Lactation, 
 Milk, Parturition, Index II. ; Vital 
 Properties, Index I. 
 occasions an endless amount of reflex 
 nervous influences from those which 
 are at work upon the stomach from 
 the outset, and with various intensi- 
 ties and intermissions, to those which 
 are in perpetual progress in gradually 
 unfolding the mammae till their force 
 and rapidity of action upon those 
 organs become suddenly increased at 
 the crisis of parturition — and which 
 supply a ready interpretation of the 
 modus operandi of all morbific and 
 remedial agents, and according to the 
 nature of each one, through the same 
 alterative influences of reflex action 
 of the nervous system, and whether 
 those influences be suddenly exerted 
 as in the case of cathartics and emet- 
 ics, or continuously as with setons
 
 INDEX II. 
 
 1057 
 
 Pregnancy — continued. 
 
 and frequently repeated doses of medi- 
 cines, p. 56, () 120, 121 ; p. 61, (^ 133 c ,■ 
 p. 87, «^ 177; p. lll,(J233i; p. 117- 
 120, ^ 234 ^-235 ; p. 231-232, ^ 424 ; 
 p. 330, ^500 nw; p. 335-336, ^ 512 
 a, b ; p. 352, () 524 d ; p. 662-663, <J 
 896 ; p. 686, (> 905^ b. Also, Uterus, 
 Okgans of Generation, Lactation, 
 Parturition, Milk, Kidney, Mental 
 Emotions, Love, Jealousy, Fear, 
 Reflex Action, Cathartics, Emet- 
 ics, Respiration, Sphincter Mus- 
 cles, Alteratives; Antimony, Tar- 
 TAiLizKD, Index II. ; Nervous Power, 
 Youth, Lidex I. and II. 
 Prescriptions, 
 
 should be extemporaneous, and all for- 
 mulse of, with definite proportions of 
 the constituents, empirical and re- 
 gardless of pathological conditions, 
 p. 67-68, () 150-152 ; p. 543-544, i) 
 857 ; p. 545, () 859 b ; p. 554-556, () 
 872 a. Also, Pathological Cause, 
 Remedies, Index II. 
 Primordial Cell. See Cell, Primor- 
 dial, Index II. Also, Ovum. 
 Pritchard, 
 
 " gets rid of the mystery of Vitality," 
 and Carpenter also, p. 40, <J 94 h. 
 Protein — continued from Index I, 
 not in the blood, p. 784, (} 1031 b. 
 conceded that "the term is destined to 
 indicate a past epoch in Organic 
 Chemistry," p. 781, ^ 1029. 
 Prout, 
 
 his opinion upon chymification, p. 152- 
 153, (J 345-347. 
 Proximate Cause. See Pathological 
 
 Cause, Index II. 
 Proximate Principles — continued from 
 Index I, 
 are artificial transformations, p. 781, ^ 
 1030; p. 791, () 1032 c. 
 Puerperal Fever. See Fever, Puer- 
 peral, Index II. 
 Puj.se, 
 
 considered in its only important symp- 
 toms — hardness, softness, meompress- 
 ibilily, compressibility , quickness, slow- 
 ness, frequency, fulness, sviallness, 
 strength, lueakness, obstruction, free- 
 dom, intermission, redoubling, trem- 
 bling, and other inequalities, p. 443- 
 448, «J 687^, 688. 
 hardness and incompressibility charac- 
 teristic of inflammation, and the most 
 important and reliable symptoms as 
 denoting the nature and force of the 
 disease — owing to the propagation of 
 nn alterative reflex nervous influence 
 upon the arteries, and through which 
 influence the blood, also, is so changed 
 in its condition as to result in buffing 
 and cupping after its abstraction, 
 
 X X 
 
 Pulse — continued. 
 
 while, again, the nervous influence 
 may be immediately so altered in its 
 influence by loss of blood, or a mental 
 emotion, or more gradually by other 
 causes, as to dissipate those symptoms 
 — thus showing, also, how the nervous 
 influence is variously modified by dis- 
 ease, and how remedies of a heteroge- 
 neous nature will effect modifications 
 that will bring about a common result, 
 and how the mental emotions are on 
 the same ground of causation as phys- 
 ical agents, p. 66-67, (/ 148-151 ; p. 
 310, H85; p. 313, ^ i87 gg ; p. 444 
 -445, ^ 688 a-f; p. 547-550, ^ 863 d; 
 p. 552, ^ 868 b ; p. 664-665, ^ 900, 
 901; p. 703-710, (/ 940-9.52 b; p. 
 731-732, () 970 c. Also, ^ 811; <) 
 826 cc. Mental Emotions, Reme- 
 dies, Soul and Instinct, Ind. II. ; 
 Nervous Power, Index I. and II. 
 frequency of, the next most important 
 
 condition, p. 446-447, () 688 i. 
 nevertheless, affections of the brain and 
 heart may bestow more unequivocal 
 signs, p. 212, () 390 b ; p. 313, ij 487 
 gg; p. 443, () mih ; . p. 447, 448, ^ 
 688 i-l. 
 intermission of, and other irregularities, 
 are mostly dependent upon hepatic 
 disorders, when not owing to affec- 
 tions of the heart and brain, and are 
 not often important in the former case, 
 p. 211-212, <5i 390 b; p. 447-448, (} 
 688 i-l. 
 is so capriciously influenced by all men- 
 tal emotions, posture, motion, reme- 
 dies, food, and particularly by the re- 
 flected influences of the nervous sys- 
 tem as developed by diseases, that it 
 cannot be often trusted without the 
 support of other symptoms, unless as 
 it respects hardness and incompressi- 
 bility, p. 443-448, ^ 687^-688 ; p. 
 511-512, () 815-817; p. 704-705, (j 
 943 a, b; p. 712, () 955 b; p. 714, (j 
 958 b; p. 723, () 960 h ; p. 725-726, 
 ^96lb,c; p. 727, ^ 962-964 ; p. 756 
 -760, <J 1005 a-k; Note Ll p. 1140. 
 to be regarded, therefore, merely as 
 supplying certain symptoms through 
 which the force and modifications of 
 the nervous influence, either direct or 
 reflex, as arising from all diseases, 
 excepting of the heart, are more or 
 less ascertained, and thus through its 
 various influences upon the sanguifer- 
 ous organs the nature and force of 
 disease is inferred, in part, by the 
 sense of touch — with the understand- 
 ing that the capillary bloodvessels are 
 the main instruments of disease upon 
 which both direct and reflex action of 
 the nervous system is deternyned with 
 X
 
 1058 
 
 INDEX II. 
 
 Pulse — continued. 
 
 the alterative effects that arise from 
 morbific and remedial causes, both 
 physical andmental, p. 226-227, HlO, 
 411, p. 301-310, ^80-485; p. 354- 
 355, ^ 526 a, b; p. 443-448. i) 687^- 
 688; p. 804-805, ^1040. A1so,Heart, 
 Tongue, Sweat, Urine ; Brain, In- 
 flammation OF ; Mental Emotions, 
 Index II. ; Nervous Power, Index I. 
 H. Also, () 500 m, 694i, 826 cc, 829. 
 
 method of feeling the pulse, § 687j, 
 688 a, 805, 812, 961, 971, 990 g. 
 Purpura Hemorrhagica, 
 
 its pathology, and treatment by blood- 
 letting, p. 754, () 1002 d-f. 
 Pus, 
 
 a new formation, the result of a secretory 
 process brought about by inflamma- 
 tion, and which constitutes a natural 
 termination of the formative stage of 
 that disease, p. 471, <J 730. 
 
 liable to be affected in its condition by 
 causes acting locally, but more gen- 
 erally through alterative influences of 
 reflex action of the nervous system 
 originating in s^me internal disease, 
 or by the same influences propagated 
 in a direct manner upon the instru- 
 ments of its formation by Mental 
 Emotions, p. 478-480, ^ 740-741. 
 Also, Inflammation, Secretion and 
 Excretion, Milk, Bile, Reflex Ac- 
 tion, Mental Emotions, Sympathv, 
 Index II. ; Nervous Power, Index I. 
 and II. ; Vital Properties, Sudo- 
 RiFics, Index I. 
 
 allied, in principle, to lymph, mucus, 
 and serum, when the latter are prod- 
 ucts of inflammation — each being 
 consequences of the formative stage, 
 p. 471-472, «^ 732 i-733, and refer- 
 cnces there ; p. 474-475, () 733 f-h— 
 all of which are designed for useful 
 ends, but lymph and pus most so, p. 
 471-476, <J 732-733 ; p. 546-547, ^ 
 862-863; p. 550-551, ^ 863 c-864. 
 
 all its varieties, like those of mucus, de- 
 pend upon precise pathological condi- 
 tions, and more or less upon the nat- 
 ural constitution of the part — which 
 may be presented to Organic Chem- 
 istry as a problem for its solution, 
 taking along the Mental Emotions as 
 among the causes which modify the 
 pathological states, p. 120-121, § 237 ; 
 p. 452, ^ 693 ; p. 478-480, () 739-741 
 b. Also, p. 61-62, «J 133-136 ; p. 67, 
 (l 149-151 ; p. 224, ^ 409 h; p. 226, 
 ^ 410; p. 436, () 682 b, 409 d. 
 
 R. 
 Race, Human, Unitv of — continued from 
 Index I., 
 briefly considered, p. 906-907, ^ 1078 s. 
 
 Recuperation, Law of, 
 
 so designated by the Author in prefer- 
 ence to Vis Medicatrix Natura — in- 
 grafted upon the constitution of all 
 organic beings, and upon which the 
 Art of Medicine reposes, and without 
 which the whole animal kingdom 
 would perish. See Vis Medicatrix 
 Nature, Vital Properties, Organic 
 Life ; Adaptation, Law of. Index I. ; 
 Remedies ; Causes, Morbific ; Dis- 
 eases, Self-limited, Index II. 
 instability of the properties of life, or- 
 dained for useful purposes, and their 
 inherent tendency to maintain them- 
 selves in their normal state, lie at the 
 foundation of Therapeutics, and the 
 former, especially, of disease — mor- 
 bific causes altering them in one way, 
 and remedies in another less pro- 
 foundly morbid, by 'vhich the law of 
 recuperation is brought into effect, 
 and this mutability is the source of 
 natural changes which the system un- 
 dergoes either in function or devel- 
 opment of structure, as manifested in 
 gestation, lactation, &c., and in the 
 transition stages from infancy to adult 
 age, in metamorphosis, &c., and is 
 displayed in its morbific aspect by the 
 impregnated ovum, p. 44-49, iji 67-80 ; 
 p. 61, ij 133 c ; p. 68-69, ^ 152-156 ; 
 p. 83, ^ 174; p. 87, ^ 177-182; p. 
 88, {) 184 b; p. 95-96, (J 189 h ; p. 
 98, () 191 a, b; p. 108, <^ 228 a; p. 
 109-110, ^ 230-232; p. 120-122, <J 
 237-240 ; p. 131-132, (} 285 ; p. 352, 
 () 524 d ; p. 373-383, <) 576-584 ; p. 
 514, (J 642 b; p. 538-540, f) 847 g- 
 848 ; p. 541, (;» 853 ; p. 542-543, ^ 
 854 c-856 ; p. 551, <;> 863 /( ; p. 558- 
 559, <) 879-883 b; p. 600, <^ 892 d; 
 p. 664-665, <J 899-901 ; p. 736, ^ 980 ; 
 p. 902, (} 1078 p ; p. 435, <^ 680. 
 Uterus, Organs of Generation, 
 Parturition, Index II. ; Vital Prop- 
 erties, Vis Medicatrix Natur.« ; 
 Adaptation, Law of. Index I.; 
 Youth, Index I. and II. 
 
 Reflex Action of the Nervous System 
 and Direct Action, 
 the term direct, and its distinction from 
 reflex (the latter of which the Author 
 sometimes designates as mdireet, and 
 oftener Symjta/hy), introduced as the 
 basis of his interpretation of the mo- 
 dus operandi of the Will and Mental 
 Emotions, and of the nervous influence 
 as excited by affections of the nervous 
 centres, and for expounding, along 
 with reflex action, the modus operandi 
 of Loss of Blood, and for demonstrat- 
 ing the substantive existence and self- 
 acting nature of the Soul and Instinct- 
 ive Principle — and, as farther explain-
 
 INDEX II. 
 
 1059 
 
 Reflex Action, &c. — continued. 
 
 ed, the Author means by the term 
 direct that the excito-motory nerves 
 or fibres of compound nerves are alone 
 engaged, unless the Passions, as is 
 common, and diseases of the nervous 
 centres, &c., institute impressions 
 upon distant parts that are reverber- 
 ated through centripetal nerves upon 
 those centres, when the nervous in- 
 fluence may thus establish complex 
 circles of reflex actions, and undergo 
 modifications of its alterative influence 
 according to the nature of the mental 
 emotion or any aflfection of the nervous 
 centres, as, also, according to that of 
 the particular natural constitution of 
 different parts, and any present modi- 
 fied condition of parts upon which it 
 may fall, since, also, any preternatural 
 condition of an organ, whether render- 
 ed temporarily so by disease, or only 
 disturbed by the nervous influence 
 (as in sneezing from a strong light 
 impinging upon the retina, p. 327, ^ 
 500 i; p. 333, () 504; p. 340-341, ij 
 514 /), is equivalent to influences 
 propagated in like manner by the ac- 
 tion of remedial and morbific agents, 
 and will modify the nervous influence 
 in a corresponding manner ; and upon 
 this reflected influence and its modifi- 
 cations depend the diseases of organs 
 that grow out of each other, and the 
 nature of the affections as they may 
 spring up consecutively, and in con- 
 nexion with the constitutional nature 
 of different parts, or as they may 
 conspire together in aggravating or 
 relieving the conditions of each other 
 — subject always to variations from 
 age, sex, habits, &c., and although 
 the nervous influence as propagated 
 upon the voluntary muscles always 
 terminates in the simple production 
 of voluntary motion so long as the 
 "Will continues to operate, there is 
 the remarkable exception of roosting, 
 and some examples of man sleeping 
 in an erect posture, in which it estab- 
 lishes an unceasing reflex action, and 
 occasional instances of vomiting in 
 which the Will is a concurring cause 
 with some mechanical irritation of the 
 stomach, p. 59, <J 129 h, i; p. 61-68, 
 >J 133-152; p. 73, H63; p. 101-102, 
 ^ 201-202; p. 107-119, (} 227-234; 
 p. 282-284, () 451-453 ; p. 285-286, 
 <) 455 ; p. 296, ^ 476 c ; p. 321, ^ 496, 
 497; p. 323-328, H99-500 / ; p. 331 
 -334, § 500 0-510 ; p. 347-348, () 516 
 d, No. 13, 517 ; p. 429-430, ^ 674 d; 
 p. 526, (J 828 rf; p. 539, ij 848 ; p. 592, 
 () 89U k; p. 646-648, <J 893 e-g ; p. 
 661-663, {} 894-896 ; p. 665-676, ^ 
 
 Reflex Action, &c. — contbmed. 
 
 902 a-904 b ; p. 679-681, ^ 905 a ; p. 
 692, () 914-921 ; p. 698-699, ^ 930- 
 935 ; p. 703-710, ^ 940-952 , p. 745 
 -746, () 990,^ ; p. 831-833, t) 1057/ 
 -A; p. 838, (} 1057i; p. 865-868, (} 
 1067; p. 874-881, ^ 1071-1075; p. 
 886-891, () 1077. Also, Will, Nerv- 
 ous Power, Sympathy, Lidex J. and 
 II. ; Ment.\l Emotions ; Br.'IIV, In- 
 
 FLAMM.4TI0N OF; RooSTING, //(fZcT 7/. 
 
 rejecting entirely the exceedingly simplfi 
 doctrine of Chemistry as to the agency 
 of the nervous system in the various 
 processes and products of the animal 
 kingdom, and which have no reference 
 to the physiological laws of that sys- 
 tem, but consisting alone in an abstract 
 idea, the Author maintains in all his 
 principal writings, as the groundwork 
 of their philosophy, that the nervous 
 system is endowed with a property, 
 power, or influence (no matter which) 
 that operates as a vital agent, and is 
 so far on common ground with other 
 vital agents, and that it is susceptible 
 of an endless variety of modifications 
 according to the nature of the causes 
 by which it is brought into action, 
 and that there is imparted to it the 
 essential virtues of the various causes 
 respectively, both physical and mental, 
 and that when morbific and remcdi:i! 
 agents bring about changes in the 
 natural condition of the solids and 
 fluids, in parts beyond the scat of 
 their direct action, or whenever anal- 
 ogous effects are exerted by the Men- 
 tal Emotions, or when diseases ensue 
 upon each other, or when one disease 
 becomesthe cause of relief to another, 
 whether natural or artificial, it is al- 
 ways by alterative influences of direct 
 or reflex action of the nervous system 
 determined upon the capillary vessels, 
 or main instruments of all organic 
 functions, and that these influences 
 depend not only on the nature of the 
 exciting causes and other accidental 
 circumstances, but also more or less 
 upon the special vital constitution of 
 different tissues and different parts 
 of a continuous tissue — and whether, 
 therefore, the Chemical Philosopher 
 have any vague regard to the nervous 
 system, or ascribe, as he mostly does, 
 all the results of physical agents to 
 their absorption and direct chemical 
 action, and leaves the " action of the 
 nerves" and mental phenomena ob- 
 scured by " a \6i[ which is not to be 
 raised" (p. 183, <S> 350| gg), the dif- 
 ference between him and the Author 
 consists in the violation by the former 
 of all the facts and analogies supplied
 
 1060 
 
 INDEX II. 
 
 Reflex Action, &c. — continued. 
 
 by that inorganic world from which he 
 professes to derive his conclusions, 
 and the absolute inapplicability of any 
 one of the doctrines to practical medi- 
 cine, while the Author presents, as 
 he believes, a perfectly consistent ar- 
 ray of an endless series of facts and 
 of practical doctrines which are incon- 
 trovertible in every detail, and which 
 has the special merit of bringing the 
 
 • Author's doctrine of the operation of 
 the Mental Emotions and the Will 
 through the medium of the nervous 
 influence into perfect harmony with 
 that of all physical causes, p. 59, (^ 
 127 i; p. 65, () 143 b, c; p. 67-68, () 
 149-152; p. 89, ^ 188; p. 101-102, 
 () 201-202 ; p. 106-111, <^ 222-2331 ; 
 p 230-233, ^ 422-427; p. 282-284, 
 SS 451-453 ; p. 285, ^ 455 b, f; p. 295 
 -296, f) 476 b, c; p. 301-304, ^ 480- 
 481 ; p. 305, ^ 481 h; p. 307-308, () 
 483 c; p. 310, ^ 484, Nos. 5, 6 ; p. 
 313, H87/t; p.314, H88i; p. 321, 
 SS 496, 497 ; p. 323-328, ^ 499 J-500 
 m; p. 333-341, ^ 503-514; p. 344- 
 345, <J 516 (Z, No. 6 ; p. 347-349, ^516 
 d, No. 12-520; p. 351-353, (} 524; 
 p. 356-358, <^ 526 d; p 360-362, <J 
 528, 529 b, 530 ; p. 421-423, ^ 657 a- 
 660 ; p. 426, ^ 666 a ; p. 465-467, ^ 
 714-719 ; p. 506, () 803, 804 ; p. 520 
 .-521, ^ 826 d; p. 523, 6 827, b, c ; p. 
 538, <^ 847 g ; p. 549, () 898 ; p. 565, 
 f) 889/, g; p. 592-593, ^ 89H k; p. 
 619, ^ 892 Jf t ; p. 631-632, () 892J ; p. 
 634, ^ 892A 6; p. 640, ij 892| h; p. 
 644-650, •^''893 c-i; p. 652-656, § 
 893 n; p. 661-672, <J 894-904; p. 
 679-681, {} 905 a; p. 703-711, ^ 940 
 952; p. 732-736, <;» 971-980; p. 745 
 -746, § 990J, ; p. 803, (J 1039 ; p. 862 
 -868, <^ 106"6-1067; p. 875-877, () 
 1072 a ; p. 879-880, (^ 1074 ; p. 887- 
 890, ^ 1077 ; p. 930-932, () 1088 a-d. 
 a still more remarkable attribute of the 
 nervous influence than the modifica- 
 tions to which it is liable, and perfect- 
 ly demonstrable, is a perpetual elec- 
 tion, throughout the organism, of par- 
 ticular excito-motory nerves without 
 any apparent reference to their order 
 of arrangement, manifesting its ef- 
 fects between parts remote from each 
 other, and remote from the nervous 
 centres, and neglecting all intermedi- 
 ate parts, and equally so whether the 
 natural stimuli of life, or Mental Emo- 
 tions, or the Will be the exciting 
 cause ; and since this is also equally 
 true of remedial and morbific agents, 
 and could not be so were their op- 
 eration through the medium of the 
 circulation, the Author derives from 
 
 Reflex Action, &c. — continued. 
 
 these exact coincidences between the 
 natural, remedial, and morbific agents 
 an irresistible proof that the latter ex- 
 ert their effects equally with the for- 
 mer through the medium of reflex ac- 
 tion of the nervous system (or orig- 
 inally direct in the case of Mental 
 Emotions), and v,'hich renders the 
 chemical, galvanic, electrical, and oth- 
 er physical hypotheses simply ridicu- 
 lous, p. 75-79, § 166-167/; p. 112, (^ 
 234 a; p. Ill, (j 233i ; p. 116, ^ 234 
 /; p. 326-328, ij 500 g-m ; p. 330, (i 
 500 nn; p. 666-672, I) 902 6-904 b. 
 Also, p. 174-183, ^ 350i-350f gg. 
 various explanations relative to the 
 mechanism through which the nerv- 
 ous influence operates in its function 
 of reflex action, for the purpose of ap- 
 plying it to the interpretation of the 
 modus operandi of all remedial and 
 morbific agents upon parts beyond the 
 seat of their direct operation, and also 
 of its limitation in other cases to the 
 motor nerves, or as direct impressions 
 when thus produced may give rise to 
 reflex actions, and as the cause of all 
 the physiological changes in the solids 
 and of all increased or otherwise mo- 
 dified changes in the fluids, through 
 its various influences upon the instru- 
 ments of organic processes, and of its 
 modifications according to the nature 
 of its exciting causes, as well, also, for 
 proving the substantive existence and 
 self-acting nature of the Soul and 
 Principle of Instinct, p. 101-102, <J 201 
 -202 ; p. 108, () 227, No. 2 ; p. 112, *;> 
 234 b; p. 116-117, ^ 234/; p. 282, 
 () 451 d; p. 285-287, <^ 455 d-459 a; 
 p. 290-296, ^ 462-4761 ; P- 300, ^ 
 479 ; p. 309-310, (} 484 b, Nos. 5 and 
 6 ; p. 312-315, !) 487 ir-489 ; p. 321, 
 ^ 496, 497 ; p. 323-328, I) 499 a-500 
 m ; p. 331-341, () 500 0-514 n ; p. 344 
 -345, ^ 516 d, No. 6 ; p. 347-349, § 
 516 d, No. 13-520; p. 416-417, () 
 649 c; 421-423, 657-658; p. 465- 
 466, ^ 715; p. 484, <} 746 c; p. 523, 
 (} 827 c ; p. 565-566, () 889 /, g ; p. 
 592-593, ^ 89\^g, k; p. 642-647, § 
 893 a-c ; p. 661-663, (} 894-896 ; p. 
 665-670, (^ 902 a-n ; p. 679-68 1 , ^J 905 
 a; p. 703-710, «J 940-952; p. 733-734, 
 () 974 c-975 b; p. 873-881, ^ 1069- 
 1075; p. 886-891, 9 1077. Also, 
 Nervous Power, Index J. and II. 
 its essential principle, the nervous pow- 
 er, or whatever it be, is not a mova- 
 ble substance, in transitu from part to 
 part, but, like the principle of Light, 
 is every where diffused through its 
 appropriate medium, and, like that 
 principle, is brought into operation by
 
 INDEX II. 
 
 1061 
 
 Reflex Action, &c. — continued. 
 
 exciting causes, and with every va- 
 riety of effect, according to the nature 
 of the causes ; nor is there any great- 
 er difficulty in understanding its im- 
 puted modifications than the polari- 
 zation of light, or any other attributes 
 which the Author assigns to them, 
 than such as appertain to Light, p. 
 80, ^ 169 b, d; p. 84, ^ 175 b, bb ; p. 
 88, () 184 b; p. no, ^ 232; p. 114- 
 120, (} 234 e-235 ; p. 330, ^ 500 rjn ; p. 
 334, ^ 507 ; p. 670, ^ 902 k. 
 its application to the modus operandi of 
 all remedial and morbific causes is 
 founded upon natural laws ; and the 
 Author maintains that, if there be any 
 thing in the consistency of Nature, 
 or any thing in facts, the same physi- 
 ological laws which govern the organ- 
 ization of the animal kingdom in its 
 normal state are equally at the foun- 
 dation of all its deviations from the 
 natural standard, and that this uni- 
 versal principle embraces completely 
 the physiological laws of the nervous 
 system, which, indeed, the Author has 
 demonstrated by a multitude of exact 
 coincidences between the results of 
 natural causes and those of a morbific 
 and remedial nature, both physical 
 and mental, as appears in a summary 
 manner in the following sections, and 
 in great amplification under the top- 
 ics embraced in the Article Generali- 
 zation of Reflex Action, Index II., p. 
 1-2, ^l a; p. 3-4, ^ 2 b-d ; p. 106- 
 1 12, <;> 222-234 b ; p. 282-295, ^ 451- 
 475; p. 321-362, H95-530; p. 405- 
 412, i!i638; p. 413, ^639-640 ; p. 541 
 -543, {) 852 rt-857 ; p. 661-678, (} 894 
 -904; p. 679-681, ^ 905 a ; p. 692- 
 693, ^ 915-921 ; p. 698-699, ^ 929- 
 935 ; p. 703-711, (} 940-952. Also, 
 Soul and Instinctive Principle, 
 Ind. II.— () 718, 795, 892 b, 990^ a, b. 
 the entire dependence of respiration 
 upon reflex action of the nervous sys- 
 tem, as the stimulus of the muscular 
 mechanism, coincides with the de- 
 pendence of the act of vomiting upon 
 the same causation, and carried by the 
 Author through a long chain of anal- 
 ogies consisting of the various modi- 
 fications of respiration, of vomiting as 
 produced by emetics of various kinds, 
 by loss of blood, by tickling the fau- 
 ces, by tobacco applied to the soles of 
 the feet, by pregnancy, by shock of 
 falls, iStc, and by Mental Emotions, 
 and the divers influences and results 
 according to the nature of the cause, 
 and other coincidences supplied by the 
 iris, sphincter muscles, heart, cold, 
 suppositories, tetanus, &c., which de- 
 
 Reflex Action, &c — continued. 
 
 pend upon other institutions of the 
 nervous influence through centripetal 
 and centrifugal nerves, and the anal- 
 ogies supplied by the Will in volun- 
 tary motion — all carried to the inter- 
 pretation of all the effects of active 
 emetics and cathartics, both remedial 
 and morbific, and, by the same analo- 
 gies, their effects when they fall short 
 of vomiting and purging, or other 
 prominent results that arise from 
 large'r doses, through alterative in- 
 fluence of reflex action of the nerv- 
 ous system, and against the chemical 
 and physical doctrines of operation 
 through absorption — and all this chain 
 of analogies applied to the modus op- 
 erandi of all other remedial and mor- 
 bific causes, physical and reental, 
 while the same interpretation of all 
 the others is sustained by other spe- 
 cial demonstrations in immediate con- 
 nection with a large number of the 
 several things respectively, p. 66-67, 
 ^ 148 ; p. 110, () 232 ; p. 323-341, <) 
 499-514 m ; p. 334-335, ^ 5\6 d, No. 
 6 ; p. 347-348, () 516 d, No. 13 ; p. 
 421-423, () 657-658 ; p. 526, (} 828 a ; 
 p. 532-533, <J 841 ; p. 542-543, <^ 854 
 c~f; p. 547-550, i) 863 d; p. 563- 
 566, ^ 889 a-ff; p. 568-569, ^ 889 
 VI, mm; p. 592-593, <J 89 U k ; p. 
 631-632, ^ 8921 b ; p. 661-663, ^ 
 894-896 ; p. 666-678, ^ 902 6-904 d; 
 p. 679-681, () 905 a; p. 703-710, ^ 
 940-952; p. 831-833, '^ 1057 /-o-; 
 p. 838, (} 1057*-. Also, Stomach, 
 Nauseants, Disgust, Emetics, Men- 
 tal Emotions, Tetanus, Remedies ; 
 Causes, Morbific ; and General- 
 ization of Reflex Action, Index 
 //.—Notes D p. 1114, Co p. 1132. 
 in the natural state of the body, although 
 in constant operation among all parts, 
 is not strongly manifested exceptin"- 
 in particular functions, as in respira- 
 tion, motions of the heart and intesti- 
 nal canal, motions of the iris, &c., or 
 unless brought into action by special 
 causes, as when it starts the urine as 
 excited by cold, or the milk at the 
 time of parturition, and by the Men- 
 tal Emotions when its displays are 
 very strongly pronounced, the influ- 
 ence being then primarily developed 
 in a direct manner, and by the Will, 
 when it is always direct, but exactly 
 equivalent to reflex action, p. 54-55, 
 <!> 111-117; p. 230-232, (J 422 J-424 ; 
 p. 284-289, (} 454-461 ; p. 296, ^ 476 
 c; p. 323-335, <J 499-512; p. 355, 
 ^ 526 a. Also, Remedies ; Causes, 
 Morbific ; Remedial Action, Men- 
 tal Emotions, the individual Pas-
 
 1062 
 
 INDEX II. 
 
 Reflex Action, &c. — continued. 
 
 sions, Disgust; Brain, Inflamma- 
 tion OF ; Secretion and Excretion, 
 Ukine, Sweat, Skin, Cold, Milk, 
 Bile, Food, Roosting, Respiration, 
 Sphincter Muscles, Youth, Ute- 
 rus, Organs of Generation, &c., 
 Index II. 
 
 is the exciting cause (primarily direct 
 or centrifugal in affections of the 
 nervous centres) of all diseases which 
 ensue as consequences of each other, 
 but the secondary affections may be 
 very different from the primary, de- 
 pending, in part, upon the peculiar 
 constitution of different tissues or of 
 parts of a tissue, p. 61, ^ 153 a, b; p. 
 62-68, <^ 135-152 ; p. 109, () 229 ; p. 
 339-340, ^ 514 h ; p. 355, () 426 a ; p. 
 450, {) 689 / ,- p. 465-469, () 715-722 ; 
 p. 731, <!i 970 c ; p. 483-484, () 746 c. 
 Also, Causes, Morbific ; Inflamma- 
 tion; Brain, Inflammation of; 
 Skin, Tobacco, Seton, Index II. ; 
 Nervous Power, Sympathy, Index I. 
 and II. 
 
 through its influences upon the organic 
 properties, is the cause of all increase 
 or diminution of the secretions, and 
 of all other changes that may befall 
 them, when not the immediate conse- 
 quence of the direct local operation 
 (if other causes, as in vesication, and 
 of many of the changes which the 
 Mood undergoes, and whenever af- 
 fected by Mental Emotions, though 
 ill the latter case the primary devel- 
 opment of the nervous influence is 
 directly centrifugal, and in all these 
 cases through an exciting, or depress- 
 ing, or other modifying effects upon 
 the instruments of the organic pro- 
 cesses, p. 230-232, <5 422 6-424 ; ]). 
 289, ^ 461 ; p. 296, «J 470 c; p. 310, 
 () 485 ; p. 331, ^ 500 o; p. 332-334, 
 <j 501-507 ; p. 335-336, <) 512 a-513 ; 
 p. 421-423, () 657-658 ; p. 483-484, 
 (J 746 c; p. 592-593, ^ 89U k; p. 
 631-032, ^892 J; p. 666-669,'^ 902 i- 
 h; p. 704, (Ji 943 ajj ; p.710,ij 952 b-h; 
 p. 353, JN'o. 7. Secretion and Ex- 
 cretion, Urine, Milk, Bile, Weep- 
 ing, Sweat, Food, Fear ; Water, 
 Hot; Antimony, Tartarized ; 
 Bloodletting, Mental Emotions, 
 Index II. ; Sudorifics, Index I. 
 
 examples of its effects in subduing vio- 
 lent inflammations, and of variously 
 and suddenly modifying the condition 
 of morbid fluid products and the con- 
 dition of the blood, when brought into 
 operation primarily in a direct man- 
 ner by Mental Emotions, p. 296, ^ 
 476 c ; p. 230-232, I) 422 J-424 ; p. 
 335-330, () 512 a, d ; p. 355, () 526 a ; 
 
 Reflex Action, &.c. — continued. 
 
 p. 630-632, ^ 8924 b ; p. 709-710, ^ 
 951 i-952 ; p. 865-868, ^ 1067. 
 
 explains the philosophy of metastasis 
 and rcvulswn, which is applied ana- 
 logically to the modus operandi of 
 morbific and remedial agents through 
 the reflex action of the nervous sys- 
 tem. See Metastasis, Index II. 
 
 the cause of all violent disturbances and 
 convulsions, a large proportion of 
 which depend upon simple irritations 
 of comparatively unimportant parts, 
 and supply a fertile analogy for the 
 Author's interpretation of the modus 
 operandi of morbific and remedial 
 causes, physical and mental, through 
 direct and reflex action of the nervous 
 system, p. 357-358, (j 526 d; p. 467- 
 468, <J 719 ; p. 590-591, l^ 89U b ; p. 
 592-593, <J 89 1 i k. Also, Convul- 
 sions, Hysteria, Spasmodic Affec- 
 tions, Tetanus, Antispasmodics, 
 Opium, Index II. — Note D p. 1114. 
 
 influences the production of animal 
 heat, which the Author endeavors to 
 show is a secreted product, and upon 
 common ground with other secre- 
 tions, p. 267-270, (Ji 446-447 ; p. 807- 
 808, ^ 1044-1045. Also, p. 68, () 152 
 a ; p. 245, ^ 440 e ; p. 250-251, (^ 441 
 c; p. 335-336, (} 512 a, b ; Tp. 339, (/ 
 514 h; p. 365, <J 889^; p. 579-580, 
 () 890^ d. Organic Heat, Index I. ; 
 Hybernating Animals, Tea, Index 
 II. 
 
 extensively applied in refutation of the 
 chemical hypothesis of animal heat, 
 p. 240, (;> 440 h ; p. 250-253, (} 441 
 c, d; p. 255-256, ^ 44H a; p. 262- 
 270, () 446 fl-447 d ; p. 335-336, ^ 
 512, 1044 a, Note T p. 1125. 
 
 the Author's doctrine of its being the 
 immediate and universal exciting 
 cause of all the effects of morbific and 
 remedial agents beyond the seat of 
 their direct operation, through its in- 
 fluences upon the instruments of or- 
 ganic processes, and the philosophy 
 which concerns the substitution of 
 transitory pathological conditions for 
 the more profound, illustrated by the 
 modus operandi of a Sct07i, p. 679- 
 681, ^ 905 a. 
 
 is always the cause of disease that may 
 supervene in parts which are the di- 
 rect scat of the operation of miasma- 
 ta, or as it may spring up in the skin 
 when ordinary degrees of cold give 
 rise to pneumonia, &c., through the 
 same reflex action, and in many anal- 
 ogous cases, and is generally a con- 
 curring cause in the production and 
 euro of diseases in parts upon which 
 all morbific and remedial agents exert
 
 INDEX II. 
 
 1063 
 
 Reflex Action, &c. — continued. 
 
 their direct effects, and in all cases 
 the influence thus reflected may be 
 simply a reverberation through the 
 centrifugal nerves of the parts imme- 
 diately acted upon, or the reflex influ- 
 ence may depend upon impressions 
 transmitted from the superficial to in- 
 ternal parts, whether morbific or cu- 
 rative — exceptions to which may ap- 
 pear to occur in Setons, Counter-irri- 
 tants, &c.,but in these cases reflected 
 action upon the injured part is sooner 
 or later brought into operation, p. 66- 
 67, 9 148 ; p. 284-287. ^ 454 c-459 ; 
 p. 289, (, 461 ; p. 315-316, ^ 492 ; p. 
 336-340, i) 514 b, g, h ; p. 351-353, 
 «J 524 d ; p. 416-417, ^ 649 c ; p. 421 
 -423, {) 657-653 ; p. 483-484, ^ 746 
 c; p. 522-523, () 827 b, c ; p. 531, (J 
 840. Also, Miasm, Predisposition, 
 Skin, Cold, &c., Index II. 
 considered in its slowly progressive op- 
 eration when brought into effect by 
 Author's group of Alteratives, and an- 
 alogous means both physical and men- 
 tal — the same being also true of the 
 slowly progressive operation of mor- 
 bific causes, p. Ill, <J 233^, 2333 ; p. 
 285-286, H55 d-f; p. 333, (J 503-506, 
 p. 339, ^ 514 g; p. 344-345, ij 516 d, 
 No. 6 ; p. 365, \ 551 ; p. 366, ij 556 ; 
 p. 416-417, (J 649 c; p. 420-424, <J 
 654-661 ; p. 532, (J 841 ; p. 547, ^ 
 863 d; p 551, ^ 877; p. 568-569, () 
 889 m, mm; p 592-593, |J891K-,- P 
 599-600, I) 892 d ; p. 646-649, (J 893 
 e-k; p. 661-663, 1^894-896; p 668- 
 670, i) 902 g-m ; p. 675-676, () 904 b ,■ 
 p. 679-681, <J 905 a. Also, Hydro- 
 PHOBH, Virus of ; Predisposition, 
 Mi.iSM, S.M.4LL-P0X, Alter.\tives, 
 Sphincter Muscles, Index II. 
 applied in expounding the modus ope- 
 randi of Cinchona, Loss of Blood, and 
 of other things of which we are said 
 to be ignorant, and in connexion with 
 illustrations drawn from the modus 
 operandi of a Seton, and where, also, 
 under the several references, the or- 
 ganic influences of remedial agents 
 through the instrumentality of nerv- 
 ous action, and the philosophy which 
 concerns their substitution of transi- 
 tory pathological conditions for the 
 more profound as the fundamental 
 cause of cure, is summarily present- 
 ed, p. 596-597, () 892 b, c ; p. 676- 
 681, ^ 904 b-90b a. Also, p. 67, () 
 149-151 ; p. 73, ^ 163; p. 108-110, 
 (J 227-232 ; p. 542, ^ 854 c-e ; p. 554, 
 ^ 871 ; p. 592-593, () 891* /:; p. 661 
 -663, ^ 894-896 ; p. 664-605, () 900- 
 901. Also, Bloodletting, Reme- 
 dies, &c.. Index II. 
 
 Reflex Action, &c. — continued. 
 
 but it is not alone the foregoing anal- 
 ogies, as supplied by respiration, vom- 
 iting, (Sec, and a multitude of others 
 of a corresponding nature, that are 
 tributary to the Author's doctrine of 
 the modus operandi of remedial and 
 morbific agents, through reflex or di- 
 rect action of the nervous system, but 
 an almost universal proof to the same 
 effect is supplied by all the muscular 
 movements in organic life, by that of 
 the muscular coat of the intestinal 
 canal, by the muscles of deglutition, 
 that of the bladder, that of the uterus, 
 &c., and, what is especially import- 
 ant, by the heart and entire arterial 
 and venous systems, whose active mo- 
 tions, if not wholly determined as it 
 respects their exciting cause, are at 
 least greatly influenced by the refle.x 
 action of the nervous system excited 
 by the stimulus of blood, being whol- 
 ly true of the heart, p. 301-310, ^ 
 481-485; p. 338-339, 514/; p. 343, 
 344-348, () 516 d, Nos. 3-5, 7, 12, 13, 
 and conspicuously so by mental emo- 
 tions, food, exercise, &.C., and by dis- 
 eases generally, all of which is refer- 
 able alone to the stimulus of nervous 
 influence — upon which, collectivel}% 
 is founded, in part, the Author's doc- 
 trine of the action of the capillary ar- 
 teries and of the veins as among the 
 important elements in the circulation 
 of the blood, p. 62, (} 136 ; p. 209-210, 
 <) 384-337; p. 211, () 390 b, and de- 
 duced, in farther part, from experi- 
 ments made upon arteries by Buniva, 
 Procter, and Kreimer, p. 215-216, () 
 399 ; p. 310, () 485, and subsequent- 
 ly confirmed by Brown-Sequard and 
 others, p. 803-804, () 1039 ; p. 805, () 
 1041 — and which is at the foundation, 
 in part, of the Author's theory of the 
 active condition of the instruments of 
 inflammation, p. 485-486, ^ 750-751, 
 and references there, and of his the- 
 ory, also, of the ready transition of 
 venous congestion into the ordinary 
 form of inflammation, p. 506-507, () 
 803, 804 — and in consideration of all 
 of which, and of the manifest influ- 
 ences of the nervous system upon the 
 capillary bloodvessels (those main in- 
 struments of all organic processes and 
 their results, p. 226-227, <J 410, 411) 
 that are determined upon them by a 
 vast variety of the natural stimuli of 
 life, physical and mental, it cannot be 
 doubted that all remedial and morbific 
 agents must of necessity exert, through 
 that same nervous influence, more 
 powerful and disturbing effects upon 
 those instruments, and thus become
 
 1064 
 
 INDEX II. 
 
 Reflex Action, &c. — continued. 
 
 the immediate exciting cause of dis- 
 ease, of the increase, diminution, and 
 other changes in the secretions, and 
 equally also of those pathological va- 
 riations impressed by remedial agents, 
 and through which the more profound- 
 ly morbid are placed in the way of 
 tlie recuperative process, p. 541-542, 
 ^ 852-854 e ; p. 664-665, <J 899-901. 
 Also, Skin, Cold, Kidney, Organs of 
 Generation, Uterus, Parturition, 
 Food. Fear, Disgust, Nervous Sys- 
 tem, &c.. Index II. ; Vital Proper- 
 ties, Organic Life, Index I.; Nerv- 
 ous Power, Index I. and II. 
 but the nervous influence is in no fun- 
 damental sense, as is generally sup- 
 posed, the cause of the organic func- 
 tions in Animals any more than of the 
 analogous functions of Plants, which 
 are carried on by properties implant- 
 ed in all parts, but contributes a mod- 
 ifying and exciting or depressing in- 
 fluence to the nutritive and other se- 
 cretory vessels, through which the 
 products are perfected, or increased, 
 (ir diminished ; but these instruments 
 are constantly liable to preternatural 
 influences from either direct or reflex 
 nervous action, and of an endless va- 
 • ricty, and there is no function in the 
 natural state of the body, no condition 
 of disease, no action of remedies, in 
 which the nervous system does not 
 participate (p. 54-55, <J 109 b-\ 17 ; p. 
 284-287, () 454 c-459 ; p. 289, ^61; 
 p. 483-484, (J 746 c), while organs in 
 their compounded condition are more 
 evidently under its perpetually har- 
 monizing influence through the im- 
 pressions made upon their minute 
 structure — and coming to many func- 
 tions that are less concerned, or not 
 at all, in the essential processes of or- 
 ganic life, as in respiration, contrac- 
 tion of tiic sphincter muscles, motion 
 of the iris, peristaltic movements, &lc., 
 the nervous influence is the only im- 
 mediate exciting cause — an obvious 
 distinction, therefore, being made by 
 the Author between the nervous influ- 
 ence as an exciting or modifying cause 
 or vital agent and the fundamental 
 causes or organic properties by which, 
 in connexion with organization, the 
 functions are carried on ; and hence, 
 whenever the Author speaks of the 
 nervous influence as a cause, he sim- 
 l)iy means an exciting or vwdifymg 
 cause, p. 23, <J 34-38 ; p. 24, ij 41, 42 ; 
 p. 54-55, () 109 i-117; p. 60-67, (j 
 148 ; p. 75-76, (^ 107 a ; p. 88, () 183, 
 184 ; p. 110, <) 233 ; p. 222-227, <J 409 
 c-411 ; p. 284-286, § 454-457; p. 
 
 Reflex Action, &c. — continued. 
 
 289, l^ 460-46H ; p. 294, (^ 475 ; p. 
 295-296, i) 476 b ; p. 31 1-315, i) 488- 
 489 ; p. 317-318, ij 493 ; p. 421-423, 
 ^ 657-658 ; p. 483-484, (J 746 c ; p. 
 745-746, ^ 990^. Also, Vital Prop- 
 erties, Organic L.ife, Index I. ; Res- 
 piration, Sphincter Muscles, Iris, 
 Cathartics, &c.. Index II. 
 
 influences the sensibility of nerves, by 
 which it is the cause and cure of pain 
 when not the direct result of causes 
 acting locally, and according to the 
 nature of the means by which it is 
 brought into operation, whether mor- 
 bific, or sedative, or loss of blood, 
 &c., and pain is equally relieved 
 through the same influence by Mental 
 Emotions, and according to their na- 
 ture, p. 102, ^ 201-202 ; p. 108, ^ 227 ; 
 p. 296, <J 476 c; p. 302, M81 6; p. 
 323-324, () 500 c; p. 584-585, ^ 891 
 d, e; p. 587-590, ^ 891 /t-s,- p. 592- 
 593, () 891i k; p. 831-832, <J 1057/; 
 p. 838, ^ 1057i ; p. 862-864, ^ 1066. 
 Also, Antispasmodics, Sedatives 
 (Aconite), Opium, Neuralgia, Pain, 
 Poultices, Warm Bath, Bloodlet- 
 ting, Index II. 
 
 may be brought into suddenly fatal op- 
 eration upon the nervous centres ei- 
 ther through centripetal nerves, as in 
 blows upon the epigastrium, &c., or 
 by mental or other causes acting di- 
 rectly upon those centres, when life 
 may be instantly extinguished by their 
 direct violence upon their organic con- 
 stitution, or may be also simultane- 
 ously reflected with a corresponding 
 fatal eflect upon the whole organism, 
 p. 107-111, ^ 226-233J; p. 296, (J 
 476 e; p. 298, () 476i h; p. 300, ^ 
 479 ; p. 301, (^ 480 ; p. 302, () 481 b ; 
 p. 304, () 481 g; p. 306-308, ^ 483 
 b ; p. 320, i) 494 dd ; p. 324, ^ 500 c, 
 d; p. 334-335, i) 509-511 ; p. 402- 
 403, () 634-635 ; p. 534, <) 844 ; p. 
 704, () 943 a-944 a ; p. 707, ^ 947 ; 
 p. 709, <J 951 b-d ; p. 831-833, <J 1057 
 /, g; p. 858, <) 1057+ ; p. 862-864, (/ 
 1066; p. 865-868, <) 1067; p. 878- 
 881, (J 1074-1075; p. 887, 5 1077. 
 Also, Joy and Anger, Mental Emo- 
 tions, Pain, Neuralgia, Opium, An- 
 tispasmodics ; Serpents, Virus of; 
 Hydrocyanic Acid ; Brain, Inflam- 
 mation of; Stomach, Blows upon; 
 Bloodletting, Loss of Blood, Re- 
 medial Action, Index II. ; Will, In- 
 dex I. and II. 
 
 is the main cause of hardness and tw- 
 compressibilitij of the pulse, and of 
 bufiing and cupping of blood, in in- 
 flammations, while the Loss of Blood 
 or a Mental Emotion will speedily
 
 INDEX II. 
 
 1065 
 
 Ruriex Action, &c. — continued. 
 
 modify its influence and render it sub- 
 versive of those conditions, and is also 
 mostly the exciting cause of the va- 
 rious appearances presented by the 
 tongue, and which, in both cases, as 
 with many other symptoms, are most- 
 ly useful in denoting the special modi- 
 fication and force of the nervous in- 
 fluence, and through which is inferred 
 the nature, seat, and force of disease, 
 the effects of remedies, &c., p. 444- 
 445, <J 688 ; p. 708-710, I) 951-952 b. 
 Also, Tongue, Kidney, Urine, Sweat, 
 Bloodletting, Index II. ; () 500 m. 
 
 mistakes in regard to, from confounding 
 the results of experiments on trunks 
 of nerves with those upon their ex- 
 panded extremities, p. 338, (} 514 d; 
 p. 347, {) 516 d, No. 10; p. 520-521, 
 ^ 826 d. Also, Medical and Physio- 
 logical Commentaries, vol. i., p. 507, 
 563-566. 
 
 the distinction should be observed be- 
 tween irritability, and common, spe- 
 cific, and sympathetic sensibility, and 
 that the last only is concerned in re- 
 flex action of the nervous system, and 
 that causes affecting the nervous cen- 
 tres in a direct manner operate pri- 
 marily through excito-motory nerves 
 alone, p. 88-89, () 183-188 c; p. 100 
 -103, ^ 197-204 ; p. 280-282, <) 450- 
 451 ; p. 671, <J 903. Also, Mental 
 Emotions, Disgust, the individual 
 Passions; Brain, Inflammation of, 
 Index II. 
 
 recent observations upon, confirmingim- 
 portant principles in these Institutes, 
 p. 803-808, (j 1039-1045. 
 
 the coincidences in effects of reflex and 
 direct action of the nervous system, 
 or as the centripetal and centrifugal 
 nerves are engaged in the former pro- 
 cess, and the centrifugal alone in the 
 latter, form the basis of the Author's 
 demonstration of the substantive ex- 
 istence and self-acting nature of the 
 Soul and Instinctive Principle, p. 873 
 -910, (j 1069-1082. Also, Mental 
 Emotions, the individual Passions, 
 Index II. ; Will, Lidcx I. and II. 
 
 employed by the Author to expound the 
 dependence of the first act of respira- 
 tion, when the point of departure is 
 from the skin, in Medical and Physi- 
 ological Commentaries, and again in 
 the original Essay on the Soul and In- 
 stinctive Principle, and in analogical 
 demonstration of the substantive ex- 
 istence and self-acting nature of the 
 Soul in the latter work, and in the 
 former on account of Miiller's affirma- 
 tion that " it appears to me to be 
 solely the stimulus aflTorded to the 
 
 Reflex Action, &c. — continued. 
 
 brain and medulla oblongata by the 
 blood,vi\\ic)\ immediately becomes ox- 
 ydized in the lungs" (Mijller's Phys- 
 iology, p. 335), upon which the En- 
 glish Translator remarks, " How can 
 the air be drawn into the lungs'!" — 
 and, in the foregoing Essay, the Au- 
 thor remarks that "a beautiful ex- 
 emplification (of reflex action of the 
 nervous system) is seen in the new- 
 born infant and other animals breath- 
 ing with lungs, as I have explained on 
 a former occasion, since here the first 
 impression is transmitted to the nerv- 
 ous centres through the sensitive 
 nerves of the skin in consequence of 
 the contact of cold air with the sur- 
 face. This is the rationale of the first 
 breath we draw, standing alone in or- 
 ganic life ; and the same thing hap- 
 pens, as I also explained, when cold 
 air or cold water, applied to the sur- 
 face, reproduces breathing in syncope ; 
 or, if it be ammonia, &c., applied to 
 the nose, then the sensitive nerves 
 are branches of the fifth pair of cere- 
 bral. I will also now say that the 
 function of the pneumogastric nerve 
 is developed for the first time by the 
 first act of inspiration, and fully de- 
 veloped, both as it respects the lungs 
 and the stomach." — Essay on the 
 Soul and Instinct, p. 57-58 (1849). 
 Also, Skin, Loss of Blood, Syncope, 
 Index II. Also, p. 406, § 638. 
 
 explains, through its primary direct de- 
 velopment by the Will, the act of 
 roosting and of sleeping in the erect 
 posture, and in a manner analogous 
 to its action upon the sphincter mus- 
 cles, and employed in demonstrating 
 the substantive existence and self- 
 acting nature of the Soul and Princi- 
 ple of Instinct, p. 890-891, (J 1077. 
 Also, Sphincter Muscles, Alter.v- 
 TivEs, Roosting, &c.. Index II. 
 
 its physiological laws without any prac- 
 tical use till applied by the Author to 
 Pathology and Therapeutics, p. 106, 
 ij 222 b; p. 111-112, ^ 334 a, b; p. 
 1 18, () 234 h ; p. 283, ^ 452 b ; p. 285- 
 286, () 455 d-f; p. 296, () 476 c ; p. 
 317-318, (} 493 a-d; p. 320, ^ 494 
 dd; p. 329-330, (} 500 nn; p. 341- 
 342, () 514^ b ; p. 515, (J 819, 820 ; p. 
 579, () 890^ c ; p. 596, (} 892 b ; p. 690 
 -691, () 906 ^-910 ; p. 361, ^ 530. 
 
 for the convenient reference of those 
 who may take an interest in the Au- 
 thor's reclamation (p. 912), he sub- 
 joins some of the distinct claims and 
 proofs, which for seventeen years had 
 received universal acquiescence, of 
 his priority in the application of the
 
 1066 
 
 INDEX II. 
 
 Reflex Action, &c. — continued. 
 
 physiological laws of reflex action of 
 the nervous system to Pathology and 
 Therapeutics in all its ramifications, 
 and of the dependence of the effects 
 of the Mental Emotions and of the 
 Will upon the same nervous influence, 
 as variously presented in this work, 
 and which application is still limited 
 to his writings, <J 111-113; ij 224 ; () 
 226; () 234 a, b; p. 113-114, i) 234 
 d; p. 116-117, <J 2Mf,g; p. 236, i) 
 435-436 ; p. 262, (J 446 a ; p. 264, <j 
 446 d; p. 282-284, () 451 rf-453 ; p. 
 289, <^ 459 g; p. 295, () 476 a; p. 
 295, () 475MV6^ b; p. 298-299, ^ 
 477 a; p. 301-302, <J 481 h; p. 309- 
 310, (i 484, No. 5 ; p. 318, ^ 493 d ; p. 
 320, ^ 494 dd ; p. 323-353, () 499-524 ; 
 p. 357-358, i) 526 d; p. 361-362, ^ 
 530 ; p. 515-516, <^ 819 6-820 ; p. 523, 
 ^ 827 c ; p. 592-593, ^ 891^ k ; p. 643, 
 () 893 a ; p. 671-672, ^ 903, 904 a ; 
 p. 676-677, <J 904 c; p. 679-681, ^ 
 905 a ; p. 690-691, (J 906 g ; p. 692- 
 693, ^ 914-921 ; p. 698-699, ^ 929- 
 935 ; p. 703-710, ^ 940-952 ; p. 733 
 -735, (} 972-978 ; p. 745-746, () 990 
 *-990i b ; p. 873-891, ^ 1069-1077 ; 
 p. 912-920, () 1084— and Medical and 
 Physiological Commentaries, Articles 
 particularly on Bloodletting and Hu- 
 moral Pathology, vol. i. (1840); and 
 on the Modus Operandi of Remedies, 
 vol. iii. (1842) ; and as to the ^' exci- 
 to-secretory action" (p. 913), which 
 had been noticed by Uichat (p. 270, 
 () 447 d), and fully established by 
 Philip's Experiments as early as 
 1815 (and therefore more than twen- 
 ty years prior to the cursory observa- 
 tions of Henle and others, who had 
 only incidentally referred to it, p. 
 314-315, (j 489; p. 317-318, ^ 493 
 «-(/), the Author applies it through- 
 out this work to all the functions 
 which undergo any increase of their 
 products (with the few exceptions, as 
 in the case of vesicants, &c., where 
 the physical agents, more than the 
 nervous influence, are the exciting 
 causes), and the Author carefully de- 
 fines the nervous influence, both in its 
 connexion with the secretions and all 
 other results, as " an exciting and 
 modifying cause," or a " vital agent," 
 to distinguish it clearly from the or- 
 ganic properties upon which they es- 
 sentially depend, p. 106-110, <^ 224- 
 233; p. 193, <;> 356 a; p. 230-232, (^ 
 422-424; p. 262-263, <i 446 a; p. 
 289, (J 461 ; p. 294, ^ 475, and refer- 
 ences there ; p. 325-326, <^ 500 ce ; 
 p. 335-336, <J 512 a, h ; p. 350-353, 
 () 524, No. 1,7; p. 630-632, () 892| 
 
 Reflex Action, &c. — continued. 
 
 b; p. 667-669, <;> 902 f-h ; p. 704, () 
 943 a, b ; p. 733-734, ^ 974 a-c ; p. 
 746, I) 990^- b — and not less sedative, 
 p. 107-108,^ 226, 227; p. 109, ^ 
 230 ; p. 302-303, <^ 481 c,d; p. 507- 
 508, <;i 806 ; p. 592-593, ij 89 H ^c ; p. 
 661-663, () 894 b-896 ; p. 746, ^ 990^ 
 b ; Sedatives, Index II. — but, what is 
 incomparably more important, and 
 alone of any value, and which the 
 Author claims as his own, is the prac- 
 tical application of the laws of the 
 nervous system to Pathology and 
 Therapeutics, while, also, he constant- 
 ly represents its reflex and direct ac- 
 tion, when brought into unusual op- 
 eration, as altering the natural condi- 
 tion of the secreted fluids and the 
 blood by its influences upon organic 
 processes, and uniformly expounds 
 all tlie effects of remedial and mor- 
 bific agents beyond the seat of their 
 direct operation, and the analogous ef- 
 fects of the Mental Emotions, through 
 its alterative action, and represents it 
 as always participating, as a vital 
 and modifying cause, in the organic 
 processes of animals, and exerting 
 upon the organic fluids a vitalizing 
 influence — and it has been no less 
 an object to array all this philosophy 
 against the chemical, humoral, and 
 physical doctrines, p. 193, <J 356 a; 
 p. 262-263, (J 446 a; p. 289, ^61; 
 p. 335-336, () 512 a, b; p. 475, ^ 
 733 h ; p. 710-711, (J 952 A-^— though 
 to what extent is doubtful, p. 54-55, 
 § 110-117; p. 108-110, () 227-233; 
 p. 224, <^ 309 g ; p. 286, () 456 ; p. 
 289, (^ 461 ; p. 303, H81 rf; p. 332- 
 333, ^ 501-502 ; p. 483-484, () 746 c ; 
 p. 746, () 990^ b — nor can it be de- 
 cided, p. 286-289, {/ 458-461 ; p. 296, 
 (J 476^ b; p. 298, () 476^ h; p. 300, 
 () 479 ; p. 303, () 481 e, f; p. 342- 
 343, () 516 a-d ; p. 792-793, <) 1032 d. 
 
 Religion, 
 
 distinguishes Reason from Instinct, p. 
 901, ^ 1078 n. 
 
 Remedial Action, 
 
 a chapter devoted to a summary review 
 of direct and reflex action of the nerv- 
 ous system, as variously expounded 
 in preceding parts of the work, and 
 preparatory to an exposition of the 
 modus operandi of Bloodletting, re- 
 garding it as the great alterative agent 
 in the production and cure of dis- 
 eases, modified in its nature accord- 
 ing to tlie nature of each exciting 
 cause, whether physical or mental, 
 stimulating, depressant, or sedative, 
 either simply so or with alterative ef- 
 fect, and producing through the me-
 
 INDEX II. 
 
 1067 
 
 Remedial Action — continued. 
 
 dium of organic structure correspond- 
 ing changes in the solids and fluids, 
 p. 661-683, () 894-905. Also, Nerv- 
 ous Power, Sympathy, Index I. and 
 II. ; Reflex Action of Nervous 
 System, Remedies ; Causes, Morbif- 
 ic ; Bloodletting, Loss of Blood, 
 Leeching, Therapeutics, Mental 
 Emotions, &c.. Index II. 
 
 the whole philosophy of the operation 
 of remedial and morbific agents rests 
 upon physiological principles, wheth- 
 er as manifested through the medium 
 of the nervous influence, or in their 
 more independent action upon the or- 
 ganic constitution of parts with which 
 they may come into contact, but dif- 
 fering from the natural stimuli of life 
 not only in the greater manifesta- 
 tions of the nervous influence, but in 
 the alterative effects which it exerts, 
 p. 1, (J 1 a ; p. 2-4, (} 2 a-4: a ; p. 36- 
 49, <J 63-81 ; p. 54-55, <J 109-117 ; p. 
 58-59, ^ 129 c-i; p. 61-73, (j 133- 
 163; p. 101-J02, <) 201-202; p. 106 
 -112, <5 223-234 ; p. 121-122, () 237- 
 240 ; p. 147, 1) 330 ; p. 282-362, () 451 
 -530 ; p. 352, ^ 524 d ; p. 405-414, <) 
 638-640 ; p. 541-543, <^ 832-854 ; p. 
 565, I) 889 f,g; p. 592-593, <J 891^- 
 k ; p. 661-667, <^ 894 i-902 d ; p. 679 
 -681, §905 a; p. 703-710, 'J 940-952 ; 
 p. 732-736, () 971-980 ; p. 745-746, () 
 990^ ; p. 131-132, ^ 285-288 ; p. 398, 
 () 626 ; p. 467, ^ 715-719 ; p. 503, (} 
 795 ; Reflex Action, Remedies ; 
 Causes, Morbific, Index II. 
 
 lying at the foundation of the whole, 
 both of remedial and morbific action, 
 is the mutability of the Organic Prop- 
 erties, which, in being designed for a 
 variety of useful purposes, such as 
 the progressive changes of organiza- 
 tion from Infancy to Manhood, gesta- 
 tion, lactation, &c., is necessarily sub- 
 ject to deleterious influences from nu- 
 merous external and internal causes, 
 while others of a different nature are, 
 for the same reason, and through an- 
 other great law (the increased sus- 
 ceptibility of morbid states to the ac- 
 tion of the latter class in such regu- 
 lated modes as shall not act profound- 
 ly), capable of substituting other path- 
 ological changes, which, through an- 
 other great law (the inherent tend- 
 ency of the organic properties to 
 maintain their normal state), subside 
 spontaneously into the natural phys- 
 iological conditions. See Vital Prop- 
 erties, Index I. ; Causes, Morbific ; 
 Remedies, Therapeutics, the several 
 subdivisions relative to the foregoing 
 topics. Also, Pregnancy, Parturi- 
 
 Remedial Action — continued. 
 
 TioN, Lactation, Organs of Gener- 
 ation, Index II. ; Youth, Index I. and 
 II. 
 
 illustrations, exemplifj'ing, by natural 
 processes, the modus operandi of re- 
 medial and morbific agents, physical 
 and mental, through direct and reflex 
 action of the nervous system, p. 110, 
 S^ 232; p. 230-232, () 422-426; p. 
 250-251, i) 441 c; p. 262-263, § 446 
 a ; p. 284-286, () 454-456 ; p. 296, § 
 476 c; p. 302, ^81^; P- 323-328, ^ 
 500 c-500 m; p. 331-332, <J 500 o, 
 501; p. 334, >;> 509 ; p. 335-341, § 512 
 -514 VI ; p. 344-345, () 516 d. No. 6 ; 
 p. 347-348, ij 516 rf, No. 13 ; p. 350- 
 353, I) 524 ; p. 359, (^ 527 b ; p. 413, 
 § 639 a ; p. 565, § 889 g ; p. 592-593, 
 ^ 89U I:; p. 631-632, ^ 892J b; p. 
 745-746, i) 990^ ; p. 886-891, (} 1077. 
 Also, Youth, Pregnancy, Lactation, 
 Organs of Generation, Index II. 
 
 its modus operandi and of morbific 
 causes through direct and reflex nerv- 
 ous action demonstrated by experi- 
 ments upon the nervous system, p. 
 295-321, <) 476-494. 
 
 the physiological laws of the cerebro- 
 spinal and ganglionic systems intro- 
 duced to illustrate and corroborate 
 the Author's doctrine of remedial and 
 morbific action through alterative in- 
 fluences of direct and reflex nervous 
 action, p. 290-294, () 462-475 ; p. 335 
 -362, ^ 512-530. 
 
 a special example of extensive remedial 
 effect through alterative influence of 
 reflex nervous action in the emetic 
 operation of Tartarized Antimony, 
 and where the secretions are seen to 
 be suddenly and greatly augmented 
 through that influence, as in the ex- 
 amples supplied naturally by the kid- 
 neys, skin, lachrymal gland, salivary 
 and mammary glands, liver, &c., p. 
 668-669. ^ 902 g, h ; p. 672, § 904 a. 
 Also, Kidney, Skin, Urine, Bile, 
 Milk, Loss of Blood, Weeping, 
 Food, &c.. Index II. 
 
 other examples of Tartarized Antimony, 
 Mercury, and other things, of their 
 gradually alterative action — illustrat- 
 ing the difference in development of 
 reflex nervous influence from what 
 obtains when remedies operate more 
 abruptly — the same being also true 
 of morbific causes, p. 669-681, ^ 902 
 j-905a. Also, p. Ill, § 233^,233}; 
 p. 285-286, (J 455 d ; p. 333, (; 503- 
 506 ; p. 339, (J. 514 ^, A ; p. 344-345, 
 <} 516 d, No. 6 ; p. 365, (} 551 ; p. 366, 
 () 556 ; p. 416-417, (j 649 c ; p. 420- 
 424, § 654-661 ; p. 532, § 841 ; p. 
 547, 4 863 rf; p. 551, § 867 ; p. 568-
 
 1068 
 
 INDEX II. 
 
 Remedial Action — continued. 
 
 569, () 889 m, mm ; p. 592-593, <J 891*- 
 k ; p. 599-600, <^ 892 d ; p. 646-649, 
 ^ 893 c-h; p. 661-663, § 894-896; 
 p. 668-670, i) 902 g-m ; p. 675-676, 
 ^ 904 b. Also, Alteratives, Index 
 II. 
 illustrations of the rapidity with which 
 the reflex action of the nervous influ- 
 ence is determined with fatal efiect 
 by Hydrocyanic Acid and Strychnia 
 — being analogous to sudden death 
 from blows upon the epigastric re- 
 gion, and the shock of surgical opera- 
 tions, only in the former case the 
 nervous influence is fatally modified 
 in its nature, while in the latter it is 
 excited only in greater intensity and 
 suddenness, and against their sup- 
 posed absorption, p. 176, ^ 350^ -p 
 p. 298, () 476^ h; p. 320, (^ 494 dd 
 p. 523-524, (} 827 d ; p. 670, <J 902 / 
 p. 672, <J 904 b — and illustrations, in 
 connexion with the foregoing, of the 
 corresponding modus operandi of Opi- 
 um, Hyoscyamus, Atropia, Tobacco, 
 Belladonna, Rhus vernix, p. 338, ^ 
 516rf, No. 13; p. 592-593, ^ 89H k; 
 p. 673-675 — and farther illustrations 
 of the cfiicient instrumentality of the 
 nervous influence when syncope or 
 death is suddenly brought on, or dis- 
 ease suddenly arrested by loss of blood 
 or by mental emotions — all showing 
 how the nervous influence may be de- 
 termined directly upon the organic 
 constitution of the nervous system, 
 as well as upon other organs, either 
 by the suddenness of the shock or by 
 special virtues of morbific causes, and 
 all conspiring together in showing 
 that a common cause is the immedi- 
 ate agent, p. 109, () 230 ; p. 298, () 
 476^ h ; p. 304, H81 5" ; P- 307-308, 
 ^ 483 c; p. 334-335, i) 509-511 ; p. 
 G62-663, ^ 895, 896 ; p. 703-704, <;> 
 942 b ; p. 706-707, ^ 947-948 ; p. 709, 
 ^ 951 b — and associate with the fore- 
 going the sudden death of warm- 
 blooded animals from the bite of ven- 
 omous reptiles, and which was shown 
 by Girtanner, and again by Van Dcen 
 and Stilling, to be as quickly fatal in 
 eviscerated frogs as in the entire, p. 
 319, ^ 494 b; p. 325-326, () 828 h-d 
 — to all of which Chemistry is de- 
 sired to render an intelligible answer, 
 if dt can, consulting, also, in the same 
 connexion. Reflex Action, Mental 
 Emotions, Joy and Angek, Fear, 
 Disgust ; Stomach, Blows upon ; 
 Hydrocyanic Acid, Antispasmodics, 
 Sedatives {Aconite), Opium, Tobac- 
 co, Cantharides, Bloodletting, 
 Loss of Blood, Lidcx II. 
 
 Remedial Action — continued. 
 
 statement by Pereira that " the fact is 
 that in the present state of our knowl- 
 edge we cannot explain the modus 
 medendi of a large number of our best 
 and most certain remedial agents," 
 and that " the methodus medendi of 
 Cinchona, in its cure of intermittents, 
 is quite inexplicable," considered in 
 relation to Cinchona by interrogating 
 its methodus medendi as a Tonic in 
 opposition to the doctrine of " aiig- 
 mentalion of cohesion of the organic 
 mass," as in the process of tanning, 
 and thence deducing its operation in 
 all forms of disease, and of all oth- 
 er remedies, through alterative action 
 of reflex nervous influence, and far- 
 ther illustrated as an antiperiodic by 
 comparison with the antidotal nature 
 of Coflfee and the Cold dash in poi- 
 soning by Opium, and of Antispas- 
 modics in cases of spasm, and by the 
 morbific and curative eflects of a Se- 
 ton, and converting the whole to one 
 common account, \jhich is relative to 
 variously modified conditions of reflex 
 nervous action according to the nature 
 of the causes by which it is brought 
 into preternatural operation, and the 
 nature of the pathological conditions, 
 p. 338, <;i 514 rf ; p. 592-593, ^Q9\^k; 
 p. 596-597, (5i 892 i, c ; p. 676-681, ^ 
 904 c-905 a; p. 737-738, (^ 984 h. 
 Also, p. 67, ij 149-151 ; p. 73, i) 163 ; 
 p. 108-110, (j 227-232 ; p. 542, ^ 854 
 c-e; p. 554, l^ 871; p. 661-663, ^ 
 894-896 ; p. 664-665, (J 900-901. 
 
 modus operandi of warm poultices and 
 hot fomentations considered through 
 a series of analogies in relation to 
 other remedies, till we arrive at these 
 most simple, but important auxili- 
 aries in establishing the restorative 
 disposition, p. 68 1-683, i; 905 b. Also, 
 ■Poultices, Index II. 
 
 the supposed absorption of blue mer- 
 curial ointment contradicted by the 
 failure to detect the metal in the sol- 
 ids or fluids, and in being useful in 
 cases of indurated tumours only when 
 applied directly over them, and the 
 statement in Pereira's Materia Mcdi- 
 ca, which expresses the common doc- 
 trine that "the occasional use of the 
 warm bath promotes an absorption of 
 the blue mercurial ointment when ap- 
 plied to the skin," is remote from the 
 philosophy which refers the greater 
 eflects of the mercurial to an in- 
 creased susceptibility of the skin and 
 system at large, which the warm bath 
 alone " promotes," and which is more 
 cflTectually promoted by loss of blood 
 and cathartics when mercury is ad-
 
 INDEX II. 
 
 1069 
 
 Remedial Action — continued. 
 
 ministered internally, p. 367, <J 556 c; 
 p. 520, '^i 826 c ; p. 524, I) 827 e. Al- 
 so, Mercurial Remedies, Index II. 
 modus operandi of open air, change of 
 air, exercise, &,c., in their curative ef- 
 fects through complex influences of 
 reflex nervous action, p. 543, ^ 855 ; 
 p. 670-671, {) 902 in. Also, p. 335- 
 336, ^ 512 a, b ; p. 351-352, ^ 524 c ; 
 p. 354, ^ 525 c ; p. 359, <J 527 b ; p. 
 421-422, ^ 657 a; p. 685, ^ 905^ b. 
 Also, Exercise, Phthisis, Whoop- 
 iNG-CouGH, Ulcers, Food, Altera- 
 tives, Amenorrhcea, Index II. 
 demonstration of the coincident eflTects 
 of direct and reflex action of the nerv- 
 ous system when brought into simple 
 operation in voluntary and involun- 
 tary respiration, and in the voluntary 
 • and involuntary contraction of the 
 sphincter muscles, and carried as the 
 fundamental philosophy to the inter- 
 pretation of the modus operandi of 
 Mental Emotions and of physical 
 causes in the production and cure of 
 disease through the same direct and 
 reflex nervous action, and in proof, 
 also, of the substantive existence and 
 self-acting nature of the Soul and 
 Principle of Instinct, p. 106-112, ^ 
 222-234 ; p. 124-125, (} 243-246 ; p. 
 296. ^ 476 c ; p. 302, (J 481 b ; p. 323 
 -330, () 500 c-nn ; p. 338, 339, ^ 514 
 d, g, h ; p. 662, () 896 ; p. 666-670, () 
 902 b-m; p. 874-881, ^ 1071-1075. 
 Also, Mental Emotions, Respira- 
 tion, Sphincter Muscles, Iris, &c.. 
 Index II. 
 distinction between the foregoing ef- 
 fects of the nervous influence in the 
 natural processes and in the opera- 
 tion of remedial and morbific causes, 
 physical and mental — that, in the lat- 
 ter cases, the influence is alterative, 
 and attended by complex circles of 
 reflex action of the nervous system, 
 and exemplified by Cathartics, Emet- 
 ics, Counter-irritants, Grief, Hope, 
 &c., p. 67-68, <J 149-152 a; p. 121- 
 122, \ 237-240 ; p. 296, I) 476 c ; p. 
 323-324, ^ 500 c, d; p. 563-566, ^ 
 889 a-rr; p. 568-569, ^ 889 m,mm; 
 p. 592-593, <!i 89U /t; p. 646-650, ^ 
 893 c-i; p. 666-672, () 902 i-904 b; 
 p. 746, ^ 990J b. 
 organs not morbidly affected which may 
 be brought under the influence of rem- 
 edies 'contribute to the cure of such 
 as are diseased, through the alterative 
 influence of reflex nervous action, the 
 latter organs being now rendered sus- 
 ceptible of such influences by their 
 morbid states, and the influences thus 
 propagated will depend upon the na- 
 
 Remedial Action — continued. 
 
 ture of the remedy, as, for example, 
 Tartarized Antimony will establish a 
 powerful reflected influence from the 
 skin, though it do not induce sweat- 
 ing, but Hot Water taken internally, 
 and Fear, will exert no effect, though 
 they bathe the skin with perspiration, 
 while the compound powder of Ipe- 
 cacuanha and Opium, though it estab- 
 lish free diaphoresis, may prove mor- 
 bific in the same cases — showing, 
 also, that the same principle holds 
 with morbific causes, while there fol- 
 lows in the example before us, and in 
 other instances where the skin is 
 likely to contribute to the curative 
 process (as in the cases of Cathartics), 
 and along with other facts, a practical 
 corollary that the skin participates far 
 more than is apt to be supposed, not 
 only in remedial influences, but in 
 morbific, and that it should not be im- 
 paired in the former function by ex- 
 posure to cold, but rather promoted 
 by the warmth of a bed ; and the fol- 
 lowing sections, as with all other ref- 
 erences, have a direct or an illustra- 
 tive bearing upon the subject, p. 55, ^ 
 117; p. 59, ^ 129 i; p. 63, ^ 137 <^,- 
 p. 65, ^ 143 c; p. 66-67, (j 148; p. 
 68, ^ 152 a, b ; p. 230-232, f) 422-424 ; 
 p. 285-286, () 455 c-f; p. 302-303, ^ 
 481 c-e; p. 308-310, () 484; p. 319 
 -320, ^ 494 d, dd; p. 335-336, () 512 
 a, h; p. 338, ^ 514 d; p. 339-340, (j 
 514 h ; p. 350-353, ^ 524 a-d; p. 360 
 -361, § 528 ; p. 421-422, i} 657 a ; p. 
 451, ^ 692 a; p. 465-466, f) 715; p. 
 538-539, ^ 847 g--848 ; p 546-550, ^ 
 863 a-f; p. 563-564, <;i 889 a ; p. 565, 
 ^ 889 £r; p. 570, (j 889 n; p. 633- 
 635, ij 892| a-c ; p. 637, ^ 8924 d, e ; 
 p. 667-669, 1) 902 e-i; <J 956. Skin, 
 Cold, Miasm, Whooping - Cough, 
 Phthisis, Shower-Bath, Counter- 
 Irritants, Index II. 
 the occurrence of a secondary or sym- 
 pathetic disease is sometimes follow- 
 ed by a subsidence of a primary affec- 
 tion upon which the secondary de- 
 pends, as a consequence of alterative 
 reflex nervous actions which are an- 
 alogous to such as are instituted by 
 counter-irritants, though in a general 
 sense the primary affection gets no 
 benefit, but the contrary, from second- 
 ary developments, p. 65-66, () 143 c, 
 and references there ; p. 67, ij 148 ; p. 
 351-352, () 524 c; p. 360, ij 528 ; p. 
 421-422, (J 657 ; p. 506, ^ 804 ; p. 
 539, (j 848 ; p. 570. (^ 889 n ; p. 652- 
 654, (J 893 n; p. 679-681, () 905 a. 
 Also, Metastasis, Poultices, Index 
 II
 
 1070 
 
 INDEX II. 
 
 Remedial Action — contmued. 
 
 as displayed by the Mental Emotions, 
 whether in their primary connexion 
 with excito-motory nerves alone, or as 
 they give rise to subsequent devel- 
 opments of reflex nervous action (see 
 Mental Emotions and Disgust, In- 
 dex II), a perfect correspondence is 
 seen between their effects and those 
 of physical causes, operating alike 
 upon distant parts, or upon the or- 
 ganic constitution of the nervous cen- 
 tres, with both morbific and remedial 
 effect, or as anger and joy may extin- 
 guish life in the same sudden manner 
 as a blow upon the head, or through 
 those more complex nervous influ- 
 ences that spring from a blow upon 
 the region of the stomach, or from 
 the shock of a surgical operation, or 
 from drinking cold water in " a heat- 
 ed state of the body," or from hydro- 
 cyanic acia ; and we unavoidably de- 
 duce from the vast variety of efTccts 
 according to the nature of the emo- 
 tion or the physical cause, and from 
 the exact coincidences in all their ef- 
 fects, the certainty of an immediate 
 cause appertaining to the nervous 
 system and its endless modifications 
 according to the nature of the remote 
 exciting cause, and looking alone at 
 the mental emotions and those phys- 
 ical causes which arc incapable of ab- 
 sorption, and at the diseases which 
 grow consecutively out of each other, 
 we are constrained by all the immense 
 amount of proof which is thus sup- 
 plied to carry it analogically to the 
 interpretation of the modus operandi 
 of all other remedial and morbific 
 agents through alterative influences 
 of that same reflex action of the nerv- 
 ous system upon all parts beyond the 
 seat of their direct operation, and may 
 finally appeal for the same testimony 
 to the natural stimuli of life, to the 
 blood as it maintains the action of the 
 heart through the same process of re- 
 flex nervous influence, and so of the 
 urine and the bladder, the faeces and 
 the sphincter ani, the motions of the 
 iris, the sneezing as induced by snuff 
 and the sun's light, the process of 
 respiration, the act of deglutition, and 
 as some are imitated and others influ- 
 enced by the will, and as the genital 
 organs unfold the peculiarities of 
 youth, as pregnancy nauseates the 
 stomach and develoi)s the mammary 
 glands, and as parturition starts the 
 flow of milk and leaves the uterine 
 system in a condition to perpetually 
 excite a reflex nervous influence that 
 shall maintain the secretion till men- 
 
 Remedial Action — continued. 
 
 struation terminates the process, 
 while, also, the stimulus of suction 
 propagates a reflex nervous influence 
 upon the uterine organs, and main- 
 tains them in a condition to carry out 
 the final cause of lactation — or, turn- 
 ing to the natural displays of the mind, 
 we may pursue the coincidences be- 
 tween the effects of fear and the con- 
 tact of cold with the surface of the 
 body in starting on the instant the se- 
 cretion of urine, or as the odor of food, 
 or its expectation, and its presence in 
 the stomach equally determine an ex- 
 citing nervous influence upon the sal- 
 ivary glands, and as grief and sneez- 
 ing alike give rise to tears, and as the 
 sun's light and thinking of the parox- 
 ysm occasion sneezing, and as dis- 
 gust and its recollection, and an emet- 
 ic, and tickling the fauces alike pro- 
 duce vomiting — and we conclude by 
 commending, in connexion with the 
 foregoing, the following sections, 
 which are mostly relative to the Men- 
 tal Emotions and the Will, to the 
 candid attention of the Organic Chem- 
 ist and the impartial Materialist, the 
 former of whom will find these work- 
 ings of the mind through the nervous 
 influence applied in a great variety of 
 modes as parallel examples with the 
 influences of physical agents on life, 
 and designed to illustrate the modus 
 operandi of morbific and remedial 
 agents of every denomination and 
 shade, and the latter an irrefutable 
 demonstration, as the Author be- 
 lieves, of the substantive existence 
 and self-acting nature of the Soul, p. 
 89, () 188 ; p. 95, (^ 188^- d; p. 104, 
 <J 215 ; p. 107, <^ 227 ; p. 108-110, <J 
 228; p. 111,(;.233|; .p 124-125, (^ 243 
 -246 ; p. 128, ^ 226, 227; p. 230, ^ 422 
 b; p. 263, H46a; p. 281, <^ 451 a; P- 
 296, ^ 476 c ; p. 298, (J 476i h ; p. 300- 
 302, ^ 479, 480, 481 6; p. 312-313, ^ 
 487^,A;p.314, H88i; p. 823-331,'^ 
 500 c-o; p. 334-336, () 507-513 ; p. 
 337, ^ 514 c ; p. 338, <^ 514 f; p. 340- 
 341, <;. 514 /, m ; p. 356, (t 520 c ; p. 369 
 -370, ^ 565-568 ; p. 378-381, () 578 
 ■ r/-579 ; p. 382, ^ 581 c-e ; p. 387, (} 
 597 d ; p. 388, ^ 598 d ; p. 390, (J 
 600 h, 601 c ; p. 417, ^ 649 c ; p. 478, 
 ^ 740 a ; p. 523, <J 827 c ; p. 525- 
 526, <) 828 a-c ; p. 527, s'' 828 e ; p. 
 530, ^ 837 b ; p. 534, () 844 ; p. 547, 
 ^ 863 d; p. 580, <) 890^ d; p. 586, (} 
 891 p, h; p. 589-590, () 8'Jl p; p. 
 592-593, (Ji 89H A- ; p. 624, s^ 892? d ; 
 p. 631-632, <) 892f b, c; p. 662-663, 
 (J 896 ; p. 664, {) 900 ; p. 070-672, ^ 
 903-904 a ; p. 674, t) 904 b ,- p. 075,
 
 INDEX II. 
 
 1071 
 
 Remedial Action — continued. 
 
 ^ 904 b; p. 681-682, () 905 d; p. 
 701, ^ 938 b ; p. 704, () 943 ft-944 a ; 
 p. 707, <!i 947 ; p. 709, (J 951 d ; p. 
 714, () 958 6 ; p. 733, <^ 974 c ; p. 
 734-735, ^ 975 i-976 ; p. 745-746, ^ 
 960:^ a, 6 ,• p. 804, <^ 1040 ; p. 865- 
 868, () 1067 ; p. 874, ^ 1071 ; p. 875- 
 881, ^ 1072-1075; p. 886-891, ^ 
 1077. Also, the several topics al- 
 luded to in the foregoing preamble, as 
 embraced in Index II. 
 
 illustrated in all its phases by the mo- 
 dus operandi of Setons, whose variety 
 of eftects manifest all that is essen- 
 tially relative to the operation of all 
 remedial and morbific agents, physic- 
 al and mental, and as well in respect 
 to the direct local action of physical 
 causes as to their influences through 
 the medium of reflex action of the 
 nervous system, and exemplifying 
 also the distinction made by the Au- 
 thor between the transient operation 
 of the nervous influence as brought 
 into effect by a single or interrupted 
 applications of remedial and morbific 
 agents and by their undisturbed or but 
 temporarily suspended application, p. 
 679-681, <J 905 a ; p. 668-669, <;. 902 
 g-i. Also, Alteratives ; Antimo- 
 ny, Tartakized ; Sphincter Mus- 
 cles, Roosting, Index II. 
 
 if disease be limited to a part on which 
 remedies make their direct impression, 
 the change may then be instituted by 
 the direct action of the cause upon 
 the organic states of the part (the 
 nerves, however, participating more 
 or less, p. 475, ^ 733 h ; p. 483-484, () 
 745 c), and which may be also true 
 of morbific causes in their production 
 of disease, as seen, in either case, of 
 the curative or morbific effects of 
 caustics, &c. ; but it more commonly 
 happens that a reflected nervous in- 
 flluence upon the part is the immedi- 
 ate agent, p. 66-68, (} 148 ; p. 422- 
 423, ^ 658. Also, Remedies, where 
 this subject is illustrated through nu- 
 merous references. Index II.; ^ 514 b. 
 
 distinctions to be observed between im- 
 pressions made on vritabiUty, and 
 common, specific, and sympathetic sen- 
 sibility, and that the last only is con- 
 cerned in reflex action of the nervous 
 system, while causes affecting the 
 nervous centres in a direct manner 
 operate primarily through excito-mo- 
 tory nerves alone, p. 671, <S> 903. 
 Also, p. 88-90, ij 183-188 c ; p. 100- 
 103, {) 197-204; p. 280-282. <J 450- 
 451 ; Mental Emotions, Reflex Ac- 
 tion, individual Passions, Disgust ; 
 Brain, Inflammation of. Index II. 
 
 Remedial Action — continued. 
 
 the fundamental philosophy of disease 
 and its cure, according to the Au- 
 thor's interpretation, is perfectly sim- 
 ple, but involves very complex laws 
 and details, consisting in the former 
 respect of certain changes in the nat- 
 ural physiological conditions, and in 
 the latter of introducing other patho- 
 logical changes that shall subside 
 spontaneously into the natural condi- 
 tions, p. 3-4, s^ 2 b-d; p. 331, <;> 500 
 o; p. 122, i) 239, 240 ; p. 333, ^ 503- 
 505 ; p. 352, () 524 d; p. 413-414, (^ 
 639-640 ; p. 427, <^ 667-669 ; p. 473- 
 474, () 733 e, f ; p. 531, i) 839; p. 
 535-539, (j 847-850 ; p. 541, (} 852- 
 854 b; p. 542, (J 854 c-e ; p. 544- 
 
 545, <^ 858-859 a ; p. 592-593, § 89U 
 k ; p. 662, ^ 895 ; p. 663-665, <J 897- 
 901 ; p. 646, () 893 e ; g. 652, ^ 893 / ; 
 p. 679, () 905. Remedies ; Causes, 
 Morbific ; Therapeutics ; Diseases, 
 Self-Limited ; Small-Pox, Struc- 
 ture, Index II. 
 
 may introduce a variety of pathological 
 changes in any existing disease, ei- 
 ther of which may be adequate to the 
 cure, since all remedies operate by 
 establishing morbid states that will 
 soon subside spontaneously, the re- 
 flex nervous influence through which 
 the changes are effected being modi- 
 fied according to the special virtues 
 of every remedy (which includes the 
 dose, the nature of the disease, con- 
 tingent influences. Sec), and hence 
 the reason why loss of blood, cathar- 
 tics, tartarized antimony, mercury, 
 ipecacuanha, counter-irritants, syn- 
 cope from mental emotions, &c., will 
 alike remove common inflammation, 
 and certain " specifics" (cinchona, ar- 
 senic, guaiacum, colchicum, iodine) 
 specific forms of inflammation when 
 they would increase common inflam- 
 mation, and cinchona, arsenic, a 
 shock of the mind, and many other 
 things whose chemical and other 
 physical properties are totally differ- 
 ent from each other will break up an 
 intermittent fever, and which are also 
 propounded as problems for Organic 
 Chemistrv, p. 107-111, () 227-233J ; 
 p. 333, •^■'503-505; p. 417, ij 649 c, 
 650 ; p. 424-425, () 662 a-e ; p. 428, 
 <J 671-674 ; p. 486, ^ 750 h ; p. 542, 
 ^ 854 c-e; p. 544, ^ 857; p. 545- 
 
 546, () 859 i-861 ; p. 547-550, () 863 
 d ; p. 553, (J 870 an ; p. 596-597, (> 
 892 b, c; p. 604-606, (^ 892 m-p ; p. 
 611-612, ij 892i/-2 ; p. 659, () 893 q ; 
 p. 662-665, (J 896-901 ; p. 709, <J 951 
 b; p. 737, >J 984; i, 892 b; () 892^ 
 v; \ 904 d; fj 1059. Mental Emo-
 
 1072 
 
 INDEX II. 
 
 Remedial Action — coritinued. 
 
 TioNs, Joy and Anger, Fear, Hope, 
 Disgust, &c.. Index II. 
 
 in very complex conditions of disease, 
 as idiopathic fever attended by in- 
 flammations of many parts, the rela- 
 tions between the morbid states may 
 be such that a single remedy, as loss 
 of blood, tartarized antimony, or mer- 
 cury, may overthrovsr the entire as- 
 semblage, p. 63, ^ 147 c-e ; p. 65, ^ 
 143 c; p. 66-67, () 148-151 ; p. 298, 
 () 476.^ h ; p. 337, () 514 b, c ; p. 367, 
 ^ 557 a, h ; p. 465-466, () 715 ; p. 538, 
 ^ 847 g; p. 552-554, ^ 869-871 ; p. 
 662-664, <) 895-900 ; p. 731-732, () 
 970 c ; p. 739-740, ^ 986-987. 
 Remedies — continued from Index I., 
 
 operate through the natural laws which 
 govern organic processes in the ani- 
 mal kingdom, as do also morbific 
 causes, but bring into preternatural 
 effect the nervous influence. See this 
 subdivision under Reflex Action of 
 THE Nervous System. Also, Hu- 
 moral Pathology, Chemical Physi- 
 ologists, /nrfcx 77. ,• Organic Chem- 
 istry, Index I. and II. 
 
 should be addressed to the pathological 
 conditions as denoted by the whole 
 assemblage of symptoms, and not to 
 isolated ones, p. 65-67, () 143 c-151 ; 
 p. 73, ^ 163 ; p. 147, () 330 ; p. 424- 
 425, ^ 661-662 ; p. 428, () 694 a; p. 
 430-433, i) 675-676 a ; p. 437-442, ^ 
 684-686 ; p. 456-460, «^ 695-708 ; p. 
 479-480, <J 471 a, b ; p. 486, (} 750 b ; 
 p. 487-489, ^ 756 ; p. 498-499, <J 785 ; 
 p. 505, ^ 801 ; p. 510, ^ 813 b ; p. 541 
 -542, ^ 854 bb ; p. 545, () 859 b ; p. 
 548-550, ^ 863 d; p. 551-554, () 867 
 -871: p. 560-561,(^886-888; p. 597 
 -600, ^ 892 c, d ; p. 603-004, ^ 892 k ; 
 p. 606, ^ 892 ;; ; p. 609-610, <J 892i 
 (/; p. 613, () 8921 c; P- 615-617, ^ 
 892i f-k ; p. 636-642, !) 8924 d-i ; p. 
 063-665, {} 897-901 ; p. 724-728, (J 
 901 ; p. 729-732, ^ 906-970 ; p. 732- 
 736, () 971-980. 
 
 by their impression upon parts with 
 which they come in contact, if their 
 nature admit of it, or according to 
 other impressions arising from loss 
 of blood, exercise, &c., influences are 
 transmitted tlirough sensitive fibres of 
 compound nerves (mainly of the sym- 
 pathetic) to the cerebro-spinal axis, 
 whicii rouse and reflect the nervous 
 influence upon various parts of the 
 organism, but particularly upon the 
 seats of disease, and when Mental 
 Emotions give rise to analogous ef- 
 fects, the principle is the same, only 
 the influence is now primarily exerted 
 directly upon the nervous centres and 
 
 Remedies — continued. 
 
 the first movement centrifugal, and 
 what is true in this respect of reme- 
 dies is equally so of morbific causes, 
 p. 88, () 183-185; p. 89, <J 188 a, b; 
 p. 95, () 188^ d, 189 a ; p. 96-98, ^ 
 189 c-191 b; p. 101-103, <J 201-208 ; 
 p. 106-112, 1^222-234 i; p. 230-231, 
 ^ 422-423 ; p. 253, () 4AI d; p. 262- 
 270, () 446 a-447 d; p. 282, ^ 451 f; 
 p. 283-284, (} 452 c, 453 ; p. 285-286, 
 <) 455 d-4:57 ; p. 289, 1) 459 g ; p. 295, 
 () 476 a; p. 296, ^ 476 c, 476^^ J; p. 
 298-299, (j 477 a; p. 301-303, () 481 
 b-d ; p. 309-310, ^ 484 i-485 ; p. 312 
 -314, () 487 g--488i ; p. 315-318, (} 
 492-493 ; p. 320, () 494 dd ; p. 321, § 
 496, 497 ; p. 323-362, (J 499-530 ; p. 
 364,1^547; p. 415-417, « 649 ; p. 421 
 -423, () 057-658 ; p. 430-432, <) 675 ; 
 p. 451, ^ 691-692 ; p. 478-479, ^ 740 
 -741 ; p. 509, i^) 811.; p. 515-516, ^ 
 819 J-820 ; p. 522-523, () 8.27 b, c ; p. 
 530-533, <;» 837 i-841 ; p. 534, <) 844 ; 
 p. 541-542, (} 854 bb ; p. 544, () 857 ; 
 p. 545, (J 859 a-c ; p. 547-550, () 863 
 d ; p. 551-553, «J 867-870 ; p. 553, ^ 
 870 aa ; p. 554-556, () 872 ; p. 592- 
 593, ^891 k ; p. 644-652, ^ 893 c-m ; 
 p. 661-683, ^ 894-905; p. 692-693, 
 ^ 914-921 ; p. 698-699, <) 929-935; 
 p. 703-710, <^ 940-952 ; p. 724-723, 
 <) 961-964; p. 732-736, () 972-980; 
 p. 745-746, I) 990 s-990i b ; p. 766- 
 767, (J 1009 a,b; p. 862-868, (^ 1060 
 -1067. 
 operate through influences of reflex 
 nervous action according to structure 
 and special vital constitution of differ- 
 ent farts (some remedies affecting 
 particular tissues as united in certain 
 compound organs only, or only par- 
 ticular parts of a continuous tissue), 
 and according to the changes they un- 
 dergo from infancy to adult age, and 
 temperament, and especially as they 
 may be diverted by morbid states from 
 their natural condition, which renders 
 them more susceptible of remedial in- 
 fluences, but also according to the nat- 
 ural stimuli of life, though differing 
 from the natural not only in the far 
 greater manifestations of the reflex 
 nervous influence, but in the altera- 
 tive effect it exerts in diseased states 
 of the body — the same being true in 
 principle of morbific causes ; while, 
 also, many natural stimuli, especially 
 food, may be profoundly morbific or 
 curative in diseased states of the 
 body, p.3,()2b; p. 55. (J 113-117; 
 p. 59, ^129^-?; p.61-73, H33-161 ; 
 p. 98, «J 191 b; p. 120-122, i} 237- 
 240 ; p. 130, (J 278 ; p. 231, ^ 422 c- 
 424 ; p. 284-289, <} 454-461 ; p. 352,
 
 INDEX II. 
 
 1073 
 
 Remedies — continued. 
 
 ^ 524 d; p. 354-361, ^ 526-530; p 
 364, <^ 548 ; p 365-368, ^ 551-560 ; 
 p. 373-390, t) 574-601 ; p. 399, () 630 , 
 p. 415-416, (} 648 rf-649 h; p. 418, ^ 
 651 a, b; p. 421-422, i) 657 a, b; p. 
 424, ^ 662 ; p. 425, () 663 ; p. 428, (} 
 671; p. 435, 1^680; p. 467, i!» 718 ; p. 
 468-469, ^ 722 ; p. 502-504, (^ 793- 
 798 , p. 509, ^811; p. 520-521, ^ 826 
 d; p. 522-523, () 827 b, c; p. 530, (J 
 837 b ; p 535-539, () 847-850 ; p. 541 
 -542, () 854 bb ; p. 543, () 855 ; p. 545, 
 ^ 859 a-c ; p. 553, ^ 870 aa ; p. 554, 
 ij) 871 ; p. 565-566, ^ 889 g, i ; p. 579 
 -580, ^ 890.^ (i ; p. 597-598, () 892 c ; 
 p. 612, (J 892^ a ; p. 624, () 892| rf ; p. 
 634-636, (J 8924 J, c ; p. 647, (} 893 c ; 
 p. 649, <J 893 k; p. 651, ^ 893 k; p. 
 657-659, ^ 893 ;>, q; p. 661-665, <5i 
 894-900 ; p. 669, <^ 902 t ; p. 676-679, 
 ^ 904 c, (i; p. 703-711, ^ 940-952; 
 p. 731, ^ 970 c; p. 732-736, (J 972- 
 980 ; p. 745-746, ^ 990^ ; p. 864, ^ 
 1066. 
 distinction in the natural constitution of 
 different tissues and of parts of a con^ 
 tinuous tissue, and of compound or- 
 gans of which they form component 
 parts, illustrated by natural stimuli, 
 and by their products, and by their 
 disturbing influences when morbidly 
 affected, p. 61, () 132-133 b; p. 62- 
 68, ^ 135-152, and references there, 
 and ut supra — and farther illustrated 
 by the effects of Aloes (showing that 
 it does not act particularly, as gener- 
 ally supposed, upon the rectum, but 
 mostly on the small intestine), p. 
 467, ^ 718 ; p. 566, i) 889 i ; p. 856- 
 857, {) 1063 b; also, p. 565-566, (} 
 889 g — and by other cathartics. Rhu- 
 barb, Senna, the Saline, Calomel, Jal- 
 ap, &c., according to the special vir- 
 tues of each, their doses and combina- 
 tions, p. 554-556, ^ 872 a ; p. 566, () 
 889 i; p. 568-569, () 889 m,mm; p. 
 571, ^ 890 b; p. 575, (^ 890 i; p. 838 
 -861, <J 1058-1065— and by Tartar- 
 ized Antimony, Cantharides, Iodine, 
 Ergot, and lAmerous other individual 
 substances. See the Art teles, Index 
 11. 
 tabular views of the foregoing consid- 
 erations relative to peculiarities of 
 structure as they respect the opera- 
 tion of remedies and morbific causes, 
 and in the relation of tissues to com- 
 pound organs, illustrated by their rel- 
 ative liability to inflammation in dif- 
 ferent parts, and the relative degrees 
 of danger, and the relative exigencies 
 for loss of blood as the disease may 
 affect one part or another, p. 69-73, 
 «J 160-162. 
 
 Y 
 
 Remedies — continued. 
 
 render the nervous influence alterative, 
 excitant, sedative, or simply depress' 
 ant, according to the nature of each 
 one (which includes the dose, combi- 
 nations, &c., and the modifying influ- 
 ences of disease and surrounding cir 
 cumstances), and this whether it op- 
 erate through reflex action, as in the 
 case of external causes, or in a direct 
 manner, as with mental emotions — 
 and so, also, with morbific causes, p. 
 95, >J188irf; p. 107-1 11, 1^226-233 J; 
 p. 253, () 441 d; p. 296, () 476 c; p. 
 301-305, <) 481 A-482 ; p. 306, 1) 483 ; 
 p. 315, ^ 492 ; p. 323-353, I) 500 c- 
 524 ; p. 365-366, i) 551-556 ; p. 427- 
 428, (J 670, 671 ; p. 430-433, (} 675 ; 
 p. 480, i) 743 ; p. 509, ^J 81 1 ; p. 512, 
 •J 817 ; p. 523, ^ 827 ; p. 534, <^ 844 ; 
 p. 565, i) 889 /, g ; p. 570, <5 889 n ; p. 
 657, ^ 893;; ; p. 661-663, <J 894-896 ; 
 p. 666-672, ^ 902 6-904 a ; p. 724- 
 727, § 961-963; p. 733-735, () 974- 
 976; p. 773-775, () 1023-1024; p. 
 829, {) 1057 a; p. 865-868, i) 1067. 
 
 their operation through alterative influ- 
 ence of reflex nervous action rendered 
 manifest by the special relations of 
 the alimentary canal to the nervous 
 system, and other special anatomical 
 provisions, p. 335-336, <J 512 a-513 ; 
 p. 565-566, (f 889 g. Also, Mucous 
 Tissue, first subdivismi, L.icte.\ls, 
 Index II. 
 
 what general considerations should de- 
 termine the use of one remedy or an- 
 other, and other relative things, p. 430 
 -433, <) 675 ; p. 438-442, ^ 688 b-d; 
 p. 540, ^ 851 ; p. 543-544, ^ 857 ; p. 
 545, () 859 b ; p. 556-557, § 873-875 ; 
 p. 560-562, () 885-888 ; p. 567-568, () 
 889 / ; p. 570, () 889 n ; p. 600, (> 892 
 d ; p. 605, () 892 m ; p. 740, i) 989. 
 
 according to the nature of each one, or 
 of two or more in combination, and 
 according to the number of constitu- 
 ent parts, respectively, a new remedy 
 is created, which enables us to great- 
 ly simplify the Materia Medica, and 
 exemplified — showing, also, the im- 
 portance of extemporaneous prescrip- 
 tions, and the injurious tendency of 
 standing formulae, and how the reflex 
 nervous influence may be variously 
 directed in the cure of diseases by ar- 
 tificial means — and what is true of 
 the effects of one, or more remedies 
 in combination, or in consecutive or- 
 der, is also, in principle, of morbific 
 causes, p. 27, (J 52 ; p. 94-95, ^ 188^ 
 d; p. 107-110, i) 227-232 ; p. 340, i) 
 514 h; p. 417, () 650; p. 418-419, ^ 
 652 ^'-653 c ; p. 424-425, ^ 662-663 ; 
 p. 545, ^ 860 ; p. 547, 9 863 d ; p. 554 
 
 Y
 
 1074 
 
 INDEX II. 
 
 Remedies — continued. 
 
 -556, (j 872 a ; p. 5G6-567, <J 889 k ; 
 p. 661-662, ^ 894; p. 838-841, \ 
 1058 ; p. 851-862, <J 1060-1065. 
 
 combinations and uses of, and their phi- 
 losophy in variously modifying the al- 
 terative influence of reflex nervous 
 action, ibid. 
 
 often possess compound virtues, when 
 they should be regarded as acting as 
 a whole ; but one of the virtues, al- 
 though in opposition to each other, 
 may take full eflect without the oth- 
 ers being manifested, according to the 
 nature of the pathological conditions, 
 as, either the tonic or antiphlogistic 
 virtue of Cinchona may be fully in 
 the ascendant in the same disease, or 
 the tonic, stimulating, antiphlogistic, 
 or astringent virtue of Rhubarb — such 
 remedies being also distributed in the 
 Author's Therapeutical Arrangement 
 of the Materia Medica into as many 
 different groups as they are distin- 
 guished for two or more virtues, p. 
 424, <J 662 b ; p. 430-433, i) 675 ; p. 
 487-489, ^ 756 a, b ; p. 553, () 870 aa ; 
 p. 554-556, <^ 872 a ; p. 571-572, () 
 890 b; p. 575, <J 890 t, k; p. 581, () 
 890.^^ e ; p. 597-598, ^ 892 c ; p. 605 
 -607,<J892m-r; p. 611,<^892iA; p. 
 855, () 1062. 
 
 the right doses of, and the extent of 
 other means, next in importance to 
 the right remedies, but often of very 
 difficult adjustment, and some exam- 
 ples — also, against the chemical and 
 other physical hypotheses, and de- 
 monstrative of the accuracy of the 
 Author's doctrine of their operation 
 through alterative influence of reflex 
 nervous action, p. 532-533, <S> 841 ; p. 
 543-544, <) 857 ; p. 553, <;» 870 aa ; p. 
 566-569, (^ 889 k-m?n ; p. 598-604, ^ 
 
 892 d-k; p. 650-651, i) 893 i-k ; p. 
 672, {) 904 a ; p. 675-676, ^ 904 b ; p. 
 711-714, () 954-958; p. 726-728, ^ 
 961 c-964 c; p. 729-730, ^ 968-969 ; 
 p. 733-736, () 974-980 ; p. 748-749, 
 <) 992 b, c ; p. 750-751, l) 994-999 ; p. 
 840-841, () 1058 d; p. 870-872, ^ 
 1068 c, d. 
 
 time and order of their administration 
 next in importance, and variously ex- 
 emplified, p. 367, () 556 c ; p. 428, (} 
 672 ; p. 430-433, () 675-676 a ; p. 548 
 -549,^ 863 rf; p. 551-554, <J 867-871 ; 
 p. 570, <) 889 n ; p. 595-596, <S> 892 aa ; 
 p. 595-598, <} 892 ; p. 600, ^ 892 d ; 
 p. 641-642, () 892A i ; p. 648-649, ^ 
 
 893 g, h; p. 658-659, () 893 p; p. 
 728, <) 964 d; p. 841, ^ 1058 c. 
 
 in disease, their action is on common 
 ground with morbific agents, physic- 
 , al and mental, and the natural stimuli | 
 
 Remedies — continued. 
 
 of life, all of which operate with in- 
 creased intensity in morbid states, and 
 according to the varying susceptibili- 
 ties, and many remedies, such as tar- 
 tarized antimony, iodine, ergot, arse- 
 nic, &c., which are powerfully cura- 
 tive in their smallest doses, exert no 
 effect in such doses upon healthy or- 
 gans, and being alike true whether 
 operating upon the organic constitu- 
 tion of parts or through reflex action 
 of the nervous system, a simple exem- 
 plification of the whole of which is seen 
 in the failure of a mild solution of the 
 acetate of lead to produce any effect 
 upon the tunica conjunctiva in its natu- 
 ral state, which may quickly remove a 
 mild inflammation of the membrane, 
 or, on the contrary, aggravate to a more 
 intense degree, and connecting this 
 with the curative and morbific effects 
 of a Setori upon the same disease 
 when inserted in the nape of the neck 
 (p. 679-681, <) 905 a), we arrive at 
 the combined aspect of the operation 
 of remedies through alterative influ- 
 ences of reflex nervous action, either 
 for good or for evil, upon parts con- 
 cealed from observation, and upon 
 their organic constitution, and accord- 
 ing to the increased and varying sus- 
 ceptibilities arising from disease, as 
 well also according to the natural con- 
 stitution of the affected parts, p. 3, ^ 2 
 b; p. 59, {}U9h ; p. 63, (J 137 <i ; p. 65, ij 
 143 c ; p. 67, (j 149-151 ; p. 68, ^ 152 
 b ; p. 120-122, <J 237-240 ; p. 332-334, 
 (j 502-506 ; p. 339-340, ^ 514 ^, A ; p. 
 352, (J 524 (Z; p. 415-417, <^ 649 a-d; 
 p. 421-423, (j 657-658; p. 435, () 
 680 ; p. 456, () 698 ; p. 465-466, () 
 715 ; p. 482, ^ 744 ; p'. 509, (^ 810 ; 
 p. 531, <;• 838-840 ; p. 535-539, <J 847- 
 850 ; p. 541-542, (j 854 hb ; p. 545, ij 
 859 a, b ; p. 553, ^ 870 aa ; p. 607- 
 608, I) 892 a, b ; p. 612, (^ 892^ a ; p, 
 623, ^ 8921 c; p. 665-671, ^ 902 «- 
 m; p. 709, () 961 b-d ; p. 724-726, () 
 961 a-e ; p. 733-736, ^ 974-980. 
 from the foregoing aiftl other premises 
 of a fundamental nature we reach the 
 conclusion that if disease be limited 
 to the part upon which remedies 
 make their direct impression, the sal- 
 utary influence may be exerted most- 
 ly upon the organic states without 
 the intervention of the nervous influ- 
 ence, excepting so far as the nerve.9 
 constitute a part of the structure, 
 which is particularly true of a few 
 remedies which arc intended to be 
 thus restricted, such as caustics, and 
 many applications to cutaneous dis- 
 eases ; but it is in respect to most
 
 INDEX II. 
 
 1075 
 
 Remedies — continued. 
 
 remedies, as with most morbific caus- 
 es in their production of disease in 
 parts upon which their direct morbific 
 impression is made, that, in the for- 
 mer case, the curative etfect upon a 
 diseased part as it respects the di- 
 rect impression is greatly the result 
 of an alterative reflex nervous influ- 
 ence reverberated through the appro- 
 priate nerves of the part, or as the 
 remedy or morbific cause may insti- 
 tute sources of reflex action in other 
 parts — all of which may be illustrated 
 by the act of vomiting, whether pro- 
 duced by an emetic, or the gravid ute- 
 rus, or disease of the kidney, or to- 
 bacco applied to the surface, or tick- 
 ling the fauces, or by a mental emo- 
 tion, when, in all the cases, a reflex 
 action is reverberated upon the stom- 
 ach through the excito-motory fibres 
 of the same nerve that transmitted the 
 primary impression to the nervous 
 centres, p. 66-67, ^ 148 ; p. 89, «J 188 
 a ; p. 102, <J 203 ; p. 284-287, § 453 
 c-459 ; p. 289, H61 ; p. 296, ^ 476 c ; p. 
 302,^i8lb; p. 31 5-316, <J 492; p. 323 
 -324, (i 500 c ; p. 327, () 500 i ; p. 338, 
 ^5Ud; p. 339-341,^ 514 g--m; p. 347 
 -348, <J 516 d, Nos. 11-13; p. 416- 
 417, ^ 649 c; p. 421-423, § 657 a- 
 658 ; p. 475, () 733 k ; p. 483-484, ^ 
 746 ; p. 522-523, ^ 827 b, c; p. 531, 
 <5 840 ; p. 547-550, <J 863 d ; p. 666- 
 672, ^ 902 6-904 b, p. 336, ^ 5Ub. 
 the foregoing inquiry has been intro- 
 duced under the Article Remedial 
 Action by a reference to certain sec- 
 tions where the modus operandi of 
 Cinchona and Mercury and some oth- 
 er things is shown to depend upon al- 
 terative influences of reflex nervous 
 action, and we may now look at other 
 sections relative mostly to Tartarized 
 Antimony, partly for the purpose of 
 illustrating what is known as the cu- 
 mulative eflTect of remedies (that is to 
 say, when their effects are not partic- 
 ularly manifested until after a num- 
 ber of doses, and there may be then a 
 sudden and powerful display of a cu- 
 rative or morbific nature), and in part 
 as a farther demonstration against the 
 doctrine of operation by absorption, 
 since, if it be allowed that the medi- 
 cine is absorbed, all itp influences upon 
 disease may be shown to depend on 
 its action upon the stomach and con- 
 sequent reflex actions of the nervous 
 system — for if the doctrine of absorp- 
 tion were true, it should not be nec- 
 essary to carry its small therapeutical 
 doses to near the point of nausea to 
 subdue inflammations and febrile ex- 
 
 Remedies — continued. 
 
 citements, while it is one of the most 
 familiar facts that the dose must gen- 
 erally be gradually increased, often 
 from the sixteenth of a grain to half 
 a grain or more, to maintain the effect 
 upon disease, the skin, general ex- 
 citement, &c., which was originally 
 produced by the smallest dose ; but 
 so long as the sixteenth or the fourth 
 of a grain manifest an approximation 
 to the point of nausea, it will as ef- 
 fectually break down arterial excite- 
 ment, produce perspiration, and over- 
 throw pneumonia as effectually as 
 when two grains may be necessary to 
 the same amount of impression upon 
 the stomach, and without which the 
 symptoms will again increase — and 
 also exemplified to the same eflect by 
 the manner in which it overcomes 
 croup, in which affection no relief will 
 follow till it produce some degree of 
 nausea, whatever the quantity exhilv 
 ited, but as soon as its nauseating in- 
 fluence is felt, the well-marked symp- 
 toms of the disease begin to yield, 
 and rapidly so when vomiting ensues, 
 showing that the whole effect is due 
 to the influence upon the stomach, 
 which determines the act of vomiting 
 — and, finally, according to the doc- 
 trine of absorption, there should be 
 no necessity whatever between this 
 gastric irritation and the salutary ef- 
 fects of the remedy, and the only rule 
 should be to introduce a certain quan- 
 tity into the circulation, p. 344-345, 
 <) 516 d, No. 6 ; p. 351, (} 524 a. No. 
 1 ; p. 355, ^ 526 a ; p. 356-357, ^ 
 514 b,c; p. 365-368, () 549-559 ; p. 
 431, ^ 675; p. 486, ^ 750 b; p. 530- 
 533, ^ 837 b-8il ; p. 547, () 863 d ; 
 p. 556-557, <!> 873 ; p. 567-569, <J 889 
 l-mm; p. 612-613, ^ 892i- a, b; p. 
 634, (} 8924 b ; p. 638-640, (} 892-+. 
 g; p. 641, (J 892f i; p. 666-670, ^ 
 ^ 902 b-m ; p. 675-676, () 904 b ; p. 
 833, <J 1057 h; p. 850-851, <} 1059. 
 physiological distinctions between Ca- 
 thartics and Emetics, and correspond- 
 ing effects of Mental Emotions, and 
 other relative considerations, and as 
 acting through the medium of the 
 nervous influence variously modified 
 according to the nature of its exciting 
 cause, p. 547-550, ^ 863 d; p. 631- 
 632, (} 892i b. Also, Ment.\l E.mo- 
 TioNS, Disgust, C.vth.\rtics, Emet- 
 ics, Index II. 
 the usage of reasoning from the results 
 of experiments with remedies upon 
 
 t man in health to their effects upon 
 morbid conditions must be included 
 among the important obstacles in the
 
 1076 
 
 INDEX II. 
 
 Remedies — cmitinucd. 
 
 way of philosophical as well as prac- 
 tical medicine on account of the vital 
 changes in the diseased parts, and the 
 alterative influences of these changes 
 upon the susceptibilities of all parts 
 (p. 535-539, () 847-850, and Law of 
 Adaptation, Index I. ; Diseases, 
 Self-limited, cecond subdivisioii), 
 and especially from similar experi- 
 ments upon animals, who differ not 
 only from man, but each species 
 from others in their vital constitu- 
 tion, p. 3, (Ji 2 i; p. 63, <J 137 d; p. 
 65, ^ 143 c ; p. 67, ^ 149-151 ; p. 68, 
 ^ 152 ^» ; p. 73, <J 163 ; p. 122, <) 240 ; 
 p. 148, ^ 334 ; p. 430-433, () 675-676 
 a ; p. 435, «^ 680 ; p. 456, () 698 ; p. 
 465-466, ^ 715; p. 482, <) 744; p. 
 498, 784 a ; p. 509, ^ 810 ; p. 530, () 
 837 cc-840 ; p. 535-539, () 847-850 ; 
 p. 541-542, <J 854 bb ; p. 545, <J 859 a, 
 b ; p. 548-549, <) 863 d ; p. 607-608, 
 ■5) 892 a, 6; p. 612, ^ 892^ a; p. 623, 
 ^ 8921 c ; p. 676, () 904 c— and when 
 injected into the circulation, they 
 must of necessity give rise to some 
 of the effects, among a greater varie- 
 ty, as when administered by the stom- 
 ach, p. 529-533, () 836-841, though 
 these may have been as much over- 
 rated as certain supposed effects of 
 quinine, p. 603, ^ 892 k, and which is 
 rendered the more probable by the 
 statements of other distinguished ob- 
 servers as to the effects of morbific 
 agents when injected into the circu- 
 lation, p. 482, <) 744 ; p. 527-528, <5> 
 830-831 ; p- 932, () 1088 d. 
 
 their operation by absorption, as gener- 
 ally interpreted, very embarassing to 
 a distinguished advocate thereof on 
 account of a perplexing difficulty of- 
 fered by the portal vein, p. 527, <J 
 829. 
 
 as disease consists of a succession 
 of changeable pathological causes, 
 whether it terminate favorably or fa- 
 tally, remedies operate like morbific 
 causes, and for other reasons assign- 
 ed, but with the difference that the 
 former are less profoundly morbific, 
 and substitute pathological states that 
 are readily capable of subsiding spon- 
 taneously through the inherent tend- 
 ency of the properties of life to re- 
 turn to their natural states, and there- 
 fore by no possibility can they trans- 
 mute the morbid into a healthy con- 
 dition, which is alone the work of elab- 
 orate processes of organization — all 
 of which are impossible problems for 
 Chemistry and Physics, especially if 
 connexion with the variety of means 
 that will subdue a given form of dis- 
 
 Remedies — continued. 
 
 ease, the necessity of accurate doses, 
 and the importance and the ability 
 of projecting a plan of treatment con- 
 sisting of a variety of means to be 
 applied in an exact consecutive order 
 to fulfill the intention of introducing 
 a succession of pathological changes 
 of which each one is necessary to the 
 next in order, from the abstraction of 
 blood to the cathartic, then to the an- 
 timonial or mercurial alterative, then 
 a blister, mayhap quinine, or arsenic, 
 or guaiacum, or colchicum, or iodine, 
 &c., and where there are but shades 
 of difference in the morbid states — 
 while, also, any given form of disease, 
 such as intermittent fever, may be ar- 
 rested by cinchona, or arsenic, or cob- 
 web, or an emetic, or loss of blood, or 
 a mental emotion, and syphilis by 
 mercury, or iodine, or bromine, &c., 
 each one a simple element, but hav- 
 ing physical properties and chemical 
 relations very widely different, and 
 which may be just as consistently as- 
 sumed to form salts with each other 
 as that they will alike cure the same 
 conditions of disease by chemical ac- 
 tion upon the tissues, or upon the 
 blood or miasms, and considering, too, 
 that less than a grain of quinine or 
 of arsenious acid will subdue an in- 
 termittent fever, or that quantity of 
 the latter break up a chronic cutane- 
 ous disease over the whole surface of 
 the body — but thus showing that the 
 substitution of a large variety of path- 
 ological changes corresponding with 
 the alterative virtues of the several 
 remedies, respectively, is capable, 
 each one, of placing the more pro- 
 foundly morbid states in the way 
 of spontaneous subsidence, so that, 
 whether it be a simple intermittent 
 fever or complicated with cutaneous 
 eruptions, when the impression is 
 made that will enable Nature to throw 
 offthe fever, the same artificial change 
 may equally induce, upon the same 
 recuperative principle, the disappear- 
 ance of the chronic affection of the 
 skin, p. 67, () 149-152 ; p. 87, ^ 177- 
 182; p. 122, (J 237-240; p. 147, <) 
 330; p. 333, ^ 503; p. 417-418, (j 
 650 ; p. 424, () 662 ; p. 426, ^ 666 ; p. 
 428, () 672; p. 430-433, <J 675; p. 
 438, ^ 684, IVo. 9 ; p. 470-471, ^ 729 
 -731 ; p. 473-474, <J 733 c; p. 486, ^ 
 750 b ; p. 487-488, () 756 ; p. 535- 
 539, ^ 847-850; p. 541-545, ^ 854- 
 860 ; p. 547-549, ^ 863 d ; p. 551- 
 554, ^ 867-871 ; p. 561-562, <J 888 a- 
 d ; p. 596, ^ 892 /;, c ; p. 606, ^ 892 p ; 
 p. 637, () 8924 <Z, c ; p. 648-649, () 893
 
 INDEX II. 
 
 1077 
 
 Remedies — continued. 
 
 g; p. 661-670, <J 894-902 ; p. 679- 
 683, ij 905 a, J ; p. 696, .;. 926. 
 it follows, therefore, that one remedy 
 prepares the way for another, and in 
 a variety of respects, p. 367, <J 556 c ; 
 p. 423, ^ 659 ; p. 424, ^ 662 b ; p. 428, 
 ^ 672 ; p. 545, ^ 859 b; p. 551-552, 
 <J 867-868 ; p. 554-556, ^ 892 ; p. 
 561, ^ 888 ; p. 595-600, ^ 892 a-d ; 
 p. 658, () 893 p ; p. 664-665, () 900- 
 901 ; p. 843, () 1058/; p. 844-847, (; 
 1058 m-q. 
 the Author anticipates an assumption, 
 when the doctrine of the operation of 
 remedial and morbific causes, physic- 
 al and mental, through reflex and di- 
 rect action of the nervous system, can 
 no longer be resisted, that the nerv- 
 ous influence is the chemical agent 
 which does the work, and answers 
 that the obstacles will be in no re- 
 spect removed, for, in this special re- 
 spect, in carrying out the Chemical 
 hypothesis, there should be no varie- 
 ties in results corresponding to the 
 nature of the remote exciting causes, 
 but the nervous influence should al- 
 ways act in conformity vi'ith any spe- 
 cial agent employed in the Labora- 
 tory, and therefore produce uniform 
 phenomena, at least in any given part, 
 as when an acid unites with an alka- 
 li, or platina predisposes oxygen to 
 unite with hydrogen, while, on the 
 contrary, the Author's doctrines con- 
 form to the very maxim of the Law — 
 qui facit per alium, facit per se. As 
 
 ABOVE. 
 
 their effects owing to the mutability of 
 the properties of life, which is design- 
 ed for useful purposes. See Remedi- 
 al Action ; Recuperation, Law of, 
 Index II. ; Vital Properties, In- 
 dex I. 
 
 are abortive whenever the morbid 
 changes transcend the recuperative 
 law, p. 420, ^ 654 a ; p. 552, <^ 868 
 b; p. 661, mottoes; p. 728, <J 964 c. 
 Also, Recuperation, La.w of, Index 
 II. ; Vital Properties, Index I. 
 
 the great law of recuperation demon- 
 strable in the self-limited diseases, 
 and in animals, p. 531, () 839 ; p. 544 
 -545, i) 858, 861 ; p. 551, «^ 863 A— and 
 by the simple system of watching or 
 expectant plan, p. 543, ^ 855-857 ; p. 
 558-559, <J 877-881. 
 
 hence, in a general sense, the most im- 
 portant remedy in the treatment of 
 diseases, acute and chronic, is a prop- 
 erly regulated diet — a limitation to 
 farinaceous fluids in the early stages, 
 at least, of the former, while in the 
 latter, the circumstances of each case 
 
 Remedies — continued. 
 
 must determine the choice — there be- 
 ing ingrafted upon the constitution 
 of the whole animal kingdom a prin- 
 ciple, latent in health, but which en- 
 ables them in disease to bear an ab- 
 stinence that will alone surmount the 
 most formidable conditions, but which 
 would probably be often fatal in the 
 natural state of the system — and in 
 man the principle is the same as that 
 which renders the most active remedies 
 curative instead ofmorbific, p. 63, <^ 137 
 b-e ; p. 67, ^ 149 ; p. 69, § 156 b ; p. 
 538-540, (f 847 §--848 ; p. 543, ^ 855 
 -856; p. 551, ^ 863 k; p. 558-559, 
 (J 879-883 b ; p. 600, () 892 d ; p. 736, 
 ^ 980. Also, Adaptation, Law of. 
 Index I. ; Recuperation, Law of, In- 
 dex II. 
 
 by healing a primary disease which had 
 given rise to sympathetic develop- 
 ments of disease in other parts, the 
 sympathizing ones often recover not 
 only as a consequence of the subsi- 
 dence of the morbific reflex nervous 
 influence, but the abatement of the 
 primary affection may become also 
 a source of salutary sympathetic in- 
 fluences upon the secondary devel- 
 opments ; or, one disease .luperven- 
 ing as a sympathetic result of another 
 may be the means of reflecting, after 
 the manner of counter-irritants, a sal- 
 utary alterative reflex action upon the 
 primary affection, p. 65-66, ^ 143 c ; 
 p. 67, (J 148; p. 351-352, () 524 c; 
 p. 360, <;> 528 ; p. 421-422, ^ 657 ; p. 
 506, ^ 804 ; p. 539, <^ 848 ; p. 570, <J 
 889 n; p. 652-654, () 893 n; p. 679- 
 681, ^ 905 a, b; p. 592, <J 89H A-; p. 
 666, I) 902 b. Metastasis, Ind. II. 
 
 often bring organs not affected by dis- 
 ease, through reflex nervous action, 
 particularly the skin, into a condition 
 which becomes the exciting cause of 
 other reflex influences that fall upon 
 diseased organs with a salutary ef- 
 fect. See this subdivision under Re- 
 medial Action, Index II. 
 
 operate progressively or abruptly,' ac- 
 cording to the intervals of application, 
 when, in the former case, the reflex 
 nervous influence is maintained in 
 unceasing action by a succession of 
 different remedies, or doses of the 
 same remedy, at short intervals, and 
 even in the latter case, as after the 
 administration of an efficient emetic 
 or cathartic, the reflex influence is 
 kept up by the impression made on 
 the gastro-intestinal mucous tissue 
 with alterative effect for some hours 
 after their more manifest effects are 
 over, and the same principle holds in
 
 1078 
 
 INDEX II. 
 
 Remedies — continued. 
 
 respect to mental emotions — and far- 
 ther, that remedial influences are ex- 
 erted and maintained by the small- 
 est doses of the remedies designated 
 by the Author as Alteratives, is evi- 
 dent not only from the abatement of 
 symptoms, but from the vomiting 
 which will often follow after the first 
 few doses of an eighth of a grain of 
 tartarized antimony or a grain of ipe- 
 cacuanha — and so of mercury, arse- 
 nic, iodine, quinine, &c., p. Ill, <J 
 233i, 233} ; p. 285-286, (} 455 d; p. 
 333, (} 503-506 ; p. 339, <) 514 g, h ; 
 p. 344-345, <) 516 rf. No. 6 ; p. 365, 
 ■^ 551 ; p. 366, -;. 556 ; p. 416-417, () 
 469 c; p. 420-424, ^ 654-661; p. 
 532, ^ 841 ; p. 547, () 863 d; p. 551, 
 ^ 867 ; p. 568-569, i) 889 m-mm ; p. 
 592-593, () 89U k ; p. 599-600, ^ 892 
 d; p. 646-649, () 893 c-h; p. 661-663, 
 ^ 894-896 ; p. 668-670, () 902 g-7n ; 
 p. 675-676, () 904 b; p. 679-681, () 
 905 a. Aiso, Alteratives, Sphinc- 
 ter Muscles, Roosting, Miasm ; Hy- 
 drophobia, Virus of; Mental Emo- 
 tions, Index II. 
 a single remedy may be adapted to a 
 large variety of pathological condi- 
 tions, and these may exist simultane- 
 ously in different parts as the sympa- 
 thetic results of a single disturbance, 
 and associated also with idiopathic 
 ijver, and the remedy may be ade- 
 quate to the removal of all the func- 
 lional lesions, or preparatory of the 
 whole to the favorable action of an- 
 other remedy of opposite virtues, and 
 upon which the cure may ultimately 
 depend — thus showing, also, by the 
 variety of means which individually 
 may arrest very complex states of 
 disease, that our doctrine of alterative 
 influence of reflex action of the nerv- 
 ous system, modified according to the 
 nature of the remedy, and the har- 
 monizing influences of coexisting dis- 
 eases upon each other through the 
 medium of the same reflex action as 
 brought into reciprocal operation by 
 the several afliectcd parts, and the 
 substitution of pathological states 
 with a disposition to subside sponta- 
 neously, can alone explain the phe- 
 nomena with any consistency with 
 the immediate facts and with those 
 which relate to Chemistry and Phys- 
 ics, p. 63, ^ 137 c-c; p. 65-67, () 143 
 h, c-148-151 ; p. 298, <) 476^ h; p. 
 304, ^ 481 p; p. 309-310, (} 484 b, 
 No. 5 ; p. 337, ^ 514 b, c ; p. 361, (} 
 529 b ; p. 367, () 557 a, b ; p. 426, ^ 
 666 ; p. 430-433, ^ 675 ; p. 465-466, 
 ^ 715; p. 470^80, () 741 a, b; p. 
 
 Remedies — continued. 
 
 498, ij 784 J; p. 509, (jBU; p. 535- 
 539, {) 847-848 ; p. 542-543, i) 854/, 
 and references there ; p. 552-553, <j 
 870 a, aa ; p. 597-599, l^ 892 c, d ; 
 p. 608-610, (} 892i c, d; p. 662-664, 
 ^ 895-900 ; p. 731-732, I) 970 c ; p. 
 739-740, (^ 986-987. Also, Adapta- 
 tion, Law of. Index I. ; Diseases, 
 Self-Limited, Index II. 
 
 distinction among various remedies that 
 ' may produce some common result, 
 and that result apt to be most relied 
 upon as a remedial test, yet shown to 
 be insignificant, and that the virtues 
 of remedies must be tried by different 
 considerations, p. 547-550, ^ 863 d ; 
 p, 566, ^ 889 I ; p. 571, ^ 890 b ; p. 
 572-573, {) 890 d ; p. 576-577, I) 890 
 l-o ; p. 587, (} 890^ b ; p. 590-593, (i 
 69li a-k ; p. 628-633, ^ 892| g-892} 
 d ; p. 636-640, ^ 892-J d-f; p. 669, l 
 902 h ; p. 687-688, ^ 905^ c ; p. 857, 
 ^ 1063 b. Also, SuDORiFics, Index I. 
 
 their application in acute and chronic 
 diseases subject to great differences 
 in the details, the latter of which fall 
 under what the Author designates as 
 Vital Habit. See Pathology, and 
 the various practical Articles, Lidex 
 IL 
 
 variously influenced by Mental Emo- 
 tions, p. 865-868,^ 1067. Also, 
 Mental Emotions, the individual 
 PassionSy Remedial Action, subdi- 
 vision Mental Emotions, Index II. 
 
 abuse of, — see p 988, 2d. subdivision. 
 
 the Hippocratic rule, that " severe dis- 
 eases require severe remedies," to be 
 received in a broad, not universal 
 sense, and exceptions stated, p. 723- 
 724, () 960 h, and references there. 
 
 contrast between Chemistry and Vital 
 Solidism as practically applied to 
 Therapeutics, p. 147, ij 330; p. 170- 
 173, Nos. 40-46 ; p. 176-178, ij 350| 
 a-f; p. 514-415, (} 819 ; p. 517-518, 
 (} 821 c, 822; p. 540, () 851. 
 Remedies, Endermic, 
 
 operating with purely local effect, their 
 action is doubtless greatly limited 
 to the organic constitution of the 
 skin, with that participation of the 
 nerves, however, that necessarily 
 arises from their incorporation with 
 the other tissues ; but any resulting 
 influences extending beyond the skin 
 are dependent upon reflex action of 
 the nervous system, p. 475, t) 733 h : 
 p. 483-484, $ 746 c. ij 826 c. Skin, 
 Cold, Counter -Irritants, Plas- 
 ters, Seton, Nervous Power, sub- 
 division p. 1024, Index II. ; Vital 
 Properties, Irritability, Nervous 
 PowER,/;?rfex7. Also, () 1088 b.
 
 INDEX II. 
 
 1079 
 
 Remote Causes of Disease. See Caus- 
 es, Morbific, Index II, 
 
 Reparation, 
 
 a law prevailing universally in organic 
 beings — analogies between its motli- 
 fications in Animals and Plants un- 
 der various aspects — shown to be the 
 result of inflammation in the union of 
 wounds by the first intention, and that 
 the nervous system contributes one of 
 the elements of its distinctions as pre- 
 sented by Animals and Plants, p. 474 
 -475, {) 733 /-z. Also, Vital Prop- 
 erties, Organic Life, Plants, In- 
 dex I. 
 
 Respiration, continued from Index I., 
 general anatomical and physiological ex- 
 position of, in respect to the reflex 
 action of the nervous system by which 
 it is determined, and associated with 
 th". analogous causation of vomiting 
 as occasioned by emetics, diseases, 
 mental emotions, &c., and the dis- 
 tinctions attending the effects of the 
 latter from those of the simple phe- 
 nomenon of respiration, and the dis- 
 tinctions between the complex and 
 profound alterative influences of the 
 reflex action as determined by emet- 
 ics of active virtues and the slighter 
 ones of other causes, and carried to 
 the interpretation of the modus ope- 
 randi of all morbific and remedial 
 agents, physical and mental, through 
 alterative influences of reflex or di- 
 rect action of the nervous system be- 
 yond the direct local action of phys- 
 ical agents, p. 110, <^ 232; p. Ill, <J 
 233J ; p. 290, i) 462 ; p. 296, () 476 
 c; p. 302, ^ 481 b; p. 323-330, () 
 500 c-nn ; p. 333-335, ^ 503-511 ; p. 
 336-338, (^ 514 b-d ; p. 413, <} 639 a ,• 
 p. 592-593, '^i 891 i A-; p. 666-670, 1^902 
 6-m; p. 671, <;» 903. Also, Mental 
 E.motions, Disgust, Reflex Action, 
 PiEMEDiAL Action, Index II. ; Will, 
 Nervous Power, Index I. and II. 
 various modifications of, as in sneezing, 
 coughing, yawning, laughing, asth- 
 ma, hiccough, &c., employed for the 
 foregoing purposes, p. 327, ^ 500 t ; 
 p. 338, () 514 d; p. 340, ^ 514 k, I; 
 p. 886-890, ^ 1077. Also, Hiccough, 
 Asthma, Yawning, &c.. Index II. 
 should be considered, also, in connexion 
 with the universal fact that all the 
 muscles in organic and animal life 
 are greatly or altogether dependent 
 for their movements upon the stimu- 
 lus of the nervous influence cither re- 
 flex or direct, and that this considera- 
 tion, as it respects the action of the 
 heart and arteries in their ordinary 
 motions, and as they are conspicuous- 
 ly affected through the nervous influ- 
 
 Respiration — continued. 
 
 ence by mental emotions, food, exer- 
 cise, &;c., and by most diseases, ren- 
 ders it manifest that remedial and 
 morbific agents, taken into the stom- 
 ach, must, by their action upon that 
 organ, transmit influences to the nerv- 
 ous centres that will be reflected upon 
 these exquisitely susceptible organs 
 with a more profound eflect, especial- 
 ly upon that terminating series of 
 vessels which are so sensitive to all 
 mental emotions, and which are the 
 essential instruments of all healthy 
 and morbid processes. See Reflex 
 Action, Remedies ; Causes, Morbif- 
 ic ; Heart, Cathartics, Counter- 
 Irritants, Skin, Cold, Bloodlet- 
 ting, Inflammation, Whooping- 
 Cough, Phthisis, Exercise, Mental 
 Emotions, Fear, Jealousy, Shame, 
 Food, Vessels, &c.. Index li- 
 the coincidences between voluntary and 
 involuntary, emploj'cd in demonstrat- 
 ing the action of the Will and Mental 
 Emotions through the direct propaga- 
 tion of the nervous influence upon 
 the voluntary and involuntary or- 
 gans. See references under first sub- 
 division, and Sphincter Muscles, 
 Roosting, Index II. 
 employed in demonstrating the substan- 
 tive existence and self-acting nature 
 of the Soul and Instinctive Principle, 
 p. 875-877, ^ 1072 a. 
 Revulsion. See Metastasis, /wtZca; 77. 
 Rheumatism, 
 
 treatment of, by bloodletting, tartarized 
 antimony, &c., p. 720, () 960 a ; p. 733, 
 ^ 974 a; p. 845-846, ^ 1058 ?!. 
 considered in its relations to the doc- 
 trines of metastasis and repulsion, p. 
 354, {} 525 c ; p. 652-656, ^ 893 n. 
 Also, Metastasis, Index II. 
 as affecting the heart in articular condi- 
 tions, is not owing to abstraction of 
 blood, but to the same reflex nervous 
 action which is at play among the 
 joints, and calls for farther loss of 
 blood, p. 656, i} 893 n. Also, p. 353- 
 354,^ 525 b,.c. 
 Rhubarb, 
 
 its variety of effects, cathartic, astrin- 
 gent, tonic, and stimulant, according 
 to the precise conditions of disease 
 and its doses, contradict the chemical 
 hypothesis of its modus operandi and 
 illustrate its impractical nature, and 
 how all things concur together in de- 
 monstrating those effects through va- 
 riously modified influences of the 
 nervous power, p. 554-556, (J 872 a ; 
 p. 565-566, () 889 g ; p. 571, <J 890 b ; 
 p. 575-576, () 890 i-l ; p. 578, ^ 890 
 p; p.581,<J890jc; p. 661-663, ij 894
 
 lOSO 
 
 INDEX II. 
 
 Rhubarb — continued. 
 
 b ; p. 664-670, <J 900-902 m ; p. 679 
 -681, ^ 905 a. Also, Cinchona, In- 
 dex II. 
 
 unsuited to acute inflammations and fe- 
 ver, ibid. 
 
 misapplied particularly in dysentery, 
 from neglecting the stimulating vir- 
 tue of the one and the pathology of 
 the other — the appropriate remedies 
 being strictly antiphlogistic, p. 575, § 
 890 h. Also, Dysentery, Index I. 
 RoGET, on animal heat, p. 238, ^ 438 c. 
 
 his opinion of Organic Chemistry as ap- 
 plied to digestion, p. 153, <) 348. 
 
 concedes the whole ground of Vital 
 Solidism in the development of the 
 Ovum, p. 38-39, ^ 64/. 
 Roosting, and the sleeping of quadru- 
 peds IN AN ERECT POSTURE, 
 
 and occasional instances of man's — 
 when the Will determinesj through the 
 nervous influence, a rigid state of the 
 voluntary muscles which reacts upon 
 the nervous centres, and thus main- 
 tains an unceasing reflex action that 
 corresponds exactly with the eflfect 
 of the voluntary act (and as seen also 
 in voluntary and involuntary respira- 
 tion and contraction of the sphincter 
 muscles), and holds them in the same 
 rigid contraction as instituted by the 
 Will, and which is the cause of the 
 reflex development, being a rare ex- 
 ample of reflex nervous action arising 
 from the Will — employed in demon- 
 strating the substantive existence and 
 self-acting nature of the Soul and 
 Principle of Instinct, and for illustrat- 
 ing the modus operandi of remedial 
 and morbific agents, and of Mental 
 Emotions through alterative influ- 
 ences of the nervous power, <J 500 dd, 
 514,1077. Also, Mental Emotions, 
 Index II. ; Will, Index I. and II. 
 
 Saline Cathartics. Sec Cathartics, 
 Saline, Index II. 
 
 Salivary Glands, 
 pour out the saliva under the exciting 
 influence of nervous action as devel- 
 oped by the mind, whether the re- 
 mote cause be the odor of food, or its 
 expectation, &c., p. 335, () 512 a; p. 
 866, i) 1067 ; p. 877, ^ 1072 i— -being 
 exactly coincident with the flow of 
 urine and sweat as occasioned by 
 Fear, p. 630-632, () 892J b, and weep- 
 ing by Grief, p. 880, ^ 1074— and 
 with the increased production of sali- 
 va and bile as determined by the pres- 
 ence of food in the stomach, through 
 
 Salivary Glands — continued. 
 
 Tcflcx action of the nervous system, p. 
 335-336, ^ 512 a, b ; p. 339-340, ^ 
 514 h — and with that of urine as the 
 result of cold applied to the surface, 
 and of lactation through the same cau- 
 sation, p. 230-232, () 422 6-424— and 
 employed along with other analogies 
 to interpret the modus operandi of 
 morbific and remedial agents, physic- 
 al and mental, through alterative in- 
 fluences of the same nervous action, 
 ibid. Also, Secretion and Excre- 
 tion, Urine, Milk, Bile, W^eeping, 
 Parturition, Odors, Fear, Jeal- 
 ousy, Kidney, Skin, Food, &c.. In- 
 dex II. ; Sudorifics, hidex I. 
 Sap, Circulation of, continued from In- 
 dex I, 
 
 chemical thcorv of, analogous to Lie- 
 big's of the blood.p. 817-819, ij) 1054. 
 
 absorption, capillary attraction, and evap- 
 oration inadequate causes, p. 817, <5 
 1054. 
 
 the cause supposed to reside in the leaf, 
 and of a chemical nature, p. 818, i) 
 1054. 
 
 the supposed causes of, allowed to be 
 equally necessary for the blood, p. 818 
 -819, '() 1054 — but, contradicted by 
 Hale's experiments, which were in- 
 tended to sustain the physical hypoth- 
 esis, p. 820-822, {) 1054. 
 
 the usual inconsistency of Organic 
 Chemistry when it aspires at a solu- 
 tion of the problems of Life, as dis- 
 played by LiEBiG in the important 
 matter of the circulation of the blood, 
 p. 823, <J 1055. Also, p. 175-176, I) 
 350i- n-q. 
 
 ascribed by Professor Lindley wholly 
 to vital action, p. 823, (j 1054. 
 Scammony, 
 
 its therapeutical and morbific eflfects, p 
 856-857, <^ 1063. 
 Scarlet Fever See Fever, Scarlet, 
 
 Index II 
 Schultz, Professor, 
 
 his vital philosophy of digestion, p. 202, 
 <!» 376. 
 Scrofula, 
 
 constituted by a specific form of inflam- 
 mation, and, when affecting the lungs, 
 demands an antiphlogistic treatment ; 
 and leeching, particularly, may be also 
 often usefully associated with Iodine 
 when the disease is limited to super- 
 ficial parts, with various explanatory 
 remarks relative to principles and 
 practice, p 424, () 602 a; p 615, ^ 
 m-2\ e; p. 638-639, () 892± g ; p. 
 649, ^ 893 ; p 659. (> 893 q'; p. 684, 
 (i 905^ b; p. 696-697, () 926, 927 a. 
 Scurvy, 
 
 opinions of distinguished physicians as
 
 INDEX II. 
 
 108] 
 
 Scurs'y — conlinued. 
 
 to its pathology and treatment, p. 754, 
 ^ 1002 d, e. 
 
 Sea-Sickness 
 
 depends in part upon mental emotions, 
 and partly upon unaccustomed move- 
 ments of the body, through complex 
 influences of direct and reflex action 
 of the nervous system upon the stom- 
 ach, but which soon subside under 
 the law of Habit, and may be re- 
 strained by the Will through a coun- 
 teracting development of the nervous 
 power — employed in demonstrating 
 the substantive existence and self- 
 acting nature of the Soul, and is not 
 less applicable to the modus operandi 
 of morbific and remedial agents of a 
 material nature, ij 1067 aa; <J 1077. 
 Also, Exercise, Phthisis, Whoop- 
 ing -Cough, Intestine, Mental 
 Emotions, Thunder, Disgust, Fear, 
 Joy and Anger, Reflex Action, In- 
 dex II. ; Will, Index I. and II. ; 
 Medical and Physiological Commenta- 
 ries, vol. i., p. 569-574. 
 Secreted Products 
 
 have no existence in the blood nor in 
 sap, and therefore are not " strained 
 off," p. 24, H2 ; p. 219-227, i) 408- 
 411 ; p. 478-479, <J 740-741 ; p. 484, 
 () 748 ; p. 780, <J 1029 ; p. 783, (J 
 
 1031 b; p. 790, <J 1032 b ; p. 791, <J 
 
 1032 c ; p. 800-801, ^ 1033. 
 
 the advocates of remedial action by ab- 
 sorption express " great astonishment 
 that the bile is not more frequently 
 affected by the various medicinal 
 agents put into the stomach" — and 
 why not also the chyle — why no ab- 
 sorption of the bile, of intestinal ac- 
 ids, and other offensive things that 
 often abound in the intestinal canal 
 — why no manifestation of the "me- 
 dicinal agents" by the highly irritable 
 heart 1 p. 527, ^829. Also, p. 129- 
 131, () 277-284; p. 132-134, <) 289- 
 295 ; and Lacteals, Lymphatics, In- 
 dex II. ; Veins, Index I. and II. 
 Secretion and Excretion, 
 
 analogous functions, the latter being 
 properly comprehended in the former, 
 but having certain differences in final 
 causes and composition, p. 217, () 
 402 ; p. 227-228, Ml 2-4 17. 
 
 influenced by direct and reflex action of 
 the nervous system upon their imme- 
 diate instruments, when they will be 
 simply increased or diminished, or, 
 what is greatly more important, vari- 
 ously altered, or new ones generated, 
 according to the manner in which the 
 nervous power may be modified by 
 the causes which bring it into preter- 
 natural operation, both physical and 
 
 Secretion and Excretion — continued. 
 
 mental, p. 105, ^ 220 b ; p. 107-110, 
 () 226-232 ; p. 193, ^ 356 a ; p. 215, 
 () 395 ; p. 230-232, (} 422 i-424 ; p. 
 249, () 441 c; p. 253, I) 441 d ; p. 
 262-265, ^ 446 a-447 a ; p. 262-265, 
 <J 446 a-447 b ; p. 285-286, () 455 d- 
 456 b ; p. 289, I) 461 ; p. 310, ^ 485 ; 
 p. 313-314, i) 488-489 ; p. 317, t) 493 
 a ; p. 325-326, () 500 ee ; p. 335-336, 
 «;i512a,- p. 339, <;>514/i; p. 341-342, 
 () 514^ b; p. 344, ^ 516 rf. No. 6; p. 
 348, f) 516 d, No. 13; p. 350-351, <J 
 524, No. 1 ; p. 355, ^ 526 a ; p. 430- 
 433, () 675, 676 a ; p. 450-452, <J 691- 
 693 ; p. 478-479, () 740-741 b ; p. 483 
 -484, ^ 746 c ; p. 546-549, (} 862-863 ; 
 p. 563, (} 889 a ; p. 565, I) 889 /, g ; p. 
 630-632, (^ 892J b, c ; p. 634, (j 8924 
 a, b ; p. 637, ^ S92| d ; p. 662, () 896 1 
 p. 666-672, () 902 6-904 a ; p. 704, (} 
 943 a, b; p. 709, (J 951 c ; p. 710-711, 
 952 b-g; p. 866-868, () 1067. Also, 
 Bile, Milk, Lactation, Parturi- 
 tion, Mental Emotions, Fear, Jeal- 
 ousy, Food, Skin, Cold, Kidney, In- 
 dex II. ; Organic Heat, Index I. 
 the fluid products of glandular organs, 
 sweat, gastric juice, &c., and all the 
 solids, on common ground as it re- 
 spects their dependence upon organ- 
 ic actions and their relations to the 
 nervous system, though in the normal 
 state the fluids manifest far greater 
 influences of the nervous power than 
 the composition of the solids, and the 
 glandular fluids more so than the 
 membranous ; ut supra, and Organic 
 Compounds, Vital Properties, Or- 
 ganic Life, Index I. 
 the apparently endless variety of organ- 
 ic fluids as well as solids in plants 
 and animals, and each one forever 
 the same in any given part in its per- 
 fect state, and mostly composed of 
 four elements, their ternary or qua- 
 ternary combinations, ratios and di- 
 versities in their modes of union, their 
 dependence in animals for their per- 
 fected condition upon modifying in- 
 fluences of the nervous system, while 
 they have no such tributary aid in 
 plants, and their natural and morbid 
 fluctuations in animals under the in- 
 fluence of direct and reflex action of 
 the nervous system as brought into 
 effect by mental emotions or physical 
 agents, and according to their precise 
 nature, contradistinguish the laws of 
 organic from those of inorganic bodies 
 — and a fundamental distinction drawn 
 between what belongs to organic life 
 and what is referable to its influences 
 by the nervous system, p. 21, ij 22 ; 
 p. 23-26, (J 37-48 ; p. 27-28, ^ 52-53 ;
 
 1082 
 
 INDEX II. 
 
 Secretion and Excretion — continued. 
 
 p. 30, <J 58 ; p. 193, (^ 356 a ; p. 220- 
 227, () 409 i-411 ; p. 230-232, ^ 422 
 A-424 ; p. 262-263, <!i 446 a ; p. 289, 
 (J 461; p.313-315, H88-489; p. 317 
 -318, <J 493 ; p. 335-336, (} 512 a, b ; 
 p. 355, ^ 526 a ; p. 483-484, (} 746 c ; 
 p. 547-548, () 863 d ; p. 563-564, ^ 
 889 a ; p. 630-632, () 892 J J, c ; p. 
 668-669, (i 902 ^ ; p. 704, () 943 a ; p. 
 804-805, (^ 1040 ; p. 866-867, () 1067 
 a; ^ 22li, 399, 456 a, 478 Z>. 
 by now taking in connexion what the 
 Author has said under the sections in 
 the two preceding subdivisions of the 
 influences of the reflex action of the 
 nervous system upon the secreted 
 fluids, there may be found, at p. 478- 
 480, <^ 740-741 (where the Author 
 presents an example, for illustratioti, 
 from the humoral pathologist), the 
 whole philosophy distinctly and brief- 
 ly presented relative to the part which 
 the nervous influence takes in organ- 
 ic processes, the products being gen- 
 erated by the organic mechanism 
 through its own inherent properties, 
 p. 55, () 113-117; p. 58-59, <J 129 c- 
 i ; while the nervous influence, in its 
 morbific aspect, and whether excited 
 by physical or mental causes, so mod- 
 ifies their condition that they elabo- 
 rate morbid instead of natural prod- 
 ucts ; and, turning to the example 
 of the Seton at p.''679-681, ^ 905 a, 
 there will be found, in an equally suc- 
 cinct manner, the whole philosophy 
 of the alterative influence of reflex 
 action of the nervous system as the 
 medium through which all the modi- 
 fications of secreted products, as set 
 forth under the sections embraced 
 in the foregoing subdivisions, are 
 brought about, and as exemplifying 
 all that is ever concerned in the mo- 
 dus operandi of remedial and morbific 
 causes, upon parts beyond the seat 
 of their direct operation — while, also, 
 even animal heat is on the same com- 
 mon ground with other secreted prod- 
 ucts, and its generation, therefore, is 
 alike influenced by reflex and direct 
 action of the nervous system. See, 
 also. Nervous System, hidcx II., p. 
 1029, subdivision upon Animal Heal. 
 considered by the Author as " fully set- 
 tled by experiments" made by A. P. 
 W. Philip, that " the power of secre- 
 tion is independent of, though influ- 
 enced by the nervous system," as ap- 
 pears in his Reports of the same in 
 Londo7i Philosophical Transactions for 
 1815 and 1817, and to which there 
 are summary references at p. 314- 
 315, {) 489 ; p. 317-318, ij 493 a-d— 
 
 Secretion and Excretion — continued. 
 
 and, therefore, long antecedently to 
 the suggestions upon the same sub- 
 ject by Henle, Bonders, Ludwig, &c., 
 while, also, Bichat had arrived at the 
 same opinion without the aid of ex- 
 periment, p. 270, i) 447 d. 
 uses in diseases of fluid products, being 
 different according to the nature of 
 each, p. 231, ^ 422 c; p. 232-234, ^ 
 427-428; p. 450-451, i^ 691, 692 ; p. 
 471, i) 732 b ; p. 473-474, ^ 733 e; p. 
 546-551, () 862-864; p. 637, () 8924 
 d ; p. 639, ^ 892|- g ; p. 647, () 893/ 
 Also, Sweat, Vvs, Index II. 
 
 Sedatives — continued from Index I, 
 definition of, p. 828, <^ 1057 a— and dis- 
 tribution into five groups, p. 830, § 
 1057 c. 
 the term does not imply their most es- 
 sential action, which is variously al- 
 terative through the medium of reflex 
 nervous influence, and according to 
 the nature of the Sedative ; and, al- 
 though it is the change in kind which 
 each one institutes in the organic 
 properties that forms their character- 
 istic distinction, the only two, loss 
 of blood and tartarized antimony, of 
 much importance as curative reme- 
 dies, and these in 'all other respects 
 totally unlike, will, nevertheless, ef- 
 fect such alterations in morbid states 
 as render them the most universal 
 means of subduing inflammations and 
 fevers — being also sufficiently con- 
 clusive that the philosophy of their 
 operation has not the most remote 
 alliance to the rigorous laws of Chem- 
 istry, p. 829-832, <J 1057 a-f ; p. 838, 
 ^ 1057i. Also, p. 664, (} 900 ; p. 681 
 -683, <S» 905 b. Remedial Action, 
 Stomach, Index II. 
 many of them, especially the Narcotics, 
 Hydrocyanic Acid, Aconite, Strych- 
 nia, may determine the nervous in- 
 fluence with great suddenness and vi- 
 olence upon the organic constitution 
 of the brain as upon other parts, p. 
 298, {} 476^ h ; p. 300-301, <J 479 ; p. 
 320, <) 494 dd ; p. 324, () 500 c ; p. 334, 
 ^ 509 ; p. 520-521, <!> 826 d; p. 523- 
 524, ^ 827 d; p. 592-593, (f 89U ^- ; 
 p. 671-672, ^ 904 o, b; p. 704, () 943 
 a, h; p. 706, ij 946; p. 831-832, (^ 
 1057/; p. 838, (j 1057^. Also, Stom- 
 ach, Blows upon. Index II. 
 Aconite, in relieving neuralgia when ap- 
 plied to the skin, illustrates the alter- 
 ative influence of reflex nervous ac- 
 tion upon particular nerves, p. 838, <J 
 1057^. Also, Sympathy, Contigu- 
 ous ; Counter-Irritants, Plasters, 
 &c., Index II. 
 other examples of the external applica-
 
 INDEX II. 
 
 1083 
 
 Sedatives — continued. 
 
 tion of Belladonna, Hyoscyamus, and 
 " an imponderable quantity of Atro- 
 pia," and of the bite of venomous 
 Reptiles, and of Opium, and Hydrocy- 
 anic Acid, internally, where it is evi- 
 dent that their effects were determ- 
 ined by alterative influence of reflex 
 nervous action, p. 319, ^ 494 b-ild ; p. 
 525-526, ^ 828 b, c;. p. 672-674, ^ 
 904 b. 
 
 may act as such only in special condi- 
 tions of disease, p. 829-830, <J 1057 
 a,b. 
 
 varieties in effects of Cold, p. 832, ^ 
 1057 g. Also, Cold, Skin, Index II. 
 
 comparative effects of Bloodletting, Hy- 
 drocyanic Acid, and Tartarized Anti- 
 mony, p. 831, () 1057 c. 
 
 Cotton-wool and Castor Oil, as possess- 
 ing sedative virtues, p. 833-835, ^ 
 1057 k, I. 
 
 examples of, contrasted with Stimu- 
 lants, p. 829, () 1057 a. 
 
 may produce inflammation, p. 480-481, 
 () 743 ; p. 502, <J 817 ; p. 523, ^ 827 ; 
 p. 584, () 891 d; p. 708, (J 950 ; p. 
 733, ^ 874 b ; p. 773-775, ^ 1024 ; p. 
 829, ^ 1057 a. 
 Self-Limited Diseases. See Diseases, 
 
 Self-Limited, Lidez II. 
 Senna, 
 
 its therapeutical and morbific effects, the 
 latter preponderating, p. 858, ^ 1064. 
 Senses, 
 
 weariness of, said to be similar to 
 " chemical changes on an iodized 
 plate" — supplying an example of the 
 flillacies of reasoning from the phe- 
 nomena of inorganic bodies and arti- 
 ficial contrivances to identify their 
 laws with those of living beings, p. 
 797-798, () 1034. Also, p. 132-133, 
 (j 289-291 ; p. 167, No. 29; p. 168, 
 No. 31 ; p. 172-173, No. 44, 45 ; p. 
 175-176, l^ 350^ n-j); p. 177-178, <J 
 850 J /; p. 238, ^ 438 A, c ; p. 517,^ 
 721 c ; p. 528, ^ 832-835. 
 Sensibility, continued from Index I, 
 
 important to distinguish it from Irrita- 
 bility, not only as a property peculiar 
 to animal life, but as the medium of 
 transmitted impressions in the func- 
 tion of reflex action of the nervous 
 system, p. 89, (i 188 a, &c. ; p. 101- 
 102, .J 201-202 ; p. 282-283, () 451 
 d-f; p. 671, ij 903. 
 
 some new observations as to its relation 
 to the posterior roots of spinal nerves, 
 p. 802, ^ 1037 b. 
 
 sympathetic and other modifications far- 
 ther distinguished by Brown-Se- 
 quard's experiments, p. 802, ^ 1037 
 b. Also, p. 216, (J 399 ; p. 313, (J 
 487 gg. 
 
 Serous Tissue, 
 treatment of its inflammations, p. 727, (^ 
 
 ■ 960/; p. 750, (j 995 ; p. 756-758, <! 
 1005 b-h; p. 847, () 1058 r. 
 
 Serpents, Virus of, 
 
 experiments by several hands proving 
 that it does not operate by absorption, 
 but, like the hydrophobic virus, by 
 morbific influence of reflex action of 
 the nervous system instituted by the 
 bitten part, p. 319, <J 494 b-dd; p. 
 1146 ; p- 525-526, § 828 a- 
 
 d. Also, HTDr.oPHOBi.\, Virus of, 
 Index II. 
 
 Seton, 
 
 its modus operandi both locally and 
 through alterative influence of reflex 
 action of the nervous system, exem- 
 plifying the whole philosophy that is 
 ever concerned in the operation of 
 remedial and morbific agents, p. 679-^ 
 681, i5> 905 a — originally set forth in 
 Essay on the "Modus Operandi of 
 Remedies" (1842). 
 
 Shame 
 
 doubtless awakens the consciousness of 
 an internal monitor distinct from the 
 corporeal fabric — but how does it be- 
 tray itself in the crimsoned cheeks, 
 or, if blended with a little Fear, in the 
 trembling muscles, the drops of sweat, 
 and the flow of urine, unless through 
 that amazing principle, the nervous 
 influence, which may strike us dead 
 in an instant when Joy and Anger 
 make their sudden and violent dem- 
 onstrations, or as blows upon the epi- 
 gastric region, and surgical opera- 
 tions, and the bite of venomous ser- 
 pents, and hydrocyanic acid, and the 
 respiration of chloroform, will do the 
 same — and thus, also, as unmingled 
 or compounded with other emotions. 
 Shame exemplifies the manner in 
 which remedial and morbific agents 
 of a physical nature, and according to 
 their simplicity or complexity and the 
 nature of each, will institute corre- 
 sponding influences of reflex nervous 
 action — or turning to Fear alone, 
 there may be sten in its displays of 
 the nervous influence a near coinci- 
 dence with that universal alterative 
 impression which a single morbific or 
 remedial agent may exert, as witness- 
 ed in the production of fever, and in 
 its cure by loss of blood or an emetic, . 
 or, to complete the coincidence, by a 
 mental emotion, p. 95, i^" 118^ f^; p. 
 107-111, (j 227-233J ; p. 245, <;. 440 
 
 e, No. 14 ; p. 324, i) 500 c ; p. 327- 
 328, {) 500 ;, k ; p. 332, (^ 501 c ; p. 
 333, <J 503 ; p. 339-341, <^ 514 g-m ; 
 p. 631-632, () 892} b ; p. 66K663, ^ 
 894-896 ; p. 665-670, i) 901-902 ; p.
 
 1084 
 
 INDEX II. 
 
 Shame — continued. 
 
 679-681, <J 905 a ; p. 704, <) 943 a, b ; 
 p. 706-707, () 947 ; p. 709, i) 951 b-d ; 
 p. 879-882, () 1074-1075; p. 891, () 
 1077; p. 901, () 1078 /. Also, Re- 
 medial Action, Mental Emotions, 
 Jov AND Anger, Feak, Disgust, 
 Love, Grief, Hope, Thunder, &c., 
 Index II. ; Nervous Power, Index I. 
 and II. 
 
 Shower-Bath, 
 
 its curative or morbific effects upon in- 
 ternal organs exerted through altera- 
 tive influences of reflex nervous ac- 
 tion, after the manner of cold air in 
 starting the secretion of urine, or in 
 the production or cure of disease, of 
 counter-irritants, &c. — employed to 
 illustrate the modus operandi of all 
 other remedial and morbific agents 
 upon parts beyond the seat of their 
 direct operation, and to show how 
 readily the nervous influence is modi- 
 fied in its nature by its exciting causes, 
 and how diversely it will affect or- 
 gans according to their existing con- 
 dition, the nature of tissues, &c., p. 
 832-833, () 1057 g. Also, p. 59, () 
 129 g-i; p. 61, <;. 132-133; p. 63- 
 67, () 137 t-151. Skin, Cold, Ex- 
 ercise, Friction, Amenorrhcea, hi- 
 dcx II. 
 
 SiGMOND, 
 
 his observations upon certain special ef- 
 fects of Narcotics, p. 673, 674, s^ 904 
 b. Also, Opium, Sedatives {Aco7iile), 
 Index II. 
 
 his opinion of the Anatomical School 
 of Medicine, p. 603-604, () 892 k. 
 Silver, Nitrate of, 
 
 best local remedy for leucorrhcea, p. 
 576, (J 890 m ; p. 688, ^ 905^ c. 
 
 absorbed in the condition of an inert 
 muriate, or would otherwise be con- 
 verted into an inert substance on its 
 passage to the blood — introduced for 
 the purpose of showing that Astrin- 
 gents and other remedies operate 
 upon parts beyond the seat of their 
 direct action through alterative influ- 
 ence of reflex nefvous action, p. 530, 
 (J 873 e ; p. 533, (} 842 ; p. 577, I) 
 890 0. 
 Simon, 
 
 his vital exposition of fibrin, p. 800, (J 
 1035. Also, MiJLLER.'s and Hunt- 
 er's, p. 24, l) 42. 
 Skin, 
 
 exquisitely susceptible in sympathetic 
 sensibility (p. 101-102, ^ 201-202 ; p 
 282-283, <^ 451 d-f; p. 695, <^ 924) to 
 impressions from particular causes 
 that produce no apparent disturbance 
 of its organic condition, but which are 
 capable of exciting a disturbing re- 
 
 Skin — conlinucd. 
 
 flex action of the nervous system, as 
 witnessed in the suddenly increased 
 secretion of urine on the contact of 
 cold air, and the production of in- 
 ternal inflammations from the same 
 cause, or, at other times, in the invigo- 
 rating and curative influences of cold 
 either through the medium of air or 
 the shower-bath, and as seen in rous- 
 ing the heart in syncope, and in the 
 counteracting effect of the cold dash 
 in cases of narcotic poisoning, &c., 
 and in the effects of the hot bath, 
 medicated baths, and of friction, upon 
 internal organs — and this associated 
 with the morbific action of miasms 
 and other analogous causes, and with 
 the analogies supplied bj' certain spe- 
 cial effects of narcotics, plasters, &c., 
 where absorption cannot be sur- 
 mised, and with the more strongly 
 pronounced analogies derived from 
 counter-irritants, setons, &c., and 
 uniting with the whole many natural 
 functions in which the reflex nerv- 
 ous action is the immediate exciting 
 cause, as respiration, the motions of 
 the heart, of the intestine, of the iris, 
 deglutition, &c., and taking along the 
 important part which the nervous sys- 
 tem contributes in the development 
 of the body from Infancy to Adult 
 age, in pregnancy, parturition, lacta- 
 tion, &c., and many other correspond- 
 ing facts which the Author brings to 
 sustain his conclusions in respect to 
 the Skin, he recurs to the evidence 
 supplied by that organ of its exquisite 
 sensitiveness to certain natural stim- 
 uli and morbific agents, and the un- 
 equivocal dependence of their remote 
 effects upon the nervous system, and 
 endeavors to show that all other 
 agents of less obvious modes of ac- 
 tion as mercurial ointment, or any 
 of the soluble preparations of mer- 
 cury, &c., when applied to the skin, 
 affect internal parts through the me- 
 dium of alterative influences of reflex 
 action of the nervous system, and to 
 show, also, by the collective force of 
 all the foregoing analogies, as well as 
 by the obvious mode of action through 
 the nervous sj'stcm of many things 
 applied to the alimentary mucous tis- 
 sue, such as emetics, &c., that all re- 
 medial and morbific causes exert their 
 effects through that same medium 
 upon parts beyond the seat of their 
 direct operation, p. 61, (^ 133; p. 66- 
 67,(5148; p. 107-112, (J 227-234; p. 
 230-232, {) 422-427 ; p. 245, (} 440 c ; 
 p. 253, i) 441 d; p. 308-310, (/ 484- 
 485; p. 312, H87£',- p. 319-320, ^
 
 INDEX II. 
 
 1085 
 
 Skin — continued. 
 
 494 b-dd ; p. 321, ^ 497 ; p. -323-324, 
 <J 499-500 c; f 327, <J 500 t ; p. 331 
 -332, (i 500 O-501 c, p. 333, t) 503 ; 
 p. 335-336, i) 512; p. 338, <J 514 (i ; 
 p. 339-341, «;> 514 g-m ; p. 343, ^ 516 
 (i, No. 4 ; p. 346, ^ 516 t/, No. 9 ; p. 
 348, ^ 516 d, No. 13 ; p. 349-350, (} 
 520-523 ; p. 351, <^ 524 a, No. 1 ; p. 
 352, ^ 524 c ; p. 353, ^ 524 d, No. 4- 
 7 ; p. 355, <^ 526 a ; p. 359-360, i) 527 
 a-d; p. 416-417, <J 649 c, d; p 421 
 -423, ^ 657-658 ; p. 424, () 662 a ; p. 
 430, ^ 674 rf ; p. 468, () 722 Zi ; p. 520 
 -521, (^ 826 ; p. 523-524, (^i 827 c-c ; 
 p. 525-527, 1) 828 a-tZ ; p. 532, () 841 ; 
 p 592-593, () 89U A;; p 631-632, <} 
 8924 *, f ,• p. 634, () 8924- b ; p. 661- 
 663, I) 894-896 ; p. 665-676, ^ 902- 
 904 ; p. 679-681, ^ 905 a ; p. 705, ^ 
 945; p. 803, ^1038; p.832,^ 1057^; 
 p. 838, (j 1057i ; p. 880, <j 1074, p. 
 64^-644, () 893 a-c ; () 956, 1088 i. 
 Secretion and Excretion, Sweat, 
 Bile, Salivary Glands, Cold, Fric- 
 tion, Exercise, Opium, Mental Emo- 
 tions, Fear, Jealousy, Pregnancy, 
 Parturition, Organs of Genera- 
 tion, Stomach ; Antimony, Tartar- 
 ized ; Counter- Irritants, Plas- 
 ters, Predisposition, Pathological 
 Cause, Index II ; Youth, Index I. and 
 II. ; SuDORiFics, Index I. 
 it has never been shown, however much 
 assumed, that the human Skin will 
 absorb extraneous substances, not 
 even water, as Magendie decides, and 
 the experiments relative to opium, the 
 wourari poison, the virus of serpents, 
 hydrocyanic acid, &c., goto our pres- 
 ent purpose ; and this failure of ex- 
 periments to prove absorption is far- 
 ther shown by a forced analogy drawn 
 from the supposed absorption of wa- 
 ter by the Skin of Lizards ; for, how- 
 ever the general analogies obtain in 
 respect to great fundamental laws, 
 they are quite liable to fail as regards 
 certain special functions, and it would 
 be an equal ground of reasoning with 
 the foregoing to the Skin of man from 
 animals that respire by that organ, or 
 others by whom it is periodically shed, 
 or, in other respects, from the regen- 
 eration of the Lizard's tail, &c., p 
 175-176, <5 350^ n-p ; p. 306-310, ^ 
 483 6-484 ; p. 474-475, i) 733/-? ; p 
 520, ^ 826 b-d ; p 522-523, <J 827 b, 
 c ; p 530-531, ^ 837 b-cc ; p. 827, <J 
 1055 ; p. 930, () 1088 b. 
 the effects upon, by narcotization, and 
 of acetic acid applied to the mouth 
 and skin of eviscerated frogs, em- 
 ployed in interpreting the operation 
 of remedies upon internal parts when 
 
 Skin — continued. 
 
 applied to the skin, through altera- 
 tive influences of reflex nervous ac- 
 tion. See VoLKMAN, Index II. 
 
 some parts of, more susceptible of those 
 impressions which occasion morbific 
 influences of reflex action of the nerv- 
 ous system than other parts, p. 61- 
 62, 1) 133-136 ; p. 415-416, () 649 b; 
 p. 695, i) 924, also Amenorrhoka, 
 Leeching, Index II. — which reflects 
 light upon Brown-Sequard's observa- 
 tions upon epileptiform convulsions, 
 as produced by irritation of particular 
 parts of the skin, p. 802, () 1037 a. 
 
 its eruptive diseases often occasioned by 
 a morbific reflex action of the nervous 
 system instituted by disorders of the 
 alimentary canal, as manifestly the 
 case after a debauch, and as seen, 
 also, in the immediate subsidence of 
 the cutaneous affection under the in- 
 fluence of an emetic or cathartic, 
 which not only arrest the morbific 
 cause, but determine a curative reflex 
 action ; and which serves as an index 
 to the philosophy of the origin of nu- 
 merous chionic eruptions, and of their 
 cure by gradually alterative remedies 
 operating through the same reflex 
 nervous influence — or, again, a su- 
 pervening eruptive disease may react 
 upon and relieve the internal affec- 
 tion ; and when we associate with 
 the foregoing the heterogeneous vari- 
 ety of things that will alike cure the 
 same chronic eruptions, whether in- 
 ternally or externally applied (even 
 more various in their physical prop- 
 erties than the remedies for intermit- 
 tents), and other analogous facts 
 which meet our attention on every 
 hand, the philosophy of Vital Solid- 
 ism, wielding the magic power of the 
 nervous system, falls with a crushing 
 weight upon the factitious analogies 
 borrowed from the precise laws of the 
 inorganic world, p. 352, ^ 524 c ; p. 
 359, ^ 527 a, b; p. 669-671, () 902 
 ?, m ; p. 673, ^ 904 b, also, Opium, 
 Humoral Pathology, Remedial Ac- 
 tion, Index II. — and the constitution- 
 al effects of small-pox, measles, and 
 scarlatina probably depend upon a 
 morbific reflex nervous influence in- 
 stituted by the alimentary mucous tis- 
 sue, as denoted, also, by the primary 
 appearance of the eruption in the fau- 
 ces — excepting as inoculated small- 
 pox would involve a primary reflected 
 influence of the nervous power upon 
 the mucous tissue (instituted by the 
 artificial pustule), and thence a re- 
 flected action upon the skin as the 
 exciting cause of the general erup-
 
 1086 
 
 INDEX II, 
 
 Skin — continued. 
 
 tion, p. 359, (^ 527 a, h. Also, Dis- 
 eases, Self-Limited ; Small-Pox ; 
 Hydrophobia, Virus of ; Predispo- 
 sition, Index II. ; and Medical and 
 Physiological Commentaries, vol. i., 
 p. 494-513 ; p. 569-574. 
 
 Liebig's philosophy of its supposed 
 agency in the circulation, p. 823, ^ 
 1055 
 Small-pox, 
 
 Author's theory of the primary locality 
 of the disease, and of its propagation 
 to other organs, analogous to that of 
 hydrophobia, miasmatic diseases, &c., 
 though in a more determined manner, 
 as set forth under Article Skin, Li- 
 dex II. ; p. 59, () 129 h ; p. 65, <^ 143 
 c ; p. 66-67, () 148 ; p. 333-334, ^ 
 502-506 ; p. 348, <} 516 d. No. 13, 
 518 a. b; p. 351-352, ^ 524 c; p. 
 359, <J 527 b; p. 360, () 527 d; p. 
 364, ^ 545 ; p. 368-369, ^ 559-563 ; 
 p. 416-417, () 649 c, 650; p. 420- 
 423, ^ 654-660;, p. 426, (; 666; p. 
 429-430, <) 674 d; p. 465, () 714; p. 
 522-523, <J 827 b, d ; p. 539, i) 847 h- 
 848 ; p. 546, <J 862 ; p. 553, <J 870 aa ; 
 p. 670-671, (j 902 m ; p. 862-864, ^ 
 1066. Also, Hydrophobia, Virus 
 OF ; Serpents, Virus of ; Predispo- 
 sition, Miasm, Whooping-Cough, 
 Phthisis, Bidex II. 
 
 chemical theory of, p. 172, (} 350, No 
 45. 
 
 essentially the same as the Vaccine dis- 
 ease — extinguishes the susceptibility 
 of the system to a second attack, upon 
 the same principle as involved in ac- 
 climation — distinction in time of pre- 
 disposition between natural and inoc- 
 ulated — has also the peculiarities of 
 other self-limited diseases in being 
 contagious without contact, and in 
 having a definite course of rise and 
 decline, and, like the others, illus- 
 trates by its remote cause the law of 
 contagion, p. 364, ^ 543-548 ; p. 365, 
 <^ 551 ; p. 366, <J 554 ; p. 419-420, ^ 
 653; p. 421, (J 654 b; p. 425, ^ 664: 
 p. 488, <) 756 a ; p. 544-^546, ^ 858^ 
 861. Also, Diseases, Self-Limited ; 
 Acclimation, Miasm, Contagion, Iji- 
 dcx U. 
 
 notwithstanding, however, the remote 
 cause carries with it its own curative 
 virtue, and the disease in ordinary 
 conditions admits of no active treat- 
 ment, should inflammation of impor- 
 tant organs supervene, they become 
 the means of impressing upon the 
 general malady, through an alterative 
 influence of reflex nervous action, a 
 modified condition, which enables the 
 system to bear all the vigorous treat- 
 
 Small- Pox — continued. 
 
 ment demanded by the same inflam- 
 mation when occurring independently 
 — and so of other self-limited diseases, 
 p. 65, () 143 c, and references there ; 
 p. 536-539, () 847-848 ; p. 542-543, 
 ^ 854 c-f; p. 544-545, i} 858 ; p. 553, 
 <J 870 aa ; p. 665, ^ 901 ; p. 722-724, 
 ^ 960 h ; p. 730, (J 969 a ; p. 732, ^ 
 970 c ; p. 733-734, i) 973-975. 
 like measles, scarlatina, cholera, dysen- 
 tery, &c., is liable to be rendered more 
 prevalent and malignant than at other 
 times through antecedent influences 
 of common miasmatic causes, when, 
 also, its character may be so modified 
 as to render unusual means of treat- 
 ment useful or necessary, as some- 
 times Cinchona ; and hence the im- 
 portance of looking well at any sub- 
 ordinate predisposing causes in all 
 grave forms of disease, p. 418. (j 652 
 b ; p. 544-545, (J 858 ; p. 553', () 870 
 aa. Also, p. 419, () 653 b ; p. 424- 
 425, (J 662-663 ; p. 438-442, ^ 686 ; 
 p. 489, ^ 756 b ; p. 509, MH ; P- 
 510, ^ 814; p. 511, (J 816 i* ; p. 538, 
 ^ 848 ; p. 559-560, ^ 883 b ; p. 723- 
 724, ^ 960 6-961, 630 c, c, 970 c. 
 
 Sneezing, 
 
 when occasioned by the sun's light, the 
 result of a double series of reflex ac- 
 tions of nervous system ; and may be 
 occasioned by the mind, when the 
 nervous influence is simplified in be- 
 ing direct and reflex — employed to 
 illustrate the modus operandi of mor- 
 bific and remedial agents, both phys- 
 ical and mental, through alterative 
 action of the same medium, and in 
 demonstrating the substantive exist- 
 ence and self-acting nature of the 
 Soul and Instinctive Principle, p. 
 340-341, ^ 514 /, m ; p. 666-667, ^ 
 902 c ; p. 890, ^ 1077. 
 
 Solidism and Vitalism. See Vitalism 
 AND Solidism, Index II. 
 
 Soul and Instinctive Principle. See, 
 also, Soul, Instinct, Index I. ; Mind, 
 Will, Index I. and II. 
 physiological demonstrati6n of, and dis- 
 tinguished from each other, p. 873- 
 911, {) 1069-1083. 
 the premises, relative to the nervous 
 
 system, p. 873-874, (j 1071. 
 mechanism and phenomena of reflex 
 nervous action as forming the basis 
 of demonstration, p. 873-877, i) 1071- 
 1072 
 principle the same, whether the nervous 
 influence operate through reflex ac- 
 tion, or in a direct manner through, 
 excito-motory nerves alone, as when 
 the nervous centres are directly im- 
 pressed by physical causes or by the
 
 INDEX II. 
 
 1087 
 
 Soul, &c. — continued. 
 
 Will and Mental Emotions, p. 875- 
 877, () 1072 a ; p. 886-892, (} 1077. 
 Also, Reflex Action, Mental Emo- 
 tions, the individual Passions, Re- 
 medial Action, subdivison Mental 
 Emotions, Index II. ; Will, Index I. 
 and II. 
 
 philosophy of the Will and Passions, p. 
 296, () 476 c ; p. 877, () 1072 b. Also, 
 Mental Emotions, Remedial Ac- 
 tion, subdivision Mental Emotions, 
 Mind, Index II. ; Will, Index I. and 
 II. 
 
 office of the nervous influence in the 
 demonstration — unimportant by vphat 
 name called, or what its nature, or 
 what the theory of its operation, p. 
 898, <J 1073 a; p. 880-881, () 1075 a. 
 Also, p. 117, f) 234 g; p. 330, t) 500 
 n — but, whatever it be, it is interested 
 as a medium of communication be- 
 tween the Soul and Principle of In- 
 stinct and the chief nervous centre 
 and in the phenomena of intellection, 
 p. 879, (^ 1073 b; p. 892, (} 1078 a, 
 also, p. 281, (} 450 e— and the Will 
 and Mental Emotions produce their 
 effects through the same medium, p. 
 880, ^ 1075 a. Also, Mental Emo- 
 tions, Index II. 
 
 no changes instituted in the nervous 
 centre, p. 880-881, <^ 1075 a. 
 
 various analogies betweien the effects of 
 physical agents and the Will and 
 Mental Emotions, p. 875-882, ^ 1072 
 -1075 ; p. 886-892, () 1077. Also, 
 Remedial Action, subdivision Men- 
 tal Emotions, Index II. 
 
 logical consequences as to the substan- 
 tive existence of a self-acting Soul, 
 p. 879-880, () 1074 ; p. 881, () 1075 b. 
 
 the Soul in a perfect state in Infancy, 
 p. 905, () 1078 q — but its manifesta- 
 tions may fail with the development 
 ofthebrain, p. 906, <;) 1078 g. 
 
 the Soul manifests but little instinct, p. 
 893, () 1078 a; p. 895, (^ 1078 c— 
 which is subject to its control, p. 892 
 -896, () 1098 a, b, d; p. 898-899, ^ 
 1078 g; p. 900-902, ^ 1078 i, I, p; 
 p. 903-906, () 1078 q. 
 
 immortality of the Soul, p. 893, ^ 1078 
 a; p. 908-909, () 1080, 1081— and 
 contrasted with the perishable nature 
 of the Principle of Instinct, p. 907- 
 909, ^ 1079 a, 1080. 
 
 Soul acts in greater independence of the 
 brain than Instinct, p. 892, () 1078 n ; 
 p. 903-906, <S. 1078 q. 
 
 excessive exercise of Reason contrasted 
 with the early discipline of Instinct, 
 p. 894, <J 1078 b. 
 
 comparison between the great nervous 
 centre of man and of animals, and the 
 
 Soul, &c. — continued. 
 
 relative phenomena of instinct, as dis- 
 tinguishing the Soul from the In- 
 stinctive Principle, p. 896, i/ 1078 d; 
 p. 898, ^ 1078/; p. 903-906, 1) 1078 q. 
 
 Instinctive Principle limited to the wants 
 and uses of the body, p. 892, ^ 1078 
 a ; p. 904, () 1078 q — operates in one 
 uniform way in every species of ani- 
 mal respectively, but differently in the 
 several species, p. 123, ij 241 c ; p. 
 893, (} 1078 a — always manifests it- 
 self in the mechanism of animal life, 
 p. 893, (} 1078 a — its education in in- 
 fancy, and only then, and different 
 from that of reason, p. 894-895, <5 
 1078 b ; p. 904, ^ 1078 9— essentially 
 subservient to organic life, p. 896-897, 
 ^ 1078 e ; p. 898, <J 1078 /— its 
 promptings after food, distinguished 
 from reason, p. 895, () 1078 d — con- 
 stituted with a special reference to the 
 kind of food upon which each species 
 subsists, and, in each, to the mechan- 
 ism in animal and organic life, p. 896 
 -897, I) 1078 c— its sagacity, p. 889- 
 890, I) 1078 g, A— philosophy of its 
 " tricks" and imitations, p. 895, ^ 1078 
 b — its acts often totally unlike those 
 of reason, but precise, habitual, and 
 inexplicable, p. 123-124, ^ 241 c; p. 
 896, (} 1078 d — its analogies with the 
 Soul, p. 123-124, ^ 241 c ; p. 893, ^ 
 1078 a— is immaterial, p. 908-909, ^ 
 1080, 1081— is perishable, p. 903, <} 
 1078 a ; p. 907-908, ^ 1079 a-l080 
 — supplies a problem in a suppositi- 
 tious case, p 897, () 1078 c — most de- 
 veloped in inferior animals, p. 896, () 
 1078 d: p. 898, l^ \078 J ; p. 903, (} 
 1078 q — its full development in the 
 infancy of animals contrasted with its 
 condition m the human infant, p. 893, 
 (} 1078 a; p. 895, ^ 1078 c ; p. 898, 
 <^ 1078 g-; p. 904, (> 1078 q. 
 
 while Instinct is in full operation in the 
 infancy of animals, the human infant 
 has neither reason nor instinct for its 
 guidance, which supplies a ground of 
 moral distinction in the plan of De- 
 sign, since the development of the 
 Soul, or its approximation to the early 
 displays of Instinct, would be physic- 
 ally and morally destructive of man, or 
 did not its development hold an equal 
 pace with that of the body ; but, on 
 the other hand, as the infant animal is 
 mainly dependent upon itself, and is 
 limited in wants and habits to organ- 
 ic life, the physical constitution and 
 the Instinctive Principle are at once 
 adapted to those exigencies, p. 893, ^ 
 1078 a ; p. 895-898, ^ 1078 c-e,g; p. 
 900, ^ 1078 i; p. 903-906, «J 1078 q. 
 
 the Instinctive Principle holds a relation
 
 1088 
 
 INDEX II. 
 
 Soul, &c. — continued. 
 
 to the brain or its equivalent and other 
 organs corresponding with the anal- 
 ogies which subsist among them and 
 the products of the latter, p. 904-905, 
 ij 1078 q — nor is there any good rea- 
 son to suppose that the main central 
 part of the nervous system of animals 
 bears any greater ratio of develop- 
 ment to other organs of animals than 
 in the human infant, while in respect 
 to the latter, the manifestations of the 
 Soul are in no degree correspondent 
 with the physical products of organs, 
 but advance with the progressive de- 
 velopment of the brain, p. 903-906, 
 () 1078 q. 
 
 relations of animals to sex contrasted 
 with man's, p. 900-901, i) 1078 k. 
 
 the nature of Ideas, and how far they 
 are related in man and animals, p. 
 906, <5 1078 r. 
 
 fear distinguished between man and an- 
 imals, p. 898-899, <;i 1078 g-,- p. 901, 
 ^ 1078 Z — displays of memory con- 
 trasted, p. 901, «^ 1078 o— and what 
 of conscience, love oj fame, Religious 
 sentiment, p. 901, ij 1078 l-n. 
 
 remarkable adaptations of Instinct to 
 vietamor'phoses, ingrafted upon the 
 ovum, and corresponding with the or- 
 ganic endowments, p. 902-903, ^ 
 1078 p. 
 
 the chemical hypothesis as to the Soul, 
 and objections to, p. 155, ^ 149 e; p. 
 882, {) 1076 a. 
 
 ckcmico-spiritual hypothesis, and objec- 
 tions, p. 882-884, ^ 1076 b. 
 
 hypothesis of secretion as to Soul, and 
 objections, p. 884-886, (} 1076 c. 
 
 an argument of materialism considered, 
 p. 894, i) 1078 a, note. 
 
 the substantive existence of the So\il 
 and Instinctive Principle being estab- 
 lished, they are readily seen by their 
 self-acting nature, and by every phe- 
 nomenon which they manifest, to be 
 totally different from matter, and the 
 analogies between the manifestations 
 of the Soul and its Author and be- 
 tween the Soul and the Instinctive 
 Principle enforce still farther their 
 contrast with matter as expressed by 
 the qualifying term immaterial, p. 
 908-909, () 1080-1081. Also, Mind, 
 Index II. 
 Spai.i.anzani, 
 
 his experiments upon eviscerated frogs 
 employed to show the independence 
 of animal heat of chemical laws, p. 
 S.^S. ^41/. 
 Spasmodic Affections 
 
 illustrate the great variety of causes by 
 which the nervous influence is 
 brought into active operation, either 
 
 Spasmodic Affections — continued.. 
 
 in a direct manner by causes affect- 
 ing immediately the nervous centres, 
 or indirectly through reflex action of 
 those centres, and operating, like the 
 Will and Mental Emotions, through 
 the cerebro-spinal system alone, or 
 through that system and the gangli- 
 onic conjointly, and employed by the 
 Author in advancing his application 
 of the physiological laws of the nerv- 
 ous system to Pathology and Thera- 
 peutics, and his demonstration of the 
 substantive existence and self-acting 
 nature of the Soul and Principle of 
 Instinct — and mistakes indicated in 
 regard to the pathology of spasmodic 
 affections, the misapplication of rem- 
 edies, and distinctions to be observed, 
 p 319-320, l^ 494 dd ; p. 331, i) 500 
 ; p. 356-358, () 526 d ; p. 590-593, 
 <) 891i ; p 874-877, i) 1072 ; p. 879- 
 881, 1^ 1075 a, b. Also, Convulsions, 
 
 Specifics — see Specific Action, Ind. I. 
 no remedies are properly such, and in 
 what light reputed specifics should be 
 regard'ed, p. 596-598, () 892 b, c; p. 
 600, iJ892'rf; p. 605,^ 892 m; p. 611- 
 612, ^ 892i h; p. 626-629, ^ 892J ; 
 p. 677-678, <J 904 d; p. 850, § 1053. 
 their employment in the common ac- 
 ceptation is purely empyrical, involv- 
 ing the neglect of pathological and 
 therapeuticdl principles, and other 
 remedies which may be important to 
 the usefulness or safety of the reputed 
 specific, and which alone may be more 
 speedily or perfectly curative, p. 61, (} 
 134; p. 63, () 137; p. 65, 1} 143 c; 
 p. 67, (} 150; p. 73, () 163; p. 120, 
 ^ 237; p. 371-372, ^ 569 h-e ; p. 
 424, {) 662 b, c ; p. 428, () 672 ; p. 
 430-433, ^ 675, 676 a ; p. 479, () 741 
 b ; p. 487-489, () 756 ; p. 494, () 767 ; 
 p. 512, () 817 ; p. 538, ^ 847 g ; p. 539, 
 \ 848 ; p. 540, () 854 bb ; p. 545, ^ 859, 
 p. 547-550, ^ 863 d; p. 551, () 865, 
 866 ; p. 553, (} 870 aa ; p. 554-556, 
 § 872 a; p. 561, () 888 a, b; p. 562, 
 ^•888 e; p. 596-601, ^ 892 b-f; p. 
 608, ^ 892i c; p. 611, ^ 892^ h; p. 
 615, § 892V e; p. 627, () 892J / ; p. 
 629, «^ 892 J s; p. 630, () 892J b; p. 
 p. 633, ^ 892| a ; p. 637, <) 8924, e ; 
 p. 639, () 892| g ; p. 657-6.58, ^"^893 
 p; p. 664, 1^1900; p. 679-683, ^ 905 
 
 a, b; p. 684-689, ^ 905^^ b; p. 715- 
 721, 'J 960 a-c ; p. 726, \ 961 c-c ; p. 
 729, 'J 966 ; p. 731, (J 970 c ; p. 733, ^ 
 974 ; p. 737, ^ 984 b; p. 740, (} 989 ; 
 p. 741-745, i) 990 ; p. 751, ^ 999 c; 
 p. 756-762, ^ 1005 6-1006 a ; () 1007 
 
 b, c; ^ 1019/; I) 1023 a; (} 1058 c, 
 f; sS 1058 y; <) 1059; i) 1063 a; <) 
 1065 a-d; ^ 1067 c; ^ 1068 b-d.
 
 INDEX II. 
 
 1089 
 
 Sphincter Muscles, 
 
 employed to illustrate the slowly pro- 
 gressive operation of remedies and 
 morbific causes through an uninter- 
 rupted alterative influence of reflex 
 action of the nervous system, p. Ill, 
 ^ 2331; p- 338-339, <J 514/, g; p. 
 344, i) 516 d, No. 6 ; p. 670, ^ 902 k ; 
 p. 679-681, ^ 905 a. Also, Altera- 
 tives; Antimony, Taetarized ; Hy- 
 drophobia, Virus of, Index II. 
 Spinal Cord — continued from Index I., 
 late discoveries relative to its struc- 
 ture and functions, p. 802 - 803, i) 
 1037. 
 experiments upon, and the brain, by A. 
 P. W. Philip and Le Gallois to de- 
 termine the laws of the vital func- 
 tions, and others by Stilling, M. Hall, 
 Van Deen, Girtanner, &c., employed 
 by the Author in demonstrating the 
 modus operandi of morbific and reme- 
 dial agents through alterative influ- 
 ence of reflex action of the nervous 
 system, and of the Will and Mental 
 Emotions by direct action, p 295- 
 321, fj 476-494. Also, Reflex Ac- 
 tion, Mental Emotions, the individ- 
 ual Passio7is, Index II. ; Will, Index 
 I ayid II. 
 Spontaneity of Being. See Genera- 
 tion, Spontaneous, Index I. and II. 
 Squill, 
 
 a stimulating Expectorant, unsuited to 
 
 acute inflammation, and employed by 
 
 the Author to illustrate the principles 
 
 which should govern the treatment of 
 
 . pulmonic diseases, p. 638-640, ^ 892i 
 
 Stethoscope, 
 
 some of its contributions to Pathology, 
 p. G40, ^ 892|- h. 
 
 Stilling, 
 
 his experiments with Strychnia upon 
 the spinal cord, and acetic acid to the 
 skin, employed to illustrate Author's 
 doctrine of the modus operandi of 
 morbific and remedial agents through 
 reflex action of the nervous system, 
 p. 287-289, () 459 c-g ; p. 319, <;. 494 
 b-dd. 
 
 Stimulants. See Tonics, Index II 
 
 Stomach and Intestine, continued from 
 Index I. See, also, Digestion, Index 
 II, 
 having assembled, as above, references 
 to sections which relate to the func- 
 tions of the stomach, it is simply an 
 object now to bring together some of 
 the many in which the Author en- 
 deavours to show that all remedies 
 taken internally exert their primary 
 effects upon the gastro-intestinal mu- 
 cous tissue, and upon all other parts 
 through alterative influences of reflex 
 
 Z 
 
 Stomach and Intestine — continued. 
 
 action of the nervous system insti- 
 tuted by those primary impressions, 
 with the exception of what may be 
 due to continuous sympathy — and, 
 for the foregoing purpose, the aliment- 
 ary canal is considered in its special 
 anatomical and vital characteristics, 
 its special functions, its special rela- 
 tions to the nervous system, and the 
 subordination of all parts of the body 
 and of instinct to its final cause of 
 supplying all parts with nutriment, p. 
 41, ^ 65 ; p. 62, () 135 a ; p. 63, () 137 
 c; p. 65, () 143 c; p. 129-131, () 277 
 -284 ; p. 143-146, () 322-326 ; p. 148 
 -149, (^ 336 ; p. 193, ^ 356 a ; p. 216, 
 ■51399; p. 229, <> 419 c,- p. 289,(^461; 
 p. 335-336, <J 512-513 ; p. 417, <J 649 
 c ; p. 430, t) 674 d ; p. 563-565, <} 889 
 a-g ; p. 668-669, t) 889 7n, wm ; p. 
 667-669, (j 902 e-g ; p. 896-897, ^ 
 1078 c — and considering with this the 
 exquisite susceptibility of the gastro- 
 intestinal mucous tissue in its sympa- 
 thetic sensibility (scarcely inferior to 
 that of the lungs) to a variety of caus- 
 es whose remote effects are manifest- 
 ly owing to reflex actions of the nerv- 
 ous system instituted by the irrita- 
 tion of the tissue, as seen in the move- 
 ments of the muscular coat, in the con- 
 traction of the sphincter ani, in the 
 act of swallowing (p. 338-339, (J 514 
 /, g, and Index II.), in the glow and 
 moisture that often spring from the 
 first contact of food with the stomach, 
 and in the spasms that arise from its 
 mechanical irritation, and in the vom- 
 iting occasioned by tickling the throat, 
 by pregnancy, by disease of the kid- 
 ney, by offensive odours, disgusting 
 sights, and by their recollections, and 
 as constitutionally displayed in infan- 
 cy (p. 250-251, i) 441 c; p. 327, () 
 500 i-k; p. 336-338, ^ 514 a-c ; p. 
 339-340, i) 514 h ; p. 355-356, () 512 
 a, b ; p. 374, () 576, d; p. 579-580, (J 
 890^ d; p. 590-591, <;» 89H b; p. 
 592-593, {)89\ik; p. 666-669, (J 902 
 c-g), and taking along many unequiv- 
 ocal examples supplied by the Materia 
 Medica, as emetics, cathartics, small 
 doses of tartarized antimony (see the 
 Articles, Index II.), and connecting 
 with the foregoing many familiar an- 
 alogies where diseases of various or- 
 gans inflict disease sympathetically 
 upon the alimentary canal, and the 
 more numerous ones in which prima- 
 ry affections of the stomach and in- 
 testine light up disease in all other 
 parts, and considering, also, how the 
 primary affections are often cured by 
 vesicants, the shower-bath, friction, 
 
 z
 
 1090 
 
 INDEX II. 
 
 Stomach and Intestine — continued. 
 
 &c. (see Skin, and other Articles), 
 and a large variety of other concur- 
 ring facts which these general refer- 
 ences will suggest, and which are 
 readily accessible through our Index- 
 es, we entertain the belief that our 
 main object of demonstrating the in- 
 strumentality of the nervous influence, 
 either reflex or direct, as the essen- 
 tial medium through which all reme- 
 dial and morbific causes, physical and 
 mental, exert their effects, and of con- 
 tradistinguishing the laws of organic 
 from those of inorganic beings, and 
 of reclaiming from the Laboratory of 
 the Chemist the several great branch- 
 es of Medicine, might be safely left to 
 the accumulated proof upon the sub- 
 ject before us, but, nevertheless, in- 
 vite the attention of the Reader to the 
 topics under the Article Generali- 
 zation OF Reflex Action of the 
 Nervous System, Index II. ; and Or- 
 ganic Chemistry, Vital Properties, 
 Organic Life, Organic Compounds, 
 Organic Heat, Ovum, &c., Index I. 
 
 Stomach, Blows upon, 
 
 operate, as in shocks from surgical op- 
 erations, through a sudden and violent 
 determination of reflex action of the 
 nervous system upon the organic vis- 
 cera — the modus operandi being also 
 the same in principle as when sudden 
 death is produced by hydrocyanic ac- 
 id, the virus of serpents, drinking cold 
 water when fatigued in hot weather, 
 loss of blood, apoplexy, joy and anger, 
 and illustrated by Le Gallois's and 
 Philip's experiments upon the spinal 
 cord, p. 107-108, ^227; p. 109, ij. 230; 
 p. 114, <J 234 e; p. 296, (} 476 c; p. 
 297-299, <^ 476i c-477 a; p. 300-301, 
 (} 479-480 ; p. 304, () 481 g; p. 307- 
 308, () 483 c; p. 319, ^J 494 b ; p. 334 
 -335, <J 509-511 ; p. 402-403, ^ 634, 
 635 ; p. 525-528, <^ 828 a-d ; p. 670, 
 <J 902 / ; p. 707, § 949. 
 
 "Strainage," 
 the prevailing doctrine of, opposed by 
 the laws which govern healthy and 
 morbid states, by the endless variety 
 of exact products in animals and 
 plants, composed mainly of four ele- 
 ments in intimate union, but derived 
 from fluids constituted of sixteen or 
 eighteen, by the influences which are 
 exerted upon the blood and all the 
 fluids of the animal body by reflex or 
 direct action of the nervous system, 
 and by the analogy supplied by the 
 admitted fact that the proximates of 
 the bile have no existence in the 
 blood, p. 21, ^ 22 ; p. 23-26, (} 37- 
 48 ; p. 27-28, <) 52-53 ; p. 30, (J 58 ; 
 
 " Strainage" — continued. 
 
 p. 34-36, ^ 62 a-i ; p. 62-64, ^ 135- 
 138 ; p. Ill, () 233f ; p. 128, () 226; 
 p. 193, (} 356 a : p. 216, (ji 399 ; p 
 219-227, () 407-411 ; p. 318, () 493 
 d ; p. 484, I) 748 ; p. 783, § 1031 b ; 
 p, 788-789, () 1032 a, b ; p. 801, () 
 1039 ; p. 911, () 1083. Also, Secre- 
 tion AND Excretion, Lactation, 
 Bile, Milk, Pus, Parturition, Men- 
 tal Emotions, Index II. 
 Structur>e — continued from Index I.; 
 also, Tissues, Index I. ; Mucous Tis- 
 sue, hidex I. and II. 
 
 analogies of simple tissues, p. 52, ^ 85- 
 89 — distinguished from the compound 
 or complex organs which they com- 
 pose although compounded them- 
 selves, p. 52, 53, <^ 85, 89, 91, 92. 
 
 every part a labyrinth of designs, p. 59, 
 () 130 — each simple texture, in com- 
 pound organs, has its own organic 
 functions, p. 61, (^ 132. 
 
 structure of general body radiated and 
 symmetrical, p. 53, i^i 93-95 
 
 general division of organs and functions 
 of animal life and of organic life, and 
 their designations and uses, p. 53-54, 
 {) 96-106 ; p. 125, (^ 248-250— those 
 of organic life quite analogous in low- 
 est plants and animals, p. 54, i^i 107 ; 
 p. 474, i) 733/ — no organ of animal 
 life necessary, p. 54, ij 108 — indis- 
 pensable organs of a complex nature 
 generally single, p. 54, () 109 a ; p. 
 285, ^ 455 c — but the most essential 
 parts are the extreme arterial vessels, 
 to which the more compound organg 
 are subordinate, p. 54, () 109 Z*; p. 
 227, Hn ; p. 804, <J 1040. 
 
 organs and functions relative to species 
 and their sympathetic influences upon 
 the general organism of animals — 
 and their development a final cause of 
 the whole in plants and animals, p. 
 55-56, ^18-123 ; p. 376-380, () 578 ; 
 p. 817, (^ 1052 c. Also, Organs of 
 Generation, Uterus, Index II. ; 
 Youth, Index I. and II. 
 
 law of dismemberment as it respects the 
 germs and peculiarity of life in seed 
 and egg, p. 56, () 122, 123. 
 
 the properties and laws through which 
 it is developed, and carry on forever 
 its functions, and govern all morbid 
 changes, are shown by the elementa- 
 ry constitution of organic compounds 
 to be totally different from those of 
 inorganic bodies, p. 15-33, <J 7-60; 
 p. 50-52, ^ 83 c-84— and so allowed by 
 Chemists who endeavoured to prove it 
 otherwise, ibid., p. 189-190, (> 350i 7i, 
 &c. — the pursuit now virtually dis- 
 missed from the Laboratory, p. 779- 
 782, () 1028-1030— though reluctant-
 
 INDEX II. 
 
 1091 
 
 Structure — continued. 
 
 ly, p. 796-799, ^ 1034. Also, Com- 
 position, Organic Compounds, Vital 
 Properties, Organic Life, Chemis- 
 try, Organic Chemistry, hidex 1. 
 
 the same contradistinction shown by the 
 incorporation of Nitrogen, p. 33-36, <5> 
 61-62 — and by the developmental his- 
 tory of the Ovum, p. 36-49, <J 63-80 
 — and by Cells, p. 51-52, () 84 — and by 
 the development of cells in extravasa- 
 ted blood, and more particularly from 
 their generation in simple protoplasm, 
 p. 813-814, ^ 1051 b. 
 
 the properties, functions, and laws can- 
 not be deduced from the structure, 
 except in connexion with an observa- 
 tion of the results, which is the main 
 source of information, p. 3, i^i 2 c ; p. 
 50-51, <)83c; p. 59, ^ 130. 131 ; p. 
 86-87, <J 176, 177 ; p. 218, ^ 406 ; p. 
 353, () 525 a ; p. 354, (} 526 a ; p. 
 801, ^ 1036 — with analogies, also, 
 ibid., and p. 223, <J 409 c — yet a 
 knowledge of structure is indispens- 
 able, and at the foundation of all med- 
 icine, ibid. 
 
 each tissue distinguished by differences 
 in organization and modifications of 
 vital endowments, and these distinc- 
 tions become more remarkable in the 
 vegetable kingdom, where they corre- 
 spond with the more fundamental dis- 
 tinction of organizing compounds out 
 of the elements of matter — and un- 
 dergo changes from infancy to adult 
 age — and these differences are farther 
 denoted by differences in vital stimu- 
 li, by the products, by the action of 
 morbific and remedial agents, by the 
 varieties in a common form of disease, 
 especially inflammation — and these 
 differences in vital endowments exist 
 in different parts of one and the same 
 continuous tissue, as in the gastro-in- 
 testinal and pulmonary mucous, p. 15, 
 ^ 13-14 b ; p. 52, () 85, 89 ; p. 61-70, 
 (} 133-160 ; p. 73, «J 163 ; p. 82-83, 
 ^ 172, 173 ; p. 88, (^ 185 ; p. 98, ^ 
 191 a, b ; p. 138, () 303|^ ; p. 140-141, 
 {) 306, 307; p. 218, ^ 406 ; p. 229- 
 230, ^ 419 c-422 b ; p. 353, ^ 525 a; 
 p. 354, 526 a; p. 373-380, <J 576- 
 578 ; p. 473, ^ 733 b ; p. 480, (J 741 
 c; p. 522-523, ^ 827 b, c; p. 671, (^ 
 904: b; p. 815-816, ^ 10.52 a. 
 
 each part has its own natural stimuli 
 according to the peculiarities of its 
 properties and functions, and each 
 suited only to the several parts re- 
 spectively, and may be poisonous to 
 other parts — though arterial blood is 
 adapted to all parts, p. 62-63, ^137 
 a; p. 671, {) 904 6. 
 
 mistakes in practice from not regarding 
 
 Structure — continued. 
 
 the foregoing modifications of vital 
 endowments in the different tissues 
 and parts of a continuous tissue, p. 
 63, ^ 163 c. 
 
 the law of adaptation, p. 63, <) 137 c ; p. 
 65, () 143 c, and references there •, p. 
 68, ^ 152 ; p. 69, ^ 156 b, and refer- 
 ences; p. 535-539, (J 847-850; alsO; 
 Adaptation, Law of. Index I. 
 
 the natural modifications which tissues 
 and compound organs undergo in 
 their structure and vital endowments 
 in the progress of life give rise to 
 new diseases and modifications of for- 
 mer diseases, and new susceptibilities, 
 and develop or modify the passions, 
 and affect the details of practice, p. 
 68-69, § 153-159 ; p. 373-383, ^ 576 
 -584 ; p. 401-402, () 633. 
 
 certain tissues or parts of a continuous 
 tissue more liable to disease than oth- 
 ers, and to degrees of severity, ac- 
 cording to the nature of the compound 
 organ in which they may be associ- 
 ated, p. 64, ^ 138, 139 ; p. 70, ^ 160 
 -162. 
 
 the difference in organization and vital 
 endowments of different tissues in 
 their relation to different compound 
 organs, and of different parts of a 
 continuous tissue, illustrated by tabu- 
 lar views of their relative liability to 
 inflammation, and the relative degrees 
 of danger, and the relative propor- 
 tions of loss of blood as may be re- 
 quired by one part or another accord- 
 ing to the compound organs with 
 which they may be associated, p. 69- 
 73, ^ 160-162; also. Bloodletting, 
 Inflammation ; Brain, Inflamma- 
 tion OF, Index II. 
 
 tabular statement, indicative of the lia- 
 bility of different tissues of the same 
 nature, remote from each other, to 
 sympathize together in their diseases 
 respectively, through reflex action of 
 the nervous system, and applications 
 of the principle, p. 353-358, <) 525- 
 526 — and another showing the rela- 
 tive liability of different tissues, re- 
 spectively, when morbidly affected, to 
 continuous sympathy in their several 
 parts, by which reflex actions of the 
 nervous system are generated, and ex- 
 planations, p. 354-356, () 526 a-d, and 
 in connexion with tables at p. 70-73, 
 and with continuous sympathy as set 
 forth under Leeching ; Oil, Croton ; 
 Suppositories, and Sympathy, Con- 
 tinuous, Index II. — all serving as a 
 basis of an extended philosophy in 
 Physiology, Pathology, and Thera- 
 peutics — another table exhibiting an 
 arrangement of organs according to
 
 1092 
 
 INDEX II. 
 
 Structure — continued. 
 
 their relative functions, p. 57 — anoth- 
 er, of their secreted products, p. 218, 
 
 the simple tissues the seats of disease, 
 and a knowledge, therefore, not only 
 of their anatomical, but of the special 
 vital characteristics of each is indis- 
 pensable in practical medicine, p. 52, 
 ^ 85 ; p. 61, <J 133-134 ; p. 63, (} 137 
 b, c; p. 64-65, (> 138-143; p. 67, () 
 149-151 ; p. 467, «J 718, &c. 
 
 upon the peculiarities in the special vital 
 endowments of each tissue depends 
 greatly the character of disease and 
 the efl'ects of remedies and of morbific 
 causes, as exerted through reflex nerv- 
 ous action, p. 61-63, <J 133-134, 137 
 a-e; p. 466, 467, () 715, 718 ; p. 652 
 -656, {) 892 n 
 
 the foregoing special endowments of 
 the tissues respectively, and there- 
 fore their special modifications in dis- 
 ease, conform to the general nature of 
 the complex organ of which they may 
 form component parts, p. 64, ^ 138. 
 
 the organic properties of all tissues mu- 
 table in their nature, upon which de- 
 pends a variety of natural changes, 
 and in being thus constituted for use- 
 ful ends, and from their inherent tend- 
 ency to maintain their normal state, 
 this mutability is at the foundation 
 of disease and its cure — while, also, 
 all morbid states increase the sus- 
 ceptibility of the organic properties 
 to the action of remedial and morbific 
 agents, and the disposition to under- 
 go changes, p. 61, ^ 133 c ; p. 63, ^ 
 137 d, e ; p. 65-68, <) 142-156 ; p. 
 82-83, <J 172; p. 87, () 177, 182 b; 
 p. 414, () 642 b ; p. 665, () 901. Also, 
 Gestation, Lactation, Index II. ; 
 Youth, Index I. and II. 
 
 increased susceptibility of tissues, aris- 
 ing from disease, to direct action of 
 remedies, and to reflex nervous in- 
 fluence, and according to the nature 
 of a tissue, or part of a tissue, or of 
 the more compound organ, one of the 
 most important laws in medicine, p. 
 61-62, <J 133-134, 137 a-e ; p. 63, ^ 
 137 d ; p. 64, () 138 ; p. 65, *;. 143 ; 
 p 67, () 149-151 ; p. 73, <) 163— and 
 60 of morbific causes, ibid. — which 
 presents a problem for Organic Chem- 
 istry, p. 63-64, () 137 e; p. 652-656, 
 «J 893 ?(, &c. ; p. 674, (} 904 b. 
 
 varying susceptibilities in different parts 
 of a continuous tissue, according to 
 the nature of a part, through which 
 morbific and remedial agents will act 
 more in conformity with the acquired 
 susceptibilities than the natural mod- 
 ifications, p. 65, <J 143 a. 
 
 Structure — continued. 
 
 preternatural susceptibility or predispo- 
 sition may be universal, and followed 
 by a simultaneous explosion of dis- 
 ease in all organs, as in idiopathic fe- 
 ver, when, also, a single remedy may be 
 adequate to the cure, and even when 
 complicated with local inflammations, 
 p. 65-67, ^ 143 b-d, 148 ; p. 367, i) 
 557; p. 464, (^ 712; p. 465-466, (> 
 715 ; p. 535-539, () 847-850 ; p. 664, 
 (^ eCO ; p. 713, <J 956 ; p. 731-732, ^ 
 907 c, also. Remedies, Fever, In- 
 flammation, Pkedisposition, Index 
 II. ; Adaptation, Law of, Index I. — 
 but where inflammations are attend- 
 ant upon fever, and where many or- 
 gans become invaded by uncompli- 
 cated inflammations or other forms of 
 disease, the affections are apt to 
 spring up consecutively as sympa- 
 thetic consequences of each other, 
 ibid., and Causes, Morbific, Index II. 
 
 next to the distinction between Ani- 
 mals and Plants which relates to their 
 modes of subsistence is the incorpo- 
 ration of the cerebro-spinal and gan- 
 glionic systems of nerves in all parts 
 of the animal and organic life of An- 
 imals, each of which has special uses, 
 respectively, and others collectively, 
 and through the latter of which all 
 parts of the organic mechanism are 
 maintained in one harmonious con- 
 cert of action, p. 54-55, (J 110-116 ; 
 p 63, ^ 137 e; p. 110, (^ 232; p. 
 284-286 ; p. 290-295, ^ 462-475 ; p. 
 326, ij 500 g ; p. 330, ^ 500 n ; p. 
 474-475, <J 723 f-i — from which arises 
 a general coincidence in the patholog- 
 ical as well as physiological condition 
 of the whole, and renders them equal- 
 ly amenable to remedies ; but altera- 
 tive reflex nervous influence not 
 equally reciprocal, p. 55, ^ 117; p. 
 03, (J 137 c ; p. 284-289, (} 454-461^ 
 — and ultimately illustrated by the 
 laws of reflex action of the two sys- 
 tems of nerves, and the Author's di- 
 rect action through the Will and Men- 
 tal Emotions, and applied to Pathol- 
 ogy and Therapeutics, p. 284-289, ij 
 454-4611 ; P- 295-335, ^ 476-511 ; 
 p 335-362, <) 512-530. Also, Men- 
 tal Emotions, hidcx II. ; Will, In- 
 dex I. and II. 
 
 the natural sympathetic relation of or- 
 gans, through an unceasing reflex ac- 
 tion of the nervous system, of the 
 greatest practical importance, and 
 evinces the highest order of Design, p. 
 58-59, ^ 126-129 i ; p. 284-289, § 
 454-461 ; p. 328, () 500 /. Also, Re- 
 flex Action, Sympathy, as it re- 
 spects tissues and complex organs ;
 
 INDEX II. 
 
 1093 
 
 Structure — conlinucd. 
 
 Causes, Morbific; Remedies, Blood- 
 letting, Index II 
 
 the syttipathetic relations variously mod- 
 ified by disease, according to the spe- 
 cial vital endowments of organs and 
 tissues and the disturbances of the 
 reflex nervous influence, p. 58-59, () 
 129 d-i; p. 67, <J 149-151 ; p. 73, i^ 
 163 ; p 107-110, i) 226-232 ; p. 110, 
 ^ 232 ; p 286, i) 456 b ; p. 332, () 501 
 c ; p. 661-663, <J 894-896— in conse- 
 quence of which, and as a natural re- 
 sult of the established relations, rem- 
 edies call the alterative action of re- 
 flex nervous influence into profound 
 operation, and develop curative reflex 
 influences among organs diseased, 
 and exact contributions from the un- 
 affected, p- 59, () 129 I, and references 
 there ; p. 65-66, () 143 c, and re/er- 
 enccs there; p. 661-663, (; 894-896 
 Also, Remedies, Skin, Index II 
 
 hence, in view of the foregoing natural 
 relations, and the differences in the 
 vital constitution of tissues and or- 
 gans, we readily understand the 
 ground of the variety among sympa- 
 thetic diseases, and how all organs 
 may be disturbed by disease of one, 
 p. 55, i) 117; p. 59, (} 129 h ; p 64- 
 65, <^ 140-143 c ; p- 107-108, () 227 ; 
 p. 332, « 501 ; p. 339-340, ^ bU h , 
 p 359-360, <J 527: p 361, ij 529 6; 
 p. 415, ^ 647; p 423-424, (^ 660 ; p. 
 465-467, () 715-719. 
 Strychnia, 
 
 employed, through the analogies of its 
 spasmodic effects with convulsions 
 that arise from teething, indigestible 
 food, &c., and with traumatic teta- 
 nus, and in connexion with the coun- 
 teracting influences of Antispasmod- 
 ics, opium, &c , as one of the numer- 
 ous illustrations of the less obvious 
 modus operandi of morbific and reme- 
 dial agents through alterative influ- 
 ence of reflex action of the nervous 
 system, p 109-110, () 230-232, p. 
 Ill, ij 233f ; p. 319, <;» 494, b, dd ; p. 
 334, <;> 509 ; p 338, <) 514 d; p 525- 
 527, (} 828 a-d ; p 590, «J 891M ; P 
 592-593, <) 891i k; p. 671-674, i) 
 904 a, b. Also, Convulsions, Opi- 
 um, Remedial Action, Hydrocyanic 
 Acid. Antispasmodics, Coffee, In- 
 dex II. Also, p. 930, () 1088 a. 
 SuDORiFics. See Index I. Also, Sweat, 
 Skin , Antimony, Tartarized ; Wa- 
 ter, Hot, Index II. 
 Sugar, Animal, 
 
 whence derived, p. 784-793, ii 1031 h- 
 1033. 
 
 sugar of milk, a product of the mam- 
 mary gland, and has no existence in 
 
 Sugar, Animal — conlinued. 
 
 the general mass of blood, p. 785, <5> 
 
 1031 b; p 789-790, () 1032 b. 
 
 does it pre-exist in any part of the cir- 
 culation, and is it a product of the 
 liver 1 p. 783-793, () 1031 4-1033. 
 
 vegetable food not necessary to its pro- 
 duction, p 785, <^ 1031 b. 
 
 diabetic, formed by kidney, p. 789, <) 
 
 1032 b — restricted to diabetes, p. 786, (^ 
 1031 b — found in urine after pricking 
 medulla oblongata, p. 792, () 1032 d. 
 
 saccharine matter not absorbed by lac- 
 teals, p 788, 789, {) 1032 b. 
 methods of searching for, p. 794, ^ 
 
 1033 a. Placental origm of, <J 1086. 
 Sulphuric Acid, 
 
 introduced as one of the proofs that As- 
 tringents and all other remedies op- 
 erate upon parts beyond their direct 
 seat of action through alterative in- 
 fluence of reflex action of the nervous 
 system, p 530, ^ 837 c ; p. 533, <) 842 ; 
 p. 577, () 890 0. Also, Lead, Ace- 
 tate OF ; Silver, Nitrate of ; Opi- 
 um. Cold, Ipecacuanha, Index II 
 Sulphuric Ether, and other Anjes- 
 tHetics, 
 
 facts and arguments to show that they 
 are not absorbed, but produce their 
 constitutional effects through altera- 
 tive influence of reflex nervous action 
 — the philosophy being the same as 
 concerned in respiration, where the 
 reflex action is instituted by an inap- 
 preciable irritation of the pulmonary 
 mucous tissue — and illustrate, also, 
 the distinctions between common, 
 specific, and sympathetic sensibility, 
 p. 522-523, f) 827 b-d ; p. 862-864, 
 (} 1066; p. 671, (} 904 b. Also, p. 
 101-102, ^ 201-202; p. 282-283, (} 
 451 d-J ; and Structure, An.i;s- 
 THETics, Oxygen, Index II 
 Suppositories 
 
 supply one of a thousand clear demon- 
 strations of the operation of remedial 
 and morbific agents upon distant parts 
 through alterative influence of reflex 
 action of the nervous system, and of 
 the modifications of that influence ac- 
 cording to the nature of the cause, 
 while, also, in making their impres- 
 sions partly through continuous sym- 
 pathy, they concur with Croton Oil 
 applied to the tongue, Leeching the 
 anus, and Enemas of warm water, in 
 showing how local impressions of this 
 nature correspond with the nature of 
 the ao;ent, and give rise to a corre- 
 sponding modification of the nervous 
 influence, p. 666, <) 902 b; p. 673- 
 675, I) 904 b. Also, p. 107-109, () 
 226-229, p. 661-663, ^ 894-896; 
 and Oil, Croton ; Leeching, Heat ;
 
 1094 
 
 INDEX II. 
 
 Suppositories — continued. 
 
 Sympathy, Continuous ; Inflamma- 
 tion, Index II. ; Nervous Power, 
 Index I. and II. 
 SuppuRANTs. See Seton, Counter-Ir- 
 
 RiTANTS, Index II. 
 Suppuration — continued from Index I., 
 designed for useful ends, and its design, 
 along with the production of lymph, 
 displayed especially in deep-seated 
 abscesses, p. 471-474, <^ 732 6-733. 
 Also, p. 546-547, ^ 862-863; and 
 Mucus, Pus, Lymph, Inflammation, 
 Index II. 
 Swallowing, Deglutition, 
 
 like the involuntary and voluntary acts 
 of respiration, and contraction of the 
 sphincter muscles, illustrates the coin- 
 cidences between the physical agents 
 and the Will as equally substantive 
 causes, and their common dependence 
 upon the nervous influence (reflex in 
 one case, direct m the other), as their 
 medium of bringing the organic struc- 
 tures into action, and employed, also, 
 in advancing the Author's demonstra- 
 tion of the operation of morbific and 
 remedial agents and the Mental Emo- 
 tions through the same causation, p. 
 338-339, 1^ 514: f,g. Also, Reflex 
 Action, Mental Emotions, Respira- 
 tion, Sphincter Muscles, Soul and 
 Instinctive Principle, Index II ; 
 Will, hidex I. and II. 
 Sweat — continued from Index I. See, 
 also, SuDORiFics, Index I., 
 an unimportant evacuation, abstractly 
 considered, and not a rehable or im- 
 portant symptom unless supported by 
 others, and induced by causes of an 
 internal nature that impart an altera- 
 tive influence to the reflex action ot 
 the nervous system upon which it 
 then depends, when it may be favor- 
 able or indicative of danger — and, as 
 occasioned by remedies, it is conform- 
 able to the nature of each one, or as 
 each may modify the reflex nervous 
 influence, and it is the special impres- 
 sion that may be thus made upon the 
 skin which does tlie essential service, 
 and very little so the evacuation, as 
 may be readily seen in the diflerences 
 between the sudorific effects of hot 
 drinks, fear, exercise, &;c., and as they 
 spring from tartarized antimony, ipe- 
 cacuanha, loss of blood, opium, &c. — 
 in one series of cases the nervous 
 power operating as a simple stimu- 
 lant, while in the other it is profound- 
 ly alterative of organic action ; and 
 in both the cases the skin may re- 
 act through a corresponding nervous 
 influence upon morbidly susceptible 
 parts, and, therefore, with far greater 
 
 Sweat — continued. 
 
 effect in the latter than the former 
 cases, p. 107-109, (} 226-230 ; p. Hi, 
 (^ 233J : p. 230-232, <) 422 A-424 ; p. 
 250-251, (J 441 c, p. 335-336, () 512 
 a,b, p 338, (J. 514 rf; p. 339, ^514 
 h ; p. 350-351, <^ 524 ; p 355, (J 526 
 a; p. 451-452, «^ G92 a; p. 546-550, 
 <) 862-863/; p. 550, t) 863 d ; p. 592 
 -593, I) 89H k ; p- 631-632, i) 892f ; 
 p. 634, (J 8924 a, b ; p. 661-664, <» 894 
 -900 ; p. 665-669, <) 902 a-i ; p. 678, 
 ^904tZ,- p.704,<;i943a. Also, Secre- 
 tion and Excretion, Skin, Struc- 
 ture, Hybernating Animals, Rem- 
 edies ; Antimony, Tartarized, Index 
 II. ; Nervous Power, Index I. and 
 II. 
 employed to illustrate modus operandi 
 of Astringents through alterative in- 
 fluence of reflex action of nervous 
 system, p. 530, ^ 837 c ; p 533. () 
 842; p 577, (J 890 o. 
 Symbols, Chemical, 
 
 as carried into Physiology, admitted to 
 be fallacious, p 779-782. <) 1029, 
 1030. 
 Sympathy — continued from Index I., 
 under this comprehensive designation 
 are included remote, contiguous, and 
 continuous sympathy, the first two 
 representing reflex action of the nerv 
 ous system, and the last having no 
 manifest connexion with that action, 
 but probably influenced by the nerves 
 so far as they form a component part 
 of the various tissues ; and under the 
 general designation are arranged the 
 laws of reflex nervous action and the 
 numerous experiments brought to 
 their illustration, and introduced by 
 the Author for the purpose of apply- 
 ing them to Pathology and Therapeu- 
 tics — the order of the subjects pro- 
 ceeding as follows ; 
 On the general Uses of the Nervous 
 
 System, p. 284-290, (f 454-461. 
 On the different Orders of Nerves, p. 
 
 290-292, () 462-470. 
 Laws vj Action of Motor Nerves of 
 
 the Cerehro- Spinal System, p. 292, 
 
 <.471. 
 Laws of Action of Sensitive Nerves of 
 
 the Cercbro- Spinal System, p. 292, 
 
 t) 472 ; p. 802-803, 4 1037 b. 
 On the Spinal Cord, p. 292-295, <j^ 
 
 473-475 , p. 802-803, () 1037 b. 
 Experiments to determine the Laws of 
 the Vital Functions, and applied to 
 Pathology and Therapeutics 
 1st. On the Principle on which the 
 
 Action of the Heart and Vessels of 
 
 Circulation depends, p. 295-301, § 
 
 476-479 ; p. 803-804. () 1039 ; p. 
 
 805-807, <J 1041.
 
 INDEX II. 
 
 1095 
 
 Sympathy — continued. 
 
 2d- On the Relation which subsists 
 between the Heart and Vessels of 
 Circulation and the Nervous Sys- 
 tem ; and the Influence of the Nerv- 
 ous System upon the Capillary 
 Bloodvessels, p. 301-310, () 480- 
 485. 
 Zd. On the Principle on which the Ac- 
 tion of the Muscles of Voluntary 
 Motion depends, and the Relation 
 which they bear to the Nervous Sys- 
 tem, p. 310, () 486. 
 Ath Experiments to ascertain the com- 
 parative effects of Stimuli applied 
 to the Brain and Spinal Cord on the 
 Heart and Muscles of Voluntary 
 Motion, p. 311-315, ^ 487-489. 
 5th. On the Principle on which the 
 Action of the Alimentary Canal de- 
 pends, p. 315, i) 490. 
 &th. On the Relation which the Ali- 
 mentary Canal and Lungs bear to 
 the Nervous System, p. 315, () 491. 
 Review of the Inferences from the pre- 
 ceding and other Experiments, p. 
 315-321, (j 492-494. 
 on the Varieties or Kinds of Sympathy, 
 and appUed to Pathology and Thera- 
 peutics, p. 321-335, (j 495-511. 
 the Laws of Sympathy, or Reflex Ac- 
 tion of the Nervous System, and their 
 AppUcation to Pathology and Thera- 
 peutics, p. 335-362, () 512-530. 
 \st. General Facts and Laws relative 
 to the Cerebro- Spinal and Gangli- 
 onic Systems, p. 335-341, ^ 512- 
 514. 
 2d. Laws of Action of the Sympa- 
 thetic Nerve, and the Propagation 
 of Impressions in it, p. 341-342, (j 
 5141 a-515. Also, p. 216, ^ 399. 
 2d. Of the Action of the Sympathetic 
 Nerve in Involuntary Motions, p. 
 342-349, ij 516-521. 
 Ath. Laios of the Sensitive Fibres of 
 the Sympathetic Nerve, p. 350, ^ 
 523. 
 5^^. Laws of the Organic Functions 
 of the Sympathetic Nerve, p. 350- 
 353, ^ 524. Stmpath. Nerve, /. i. 
 of the Sympathies of the Individual Tis- 
 sues : 
 1 St. Sympathies of similar Tissues, p. 
 
 353-358, () 525-526. 
 2d. Sympathies of Dissimilar Tis- 
 sues, p. 359-360, ^ 527. 
 3d. Sympathies of Individual Tissues 
 in their Relation to each other in 
 Compound Organs, and with entire 
 Organs, p. 360-361, <^ 528. 
 Sympathies of Compound Organs with 
 each other, p. 361-362, ^ 529-530. 
 Sympathy, Remote and Contiguous, 
 terms of brevity, whose generic name is 
 
 Sympathy, &c. — continued. 
 
 derived from that of the nerve which, 
 with the pneumogastric, is the prin- 
 cipal channel through which reflex 
 actions of the nervous system are 
 conducted (and is thus employed by 
 Miiller and other Physiologists, p. 349, 
 ^ 520 ; p. 352, <) 524 c, &c.), and the 
 only distinction between them con- 
 sists in the greater limitation of the 
 former to the cerebro-spinal axis as 
 the central parts for reflected actions, 
 while contiguous sympathy is mani- 
 fested more particularly through local 
 centres, which may consist of either 
 the ganglia of the sympathetic nerve, 
 or of plexuses of nerves, or of some 
 portion of individual nerves (the last 
 of which the Author, as will be seen, 
 had considered probable, and which 
 has been recently experimentally as- 
 certained), but is, doubtless, always 
 associated more or less with reflex ac- 
 tions conducted through the brain and 
 spinal cord, as conspicuously mani- 
 fested in the action of Vesicants and 
 Leeches when applied over some in- 
 ternal inflammation, and, in its more 
 circumscribed aspect, in the examples 
 of dilatation of the iris at p. 673-674, 
 ^ 904 b, and of the sciatic nerve at p. 
 838, ^ 1057i — and it now remains 
 only to refer the inquirer for the prac- 
 tical applications oi remote sympathy 
 to the sections embraced under the 
 Article Reflex Action of the Nerv- 
 ous System, Index II. ; while he will 
 find under the following sections the 
 combined aspects of reflex action as 
 conducted more or less through local 
 centres of the nervous system, and its 
 main centres, with various illustra- 
 tions, and designated by the old name 
 of Contiguous Sympathy, p. 287- 
 289, {) 458-461 ; p. 293, ^ 473 c; p. 
 294, No. 5 ; p. 312, ^ 487 g ; p. 319, 
 (j 494 dd; p. 321, § 497; p. 323, () 
 499 a ; p. 334, ^ 507 ; p. 343-344, (> 
 516 d, Nos. 3-5 ; p. 345-346, () 516 
 d, Nos. 7-9 ; p. 349, <^ 520-522 ; p. 
 353, (j 524 d, Nos. 4-7 ; p. 642-644, ■ 
 ^ 893 a-c ; p. 646-653, () 893 e-n ; 
 p. 803, ^ 1038 ; p. 838, § 1057^. 
 
 Sympathy, Continuous, 
 
 an old designation, and liable to the ob- 
 jection of being confounded with the 
 laws of reflex action, and therefore 
 the Author proposed the substitution 
 of continuous influence (p. 322, ^ 498 
 a) — is common to Plants as well as 
 Animals, but differing in the latter not 
 only according to the nature of tis- 
 sues (being far more strongly pro- 
 nounced in some than in others, as in 
 the veins and lymphatics), but by the
 
 1096 
 
 INDEX II. 
 
 Sympathy, Continuous — continued. 
 
 incorporation of the nerves in all ani- 
 mal tissues (p. 483-484, i) 746 c), and 
 exemplified by the prick of a pin when 
 the resulting inflammation extends in 
 a continuous manner from point to 
 point, or as seen in erysipelas, but 
 sometimes remarkably limited in its 
 progress, as at the divergence of veins, 
 and shown, also, in a variety of other 
 ways, as by the cathartic effect of 
 croton oil applied to the tongue, by 
 leeching the anus, by suppositories, 
 and more or less by cathartics, espe- 
 cially such as act upon the liver, by 
 the manner in which chewing tobac- 
 co, &c., excites the salivary glands, 
 or irritation of the eye the lachrymal, 
 &c., and is an element in venous cir- 
 culation, but which, in all the cases, 
 and according to the nature, extent, 
 and force of the impression that may 
 be continuously made, whether in- 
 flammatory, or simply an irritative, or 
 a sedative effect, and according, also, 
 to the nature of the tissue and of the 
 compound organ, gives rise to a cor- 
 responding reflex action of the nerv- 
 ous system, which may fall upon va- 
 rious distant parts, and with all the 
 variety of effect as set forth under 
 Articles Reflex Action and Nerv- 
 ous Power, or may be directed upon 
 the part which is the seat of the con- 
 tinuous affection and increase its ex- 
 tension and force, and thus multiply 
 the force of the reflex action, and in- 
 stitute new circles and other influ- 
 ences upon other organs, p. 58, § 129 
 c,f; p. 64, (J 141 b; p. 66-67, (;. 148; 
 p. 209-210, ^ 387; p. 321, ^ 494 c; 
 p. 322-323, (/ 498 ; p. 343, ^ 516 d; 
 p. 350, ^ 523, Nos. 6, 7 ; p. 351, (j 
 524 a, No. 2 ; p. 355-356, <;» 526 b, c ; 
 p. 465-466, i) 715; p. 475, <^ 733 h; 
 p. 483-484, ^ 746 c ; p. 506, () 803, 
 804 ; p. 524, (J 827 e ; p. 526, () 828 
 d; p. 503-564, (i 889 a; p. 694-695, 
 •Ji 923. Also, Oil, Croton ; Leech- 
 ing, Suppositories, Heat, Circula- 
 tion OF THE Blood, Index II. ; Ve- 
 nous Tissue, Venous Congestion, 
 Index I; p. 665, I) 902 a. Notp: U. 
 
 Symptoms, Morbid, 
 
 distributed into five groups — 1st, vital 
 signs ; 2d, relative to the instruments 
 of disease, but independent of struc- 
 tural changes ; 3d, relative to the se- 
 cretions and excretions ; 4th, of the 
 foregoing nature, but determined or 
 modified by changes of organization ; 
 5tb, of a physical nature depending on 
 changes of structure, accumulated flu- 
 ids, &c. — the first three being jfjriwari/, 
 the last two secondary, p. 435, iji 68 1 a. 
 
 Symptoms, Morbid — continued. 
 
 describe the nature, seat, &c., of dis- 
 eases, and often assisted by a knowl' 
 edge of the predisposing causes, p. 
 424-425, <) 662 ; p. 434-436, ^ 679- 
 681 ; p. 459, <) 705 a ; p. 500, ^ 789 ; 
 p. 560-561, () 885-887; p. 487-489, 
 ^ 756 ; p. 509, ^ 811 ; p. 510, () 813 
 b; p. 545, ^ 859 b; p. 561, (J 886. 
 
 owing to the instability of the proper- 
 ties of Life, see Vital Properties, Li- 
 dex I., subdivisions — mutable in their 
 nature — their mutability designed for 
 useful purposes — their mutability the 
 fundamental cause of disease — their 
 mutability the groundwork of cure — 
 their mutability the great cause of the 
 drffieulties in Medicine. 
 
 their uses and abuse, practically consid- 
 ered, p. 370-372, ^ 569 ; p. 428-434, 
 t) 673-676; p. 430-433, (j 675; p 
 
 436, i) 682 a, b; p. 447-448, (; 668 I 
 p 456-460, () 699-708 ; p. 489, ^ 756 
 b; p. 511, (} 815; p. 548-549, ^ 863 
 d; p. 560-561, <) 884-887; p. 572- 
 576, ^ 890 d-n; p. 587, ^ 891 k; p. 
 590-591, iji 89H a-f; p. 626-627, ^ 
 8921 /; p. 636-641, t) 892| d-i ; p. 
 724-725, I) 961 a, b; p. 759-760, <^ 
 1005;,- p. 848, ^ 1058 v-x. 
 
 are apt to be regarded as the disease it- 
 self, without connecting them with 
 the only useful considerations of 
 which they are indicative, and reme- 
 dies are accordingly addressed to a 
 single symptom, p. 73, (Ji 163 ; p. 464, 
 ^ 713 ; p. 570-576, ^ 890 a-n ; p. 579, 
 (J 890^ a; p. 584, () 891 d; p. 587- 
 588, <) 891 k; p. 589, () 891 n ; p. 590 
 -591, () 89U b-f; p. 599, (} 892 d; p. 
 626-627, t) 892§ I ; p. 628-629, {} 892? 
 r; p. 630, () 892i b; p. 633-634, I 
 892| a ; p. 637-640, (j 892|. e-g ; p. 
 684^688, <J 905^ b, c. 
 
 diagnostic, and how far reliable, p. 436 - 
 
 437, () m2— prognostic, p. 437, (j 683 
 — other special ones — pulse, p. 443- 
 448, (J 687i-688— relative to tongue, 
 p. 448-450, ij 689 — secretions and ex- 
 cretions, p. 450-455, ^ 690-694i Al- 
 so, Pulse, Tongue, Sweat, Urine, 
 Mucus, Secretion and Excretion, 
 Heart, Index II. 
 
 the force of, difficult to define, but a sin- 
 gle one may denote a profound con- 
 dition of disease, p. 438, <J 685, No. 9 ; 
 p. 442, ^ 686 c. 
 
 all of them to be considered in connex- 
 ion, with a view both to the patholog- 
 ical cause and the treatment, p. 63, 
 i) 173 ; p. 73, () 163 ; p. 428, ^ 874 a : 
 p. 437-442, <i 684-686 ; p. 456-460', 
 () 695-708; p, 479-480, ^ 741 a, b; 
 p. 541-542, (} 854 bb ; p. 548-550, (> 
 863 rf; p. 551-554, <^ 867-871 ; p. 572
 
 INDEX II. 
 
 1097 
 
 Symptoms, Morbid — continued. 
 
 -576, <J 890 d-n; p. 587, ^ 891 k; p. 
 636-642, I) 892| d-i ; p. 663-665, § 
 897-901 ; p. 685-686, () 905^ b ; p. 
 759, (J 1005 j. Also Pathological 
 Cause, Index II. 
 
 nevertheless, there is generally a group 
 of symptoms which serve as a com- 
 mon index to pathological conditions 
 and the effects of remedies, mani- 
 fested by the heart and larger arte- 
 ries, tongue, skin, and kidneys — or- 
 gans that are not the seats of disease 
 in most of the cases, but only exhibit- 
 ing sympathetic influences as determ- 
 ined upon them by parts morbidly af- 
 fected, or which may sustain impres- 
 sions from remedial agents, and which 
 go with a thousand other things in 
 enforcing the importance of turning 
 our attention away from the iatro- 
 chemical and iatro-physical doctrines 
 to the lavys of sympathy or reflex ac- 
 tion of the nervous system, and to the 
 manner in which the nervous influ- 
 ence is variously modified and ren- 
 dered alterative, for good or for evil, 
 by disease and remedies, and accord- 
 ing to the exact condition of one or 
 the precise virtues, doses, &c., of the 
 other, p. 230-231, ^ 422-423 ; p. 232 
 -233, ^ 425-427 ; p. 350, ^ 523, No. 
 7 ; p. 355, ^ 526 a ; p. 429-430, ^ 674 
 d; p. 438-441, () 686 ; p. 443-450, ^ 
 687-689 Also, Pulse, Tongue, Skix, 
 Heart, Kidney, Index II. 
 
 mode of investigating. See Symptoms, 
 Index I. 
 Syncope — continued from Index I., 
 
 when occasioned by loss of blood, is 
 owing to united effect of direct and re- 
 flex action of nervous system — when 
 only by nausea induced by a variety 
 of other physical causes remote from 
 the stomach, consecutive reflex ac- 
 tions are instituted, being first determ- 
 ined upon the mucous tissue of the 
 stomach with a nauseating effect, and 
 thence with a prostrating effect upon 
 the organs of circulation — and when 
 induced by mental emotions, it may 
 result either from the direct nervous 
 influence acting immediately upon the 
 circulatory organs, or from first insti- 
 tuting nausea, after the manner of 
 disgust, and a consequent reflex ac- 
 tion as in the last foregoing case — 
 and the remedies consist of a variety 
 of things which operate by instituting 
 a stimulating reflex nervous action, 
 having its centripetal origin in vari- 
 ous parts, and taking a centrifugal 
 course upon the centre of circulation 
 — all the variety going with our other 
 multitudinous facts and demonstra- 
 
 Syncope — eontinued. 
 
 tions in substantiating, by the force 
 of exact analogies, the Author's doc- 
 trine of the modus operandi of mor- 
 bific and remedial agents, physical 
 and mental, through alterative influ- 
 ( ncjs of direct and reflex action of the 
 nervous system, and of the modifica- 
 tions of that influence according to 
 the nature of the causes by which it 
 is brought into operation, and supply- 
 ing simple elements of the manner in 
 which the nervous influence, whether 
 reflex or direct, will reach particular 
 internal parts whe<j, as in the former 
 case, the centripetal impulse proceeds 
 from a variety of sources, and how 
 very dissimilar remote causes will 
 bring about a common result, as seen 
 in those which induce syncope, and 
 in the other series which remove it, 
 p. 703-706, ^ 942-945 ; p. 707-708, () 
 949 ; p. 709, <J 951 c, d. Also, p. 107 
 -111,^ 227-233 J; p. 113-114, ^ 234 
 d ; p. 312,^ 487 g ; p. 326-328, <J 
 500 g-m; ff 331, "(} 500 o; p. 333, ^ 
 503 ; p. 338, <;> 514 </; p. 661-663, ^ 
 894 i-896 ; p. 664, ^ 900 ; p. 670, () 
 902 I ; Loss of Blood, Mental Emo- 
 tions, Disgust, Stomach, Reflex 
 Action, Index II. 
 acupuncturation of heart proposed by 
 Author in violent cases of, vi Medical 
 and Physiological Comme7itaries, vol. 
 i,, p. 178, note, 1840. 
 
 Tables relative to Tissues. See Struc- 
 ture, Index II. 
 
 Tea, 
 
 the great calefacient of the Arctic trav- 
 eller after long exposure to intense 
 degrees of cold, and which, from its 
 well-known influence upon the nerv- 
 ous system, goes with the rest in de- 
 monstrating the influence of reflex 
 nervous action in the production of 
 animal heat, and that, whatever may 
 be its nature, its generation is on com- 
 mon ground with other secreted prod- 
 ucts, and liable, like the others, to be 
 increased or diminished by the nerv- 
 ous influence, p. 811, ^ 1049. Also, 
 Organic Heat, Index I. and II. 
 
 Temperament — continued from Index I., 
 its varieties, and corresponding differ- 
 ences in the effects of the natural 
 stimuli of life and of morbific and re- 
 medial agents, that ar^ mainly owing 
 to slight differences in the organic 
 property irritability, and to variations 
 in the natural or the alterative influ- 
 ences of direct or reflex action of the
 
 1098 
 
 INDEX II. 
 
 Temperament — continued. 
 
 nervous system, according to the na- 
 ture of the physical cause or of the 
 passion which may bring it into op- 
 eration, and the analogies in Plants 
 arising from substitutions of climate, 
 cultivation, &c., and in their diseases, 
 and some other facts closely allied to 
 the foregoing, illustrate the broad dis- 
 tinction between organic and inorgan- 
 ic beings, and the fallacy of applying 
 the chemical and physical doctrines 
 to the problems of life, p. 88, () 183- 
 185 ; p. 89, <^ 188 ; p. 95-100, ^ 189- 
 193 ; p. 383-400, <J 585-630. Also, 
 Vital Properties, Organic Life, 
 Index I. ; Youth, Index I. and II. ; 
 Organs of Generation, Index II. 
 
 Temperature. See Organic Heat, In- 
 dex I. and II. 
 
 Tetanus, 
 
 from the prick of a tendon, employed 
 in corroboration of Author's doctrine 
 of the operation of all morbific and 
 remedial agents bevond the seat of 
 their direct operatiwi through altera- 
 tive influence of reflex nervous action, 
 and against the chemical and phys- 
 ical hypotheses, and farther to the 
 same effect through its coincidence 
 with spasmodic affections arising from 
 a variety of other causes, p. 358, <^ 
 526 d ; p. 526, ^ 828 d. Also, Spas- 
 modic Affections, Hysteria, Con- 
 vulsions, Antispasmodics ; Hydro- 
 phobia, Virus of , Serpents, Virus 
 of. Index II. 
 
 Therapeutics, p. 541-563, ^ 852-888. 
 the great ultimate object of all medical 
 inquiries, p. 3, ^ 2 b ; p. A13, () 639 
 a ; p. 541, ^ 852. 
 simple in principle, complex in details, 
 
 p. 541, /) 852 i-853. 
 remedies of positive virtues are morbific 
 in action, and therefore operate upon 
 the same principle as the remote 
 causes of disease — the diflerence be- 
 ing that the latter impair the recupe- 
 rative principle more than the former, 
 which substitute pathological condi- 
 tions less profoundly morbid, and 
 therefore capable of subsiding spon- 
 taneously, p. 333, <J 503-506 ; p. 417- 
 418, <J 650 ; p. 430-432, <^ 675 ; p. 
 541-543, () 854 a-e , p. 544, (^ 857 ; 
 p. 547-549, (} 863 d; p. 551-553, () 
 867-870 ; p. 554-556, () 872 ; p. 644- 
 652, ^ 893 b-e ; p. 636-640, ^ 892A 
 c-h ; p. 643-652, ^ 893 b-m ; p. 669^ 
 ^ 902 I ; p. 675-676, I) 904 h ; p. 679- 
 681, () 905 a — often consist of natu- 
 ral means, p. 543, () 855 ; p. 600, ^ 
 892 d — or of simply withholding ex- 
 citing causes, p. 543, <^ 856 ; p. 682, 
 ^ 905 b — the cure being therefore cs- 
 
 Therapeutics — continued. 
 
 sentially the work of Nature, p. 65- 
 66, () 143 c, d ; p. 67-68. <^ 149-152 ; 
 p. 87,(5 177-182; p. 122, () 239; p. 
 542-543, <J 854 c, 856 ; p. 661, ^ 894 
 a, mottoes; p. 669, ^ 902 i — as illus- 
 trated by self-limited diseases, p. 544 
 -546, {} 858, 861, and by diseases of 
 animals, p. 545, (^ 858 ; p. 551, (^ 863 
 h, and by the system of " watching," 
 p. r*58, (} 877, 878— all of which de- 
 pends upon the mutability of the 
 properties of life as designed for use- 
 ful purposes, as set forth under Re- 
 cuperation, Law of ; Remedial Ac- 
 tion, Remedies ; Causes,-Morbific, 
 Index II. ; Adaptation, Law of. In- 
 dex I; p. 850, ^ 1059. 
 
 the morbid effects of positive remedies 
 to be avoided only by a careful regu- 
 lation of doses, &c., which shows 
 them curative by introducing mild 
 pathological conditions corresponding 
 with the virtues of each remedy, al- 
 though a great variety may institute 
 the requisite changes in a given form 
 of disease, as in intermittent fever, 
 inflammation, &c.,p. 543-544, () 857, 
 858 ; p. 547-550, () 863 d; p. 664,^ 
 900 ; p. 669, <J 902 i. Also, Counter- 
 Irritants, Cantharides, Remedial 
 Action, Index II. 
 
 each remedy, like morbific causes, oper- 
 ates according to its own nature, 
 dose, &c., and therefore no two alike, 
 and according, also, to two or more 
 in combination and the relative pro- 
 portion of each, the nature of the dis- 
 ease, &c., p. 27, (J 52 ; p. 479-480, (J 
 741 b ; p. 544, «J 857 ; p. 545, <) 860 ; 
 p. 547-550, () 863 d ; p. 554-556, (} 
 872. Also, Remedies ; Causes, Mor- 
 bific, Index II. 
 
 as every disease consists of a succession 
 of pathological changes, it is the ob- 
 ject of every successive remedy to in- 
 troduce a new pathological condition 
 till that one is attained which is most 
 conducive to a spontaneous subsi- 
 dence, and hence the importance of 
 applying the right remedies, and in the 
 right doses, and at the right time, and, 
 as one remedy prepares the way for 
 another, in a well-regulated consecu- 
 tive order, and of projecting, as far as 
 possible, a plan of treatment at its be- 
 ginning, p. 67, (f 149-151 ; p. 73, ^ 
 163; p. 87, <;. 177-182; p. 426, 1^666; 
 p. 428, (^ 672 ; p. 430-433, <J 675-676 ; 
 p. 473-474, <;. 733 c ; p. 479-480, ^ 
 741 b; p. 543-544,^ 857; p. 548- 
 549, () 863 d; p. 553, ^ 870 aa; p. 
 554, <) 871 ; p. 561-562, (J 888 a-d; 
 p. 566-570, (J 889 k-n ; p 595-596, ^ 
 892 aa ; p. 597-600, ^ 892 c ; p. 608,
 
 INDEX II. 
 
 1099 
 
 Therapeutics — continued. 
 
 ^ 892^ c; p. 648-651, () 893 g-k ; p. 
 657-658, () 893 p; p. 661-665, ^ 894 
 -901 ; p. 664-671, () 899-902 a-m; 
 p. 679-681, ^ 905 a; p. 696, ^ 926 ; 
 p. 715-722, I) 960 ; p. 728, <5. 964 d; 
 p. 752, <^ 1000 ; p. 756-760, () 1005. 
 
 effect of morbid habit upon the action 
 of remedies, p. 364-368, ^ 544-561 ; 
 p. 552, ^ 869 ; p. 648-649, ^ 893 g; 
 p. 696, <^ 926. 
 
 law of adaptation, dependent upon reflex 
 action of the nervous system, pro- 
 foundly interested, p. 62-63, ^ 136- 
 137 e ; p. 65, I) 143 ; p. 67-69, () 149- 
 156 ; p. 531, ^ 838 ; p. 535-539, ^ 
 847-850 ; p. 542-545, <J 854 /-858. 
 Also, Adapt.\tion, L.wv of. Index I. ; 
 Diseases, Self-Limited, Index II. 
 
 no " specifics," but predisposing causes 
 often modify a common form of dis- 
 ease, as inflammation and fever, in 
 such modes as to require, more or 
 less, the agency of remedies not adapt- 
 ed to the common form, p. 424-425, 
 ^ 662 ; p. 487-488, (^ 756 ; p. 509, ^ 
 811; p. 510, <^ 813 b; p. 545, () 859 
 b; p. 551, 4 865, 866 ; p. 561, ij 886 ; 
 p. 597, ^ 892 c. Also, Cinchona, 
 Coffee, Iodine, Index II. 
 
 compound diseases often require a care- 
 ful adjustment of remedies, p. 542, (} 
 854 /,• p. 545, () 858 ; p. 553, § 870 
 aa; p. 725-732, ^ 961 i-970. 
 
 advantage of combining remedies — cu- 
 mulative effect of remedies. See Rem- 
 edies, Index II. 
 
 effect of the mind upon the action of 
 remedies, p. 865-868, ^ 1067 and ref- 
 erences there — effect of pain in coun- 
 teracting Narcotics, p. 557, <J 874 ; p. 
 587, i) 891 k; p. 590, ^ 891 r, and the 
 same by the delirium of drunkenness, 
 p. 590, <) 891 r; p. 734, (} 976 b—a\l 
 the variety in effects being due to dif- 
 ferent modifications of the nervous in- 
 fluence as brought into preternatural 
 action by the several causes respect- 
 ively. See Reflex Action, Mental 
 Emotions, the Individual Passions, 
 Index II. 
 
 the curative effects of remedies upon the 
 seat of their direct operation, particu- 
 larly in morbid states of the stomach, 
 is less owing to their direct alterative 
 action than to a reflex action of the 
 nervous system — and this corresponds 
 with the morbific effects of many 
 causes of disease when manifested in 
 the seat of their direct operation, as 
 seen particularly of cold and miasms 
 — and problems of the same and more 
 complex nature are involved in the 
 salutary effects of exercise, change 
 of air, &c., in dyspepsy, whooping- 
 
 Therapeutics — continued. 
 
 cough, phthisis, &c. — in all of which 
 cases, as well also in all that concerns 
 the operation of remedial and morbific 
 agents beyond the seat of their direct 
 action, the effects arc owing to reflex 
 influence of the nervous system — and 
 for these several specifications see 
 Reflex Action, Remedial Action, 
 Sympathy, Remedies, Alteratives, 
 Bloodletting ; Causes, Morbific ; 
 Whooping-Cough, Phthisis, Exer- 
 cise, Friction, Cold, Miasm, Show- 
 er -Bath, Sea- Sickness, Mental 
 Emotions, Index II. ; Nervous Pow- 
 er, Itidex I. and II. 
 diseases often subside spontaneously as 
 others spring up sympathetically upon 
 them, the nervous influence being the 
 exciting cause in all the cases so far 
 as any influences are sustained by the 
 pathological conditions, the philoso- 
 phy being also the same as when vesi- 
 cants produce inflammation of the 
 bladder, or aggravate or remove in- 
 flammations of other parts — the only 
 difference between tlie morbific and 
 curative effects being, that the reflex 
 action of the nervous system is either 
 more profoundly morbific or different- 
 ly modified in one case than in the 
 other — but, as it is the general tend- 
 ency of diseases to generate others 
 and to aggravate antecedent ones, and 
 as the most favourable results of these 
 reactions of the nervous influence are 
 rarely salutary in the end, it is a great 
 error to promote the continuance of 
 natural diseases in the very slender 
 hope that a greater evil may be thus 
 overcome or an apprehended one 
 avoided (not even the hemorrhoidal 
 flux, though arresting it by a removal 
 of its remote cause) ; and, although 
 artificial diseases may be instituted in 
 the skin by agents of transient effects 
 with a view to salutary influences 
 upon internal diseases, they cannot 
 be set up in other organs, particularly 
 the alimentary canal, but with an ad- 
 verse effect — and it is upon this same 
 principle that the habitual use of small 
 doses of cathartics in a large propor- 
 tion of d}'speptic cases overcomes con- 
 stipation without detriment, while the 
 indigestible food which is used for the 
 same purpose proves morbific, p. 67, 
 <) 148 ; p. 351-352, () 524 h-d ; p. 360 
 -361,^528,529 6; p. 421-422, «^ 657 j 
 p. 506, () 804 ; p. 539, (^ 848 ; p. 559, 
 () 882 ; p. 568-569, <) 889 m, mm ; p. 
 570, () 889 n ; p. 652-656. ^ 893 n ; 
 p. 679-681, () 905 a; p. 695, ^ 924; 
 p. 722, ^ 960 ^,- p. 856-862, () 1063- 
 1065. Also, Cantharides, Counter-
 
 1100 
 
 I>.'DEX II. 
 
 Therapeutics — conitnucd. 
 
 Irritants, Mercurial Remedies, In- 
 dex II. 
 
 the recuperative principle displayed in 
 the secretions, their therapeutical uses 
 according to their nature, and as sup- 
 plying important suggestions in prac- 
 tical medicine, p. 230-231, ^ 422 b, 
 c ; p. 232-234, () 425-428 ; p. 352, ^ 
 524 c ; p. 430-432, ^J 675 ; p. 450- 
 452, § 691-693 ; p. 471-476, ^ 732- 
 733 ; p. 633-634, ^ 8324. a ; p. 635- 
 640, ^ 892f h. Also,''SuDOEiFics, 
 Index I ; Antimony, Tartaeized ; 
 Diuretics, Index II. 
 
 emaciation curative, p. 551, (} 863 h; p. 
 597, <;» 892 c. Also, Remedies {Food), 
 Index II; 984 c. 
 
 simplicity of treatment, a ruling princi- 
 ple, p. 553, () 870 b : p. 593, ^ 892 a, 
 motto. 
 
 the active and expectant plans of treat- 
 ment, p. 557-559, i) 875-882— and 
 the rational and empirical, p. 559- 
 562, <J 883-888 b. 
 
 four fundamental points — 1st, the direct 
 local effects of remedies — 2d, their ef- 
 fects upon remote parts through re- 
 flex action of the nervous system — 
 3d, their ultimate effects after their 
 direct action is over — 4th, the general 
 influence of each remedy upon the 
 course and termination of the disease, 
 p. 562, ^ 888 c. 
 Thirst, 
 
 its earliest deleterious influences arc ex- 
 erted through reflex and direct action 
 of the nervous system, the centripetal 
 source heing mostly the mucous tis- 
 sue of the stomach and throat, pro- 
 ' gressively increased by the centrifu- 
 gal action of the mind, while sooner 
 or later a universal injury springs 
 from the want of the necessary dilu- 
 tion of the blood — presenting, there- 
 fore, in the former aspect, the com- 
 pounded influences that consist of 
 reflex action, and the direct which 
 results from mental emotions, and 
 should be associated with the physi- 
 ology of vomiting as determined by 
 mental emotions and various physical 
 causes, and asthmatic breathing, the 
 examples relative to food, &c., in ap- 
 plying the philosophy to the modus 
 operandi of morbific and remedial 
 agents. See Hunger, Stomach, Vom- 
 iting, Disgust, Asthma, Respira- 
 tion, Sea-Sickness, Mental Emo- 
 tions, Seton, Index II 
 Thoracic Duct, and Absorbents, 
 
 circulation in, depends upon suction 
 power of the heart, and upon their 
 own action, and upon that of the cap- 
 illai-ies, p. 211, <^ 389, 390 a. Also, 
 
 Thoracic Duct, &c. — continued. 
 
 Circulation of the Blood, Index 
 
 n. 
 
 Thunder, 
 
 physiology of its effects in producing 
 disease through alterative influence 
 of the nervous system determined in 
 a direct manner, p. 631-632, <J 8923- 
 b, and references there ; p. 886-887, 
 (^ 1067 a. Also, Reflex Action, 
 Mental Emotions, Disgust, Index 
 II 
 
 Tissues. See Structure, 7n(7ea; //.; Tis- 
 sues, Index I. 
 
 Tobacco — continued from Index I, 
 
 the diversity of its effects — its fumes in- 
 noxious when inhaled, but poisonous 
 to the alimentary canal — morbific 
 from chewing on beginning its use, 
 but becoming a luxury, while no rep- 
 etitions will abate its pernicious ef>- 
 fects when swallowed, or as an enema, 
 or when applied to the skin, and an 
 example of its special sympathetic ef- 
 fects upon the heart through the me- 
 dium of the rectum, and an analogy 
 supplied by sneezing as produced by 
 snuff and light and by thinking of the 
 paroxysm, and the coincidence in 
 habit between the ultimate failure of 
 chewing and smoking to affect the 
 mouth, and snufiing the nose, and thus 
 establishing a correspondence in 
 these parts with the constitutional in- 
 sensibility of the pulmonary mucous 
 tissue to the fumes of tobacco, with 
 other analogous considerations, con- 
 tradict the hypothesis of absorption, 
 and bring all the effects of tobacco 
 under the law of reflex action of the 
 nervous system, and present a com- 
 prehensive ground of analogy for sus- 
 taining our interpretation of the mo- 
 dus operandi of Anesthetics, and its 
 direct afiinities in those respects with 
 a multitude of other things of not less 
 obvious action give to our demonstra- 
 tion an important weight in the gen- 
 eral assemblage of facts as a ground 
 of reasoning to other remedial and 
 morbific agents whose modus operan- 
 ■ di through reflex action of the nerv- 
 ous system is less manifestly pro- 
 nounced — while, also, the effects of 
 tobacco illustrate the difference in 
 the vital constitution of different tis- 
 sues, the law of Vital Habit in a lim- 
 ited relation of tobacco to the mucous 
 tissue of the mouth and nose, &c., p. 
 61, () 133, a, b; p. 62-63, (J 136-137 
 c; p. 67-68, (} 149-152 ; p. 107-110, 
 <) 227-232; p. 323-328, (J 500 a-l; 
 p. 333, <) 503-505 ; p. 338-341, ^ 514 
 d-m; p. 347-348, <) 516 d, No. 13; 
 p. 364, <J 543 ; p. 522-524, (J 827 b-e;
 
 INDEX II. 
 
 1101 
 
 Tobacco — continued. 
 
 p. 527, <} 829 ; p. 661-663, <J 894- 
 896 ; p. 665-670, () 902 a-m ; p. 672- 
 676, (} 904 b; p. 679-681, () 905 a; 
 p. 862-864, () 1066— and concurring 
 with the foregoing is the frequent 
 effect of the habitual and even tem- 
 porary smoking in producing or ag- 
 gravating piles — displaying, also, the 
 special relations of a sympathetic na- 
 ture which subsist between different 
 parts of a continuous tissue, espe- 
 cially the mucous, and a complexity 
 of reflex actions of the nervous sys- 
 tem which are simultaneously de- 
 termined upon the anal extremity 
 through a primary action of the reflex 
 influence upon the stomach and liver 
 — all originating in the mucous tis- 
 sue of the mouth, p. 350, () 523, No. 
 6, 7. Also, Skin, Stomach, Remedi- 
 al Action, Anesthetics, Narcot- 
 ics {Aconite), Opium, Suppositories. 
 experiments showing it is not absorbed, 
 p. 302, () 481 c; p. 306, ^ 483 a. 
 Tolerance of Remedies, 
 illustrated under the law of vital habit. 
 See Hadit, Vital, Index II. 
 Tongue 
 
 rarely sustains much disease, though 
 generally suffers, in its surface at 
 least, some modified action from the 
 diseases of other parts, especially of 
 the abdominal organs, arising from 
 an alterative influence of reflex action 
 of the nervous system, and serves, 
 like the pulse, as an index of the na- 
 ture of these reflected influences, and 
 therefore of the nature and force of 
 the remote diseases, and, although 
 the universal and habitual examina- 
 tion of the tongue and pulse is purely 
 an empirical inquiry, the philosophy 
 of their signs has a deep foundation 
 in the recesses of physiology^ and is 
 a luminous guide to the modus ope- 
 randi of morbific and remedial agents 
 through alterative influences of reflex 
 nervous action, and to the develop- 
 ment of diseases among distant or- 
 gans as consequences of their own 
 conditions, p. 448-451, <J 689 ; () 826 
 cc; (J 864. Pulse, Sweat, Kidney, 
 Urine, Heart, Structure, Ind. II. 
 Tonics and Diffusible Stimulants, 
 the counterparts of Antiphlogistics, p. 
 579, ^ 890^ a — and comparatively of 
 very limited importance, ih'id. 
 have been extensively injurious, from 
 erroneous hypotheses of disease and 
 of their modus operandi, p. 579, !) 
 890i a-c. Also, p. 371-372, <5 569 
 h-t; p. 395-396, i^ 621 a; p. 433- 
 434, lij 676 h ; p. 541-542, ^ 854 bb ; 
 p. 572-576, f) 890 d-n ; p. 596, ij 892 
 
 Tonics, &c. — continued. 
 
 b ; p. 599-600, (J 892 d ; p. 715-722, 
 {) 959-960 e ; p. 748-749, () 992 b ; 
 p. 752, () 1000-1001 b ; p. 756-766, ^ 
 1005-1008; p. 772-776, () 1020- 
 1026; p. 854, ^ 1061 ; p. 857-861, (J 
 1063-1065, 1068 a, b; p. 872, P.S. 
 operate, like all other remedies, as alter- 
 atives through reflex nervous influ- 
 ence, which, as in all other cases, is 
 affected in its action according to the 
 special virtues of its exciting cause — 
 with various illustrations drawn from 
 the natural stimuli of life and from 
 other remedial and morbific agents ; 
 as when, for example, solid animal 
 food, taken by one long abstinent and 
 during a long exposure to a chilling 
 atmosphere, increases muscular vigor 
 and lights up warmth of the skin as 
 soon as it enters the stomach, and as 
 diffusible stimulants and bitter tonic 
 infusions will do the same, or, the con- 
 verse of this, as when all the fore- 
 going will alike instantly aggravate 
 febrile excitement, showing through- 
 out a common modus operandi ; and 
 since the solid animal food must ex- 
 ert its general effects through the me- 
 dium of reflex nervous influence, so 
 also do the tonics and stimulants, p. 
 579-582, ^ 890 i- d-h. Also, p. 67-68, 
 ^ 149-152; p. 107-110, () 227-232; 
 p. 250-252, () 441 c ; p. 303, (} 481 d; 
 p. 323-336, ^ 499-512 ; p. 563-567, 
 I 889 d-k; p. 661-663, ^ 894-896; 
 p. 679-681, 5 905 a; p. 835-838, ^ 
 1057^^, and Remedies, Remedial Ac- 
 tion; Causes, Morbific ; Cinchona, 
 Index II. Also, p. 172, no. 94. 
 although no two are exactly alike in ef- 
 fects, they are more so than the mem- 
 bers of other groups, and no one is an 
 excrescence upon the Materia Med- 
 ica ; and, whether mineral or vege- 
 table, as with other groups, will alike 
 remove the same conditions of dis- 
 ease, and in conformity with the pre- 
 cise aflSnities of a chemical nature — 
 or rather, how completely does all 
 this variety of means, cinchona, iron, 
 acids, shower-bath, exercise, hope, 
 &c., appealing every where to our 
 senses as well as understanding, ex- 
 pose the fallacy of applying the exact 
 and exclusive laws of chemical affini- 
 ties, or of any other physical hypoth- 
 esis, in explanation of that one and 
 the same result to which all the het- 
 erogeneous variety of remedies will 
 lead, p. 581-583, () 890^ g-h ; p. 664, 
 f) 900. Also, Remedies, Remedial 
 Action, Cathartics, Index II. 
 the only conditions under which they 
 are applicable, p. 580-581, ^ 890 i e,f.
 
 1102 
 
 INDEX II. 
 
 Tonics, &c. — continued. 
 
 may be united with direct antiphlogis- 
 tics, and why, p. 581,iJ 890^^ c. Also, 
 p. 487-489, § 756 ; p. 561, (} 888 b; 
 p. 727-728, ^ 964 a, i.— Note Ee. 
 
 their occasional success in removing in- 
 flammations is no proof of the accu- 
 racy of the distinction which has been 
 made of the disease into active and 
 passive, or that the pathology is not 
 essentially the same, p. 486-489, ^ 
 752-756 ; p. 664, § 900. 
 
 difference between Tonics and Diffusi- 
 ble Stimulants, and the different con- 
 ditions under which one or the other 
 may be useful, showing, also, in their 
 united effects, the important law by 
 which one remedy may quicken the 
 action of another by raising the irri- 
 tability of the part or of the system 
 atlarge, p. 581-582, iJ890ig'. Also, 
 p. 63, () 137 d; p. 65, <;» 143 c,d; p. 
 67, (J 149-151 ; p. 367, () 556 c; p. 
 566-567, (J 889 k, I. 
 Travers, Sir Benjamin, 
 
 his opinion of the Anatomical School 
 of Medicine, p. 457, () 699 c. 
 
 U. 
 
 Ulceration 
 
 a consequence of inflammation, and con- 
 spicuous in its Design for useful ends, 
 and has close analogies in Plants, p. 
 470-471, () 729 a-730 ; p. 472-476, ^ 
 733 ; p. 477, () 736 c ; p. 478-479, ^ 
 740-741. Also, Pus, Lymph, Lidex 
 IT. 
 
 Ulcers 
 
 upon the extremities improved by open 
 air through complex influences of re- 
 flex action of the nervous system, and 
 the influences traced out, p. 662-663, 
 ^ 896 ; p. 670-671, <;. 902 m. Also, 
 Skin, Phthisis, Whooping- Cough, 
 Exercise, Friction, Index IT. 
 
 'Urjemi.\. See Urea Diathesis, Index II. 
 
 Urea — continued from Index I., 
 an artificial, not a natural product, p. 
 784, () 1031 b ; p. 787-788, ^ 1032 a. 
 
 "Urea Diathesis," or Uremia, 
 
 an imaginary evil, and " altogether re- 
 mains to be proved," p. 787-788, ^ 
 1032 a. Also, p. 232-233, ^ 427. 
 
 Urinary Bladder, 
 
 excited to contraction equally by its 
 contents, by the external application 
 of cold and heat, and by the Will, and 
 as the effect in the former cases is 
 through reflex action of the nervous 
 system, it must be the nervous influ- 
 ence in the latter ; from which it fol- 
 lows that the action of the Will is 
 prompted as much by a substantive 
 
 Urinary Bladder — continued. 
 
 agent as the urine is substantive, and 
 since cold and heat simply denote an 
 impression upon sympathetic sensi- 
 bility of the skin by an abduction of 
 caloric in one case and its stimulus in 
 the other, and scarcely more appreci- 
 able as physical causes than the mu- 
 co-pulmonary irritation which excites 
 the nervous influence in respiration, 
 we are thus in some degree aided in 
 understanding how an immaterial sub- 
 stance may act upon matter ; while, 
 also, the several modes in which the 
 nervous influence is determined upon 
 the bladder in micturition, the variety 
 of causes, the variety of centripetal 
 nerves, and the limitation of the cen- 
 trifugal influence to certain special 
 nerves, along with a multitude of an- 
 alogous examples, conduct us to a 
 ready apprehension of a correspond- 
 ing modus operandi of all morbific 
 and remedial agents, both mental and 
 physical, p. Ill, «^ 233f ; p. 230-231, 
 (} 422 b ; p. 347-348, () 516 d, No. 13 ; 
 p. 630-631, ^ 892f b; p. 662-663, ^ 
 896. Also, Stomach, Skin, Kidney, 
 Cold, Respiration, Phthisis, Ame- 
 norrhcea, Remedial Action, subdi- 
 vision Mental Emotions, Organs of 
 Generation, &c.. Index II. 
 
 Urine — continued from Index /., 
 
 analyses of, not reliable, and rarely of 
 any importance, p. 228, ^ 417 ; p. 
 232, (J 425-427; p. 450-451, (J 691 ; 
 p. 780, ij 1029; p. 848, ^ 1058 s— 
 but divert attention from the patholo- 
 gy of disease, and lend to imaginary 
 evils, ibid., and p. f33, ^ 892i/, and 
 Symptoms, Index II. 
 not " strained off" from the blood, and 
 its sudden increase or diminution, and 
 most of its morbid changes, depend 
 upon direct or reflected influences of 
 the nervous system, p. 230-233, () 
 422-427; p. 450-451, ^ 691 ; p. 631 
 -632, ^ 892|. Also, " Strainage," 
 Reflex Action, Fear, Index II. 
 the foregoing manifest exemplifications 
 of the influence of the reflex action of 
 the nervous system upon the secern- 
 ing vessels of the kidneys, consider- 
 ed in connexion with the diuretic and 
 sudorific effects of fear, and with the 
 dependence of lactation, weeping, and 
 all deviations of other secretions from 
 their natural condition, upon the nerv- 
 ous influence either reflex or direct, 
 as forming a part of the Author's de- 
 monstration of the modus operandi of 
 all remedial and morbific agents, phys- 
 ical and mental, through the same 
 causation — the nervous influence be- 
 ing simply excitant or depressant, or
 
 INDEX II. 
 
 1103 
 
 Urine — continued. 
 
 variously modified and rendered alter- 
 ative, according to the nature of the 
 causes by which it is brought into 
 preternatural operation, p. 106-111, 
 ^ 233-2331 ; p. 230-232, () 422^24 ; 
 p. 249, ^ 441 c ; p. 253, ^ 441 d ; p. 
 262-263, (J 446 a ; p. ?64-265, ^ 446 
 c, d; p. 289, ^ 461; p. 313-314, ^ 
 488 ; p. 317, (} 498 a; p. 325-326, ^ 
 500, ee; p. 335-336, (} 512 a, b; p. 
 338, () 514 d; p. 339-340, i} 514 h; 
 p. 347-348, (j 516 d, No. 13 ; p. 351, 
 i) 524, No. 1 ; p. 352, <J 524 d ; p. 450 
 -451, (J 691-692 a; p. 453, () 694 i; 
 p. 478, (j 740 a; p. 546-549, ^ 863 
 a-d,- p. 563-564, «J 889 a; p. 631- 
 632, ^ 8921 J, c ; p. 637, () 8924 d ; 
 p. 662-663, ^ 896 ; p. 666-669, (J 902 
 c-i ; p. 704, () 943 a, J ; p. 709, ^ 951 
 c. Also, Kidney, Mental Emotions, 
 the individual Passions, Index II. ; 
 Nervous Power, Index I. and II. 
 its morbid fluctuations not often owing 
 to absolute disease of the kidneys, but 
 to diseases of other parts, especially 
 disorders of the stomach, liver, and 
 intestine, when it is to be regarded 
 mostly as a symptom, like the pulse 
 and appearances of the tongue, de- 
 noting the force and modifications of 
 the reflex nervous influence as excited 
 by the diseases of other parts, and 
 therefore, more or less, their nature 
 and force — from whence arises a co- 
 rollary, that the administration of the 
 so-called Diuretics for the purpose of 
 promoting or otherwise modifying this 
 secretion in the cases supposed is de- 
 void of just pathological and thera- 
 peutical considerations, which should 
 turn upon the diseases in which this 
 symptom truly originates, p. 232-233, 
 ^ 426, 427; p- 450-451, ^ 691; 
 p. 630-633, ^ 892J. Also, Pulse, 
 Tongue, Skin, He.irt, Index II. 
 
 Uterine Agents — continued from In- 
 dex I, 
 introduced to illustrate principles, and 
 especially those which guided the Au- 
 thor in his therapeutical arrangement 
 of the Materia Medica, p. 684-686, <) 
 905^ a, b. 
 embrace a great variety of virtues, which 
 are often mostly relative to various 
 pathological conditions remote from 
 the uterus, whose interrupted func- 
 tions are apt to be rather unimpor- 
 tant sympathetic consequences, but 
 frequently mistaken for the essential 
 disease and the primary ones as ulti- 
 mate effects, p. 628-629, ^ 892J ; p. 
 684-686, () 905^ b. Also, Emmen.i- 
 gogues, Amenorrhcea, Index II. ; 
 Menstruation, Index I. 
 
 Uterus, 
 
 susceptible in its mucous tiosue of in- 
 fluences through reflex action of nerv- 
 ous system from various causes, in- 
 ternal and external, consisting of ab- 
 dominal diseases, cold applied to the 
 feet, pediluvium, lifting weights in 
 pregnancy, many remedies, mental 
 emotions, &c., according to the nat- 
 ural fluctuations that grow out of its 
 special vital constitution, or as it may 
 be affected in pregnancy, or by hy- 
 datids, or disease, p. 63, ^ 137 b-d 
 p. 65, ^ 143 c ; p. 67, (i 149-151 
 p. Ill, ^ 2331; p. 234, ^ 429, 430 
 p. 624, ^ 892f d ; p. 628-629, ^ 892^ 
 q-t; p. 684-686, (} 905^ b. Also, 
 Cold, Skin, Leeching, Exercise, In- 
 dex II. 
 
 considered in connection with aloes, can- 
 tharides, ergot, &c., and, as it respects 
 aloes for the purpose, particularly, of 
 illustrating the philosophy of its ef- 
 fects as an emmenagoguo, and possi- 
 bly as leading to abortion — showing 
 that these effects are not in conse- 
 quence of the supposed, though mis- 
 taken action of aloes upon the rectum, 
 but that it arises from a special rela- 
 tion of this agent to the mucous tis- 
 sue of all parts through which it de- 
 termines an alterative reflex nervous 
 influence upon the tissue in its pre- 
 ternaturally irritable states, being in 
 this respect upon the same physiolog- 
 ical ground as cantharides in its spe- 
 cial action upon the genito-urinary or- 
 gans, or as expectorants in their rela- 
 tion to irritable conditions of the pul- 
 monary mucous tissue, and, also, to 
 illustrate the special differences in the 
 vital constitution of different tissues, 
 and of the same tissue in different 
 parts, and of different parts of one and 
 the same continuous tissue, and the 
 corresponding relations of remedial 
 and morbific agents, p. 59, ^ 129 h, i ; 
 p. 61, ^ 132-133 ; p. 62-63, <J 135 a- 
 d; p. 65, ^ 143 c; p. 67, I) 149-151 ; 
 p. 73, ^ 163; p. 111,<^ 133i; p. 231 
 -232, ^ 424 ; p. 234, () 429, 430 ; p. 
 352-353, () 524 d ; p. 366, ^ 556 b ; 
 p. 547-548, ^ 663 d ; p. 556, <J 889 i ; 
 p. 624, ^ 892f d ; p. 628-629, <5 892^ 
 q-t; p. 684-686, § 905^ b; p. 856- 
 857, ^ 1063 b. Also, C.1!^'THARIDEs, 
 Ergot, Index II. 
 
 its development, and that of the ovaria 
 at puberty, exerts a powerful influ-_ 
 ence in advancing the maturity of the 
 general organism, through an unin- 
 terrupted reflex action of the nervous 
 system, harmoniously with their rela- 
 tions in the perpetuation of the spe- 
 cies, and this influence is forever aft-
 
 1104 
 
 INDEX II. 
 
 Uterus — continued. 
 
 erward extended in subdued and mod- 
 ified conditions to the nervous cen- 
 tres, and reflected abroad with that va- 
 riety of effect which is witnessed in 
 the differences between the perfect 
 and the altered animal, and brings the 
 mind and its passions more or less 
 under its sway, the nervous influence 
 in the latter case falling as well upon 
 the centres in which it originates as 
 upon other parts ; being, also, equally 
 true of the other sex — and when with 
 the foregoing are associated those 
 long progressive alterative influences 
 of refle:: nervous action upon the 
 mammae which have their centripetal 
 source in the gravid uterus, and un- 
 fold their great final cause, and the 
 sudden increase of that action at the 
 time of parturition, and the liability 
 of the milk to be affected both in quan- 
 tity and quality by mental emotions, 
 another of our many isolated exam- 
 ples is presented, which, through its 
 analogies, interprets the modus ope- 
 randi of morbific and remedial agents, 
 mental as well as physical, and defies 
 in its own behalf, and in that of its 
 analogies, every law that rules in the 
 ■v\orld of dead matter, p. 68-69, ^ 153 
 -159; p. 80, <J 169 d ; p. 87, ^ 180; 
 p. 88, <) 185; p. 120-121, () 237; p. 
 231-232, () 424; p. 330, ()5Q0 mi; p. 
 335-336, ^ 5l2a,h, p. 352, ^ 524 d ; 
 p. 376-380, ^ 578 ; p. 434-435, (} 
 080 ; p. 662-663, () 896 ; p. 686, ^ 
 905^ b; p. 279-280, ^ 449 a-d, 625i 
 
 V. 
 
 VicciNE Disease. See Small-Pox, In- 
 dex II. 
 
 Van Deen, 
 
 his experiments, with others by Girtan- 
 ner. Stilling, Budge, Home, and John- 
 son, proving that the poison of the 
 viper in producing death is not ab- 
 sorbed, but exerted through the me- 
 dium of the nervous system, and oth- 
 er analogous demonstrations, p. 319- 
 320, ^ 494 b-dd ; p. 525, <) 828 b, c. 
 Also, Hydrophobia, Virus of. Index 
 II. 
 
 Varix, 
 
 its pathology, and employed to illustrate 
 the dependence of venous congestion 
 upon inflammation of the veins, p. 
 500-504, (j 790-798. 
 
 Veins — continued from Index L, 
 
 anatomical account of, in connexion 
 with the circulation of the blood, and 
 with the pathology of venous conges- 
 tion, phlebitis, and varix, p. 210, ^ 
 
 Veins — continued. 
 
 386 ; p. 503-504, ^ 794-797. Also, 
 Venous Congestion, Index I. 
 
 particularly liable to diffuse inflamma- 
 tion, as seen in phlebitis and venous 
 congestion, p. 355-356, ^ 526 b. 
 Also, Sympathy, Continuous, Index 
 II. 
 
 the circulation in, depends upon several 
 associated causes : 1st, the suction 
 power of the heart ; 2d, the action of 
 the capillary arteries ; 3d, concert of 
 action between the capillary veins 
 and arteries through reflex influence 
 of the nervous system determined 
 mostly by the varying quantities of 
 transmitted blood and the existing 
 condition of the arterial capillaries ; 
 4th, an active contraction and dilata- 
 tion of the veins simultaneously over 
 a great extent by their longitudinal 
 muscular fibres, in which continuous 
 sympathy is especially interested, and 
 which contributes to the foregoing 
 reflex action, and, as a constitutional 
 endowment, is at the foundation of 
 their diffusive inflammation — this ex- 
 position, with the exception of the 
 suction power of the heart, being pro- 
 pounded by the Author, p. 207-212, 
 \ 370-392 a; p. 214, ^ 392 d; p. 
 227, <J 411 ; p. 355-356, ^ 526 b, 
 c. Also, p. 21, ^ 22; p. 62, ^ 136 ; 
 p. 80, {} 169 d ; p. 88, <^ 185 ; p. 223, 
 <) 409 e ; p. 355-356, «^ 526 b ; p. 474, 
 ^ 733 /; p. 501-504, (} 792-796 ; p. 
 506, () 803, 804 ; p. 507-509, (} 806 
 -811 ; p. 724-726, <) 961 ; and Sym- 
 pathy, Continuous ; Oil, Croton ; 
 Leeching, Suppositories, Index II. 
 
 the suction power of the heart as a 
 principal cause of venous circulation 
 shown especially by the portal circu- 
 lation, and that of the absorbents and 
 umbilical vein, p. 211, ^ 390 a; p> 
 214, () 392 c, d; p. 212, (j 391 
 
 the intestinal do not absorb, p. 128, 129, 
 I) 269, 277; p. 527, ij 829. Also, 
 ^Iagendie, Index II. ; Veins, Index I. 
 Venous Congestion — continued from In- 
 dex I, 
 
 propagates, on account of the special vi- 
 tal constitution of the venous tissue, 
 a depressing reflex action of the nerv- 
 ous system upon the heart and arte- 
 ries, as does also acute venous inflam- 
 mation ; but, nevertheless, this influ- 
 ence manifests in the condition of the 
 pulse and blood, particularly in cere- 
 bral congestions, that pathological 
 condition which, when affecting other 
 tissues, demands a strictly antiphlo- 
 gistic treatment, and which is con- 
 firmed by the effects of remedies, 
 while, also, it exemplifies some of the
 
 INDEX II. 
 
 1105 
 
 Venous Congestion — continued. 
 
 remarkable differences which exist 
 among the tissues in their vital con- 
 stitution, p. 61-63, 'Ji 133-137; p. 64, 
 ^ 138-142 ; p. 67, () 149-151 ; p. 72, 
 Table 3 ; p. 355-356, (J 526 b ; p. 444 
 -446, <) 688 d-f; p. 606-509, () 806- 
 811 ; p. 511, ^ 815; p. 724-734, (^ 
 961-976; p. 735-736, <^ 978-980. 
 Also, Venous Tissue, Index I. 
 and congestive fever, treatment of, par- 
 ticularly by bloodletting, or as qui- 
 nine, &c., may be required in mias- 
 matic forms, p 724-732, () 961-970. 
 Also, Causes, Morbific ; Miasm, 
 Cinchona, Index II. 
 
 Veratrum Viride, , 
 
 its late pretensions as a substitute for 
 Bloodletting, p. 860, ^ 1065 a. Also, 
 Tobacco, Index I. — Note I p. 1118. 
 
 Vesicants. See Counter-Irritants, In- 
 dex II. 
 
 Vessels — See Blood-vessels, Index I. 
 the most important are the terminating 
 series of the arterial capillaries, whose 
 variety of functions and products, and 
 their modifications as induced by mor- 
 bific and remedial agents, and by 
 mental emotions, through the medi- 
 um of the nervous influence, and the 
 analogies between the organic proc- 
 esses of animals and plants, concur 
 with all things else in demonstrating 
 the broad distinction between the 
 laws that govern the organic and in- 
 organic kingdoms, p. 220-227, () 409 
 b-411 ; p. 355, ^ 526 a. Also, In- 
 flammation, Structure, Lidcx II. ; 
 Composition, Organic Compounds, 
 &c., Index I. Also, p. 215, (J 394^399. 
 
 "Vestiges of Creation," 
 introduced to illustrate the consequences 
 of the Chemical doctrines of Life, p. 
 183-192, ^ 350i/-353; p. 925, ^ 1085. 
 
 Vision — continued from Index I., 
 the latest interpretation of, as a chemi- 
 cal phenomenon, p. 798, ^ 1034. 
 
 Vital FaNCTioNs. See Functions of 
 Life, Index I. and II. 
 
 Vital Habit. See Habit, Vital, Ind. II. 
 
 Vis Medicatrix Nature — See Index I. 
 
 Vitalism and Solidism— continued from 
 Index I., 
 the doctrines of, continue to be essenti- 
 ally conceded by the Chemical School 
 of "Medicine, p. 779-782, 1) 1028-1030 ; 
 p. 796-799, () 1034. 
 
 Vital Principle — continued from Index 
 I., 
 continues to be the incubus in the 
 dreams of Organic Chemistry, p. 796 
 -797, ^ 1034. 
 
 Vital Properties — continued from In- 
 dex I., 
 late experiments relative to, showing the 
 
 4 
 
 Vital Properties — continued. 
 
 distinction between the organic prop- 
 erties and the nervous power, and con- 
 firming the writer's philosophy upon 
 this subject, that the former, through 
 the instruments of action, carry on the 
 functions, while these, in the animal 
 kingdom, are constantly influenced 
 by the nervous power as a vital agent, 
 p. 803-808, () 1039-1044. Also, Vi- 
 tal Principle, Organic Life, Index 
 I. ; Iris, Index II. ; Nervous Power, 
 Index I. and II. 
 an agreement upon, between Dr. Car- 
 penter and the Author, p. 95-96, ^ 
 189 J. 
 
 Volition. See Will, Index I. and II. 
 
 V OLKMANN, 
 
 experiments by, showing that the Skin 
 is rendered by narcotization an ex- 
 tremely sensitive source of convul- 
 sions, and indicative of a broad dis- 
 tinction between the trunks of nerves 
 and their expanded extremities — in- 
 troduced, along with the analogies 
 supplied by Cold, Friction, &c., to 
 show that Vesicants, Setons, Issues, 
 Mercury, Iodine, Tobacco, and other 
 things applied to the skin, produce 
 their effects upon internal parts 
 through alterative influences of reflex 
 nervous action, modified according to 
 the nature of the agent, and the ef- 
 fects determined, also, according to 
 the fluctuating susceptibilities of the 
 organs, p. 338, ^ 514 d ; p. 348. () 516 
 d. No. 13 ; p. 592-593, <J 89H k; p. 
 666-667, () 902 i-904. Also, Skin, 
 Cold, Shower-Bath, Counter-Ir- 
 ritants, Seton, Leeching, Plas- 
 ters, Tobacco, Sedatives {Aconite), 
 Poultices, Mercurial Remedies, 
 Index II. ' 
 
 Vomiting, 
 
 its physiological analogies to respira- 
 tion, the great variety of means by 
 which it may be determined that are 
 incapable of absorption, including 
 mental emotions, associate with their 
 modus operandi through reflex action 
 of the nervous system that of the true 
 emetics, which, along with the pro- 
 found physiological and therapeutical 
 effects of the latter and the superficial 
 ones of the former, concur with all 
 our other demonstrations in bringing 
 the modus operandi of all remedial 
 and morbific causes, physical and 
 mental, under one common philoso- 
 phy, p. 325-328, i) 500 e-m ; p. 333- 
 335, <^ 503-511 ; p. 336-337, ^ 514 6; 
 p. 664, <) 900 ; p. 666-672, () 902 b- 
 904 a ; p. 704, () 943 a-944 a. Also, 
 Emetics, Stomach, Disgust, Sea- 
 Sickness, Respiration, Reflex Ao 
 A
 
 1106 
 
 INDEX II. 
 
 Vomiting — continued 
 
 TioN, Remedial Action, Mental 
 Emotions, &c.. Index II. 
 a constitutional provision for the exi- 
 gencies of Infancy in man, but not of 
 animals, illustrating their physiologi- 
 cal distinctions, and presenting an el- 
 ementary principle in the general 
 plan of Organic Designs, showing, 
 also, how all physical agents, whether 
 natural, morbific, or remedial, corre- 
 spond in their influences according to 
 the existing physiological conditions, 
 and, in connexion with its disappear- 
 ance in advancing life, indicative of 
 the natural changes that are incident 
 to organs in their mutable properties, 
 and that this mutability lies at the 
 foundation of disease and its cure, 
 and that, in correspondence with the 
 changes in other organs, the nervous 
 centres naturally fluctuate in their 
 liability to developments of reflex 
 nervous actions and in their modes 
 and influences upon which vomiting, 
 and much of the progressive muta- 
 tions in organic life, and the corre- 
 sponding effects of morbific and reme- 
 dial agents depend, p. 373-381, () 576 
 -579. Also, Infancy, Uterus, Lac- 
 tation, Structure, Index II. ; Vital 
 Properties, Organic Life, Index I. ; 
 Youth, Nervous Power, Index I. 
 and II. 
 
 W. 
 
 Warm Bath, 
 
 its effect in relieving pain and promot- 
 ing sleep, the result of a sedative re- 
 flex action of the nervous system de- 
 termined upon the nervous mechan- 
 ism, p. 589, <J 891 p, exemplifying, 
 also, the modus operandi of Narcotics, 
 Antispasmodics, &c., and the great 
 recuperative law, p. 592-593, <J 89H 
 k; p. 681-683, <) 905 b; p. 838, ^ 
 1057^ — while it equally extends its 
 influence to all other parts through 
 the same medium, operating accord- 
 ing to the nature of the part and ex- 
 isting susceptibilities, being like cold 
 in its action upon the kidneys a stim- 
 ulus to the bladder, by which it will 
 immediately determine its contraction, 
 which is one of the numerous simple 
 processes that interpret the modus 
 operandi of morbific and remedial 
 agents, and its relief of diseases ac- 
 cording to temperature and the activ- 
 ity or indolence of morbid states and 
 the nature of the affected part, pre- 
 sents a parallel with the effects of in- 
 ternal remedies according to their 
 doses and analogous conditions, and 
 
 Warm Bath — continued. 
 
 thus farther illustrates the Author's 
 doctrine of morbific and remedial ac- 
 tion as applied to all cases through 
 the medium of reflex nervous influ- 
 ence, and of his doctrine of modifica- 
 tion of that influence according to the 
 nature of its exciting causes, ibid., 
 and Skin, Cold, Kidney, Sedatives, 
 Opium, Poultices and Hot Fomenta- 
 tions ; Recuperation, Law of; Res- 
 piration, Food, Exercise, Struc- 
 ture, Index II. 
 
 Water, Hot, 
 
 its effects in its action upon the stom- 
 ach in producing free perspiration, 
 ,like the glow and moisture of the sur- 
 face which often spring from the first 
 contact of food with the stomach, or 
 as the odour or expectation of food 
 increase the flow of saliva, or as the 
 contact of cold air with the surface 
 starts the secretion of urine, or as 
 fear, and anxiety, and jealousy will do 
 the same along with perspiration, or 
 grief the tears, and all depending upon 
 reflex or direct action of the nervous 
 system, illustrates the perpetual op- 
 eration of that influence in its most 
 simple conditions in modifying the ac- 
 tion of the secerning vessels, and the 
 whole collectively stretch their con- 
 clusive analogies to the correspond- 
 ing effects of emetics, cathartics, loss 
 of blood, &c., and through their an- 
 alogies, and independently of our oth- 
 er accumulated proof, to the various 
 other simultaneous effects that are in- 
 cident to morbific and remedial agents 
 in their action upon parts beyond the 
 seat of their direct operation, and thus 
 also show how the nervous influence 
 is variously modified in all the cases 
 according to the nature of its exciting 
 causes, and that the changes in the 
 secretions are owing to these various- 
 ly modified conditions, and proclaim 
 the substantive existence and self-act- 
 ing nature of the Principle in which 
 the Mental Emotions originate — and 
 now leaving the stomach for the rec- 
 tum, and considering how the sphinc- 
 ter muscle is held in contraction by a 
 perpetual determination upon it of 
 the nervous influence, and that the 
 natural peristaltic movements depend, 
 also, upon reflex actions of the nerv- 
 ous system that have their centripe- 
 tal origin in all parts of the gastro- 
 intestinal mucous tissue, as much so 
 as the muscles in deglutition in a 
 more circumscribed portion, or all 
 things that produce vomiting in the 
 mucous lining of the stomach, and 
 that it is through the same causation
 
 INDEX II. 
 
 1107 
 
 Water, Hot — continued. 
 
 that an enema of warm water increas- 
 es the intestinal movements, we be- 
 come assured that their greater accel- 
 eration, and other attendant effects 
 that result from the addition of salt, 
 or soap, or aloes, &c., to the simple 
 enema, depend equally upon the same 
 reflected influence, and equally, there- 
 fore, when cathartics are administer- 
 ed by the stomach, since, also, if the 
 enemas do not increase the peristal- 
 tic movements by their absorption, 
 but, like the natural movements and 
 the contraction of the sphincter mus- 
 cle, and the act of swallowing, and 
 the vomiting from drinking warm wa- 
 ter or tickling the fauces, or a mental 
 emotion, through the nervous influ- 
 ence, then, since there is no absorp- 
 tion, must all the other effects, cura- 
 tive or morbific, be equally due to that 
 influence — and thus, finally, a broad 
 ground of exact analogies is obtained 
 for going in pursuit of an apparently 
 endless variety of other concurring 
 facts that are relative to the modus 
 operandi of all other remedial and 
 morbific agents, physical and mental, 
 p. 107-111, () 226-2331 ; p. 230-232, 
 ^ 422 6^24; p. 289, M61 ; P- 296, 
 ^ 476 c ; p. 301-302, i) 481 b ; p. 335 
 -336, <^ 512 a, b; p. 339-340, ^ 514 
 h; p. 351, ^ 524 a, No. 1 ; p. 451, (J 
 692 a; p. 478-479, <J 740 a, b; p. 
 483-484, () 746 c ; p. 534, () 844 ; p. 
 563-565, ^ 889 a-g ; p. 630-632, ^ 
 8921 b, c ; p. 634, I) 892| b ; p. 662- 
 663, ^ 896 ; p. 667-670, ^ 902 d-i ; 
 p. 704, ^ 943 a ; p. 866-867, <J 1067 
 a. Also, Reflex Action, Remedial 
 Action, Secretion and Excretion, 
 Sweat, Bile, Weeping, Fear, Dis- 
 gust, Cathartics, Emetics, Alter- 
 atives, Bloodletting, Leeching, 
 Suppositories; Sympathy, Continu- 
 ous ; Soul and Instinctive Princi- 
 ple, Index II. 
 
 Weeping, 
 
 the result of an emotion, however vio- 
 lent, that rarely produces much dis- 
 turbance, not even of the organs of 
 circulation, since it determines the 
 nervous influence mostly upon the 
 lachrymal glands, as disgust does upon 
 the mucous tissue of the stomach, and 
 anger upon the voluntary muscles, 
 while other emotions, like fear, im- 
 part to that influence a more univer- 
 sal direction — thus exemplifying, like 
 the physiology of respiration, of the 
 contraction of the sphincter muscles, 
 &c., the manner in which morbific 
 and remedial agents direct the nerv- 
 ous influence upon special parts, ac- 
 
 Weeping — co?ilinucd. 
 
 cording to the nature of the former 
 and the natural or acquired suscepti- 
 bilities of the latter ; and connecting 
 the foregoing with the morbific effects 
 of grief and the curative ones of hope 
 and joy, we come to readily under- 
 stand, through these facts alone, how 
 the nervous influence is variously 
 modified and rendered alterative by 
 physical agents according to the par- 
 ticular virtues of each one — and these 
 coincidences denote the substantive 
 existence and self-acting nature of 
 the Soul. See references under Wa- 
 ter, Hot, Index II , and p. 880, ^ 
 1074. 
 
 Whooping-Cough, 
 
 treatment of, p. 640, <;. 892-t- A; p 844, 
 
 ^ 1058 k. 
 emetics break up a paroxysm by substi- 
 tuting a new modification of reflex 
 nervous influence, since in coughing 
 and vomiting the abdominal muscles 
 are alike concerned, and when an 
 emetic operates it introduces through 
 the reflex nervous action a new com- 
 bination of movements, and thus nec- 
 essarily interrupts those upon which 
 coughing depends, and for this rea- 
 son should the cough, or tickling the 
 fauces, or any other cause bring on 
 vomiting, the paroxysm of coughing 
 will be equally arrested ; but in all 
 the cases the results beyond the in- 
 terruption of the paroxysm will de- 
 pend more or less upon the special 
 nature of the nauseant or emetic em- 
 ployed — all of which advances our 
 other multitudinous demonstration? 
 of the modus operandi of all morbific 
 and remedial agents beyond the seat 
 of their direct operation through al- 
 terative influences of reflex action of 
 the nervous system, and against the 
 crude devices of Chemistry, p. Ill, ^ 
 233i ; p. 336-338, <J 514 b, c. Also, 
 Antispasmodics, Hiccough, Hyste- 
 ria, Respiration, Stomach, Emet- 
 ics, Index II. ; Nervous Power, In- 
 dex I. and II. — Notes D p. 1114, Co. 
 philosophy of effects of open air and 
 change of place in relieving — exem- 
 plifying a complex series of reflex 
 actions of the nervous system as the 
 immediately alterative means, a cu- 
 rative reflex influence being first pro- 
 pagated upon the digestive organs 
 through a primary impression upon 
 the mucous tissue of the lungs and 
 skin, and subsequently through the 
 improved or invigorated condition of 
 the former organs upon the pulmo- 
 nary mucous tissue ; the same phi- 
 losophy being applicable when change
 
 1108 
 
 INDEX II. 
 
 Whooping-Cough — continued. 
 
 of climate, exercise, cold or warm 
 bathing, friction, and analogous means 
 promote the healing of superficial ul- 
 cers or assuage pulmonary phthisis, 
 though the relief doubtless depends 
 more or less upon reflex influences 
 propagated directly from the skin 
 upon the main seats of disease, or 
 from the voluntary muscles as the re- 
 sult of their exercise, while, also, no 
 small amount of what is thus appa- 
 rently due to physical causes is often 
 owing to a direct nervous influence 
 excited by those emotions that are 
 awakened by the gladdening aspects 
 of Nature, by social intercourse, &c. 
 — ail of which is rendered tributary to 
 the Author's general object of advanc- 
 ing that philosophy in medicine which 
 appears to him to hold no fellowship 
 with the institutions of inorganic Na- 
 ture, p. 543, {) 855-856 ; p. 579-580, 
 <^ 890^ d, and references there ; p. 
 662-663, <;. 896; p. 670-671, ^ 902 
 m. Also, Reflex Action ; Causes, 
 Morbific ; Remedial Action, Men- 
 tal Emotions, Hope, &c., Index II. 
 relieved by Antispasmodics through a 
 sedative reflex influence acting upon 
 the muscular tissue, p. 592-593, ^ 
 
 89 U ^■• 
 Will — continued from Index I., 
 
 considered in its relations to the higher 
 faculties of the Mind and to the In- 
 stinctive Principle, p. 877-881, ^ 1072 
 6-1075 
 
 acts upon the intestine in defecation as 
 upon the bladder in fulfilling an anal- 
 ogous function, is sometimes capable 
 of ejecting food from the stomach, or, 
 on the contrary, will often restrain 
 nausea, p. 325, {) 500 e ; p. 326, ^ 500 
 k. Also, Defecation, Sea-Sickness, 
 Index II. 
 
 by its direct action upon the main cen- 
 tre of the nervous system it determ- 
 ines the nervous influence in an elect- 
 ive manner, and without regard to in- 
 termediate nerves, upon the voluntary 
 muscles, which are thus brought into 
 action by their own inherent proper- 
 ties, to which the nervous influence 
 sustains the relation of a stimulus ; 
 and when it is considered with what 
 vehement power the Will may urge 
 the nervous influence upon the mus- 
 cles of volition, we are supplied with 
 an interpretation of the violence which 
 excessive Joy, Anger, Fear, blows upon 
 the epigastrium, surgical operations, 
 prussic acid, the virus of serpents, 
 &c., may inflict upon the organs of 
 orj^anic Hfe through the same medi- 
 um, p. 89, (j 188 ; p. 103, <^ 205 ; p. 
 
 Will — continued. 
 
 107-111, l^ 227-233f ; p. 124, ^ 243; 
 p. 295, () 475^ ; p. 296, i) 476 c ; p, 
 298, (i 476i h; p. 300, ^ 479 ; p. 302. 
 {) 481 b; p. 319, (J 494 h-e ; p. 323- 
 328. () 500 c-m; p. 334, ij 509-511 ; 
 p. 525, () 828 a-c ; p. 643, () 893 a. 
 with rare exceptions, it so disposes the 
 nervous influence that it terminates 
 without instituting reflex actions, as 
 are apt to arise from Mental Emo- 
 tions ; but a remarkable exception oc- 
 curs in sleeping in an erect posture, 
 especially in roosting, and very anal- 
 ogous to that are the spasmodic affec- 
 tions (particularly of the muscles of 
 the lower extremities when rendered 
 susceptible by diseases of the abdom- 
 inal organs) which arise from extend- 
 ing or " stretching" the limbs when 
 in a horizontal posture, and as often 
 experienced by the Author, p. 890- 
 891, i!> 1077. Also, Roosting, hidex 
 II. 
 while the Will limits the nervous influ- 
 ence to whatever voluntary muscles 
 it chooses, the Mental Emotions gen- 
 erally affect particular parts in their 
 natural state according to the particu- 
 lar nature of each one, or as they may 
 be compounded, as Shame the capil- 
 laries of the face, Grief the lachrymal 
 glands and stomach, Disgust the stom- 
 ach mostly. Fear the kidneys, skin, 
 and heart. Anger the voluntary mus- 
 cles, &c. ; and what is thus true of 
 mental emotions is more or less so of 
 certain morbific and remedial agents 
 of a physical nature, as Cantharides 
 strikes at the genito-urinary organs, 
 Narcotics, the brain, Mercury at the 
 salivary glands, &c. ; but in a gen- 
 eral sense morbific agents are less cir- 
 cumscribed, and some of them, as the 
 predisposing causes of fever, render 
 the nervous influence universally al- 
 terative, and coming to conditions of 
 disease this complexion is changed, 
 and all external things, food, exercise, 
 mental emotions, &c., present new 
 phenomena, notonly according to their 
 nature, force, &c., but in parts upon 
 which they may have no apparent 
 effect in their natural states , and 
 since the foregoing general limitation 
 of the effects of morbific and remedial 
 agents to particular parts according to 
 the nature of the agent, and the part, 
 and the varying susceptibilities, is en- 
 tirely opposed to the diffusive action of 
 galvanism and electricity, and as there 
 is no analogy between tlie exciting 
 causes and modifying influences of 
 the nervous agent and those of which 
 Chemistry takes any cognizance, and
 
 INDEX II. 
 
 1109 
 
 Will — continued. 
 
 since the same limitation of effects 
 applies in health with the precision 
 of laws to the Will and Mental Emo- 
 tions, and as the Will has the nerv- 
 ous medium through which physical 
 agents produce their effects under its 
 own self-acting control in its office of 
 voluntary motion, and as some of the 
 Mental Emotions rarely institute re- 
 flex actions, but are restricted to one 
 half of the supposed galvanic circuit, 
 and as the Will nearly always oper- 
 ates exclusively through the motor 
 half,* the proof becomes conclusive 
 that our Chemical friends must look 
 for some other instrumentality than 
 galvanism or any of their known ag- 
 encies or laws to expound the prob- 
 lems of life and disease. See fore- 
 going references; Causes, Morbific; 
 Remedies, Mental Emotions, the in- 
 dividual Passions, Remedial Action, 
 Reflex Action, Structure, Index II. 
 employed in demonstrating the substan- 
 tive existence and self-acting nature 
 of the Soul and Instinctive Principle, 
 p. 874-879, ^ 1071-1075. 
 
 Yawning 
 
 may be the result of thinking about it, 
 or of mental sympathy, or of weari- 
 ness, and depends immediately upon 
 complex influences of direct and re- 
 flex actions of the nervous system — 
 the former cases displaying the in- 
 cipient development by the direct ac- 
 tion of the mind and a consequent 
 institution, through its irritation of 
 the pulmonary mucous tissue, of re- 
 flex action, as in involuntary respira- 
 tion, and after the manner of Disgust 
 in producing vomiting, while in the 
 latter case the primary influence of 
 the nervous centres proceeds from the 
 voluntary muscles — employed in ex- 
 pounding the modus operandi of mor- 
 
 Yawning — continued. 
 
 bific and remedial agents, and in de- 
 monstrating the substantive existence 
 and self-acting power of the Soul, p. 
 327-328, ^ 500 ;-m ; p. 340, ^ 514 k- 
 m ; p. 534, (J 844 ; p. 631-632, ^ 892 
 b; p. 888-889, ^ 1077. Also, Dis- 
 gust, Sneezing, Se.\-Sickness, Ex- 
 ercise, Mental Emotions, &c., In- 
 dex II. 
 
 Youth — continued from Index I., 
 
 its various developments are strongly 
 illustrative of the natural mutability 
 of the properties of life which is 
 greatly designed to fulfil the exigen- 
 cies incident to the progressive stages 
 from Infancy to Manhood, and from 
 which arise diseases and their cure — 
 thus supplying, also, natural examples 
 of well-marked alterative influences 
 of the nervous system in the deep re- 
 cesses of organic life, since all the re- 
 markable mutations which character- 
 ize this stage of progress, and much 
 of its moral attributes, are mainly ofv- 
 ing to the development of the organs 
 of generation, and an attendant al- 
 terative influence of reflex nervous 
 action, whose centripetal source is es- 
 pecially the testes in one sex and the 
 ovaria in the other — and farther il- 
 lustrated by the differences between 
 the perfect and altered animal, while, 
 also, the physiological changes be- 
 come the groundwork of new dis- 
 eases or modifications of former ones, 
 and all serving as a standard of inter- 
 pretation of the modus operandi of 
 morbific and remedial agents, physic- 
 al and mental, p. 55, Ml'^; P- 56, (} 
 120 ; p. 61, (J 133 c ; p. 68-69, ^ 153 
 -159; p. 121, ^237; p. 352, (J 524 rf ; 
 p. 376-378, (J 578. Also, Organs of 
 Generation, Parturition, Preg- 
 nancy, Alteratives, Predisposi- 
 tion, Miasm ; Antimony, Tartar- 
 izED ; Reflex Action, Index II. ; 
 Vital Properties, Organic Life, 
 hidex I. 
 
 * The Chemist is desired to consider particularly this fact (S 409 hh, 493 cc, 893 a), 
 —Also NoTB Y p. 1130.
 
 INSTITUTES OF MEDICINE. 
 
 NOTES. 
 
 As stated in the Preface to the Seventh Edition of this work, the Author has af- 
 fixed some brief Foot-notes to that Edition (as at p. 172, 350, 503, 679, 72.5, 863, 895, 
 920) ; but soon after the first impression was strucli off he concluded to introduce a 
 few other Notes at the end of Index II., which will be attached to the copies of that 
 impression which may remain on hand. This method of adding or modifying will 
 be continued hereafter, and references to the Notes thus appended will be inserted 
 in the text in future impressions, and probably, also, other foot-notes, and other 
 improvements. Such, indeed, have been made in this second impression of the 
 seventh edition, as at p. 493, 606, 699, 1052, &c.— September, 1862. 
 
 NOTE A.— EXCITING CAUSE OF PARTURITION. 
 
 Note A. — In section 892| d occur some remarks about the institution of labor, 
 and I am now led to other comments by certain suggestions made by Professor G. 
 S. Bedford, M.D., upon the same subject in his late work upon the "Principles and 
 Practice of Obstetrics," and which was reviewed by myself in the "Boston Medical 
 and Surgical Journal," November 7th, 1861. In that Review I remarked that Dr. 
 Bedford, after a genei-al examination of the principal hypotheses relative to "the 
 determining cause of labor, or that peculiar influence which first excites the muscular 
 fibres of the uterus to contraction," and having considered particularly the ovarian 
 hypothesis of Dr. Tyler Smith, and the orificial irritation of Dr. John Power, both of 
 which are founded upon the laws of reflex nervous action, delivers his own rationale 
 in considerable detail. Our Author's doctrine is j)redicated of the principle that 
 " there seems to be a necessary connection between the first spontaneous movements 
 in the muscular walls of the uterus and a matured development of the muscular 
 structure of the organ itself." That the institution of labor is due to a cause that 
 operates at uniform times not only in the human species but in all animals is suffi- 
 ciently obvious. It must be independent, in a constitutional sense, of all accidents 
 that may affect the specific periods. The hypothesis of orificial irritation is contra- 
 dicted not only by the periodical uniformity of the process, which is very variable in 
 different species of animals, but by the variety of presentations, and that woman 
 alone is liable to the imputed cause before the contractile movements shall have be- 
 gun. We must therefore look to the uterus itself for the requisite provision, and this 
 can be found only in a law which is exactly obedient to a matured development of 
 the organ. But this does not expound the great and wonderful ])roblcm — the how 
 or the ivhi/ the "spontaneous movement" grows out of the "matured development 
 of the muscular structure." Are there any analogies, any physiological principle, 
 to sustain Dr. Bedford's conclusion that there is an inherent ability in the fully de- 
 veloped uterine muscular structure to institute the parturient process independently 
 of any other existing cause, and above all that, as our Author affirms, "it has no 
 connection whatever with a reflex or neiTous force" ? For this conclusion our Au- 
 thor offers a supposed analogy in the peristaltic movements of the intestine, found- 
 ed upon the assumption that those actions are independent of the nervous influence, 
 which, however, has not been rendered even ])robable. Experiments have only 
 shown that other causes are capable of exciting those movements, such as atmos- 
 pheric air, mechanical injuries, electricity, etc. (§ 262-265, 475^). In the natural 
 condition of the intestine there must be equally an exciting cause of the peristaltic 
 movements as of the action of the heart (§ 475^), or of the respiratory muscles 
 (§ 500 i-»0, or of the iris (§ 514 k, 1072 a), or of the sphincters (§ 514/^ g), and, 
 as in the latter cases, what else than the nervous influence in that of the intestine ?
 
 1112 NOTE A. EXCITING CAUSE OF PARTURITION. 
 
 And is not this confirmed by the eifects of cathartics and suppositories (§ 514/)? 
 Why are the natural movements suspended in jaundice, or when food is long with- 
 held, unless bile and the ingesta be remote causes of those movements, and how else 
 can they reach the intestinal muscular tissue than through reflected action from the 
 nervous centres? How else can the stimulus of the blood affect the muscular sub- 
 stance of the heart than through the circuitous route of the nervous system, or what 
 other important function do the cardiac nerves subserve? (p. 803, Ex. 15; p. 321). 
 
 Physiologists are also greatly in error in supposing that the nervous influence 
 ceases to operate immediately after apparent death, and therefore in the inference 
 that the expulsive movements of the uterus after apparent death are not excited by 
 the stimulus of the nervous influence. The expulsive efforts are ample proof that 
 there is still remaining life ; and various recorded facts substantiate the continued 
 action of the nervous system as long as muscular irritability and contractility remain 
 (§ 447 d, 637, 1042, 1072 «, Note Aa, p. 1131). 
 
 As to the experiment of destroying the lower portion of the spinal cord for the 
 purpose of showing that labor may take place without the stimulus of the nervous 
 influence, it has been completely neglected that the uterus is still connected with the 
 essential parts of the nervous system by contributions from the sympathetic nerve 
 and from other parts of the cerebro-spinal system (§ 459/, 478 6, 483 c, 490). More- 
 over, it is now well ascertained that the ganglia of the sympathetic nerve, even the 
 plexuses of that nerve, are, as one of their uses, centres for reflected nervous action, 
 especially when preternatural influences are in operation, as when, for example, ves- 
 icants subdue deep-seated inflammations (§ 516 c?-522, 893). In the case of the 
 parturient efibrts after the destruction of the lower portion of the spinal cord, that 
 very injury calls into operation other resources in the nervous system with which the 
 uterus is indirectly supplied. It is also universally conceded that, in the language of 
 our Author, " as a general rule, labor is in part accomplished through reflex nervous 
 action," and it is therefore farther inferable that when labor takes place after de- 
 stroying the inferior portion of the spinal cord "the general rule" still obtains, and 
 that the experiment supplies no evidence that "childbirth is not necessarily depend- 
 ent upon nervous agency." The supposed "inherent action" is, possibly, sufficient, 
 2}er se, for a single contractile movement, but an exciting cause independent of the 
 "matured development of the uterus" is necessary to a long series of alternate con- 
 tractions and relaxations. That condition resulting from the "matured develop- 
 ment of the muscular structure of the organ" becomes the exciting cause of reflex 
 nervous actions, just as the want of atmospheric air in the lungs is the remote cause 
 of the reflected nervous influence that determines the respiratory movements — ex- 
 cepting in the case of the uterus the compounded sensitive and excito-motory nerves, 
 which are the channels of the transmitted influences, appertain exclusively to the 
 muscular tissue of the organ. This, however, has its exact analogy in the reflex 
 nervous actions upon which, as I have shown, roosting and sleeping in an erect pos- 
 ture depend, as also the spasms which are sometimes excited in irritable muscles of 
 the lower extremities by a forcible act of the Will (§ 500 dd, 514, p. 891, § 1077). 
 In the former case there is a natural adaptation of the muscles to that exercise of 
 the Will, which, by placing them in a rigid state, establislies a reflex nervous action 
 that maintains them in permanent contraction as in the more compounded case of 
 the sphincter muscles. The same natural provision becomes developed in the gravid 
 uterus to subserve the exigencies of parturition, and is allied to that irritable state 
 of the voluntai7 muscles in which the Will may institute spasmodic movements. As 
 soon, however, as "the determining cause" has initiated the process of labor, the 
 point of departure for the reflected stimulus of the nervous power becomes compound- 
 ed, and the foetus participates as an exciting cause of the reflected nervous influence 
 by its pressure upon the uterus. In this respect there exists an analogy in the first 
 of the respiratory movements as related to all the subsequent, so far as the first in the 
 series is determined by the contact of cold air or other physical causes acting upon 
 the surface of the body, while in all the subsequent movements the point of depart- 
 ure for the reflected nervous influence is the mucous tissue of the lungs. 
 
 As to the alternate contractions and relaxations that are maintained by air, me- 
 chanical injuries, electricity, &c., in the extirpated intestine and heart, and where 
 there may be no reflected nervous influence determined by those causes through 
 local centres of the sympathetic nerve, such alternations of action are as readily pre 
 duccd by the artificial irritants as by the stimulus of the nervous power in virtue of 
 the natural constitution of those organic muscles, which are specifically designed for 
 that mode of action (§ 262-265, 475i and references there, 476^ c, 490, 498 e, 500 
 c-e, o, 514/ 516 d 8 and 9, 891, 8921, 1077).*
 
 NOTES B-C. — POISONS AND THE ORGANIC NERVE. — DEATH. 1113 
 
 NOTE B.— POISONS AND THE ORGANIC NERVE. 
 
 Note B. — Some late Experiments by Peliko and Dybrowski, showing the action 
 of certain poisons upon the heart, exemplify the transmission of influences through 
 the sympathetic nerve in the absence of the brain, as set forth in § 46H, 477-478, 
 481 Exp. 14, 15, 483 c, 484 b, 487/, g, 488.}, 490, 494 Exp., p. G75, § 904 h. They 
 aro introduced here, therefore, not on account of their supposed novelty, but as new 
 contributions in support of the doctrines which I have advanced as to the modus 
 operandi of morbific and remedial agents through reflected influences of the nerv- 
 ous system, and as showing that these influences may be fully propagated through 
 the sympathetic nerve, as is also seen of the natural stimuli in the aneucephali 
 (§46U«). 
 
 According to a communication made to the Parisian Academy of Sciences by the 
 foregoing Pliysiologists, poisons derived from the upas antiar, tanghinia venenifera, 
 veratrum viride, digitalis purpurea, introduced into the stomach or inserted in the 
 skin of frogs, arrested the action of the heart in periods varying from ten to twenty 
 minutes, leaving the animal for some time with the exercise of voluntaiy motion. 
 They found this paralyzing influence to be equally the same when the brain was sep- 
 arated from its connections with the spinal cord, from which they deduce the con- 
 clusion that the poisons exert a peculiar eff'ect upon the nerves supplying the heart 
 or such as may influence the movements of the organ. By consulting the references 
 to the Institutes as suggested in this Note, it will be evident from similar experi- 
 ments long since made (by Brodie, for example, with tobacco, p. G75, § 904 6), that 
 the heart was not paralyzed in the foregoing cases through an absorption of the poi- 
 sons, but by pernicious influences reflected by central parts of the nervous system. 
 
 The experiments possess, also, the interest of showing the dift'erence in functions 
 between the cerebro-spinal and ganglionic systems, and the transmission of influ- 
 ences in organic life (as in the case of the Will in animal life), through special or- 
 ganic nerves, according to the nature of the remote causes and the natural or ac- 
 quired susceptibility of organs (§ 137-152, 233J, 500 g-in, and Note at p. 864). 
 
 NOTE C— ORIGIN OF DEATH. 
 
 Note C. — Refers to section 632, page 401. Nothing upon the subject of death 
 can be predicated of man as deduced analogically from the original constitution of 
 animals. The weapons of destruction with which the latter are provided is a cogent 
 proof that death was their primitive allotment, and a still greater may be seen in the 
 universal means of subsistence among the aquatic tribes and the carnivorous of every 
 denomination. The last reaches to man, for whose uses the animal as well as the 
 vegetable kingdom was created, and in which respect the pronunciation of Scripture 
 corresponds with the constitution of man, which is obviously designed for both ani- 
 mal and vegetable food. jNIan is not only thus isolated, and all reasoning from 
 analogy predicated of the death of animals excluded, but since, also, animals were 
 rendered subservient to mankind as a means of sustenance, and as the death of man 
 is not tributary to any useful purpose whatever in the economy of nature beyond the 
 mere elementary principle, it is evident that death has been ingrafted upon man's 
 constitution without any apparent final cause. This conclusion, though wanting in 
 absolute proof, is prompted by reason in its logical methods of investigation, and it 
 seizes upon Revelation as supplying a remarkable conciu-rent testimony of the ac- 
 curacy of its own ratiocination, and as affording a satisfactory solution of the won- 
 derful problem. But that is not all. Man is still more estranged from the brute 
 creation by his endowment, according to my induction from final causes (p. 893), 
 with an imperishable Soul, while the instinctive principle of animals dies with the 
 material body. The analogy, therefore, which has been carried from the mortality 
 of animals to the human race is again rendered nugatory by the final causes of the 
 Soul and of the principle of Instinct (p. 842, § 1078).— Note Pp p. 1142.
 
 1114 NOTES D-r. KEFLEX NEKVOUS ACTION. NARCOTICS. 
 
 NOTE D.— KEFLEX NERVOUS ACTION. 
 
 Note D. — The demonstrable manner in which light produces sneezing, or the 
 mind in dwelling upon the paroxysm, as set forth in § 514 k-l, 1077, and in which 
 disgust, whether arising from offensive sights or offensive odors, or from a recollec- 
 tion of their effects, gives rise to vomiting, as expounded in § 500 i-m, 603-512, 514, 
 S92i, 1074, 1077, and as an attendant result to sweating (ibid.), and where in the 
 latter case the nervous influence is conspicuously manifested as well in the organs 
 of organic as of animal life, enables us to readily comprehend the involved processes 
 of reflex nervous actions that may be instituted by remedies administered by the 
 stomach or applied to the skin, as variously set forth in this work (§ 228 b, 514 h, 
 G57, 674 d, 692 a, 715, 811, 848, 863, 889 a, n, 902 g, 904 bb, and Index II., Article 
 Skin). Thus, also, it is rendered manifest how agents of special virtues may not 
 only propagate a curative reflex nervous influence directly upon a morbidly suscepti- 
 ble part, as tartarized antimony in the cure of pneumonia, but how, also, the same 
 remedy may simultaneously reflect the nervous influence upon other organs not the 
 seat of disease, as the skin, and thus render that organ the source of a salutary re- 
 flex nervous influence upon the morbidly susceptible lungs, as otherwise and vari- 
 ously expounded in the foregoing and other sections. 
 
 It may be farther said of sneezing as brought about by the action of light upon the 
 retina, or by the mind in dwelling upon the paroxysm, and of vomiting as occasioned 
 by offensive sights and offensive odors, that in the former case the nervous influence, 
 in being first reflected or directly projected (as the light or the mind may be the re- 
 mote exciting cause) upon the Schneiderian membrane, acts upon that membrane 
 after the manner of snvff, when the irritation is reverberated upon the nervous cen- 
 tres, the nervous influence again excited and i-eflected upon the abdominal mus- 
 cles ; while in the case of vomiting, it is the mental emotion alone which excites 
 and projects the nervous influence upon the raucous coat of the stomach (always in 
 a direct manner, according to a distinction which I have made between direct and 
 reflex action, § 227, 500 c-m, 893 a, 896, 903, 1072 n, 1074), where the nervous in- 
 fluence thus determined by the emotion, whether resulting from the spectacle, or the 
 odor, or from the recollection of their effects, acts precisely as an emetic, when the 
 chain of causations ends in the transmission of that nauseating influence to the nerv- 
 ous centres where the nervous power is thus excited in an indirect manner, and 
 then reflected with a convulsive effect upon the same muscles that are engaged in 
 sneezing. 
 
 The foregoing examples are reproduced here that they may be presented in an iso- 
 lated state, and to attract to them attention both on account of the novelty of the 
 Author's interpretation of the action of the Will upon the voluntary muscles, and of 
 mental emotions upon all parts of the organic mechanism, through the instrument- 
 ality of*the nervous power, and that they may be recognized as distinct illustrations 
 ofthe modus operandi of natural, remedial and morbific agents in refutation of the 
 doctrine of operation by absorption. 
 
 NOTE E.— OPERATION OF NARCOTICS. 
 
 Note E. — In expounding the therapeutic effects of Narcotics I have endeavoured 
 to show that they operate essentially by reducing irritability and sensibility, and thus 
 render the blood and other exciting causes less stimulating, so that in local condi- 
 tions of disease attended by an exaltation of those properties the restorative process 
 supervenes upon that sedative influence (§ 891 i, 905 b, 1057). Tiiese remarks are 
 intended to illustrate the probable action of Conivm and Belladonna in mitigating 
 the severities of cancerous affections, and that the results are in no respect due to 
 an alterative virtue which has been for a long time attributed to those narcotics. 
 
 NOTE F.— ALCOHOL versus ANTIPHLOGISTICS. 
 
 Note F. — To carry out the objects of the Postscript at p. 872 I subjoin the sta- 
 tistics of mortality arising from pneumonia, bronchitis, croup, and conswnpfion in the 
 city of New York during the months of January, February, March, and April of
 
 NOTE F. ALCOHOL Vet'SUS ANTIPHLOGISTICS. 1115 
 
 1861 and 1862, from which it will be seen that the " stimulating plan" of treatment 
 was no more successful than in the same months of 1860. 
 
 In 1861 the total number of deaths during the foregoing months was 6987, of 
 which 527 are reported as "Inflammation of the Lungs;" Bronchitis, 185; 
 Croup, 212; Consumption, 1062. 
 
 In 1862 the total number of deaths for the same time was 7035, of which are re- 
 ported as " Inflamjiation of the Lungs," 498; Bronchitis, 119; Croup, 187; 
 Consumption, 1165. 
 
 The ratio of deaths from pneumonia during the first four months of 1861 and 
 
 1862 was about the same as distinguished the corresponding period of 1860, while, 
 had the depletive treatment been adopted, especially bloodletting, which, continues 
 to be proscribed in this City of New York, that ratio, instead of amounting to about 
 1 in 12 of all the deaths, would not have been 1 in 100. The aggregate mortality, 
 therefore, I reiterate, must not be imputed to any remarkable insalubrity of New 
 York (p. 760, § 1005 ^-)•— Note Mm p. 1141. 
 
 As to the ratio of deaths from Consumption, some improvement may be anticipated 
 from the late work upon that disease by Dr. James Copland, who advocates the an- 
 tiphlogistic treatment, especially in the early stages. It will, however, be a tardy 
 gain over the stimulating treatment, since it is said, in the leading medical journal 
 of the day, by a rather liberal reviewer of Dr. Copland's work, "that bleeding for 
 haemoptysis is not a practice which meets with much favour in the present day. 
 Most living physicians with whose opinions we are conversant would as soon think 
 of drawing blood to arrest uterine hemorrhage, or to stop a wounded artery (§ 699 
 c, 805, 862-864, 890 d-f) ; and, secondly, that the main improvement (in treatment) 
 depends on the universal acceptation of the doctrine that phthisis is essentially a dis- 
 ease of imperfect nutrition and assimilation, and that eiforts in treatment must there- 
 fore be mainly directed, not to the pulmonary, but to the digestive systems. The 
 principal treatment of phthisis nowadays consists in the free administration of nour- 
 ishing animalized diet, containing a large proportion of the fatty elements of nutri- 
 tion ; in exercise, witli unrestricted exposure to the invigorating intiuences of sun 
 and air ; and in the substitution of a few simple but elfective tonic medicines for the 
 effete polypharmacy of our predecessors." The objection to polypharmacy is very 
 well, although it does not apply to any of the most eminent ^' of our predecessors," 
 whose principal treatment in the early stages of phthisis consisted of bloodletting, a 
 non-stimulating diet, counter-irritants, and free exercise in the open air, but all of 
 which, save the air we breathe, is now so greatly changed that the Reviewer remarks 
 of Dr. Copland's treatment that "we have certainly been surprised to find local, 
 and in some instances general bloodletting still advised in the first stage of phthisis." 
 — (The Italics are mine.)— British and Foreign Medico-Chirurgical Review, 
 January, 1862, p. 159. 
 
 Nowthere might seem in the foregoing statistics a sufficient justification of this 
 extended discussion. But it may be said that they are too local, not sufliciently 
 comprehensive, and that as statistics (founded upon the '^ numerical method'') are 
 " the great criterion nowadays of the merits of treatment," they should not be liable 
 to the objection which I have anticipated, although they run through four corre- 
 sponding months of three consecutive years, and relate to a population of about one 
 million. I shall therefore offer a copious amount of similar testimonials from the 
 same number of the Review to which I am indebted for the foregoing quotations. 
 Thus, in an elaborate Article upon "Military and Naval Hygienics" (iha Italics be- 
 ing mine), it is said of " Diseases of the Lungs, &c., including pulmonary consump- 
 tion," that, "among the troops at home, these maladies occasion more admissions 
 into hospital than all fevers and diseases of the bowels together ; and more than three 
 times as many deaths. Tico thirds of all the mortality in the army of the United 
 Kingdom are due to them ; and of these two lYavAs, four fifths are due to consump- 
 tion." "In the Mediterranean garrisons, the proportion of chest diseases to all other 
 causes of sickness has been nearly as high as in Great Britain, viz., a sixth or a sev- 
 enth of the whole. They have not been quite so fatal ; still, the mortality from them 
 alone has constituted between a half and a third of all the deaths. In the North 
 American command, their frequency and fatality have been nearly the same as at 
 home. 
 
 " In the navy, respiratory diseases are the most prolific source of sickness and 
 death." "il/ore than a fifth of the deaths from all causes is occasioned by them." 
 "In 1856, out of a total mortality of 629 from disease, 175 deaths were due to pul- 
 monic affections, chiefly phthisis (nearly one fourth) ; and of the 918 men invalided 
 from disease that year,'l03 were discharged on account of consumption, and 49 from
 
 1116 NOTE G. MODUS OPERANDI OF CATHARTICS. 
 
 Other pulmonic disorders. In 1857, of the total deaths (623) from disease in the 
 sei-vice, 129 were caused by consumption" (more than one fifth). — Ibid., p. 109, 110. 
 
 In reviewing the statistics of consumption, it should not be forgotten that besides 
 the substitution of tonics and stimulants for the "effete polypharmacy of our prede- 
 cessors," a lavish use of cod's liver oil is a main ground of dependence ; though we 
 hold the tonics and stimulants, and the ' ' free administration of nourishing animal- 
 ized diet," and the absolute neglect of an antiphlogistic treatment, at the early stage 
 of the disease, responsible for the excessive mortality (<J 836, 892f ^-0-* 
 
 In the Medical and Physiological Commentaries, in an article on the '■'■Pa- 
 thology of Tubercle and Scrofula" (vol. ii., p. 608-634) and, also, in a critical exam- 
 ination of.the "Pnndpal Writings of P. Ch. A. Lo2tis" (Hid., p. 679-815), I have 
 endeavoured, at great length, to substantiate the highly inflammatory nature of phthi- 
 sis pulmonalis, and have recited the experience of the most illustrious practitioners 
 in behalf of a decided antiphlogistic treatment, especially bloodletting, in the early 
 stages of the malady, and with which my own, throughout a long and active pro- 
 fessional life, has fully corresponded. But there has arisen a general, or, rather, a 
 nearly universal acquiescence in Louis' contra-inflammatory doctrine, as deduced by 
 him from the debris of the body, though, as I have unquestionably shown, in opposi- 
 tion to his own dissections (e. g. ut supra, p. 631-633). It is this especially, not the 
 "numerical method," and as generally admitted, which has prompted the stimulating 
 treatment of consumption (§ 756 a). Moreover, in respect to this, and all other dis- 
 eases, the denunciation of bloodletting is too formidable to be encountered by any 
 but well-established practitioners, and who possess, also, more than Galen's heroic 
 firmness (§ 1004 c, note; also p. 488, § 756 a; p. 722, § 690 g; p. 861, § 1065 c). 
 
 NOTE G.— MODUS OPERANDI OF CATHARTICS. 
 
 Note G. — The explanation which is rendered in § 880 f of the necessity of pro- 
 found impressions upon the intestinal mucous membrane by cathartics for successful 
 
 * In regard to the causes -which hare led to an almost universal adoption of a stimulating treat- 
 ment where the "antiphlogistic" had, with only rare and partial exceptions, obtained throughout 
 the past (5 1004 a), I have represented those of a general nature both in this work and the Medical 
 and Physiological Commentaries (5 4S7 /<, 5G9 6-c, 621 a, 743, 756 a, TS5, S15, SCO, 861 b, 967, 979, 99-2, 
 999 c, 1001, 1U05-1007, 1022-1026, 106S «, W. But there are many incidental causes, which have 
 given a great impulse to the revolution, and a knowledge of which will be Interesting to the future 
 historian. Among the thousand influences of this nature, which are of themselves of important and 
 comprehensive import, may be mentioned the following recommendation, signed by nine of the prin- 
 cipal physicians of the City of New York (six of whom, at least, are Professors in some of our Jletro- 
 politan Colleges), and which, of course, has been extensively ckculated as an advertisement. Thus : 
 
 " New York, May 1, ISGl. 
 " Mr. Wm. T. Cuttee, Jr., Louisville, Ky. 
 
 *•' Deak Sib, The great difficulty experienced in procuring Brandy sufficiently pure for medicinal 
 
 pui-poses, has induced many of the physicians of this vicinity to adopt Bourbon Whisky as a substi- 
 tute, both in the hospitals and private pr.actice; and since the latter HAS COME INTO SUCH 
 GENERAL USE, we have reason to believe that a gi'eat deal now sold is of very inferior quality. 
 
 " Presuming that your residence in the vicinity of the manufacturers of Whisky in Kentucky, as 
 well as your skill as a chemist, will enable you to select a reliable article, and having full confidence 
 in your integrity, we are led to inquire whether you will not aid us in having this market supplied, 
 through an agency, with the best quality of Pure Old Bourbon Wliisky for the use of the sick." — 
 The aqMals are iiiine. 
 
 Another favourite stimulant, known as Wolfe's Schiedam Schnapps (or, more familiarly, Holland 
 Gin), is worthy of notice on account of its special recommendation by high medical authority. This 
 gin has enjoyed a distinguished professional patronage and a brilliant career for many years, and 
 the appetite for it has been very recently sharpened by a fresh recommendation signed by seven of 
 the principal physicians of the city of New York, several of whom are Professors in our Medical Col- 
 le"es. It appears as a newspaper advertisement, and the following extract will show that I do jiot 
 magnify the extent of the evil : 
 
 ^ ' " New York, March 13, 1862. 
 " Udolpho Wolfe, Esq. . , ,. 
 
 " Deab Sir,— We have tested the several articles imported and sold by you, including your Gin, 
 which you sell under the name ofAroirmtic Schiedam Sclinapjts, which we consider justly entitled 
 to the higli reputation it has acquired in this country ; and, from your long experience as a foreign 
 importer, your bottled Wines and Lttjuors should meet with the same demand. 
 
 " Wc would recommend you to appoint some of the respectable apothecaries, in diflferent parts of 
 the city as agents for the sale of your Brandies and Wines, where the profession can obtain the same 
 when needed for medicinal purposes. Wishing you success in your new enterprise, we remain your 
 obedient servants." 
 
 All this may seem to be hardly worthy of record, even in a Note; but it forms no small part of the 
 history of the most remarkable revolution that has ever befallen practical medicine, and, moreover, 
 the hope may be entertained that something may be thus contributed toward arresting the career 
 of this wide-spread calamity. It also supplies a principal ground of solution for the disappearance 
 of those remarkable efforts that had pervaded the United States for the suppression of intemperance.
 
 NOTE H. NARCOTICS VeiSUS ANTIPHLOGISTICS. 1117 
 
 Invasions upon certain obstinate conditions of disease not only plainly refutes the 
 humoral interpretations of the modus operandi of cathartics in their peristaltic ac- 
 tion and their effects upon disease, but it lays open the philosophy of the effects of 
 elateriuin and of other violent cathartics in sometimes subduing dropsical affections 
 as set forth at p. G55-65G, § 893 n, and which is there shown to have been explain- 
 ed "upon the pi-inciple of counter-irritation, or metastasis of the physical school," 
 while, at the same time, a confirmation is thus obtained of the inflammatory nature 
 of dropsical effusions, whether acute or chronic, as set forth among other facts in the 
 Author's Medical and Physiological Commentaries, vol. i., p. 180-183, 186, vol. ii., 
 p. 556, note ; 1840. Also Institutes, § 892^ k, 892} b, e, g. 
 
 NOTE H.— NARCOTICS versus ANTIPHLOGISTICS. 
 
 Note H. — I have occasionally embraced opportunities of contrasting the substitutes 
 for bloodletting in the treatment of inflammations and fevers which have been com 
 mended by those who are opposed to the latter remedy (§ 95-4 b, 9G0 a, b, 1005, 1006 /J 
 1068), and although the abstraction of blood is now very generally sacrificed to the 
 ad captanduin practice of tonics and stimulants, and all but animal nutriment is 
 mostly proscribed, there has sprung up a narcotizing school whose excesses far sur- 
 pass any foi-mer records of this kind of antiphlogistic treatment, and presents a doubt- 
 ful alternative for the "tonic and stimulating plan." It seems to be jiroper, there- 
 fore, that these Institutes should be "posted up" upon the peculiar claims of the 
 "opium treatment," and as these consist in effecting narcotization, my purpose will 
 be sufficiently accomplished by showing how it is done — for the method is far in ad- 
 vance of the practice as it existed when the record was made in § 891 c. A greater 
 importance has been also given to the subject by the accessions which have been 
 made to the school from the influential ranks, and that this may be at once appa- 
 rent, I shall have fulfilled the object of this note by presenting the following quota- 
 tion from a writer of good repute, who has also quoted the statement from one of 
 the most indulgent Commentators. The particular disease in the present instance 
 was puerperal fever, but the same narcotizing treatment is applied to the common 
 form of peritoneal enteritis. But, in the mean time, the inquisitive reader should 
 refresh himself of the past by turning to § 1005. The first sentence of our quotation 
 is from the text of Professor G. S. Bedford's late work on Obstetrics (1861), and the 
 residue is embraced in an associated note. Thus : 
 
 "Professor Alonzo Clai-k, of tlie College of Physicians and Surgeons of this city, 
 has employed opium in heroic doses during the prevalence of puerperal fever at the 
 Bellevue Hospital, and with good success. Some interesting details furnished by 
 Professor Keating, the able annotator of Dr. Ramsbotham, touching Dr. Clark's ex- 
 perience with opium in puerperal fever, will be found in Ramsbotham's System of 
 Obstetrics, p. 584. Pmay here, however, be permitted to quote the following as an 
 evidence of the extraordinary extent to which opium may be administered without 
 fatal results. Professor Clark says : 'Regarding the tolerance of opiates in some of 
 these cases — at the risk of being charged with rashness and trifling with human life 
 — I will make some extracts from case seven. The treatment was commenced at 10 
 A.M., on the 26th of December, two grains of opium hourly. At 2 P.JM., no change 
 in the symptoms, dose increased to gr. iv. ; at 3, gr. iv. ; at 4, gr. v. ; at 5, gr. v. ; at 
 6, gr. viii. ; at 8, gr. x. ; at 9, gr. xij. ; at 11, sol. morph. sulph. (16 gr. to f. §1.) 
 jiss. ; at 12, 3i. ; at H A.M. (respiration 6), 0; at 6 A.M. (respiration 12), opium 
 gr. xij. ; at 10, sol. 3i. ; at 12 M., opium gr. xij. ; at 1| P.M., sol. jij. ; at 2^, 3ij. ; 
 at 3^, opium gr. xxiv. ; at 5, gr. xij. ; at 6^, sol. jijss. ; at 7k, 5U- ; at 9, opium 
 gr. xiv. ; at 10, gr. xvj. ; at 11, gr. xviij. ; 2Sth, at 1 A.M., sol. sijss. ; at 2, siv. ; 
 at 3i, opium gr. xx. ; at 4, sol. sijss. ; at 5, jiii. ; at 6, jiijss. ; at 6i, opium gr. x. ; 
 at 7, sol. siijss. ; at 8, opium gr. xxij. ; at 9J-, sol. jiv. ; at 10, jiij. ; at llj, siij. ; 
 at 12, 0. Thus this woman took, in the first 26 hours of her treatment, opium 
 Ixviij. and sulph. morph. gr. vij. ; or counting one grain of sulph. moii)h. as four 
 grains of opium, one hundred and six (106) grains of opium. In the second 24 
 hours, she took opium gr. cxlviii., and sulph. morph. Ixxxj., or opium four hundred 
 and seventy-two (472) grains ! On the third day, she took 236 grains ; on the fourth, 
 120 grains; on the fifth, 54 grains; on the sixth, 22 grains; on the seventh, 8 
 grains ; after which the treatment was wholly suspended. This woman was not ad- 
 dicted to drinking, and, after her recovery, she assured me repeatedly that she did 
 not know opium by sight, and had never taken it, or any of its preparations, unless
 
 1118 NOTE I. REMEDIAL ACTION THROUGH THE HEART. 
 
 it had been prescribed by a physician. This is, perhaps, ' horrible doMng, ' and only 
 justifiable as an experiment on a desperate disease ; yet this woman is alive to tell 
 her own story, as are several others, who took surprising quantities of this drug. 
 But later observations have shown that the tenth to the thirtieth part of this maxi- 
 mum is sufficient in controlling the disease' " (§ 960 a, 1064, 1065 d). 
 
 Although we may not hope to defeat the attempts to substitute other means for 
 bloodletting, ranging from dry-cupping to tonics and stimulants, or consisting of the 
 most violent poisons of the Materia Medica — aconite, tobacco, veratrum viride, opi- 
 um, &c. (§ 960, 1065 a) — and where the abstraction of blood maybe most demanded 
 by the exigencies of disease, we may reasonably insist that the doses shall not be so 
 large as to incur the penalties of the law were they administered by any other than 
 professional hands. It was worthily said by Sigmond to his medical Class, that 
 
 "There is no doubt that any indiscretion in the use of violent remedies, any want 
 of caution, may prove fatal ; and notwithstanding the occasional escape of persons 
 after the employment of fearful doses, I would impress upon your minds that you are 
 never justified, because a solitary case, here and there, is thrust before your notice of 
 extravagant quantities having been given, to administer, but with the remembrance 
 of the sacredness of human life, any remedy which may have the slightest uncertainty 
 in the intensity of its action. Nor do I think if any untoward event occurred in 
 your practice from a very large dose that an excuse should be pleaded on the score 
 that in some particular case such a quantity had been fearlessly employed, and for- 
 tunately no bad effects had resulted" (p. 720, § 960 o). — Sigmond's Lectures in Lon- 
 don Lancet, December, 1837, p. 403, 404. 
 
 NOTE I.— REMEDIAL ACTION THROUGH THE HEART. 
 
 Note I. — In sections 500 m, 604i, 826 cc, «&c.,I have represented the action of 
 the heart when influenced by remedies as resulting generally from either .their mod- 
 ifying efi'ccts upon disease and a consequent modification of the nervous influence 
 thus reflected upon the heart, or from a simple modification of that influence gener- 
 ated by the direct action of the remedy upon the part to which it may be ap])lied — 
 either the gastro-intestinal mucous membrane or the skin — while in § 1065 a I have 
 imputed tl)e effect of certain agents, digitalis, colchicum, veratrum viride, in dimin- 
 ishing the frequency of the pulse to a narcotic virtue, and have objected to the ther- 
 apeutical conclusions which have, in consequence, been predicated of those remedies. 
 The latter are examples which illustrate the difficulties of medicine ; for there can 
 be no greater fallacy than the hypothesis that "remedies which lessen the frequency 
 of the pulse are best adapted to inflammatory and febrile diseases." Every thing 
 depends upon the mode in which the heart's action is influenced. To be significant 
 of a salutary effect, whether the modified action consist in a diminished frequency or 
 any other apparently favorable change, the influence must C(*me especially thijpugh 
 a salutary impression upon the parts diseased, if the heart have been disturbed by 
 such affections ; or, if such disturbance of that organ have not been thus inflicted, 
 the modifying influence of any remedy upon its action, per se, is either useless or in- 
 jurious, although a salutary e'ffect of the agent upon any morbid process may sim- 
 ultaneously exert a modifying influence upon the heart's action. To be useful, 
 therefore, the blow must be struck, not at the heart, but at those extreme vessels which 
 carry on the morbid process (§410,411,639,750,999 c) ; and hence our conclusion, 
 as expressed in the text (p. 800), that the substitution of veratrum viride, &c., for the 
 abstraction of blood in the treatment of inflammation has grown out of very mis- 
 taken views in pathology and ther.^peutics. It is true, however, of some other rem- 
 edies that diminish the frequency of the heart's action by their direct effect upon the 
 gastro-intestinal mucous membrane, as small and frequently repeated doses of tar- 
 tarized antimony, and jalap in cathartic doses (§516 d, No. 0, 904 bb, 1060, 1063 />), 
 that this effect, which is in no respect due to a narcotic virtue, doubtless contributes 
 to the salutary influence which is simultaneously and essentially impressed by the 
 remedy upon the instruments of the morbid process, and which is indispensable to 
 any lasting effect upon the heart's action if that organ have sustained any disturb- 
 ance as a consequence of the malady (§ 500 m).
 
 NOTE K. EXCESSIVE MEDICATION BY QDINIA. 1119 
 
 NOTE K.— EXCESSIVE MEDICATION BY QUINIA. 
 
 Note K. — To illustrate still farther the empirical nature of the practice of admin- 
 istering large doses of quinia in the treatment of intermittent fever (§ 892 d-k), as 
 well as the fallacy of the humoral hypothesis, and to show the probability that such 
 excessive medication must be injurious, as variously set forth in former sections 
 (§ 675, 863 d, 870 aa, 900, 904 d, &c.),I shall introduce here the experience of Mr. 
 Parkin, of England, who, in 1842, visited the South of France, where the intermit- 
 tent fever was very prevalent and obstinate, and where some of the resident physi- 
 cians were just beginning the treatment of the fever by the compound of quinia and 
 carbonic acid gas ; and it was particularly to witness the effects of this compound 
 that the visit was made. The dose of the solution of sulphate of quinia along with 
 the gas that was employed by Mr. Parkin was generally an ounce and a half, which 
 contained much less than a grain of the sulphate of quinia. The largest doses had 
 only a grain and a half. His success was so remarkably great that in the following 
 autumn he went to Madrid for the same purpose, where the Minister of the Interior 
 assigned to him a ward in the General Hospital of that Capital to carry on his ex- 
 periments, and here he was equally successful with the moderate treatment as he 
 had been in the South of France. But it was not only by small doses of the alka- 
 loid that he accomplished his cures, but often by a single dose. And now observe 
 how his critical experience as to the most useful time for administering the dose con- 
 tradicts the humoral hypothesis, both as to the pathology of the disease and the mo- 
 dus operandi of the remedy, and establishes my interpi-etation of the latter through 
 reflected actions of the nervous system. " The result of these trials," says Mr. Par- 
 kin, " confirm me in a conclusion I had previously formed as to thQ proper time for 
 the administration of the remedy, which I found to be inimediateltj before the acces- 
 sion of a paroxysm. When thus administered, I have generally found that it short- 
 ened the paroxysm, and that it arrested it altogether, upon the average, at the third 
 administration of the remedy. The same result was experienced in old as in recent 
 cases, even where the disease had existed twelve months. There were numerous 
 cases in which no return was experienced after the first administration of the reme- 
 dy, while in some cases the expected attack was not experienced at all."* — London 
 Lancet, April 29, 1843, p. 139. 
 
 That the remedy should be administered at some period of the intermission, and 
 suspended during a paroxysm, has been always I'cgarded as an indispensable rule of 
 practice (§ 675) ; but in the case of the particular compound now before us, it was 
 found by a critical observer that the most appropriate time was circumscribed within 
 a few minutes. Now, if the doctrine of operation by absorption had any foundation 
 —whether the remedy be supposed to neutralize or extinguish some poison assumed 
 to exist in the blood, according to a large school, or to unite chemically with the 
 solids, according to Liebig and his followers (p. 171, No. 42), — the remedy if admin- 
 istered during the hot stage of a paroxysm of intermittent fever should not as uni- 
 formly aggravate and prolong the disease as it arrests its career when administered 
 during the period of intermission (§ 675), and least of all should it be most salu- 
 tary if given at the precise moment indicated by Mr. Parkin. f 
 
 I have illustrated the influence of vital habit by a reference to the periodical return 
 of an intermittent fever through a series of years, notwithstanding the early removal 
 of the subject from a miasmatic region to a climate entirely exempt from intermit- 
 tents (§ 560) ; a fact which, in itself, disposes of the whole question before us, wheth- 
 er it respect the assumed absorption of a poison, its continued presence in the system, 
 or the humoral interpretation of the modus operandi of the remedy. Analogous 
 facts abound in the history of diseases, and are worthy the consideration of those 
 who aspire at the realities of Nature, and would escape the seductive simplicity' of the 
 substitutions of art (§ 506, 526 c, 657 a, 826 b, 828 a). Again, also, in all our rea- 
 soning upon these leading principles in the philosophy of medicine, we should not 
 neglect, in connection with the foregoing subject, tlie minuteness of the quantity of 
 quinine that may be sufficient to arrest a very violent and protracted fever (§ 870 aa) ; 
 and the same may be alleged of the arsenical preparations. 
 
 * The folio-wing ia the formula employed : R Sulphate of quinia, grs. xvi. ; tartaric acid, gra. Ix. ; 
 oicarbonate of Eoda, gra. Ixxv. ; water, tbij. The alkaline carbonate i3 added last. 
 
 t See corresponding evidence and philosophy of tlie subject at p. 430^32, § CT5 ; p. 54S-549, 
 5 SOS d; p. 59T, i S;)2 c • p. T39, § 987
 
 1120 NOTES L-M. ARSENIC AND ANTI-PERIODICS. ANAESTHETICS. 
 
 NOTE L.— MODUS OPERANDI OF AESENIC AND ANTI-PERIODICS. 
 
 Note L. — As to the modus operandi of arsenic (§ 892^ g), it is readily seen from 
 the mineral nature of the substance that it cannot exert the same effects as the veg- 
 etable substance Peruvian bark, no more so than does the animal product, spider's 
 web, in doing the same thing, exercise the influences of either, no more so than 
 when an emetic, or a strong mental emotion, or loss of blood, suddenly breaks up 
 the same condition of disease. And yet the chemist has the singular infelicity to tell 
 us that all this medley of things cures intermittents equally either by their chemical 
 union with some imaginary poison in the blood, or by forming new compoimds with 
 the solids ; which is equivalent to saying that arsenic and cinchona and spidei-'s web 
 (neglecting emetics and mental emotions and loss of blood) will as readily unite with 
 each other as acids do with alkalies (§ 675, 863 d, 870 aa, 892 b-k, 900, 904 d, 986). 
 
 The vital solidist, in rejecting the chemical rationale, may briefly reiterate the 
 philosophy which he would substitute — that each agent has its peculiar virtues, ex- 
 ceedingly unlike where they are most curative (as cinchona, arsenic, and spider's 
 web), and each exerts its own peculiar changes in the morbid states, places them in 
 other conditions less intensely morbid, and thus enaTales the physiological laws to in- 
 stitute the restorative process (§ 854, 900, 902 h, 904 hh). No matter, therefore, 
 whether arsenic be administered in simple intei-mitting fever, or as that disease may 
 be complicated with chronic cutaneous eruijtions, when the impression is made which 
 enables the great recuperative law to throw off the fever, the same artificial change 
 may equally induce, through the same constitutional principle, the disappearance of 
 the chronic aff'ections of the skin (§ 902, 1059).— Note R p. 1123. 
 
 Again, that the constitutional effects of arsenic depend upon its primary action 
 upon the alimentary mucous tissue and the subsequent development and reflection 
 of an alterative nervous influence may be distinctly shown by the remarkable con- 
 trast in the phenomena and pathological conditions that are induced in different in- 
 dividuals by poisonous doses. It is well known that the symptoms are generally 
 those of violent gastro-enteritis, but that there are rare instances in which the symp- 
 toms are such as are produced bj poisoning with opium. Of these exceptions, which 
 form a most imposing contrast with the more numerous class of cases, there has oc- 
 curred in my practice one strongly marked example, in which vomiting was effected 
 with difficulty by emetics, and which would have been mista'Kcn for poisoning by 
 opium had not the nature of the cause been known from the beginning. About an 
 ounce of the white oxide of arsenic had been swallowed, and large quantities of it 
 were thrown off from the stomach. Death took place in about twelve hours. Leth- 
 argy came on early, and was very overpowering. No gastric uneasiness or purging. 
 Respiration became very slow some six hours before death, accompanied by a very 
 irregular pulse, varying from twenty to fifty beats in two successive minutes, but not 
 intermitting. The action of the heart was strongly affected by the respiratory move- 
 ments, which were without any uniformity. They would be suspended for several 
 seconds, and then would follow a long and deep inspiration ; and of these move- 
 ments there were from three to six in a minute. During the suspension the pulse 
 would sink down to its lowest frequency, and when inspiration took place the pulse 
 would suddenly bound from 20 to 40 or 50 strokes, and become much increased in 
 volume. The case being obvious, the distress of the family rendered it inexpedient 
 to request an examination after death. But post mortem examinations have been 
 made in other analogous cases. 
 
 The principal remaining point to be observed in the two series of cases is the cor- 
 respondence of the cadaverous appearances with the phenomena during the action 
 of the poison, and it shows that the difference in the local and constitutional symp- 
 toms, in the opposite cases, is owing to the different modes in which the gastro-intes- 
 tinal mucous membrane is affected by the poison ; since it exhibits in one series of 
 cases the most positive signs of inflammation, while in the other, or form of narcotic 
 poisoning, no morbid condition of the stomach at all resembling inflammation is ap- 
 parent on dissection (§ 512, 826 cc, 841, 902, 904 bb). 
 
 NOTE M.— MODUS OPERANDI OF ANiESTHETICS. 
 
 Note ^M. — In speaking of the modus operandi of chloroform and sulphuric ether 
 when respired, I adverted to the difference in their effects when employed in that
 
 NOTES N-P. DIGESTION NECESSARY TO NUTRITION, ETC 1121 
 
 manner and as administered by the stomach (p. 8G4r, § lOGG b), and intended to im- 
 ply that such a diiference should not obtain if these agents operate tlirough the me- 
 dium -of the circulation. They shoidd not manifest the effects simply of a diffusible 
 stimulant in one case and of an antesthetic in the other; for, whether absorbed through 
 the mucous tissue of the lungs or of the stomach, or whether the supposed intermix- 
 ture with the blood take place in the pulmonary air-cells or at the junction of the 
 chyliferous duct with the subclavian vein, there can be no difference as to the impreg- 
 nation of the blood, which is the essential fact in question. But a ready explanation 
 of the difference in effects will be found in the vast difference between the vital con- 
 stitution and functions of the mucous membranes of the stomach and of the lungs, 
 and in the well-known diversity of effects that arise from a thousand cause* as they 
 may be introduced into one organ or the other (§ 133-137). Each cause exerts 
 special but different effects upon the mucous membrane of either organ respectively; 
 and according to those effects the nervous influence will be developed and modified 
 in a corresponding manner, and, by its reflection upon other parts, will exert upon 
 them effects corresponding with the primary impressions, as variously expounded in 
 this work. 
 
 Again, if it be true, according to Lallemand, that "ether, chloroform, and amy- 
 lene are absorbed and act first in a direct manner on the brain and other nervous 
 centres, where they accumulate, and are, as it were, stored tip, and that, secondly, they 
 afterward proceed to act upon the blood," there should not be, under such circum- 
 stances, any necessity for the uninterrupted respiration of antesthetics to maintain in- 
 sensibility, nor any sudden subsidence of the ana?sthetic influence. But the facts 
 establish an evanescent effect conformable to superficial impressions of a very tran-i 
 sitory nature, Avhich as suddenly and transiently rouse the nervous influence, while 
 they equally and as plainly contradict the hypotiiesis of ^^accumulation and storing 
 up" (§ 827). Finally, the volatility of these agents is against the doctrine. 
 
 NOTE N.— DIGESTION NECESSARY TO NUTRITION. 
 
 Note N. — If it be admitted that alcohol, sugar, animal broths, &c., enter the cir- 
 culation unchanged, it is impossible that they should be tributary to nutrition, since 
 that unique, homogeneous substance the blood can alone fulfil this great ultimate ob- 
 ject of the elaborate system of organs which is designed for the formation and vital- 
 ization of that fluid, and towards which the first and indispensable step is a positive 
 change instituted in all nutritive matter by the gastric juice, while the kidneys are 
 placed at the other extremity of the series in part for the removal of any matter 
 which may have escaped the organizing influence of the chylopoictic organs. Hence, 
 the application of butter, &c., to the skin, and that most plausible of all devices to 
 sustain the bodv, enemas of animal broths, must be regarded as fallacious (p. 171, 
 172, § 350, Nos' 41, 42, 43, 94 ; p. 222, § 409 b ; 440 bb, 441 c; p. 790, § 1032 6). 
 
 NOTE O.— CEREBRAL CIRCULATION. 
 
 Note O. — In confirmation of the conclusion from my experiments upon the brain 
 that the quantity of blood circulating within the organ has been much overrated, it 
 should have been said in the text at page 826 that both carotids have been success- 
 fully tied in the human subject, at an interval of a few days for each carotid, with- 
 out injury to the cerebral functions. In some animals, as the rabbit, tlic same oper- 
 ation has been performed simultaneously upon both carotids and one vertebral arteiy 
 without injury to the brain. 
 
 NOTE P.— EXAGGERATIONS OF INSTINCT. 
 
 Note P. — If the following statement has not been made as an illustration, merely, 
 of the propensity to magnify the endowments of Instinct, it was designed not only 
 to ascribe the rational faculty to animals, but, in presenting a case of dishonesty, to 
 impute to them the moral sense or conscience (§ 1078 h, I). It is derived from Dr. 
 John Brown's veracious Horce Subsecivre (vol. ii.): 
 
 " Mr. Carruthers, of Inverness, told me a new story of these wise sheep-dogs. A 
 
 4B
 
 1122 NOTE Q. PARAPI-EGIA. AND KEFLEX KERV0U9 ACTION. 
 
 butcher from Inverness had purchased some sheep at Dingwall, and giving them in 
 charge to his dog, left the road. The dog drove them on till, coming to a toll, the 
 toll-wife stood before the drove demanding her dues. The dog looked at her, and, 
 jumping on her back, crossed his forelegs over her arms. The sheep passed through, 
 and the dog took his place behind them and went on his way." 
 
 NOTE Q.— PARAPLEGIA AND REFLEX NERVOUS ACTION. 
 
 Note Q. — In expounding the causes of a form of paraplegia which Dr. Brown- 
 Sequard denominates reflex, in his recent "Lectures on Paralysis of the Lower Ex- 
 tremities" (1861), several principles are recognized that are tributary to some of tbc 
 important doctrines of these Institutes. The Author supposes, for example, that af- 
 fections of internal organs will not only induce a congestive state of some portion 
 of the spinal cord that will lead in a direct manner to paralysis of the lower ex- 
 tremities, but that at other times they will propagate a morbific influence througli 
 sensitive upon excito-motory nerves, and thus occasion " a contracted or spasmodic 
 condition of the blood-vessels of the spinal cord, unaccompanied by actual sti'uctural 
 alteration," which results in paralysis of the lower extremities. Although it be true 
 that the supposed contraction of the blood-vessels cannot be anatomically shown, 
 but is inferred from the absence of morbid vascularity in connection with an experi- 
 ment to be soon mentioned, and although I apprehend that the supposed contracted 
 ^tate of the blood-vessels, if founded in fact, is no more occasioned by reflected nerv- 
 ous influence than the simply congested ones in the other series of cases, and that 
 they are on common ground throughout, in a physiological sense, as sources of para- 
 lytic influence, I present the problems not only as admitted exemplifications of the 
 j)roduction of spinal disease by morbid states of internal organs, but as introductory 
 to a demonstration by our able physiologist of the local and special influences which 
 are exerted upon the blood-vessels of the spinal cord by irritations of distant organs, 
 particularly the kidneys, through which the vessels may be brought into a state of 
 contraction, and that the coi'd thus artificially afi'ected may exert a paralyzing effect 
 upon the lower extremities. The following is the demonstration : 
 
 "A contraction of the blood-vessels in the pia mater of the spinal cord I have seen 
 taking place under my eyes when a tightened ligature was ajjplied on the hilus of 
 the kidney, irritating the renal nerves, and when a similar operation was performed 
 on the blood-vessels and nerves of the suprarenal cajisules. Generally, in these 
 cases the contraction is much more evident on the side of the cord corresponding 
 with the side of the irritated nerves, which fact is in harmony with another and not 
 rare one as regards the kidney, and often seen by me after the extirpation of one kid- 
 ney, or one suprarenal capsule, that is, a paralysis of the corresponding lower limb." 
 
 The novel and interesting fact in the foregoing quotation consists in the influencC-s 
 which were actually seen to have been exerted ujion the blood-vessels in the sjjinal 
 cord by irritations of organs remotely situated, and the corroborr.ting light which is 
 thus reflected upon tlie philosophy inculcated in these Institutes concerning the 
 transmission of influences to and from the nervous centres, whether brain, spinal 
 cord, or ganglia and plexuses of the sympathetic system, through which I have inter- 
 preted not only the diseases which follow consecutively upon each other, but the 
 modus operandi of morbific and remedial agents, and have thus endeavoured to de- 
 monstrate the artificial and fictitious nature of the entire fabric of humoralism. 
 Even Brown-Se'quard argues from his experiment, especially, that reflex paraplegia 
 is occasioned by "a contracted or spasmodic condition of the blood-vessels of the 
 spinal cord, owing to an irritation reflected upon their walls, and originating from 
 witliout, unaccompanied by actual structural alteration." Such may or may not be 
 the immediate cause of the paralysis; but that influences upon the vascular system 
 of the brain, and upon the cerebral substance, are constantly exerted by remote af- 
 fectiojis and by morbific and remedial agents, is corroborated by most of the phenom- 
 ena that are presented througliout the vast fields of pathology and therapeutics. So 
 obvious is all this, and such are the special developments and modifications of the 
 nen-ous influence, and such, accordingly, are its effects in organic life, that I have 
 imputed much of the depressing effect of loss of blood to a contraction of the cere- 
 bral vessels as contributing to the development of that depressing nervous influence 
 which is so largely concerned in the operation of loss of blood (§ 942, 950, p. 827, 
 § lO'tiV), and, on the other hand, the resistance of its effects to a stimulating nerr- 
 ous influence arising from an excited state of the cerebral blood-vessels in inflamma- 
 tions of the brain and of other organs (§ 233i, 974, p. 828, <J 1056, Dondeh). — Note 
 T p. 1125, "Warren's ease. Also, p. 920, Note.
 
 NOTE R. REMEDIAL ACTION, CHEMICAL DOCTRINE. 1123 
 
 NOTE R.— REMEDIAL ACTION, CHEMICAL DOCTRINE. 
 
 Note R. — Chemistry, as we have seen (p. 171, § 350, Nos. 41, 42, <fec.), informs 
 us that remedial agents accomplish the removal of disease by uniting citlier with 
 the solids or the blood, or by neutralizing some poison supposed to be intermixed 
 with or contaminating the blood, or by expelling the poison from the body, &c. 
 Without having called upon Chemistry for the proof of these assumptions, I have 
 shown that they are variously contradicted not only by the whole history of reme- 
 dial action and the soundest principles in pathology, but by the logical facts of 
 Chemistry itself. Among the multitude of the former nature the consideration 
 alone of the variety of things which will quickly subdue an intermittent fever (cin- 
 chona, arsenic, spider's-web, opium, an emetic, blood-letting, mental emotions, &c., 
 § 900, 986-988, Note L), is demonstrative of the fallacy of the entire compass of 
 the chemical rationale. Nevertheless, it is my purpose in this Note to add a few 
 words of comment upon that branch of the doctrine which assumes that remedies 
 unite chemically with the blood or with the solids, and that they thus transmute the 
 morbid into healthy conditions. This is Liebig's philosophy, and obtains extens- 
 ively in the medical ranks. It has the air of science upon its front ; but it is as 
 unmitigated an assumption as the doctrine of the permeation of tissues set forth in 
 § 350^ n, and is contradicted by the realities of Chemistry. Take, as an example, 
 the statements quoted at p. 171, Nos. 41, 42, from Liebig's ^^ Animal Chemistry." 
 What possible apology, derived from the domain of cliemistry, can be offered for 
 the proposition that — "if, by the introduction of a substance, certain abnormal con- 
 ditions are rendered normal, it will be impossible to reject the opinion that this 
 phenomenon depends on a change in the composition of the constituents of the dis- 
 eased organism, a change in which the elements of the remedy take a share in the 
 formation of new or transformation of existing compounds similar to that which the 
 vegetable elements of food have taken in the formation oi fat, of membranes, of the 
 saliva, of the seminal fluid, &c." ! 
 
 The foregoing assumption derives its importance from the general currency which 
 it has obtained in the medical profession. Upon this dictum liavc been founded 
 the enormous abuses of iron in the treatment of pulmonary consumption, anajmia, 
 chlorosis, &c., and, indeed, the general administration of remedies, whether they 
 consist of elementary substances, like iodine, or of inorganic or organic compounds, 
 some of which (as the phosphate of iron) have obtained the name of '■'' chemical 
 food.^' Iron, particularly, is supposed to meet, in this way, the exigencies of an 
 endless train of the most dissimilar maladies, on account of its assumed deficiency 
 in the blood and of its uniting readily with the globules. But it is remarkable that 
 it appears not to have been considered that nothing but food, properly so called, 
 undergoes digestion, certainly not inorganic substances, nor the organic of the Ma- 
 teria Medica, and that without antecedent digestion by the chylopoietic organs 
 every thing which gains admittance into the circulating mass of blood must fail of 
 being appropriated to any useful purpose, and must necessarilj' exist in the same 
 isolated, inanimate state till it is ejected by the emunctories.* If it exert any thera- 
 peutical effect it can be only through its direct action upon the solids as a foreign 
 agent (§827 f, 904 c). We have seen that even saccharine matter (p. 788-790, 
 § 1032 b), broth, even (Note N, p. 1121), to be appropriated must be digested, 
 vitalized, subjected at least to the gastric juice before they enter the circulation. 
 Otherwise, they are effete matter. Whether, therefore, regarded as nutriment, or 
 other things as remedial agents in virtue of their "elements taking a share," &c., 
 as quoted above, the doctrine, now in the ascendant, is alike discreditable to med- 
 icine and to chemistry (§ 13, 17, 353, 3.54, 360, 837, 847 a). 
 
 And now a few words more particularly as to iron, which, like alcoholic liquors, 
 quinia, and opium, has become a panacea. Strangely enough, this substance, 
 whether in the form of an element, or of its compounds, is supposed by chemists as 
 well as physicians to unite as readily with the blood as oxygen gas, while there is 
 no analogy in the cases, either as it respects the chemical aspect of the subject, or 
 the organs provided, respectively, for their incorporation with the blood — being the 
 peculiarly constituted lungs in the one case (§ 447^ e, 827 h), and a verj' complex 
 and elaborate system of organs in the other (§ 353, 354). The only possible mode 
 in which iron can become united with the globules of blood is through its connec- 
 tion with organic compounds, duly digested and vitalized by the whole labyrinth of 
 the chylopoietic organs (§ 17, 360), and its presence is limited to the blood alone 
 
 * Contrary, therefore, to general belief, watek is in no respect appropriated, but merely serves to 
 dilute the blood. See § 2T1, 419 r, S27 6, tOSS L'.
 
 1124 NOTE S. TYPHUS AND TYPHOID FEVER. 
 
 (§ 447^ <i, No. 1). Whatever benefit, therefore, iron bestows either upon the blood 
 or the solids can be interjjreted only upon the principles of vital solidism, — alone 
 by improving the functions of digestion. Iodine, lime, all the elements of the body, 
 observe preciselj' the same rule as to their incorporation with the blood or with the 
 folids, while it is just the reverse with plants (§ II, 14, 17, 360). It is among 
 Liebig's enlightened statements that iron exists in the blood in the state of an 
 "organic compound" (§ 447J- «), and as this is truly its condition it operates as a 
 flirther confirmation of the foregoing physiological doctrine. 
 
 KOTE S.— TYPHUS AND TYPHOID FEVER. 
 
 Note S. — But little is said specifically of typlius fever in these Institutes, and that 
 little occurs mostly in sections G86 b, 892 q ; but in the Medical and Physiological 
 Commentaries the subject is discussed extensively, particularly in the articles upon 
 tlie Medical "Writings of Louis," and upon the "Philosophy of Venous Conges- 
 tion" (vol. 2). In these Essays the Author has shown that there is no such affection 
 as ti/phoid fever as distinguished from ti//>lnis fever (an opinion, also, of the best 
 informed), and that this disease does not originate on tliis continent south of the 
 latitude of about 41°. The Author, who became familiar witli typhus fever during 
 Iiis pupilage in Boston, and was extensively concerned with it in Montreal during 
 the first fire years of his professional life, is enabled to say very confidently that the 
 disease is of rare occurrence in the city of New York and surrounding countiy, and 
 only so whei'c the predisposition has been contracted in a more northern latitude. 
 Such, too, is the testimony of able and long established physicians in this city, as 
 recorded by the Author in the Essay on the "Philosophy of Venous Congestion" 
 {Commentaries, vol. 2, p. 449-451, note). The following quotation from that work 
 affirms the same of places still farther south : 
 
 "The hospital of Philadelphia has furnished many instances of typhoid or typhus 
 fever; but we infer not only from the foregoing facts that they ■were cither imported 
 cases, or derived, as in tlic spoi'adic cases of our own hospital, from cellars, &c., 
 but from the long experience of the distinguished Di*. Dewees, of that city, wlio re- 
 marks that he ^ has never had an opportunity of seeing a case of typhus, although,^ as 
 he says, ' ice hear constantly of this disease, and our bills of mortality never fail to 
 record deaths from this fever.' — 'Dy.'wts.^sI' Practice of Physic, p. 170, 171. And so 
 Dr. Davidge, in his edition of Bancroft on Fever, &c. (p. 518), 'Typhus, 'he says, 
 ' is not, so far as my observation has extended, a disease of Maryland, perhaps not 
 of America, at any rate not south of the New England States.' 'Typhus,' says 
 Bancroft, ' is properly a disease of cold climates' {ibid, p. 342). John Hunter con- 
 sidered it a disease of winter. ' Heat,' he says, ' proves a prevention to the disease 
 as much as cold forwards its production.' — London Medical Transactions, vol. 3, 
 p. 348. The same statements are made by Blane, Lind, and Trotter, in their re- 
 sjiectivc treatises on Scu^^7, &c." — Medical and Physiological Commentaries, 
 Vol. 2, p. 450. 
 
 As to Louis's distinction of '■'■typhoid" from tyjihus fever, I have shown it, in each 
 of the foregoing Essays, particularly in the analysis of the "Writings of Louis," to 
 be simply a fiction. So far as the celebrated Parisian malady had any aflSnity to 
 typlms fever it was purely typhus. I shall, therefore, without farther preface, pro- 
 ceed to say — partly in defense of the ground which I have hitherto taken upon the 
 subject, and jiartly on account of the mortality attendant upon the disease — that 
 the so-called "tyi)hoid" or "typhus fever" that has prevailed as a most fatal epi- 
 demic among the hosts of the federal and rebel armies during the last fourteen 
 months (now September, 18G2) is the common congestive, bilious remittent fever, but 
 which is made to put on some of the worst symptoms of typhus fever, (such as delir- 
 ium and subsultus tendinuni), by the general treatment of the aftection, (with some 
 distinguished exceptions), from the very outset, by tonics and stimulants, of which 
 "Bourbon whisky" (p. 11 IG, sub-note), and quinia in potential doses (§ 892 d), 
 are prevailing favorites. For the purpose of informing myself as to the diseases of 
 the federal army, from their earliest to their advanced stages (the latter of which now 
 abound in the hospitals of New York), I visited the ])rincipal encampments, and 
 was in constant intercourse with the sick during the latter part of July, the 
 whole of August, and the former part of September, 18GI, at the large and numer- 
 ous hospitals in and around Washington, and the regimental hospital tents, and.
 
 NOTE T. SYMPATUETIC OK KEFI.EX NERVOUS ACTION. 1125 
 
 also, similar rendezvous of the sick at and about Fortress Monroe. These hospitals 
 and tents were thronged with the subjects of intermittent and remittent fever, but I 
 saw not a case of typhus fever, and recognized in every case of the so-called " ty- 
 phoid fever" the familiar remittent, ihe usual companion of the intermittent, gener- 
 ally mild at its invasion, but apt to be soon aggravated and often rendered fatal by 
 the tonic and stimulating treatment. Such was much of my experience with the 
 "Army of the Potomac ;" but not so with the fewer troops then at Fortress Monroe 
 and its vicinity, where the antiphlogistic practice mostly obtained ; and although 
 the fever was identical with that of the vast army in the region about Washing- 
 ton, the mortality was very slender, and limited to the stimulating practice. Here 
 I saw patients atfected with the reputed "typhoid" restored in twenty-four to forty- 
 eight hours by an emetico-cathartic of calomel and ipecacuanha. This was as late 
 as September. The contrast between the two methods was very impressive. 
 
 "The regular correspondent" of the New York "Evening Tost," in a commun- 
 ication dated Washington, January 10th, 18(12, remarks that — "there is here an 
 immense number of cases of the so-called typhoid fever. The peculiarity of this 
 fever, as it is developed in the vicinity of Washington at the present time is, that it 
 is of a malarious type and origin, so that if treated as a malarial fever it soon suc- 
 cumbs, but if treated as an ordinary type of the typhoid fever it is very fatal." 
 
 Nor can I refrain from alluding to an experiment which has been extensively 
 made in the army of employing quinia, and " Bourbon whisky" or brandy, as proph- 
 ylactics. In the Medical and Phijsiolo(]{oal Coiimientaries I have inquired into 
 the history of prophylactics, as exemplified particularly in the use of calomel to 
 the extent of salivation, blood-letting, and stimulants, the first two of which have 
 been tried upon an extensive scale, especially upon armies invading the West 
 Indies, when it was found that loss of blood lessened the susceptibility of the system 
 to the causes of the prevailing fevei', besides, doubtless, counteracting the stimulat- 
 ing eiFect of the ardent heat of the climate and of the animal food. In another 
 instance Kobert Jackson illustrated the principle under consideration, and set forth 
 triumphantly the medical aspect of temperance, by banishing alcoholic liquors from 
 the British Army (p. 396, § 621 a, 6.o9 b, 692 6, c, 999, 1006 c— 1008, 1065 c, 
 1068 a). — The reverse of all this has attended the stimulants when employed as a 
 protective means, having operated not only as subordinate predisposing causes by 
 rendering the system more susceptible to the action of the miasm or essential pre- 
 disposing cause, but also as exciting causes (§ 630 e, 787, 801, 810, 813, 815, 961). 
 
 NOTE T.— SYMPATHETIC OR REFLEX NERVOUS ACTION. 
 
 Note T. — The following instance of reflex nervous action corresponds with the 
 experiment of reducing the temperature of one hand by placing the other in cold 
 water, as related in section 104:4: a, and with the well-known sense of itching, &c., 
 that springs up as a sympathetic consequence of a similar sensation in the corre- 
 sponding i)art of the opposite side of the body. Thus — "A singular case is noted 
 in the Cairo military hospital (December, 1861), of a man who was shot in the 
 right leg and had it amputated. Sympathetic action took place at once in the other 
 limb, and at precisely the same part where the knife had severed its fellow a simi- 
 lar pain was felt. So severe did this become that the leg is bandaged and treated 
 as if itself wounded." 
 
 For the purpose of showing the inherent power of action in the arteries, and how 
 that action is excited and otherwise influenced by the nerves, and how that influ- 
 ence may be exerted through the reflected process, and how, also, the reflex nervous 
 influences are remarkably displayed in corresponding parts of opposite sides of the 
 body, and forming, moreover, a good example of continuous sympathy, I introduced 
 the following case into the Medical and Physiological Comuientaries from Warren's 
 '■'■Surgical Observations on Tumors.'" — Thus — "In a case where Dr. Warren tied the 
 right carotid on account of an erectile arterial tumor situated at the internal angle of 
 the right eye, this vessel and its opposite fellow and their branches pulsated with vio- 
 lence. The ligature on the right carotid removed the pulsation of the left, although 
 ' the vibrations were more conspicuous on the left than on the side originally de- 
 ranged.' 'The perfect success, from tying the right carotid, showed the affection 
 was altogether sympathetic' " (p. 827, 1056, p. 920, no??).— Med. and Puts. Com., 
 Vol. 2, Article, Theories of Inflammation, p. 149— 1840.— Sec Note Q. This well
 
 1126 NOTE U.— CONTINUOUS SYMPATHY, OR CONTINUOUS INFLUENCE. 
 
 known disposition of the corresponding parts of opposite sides of the body to sym- 
 pathize with each other has its foundation, of course, in an identity of anatomical 
 and physiological constitution, which is very well shown by the following case of 
 purpura-hemorrhagica, occurring in my practice, and recorded in the Essay on the 
 "Philosophy of Venous Congestion," in Med. and Phts. Com., Vol. 2, p. 473. 
 The case was introduced there for the purpose of showing the active, inflammatoiy 
 nature of purpura-hemorrhagica, in opposition to the humoral pathology, and to 
 exemplify the beneficial effects of blood-letting in that affection (§ 1002 d). — Thus 
 the Commentaries — 
 
 "The patient having passed a few months on the alluvion of the Mississippi was 
 attacked on his return to New York with an irregular intermittent fever. In its 
 early stage a general extravasation of blood took place over about one half of the 
 posterior part of each humerus, occupying in each arm the central part. The 
 inferior portion of the lobe of each ear was distended with extravasated blood, and 
 just at the middle of each helix was another narrow oblong extravasation of about 
 half an inch. A similar appearance existed in the conjunctiva of each inner can- 
 thus of the eye. There was not a trace of any effusion in any other part, or from 
 an\' of the internal membranes. The parts where it existed were very tender to 
 the touch. There were obvious signs of hepatic congestion. A large abstraction 
 of blood immediately arrested the effusion, and improved at once the strength of 
 the patient, who soon became convalescent. The symmetrical peculiarity of this 
 case is worthy, also, the consideration of the humoral pathologist" (§ 1002 d). 
 
 NOTE U.— CONTINUOUS SYMPATHY, OR CONTINUOUS INFLUENCE. 
 
 Note U. — Continuous sympathy, unlike reflex nei-vous actions, does not involve 
 the agency of the nerves excepting as they are an elementary part of the compound 
 tissues ; but the impressions resulting from continuous sympathy or continuous in- 
 fluence are constantly giving rise to reflex nervous actions in organic life. This, 
 as already briefly stated, is distinctly seen in the action of suppositories, enemas, 
 leeches applied to the anus or to the septum nasi, croton oil applied to the tongue, 
 &c. (§ 129 c, /; 498, 51G, No. 2, 828 d, 923 d). The examples embraced in the fore- 
 going sections are intended to illustrate the subject through impressions made upon 
 tiie intestinal mucous tissue, and, therefore, there should be associated with expo- 
 sitions of this philosophy the consideration that peristaltic motion, in the natural 
 state of the body, is excited immediately by the action of the nervous influence upon 
 the intestinal niuscular tissue (§ 233|, 475i, 490, 514/ &c.). 
 
 As some important principles in medicine are involved in the foregoing philos- 
 ophy, whether continuous influence be regarded in its abstract sense, or as insti- 
 tuting reflex actions of the nervous system; and for the sake of having the whole 
 philosophy of the subject before us in this Note, and with reference to what I am 
 about to say of rhubarb, I shall recapitulate, in a few words, some of the expositions 
 already made. Croton oil affords a clear illustration, as it exerts a cathartic effect 
 without entering the stomach, as when applied to the tongue of an apoplectic subject, 
 or when introduced into the rectum in the quantity of a drop. The impression ex- 
 erted upon those places is propagated continuously along the mucous tissue (§ 498), 
 and this, being equivalent to the direct passage of a cathartic, establishes early an 
 alterative reflex nervous action which falls upon the muscular tissue of the intestine, 
 and thus induces purging, and upon various other parts according to their existing 
 susceptibilities, the activity of the agent, &c. Suppositories and enemas observe the 
 same rule, whether they be stimulating, irritating, sedative, anodyne, soporific, &c., 
 the reflected nen'ous action being modified according to the nature of the exciting 
 cause (§ 889 a, b, g, 890i d, 89H ^, 893 a). So, also, of leeching, as expounded 
 in sections 498 y, ff. 
 
 The foregoing retrospect contemplates among its purposes a confirmation of the 
 philosophy by the action of rhubarb, and a demonstration through that action of the 
 jihysiological operation of cathartics as distinguished in tliese Institutes from the 
 doctrine of operation by absorption. It may be very briefly stated. If a little 
 rhubarb be chewed when a cathartic is about taking effect, it will often very sensi- 
 bly increase the peristaltic movements within a few seconds, and without being 
 swallowed ; the mouth itself being a point of departure for the reflected nervous 
 influence. Doubtless the same is true of some other cathartics.
 
 NOTES W-X. THE MEDICAL PUOFESSION. lUGlITS OF AUTHOUS. 1127 
 
 NOTE W.— AMERICAN MEDICAL PROFESSION AND GREAT 
 BRITAIN. 
 
 Note W. — Perhaps in consideration of wliat the Author has said at page 4G0 of 
 the superiority of the American over the European Medical Profession, it is but 
 fair that the opposite side should be permitted to speak through these Institutes, 
 according to the Author's usage; and this may be done emphatically by an extract 
 from an article lately published by the Author which embraces the opinion of the 
 leading medical Journal of Europe. Thus — 
 
 "It is time that a greater interest should be. manifested for our own medical lit- 
 erature — not a whit behind that of Great Britain, which has hitherto contrived to 
 over-ride our own. We have permitted ourselves to be whipped into this ignomin- 
 ious condition — allowing all that may be due to the jealousies of domestic competi- 
 tion ; and that there is no relaxation of the systematic discipline from abroad, or 
 of our submission to it, we are assured on turning to the Review of Professor 
 Gross' late 'American Medical Biography,' in the July (1861) number of an Amer- 
 ican edition of the British and Foreign Medico- Chirurgical Review, in which, after 
 a profusion of ridicule of what it denominates the ' biogra7>Aers and the biogra/j/iCR.?,' 
 and a characteristic John Bull hit at ^ the Union now in process of disruption,' it is 
 said, as a final and summary conclusion, that, ' We shall he sorry if it is ever our 
 lot again to meet with an American Medical Biofiraphy.'' This very Journal, too, 
 which never spared what is able in the medical literature of these United States 
 (but only what is ephemeral), notwithstanding its republication and support for 
 near half a century by those whom it maligns, now, taking counsel of the past and 
 encouraged by the hope that ' the Union is in process of disruption,' would not only 
 extinguish our ' dii immortales' and all their contributions to a Nation's best wealth, 
 but the very Nation itself.'" P.S. The republication, I regret, is discontinued. 
 
 NOTE X.— RIGHTS OF AUTHORS. 
 
 Note X. — When the Author was speaking, in his reclamation, of the agency of 
 the nervous system in the production and cure of disease, at page 91G, and as set 
 forth by himself in his "Essay on the Modus Operandi of Remedies," published in 
 the year 1842, and taught annually from his pi-ofessorial chair from that day to the 
 present (1862), it would have been, perhaps, more satisfactory to the reader had 
 the Author stated that all that is embraced in the Institutes (first published in 1847), 
 between sections 896 and 905 b, inclusive, and extending from page 662 to 681, is 
 a literal transcript of the "Essay on the Modus Operandi of Remedies," published 
 in 1842, which, of course, comprehends the Author's philosophy of the operation 
 of counter-irritants as expounded in § 905 a, being the example of the seton. 
 
 But, in a reclamation so important and comprehensive as the Author's, it may 
 be still more satisfactory to those who have not a ready access to the "Essay" 
 should the Author recite an example from the "Essay," that it may be compared 
 with the corresponding part of the Institutes. Take, then, as a continuous exam- 
 ple, section 902 d to section 902 /, inclusive, of the Institutes, and the Essay from 
 p. 44 to p. 49. Thus the Essay — 
 
 "The examples of sympathetic influences, through the reflex action of the brain 
 and spinal cord, are almost endless, as they also are in every part of the animal 
 organism. They supply the most ample ground for the interpretation of the efl^ects 
 of remedial and morbific agents in their wide range of influences. Tiie modifica- 
 tions of the circles of sympathy which relate to the respiratory system alone, as in 
 coughing, crying, laughing, yawning, &c., are a fruitful field of inquiry into great 
 and precise laws, and extensively applicable to the philosophy of medicine. The only 
 difference is, that, when disease is established in a part, or when remedial agents 
 operate, the organic properties of the part are altered in their nature, and, of course, 
 the organic actions over which they preside. A specific impression, in tlie latter 
 cases, is transmitted to the cerebro-spinal axis, and from thence reflected through 
 other nerves upon the organic properties of other parts, and, according to its nature, 
 disease will be produced or mitigated in those parts. However complex and vari- 
 able, therefore, the phenomena, nothing can be more simple than the principle 
 through which all these changes are produced.
 
 1128 NOTE X. RIGHTS OF AUTHORS. 
 
 "When an emetic operates, the philosophy of its influences is the same as that 
 which relates to respiration, &c. The impression upon the stomach is transmitted 
 to the brain and spinal cord through the pneumogastric and ganglionic nerves, the 
 nervous power developed and reflected in tlio foregoing manner 2//)o« the resjnratory 
 nerves, while another current descends along other fibres of the pneumogastric to 
 the muscular tissue of the stomach. If the emetic operate, also, as a cathartic, 
 then a new chain of actions is established, in the same way, in the abdominal mus- 
 cles, while a current of the nen^ous power is propagated upon the muscular coat 
 of the intestines. 
 
 " But, in the foregoing case something more happens than in the natural pro- 
 cesses. Here the exciting cause possesses peculiar virtues, is of a morbific nature, 
 and it not only makes peculiar impressions upon the alimentary mucous tissue, 
 according to the exact nature of its virtues, but it modifies the nervous power in a 
 corresponding manner. If the stomach be the seat of disease, the direct impression 
 upon that organ, or the change which an emetic may effect in its vital condition, 
 will be more or less varied from what is exerted in a state of health. It may, 
 therefore, prove curative to the stomach by this direct influence. But the nervous 
 power is also modified according to the impression produced upon the organic prop- 
 erties of the stomach, and is sent abroad, with alterative eft'ect, upon various pai ts of 
 the system. According to a law by which diseased parts are far more susceptible 
 of influences from vital stimuli than such as are not diseased, the modified nervous 
 power will fall with far greater effect upon the former than the latter. The organic 
 properties and actions of one may be profoundly and permanently affected, while 
 the latter are only moderately and very temporarily influenced. In consequence, 
 also, of the deep eflfect which the modified nervous power exerts on the diseased 
 parts, they may return, at once, to their natural state. 
 
 "But the milder influences which are set up by the nervous power upon parts in 
 health, or in comparative exemption from disease, play, also, their part in the salu- 
 tary process. If the emetic operate also as a cathartic, impressions are transmitted 
 from tlie intestinal mucous membrane to the cerebro-spinal system, the nervous 
 power developed and modified according to tlie nature of these impressions, and 
 radiated abroad as when the result of the action of the emetic upon the stomach, 
 and with effects corresponding to this new development and modification of the 
 nervous power. 
 
 "Again the skin is influenced in the foixgoing manner, and this organ transmits 
 that impression to the cerebro-spinal axis, and develops and modifies the nervous 
 ])Ower accordingly, when it is, as in the other instance, reflected abroad, and is felt 
 by various parts according to their degrees of susceptibility. Various other circles 
 of sympathy of the same nature set in, and become too complex for analysis ; but 
 all may fiill with one concurring, curative effect upon the diseased susceptible 
 organs. 
 
 "We thus see that when vomiting springs from the operation of tartarized 
 antimony, and often from ipecacuanha, it is only one of the consequences, and a 
 minor one, of the peculiar irritation of the gastro-mucous membrane. Other and 
 far more powerful inflirences are determined, simultaneously, upon the organic prop- 
 erties and actions of distant and diseased parts (perhaps as distant as the most 
 remote extremity), by the same nervous power that shook the respiratory organs 
 during the act of vomiting. And often, indeed, does it happen that those influences 
 are propagated with the most profound effect when the act of vomiting fails of being 
 consummated; and nausea alone shall send with jwostratintj effect the modifled 
 nervous power over the whole system ; when we shall see it simultaneously bathing the 
 whole surface with perspiration ; pourinrj the suliiia from the mouth; breaking down a 
 tumultuous excitement of the heart and arteries ; starting on the instant a torrent of bile, 
 itnd an equal effusion from the intestinal mucous viembrane; and at the next moment, 
 calling up a magnificent play of reflex actions for the evacuation of the fluids, after 
 the manner of an active purgative, — these very cff^usions, also, instituting other 
 circles of sympathy, which join in the great work of curative movements. Should 
 vomiting now follow, then shall you speedily see the vital energies returning, — the 
 cold jiaie skin giving place to a'florid hue and a warm perspiration, — the sunken 
 features starting into the fullness of health,— the gastric suffering gone as a luxury 
 obtained,— the general whirl of anxiety and distress converted into calm tranquil- 
 lity, —the headache dissipated, — the twang of the croup, or the grunt of pneumonia, 
 no longer sounding an alarm ; — and, all this stupendous succession of events, from 
 the beginning of nausea to the restoration of the vital energies and the near
 
 NOTE X. rJGHTS OF AUTHORS. 1129 
 
 resolution of disease, — composing a most astonishing consecutive series of reflex 
 actions, — may require less time than I liave hastily employed in this general nlhi- 
 siou to the subject. And now can it be entertained, tliat this has been tlie result 
 of absor])tion, or that the laws of chemistry or physics have had any connection with 
 the phenomena? 
 
 "The foregoing may be taken as an example of the principle which concerns 
 the modus operandi of all curative or morbific agents, whether physical or moral, 
 and of all the developments of disease that arise as sympathetic consequences of 
 each other. In respect to emetics, however, it should be considered that all do not 
 produce the foregoing effects, and that with the exception of the act of vomiting, 
 the results will depend upon the precise nature of the emetic, or the manner in 
 which it modifies the nervous power and thus impresses the organic properties. 
 This explains the dilFerencc in results between tartarized antimony, ipecacuanha, 
 sulphate of zinc, warm water, tickling the fauces, the mechanical irritation of un- 
 digested food, the shock of a fall, of a surgical operation, sailing, whirling, offensive 
 sights, offensive odors, loss of blood, and even their recollection, &c. 
 
 "When tlie alterations, of a sympathetic nature, are more slowly produced, as 
 ■when mercury induces salivation gradualh", and brings the whole system under its 
 influence, or when small, and repeated doses of tartarized antimony overcome in- 
 flammations of the lungs, &c., the nervous power is developed and modified at each 
 successive dose, and the repetition of its influence upon the organic properties of 
 diseased parts remote from the stomach establishes progressive changes, till an 
 absolute condition of disease may be induced in certain parts, as when mercuiy 
 salivates; while the analogous influences wliich are exerted on parts already dis- 
 eased supplant the naturally morbid states by others of an artificial nature, from 
 which tlie organic properties are able to return to their healthy condition. But 
 these impressions must be frequently repeated ; for if the interval be long between 
 the administration of the doses of such agents as only produce their effects in a 
 gradual manner, the diseased conditions, not being placed in the way of the recu- 
 perative tendency, will throw oft' the artificial impression, and the original intensity 
 of disease will be thus restored, &c. The permanent ojieration of the nervous 
 power in particular parts of the animal fabric, as in the sphincters, supplies an 
 elegant parallel with the foregoing uninterrupted influences of the same power as 
 developed by remedial or morbific agents, &c. 
 
 "When moral causes operate in the cure, or production of disease, they act di- 
 rectly upon the cerebro-s])inal axis, and develop and modify the nervous power 
 according to the nature of each mental aff'ection ; and, as in the case of physical 
 agents, the nervous power thus developed and modified may be determined as well 
 upon the organic properties of the brain and spinal cord, as upon other parts. The 
 blow upon the region of the stomach, or the opening of a thecal abscess, which 
 have destroyed life on the instant, operate in the same way as the paroxysms of 
 anger, or of joy, which have been as suddenly fatal. In these cases the nervous 
 power is first determined with a fatal eff"ect upon the organic properties of the nerv- 
 ous centre." 
 
 Again, in the Essay, at p. 51 is the following correspondence with the Institutes 
 at p. 672, § 90-1 a, which is introduced here on account of the Author's theory of 
 the diverse modifications of the nervous power, and the same doctrine as quoted in 
 the last paragraph at p. 914: of Institutes. The Essay thus — 
 
 "The nervous power is not only variously excited, exalted, or depressed, or 7nod- 
 ijied in its kind, and produces influences upon remote parts according to these 
 changes, but it is rejiected upon particular parts according to their existing suscep- 
 tibilities, the nature of the remote cause, and the part upon which the remote cause 
 may operate. Thus one impression from cold, as a blast of cold air, or a drop of 
 cold water upon the skin, will rouse the respiratory muscles. Another impression 
 from the same cause will excite catarrh, or pneumonia, or articular rlieumatism. 
 {See Med. and Phys. Comm. vol. 2. p. 18, 41—50.) IMercurial ointment will de- 
 termine the nervous power specially upon the salivary glands, and liver, and tlic 
 same effects arise from the action of mercuiy upon the stomach. Cantharides, in- 
 ternally or externally applied, irritates the neck of the bladder. One degree of im- 
 pression by tartarized antimony upon the stomach determines the nervous power 
 upon the respiratory muscles, and vomiting is the consequence ; while it simulta- 
 neously REFLECTS the same potver upon the skin, as it does in smaller doses, and of 
 ■WHICH PERSPiRATiox IS A coNSEQUEXCE, — and SO ou. But these examples em- 
 brace," &c. — The emphasis of Italics and Capitals does not occur in the Essay.
 
 1130 NOTE y. THE NERVOUS POWER AND ELECTRICITY. 
 
 NOTE Y.— THE NERVOUS POWER AND ELECTRICITY. 
 
 Note Y. — Whatever the Author may have said in objection to the supposed 
 identity of the Nervous Power and Galvanism, and especially in his remarks as 
 to the electrical circuit (p. 644, § 893 a, tfec), he desires to be understood as fully 
 recognizing the fact that electrical currents may be developed artificially in nerves, 
 even when detached from the body. This was demonstrated by Du Bois-Reymond, 
 whose method of observation is well and briefly stated in the following extract — 
 
 "Every fresh excitable nerve is the source of electric currents, as may be proved 
 by placing the two ends of the wire of a galvanometer in contact with it. But the 
 position of the nerve is of great importance. If the nerve be placed so that the 
 hires touch two points of its surface at an equal distance from the central point 
 (equator) of the nerve, no deviation of the needle takes place ; but when the wires 
 are placed so that one touches the transverse section of the nerve, and the other a 
 point on its longitudinal surface, a strong variation of the needle ensues, the current 
 going from the external longitudinal surface to the transverse. The external sur- 
 face is therefore positive ( + ) towards the transverse, which is negative ( — ) in its 
 electric relations. If both wires be placed on the surface of a nerve, one nearer the 
 centre point (equator) than the other, a weak current is produced, going from the 
 point nearest the equator towards the point at a distance from it. A point near 
 the centre point of a nerve is therefore positive towards a point at a greater distance 
 from it. In muscle the same relations are found to hold in two points of a trans- 
 verse section." 
 
 "The theory of Du Bois to explain these effects may be thus stated : — Every 
 minute particle of nerve acts according to the same law as the whole nerve. A 
 nerve consists of a number of di-polar molecules, one half presenting positive, the 
 other half negative electric properties. These di-polar molecules are arranged in 
 couplets, and so that the positive poles are turned towards each other, their negative 
 poles to the extremities of the nerve. Each couplet of molecules produces cuiTcnts 
 going from the central positive poles to tlie negative poles. A nerve is always in 
 the condition of a closed current, and when the extremities of the wires of the gal- 
 vanometer are applied, a part merely of the current is abduced. 
 
 "The foregoing facts and theory apply to a nerve when it is in a state of rest. 
 When a constant galvanic current is made to pass through part of a nerve, an 
 electrical change takes place, to which the name elcctrotonus is applied. Suppos- 
 ing that while a piece of nerve is placed on the cushions of a galvanometer, and a 
 constant deflection of the needle is produced, a constant current be passed through 
 this piece of nerve in the same direction as the nerve current, then an increase of 
 the deflection of the needle is observed. This is termed the positive phase of elcc- 
 trotonus. If a constant current be applied in a direction opposite to that of the 
 nervous current, the deflection of the needle is decreased, and this is termed the 
 negative ph.ase of elcctrotonus. If a nerve be placed with its equatorial point exact- 
 ly between the cushions, so that no deflection is produced, and if a constant current 
 be now applied to the nerve, a deflection of the needle will take place, its direction 
 being determined by that of the applied current. Such are tlie principal facts of 
 elcctrotonus, and the explanation of them furnished by Du Bois is the following. 
 When any portion of the kngth of a nerve is traversed by an electric current, be- 
 sides the cft'ect of the original nerve current, a new electro-motive action takes 
 place, which has the same direction as the applied current. This new current is 
 added to the original nerve current if the direction be the same, but subtracted ivom. 
 it, if the direction be opposite." — British and Foreign Mkdico-Cuirurgical 
 Review, &c., Lon., Jtily, 18G2, p. G, 7. 
 
 Admitting all the foregoing facts, and others of a corresponding nature, to be 
 well ascertained, they can in no respect aft'ect the validity of that other and vast 
 scries of facts presented in these Institutes which contradistinguish the nervous 
 power from electricity, nor can imagination conceive of the functions of the latter 
 when the phenomena of animals, physical and mental, and of plants, are consid- 
 ered according to their realities — Note Eee. 
 
 Note Z. — UrvEmic Poisoning. An experiment by Bernard (§ 1032 d) disproves 
 uramia, and shows that diseases of the brain, and merely sympathetic influences upon 
 it, and mental emotions, may so aflfect the kidneys that tiiey shall not only fluctu- 
 ate greatly in their excretion of urine, but may generate irritants that stimulate the 
 blad<ler to frequent micturition. It is not improbable that diabetes is greatly owing 
 to influences of the nervous system upon the kidneys, which would show us that the 
 sugar does not exist in the blood (§ 1032 rt). _
 
 NOTES TO THE EIGHTH EDITION. 
 
 The following Xotes are added to the Eightu Edition of this Work, and references to them are 
 introduced in appropriate places in the text. 
 
 NOTE Aa.— PHYSIOLOGY OF THE CEREBRO-SPINAL AND SYMPA- 
 THETIC NERVES. 
 
 There appears to be nothing in the researches into the functions and laws of the 
 nervous system since the last edition of this work that can in any respect modify the 
 statements and the philosophy as herein presented, but, on the contrary, go to their 
 confirmation. Among the most intricate experiments, and corroborative of distinct 
 orders of nerves as set forth in sections 197-201, 224, 446-447, 500 g, nn, 893 a, 
 893^, 1037 b, may be mentioned some late ones by C. Bernard upon dogs, in con- 
 tinuation of others performed several years ago, from which he deduces, as a general 
 fact (and in conformity with results that had been already obtained by others), three 
 distinct varieties of nervous influences, according to the origin, composition, and dis- 
 tribution of the nerves. Thus, in some late experiments upon the extremities of 
 dogs he found, besides the motor influence for the voluntary muscles which is impart- 
 ed by the anterior roots of spinal nerves, and the sentient influence which belongs to 
 the posterior roots (§ 1037 b), that the vascular and calorific influence appertains en- 
 tirely to the sympathetic nerve. These distinctions are fundamental throughout the 
 Institutes. That which relates to the sympathetic nerve is mostly important, as 
 through that I have interpreted all the influences upon organic functions and their 
 results, whether in a physiological, pathological, or therapeutical sense, so far as 
 nerves are tributary, and which, also, I have employed extensively in exposing the 
 fallacies of the chemical and humoral doctrines. 
 
 Besides the foregoing distinctions there should be added the motor nervous influ- 
 ence for the muscles of organic life, which is imparted by the sympathetic nerve, and 
 which is quite distinct from that which relates to the proper organic functions, since, 
 as it respects its agency in exciting the action of the organic muscles it is on com- 
 mon ground with the motor influence of cerebro-spinal nerves, and goes no farther, 
 while the same nerve exerts a special modifying influence upon the vascular system, 
 upon all organic functions, and modifies the organic products (§11 1-1 13, 224, 356 o, 
 394-396, 446, 455 a, 459/, 461, 461^, 473 c, 475^, 478 b, 483 c, 488i, 500 g, m, nn, o, 
 516 d Nos. 7-9, 524 d No. 7, 647^, 889 (j, 893 a,'c, 893^, 1044). 
 
 NOTE Bb.— CAUSES OF THE HEART'S ACTION. 
 
 In respect to the doctrines of the dependence of contiguous sympathy upon ganglia 
 and other local centres of the sympathetic nerve, and of the operation of vesicants, 
 setons, etc., through those local centres, and of the independence of continuous sym- 
 pathy or continuous influence of the nervous systems advanced in sections 129 /', 264, 
 475|^, 498 e, 514/, 515, 516 d No. 7, 893 a, c, 905 a, etc., it may be of interest to 
 state the following conclusions obtained by Golz as to the instrumentality of the 
 ganglia in the heart's action: 1. "The pulsating parts of a frog's heart constitute 
 together a system of small independent apparatuses, each of which is possessed of a 
 ganglionic central organ (§ 516 d No. 7). 2. These small nervous centres can be ex- 
 cited to action by various stimulants, and this action, according to its intensity, man- 
 ifests itself in more or less protracted contractions of the muscles which are governed 
 by the stimulated centre. The natural stimulus which incites the ganglia is the 
 blood (§ 475i). 3. A sudden contraction of any part of the heart acts slightly 
 stimulating upon the neighboring parts. Thus, when a stimulated part contracts, 
 the contraction spreads like a peristaltic movement, according to the laws which de- 
 pend on the connection of the nerves with the ganglia. 4. The reason why the heart 
 contracts rhythmically is, perhaps, to be found in the following circumstance: As 
 soon as the stimulating influence of the blood is powerful enough to act upon the 
 ganglia, the systole at once commences, and emptying the heart, removes from it the 
 stimulating cause" (§ 264, 383-386, 392-395, 475^, 514/ 516, 1090).
 
 1132 NOTES CC-DD. AVHOOPING-COUGII. — LEECIIIXG. 
 
 NOTE Cc— WHOOPING COUGH— THE PHILOSOPHY OF ITS 
 TREATiAIENT. 
 
 I Ii.ivc expoiinJed the physiological influences through which the act of vomiting 
 will suddenly arrest a paroxysm of coughing, as witnessed in whooping-cough, for 
 the purpose, particularly, of demonstrating by a distinct example the operation of 
 .emetics in organic life, through their action upon the organs of animal life, by the 
 instrumentality of the nervous system, and thence showing how these simple exam- 
 ples may be employed in interpreting the analogous results of remedial and morbific 
 agents in their removal or production of disease (Indkx II., Wliooping-cough, Hic- 
 cough, and JrhjsteiHa). It will be seen that the example is parallel in its intended 
 illustrations with many others which occur in this work, as in sections 500, 514, 51G, 
 902 g-m. 
 
 As it respects the interruption of the cough by vomiting, the emetic influence is 
 exerted upon the organic nerves of the gastric mucous tissue, while the point of de- 
 parture for the excitement of the nervous influence that determines the cough is in 
 the same nerves in the pulmonary mucous tissue, and in both cases the motor nerves 
 belong to the cerebro-spinal system, and are implanted in the thoracic and abdominal 
 muscles, and diaphragm (§ 5U i). Now, as I have said, whatever will excite vom- 
 iting during a paroxysm of coughing, even when produced by the cough itself, Avill 
 at once interrupt the latter by so modifying the development and reflection of the 
 nervous influence as to introduce a new combination of movements in the respira- 
 tory muscles (§514 c). If the vomiting be occasioned by the cough, or by tickling 
 the throat, or by a mental emotion (Note D, p. 1114), or by warm water, or by an 
 infusion of mustard-seed, the effect will go no farther (§ 902 //). To obtain, there- 
 fore, any influences from emetics upon the morbid conditions in whooping-cough, 
 they must possess also other virtues than such as determine the act of vomiting, and 
 it is through the special impression which those virtues make upon the gastric mu- 
 cous tissue that such emetics simultaneously reflect an alterative nervous influence 
 upon the absolute pathological conditions (§ 233* 500 g-l, 514/, I; 902 cl-m, 1059). 
 The best emetics for this combined purpose, and indeed the only ones for the alter- 
 ative influence, are tartarized antimony and ipecacuanha. But in cases to which 
 these are appropriate, their gradually alterative impression, as cflTected by small and 
 repeated doses just short of nausea, is generally more salutary than emetic doses at 
 distant intervals, since no greater extent of the remedy is commonly necessary in 
 whooping-cough to bring about vomiting, as it is the tendency of the cough to re- 
 flect an emetic nervous influence upon the gastric mucous membrane, which will be 
 likely to determine the act of vomiting when the same membrane is slightly predis- 
 posed by the irritating virtue of an emetic (§ 514 h, 51G d No. C, 657 a, 889 a,f, g, 
 902 c-i, 904 i6, Note D, p. 1114). The same philosophy is applicable when an 
 emetic interrupts a paroxysm of spasmodic asthma or of hysteria (§ 514 c, 891^ c,/, ^•). 
 
 NOTE Dd.— LEECHING, PHILOSOPHY OF ITS EFFECTS, HOW FAR 
 DEPENDENT UPON VASCULAR COMMUNICATIONS. 
 
 Dr. William Turner appears to have demonstrated the very interesting fact of the 
 existence of a system of anastomosing arteries between the visceral and parietal 
 branches of the abdominal aorta, and which is likely to be followed by some highly 
 practical advantages. This will be apparent from a remark which Dr. Turner makes 
 in connection with his ingenious demonstration. "This assumption," he says, 
 "of the absence of any direct communication between these two sets of vessels has 
 been employed by some physicians as aprincijml argument against the utility of local 
 bloodletting in the treatment of inflammation of the abdominal viscera. Vide Dr. 
 Bennett's Clinical Lectures, 1859, p. 280." — This common objection is founded 
 upon the universal mechanical philosophy of the modus o])erandi of loss of blood 
 when artificially cflTected — a philosophy which excludes all the magnificent laws in 
 I)hysiol()gy both as it respects the nervous influence and the organic endowments, 
 and their involutions as instituted by the incidental operation of physical and mental 
 causes, and is regardless of the inexhaustible testimony of the most enlightened ex- 
 perience (§ 910). But, although it is ])robable that the foregoing objection to leech- 
 ing will yield to the anatomical fact demonstrated by Dr. Turner, the fact itself does 
 not sujjply a ray of light to the mechanical Physicians, since the intercommunication
 
 NOTE EE. ANTIPHLOGISTICS AND TONICS CONSIDERED. 1133 
 
 of the inosculating vessels is wholly insufficient for the hypothesis which supposes a 
 diversion of blood from the internal organs to the very limited space over which 
 leeches are applied, nor does the inosculation any more explain the operation of 
 counter-irritants upon deep-seated inllammations ; and the solution, therefore, which 
 I have made of the resulting phenomena, whether of leeching or of counter-irrita- 
 tion, through the medium of the nervous system, will remain the only intelligible 
 theory (§ 893 a, c, 905 «, 915-924:, 942 b). As it respects the law of continuous 
 sympathy, its operation, in leeching, when involving only the bloodvessels, is limited 
 to the vessels of the skin, and is more or less circumscribed, according to the num- 
 ber of leeches, and the special circumstances of every case. When the bloodvessels 
 alone are interested, tlie propagation of this continuous influence along their course 
 is of very little moment excepting as it is tributary to reflected actions of the nerv- 
 ous centres (§ 498, 917, 919). 
 
 NOTE Ee.— THE EEMEDIAL VIRTUES OF ANTIPHLOGISTICS AND 
 TONICS CONSIDERED RELATIVELY. 
 
 The almost endless variety of virtues which appertain to the remedies that are 
 adapted to tlie treatment of inflammations and fevers, or which may be created by 
 uniting two or more of them together, and also according to the proportions of each 
 constituent (§ 860, 863 d, 872 a, 889 k, 892 b, 892^ a, 1058, 1060-1065), contrasted 
 with the single property that alone characterizes, as a remedial virtue, any member 
 of the groups of tonics and stimulants, should assure us that the former are designed 
 for the multifarious conditions of inflammatory and febrile diseases, while the latter 
 is equally pronounced, by its solitary virtue, to be suited only to such forms or con- 
 ditions of disease as are nearly allied to each other (§ 890^ a, It), and where, by com- 
 mon consent, the remedies that are deficient in that special virtue have compara- 
 tively little or no tendency to introduce the restorative process, but, on the contrary, 
 generally aggravate the conditions which the stimulants relieve. The phenomena 
 which ensue upon the operation of tonics and stimulants, whether of a salutary or 
 morbific nature, arc the same, respectively, throughout ; and, although loss of blood, 
 cathartics, emetics, the mercurial and antimonial alteratives, blisters, and other things 
 belonging to the class of antiphlogistics, will alike make their salutary invasions 
 upon all forms of inflammation and fever, yet in all the cases there is not only a 
 want of coincidence in all the direct manifestations, but the greatest diversity — 
 scarcely any thing in common beyond the subsidence of disease (§ 900, 1059, 86"4:). 
 
 Since, therefore, it is abundantly evident that the great varieties of remedies de- 
 nominated antiphlogistics, ranging from loss of blood, cathartics, emetics, mercurials, 
 antimonials, vesicants, and other agents that are adapted to the common form of 
 inflammation and fever, to iodine, cinchona, arsenic, cobweb, colchicum, vcratria, 
 etc., whicli are suited only to the specific forms, are endowed with an incalculable 
 variety of remedial virtues, and, also, that their combinations, both as to the num- 
 ber and nature of the constituents and the proportions of each, extend tlio variety 
 of their virtues indefinitely (§ 872), while, on the other hand, tonics and stimulants 
 possess but a single virtue in their relation to disease, and are incapable of yielding 
 any new ones by their combinations, or of displaying any of the variety of effects 
 common to the antiphlogistics by simply varying the doses (§ 516 d No. 6, 1057^), 
 it needs no farther demonstration to show that the former are intended in Nature 
 for a vast variety of pathological conditions, while the latter are as distinctly limited 
 to the simple office of reviving the exhausted or the prostrate powers of life. 
 
 The foregoing comments have grown out of the numerous contrasts that have been 
 instituted in this work between antiphlogistics and stimulants ; and I am finally led 
 to consider a principal reason for the remarkable ascendency which the stimulating 
 practice has obtained at this advanced age of knowledge. The recital will be at 
 least interesting to the future historian, and can not fail of a useful ettect upon the 
 "Divine Art." The foundation of the evil is variously presented in these Insti- 
 tutes, wliich may be briefly said to consist of the physiology whicli has been pro- 
 claimed from the laboratory of the Chemist, and the pathology which has sprung 
 from the same factitious pursuits, and a reliance upon morbid anatomy and the 
 microscope, to the exclusion, in all this vast and diversified field, of the signs and 
 philosophy which distinguish organic nature in its living condition. The absence 
 of principles, therefore, leaves the Profession as much without a guide in practical 
 medicine as the mariner at sea without his compass.
 
 1134 NOTE EE. — ANTIPHLOGISTICS AND TONICS CONSIDERED. 
 
 This brings me to an important practical comment upon the revival of an old doc- 
 trine which has been lately inculcated by many distinguished medical writers, and 
 extensively, accepted by the" Profession — formerly called ' ' a meditation upon death. " 
 Say they : " Diseases can not be arrested at any stage of their progress, even at their 
 earliest, unless it be some special form, like the intermittent fever, where an antidote 
 has been discovered for the blood poison." Hence the dogma has arisen that tonics 
 and stimulants are all that can be usefully employed, with the object of "sustaining 
 Nature while she is engaged in eliminating poisons from the blood," or in some 
 analogous office, and therefore, also, that bloodletting, cathartics, and other depress- 
 ing means must be injurious. This logic is at the foundation of a vast amount of 
 practice. 
 
 The important question now arises as to the real origin of the dogma that most, 
 if not all, diseases run an indefinite course of rise and decline in spite of all reme- 
 dies and the best directed skill. The answer is to be found in the pernicious effects 
 of the tonic and stimulating treatment, since, as I have variously shown upon the 
 soundest principles, and by the authority of all the best experience from the day of 
 Hippocrates to our own, that method of treatment prolongs all acute maladies till 
 the morbid process may succumb to the physiological laws of recuperation (§ 756 n, 
 853, 856 a, 863 h), when tonics and stimulants may yield an advantage that has led, 
 under these delusive circumstances, to their employment at the early stage of dis- 
 ease. The curious fact, therefore, presents itself, that the stimulating practice began 
 at an early period of disease quickly confirms the morbid process, and thus contrib- 
 utes, along with the neglect of appropriate remedies, to the conclusion that all dis- 
 eases terminating favorably run on until they run out ; while the same treatment, 
 continued after recuperative nature may have struggled successfully against it, is 
 supposed to have been tributary throughout to the fortunate issue. 
 
 This all-pervading school (permitted, perhaps, as an auxiliary means in the dis- 
 pensations of Providence) is naturally sustained by the prejudices and propensities 
 of the community, which render it less susceptible of reformation. But it suffers in 
 its dimensions by many seceders, whose experience with the stimulating treatment 
 had equally enforced the conclusion that diseases can not be stayed in their progress 
 toward a natural termination, and that tonics and stimulants fall under the category 
 of all other remedies, and who, therefore, insist that Nature should be left to the sim- 
 ply watching system (§ 878), or at most to the aid of tonics and stimulants when her 
 resources become apparently exhausted. Occasionally, also, disciples of the stimu- 
 lating school are prompted by their unfortunate experience to try the method at 
 which they had so long revolted, and if they venture as far as copious bloodletting, 
 and purging, in grave inflammations and congestive fevers, they are astonished to 
 find that all these diseases may be suddenly arrested at their early stages, and that 
 life should be thus as uniformly saved as it had been as uniformly lost by the stim- 
 ulating treatment — nor are there wanting illustrious examples to whom these re- 
 marks apply (§ 1005 a-h, Note Ff). 
 
 I do not flatter myself that what I have now and hitherto said on the foregoing 
 subject will exceed the usual small allotment in advancing the interests of truth in 
 its conflicts with error. They are arrayed in uncompromising hostility, and how- 
 ever powerful may be the weapons of the one, they are wielded by a few against a 
 multitude who are intrenched in the fortress of "Common Sense," and rejoice in 
 the delusion of vox popnK vox Dei. Simplicity and plausibility are tlie triumphant 
 advantages of error. A single fact that addresses itself strongly to the senses often 
 outweighs a multitude of contradictory ones which can be developed or appreciated 
 only by patient research and profound meditation. This contrast between truth and 
 error may be well exemplified by the apparent and real motions of the heavenly 
 orbs. "Common Sense" assumes that the earth is stationary and that the heavens 
 revolve about it ; but reason, through its profound investigations, decides that "Com- 
 mon Sense" is in error. But ages elapsed, and an incalculable amount of intellect- 
 ual labor was brought to the subject before the error could be dispelled. Indeed, 
 it is said that, even at this age, the "Doctors of Salamanca" daily crucify Galileo, 
 greatly prefcmng the promptings of Sense to the difficult revelations of science 
 
 And just so it is with whatever is true or false in medicine. With the multitude 
 "Common Sense" is forever the victim of appearances. It believes, for example, 
 that "debility" is the essence of disease, having no conception that it is a mere 
 symptom, and no reference to the latent causes upon which it depends and which 
 alone should guide the practitioner. "Common Sense" is also greatly responsible
 
 NOTE FF. — BLOODLETTING IN YELLOW FEVEK, ETC. 1135 
 
 for the delusions with which Humoralism and Organic Chemistry have vitiated 
 medical science. Nothing, for example, can be plainer than that the matter of erup- 
 tive diseases comes from the blood, and, tiierefore, Common Sense, according to its 
 usual superficial manner, argues that the blood is the essential seat of the malady, 
 and that tonics and stimulants are alone wanted " to sustain the strength while tlie 
 blood is casting off its impurities." Upon the same ground, "blood poison" is the 
 descriptive phrase for the wliole pathology of typhus, intermittent, yellow, and other 
 fevers, for which the same sustaining treatment and its philosophy obtain ; or here 
 quinine is supposed to neutralize the reputed poison, or, at other times, and in other 
 maladies, iron is a favorite to "enrich the blood," or iodine as a peculiar purifier 
 (Notes K, N, R). And this, according to the " recent progress of medical science," 
 about exhausts the Materia Medica. As an example of "the progress," calomel 
 and tartarized antimony are excluded by the Surgeon General, Dr. Hammond, from 
 the armies of the United States of America. Calomel is forbidden, he proclaims, 
 "with the more confidence, as modern pathology [!] has proved the impropriety of 
 the use of mercury in very many of those diseases in which it was formerly unfailingly 
 administered:' And this is only a little more arbitrary (because sustained by military 
 power) than the general policy by which Humoralism and Organic Chemistry have 
 nearly crushed out all that is most valuable in medical science (§ 5J a, 819 b). If 
 Solidism raise its voice in solemn protest, "Common Sense" points to debility, or 
 to pustular eruptions, or to vitiated secretions, and curls its lip at whatever is grand, 
 and magnificent, and practical in the laws of the organic functions and of the nerv- 
 ous systems. But nothing is more certain in the future than that, "ere the account 
 be closed, principles will stand for something, and conscience, as in all human affairs, 
 will have the last word." 
 
 NOTE Ff.— BLOODLETTING IN YELLOW FEVER, AND IN OTHER 
 CONGESTIVE FEVERS, CONTRASTED WITH THE STIMULATING 
 TREATMENT.— NO CHANGE IN THE TYPE OF DISEASES. 
 
 Besides the great amount of enlightened experience which this work supplies upon 
 the importance of Bloodletting in Yellow Fever (§ 959 b, 992 a, b, 993, 999, 1002, 
 1004, 1005^), and more particularly the Medical and Physiological Commentaries, 
 the unexampled fatality of that disease in recent times (so manifestly arising from 
 the stimulating treatment, § 1068 b), leads me to some specific statements as to the 
 quantity of blood which was often found necessary to the best success in the epidemics 
 which visited Philadelphia toward the close of the last century, while it will be also 
 seen that the principal physicians of that city applied the remedy to an extent de- 
 manded by the exigencies of the disease. Nevertheless, the tonic and stimulating 
 treatment prevailed at first, universally, and had then, as now, no reference to the 
 essential condition of the disease, but was, equally as at this day, addressed to that 
 superficial symptom debility, which, in its popular acceptation, is attendant upon all 
 diseases (see Index II., Debility). It is, indeed, fur the reason that the symptom 
 is supposed to constitute the disease that tonics and stimulants are now the only 
 remedies, in a general sense, tliat arc in the hands of the profession, and the anti- 
 phlogistic condemned as unwarranted by this leading principle in pathology. But 
 it is a more inexplicable paradox that tlie mortality attending the stimulating 
 treatment does not oftener appeal to the judgment or the conscience of these triflers 
 with human life. The annals of medicine supply but few examples of an abandon- 
 ment of a practice which has constantly illustrated its own errors and the dogma 
 upon which it has been founded. These few are mostly limited to able thinkers, who 
 are quoted in this work (§ 1005 a-h). Rush has su{)plied, in his Medical Inquiries 
 and Observations, a few instances that were signalized by the yellow fever of 1793. 
 " Dr. Pennington," he says, " informed me that he had lost all the patients to whom 
 he had given bark and wine. Dr. Johnson assured me, with great concern, about 
 two weeks before he died, that he had not recovered a single patient by them. Whole 
 families were swept off where these medicines were used. There was not a single 
 cure performed by them in New York, where they were used in several sporadic 
 cases with every possible advantage. But why do I multiply proofs of their deadly 
 effects? The clamors of hundreds whose relatives had perished by them, and the 
 fears of others, compelled those physicians who had been most attached to them to 
 lay them aside, or to prepare the way for them, as it was called, by purging and bleed- 
 ing." The physicians who adopted the latter practice "gave calomefby itself, in
 
 113G NOTE FF. — BLOODLETTIXG IN YELLOW FEVER, ETC. 
 
 small doses, on the first or second day of the fever, bled once or twice in a sparing 
 manner, and gave the bark, wine, and laiidanura, in large quantities, upon the first 
 appearance of a remission. This practice was not much more successful than the 
 purely stimulating. It resembled throwing water and oil at the same time upon 
 a fire in order to extinguish it." Nothing, indeed, succeeded but decisive blood- 
 letting and purging with the right cathartics. This was farther illustrated by the 
 French practice, of which the following is an example. The hospital at Bush Hill, 
 "where most of the patients were sent in the first stage of the fever, and provided 
 with all the necessaries and comforts that humanity could invent, or liberality sup- 
 ply, was placed, after September 22d, under the care of a French physician, who 
 employed moderate bleeding, and purging with salts in some cases," and also " nitre, 
 cream of tartar, camphor, centaury tea, and tamarind water," but no bark and wine. 
 The result was that the deaths between September 22d and November Cth amounted 
 to 448 out of 807 patients who were admitted into the hospital within that time. 
 "TIn-ee fourths of all the blacks (nearly twenty) who were patients in this hospital 
 died ;" while Dr. Rush remarks, in another jjlace, that "a great number of the blacks 
 were my patients, and of these not one died," under his treatment of bloodletting, 
 and purging by calomel and jalap (863 d). 
 
 Of the practice of "moderate bleeding" Dr. Rush remarks that "an increased ac- 
 tion of the bloodvessels was the consequence (§ 965 b, 985 6), and thus complaints of 
 the chest and head were made worse by a single bleeding. This excited or strength- 
 ened the prejudices of patients and pli3'siciaQS against it" (§ 1000-1001). These 
 patients died, and are among the multitude of instances which sustain the enliglit- 
 ened experience already quoted (§ 994-1001, 1005). Sydenham makes the same 
 aflSrmatiou of the plague. "It is not at all surprising," he says, "that bleeding in a 
 small quantity should be always prejudicial ; but I ajjijeal to the physicians who 
 continued in town during the late plague (London, 1665 and 1666), whether />ee 
 and repeated bleeding, before a swelling (bubo) appeared, was ever observed to prove 
 fatal to any of the infected." He speaks of the opposition to bloodletting as "a vul- 
 gar prejudice" (§ 1000). 
 
 It is remarkable that Dr. Rush should have begun the treatment of the yellow 
 fever of 1793 by tonics and stimulants — "bark, wine, brandy, and aromatics." But 
 after a disastrous experience, he confesses, with much lamentation, to a total failure; 
 and his conversion to bloodletting, and purging with calomel and jalap, and the 
 triumph particularly of the former remedy, are so coincident with the experience of 
 Hey, Gordon, Denman, and Cleghorn, as related in section 1005, that they may well 
 be incorporated in that category of frank confessions of disastrous experiment lead- 
 ing to tlie recognition of philosophical principles and triumphant success. "Heaven 
 alone," says Dr. Rush, "bore witness to the anguish of my soul in this awful situa- 
 tion. But I did not abandon a hope that the disease might yet be cured." Among 
 the causes of his substitution of bloodletting for stimulants "were frequent hemor- 
 rhages from every part of the body ;" and while they afforded "perfect relief" at ad- 
 vanced stages of the disease, "not a single death occurred from natural hemorrliages 
 in the first stage of disease" (§ 805, 863 a-h, 1018). He felt his way, however, cau- 
 tiously, thus manifesting that predilection for the fatal practice which we have seen 
 to be true of other converts till aroused by the havoc it produced (§ 1005 a-h). "I 
 began," he says, "by drawing a small quantity of blood at a time." This "satis- 
 fied him of its safety and efficacy," and he grew bolder. "Never before," he says, 
 "did I experience such sublime joy as I now felt in contemplating the success of my 
 remedies." As an evidence of this he makes an extract from his note-book, dated 
 September 10th: "Thank God! out of one hundred patients, whom I have visited 
 or prescribed for this day, I have lost none" (§ 1004 c). The sunken pulse and pros- 
 trated strength rose under repeated abstractions of blood (§ 961, 967, 1004 b). "I 
 paid no regard," he says, "to the dissolved state of the blood 'when it apjjcared on 
 the first or second day of the disease, but repeated the bleedings afterward in every 
 case where the pulse continued to indicate. It ums common to see sizy blood sncceed 
 tliat wliich was dissolved." "The i)resence of petechias did not deter me from re- 
 peated bloodletting where the pulse retained its fullness or tension" (§ 1002 d-f). 
 " I bled many patients twice, and a few three times a day" (§ 999 n, b). " I did not 
 lose a single jiatient wliom I bled seven times or more in tliis fever." "I cured" 
 (after he had abandoned tonics and stimulants) "a greater proportion than ninety- 
 nine out of a hundred of all who applied to me on the first day of the disease, before 
 the lotli day of September" (§ 557, 861). "After the 15th my success was much 
 limited compared with what it had been before that time. But at no period of the
 
 NOTE FF. — BLOODLErriNG IN YELLOW FEVER, ETC. 1137 
 
 disease (with the qualification aforesaid) did I lose more than one in twenty of those 
 whom I saw on the first day." "The number of deaths between the 1st of August 
 and the 9th of November amounted to 4054." Notwithstanding, however, the stim- 
 idating practice obtained with many of the physicians throughout the greater part 
 of the epidemic, Dr. Rush remarks that " not less than 6000 of the inhabitants of 
 Philadelphia probably owe their lives to purging and bleeding during the autumn." 
 "Many whole families, consisting of five, six, and, in three instances, of nine mem- 
 bers, were recovered by plentiful bleeding and purging." Other physicians gradu- 
 ally adopted the depletive treatment, " one of whom cured ten in the family of Mr. 
 11. Haydock by means of the remedies." "Dr. Pennington" (who had lost all the 
 patients to whom he had given bark and wine) "assured me on his death-bed that 
 he had not lost one out of 'forty-eight patients whom he had treated agreeably to the 
 ])rinciples and practice I had recommended. Dr. Griffiths triumphed over the dis- 
 ease in every part of the city by the use of what were called the new remedies.''' Of 
 his own success in the epidemic of 1797 he says, "I lost but one patient who had 
 been the subject of early and copious bleeding. His death was evidently induced by 
 a supper of beefsteaks and porter during convalescence." 
 
 To the untiring perseverance of Dr. Rush is due the overthrow of the stimulating 
 treatment, which reckoned almost every patient as its victim, as shown by the suc- 
 cess of the antiphlogistic practice. That fearless man, in the midst of great obloquy, 
 "defended his treatment in the public papers against the attacks that were made 
 upon it by several of the physicians of the city." "This controversy with my 
 brethren," he adds, "with whom I had long lived in friendly intercourse, carried on 
 amid the most distressing labors, was extremely painful to me." But he finally 
 triumphed, and his memory presents an imposing contrast with that of his oppo- 
 nents. The disastrous effects of the bark and wine treatment " in some of the most 
 opulent families in the city, and the almost uniform success of the depleting remedies, 
 happily restored the public mind, after a while, from its distracted state, and pro- 
 cured a submission to the latter from nearly all the persons who were affected with the 
 fever." Of the epidemic of 1794 he remarks that, "in Philadelphia and Baltimore, 
 where bleeding and purging were used in due time, and as I have described, not 
 more than one in fifty died of yellow fever." " In 1797 the stimulating mode was de- 
 serted by every physician in the city. " 
 
 In regard to the quantities of blood which were often abstracted, the following 
 are examples in the epidemic of 1794. Dr. Rush supplies a table of 23 cases in his 
 own practice, in which the quantities varied from 50 to 1 50 ounces, ' ' taken in three, 
 four, and five days." "I did not cure a single person," he says, "without at least 
 one bleeding." In the epidemic of 1793 he has examples to the extent of 100 
 ounces at repeated bleedings. In the epidemic of 1797 he mentions five individuals 
 whom he bled to the extent of more than 100 ounces. In the same epidemic "Dr. 
 Dewees bled Dr. Physic 17G ounces; Dr. Griffiths bled Mrs. Thompson 110 ounces; 
 Dr. Stewart bled Mrs. M'Phail lOG ounces ; Dr. Cooper bled Mrs. Evans 150 ounces ; 
 and Dr. Gillespie bled himself 103 ounces. All these persons had a rapid recovery" 
 (§ 992, 994). In the epidemic of 1798, "Dr. Mease was bled 1G2 ounces, and Mr. 
 J.C.Warren 200 ounces," and recovered. When bleeding had been neglected in 
 very prostrated cases, "Nature often performed that operation upon herself from 
 the gums on the fourth or fifth day. I have seen several pounds of blood discharged 
 on those days with the happiest eflfects. It appeared to take place after the revival 
 of the bloodvessels from their prostrated state" (§ 805, 863./; 890 d-g, 961-964, 984 c, 
 1018-1019, Notes Gg, Ii). In the epidemic of 1799 "there were few cases that 
 did not indicate bleeding. Mr. Rowan lost 200 ounces of blood by 22 bleedings" 
 (§ 999 a, b). 
 
 If we now compare the mortality from yellow fever that has distinguished the 
 tonic and stimulating treatment for the last forty years with the results of the stim- 
 ulating and antiphlogistic methods of the last century, it will be seen that the pro- 
 fession is again called upon to return to principles, and to that enlightened experi- 
 ence from which the principles have been deduced (§ 1004 «), and to surrender the 
 prejudice that the same diseases so fluctuate in their type in different countries and 
 at different seasons as to require opposite modes of treatment (§ 752-756, 960 g, 
 969 d, 1006 a-g, 1068). 
 
 40
 
 1138 NOTES GG-HU. — BLOODLETTING IN DYSENTEEY. — MEMORY. 
 
 NOTE Gg.— BLOODLETTING IN DYSENTERY. 
 
 This note is in connection with § 8G3/ 890 e, 984 c, 991 b, 1019, 1058/, and 
 Notes F, Ff. In Note F I liad occasion to quote the high authority of the British 
 and Foreign Mcdico-Chirurgical Review in proof of the disastrous effects that have 
 resulted from tlie abandonment of bloodletting in the early stages of diseases of the 
 lungs, and it is now my purpose to quote the same authority to show as remarkable 
 a contrast between the results of the treatment of dysentery by bloodletting, calomel, 
 opium, etc., as practiced during the British naval expedition to China in 1840-'42, 
 and which " was most in vogue twenty years ago," and the treatment adopted during 
 the second expedition for the three years 1857, '58, '59. -Thus the Review: 
 
 "Of late years (and during the second expedition) the heroic or active treatment 
 by depletion, etc., has fallen into desuetude, and reliance has been placed on milder 
 measures. Ipecacuanha, in the manner recommended by the Indian practitioners, 
 has been largely tried, together with hydrarg. cum creta, opium, the mineral acids, 
 topical bleeding, counter-irritants — in short, all the older remedial agents, excepting 
 general bloodletting and calomel." 
 
 Now, says this able digest of the "Medical Results of the recent Chinese Wars, " 
 "By presenting the products respectively in the form of figures, the mind will seize 
 at a glance the ])ainful dispaiity. 
 
 Years. 
 
 Cases of 
 
 Number 
 
 Number 
 
 Dysentery. 
 
 invalided. 
 
 died. 
 
 2102 
 
 60 
 
 188 
 
 2006 
 
 606 
 
 465 
 
 Number of 
 Jlen employed. 
 
 1840-1-2 15,470 
 
 1857-8-9 24,980 
 
 Thus, in rough numbers, in the first Chinese war, one out of every eight and a half 
 of the men attacked succumbed or was disabled from service ; in the second Chinese 
 war, one out of every two." 
 
 It appears, therefore, accoi-ding to the foregoing account of the treatment, that 
 the "painful disparity" is to be attributed to the neglect of general bloodletting, 
 since the other "heroic remedy," "calomel pushed to ptyalism," has been only an 
 occasional remedy for dysentery — never, indeed, much practiced either in Europe or 
 America. But, more than all, I am most happy to hail a returning appreciation of 
 the accumulated experience of the past (though it be the slow result of "a painful 
 dispai'ity"), as expressed in the foljowing quotation from the article to which I am 
 indebted, and which was contributed to the Review by T. Nelson, M.D., Staff Sur- 
 geon, R.N. 
 
 " Taking a dispassionate and impartial view of the facts as they have just been 
 disclosed, the conclusion to which they lead can not be avoided, namely, that the 
 recent method of treatment of dysentery in China, so far from having become more 
 successful from the additional experience which twenty years confer, has, on the con- 
 trary, very decidedly retroceded. In presence of tliis painful but inevitable infer- 
 ence, it becomes a subject for serious consideration whether the viuch contemned prac- 
 tice of twenty years ago has not been superseded somewhat rashly, for another which, 
 conforming to the quietism of the day, has brought about a series of results that in these 
 times has no parallel" (§ 1005 b-h, Note Ff). — British and For. Med. Chir. Rev., 
 July, 1863. 
 
 In the last conclusion the writer is mistaken as it respects the relative excess of 
 mortality from other modes of treating dysentery, for the stimulating and astringent 
 method, now in vogue, supplies a " more painful disparity" than the simple exclu- 
 sion of general bloodletting from the antiphlogistic treatment practiced by the Brit- 
 ish surgeons during the second Chinese expedition. 
 
 NOTE Hii.— MEMORY SUDDENLY LOST, AND SUDDENLY RESTORED 
 BY FREE BLOODLETTING. 
 
 On the 26th of October, 1862, at eight o'clock A.M., I was requested to visit Dr. 
 O. B., a medical gentleman of this city, who had sustained, in the course of the pre- 
 ceding night, a loss of memory. I had passed the evening in conversation with him, 
 at which time his memory was perfect, and he had been attending to his usual avo- 
 cations abroad during tlie day. His age was about 62 j-ears, slender in his person, 
 and he had suffered in former years much infirmity of health, which was still habit- 
 ually delicate. The case presented some very remarkable intellectual phenomena ;
 
 NOTE II. INTESTINAL HEMORRHAGES IN TYPHUS FEVER. 1139 
 
 and I record it not only for that reason, but in farther defense of the great remedy 
 against which so insane a prejudice prevails. It goes, moreover, with the rest in 
 showing that diseases do not fluctuate in the supposed manner in their pathological 
 conditions (§ 1005^ a, 1068). 
 
 The case presented a total obliteration of memory as to the past and passing events, 
 but it was sufiScient for a connected association of ideas, and reason was apparently 
 sound as it respected subjects immediately present to the mind. His remarks re- 
 ferred alone to the occurrences of the moment. As examples of the failure of mem- 
 ory, the doctor had no recollection of my visit on the preceding evening, and when 
 this information was repeated several times in as many successive minutes, it was al- 
 ready lost to his memory. And so of other things, ujjon which he would reason cor- 
 rectly, but would totally forget the conversation and tiie subjects about as quickly as 
 the words succeeded each other. 
 
 I was informed by his family that he had complained for ten days of some head- 
 ache, but that in other respects he had made no unusual complaint of his health. 
 His pulse was about ninety strokes in a minute, full, strong, and rather hard and 
 incompressible (§ G88 d, e) ; tongue clear, appetite unimpaired, muscular strength 
 undiminished, skin natural. He had arisen from bed at his usual hour. Of the 
 headache he had no recollection ; and the only circumstance which reconciled him 
 to medical treatment was the full consciousness that he had lost his memory. And 
 yet this consciousness existed only at the moment when his attention was brought 
 to the subject. And so, also, in respect to the ti-eatment. When bloodletting was 
 proposed he raised objections to the remedy, but would forget within a minute that 
 it had been the subject of discussion ; and even, at last, when the preparation for 
 bleeding was ready, he was astonished at being informed that it was my purpose to 
 bleed him, and that he had not been consulted upon the subject. 
 
 The pathological condition, in my judgment, was venous congestion of the brain 
 — such as is apt to result in apoplectic attacks. I therefore anticipated the best re- 
 sults from the remedy, and that the system would bear a free abstraction of blood 
 under the stimulating nervous influence developed by the cerebral excitement (§ 975, 
 978, 979). The patient sat in a chair, and thirty-two ounces of blood were ab- 
 stracted, when the radial pulse had yielded sensibly in, force, fullness, and frequency, 
 with other indications of approaching syncope, which, however, did not ensue. 
 While the blood was running I gave particular attention to the state of the mind, 
 and ascertained that the memory was progressively returning, and it was completely 
 restored within an hour after the blood had been abstracted. The patient continued 
 to move about the house during the day, and about the city in two days afterward. 
 He had no more headache, and no medicine was administered. There has been now 
 an interval of about two years, and there has been at no time any manifestation of 
 " debility," but rather an improved vigor of health.* Nor has there been any disturb- 
 ance of the memory, though it is an interesting fact that the doctor remembers noth- 
 ing of the occurrences of the morning of the 26th of October prior to the abstraction 
 of the blood (§ 1072 b, 1078 o). 
 
 NOTE Ii.— INTESTINAL HEMORRHAGES CURATIVE IN TYPHUS FE- 
 VER, ETC.— IDENTITY OF TYPHUS AND TYPHOID FEVERS. 
 
 Notwithstanding the accumulated experience, throughout all the ages of Medicine, 
 of the salutary eft'ects of spontaneous hemorrhages, particularly as incident to con- 
 gestive fevers, the following statement, being comprehensive and one of the latest, 
 may be usefully added to the other evidences upon that subject recorded in this 
 work. At a meeting of the New York County Medical Society, held March 2, 1863, 
 Dr. H. D. Bulkley, a physician of learning and ability, remarked th.at, 
 
 "With regard to the value of intestinal hemorrhages in typhoid fever, Drs. Bre- 
 tonneau, Chomel, Louis, and others, considered this a dangerous symptom, but that 
 Dr. Graves thought it rather favorable than otherwise, provided the loss of blood 
 was not extreme. M. Trousseau was at first surprised at this opinion of Dr. Graves, 
 but finds, on looking over his cases, that in seven years he has known but two deaths 
 from such hemorrhage. Others attacked with it not only recovered, but were better 
 afterward. Dr. Ragaine, in a memoir on this subject sent to the French Academy, 
 relates one hundred and fifteen cases of typhoid fever, of which eleven suffered from 
 hemorrhage, and they all recovered" (§ 805, 863 e, f, 890 e, 922, 984 c, 1002 /, 
 1006 d, g, 1017 b, 1018-1019, 1068, Notes F, Ff, Gg). 
 
 * Eight years have now elapsed, and Dr. Bkojjson haa continued in an improved state of health — 
 1870.
 
 1140 NOTES KK-LL. DIPHTHERIA. THE PULSE AS A GUIDE, ETC. 
 
 In respect to the identity of typhus and typhoid fevers, as shown in Note S, it may 
 be farther stated that on the foregoing occasion, "Dr. Bulkley considered typhus 
 and typhoid fevers as varieties of the same disease ;" that "Dr. Finnell maintained 
 his belief in the identity of typhoid and typhus fevers;" and that "Dr. J. Foster 
 considered the two types as one and the same malady" — all the gentlemen deducing 
 their conclusions from personal experience. 
 
 NOTE Kk.— DIPHTHERIA. 
 
 A brief reference to this complicated disease is made in a note at page 350, and 
 at page 450, § 689 I, for the purpose, especially, of indicating the pathology of the 
 disease; and it is now my object to reproduce those considerations in connection 
 with the very fatal effects of the almost universal treatment of the epidemic by tonics 
 and stimulants, and to commend to the Profession what appears to me to be the 
 only method which is waiTanted by the general and the local pathology, and which, 
 in my hands, has been attended by speedy relief, even in infancy — that is to s^, the 
 strictly antiphlogistic. Decisive bloodletting, either by the lancet or by leeches, is 
 generally indispensable ; after which a moderate dose of calomel, or of blue pill, to be 
 soon followed by castor oil, or the oil without the mercurial remedy (§ 1057 /), will 
 be about all of an active nature that can be advantageously done.* The superficial 
 hypothesis of debility is the source of the appalling mortality, and is of the same 
 nature as that which is examined in sections 487 h, 569 b-e, G21 a, 743, 752-756, 
 785, 815, 887, 961-970 c, 992 c, 999c,1005 6-A, 1006 /-1007 6,1068 a, l>, Notes F, Ff. 
 
 NOTE Ll.— THE PULSE AS A GUIDE TO BLOODLETTING. 
 
 It is a remark of Dr. Rush that "where all the different states of the pulse which 
 indicate the loss of blood are perfectly understood, and bloodletting conformed in 
 time and quantity to them, it never can do harm in any disease. It is only when it 
 is prescribed empirically, without the direction of just principles, that it has ever 
 proved hurtful." 
 
 The foregoing statement occurs in Rush's account of the yellow fever of 1794, and 
 in his " Defense of Bloodletting" he mentions particularly, in the form of very brief 
 abstract rules, ten different "states of the pulse that indicate the necessity of bleed- 
 ing." It may be safely said, however, that the " necessity" can not be inferred from 
 any one of the conditions without the light of other symptoms which refer more im- 
 mediately to the seat and pathology of the disease; and many of the modifications 
 will be thus found to contra-indicate oftcner than they "indicate the necessity of 
 bleeding." Nevertheless, the foregoing remark, however accidental it may have 
 been, is probably true in a universal sense, for it is a summary principle founded 
 upon all the circumstances of individual cases of disease. 
 
 Looking, therefore, at the fluctuations of the pulse according to the seat, nature, 
 force, and duration of the disease, it becomes evident that this universal symptom, 
 as a (jtiide to bloodletting, involves a critical inquiry into all the circumstances of 
 disease that can modify the action of the heart and bloodvessels, and from which it 
 appears that it must be very generally these combined circumstances in connection 
 with the state of the pulse, and oftener the former more than the latter, which must 
 determine the propriety of bloodletting, and " the time and the quantity" (see Index 
 II., Pulse). The pulse, .at best, as I have' endeavored to show, informs us only of 
 the nature of reflected nervous influences that are propagated upon the heart and 
 arteries by all diseases except the cardiac, as, also, by the action of remedial agents, 
 by mental emotions, etc. (§ 500 m, and references there, 687^-688). The pulse, 
 therefore, in the foregoing accejjtation, may be regarded as the sum of all the symp- 
 toms, but that its true or exact import can never be known without a reference to 
 those symptoms. Nevertheless, the multitude consider only the state of the pulse 
 and " debility," without any regard to their causes ; or, rather, the former lias now- 
 adays lost all its significance, and "debility," representing universal pathology, di- 
 rects the hand of the practitioner (§ 887). This will be manifest on considering the 
 stimulating treatment of those diseases wjiich are attended by a hard and incom- 
 pressible pulse (§ 688 d-f), such as pneumonia, enteritis, phrenitis, phthisis, etc. 
 
 • Thn pulse and mu.aonlftr strength nre in no respect guides. Both are apt to be prostrated by the 
 attendant abdominal congestion (§ CS9 I, 801, 961, p. 360, iiote).
 
 NOTES MM-00. — DEATH-RATE, NAKCOTICS, ETC. 1141 
 
 NOTE Msr.— DEATH-RATE IN THE CITY OF NEW YORK, AND ITS 
 
 CAUSES. 
 
 In preceding editions of this work (p. 872, 1115) I liave presented the statistics of 
 mortality in the City of New York from inflammation of the lungs, bronchitis, croup, 
 and consumption, during the months of January, February, March, and April for the 
 years 18G0, '61, '62, for the purpose of showing the results of the substitution of the 
 stimulating for the antiphlogistic treatment, and that the "excessive death-rate" in 
 this city is not owing to climate (than which there is no city more exempt from dis- 
 ease), nor to any temporary insalubrity of the atmosphere ; and with the same in- 
 tention I shall now record the statistics for the same months in the years 1863, '64. 
 
 In 18G3, the total number of deaths during the foregoing months was 7741, of 
 which 636 are reported as Inflammation of the Lungs ; Bronchitis, 185 ; Croup, 
 383; Consumption, 1205; or nearly I in 12 from Pneumonia, 1 in 20 from Croup, 
 and 1 in 6 from Consumption. The ratio of deaths from the four diseases to the 
 total number of deaths from all causes is about as 1 to 3^^. 
 
 In the year 1864, the total number of deaths during the same four months was 
 8493, of which 839 were from Inflammation of the Lungs; Bronchitis, 164; 
 Croup, 352 ; Consumption, 1260 ; or nearly 1 in 10 from Pneumonia, 1 in 24 from 
 Croup, and 1 in Gf from Consumption. The ratio of deaths from the four diseases 
 to the total number of deaths from all causes is about as 1 to 3^.* 
 
 It is thus seen that there has been nearly the same mortality from the four in- 
 flammatory diseases during the first four months of the five consecutive years. I 
 shall make no farther comments upon this mortality, nor upon the practice which is 
 greatly responsible for it ; but it may be worth while to show the death-rate from 
 consumption for entire years, which for the last five is as follows : In the year 1859, 
 the total number of deaths from all causes was 21,645, of which the rate from Con- 
 sumption was about as 1 to 6g ; in 1860, total deaths 22,710, rate from Consumption 
 about as 1 to 7 ; in 1861, total deaths 22,117, rate from Consumption as 1 to 7J ; 
 in 1862, total deaths 21,241, rate from Consumption about as 1 to 6f ; in 1863, total 
 deaths 25,196, rate from Consumption about as 1 to 6;^. — See Note F, p. 1114. 
 
 The statistics have been obtained from the able and elaborate reports of Cyrus 
 Ramsay, M.D., LL.B.. Registi-ar of Records and Statistics in the City Inspector's 
 Department. 
 
 NOTE Nn.— NARCOTICS AND SENSO-PARALYSANTS AS TO PAIN. 
 
 A characteristic and practical distinction between the groups of Narcotics and 
 Senso-Paralysants, according to the nature of the agents which I have assigned to 
 those groups respectively, in my work upon Therapeutics and Materia Medica (§ 891, 
 1057 d), and upon which, particularly, the groups are founded, is, that the Nar- 
 cotics exert their most characteristic effects upon the organs of organic life, while the 
 Senso-Paralysants are felt mainly in the organs of animal life. This is remarkably 
 true of pain, for the relief of which in the great organs of life, so fiir as it respects 
 the nervous agents, we are mostly limited to o[)ium, hyoscyamns, and conium, which 
 are nearly useless in neuralgia and other painful affections of the organs of animal 
 life, while it is in these conditions, and not in painful affections in organic life, that 
 aconite, veratria, belladonna, deiphinia, and stramonium display their anodyne vir- 
 tue. They exert no soporific effect in their ordinary doses, and when such doses are 
 followed by sleep it is owing to the removal of pain. 
 
 NOTE Oo.— RELATIVE LIABILITY OF MASTER AND SLAVE TO PES- 
 TILENTIAL DISEASE.— xMORE ABOUT ANIMAL HEAT. 
 
 When speaking of the subordinate predisposing causes of disease which increase 
 the susceptibility of the svstem to be acted upon by the essential ones in cases of 
 epidemics, and which, also, add to the intensity of disease, I attributed the compar- 
 ative exemption of the Negro from the epidemic fevers of the Southern States to his 
 abstinence from stimulating food and stimulating liquors (Index II., art. Acclima- 
 tion, 3d subdivision ; also § 630 e, 663, 814, 816 b, 827 e, 883 i); and it is now my 
 purpose to simply state the habits of the Negro in that respect, as represented by a 
 
 • We Icain from Cellevue Hospital (N. V.), that in the treatment of Pneumonia "the olden 
 methods of saDguineoua depletion with antimonials have heen swept away bi/ the advance of medical 
 science."— Am. Med. Times, 1864. Note E e, as to the '■'■advance of modem pathologr," and 5 5K
 
 1142 NOTE pp. — THE DEVEL0PME2<TAL HYPOTHESIS, ETC. 
 
 distinguished observer who had resided several years in their midst, and whose lius- 
 band was the wealthy proprietor of a large plantation. This information is derived 
 from a "Journal of Residence on a Georgian Plantation," by Fanny E. Kcmble 
 (then Mrs. P. Butler), in whicli it is said that "the slaves labor hard all day upon 
 two meals of Indian corn, or hominy, as it is called, as the regulation on this planta- 
 tion, and our Negroes are generally considei'ed well off. They go to the fields at day- 
 break, carrying with them their allowance for the day, which is eaten at noon ; and 
 their second meal is at night, after their labor is over — having worked, at the very 
 least, six hours without intermission of rest or refreshment since their noonday meal." 
 The foregoing statement associates itself with what has been said in this work 
 upon the connection of food with animal heat, as in sections 441 c, 1048-1050 ; and 
 it is also an evidence of the fallacy of a "prevailing opinion that a spare diet is pro- 
 ductive of disease, and incompatible with laborious pursuits (§ 1048). I will add 
 that this last subject is fully examined in the Medical and Physiological Commentaries, 
 vol. ii., p. 691-698, in an article upon '■'■Fasting.'' 
 
 NOTE Pp.— THE DEVELOPMENTAL HYPOTHESIS.— THE DARWINIAN 
 ORIGIN OF SPECIES.— "MEN AND MONKEYS." 
 
 The doctrine of the origin of species by transmutation, in all the aspects of that 
 hypothesis, is abundantly refuted as to man by the distinctions which I have indi- 
 cated between the Soul and Instinct (p. 892-906, § 1078) ; for, however great may 
 be the coincidences between the organization and the functions of man and animals, 
 there is none between absolute reason and instinct. The former, as I have shown, 
 is peculiar to man. But, if there were any just foundation for the developmental 
 doctrine, the manifestations of reason should not begin abruptly with man, but should 
 observe some degree, at least, of correspondence with the physical conditions. And 
 since, also, man is completely an animal in organization and functions, tlie ground 
 which is thus obtained may be carried analogically throughout the animal kingdom. 
 
 Lest an advantage be taken of what has been said of the modification of Instinct 
 in metamorphic animals (§ 1078;>), by applying the principle to the develojiment of 
 the rational faculties of man in his supposed evolution from the monkey tribe, it 
 may be said, notwithstanding the obvious want of all analogy, that the mutations 
 of organization in the -metamorphic animals are of the most fundamental nature, 
 while the corresponding modifications of instinct are always in strict conformity with 
 the great general plan of instinct, and farther, also, that in all these cases the several 
 mutations of structure and instinct are progressive stages of the same individual from 
 the germ to its full maturity. Instinct, as I have shown in this work, is constituted 
 throughout all the animal tribes with a sole reference to the uses of the body, and 
 that no animal has been known to manifest any of the phenomena of reason that 
 can not be resolved by the philosophy which I have predicated of instinct. 
 
 Glancing more particularly at the most novel of the repudiations of Creative 
 Power, and which has taken captive so many of the scientific world, it appears to be 
 encumbered with greater fallacies than any of its kindred doctrines. Besides the 
 many obvious considerations of a physiological nature that apply to Darwin's " ori- 
 gin of species by natural selection" (p. 814, note), it is worth saying, that as all the 
 assumed developments, or mutations of species as called by Darwin, start, at the 
 best, with the infancy of animals (§ 1085), an objection which I alleged against the 
 doctrine of spontaneity of beings in the work upon the "Soul and Instinct" (p. 158- 
 165) is equally applicable to the Darwinian origin of species. The argument pro- 
 ceeds thus : Now let us see how far the statements of Holy Writ agree with what is 
 manifestly fundamental in Nature. We are told, for eicample, that man and beast 
 were created entire out of the earth ; but had it been said that the materials of the 
 earth organized themselves into living beings, or even that the materials were pe- 
 culiar to living beings (an assumption highly probable, unless the composition had 
 been revealed), the Narrative would be rejected by all as an imposture. Nay more, 
 had it been affirmed that man was created in the condition of an infant, and thus 
 left to grow up to maturity under the laws which govern his organization, without 
 maternal sustenance and protection, without a ray of instinct, destitute of volition 
 and muscular power, the personification of helplessness, tlie statement would be uni- 
 versally pronounced absurd.* Yet is this doctrine extensively propagated through 
 the delusion that "the Creator endowed certain forms of inorganic matter with the 
 j'roperties requisite to enable them to combine, at a Jilting season, into the hitman or- 
 
 * See my deinonstrntion of the necessity of miin's creation in a state of maturity both of mind and 
 body, and all mammiferous animals, and all birds, in my work on the Soul and Instinct, p. 15S- 
 1T3. 1819. Also tins work, § 1083.
 
 KOTK PP. THE DEVELOPME^•TAL HYPOTHESIS, ETC. 1143 
 
 ganism" (§ 350 J at p. 187, 189, § 1083). What I have thus said as to the absolute ex- 
 igencies of man in early life is as applicable to all mammiferous animals, and to all 
 unfledged birds, in respect to the nature of their early food, who would, of course, 
 immediately perish without the sustenance afforded by the parent. — Essay on the 
 Soul and Instinct, p. 159, IGO. — See aTgument in Note p. 815. 
 
 If it be objected by the advocates of Darwin's assumptions that the parent of the 
 newly-developed species would have been the nursing mother, it will be readily seen 
 that no animal, however much it may approximate man in organization, is in the 
 least qualified to take charge of the human infant ; a fact which may be applied, 
 analogically, with equal force to the whole tribe of mammiferous animals, since, if it 
 can be shown that man is an exception to any of the interpretations of nature that 
 aspire at the origin of living beings the entire hypothesis necessarily falls. 
 
 In looking around for the species of animal out of which the human race has been 
 developed, according to the scheme before us, that which approximates man most 
 neai-ly in organization must enjoy the distinguished honor of paternity — the gorilla, 
 orang-outang, or some one of the monkey tribe. It is considered that organization 
 in these instances is so close upon that of man as to supply in this abstract sense a 
 plausible pretense for a still closer relationship (§ 3503 ^'^O ; and it follows, therefore, 
 by the analogies of Nature, as well as by the law of inheritance, which is so justly 
 argued by Darwin as the basis of his doctrine, that reason, the grand characteristic 
 of the human race, should have also made some approximation in the gorilla or 
 chimpanzee toward that divine attribute of man. But I have endeavored to demon- 
 strate, in the article in this work upon the Physiology of the Soul and Instinct (p. SOS- 
 Oil), that no animal evinces that endowment, and that the whole tribe of apes, 
 monkeys, and chimpanzees are vastly less provided with instinct than the honey-bee 
 (p. 896-898, § 1078 d, e), while man dwindles into insignificance by the side of the 
 orang-outang in respect to the instinctive principle (§ 1078 q, etc.). However great, 
 therefore, may be the coincidences between the organization of man and the quad- 
 rumanous tribes, it is impossible to evade the fundamental distinction which is estab- 
 lished by reason and instinct. But even in respect to organization there arc some 
 things which concur with reason in enforcing the conclusions to which it conducts 
 us. Man, for example, walks erect ; but that would not be sufficiently characteristic 
 to prove the distinct and independent nature of his being. The absence, however, 
 of all correspondence in the uses of his upper and lower extremities, while in tlie 
 quadrumanous tribes they subsci-ve the same pui-poses, does estrange them fuiula- 
 raentally from each other; and this argument is vastly increased by the fact tliat 
 the arms of the human species are intended to fulfill the promptings of Reason, wliile 
 the fore legs of the quadrumana are no more tributary to Instinct than the posterior 
 legs — both of which are properly legs. 
 
 Nor will I leave this important subject till I array another argument against the 
 so called '■^typical system" of development, and which will be seen, also, to operate 
 against the Darwinian assumptions. It is this : The differences which occur between 
 extinct and living animals and plants do not relate to organization as it respects the 
 life of the being, but only to certain details in the form of organs. This diftcrenco 
 does not involve, in the least, any difference in the plan of organization, which is 
 exactly the same in the earliest of the lowest and highest order of beings, and 
 throughout all the intermediate gradations in the ascending series, as at the ])resent 
 day. Composition, germs, growth, and reproduction are, also, common to all. Or- 
 ganic life, therefore, has always been precisely the same throughout every link of the 
 vast chain, and the physical agents of life, therefore, always the same (§ fi32 h). Hence 
 it is evident that the whole typical system of theoretical geology, which is founded, 
 not upon diff"erences in the plan of organization, but upon the form of organs, is one 
 of the greatest fallacies that has crept into science. Nor, indeed, could this specu- 
 lation have pervaded the works of geologists any more than the recent novelties of 
 Darwin, Huxley, etc., had any one of the numerous projectors been duly informed 
 upon the science of Physiology. Anatomy supplies no foundation for this reasoning 
 (§ 131, 1078 e); but, on the contrary, when associated with the physiological laws 
 which it is designed to subserve, it is opposed to their conclusions (Index I., article 
 Design). 
 
 The various attempts of arranging man in an order by himself upon the basis of 
 physical characteristics appear to be open to objections ; nor is this at all remarkable, 
 considering the near affinities between the structure and physiological characteristics 
 of man and certain other mammalia. The distinction founded by Professor Owen 
 upon certain supposed peculiarities of the human brain would establish only a specific
 
 1144 NOTE PP. — THE DEVELOPMENTAL HYPOTHESIS, ETC. 
 
 diiFerence. But even this has been controverted by Professor Huxley, who finally 
 propounds the question, "Are we justified in classifying men and monkeys to- 
 gether? The comparison," he continues, "of the human skeleton with that of the 
 gorilla, an orang, a chimpanzee, or any of the higher apes, will answer the question, 
 and show at a ghince the great resemblt^nce and similarity there is between them 
 (§ 1078 e). Now the gorilla, for example, is admittedly placed in the same order 
 as the lemur, tiie cheiromys, and the galeopitheus, which differ far more from it 
 than it does from man. Thus we can not but place them in the same order, or 
 else all our notions of afiinities and resemblances fall to the ground." 
 
 This presentation of the subject is plausible, and such as is anticipated in § 1078 e. 
 It is at best, however, an artificial grouping of animals, without showing in the least 
 that those which approach nearest in structure are not as perfectly distinct species as 
 are the orang and the honey-bee, and not more allied to each other in their origin. 
 But a common fallacy has beset all the attempts to establish man as a special order, 
 under the artificial arrangement, that of neglecting the great facts which distinguish 
 him essentially from every animal — his endowment with reason and his deficiency 
 in instinct. Even the systematists, who have indicated peculiarities in the cerebral 
 structure of man, have left the impression that reason depends upon those peculiari- 
 ties. It is the error of materialism. But if the demonstration which has been made 
 in this work of the substantive existence and self-acting nature of the soul and of the 
 instinctive principle be true to Nature, it may be safely said that reason alone places 
 man in an order by himself, whatever may be "our notions of afiinities and resem- 
 blances" among skeletons (§ 241 c, note, 1078 d, e, q, Note C). 
 
 Finally, an argument against the hypotheses which ascribe the origin of species 
 to blind material forces, and sufiiciently conclusive as to man with all who believe 
 in his immortality, may be founded upon that single fact, which so completely dis- 
 tinguishes him from the animal tribes. The same philosophy must obtain here as 
 in all the suppositive conclusions of a physical nature, and it must be equally true 
 that the soul of man not only originated, but became rational and immortal under 
 the infiuence of those natural fofces and laws which are supposed to have given origin 
 to his material body — whether it have been according to the doctrine of Carpenter, 
 Milkier, Tiedemann, etc. (§ 350i /, /, 7«), or as expounded by Professor Lewis 
 (§ 1085, p. 922), or by the late projector, Darwin (p. 814, note). The first of these 
 doctrines supposes that the elements of matter united into living beings in virtue of 
 the forces with which they are endowed, and therefore, by parity of reason, the im- 
 mortal soul of man must have had the same origin. If Creative Power be invoked 
 for this particular difficulty, the physical structure and its life must fall under the 
 same rule. There is no greater evidence of the existence of "vital properties in 
 the elements of matter" than of the soul or instinct. But it is enough that the ma- 
 terialistic doctrine excludes all direct agency of Creative Power, and consigns the 
 whole work to second causes. If that Power be allowed to have had any creative 
 action in the production of organic beings, there can be no compromise with the 
 hypothesis of second causes as it respects other parts of the same beings. While the 
 Creator was employed about the immortal soul, it must be allowed that He would 
 have equally attended to the no less diflicult organization. A similar philosophy 
 must apply, also, to the " parturitive" hypothesis (p. 922). And coming to Darwin's 
 scheme of slowly progressive mutations, it is necessary that the animals in the ad- 
 vancing series out of which man was developed should have possessed not only a ra- 
 tional soul closely allied to man's, but that soul should be immortal. This unavoid- 
 able conclusion carries us back through all the ascending series of animals till we 
 reach the "primordial cell" (§ lO."")!), or Darwin's "primordial form," for there 
 alone can we look for the beginning of an imnwrtal soul, according to the doctrine 
 of the "origin of species by natural selection." How that cell or that soul came 
 into being we are left in ignorance, as in the case of Tiedemann's "organic matter" 
 (§ SaOJ /, p. 188). But if an immortal soul were not inherent in the cell, or at least 
 in some animal anterior to man, it must have been a supernatural endowment of the 
 human race, or, in other words, a special act of Creative Power, and therefore, also, 
 by an irresistible logic, man's physical structure was equally a direct act of tlie same 
 Power. This conclusion, it is true, requires the admission of man's spiritual immor- 
 tality ; and if it be objected to this that man is not thus distinguished from animals, 
 I recur to mv argument in proof of the perjietnity of the former and the extinction 
 of the latter"(§ 1079 a). But I do not consent to the exclusion of well-established 
 Revelation from matters of science, and I therefore contend that the mission of Christ 
 determines the resurrection exclusively in favor of rational and responsible beings.
 
 NOTE QQ-RK. ANTIQUITY OF THE EACE. — LONG SENTENCES. 1145 
 
 Since, therefore, it appears from our premises that the soul of man is so contra- 
 distinguished from the instinct of animals that it can have had no relation to the 
 animal tribes, and that it follows, as a consequence, that man's physical organization 
 was equally a direct act of Creative Power, and since, also, by common consent, he 
 is on common ground with animals in his organization, it equally follows that the 
 origin of every distinct species of animal was a special act of the same Power. 
 
 NOTE Qq.— HIGH ANTIQUITY OF THE HUMAN RACE, 
 
 Although this is not the place to discuss the question which has been much agi- 
 tated of late among scientific men as to the high antiquity of the human race, or the 
 proper interpretation or authenticity of the Mosaic narrative of creation, and other 
 kindred topics, but to which, for special reasons, the author has adverted in this 
 work (§ 14 c, 250} I, 632, 1051, 1079 b, 1083, p. 922-928, § 1085), he is led to repeat 
 an objection which he alleged in his "Theoretical Geology" (§ 1079 b) against the 
 supposed antiquity. The objection consists in the physiological fact that the human 
 mind was alike endowed in the remotest past as at the present day, and is constitu- 
 tionally so progressive that as soon as the race in any given locality exceeded in 
 numbers the natural means of subsistence, they should have addicted themselves to 
 the culture of the earth and other useful arts, and there should have thus descended 
 to us from those early stages of society materials at least as advanced as those through 
 which alone we learn the former existence of a A'ast population in the Western 
 world. They should be also incomparably more abundant, since in the case of the 
 geological man he is supposed to have been multiplying through hundreds of thou- 
 sands of years ; while the origin of the monumental vestiges of the race, of an un- 
 equivocal nature, lies within the compass of four thousand years, and the testimo- 
 nials that have been recently produced in support of geological periods are insignifi- 
 cant in amount, and can not be shown to be of an earlier date than the Chaldean and 
 Egyptian Architecture. Human reason, under equal circumstances, was as creative 
 at its earliest dawn as at any later period, and the multiplication of mankind, ac- 
 cording to the nature of climate and the progress of art, went on then as now. 
 Science had not dawned when David, Solomon, Isaiah, and Homer wrote, and no 
 better thinkers and writers have since appeared. Greece and Rome perfected His- 
 tory, Architecture, Oratory, Sculpture, Painting, soon afterward, and two thousand 
 vears moi"e brings us to our own times. If, therefore, so much has been accom- 
 plished within the four thousand years beyond which we can not ascend, and such 
 a host of brilliant minds contributed to the earliest page of history, what, I say, 
 would not this same creative mind have produced had it been in operation ten thou- 
 sand years before the structures, and sculptures, and writings of Babylon, Nineveh, 
 and Egypt? It is now too late for the afterthought that the human mind has been 
 subject to changes since the law of "natural selection," or any "law" within the 
 compass of imagination, produced the physical organization of the race ; and, more- 
 over, what is known of the unvarying nature of Instinct in all species of animals 
 determines the same stability for human Reason. 
 
 NOTE Rr.— LONG SENTENCES. 
 
 «A sentence which occurs in section 638 has been very justly regarded as a "long 
 one." Indeed, the Author concedes that it may require more than one sitting to 
 read it through intelligibly. Its design may not be obvious to many, although it 
 carries its own interpretation in showing the intimate relationship of the various 
 topics involved, and which had been antecedently presented as the fabric of physio- 
 logical medicine. That a system so complex and multifarious in its constituent 
 parts, embracing the entire field of physiology and its applications to Pathology and 
 Therapeutics, should be susceptible of exposition in a continuous sentence without 
 violating the unity and harmony of a consistent whole, must be received as an evi- 
 dence of the realities of its subject. But what has been now said is more particu- 
 larly intended as a commentary upon the "long sentences" which abound in the 
 Second Index, and which will be seen to embrace a variety analogous to the char- 
 acteristic of section 638. The common nature of the subjects, under each article, 
 brought them together into compact and continuous sentences, while, also, this con- 
 gruity illustrates and confirms the harmonious system which is indicated in the first 
 paragraph of these Institutes.
 
 NOTES TO THE NINTH EDITION. 
 
 NOTE AAA.— THE HUMORAL PATHOLOGY.— Dr. S. W. MITCHELL'S 
 EXPERIMENTS WITH THE VIRUS OF THE RATTLESNAKE.— PROF. 
 W. BOECK ON SYPHILIZATION.— VACCINATION. 
 
 The prevailing humoral pathology is so entirely subversive of all principles in med- 
 icine, whether they relate to pathology or therapeutics, and so opposed to physiolog- 
 ical facts, that I am induced to refer again to this subject in its connection with the 
 operation of poisons, and for the particular purpose of showing still farther, by the ac- 
 tion of the venom of snakes, that it does not kill by any alteration of the blood, nor 
 by any effect upon the important organs of life excepting through the destructive in- 
 fluences of the nervous power. This note, therefore, refers back to the numerous 
 sections in which the laws of the nervous system are the subject of discussion, wheth- 
 er in their pathological or physiological aspects; but may be more particularly re- 
 garded as being a continuation of sections 494: b-dd, 828 a-c. 
 
 The facts to be first presented are derived from Dr. S. Weir Mitchell's very 
 able Researches on the Venom of the Rattlesnake, published by the Smithsonian In- 
 stitute. It will be seen that they fully corroborate the statements in the foregoing 
 sections, and form, with many other examples presented in these Institutes, a ground 
 of analogical reasoning as to the action of all other morbific causes upon the animal 
 organism — displaying in a luminous manner the pi'inciples of vitalism and solidism, 
 and pointing us with great significance to the magnificent laws of the nervous system. 
 
 Dr. Mitchell appears not to have been acquainted with the important experi- 
 ments of GiRTANNER, for lie remarks that no one but Fontana had tried the virus 
 of snakes upon frogs ; while the former overturned the experiments of the latter (§ 
 494 b). Mitchell's experiments are very different from Girtanner's, but the re- 
 sults are entirely harmonious. 
 
 In one Exp. the frog's heart ceased to pulsate in 3h. 10' after the bite. "In 24 
 hours the muscular parts about tlie bite were almost difHuent, while the rest of the 
 frog had no odor, or any other sign of putrefaction. " 
 
 In another Exp. death took place on the fifth day after the bite. The muscles in 
 the bitten part of the frog "were dark in color, and underwent extreme decomposi- 
 tion, while the rest of the body was not sensibly affected." 
 
 In another instance, where the bite was inflicted on the thigh of a frog, death took 
 place in ten or twelve hours. "About the bite the muscular structure was almost 
 diffluent, and could be torn with the utmost ease. A slight effusion of blood was 
 found under both fore legs, in the axillary spaces. Elsewhere the organs were 
 healthy. " 
 
 In another Exp. death took place on the third day. " The bitten leg was literally 
 soaked in blood, and was every where swollen by this local accumulation." No other 
 remarkable signs. 
 
 The effect upon birds "was so sudden that where the dose of the venom was large 
 there was hardly time to observe the resultant phenomena." "A snake four feet 
 long bit a pigeon upon the knee." " Upon its being bitten, I threw it from me ; but, 
 to my surprise, it fell a dead weight upon the table, and did not aftenvards breathe 
 or move. Thirty seconds elapsed between the bite and the death. " 
 
 A large rabbit bitten by a small snake died in one minute. "No lesion was found 
 in any organ." "7%e muscles and motor nerves were perfectly excitable several min- 
 utes -after death" (§ 1041). 
 
 In warm-blooded animals the rapidity of death was affected by the size of the ani- 
 mal. "A dog weighing 19^ pounds was bitten by several rattlesnakes, in six places 
 at least. There were absolutely no marked symptoms in this case, except increasing 
 weakness, vomiting, and movement of the bowels. The breathing then became jerk- 
 ing and labored. Death took place in three hours. The numerous bites were the 
 most formidable lesions found after death." "Except some congestion of the vessels 
 of the brain and its membranes, there was no morbid appearance in any viscus." 
 A dog weighing lo pounds was bitten in two places, and died in Hi. 20'. "The
 
 NOTE AAA. — THE HUMORAL PATHOLOGY, ETC. 1147 
 
 bitten thigh was a good deal swollen." "It was literally soaked with blood down to 
 the periosteum, which was darkly stained." Brain, lungs, abdominal organs, healthy. 
 A dog of 12 pounds was bitten in two places by two snakes, "one biting him in 
 the muscle and on the side." "The wound on the flank formed within two hours a 
 prominent, almost pendulous mass, several inches long and wide." Death in five 
 hours. "All the thoracic organs were normal. The heart as usual. The right 
 side full of fluid blood, with some dark clots ; the left side almost empty. Elsewhere 
 the organs were healthy, excepting the kidneys, which were full of blood, and pre- 
 sented the appearance of acute congestion." 
 
 The morbid appearances of the solids were mostly limited, in all the experiments, 
 to the bitten parts. As to the blood — "It was found, as a general rule, that it was 
 most affected, and least coagulable, the longer the death was delayed." " A pigeon, 
 for instance, is stricken ; it droops, faUs, and dies within thirty seconds. The blood 
 is red and coagulates perfectly. Its corpuscles are ideally healthy. In such a case 
 no physiologist would impute the death to the altered blood" — and certainly, therefore, 
 in no other case, whatever may be the morbid appearances of the blood (§ 84:5-847). 
 Finally, here is an experimentum crucis — " Two drops of venom were added to one 
 drop of pigeon's blood. Coagulation took place within four minutes" — and so of 
 other like experiments. "It becomes clear," says the author, "from these results, 
 that the mixture of venom and blood does not alter the vital fluid at first in any way 
 which is appreciable by the senses. It clots as firmly as usual. After a time, how- 
 ever, the clot softens." "In primary or acute poisoning I have never been able to* 
 detect the least alteration in the blood-cells. " But when death comes on slowly, or, 
 as the author calls it, " in chronic or secondaiy poisoning, the case," he thinks, "may 
 with propriety be then refen-ed to the incipient putrefactive changes which aft'ect the 
 blood, as well as to the continued influence of the agencies which first depress the 
 heart's action, and destroy nervous function." But, it is added — "we are still far 
 from knowing why, or precisely how, this or that structure is aff'ected." 
 
 All the results of our author's experiments refer us to the local action of the poison 
 for the constitutional uesults ; and so far from any early destruction or even depres- 
 sion of "nervous function," there was a strong development of the nervous influence, 
 as shown by the rigor of the muscles in some of the experiments, and by the \^ell- 
 known convulsions that occur in the experiments of others (§ 828 6). In one of our 
 author's cases, that of a rabbit, we have seen that he remarks that "the muscles and 
 motor nerves were perfectly excitable several minutes after death." This phraseology, 
 however, of destruction or depression of nervous function is very common when just 
 the reverse of it is the case, and where, as in our author's experiments, the alteration 
 or destruction of the organic functions is owing to an exaltation and modification of 
 the nervous influence (§ 225-232, 826 cc, 894-89G, 902, 905 a, &c. ; Index II, arti- 
 cle, Nervous Poiver). Nor does our author show that there was any sign of putreflxc- 
 tion of blood in any of his experiments. But if it be admitted that such was the feet, 
 it was manifestly the result of the morbid state of the solids ; and for a farther expo- 
 sition of which I would refer the reader to sections 516 no. 6, 845-847, 905 a, which 
 will serve as a guide to many other sections where the philosophy of the subject is 
 considered. 
 
 AVhat has been now said relative to the venom of the rattlesnake is not alone for 
 the puii^ose of giving greater eff'ect to the statements upon the same question in for- 
 mer sections of this work (§ 494 a-e, 845-847), but to contribute its light toward the 
 true interpretation of the modus operandi of the hydrophobic virus, of the virus of 
 the "dissection wound," hydrocyanic acid, strychnia, veratria, aconitina, &c., Avhich 
 present close analogies to the modus operandi of the venom of serpents, and for the 
 philosophy of which as expounded in this work the two Indexes liiay be consulted un- 
 der those several denominations. By these strongly-marked examples, as I have en- 
 deavored to show in a great variety of ways, and very extensively throughout this work, 
 Ave may be aided in our intei"pretation of the modus operandi of all other morbific 
 causes, and of all remedial agents, and be thus enabled to consign more and more 
 nearly to oblivion that stronghold of empiricism and the great incubus of Medicine, 
 the Humoral Pathology. 
 
 I would say, in conclusion, that notwithstanding the interesting nature of Dr. 
 Mitchell's Experiments, the question as to the modus operandi of the virus of 
 snakes was more distinctly and conclusively settled long ago by a single experiment 
 made upon a frog by Girtanner (§ 494 h). 
 
 Stphilization, — Whatever objections may exist against Professor W. Boeck s
 
 1148 NOTE BBB-CCC. — HEMORRHAGE, INFLAMMATION", ETC. 
 
 method of treating syphilis by inoculation, it has been well ascertained to be as suc- 
 cessful as other modes of treatment. "The value of syphiHzation as a curative 
 method has been a subject of long discussions in the Medical Society of Christiania, 
 occasioned by Dr. Hoist's report of Dr. Lane's and Dr. Gascoyen's views of Profess- 
 or W. Boeck's experiments with syphilization in London, 1865." At a late meeting 
 of that very enlightened society (1869), a great amount of statistical information, 
 from the most reliable sources, was produced ; from which it appears that the success 
 of tlie treatment is well established. 
 
 The particular bearing of this subject upon the humoral pathology is the principle 
 which it carries with it in behalf of solidism. As is well known, syphilis is slowly 
 extinguished by repeated inoculations upon the upper and lower parts of the body. 
 If the disease, therefore, were dependent upon the state of the blood, or any imagina- 
 ble " humors," its removal should be as readily effected by a large number of inocula- 
 tions of the upper parts of the body as by dividing the number between the upper and 
 inferior parts. On the contrary, however, when the entire number of inoculations, 
 which are sufficient to extinguish the disease if divided between the upper and lower 
 parts, are made wholly upon one or the other, that part which is avoided remains sus- 
 ceptible, and the disease is not eradicated (§ 76-80, 545, 657 a, 902 i). 
 
 Vaccination. — Parallel with the foregoing is a case of small-pox vanishing under 
 vaccination, which occurred in a family whom I was attending. On the third day 
 'after the mother had given birth to an infant she had a severe attack of varioloid, 
 which left no doubt that the child had contracted the smaU-pox in utero (§ 836). I 
 immediately vaccinated the infant in several places, and on the following day it broke 
 out with the small-pox. Both diseases advanced regularly till the seventh or eighth 
 day, when the pustules of the small-pox, with which the body was thickly covered and 
 confluent on the face, suddenly dried up, and were thoroughly exfoliated in two or 
 three days. No scar was produced. The vaccinated pustules went on through their 
 regular stages, forming the usual scabs and marks. 
 
 NOTE Bbb.— CAPILLARY HEMORRHAGE. 
 
 The subject of hemorrhage derives its principal importance from its significance of 
 the pathological conditions in which it originates, and therefore from its bearing upon 
 the treatment. This is especially the case with haemoptysis, hrematamesis, and pur- 
 pura hemon-hagica, in which affections I have endeavored to show that the hemor- 
 rhage is not owing to any rupture of the vessels, but is the result of a morbid process 
 analogous to secretion, and indicative of an inflammatory or congestive state that de- 
 mands an antiphlogistic treatment instead of the prevailing stimuLiting plan. Hae- 
 moptysis, whether as attendant upon pulmonaiy phthisis before ulceration has occult- 
 ed, or upon pneumonia, is Nature's remedy, and were this indication followed, we 
 should not continue to record the fearful mortahty from those diseases to which I 
 have already called the attention of the reader (§ 890 a-h, 922, 984, 1018-1019; 
 Note Mm, p. 1141; and extensively in the Medical and Physiological Com- 
 5IENTARIES, 1840, chapter on Venous Congestion). In this ^dew of the subject, there 
 is no question in practical medicine of greater importance (see Index II., article 
 Hemorrhage). But the object of this Note is more particularly to say, that no investi- 
 gations have yet disturbed my position as to the source of the hemorrhages ; and as 
 a corroborating proof of this, I may quote a late paragi'aph from a high authority. 
 Thus— 
 
 " Dr. Rasmttssen, in his raluable paper, shows that, extensively as the subject of 
 hremoptysis, especially in connection with pulmonary phthisis, has engaged the atten- 
 tion of investigators, the source of these hemorrhages, the absolute demonstration of 
 the vessel or vessels whence the blood has come, has almost entirely failed." — Brit, 
 and For. Med. Chir. Rev., Jan., 1869. 
 
 NOTE Ccc— INFLAMMATION OF THE BRAIN.— CEREBRO-SPINiVL 
 
 MENINGITIS. 
 
 Many writers in Europe and America have lately contributed their experience in 
 relation to the disease which has acquired the designation oi cerebrospinal meningitis, 
 though a difference of opinion exists as to its local or constitutional nature. That
 
 NOTE DDD. CORRELATION OF FORCES. 1149 
 
 inflammation of the brain and spinal cord, particularly of the fonner organ, is con- 
 stantly met with as a local disease, can not be doubted. But the malady is often 
 showing itself in connection with idiopathic fever (§ 712, 757 a), particularly when 
 fever prevails epidemically (§ 779) ; and there is much reason to believe that, in a 
 general sense, when cei'ebral inflammation occurs epidemically, it is an incident of 
 constitutional or idiopathic fever, as when pneumonia prevails epidemically, and of 
 which latter complication several authors have given a history. That by Cleghom, 
 an abstract of which occurs at pages 757-759, is well worthy of the reader's atten- 
 tion, not only for the light which it reflects upon epidemic cerebro-spinal meningitis, 
 but for the admirable experience in the treatment of the pneumonic complications. 
 But whether the cerebro-spinal inflammation be simply a local affection or compli- 
 cated with idiopathic fever, it is the local condition to which the treatment should be 
 mainly directed, and this treatment should consist chiefly of large abstractions of 
 blood. Whatever may be the prostration of muscular strength, or "debility" as it 
 is called (§ 487 h, 569, 887, 901-904), the patient will soon be invigorated by copious 
 bloodletting, as in Cleghorn's cases of pneumonia (§ 1005 A), or in Jackson's cases 
 of cerebral inflammation complicated with prostrating idiopathic fever (§ 992 i), or 
 as related by many other masters in the healing art whose experience is jjresented in 
 this work in the article on Loss of Blood. The failure of the remedy in the hands 
 of those who have adopted it is owing, as Sydenham well says, "to bleeding in an 
 improper manner," which means, according to Botallus, that " bleeding does no serv-. 
 ice in many cases, either because persons have recourse to it too late, or use it too 
 sparingly, or commit some error in both these particulars" (§ 1000, 1001 a). Although 
 large abstractions of blood are indispensable in the prostrating forms of epidemic 
 pneumonia (§ 1005 A), puerperal fever (§ 1005 a-g), plague, yellow fever, and so- 
 called " putrid fevers" (§ 1002-1004, NoteFf, p. 1135), in cerebral inflammation the 
 exigencies for the remedy are greater, and the system is enabled to sustain greater 
 losses of blood than in any other malady, and for reasons explained in sections 974- 
 979. 
 
 The fatality of "cerebro-spinal meningitis" has been so great in recent times, that 
 we may look for an early abandonment of the stimulating treatment, and a return to 
 the successful practice of our predecessors. Indeed, already we begin to hear of 
 bloodletting and its useful eff'ects, particularly as practiced in France. Thus, a 
 writer in the Medical Times and Gazette of May 25, 1867, remarks that — "In the 
 French epidemic large bleedings, in the early stage of the disease, were the only means 
 of treatment attended with success." — It may be safely stated that in the epidemics of 
 this disease during a few late years more than three fourths of the subjects have per- 
 ished when bloodletting has been neglected. That the disease is of the most intense 
 inflammatory nature will not be doubted, even by those who recognise no other test 
 of inflammation than its physical products. These are abundantly set forth by those 
 who have made extensive anatomical investigations. As an example, it is said by 
 Dr. Sanford B. Hunt that— 
 
 " Of 08 autopsies, the records of which have been examined, all present positive 
 evidence, not only that the meninges of the brain and spinal cord were the locali- 
 ties of inflammatory disease, but that the sufferers died from the inflammation, and 
 not from any intercurrent or other disease. The appearances in the other organs 
 were mostly negative." The vital signs were such as distinguish the worst forms of 
 cerebral inflammation. 
 
 NOTE Ddd.— CORRELATION OF PHYSICAL AND VITAL FORCES. 
 
 In what has been said specifically upon the subject of Correlation oj" Physical and 
 Vital Forces at page 921, it was simply intended to bring to the reader's attention 
 the ample discussion of the relation of the vital force to organic heat which extends 
 from page 234 to 279, and where the vital force is variously contradistinguished from 
 animal heat, and the latter shown to be only one of the numerous products of the 
 former in its operation through organic structures. In the progress of that inquiry 
 numerous facts are also presented — such, for example, as relate to the nervous influ- 
 ence, which prove incontrovertibly the absolute independence of the vital force of all 
 other forces. But the discussion of the function of calorification embraces only a 
 veiy limited array of the Author's arguments against the identity of the vital force 
 with those of physics and chemistry, or their conversion into each other. All that 
 the Author has said upon the composition and structure of organic beings, all upon
 
 1150 NOTE EEE-FFF. NERVOUS POWERS, COMPOUNDS, ETC. 
 
 the properties of life, all upon the nen'ous influence and laws of the nervous system, 
 all upon the organic and animal functions, all upon the principles relative to patholo- 
 gy, therapeutics, and the modus operandi of remedies, forms an imanswerable demon- 
 stration against the doctrine of Correlation or Equivalence of Forces. It will be seen, 
 therefore, from the foregoing references, that a greater part of this book is in direct 
 opposition to the doctrine. 
 
 The advocates of that doctrine must also identify the intellectual part of man with 
 the common forces of matter, and, from the obvious analogy between the human and 
 Divine Mind, with God Himself This they do, not only impliedly, but by a direct 
 advocacy of materialism, and not seldom by an avowal of atheism. This I shall show 
 extensively in the enlarged edition of my work on the Soul and Instinctive Principle, 
 to be soon published by the Messrs. Harper & Brothers, and where, also, may be 
 found a critical examination of the doctrine of the Correlation of Forces in its appli- 
 cation to the Life of organic beings, and to the Soul. 
 
 One of the plausible consequences of that doctrine, and which is brought to their 
 mutual support, is the assumed identity of certain artificial compounds and the sim- 
 ple transformations out of organic substances which have been generally supposed to 
 retain their organic constitution ; and which will be farther considered in Note Fff. 
 
 !bfOTE Eee.— SUPPOSED IDENTITY OF THE NERVOUS POAVER AND 
 
 ELECTRicrrr. 
 
 The mechanical theorists who had supposed that they had settled experimentally 
 the identity of the neiTous power and electricity, haA-ing from other experiments con- 
 cluded that the nerves convey their influence, whether motor or sensitive, at the rate 
 of only about 90 feet in a second, and having thus abandoned the electrical hypothe- 
 sis, have presented a serious obstacle to their doctrine of the correlation of forces. It 
 is equivalent to an admission that there is nothing in inorganic nature that will in the 
 least interpret the phenomena relative to the nervous system, and that we must there- 
 fore seek for a solution of the problem in the phenomena of life and independently of 
 artificial contrivances (§ 234 e, 409 k and references there, 893 a, Note Y). 
 
 NOTE Fff. — SUPPOSED ARTIFICIAL PRODUCTION OF ORGANIC 
 COMPOUNDS. (See Article on Composition, p. 23-49). 
 
 The numerous productions out of inorganic substances which have latel}' proceeded 
 from the laboratory of the chemist in imitation of simple transformations out of or- 
 ganic compounds, require only a very brief notice. In the first place those transform- 
 ations are the results of artificial influences, the very object of which has been to in- 
 stitute changes in the original compound, as in tlie production of morphia, quinia, 
 alcohol, &c. These substances, therefore, have, doubtless, been more or less diverted 
 from their organic constitution by the reagents employed, altliough they may have 
 been as simple as heat, or atmospheric air ; and what renders this certain are the al- 
 kalescent nature and crystalline structure of quinia, morphia, cinchonia, &c. Indeed, 
 some of these reputedly organic compounds may be made to undergo an apparently 
 endless variety of transformations ; such, for example, being the case with alcohol 
 when subjected to the action of certain acids tln-oughout its various changes. It is 
 not remarkable, therefore, that apparent imitations of some of these things should 
 have been made out of inorganic substances. But what reliance can be placed upon 
 the supposed organic nature of these chemical compounds ? Some of the best au- 
 thorities, as we have seen — Lehmann for example — assure us that analyses of organic 
 compounds are not reliable (p. 789-794, § 1028-1033). Nevertheless, the supposed 
 organic constitution of those purely artifical productions is too important to tlie doc- 
 trine of the Correlation of Physical and Vital Forces to be surrendered without a 
 struggle on the part of the materialists. In that struggle they must encounter the 
 fact tliat no organic compound has yet appeared as the natui'al product of the forces 
 and laws of inorganic nature, and that even animal organisms are incapable of organ- 
 izing the simple elements of matter or their inorganic compounds. Nothing but 
 jjlants have been able, in a solitary instance, to form an organic compound out of in- 
 organic substances. This is the great function which devolves upon them, and for 
 the manifest purpose of supplying food to tlie animal kingdom (§ 1052). Hence it 
 is not probable that the chemist will ever succeed in his aspirations at becoming Na-
 
 IS^OTE GGG. — BLOODLETTING VERSUS STIMULANTS. 1151 
 
 ture's journejTnan. Looking, therefore, at Nature alone, I ask the materialist wheth- 
 er it is probable that his favorite Nature, which, he concedes, "operates by uniform 
 laws," would have been so inconsistent as to have ordained the vegetable tribes for 
 the universal purpose of organizing the elements of matter for the sustenance of the 
 animal tribes, and at the same time have so endowed the elements of matter as to 
 unite into organic compounds, in virtue of their own inherent properties, whatever 
 physical influences may be brought to operate upon them ; while, at the same time, 
 she has denied to animals the ability which is so lavishly bestowed upon the vegetable 
 world ? Moreover, if you can discover no difference between the Force wliich ani- 
 mates the organic kingdom and the forces of external nature, do not the fundamental 
 distinctions between the organic structure of plants and all the supposable conditions 
 of the elements of matter under every imaginable influence pronounce the impossibili- 
 ty of efl"ecting by any artificial processes the compounds which are the woi'k of vege- 
 table organic structure, and then only through an elaborate series of organs which 
 are every where distinguished by consummate designs all working harmoniously togeth- 
 er/or this very result ? 
 
 As animals can not be nourished by inorganic matter, there remains to the chemist 
 an important test — try the supposed organic compounds derived from unequivocal 
 inorganic 'substances as food for animals, and should they prove a means of suste- 
 nance a great triumph will have been obtained for the doctrine of the Correlation of 
 Forces ; while, on the contrary, should failure ensue, Chemistry will as modestly re- 
 tire into its A'ast domain — the mineral kingdom (§ 1052). And yet another test ; tiy 
 a supposed compound like quinia and morphia, made from the elements of matter, 
 as remedial agents, and if the former will cm'e intermittent fever, and the latter pro- 
 cure sleep and relieve pain, they will prove a great acquisition to the Materia ]\Iedica. 
 
 Finally, the eminent Virchow, who is deeply interested in the manufacture of 
 something approximating the simplest fonns of organic substances, tells us that — 
 
 "Chemistry has not succeeded in forming a blastema [the general formative ele- 
 ment of tissues] nor physics in forming a cell. What does it matter ?" — See my 
 work on the Soul and Instinctive Principle, edition of 1870, where this subject 
 is discussed in that I'elation. 
 
 NOTE 'Ggg.— BLOODLETTING VEESUS STIMULANTS. 
 
 As might be anticipated from the results of the stimulating treatment of inflamma- 
 tions and fevers, a reaction has been taking place for a few late years, even among its 
 strongest advocates, both in this country and in Europe. It has again had, along 
 with its universal pathological principle "debility," its "temporary day." And 
 where will its advocates be in tire future annals of medicine ? Perhaps an answer 
 may be found in the remaAable fact in relation to Bloodletting in the treatment of 
 inflammations and fevers — that there is not one individual in the history of medical 
 literature who has contributed to the improvement of medicine, or whose writings 
 have survived his own generation, that has not declared bloodletting to be tlie princi- 
 pal remedy, in a general sense, for those diseases, and always so in pneumonia, pleu- 
 ritis, phrenitis, enteritis, articular rheumatism, puerperal fever, congestive fevers, &c. 
 (§ 1005^ a, 1006 g). If there be one exception, it has escaped my knowledge. It is 
 in respect to the stimulating treatment of disease and the doctrine of debility, as with 
 the efforts to carry Organic Chemistry into physiology and pathology (see p. 203, 
 § 376i). All this has been due to the simply practical character of the age, in which 
 the senses have had the lead of the understanding. And mav we not confidently af- 
 firm that such a dispensation awaits the projectors of the doctrine of the " Correlation 
 of the Physical and Vital Forces" ? 
 
 Finally, I may speak of the results of bloodletting in my own practice ; not, how- 
 ever, according to the usual " numerical method," but will simply place it upon rec- 
 ord in behalf of ]\Iedicine, in addition to my statement as to croup (§ 10r)8 jj), that 
 after an unintermitting practice of fift3--four years I have never failed of abstracting 
 blood in enteritis, pneiunonia, phrenitis, pleuritis, and puerperal fever, and with rare 
 exceptions in erysipelas, both in their simple and compHcated forms, and that I have 
 never lost a patient affected with either of the last three diseases, two only of enteri- 
 tis, one of phrenitis, and one only of pneumonia (a child of three j^ears in 1818), and 
 this last, in my judgment, from insufficient bloodletting (§ 973-980, 1058 q). 
 
 THE END.
 
 THE 
 
 INSTITUTES OF MEDICINE. 
 
 By MARTYN PAINE, A.M., M.D., LL.D., 
 
 Professor of the Institutes of Medicine and Materia Medica in the University of New York; Author 
 of the " Jledical and Physiological Commentaries," "A Treatise on the Soul and Instinct," 
 "Therapeutics and Materia Medica," etc., etc. ; Corresponding Member of the Royal Ve- 
 rein fiirHeilkunde in Preussen; Corresponding Member of the Royal Medico-Chirur- 
 gical Academy of Turin ; CoiTesponding Member of the Gesellschaft fiir Natur 
 und Heilkunde zu Dresden ; Honoraiy Member of the Imperial University 
 Physico-Medical Society of Moscow ; Member of tlie Medical Society of 
 Leipsic ; of the Medical Society of Sweden ; of the Montreal Nat- 
 ural History Society ; and of many other Learned Societies. 
 
 With a Portrait. New Edition, Revised and Enlarged, with a Copious Index. 
 
 The Publishers, in offering to the profession ^ New and Enlarged Edition of Dr. Paine's Insti- 
 tutes OF Medicine, avail themselves of the opinion of the Medical Press in behalf of the work, 
 and subjoin numerous extracts from late periodicals. Some of tlie extracts bear upon a controvert- 
 ed question, but the Publishers are not disposed that their copyright shall suffer by any abstraction 
 from the merits of the work ; and that the latter may go forth under unquestionable authority, 
 they have made the extracts of unusual length. As a prophet, also, is said to be without honor in 
 his own country, the Publishers are disposed to show that exceptions occasionally arise, and tha? 
 this may be the more apparent, and as they are content withal, they limit the extracts to American 
 periodicals ; or, rather, do not await the arrival of Foreign Notices of this Fourth Edition of tlie 
 Institutes. 
 
 October 8, 1S53. 
 
 From the New York Jourivxl of Medicine, May, 185S. 
 
 " The Institutes is full of learning and philoso- 
 phy, and the reader, while impressed with the 
 profound erudition of the author, can not but be 
 amazed at the amount of labor the book dis- 
 closes. * * Professor Paine is engaged in a strug- 
 gle for truth. His mind is concentrated upon 
 the elimination of facts, and in the pursuit of 
 what he deems right he seeks not the applause 
 of his contemporaries. He knows full well that 
 principles must and will survive the disputations 
 of the controversialist. * * He is, in every sense 
 of the word, a medical philosopher, a devotee of 
 science, and a commentator whose opinions will 
 not only pass to posterity, but receive the high 
 tribute to which they are entitled. Inflexible in 
 his convictions of truth, he can not be moved by 
 friend or foe — and he pursues his onward course 
 with an earnestness and zeal characteristic of the 
 man. • * We can confidently recommend the In- 
 
 stitutes both to the practitioner and student of 
 medicine ; to the former it will be a rich treat — 
 it will open to him the wide and fruitful field of 
 medical science, and he will see elaborated in it 
 the great and leading questions which have so 
 long constituted the basis of controversy among 
 the learned in our profession. The latter will 
 find it a treasury of knowledge — a veritable en- 
 cyclopaedia — full of the prominent facts of his 
 science ; and its tendency, moreover, will be to 
 induct him into habits of thought and reflection. 
 Lastly, we may be permitted to say that the ar- 
 ticle on the 'Rights of Authors' has been elicit- 
 ed by what Professor Paine deemed an infringe- 
 ment upon his claims ; and he has entered upon 
 the subject not only with zeal, but, in the lan- 
 guage of the law, he has made out his case by a 
 chain of very positive evidence." 
 
 From the same Jour^ial 0/ July, 1S58. 
 
 " There is no where to be found in medical lit- 
 erature, nor in all medical works extant put to- 
 gether, so full, so complete, so accurate an ex- 
 position and elucidation of the functions, and 
 the paramount importance of the ganglionic sys- 
 tem in influencing all the organic functions (in- 
 cluding secretion) physiologically and pathologic- 
 ally, as is contained in the ' Institues' and other 
 writings of Dr. Paine. An examination of the 
 Index of the ' Institutes' alone will prove this. 
 Fifty such essays as that of Dr. Campbell could 
 be compiled from the ' Institutes,' and then 
 leave material, facts, and illustrations enough for 
 as many more, all embodying and setting forth 
 
 the same doctrines. * * The author of the ' In- 
 f^titutes' and of the ' Medical and Physiological 
 Commentaries' can well afford to bide his time. 
 His fame is secure. It will grow brighter with 
 time. The profession will delight to cherish it 
 and to do him honor. They will not allow a 
 single particle of his just merits to perish, or to 
 be appropriated by others. Posterity will vindi- 
 cate all his just claims and assign his rank among 
 the great minds of our countiy. But few proper- 
 ly appreciate, or are even acquainted with the 
 extent of his Herculean labors. None but those 
 who have labored in the .same field can justly es- 
 timate the vast range of his learning. — C. A. L." 
 
 From the American Medical Gazette, New York, June, 1S5S. 
 
 "That the 'Institutes of Medicine' and the 
 'Medical and Physiological Commentaries' are 
 characterized by great analytic power, profound 
 philosophy, rare genius, and unsurpassed learn- 
 ning, no candid reader can deny ; that they will 
 rank with the foremost works in our science, and 
 entitle tlieir author to a high rank among the 
 
 greatest men in medicine, will hardly be dis- 
 puted. • * In the late Appendix to the Institutes 
 many important subjects are discus.sed with tho 
 usual acuteness and ability of the author. The 
 Index, of 175 pages, may well be called a model 
 index, as it contains a brief summary, as it were, 
 of the entire work."
 
 PKOFESSOR PAINE'S INSTITUTES OP MEDICINE. 
 
 The September Number of the foregoing jour- 
 nal contains a forcible and triumphant article of 
 thirteen pages, by Professor C. A. Lee, in defense 
 of Professor Paiue's claims of originality in elu- 
 cidating and applying what is designated as the 
 " excito-secretory function of the nervous sys- 
 tem," and showing that the term itself has been 
 derived from his Institutes of Medicine. We 
 quote the following : 
 
 " Dr. Paine claims, and very justly, as may 
 be seen by our extracts, a long priority in desig- 
 nating the nervous mechanism through which 
 the secretions are physiologically influenced ; and 
 although he baa not thought it worth his while 
 to insist upon his priority in the small matter of 
 bestowing a name upon the function, we have 
 shown that he suggested the very name which is 
 now apparently conceded by nearly all the med- 
 ical periodicals in this country to form the only 
 originality belonging to Dr. Campbell. But what 
 is alone of any importance. Dr. Paine was not 
 only the first, but still the only one to carry the 
 'excito-secretory function' and all the physio- 
 logical laws of the nei-vous system into patholo- 
 gy and therapeutics. * * But Dr. Paine regards 
 the excito-secretory function of the nervous sys- 
 tem as a very minor part of the influences of that 
 
 system, the most important of which is its vari- 
 ously alterative eflfects upon the organic func- 
 tions ; or, in his own language, ' in all the cases 
 the nervous power is rendered stivmlant, or de- 
 pressant, or alterative to the organic properties 
 and functions, and variously energetic, according 
 to the operating cause, and the intensity and 
 suddenness with which it may operate." — p. 107. 
 " The whole of this disputation has had its origin 
 in a mere pretense that has grown out of a name. 
 Excito-secretory /ii7ictio)i is the magic word which 
 is made to engulph the whole philosophy that 
 concerns the labyrinth of the organic functions 
 in their connection with the nervous system. 
 But it is a woi'd of such partial import as not to 
 convey the slightest connection with pathology 
 and therapeutics; but, on the contrary, to im- 
 press the belief that it is limited to the natural 
 state of the body. It disregards all the modify- 
 ing influences of the nervous system upon organ- 
 ic actions and their products, whether induced 
 by remedial or morbific agents; and the inap' 
 propriateness of the term, beyond its mere phys- 
 iological import, may readily be seen should any 
 one attempt its introduction into any of the path- 
 ological or therapeutical branches of Dr. Paine's 
 Institutes of Medicine." 
 
 From the Virginia 3[edical Journal, July, ISDS. 
 
 * " In these degenerate days, when all men bow to 
 the sway of public opinion, and are more prone, 
 alas, to be ruled by policy than to follow the 
 guidance of reason and judgment; in these latter 
 days — when the voice of the people is the voice 
 of God, we, at least, should not withhold our 
 praise from him who fears not to stem the cur- 
 rent of popular opinion, and who strikes a bold 
 blow in defense of the right. However we may 
 wonder at his hardihood, and hesitate to follow 
 his rash example, we involuntarily admire this 
 uncompromising devotion to his own doctrines, 
 and respect the courage we are too timid to imi- 
 tate. The author of the work we have now un- 
 der consideration is emphatically such a man as 
 we have endeavored to describe. At a period in 
 the history of medicine when the mind of the 
 profession is running like a torrent under the 
 guidance of Andral, Louis, and the other brill- 
 iant leaders of the pathological anatomists, into 
 the humoral theory of disease — when, too, the 
 reaction against the heroic school of medicine 
 had reached to such an extent as to favor the 
 rise and temporary success of the infinitesimal 
 dogma, and, more important than all — when the 
 progress of organic chemistry is startling the 
 minds of men with its bold innovations and 
 brilliant theories in physiology and pathology, 
 it was then that Dr. Martyn Paine, almost alone, 
 with nothing to support him save his indomitable 
 energy, his great learning, and his intrepid heart, 
 stood up before the medical world in defense of 
 the waning school of vital physiologists and the 
 time-honored solidism of Stahl and Hunter — 
 
 when medicine expectants was most triumphant 
 he still advocated blood-letting and the admin- 
 istration of remedies on the heroic plan — when 
 Liebig, Thompson, and Lehmann unite in lead- 
 ing the student through the attractive investiga- 
 tions and plausible theories of zoochemistry. 
 Dr. Paine Btill gallantly defends the creed of 
 Bichat and the vitalists against all comers, and 
 charges boldly and effectively upon the ever in- 
 creasing ranks of the humoral pathologists. 
 
 "It is justly due to this learned and zealous in- 
 vestigator and medical philosopher to say that 
 we do not belie%'e there can be found another man 
 in America who would have waged this unequal 
 war for so long a time and with such signal abil- 
 ity; and although we doubt whether many of 
 our readers have ever devoted time enough to 
 his various books, tracts and essays to enable 
 hira to do justice to his labors in medicine, yet 
 we will point to every thing which has emanated 
 from his pen as being characterized with an 
 amount of learning, profound reasoning, and a 
 power of resistance equal to the emergency. * * 
 We can not but be astonished at the amount of 
 ground traveled over by this zealous student, 
 and wo may point him out to the young in the 
 profession as a noble example of what may be ac- 
 complished by those who will imitate his indus- 
 try and perseverance after knowledge." 
 
 The August Number of the foregoing journal 
 contains the able article to which reference is 
 made under our extract from the New Hamp- 
 shire Journal of Medicine. 
 
 From the American Journal of the Medical Sciences, Philadelphia, July, IS^. 
 
 " Dr. Paine's Institutes of Medicine presents 
 throughout ample evidence of the general erudi- 
 tion of its author, his habits of close investiga- 
 tion, and his intimate acquaintance with the 
 subjects of which he treats, and with the views 
 entertained by others in respect to them. A de- 
 gree of originality and independence of thought 
 pervades all his teachings, whether these have 
 reference to the vital conditions and functions of 
 the human organism, the laws by which they are 
 governed, or to the nature, causes, and tenden- 
 cies of disease, and the curative measures by the 
 agency of which this may be best conducted to a 
 favorable termination. 
 
 "The Institutes of Medicine as presented by Dr. 
 Paine, whether we receive them as true, or reject 
 them as l.ilse, are, nevertheless, based upon a 
 
 truly philosophical investigation, aided by all 
 tlie accumulated light derived from the observa- 
 tions, experiments, and reasoning of preceding 
 and contemporary authorities, of the physiology, 
 pathology, and therapeutics of the human sub- 
 ject. 
 
 It is, we confess, somewhat cheering to meet 
 with one of the high intellectual endowments of 
 Dr. Paine, who, at the present day, when the 
 doctrines of physiologists, pathologists, and ther- 
 apeutists are alike verging into materialism — 
 when the organic fimctions, at least, of the ani- 
 mal organism are all referred to a mere modifi- 
 cation of the same action and reaction which oc- 
 cur in brute matter, lias sufficient courage to 
 raise his voice in defense of the vitality of the 
 system ; in recognition of the fact that our or-
 
 PROFESSOR PAINE'S INSTITUTES OF MEDICINE. 
 
 gans are built up and maintained in a healthful 
 condition for the regular performance of theii' 
 appropriate functions by a principle which we 
 denominate life, and by which the material ele- 
 ments of the animal organism are almost entire- 
 ly removed from out the control of those merely 
 physical laws to which, as dead matter, they 
 would necessarily be subjected. 
 
 "We considerthe treatise to be one well worthy 
 of an attentive study on the part of every ad- 
 vanced student and practitioner of medicine, to 
 whose notice we earnestly recommend it. Al- 
 though far from being inclined to indorse the ac- 
 curacy of every doctrine advanced by the author, 
 nor the chain of reasoning by which he attempts 
 
 its support, we are, nevertheless, convinced that 
 his prelections, from the amount of truth set 
 forth in them, and the vitality by which they arc 
 pervaded, if they do not actually convey sound 
 views on eveiy thing that relates to the philoso- 
 phy of medicine, can not fail to lead at least to a 
 correct basis for the establishment of such views. 
 The strong conservative predilections of Dr. 
 Paine, which induce him to subject every new- 
 observation and theory in medicine to the sever- 
 est scrutiny, and to refuse its admission until 
 positively established, can have no other than a 
 favorable influence upon his readers, by teaching 
 them to be progressive only in the road of posi- 
 tive truth D. F. C." 
 
 From the Korth American Medico-Chinirgical Review, September, 1S5S. 
 
 "No one can read the Institutes of Medicine 
 without being filled with respect and even ad- 
 miration for tlie profound erudition, the pains- 
 taking and systematic research, and the laborious 
 reflection exhibited so abundantly in its pages. 
 With careful and discriminatinghands Dr. Paine 
 has gathered together, from the writings of both 
 the earlier and contemporary physiologists, the 
 numerous important facts and details whicli con- 
 stitute the subject-matter — the crude material — 
 so to speak, of his favorite science, and arranged 
 and built them up into a stately edifice — the In- 
 stitutiones Medicinse — whose great corner-stones 
 
 are Physiology, Pathology, and Therapeutics. 
 We conclude our remarks by earnestly recom- 
 mending his work to the careful perusal and 
 study of every one interested in physiology, 
 whether in its aspect of a pure or an applied sci- 
 ence. The breadth and comprehensiveness of 
 manyof its doctrines, the great questions in which 
 it abound.% and the consummate skill and learn- 
 ing with which these are generally treated, stamp 
 it as a valuable treatise which should find a place 
 in every philosophical library and be consulted 
 by every physician who practices his profession 
 as a science and not as an empyrical art." 
 
 From the Medical and Surgical Reporter, Philadelphia, May, 1S58. 
 
 "Dr. Paine gives us two very copious Indexes 
 and an Appendix to his Institutes of Medicine, 
 and we find throughout the work constant refer- 
 ences from page to page to facilitate the task of 
 the student in acquiring a complete knowledge 
 of every subject. Finally, as a postscript, he de- 
 tails in full what he claims as his own, and wo 
 think we can not do better than lay his claims be- 
 fore our readers. 
 
 " In his Preface to this fourth edition Dr. Paine 
 says: 'This work, originally published in 1847, 
 remains without change, as the author has seen 
 no reason to modify any of his doctrines.' But 
 in his Appendix he does ample justice to all sub- 
 sequent discoveries in physiology and chemistry, i 
 
 He says : ' Whatever may have been subse- 
 quently disclosed in physiology and chemistry is 
 essentially in harmony with all that the author 
 incorporated in the foundation upon which his 
 Institutes are erected, and places them beyond 
 the probability of being much invalidated. In 
 his discussion of organic chemistry as applied 
 to physiology, pathology, and therapeutics, it is 
 evident that he could not doubt that this inva- 
 sion upon medicine would prove ephemeral, and 
 that the chemist would soon retreat into the ap- 
 propriate field of nature.' 
 
 " He reviews very thoroughly all the evidence 
 connected with this statement, and certainly 
 shows good logical reasons for his views." 
 
 Froin the Charleston (S. C.) Medical Journal and Review, July, 1853. 
 
 " Few men have labored more constantly, more 
 earnestly, and with more singleness of purpose 
 than the venerable and learned author whose late 
 edition of tlie Institutes of Medicine now lies be- 
 fore us. * * Tlie arrangement of the work is ex- 
 ceedingly systematic and satisfactory. Step by 
 step the reader is led on from the study of the 
 functions as they exist in health to the causes and 
 consequences of their derangement, and to the 
 methods of treatment adapted to them. 
 
 "Professor Paine's style is at once vigorous, 
 bold, and classical. Stating in few words the 
 thought which he would convey, he does so in 
 
 From the Boston Medical and 
 
 " One can not fail, in reading Dr. Paine's Insti- 
 tutes of Medicine, to be struck with the immense 
 industry of the author, with his originality, and 
 with his consistency ; and if we must differ from 
 him in some of his views, we do bo with the diffi- 
 dence due to a learned and conscientious teacher." 
 
 In a subsequent Number (July 29th) it is said 
 by " W. E. C." of Dr. Paine's Medical and Phys- 
 iological Commentaries: 
 
 " The first peculiarity of Dr. Paine that arrests 
 us is the solid, methodical manner in which he 
 plants himself at his work— the thorough dplomb 
 which he establishes for himself before he grap- 
 ples with his subject-matter. You feel assured 
 of this in the first ten lines you read. It is not 
 going to be any trifling affair, you are at once 
 
 such a manner as not to allow it soon to he ef- 
 faced. His writings are every where character- 
 ized by perspicuity and terseness ; and if his 
 meaning is not understood (as may often hap- 
 pen) it is not due to the faulty expression of it, 
 but to the fact that he deals with subjects of great 
 depth and difficulty of comprehension — beyond 
 the span of many minds, above the reach of all, 
 unless close attention and undeviating thought 
 be given to their study. The reader may at first 
 find some difficulty in following the writer, but 
 he will soon become accustomed to his style, and 
 read with interest and facility." 
 
 Surgical Journal, May, 1S5S. 
 
 convinced. It is a brawny student of the old 
 very old sort you have got into companionship 
 with, and if you wish to keep his company you 
 must buckle yourself closely to the matter before 
 you, and set yourself to hard work. 
 
 " The scope he has taken is our next point of 
 note. This is not only shown by allusions and 
 casual references in the text, but the foot of al- 
 most every page in the book has quotations, with 
 chapter and page, from apparently every work 
 that can possibly illustrate the subject or enforce 
 the writer's views, including not only accredited 
 books, magazines, and monographs in our pro- 
 fession, but tliose from every walk of literature, 
 giving us a high opinion of the author's cultiva- 
 tion of pursuits too often neglected by medical
 
 PROFESSOR PAINE'S INSTITUTES OF MEDICINE. 
 
 men. These are used, too, not, as is often the 
 case, simply to set off the text and suggest ideas 
 of the research of the writer, hut as genuine il- 
 lustrations either of the matter in hand and the 
 peculiar view of it taken by the writer, or of the 
 mental temperament of the time in which the 
 doctrine or its converse was first propounded. 
 In short, the book is not that of a sciolist, by a 
 great deal, but of a thorough and strong scholar, 
 from a very contact with whom strength and re- 
 freshment may be derived, even if difference of 
 opinion should exist and remain after it. 
 
 " As we have said, it is impossible to review 
 
 here such a work as Dr. Paine's, but we may 
 give an idea of some of its contents, &c., <S:c. 
 
 " A Dissertation on the Hippocratic and Ana- 
 tomical Schools, and another on the writings of 
 Louis, conclude the second volume. The last 
 paper is as remarkable and as characteristic as 
 any thing in the two vol umes ; of and in itself it 
 shows fully the scope, power, and variety of the 
 scholarly Author. We will not comment upon 
 it, but earnestly recommend a perusal of it, and 
 in return for our good advice would only like to 
 watch the countenances of certain friends of ours 
 well engaged in the recreation." 
 
 Frovi the Montreal Medical Chronicle, September, 1S5S. 
 
 " No one can peruse these volumes of Dr. Paine 
 (the Institutes and Commentaries) without being 
 forcibly impressed with the vast amount of eru- 
 dition displayed by the learned Author. Every 
 page bears witness to an extent of reading and 
 research really sui-prising. It is not only the 
 standard medical works in various languages 
 that he has consulted, but periodic.il literature 
 has been thoroughly ransacked to discover new 
 
 thoughts, truths, and experiments in support of 
 and bearing upon the peculiar views he advances. 
 " As we agree in the main with the vitalists, al- 
 though differing from them in some respects, and 
 as we admit the vast importance of much that is 
 taught by the zoo-chemists, we shall endeavor to 
 give our readers, in as few words as possible, the 
 view we take of life." 
 
 From the Buffalo Medical Journal aJid Review, September, 1858. 
 
 "The Institutes of Medicine first saw the light 
 at a time when the humor.il and chemical doc- 
 trines of life were in the ascendancy, and when 
 vitalism was scouted as an obsolete relic of by- 
 gone ages. But now, when the opinion begins 
 very generally to prevail, that the physical doc- 
 trines of life will not suffice for the satisfactory 
 solution of the varied phenomena of organic be- 
 ings in health and disease, nor for the explanation 
 of the ')nodus operaiidi of remedies, there is evi- 
 dently a commencing reaction in favor of the 
 doctrines of vitalism ; and this work, and the 
 ' Commentaries' of our author, begin to be 
 sought for with avidity. This must be greatly 
 gratifying to Prof. Paine, who, with far-reaching 
 foresight, saw very clearly that a system of med- 
 ical philosophy, based on the laws of the inor- 
 ganic world, could not stand when brought to the 
 test of observation and experiment. On reading 
 the ' Institutes,' we can not but be struck with 
 the admirable consistency of the author's views 
 throughout the entire work. The same princi- 
 ples, the same philosophy ftirm the foundation 
 and substratum of the whole. There is no in- 
 consistency, no contradiction, not even the shad- 
 0\7 of any clashing throughout. Taking up each 
 topic in its natural ordei', as each successive one 
 emanates from, or depends upon, the preceding, 
 there is a lucid order every where disjilayed — a 
 chain, with no broken link. As in a mathemat- 
 ical demonstration, each step prepares the way, 
 and is necessary for the succeeding. The dem- 
 onstration proceeds with logical exactness and 
 unbroken sequence, till the conclusion rests on a 
 basis impregnable as truth itself. 
 
 "As the author truly remarks, this is the first 
 effort that has been made to present the natural 
 relations of the whole subject of the institutes of 
 medicine, including physiology, pathology, and 
 therapeutics in their just order — to point out the 
 
 affinities, and to exhibit throughout the import- 
 ant laws and essential foundations of vitalism and 
 to maintain throughout a consistency of facts 
 and of laws that shall stamp the whole as the 
 philosophy of viedidne. This has been most 
 successfully accomplished ; and the zeal, learn- 
 ing, and genius displayed in its accomplishment 
 will forever stamp the author as a leading spirit 
 in our profession — as one of the great masters in 
 our art. If the work bear something of a contro- 
 versial aspect, it was unavoidable in carrying out 
 the great design of the writer. A simple expres- 
 sion of facts, of experience, and of philosophical 
 doctrines, would not have sufficed. It was nec- 
 essary to expose and refute the errors with which 
 the subject was environed." 
 
 In an extended analysis of the work, the re- 
 vicM'er enters upon the author's original views of 
 the nervous system, and more specifically as to 
 the " excito-sccretory system," showing that even 
 the term Itself was derived from writings of his 
 as early as 1S42, but that he regarded it as only 
 a small part Of tlie influences exerted through the 
 same system of nerves, and quotes the author 
 extensively to this effect. "No one," says the 
 Reviewer, " can read Dr. Paine's Institutes with- 
 out being satisfied that ' excito-sccretorif is every 
 where comprehended in what is set forth as to 
 the general organic influences of reflex action. 
 The grand doctrine is again and again reiterated 
 in every part of the work, as on page 6G1," &c. 
 
 "It is not too much to claim for our author and 
 countryman that, with unsurpassed acumen and 
 ability, he has abundantly established the fact 
 that secretion in animals is conducted by powers 
 implanted in every part, but that it is constantly 
 influenced physiologically, pathologically, and 
 therapeutically, by reflex action of the nervous 
 system." 
 
 From the Southern Medical and Surgical Journal, Augusta, Ga., August, 1S5S. 
 
 " Of all American writers none has been more 
 indefatigable and Laborious than Professor Paine, 
 and the works of but few, either in this country 
 or in Europe, display a greater amount of leani- 
 ing than we find enriching both the Institutes and 
 Commentaries of this perhaps most recondite of 
 American authors. On opening any of his works 
 we may be said to be at once ' lost in a sea of er- 
 udition,' and his copious references to the authors 
 of every country and every language attest his 
 familiarity with the general literature of the 
 science. * • In an ago when Humoralism and 
 Organic Chemistry are threatening to displace all 
 other views of physiological and pathological ac- 
 
 tion, this work, because it is tdtra in its vitalism 
 and solidisni, must exert a most salutary influ- 
 ence upon the liistory of the medical opinion of 
 the present and the rising generation. It re- 
 quires no half-way assertion of the power of nerv- 
 ous action to gain its admission ; but he who 
 would advocate its unmodified sway, as Dr. Paine 
 does, must be as firm and uncompromising as he 
 has been throughout the comprehensive work be- 
 fore us. The present edition lias been prepared, 
 apparently with great care. A most copious an- 
 alytical index much enhances the value of the 
 volume, and attests well the perseverance and 
 industry of the author."
 
 PROFESSOR PAINE'S INSTITUTES OF MEDICINE. 
 
 From the Memphis Medical Becorder (Tenn.), March, 1S53. 
 
 "All praise, we say, to those pathologists, with 
 Professor Paine at the head of tliera, who so long 
 and so ably kept alive the anticipation that it 
 was through the reactions of various departments 
 of the nervous organization, one on the other, 
 that pathological and physiological sympathy re- 
 sulted. * * In America no earlier or more sedu- 
 lous laborer in this field can be pointed out, as we 
 think, tlian Professor Paine ; whether discussing 
 the principles of pathology, or physiology, or 
 
 therapeutics, it has been the distinguishing merit 
 of this writer always to keep steadily before his 
 mind the probable influence of reflex nervous ac- 
 tion in the production of the phenomena he may 
 be treating of * * Especially has he acquired 
 well-won laurels by the use he has made of this 
 principle in the controversy with the mere chem- 
 ical theories upon which the influence of Liebig 
 was leading men to ground all explanations of 
 vital or even mental processes.'' 
 
 From the Nashville Monthly Record (Tenn.), September, 1858. 
 
 After commending the Medical and Physiolog- 
 ical Commentaries, Professor Wright remarks 
 that : 
 
 "It is in the Institutes of J4edicine that the 
 great principles of vital pliysHlogy and pathol- 
 ogy are broadly and systematically stated. It 
 would be impossible for us, if we had much more 
 space than we have, to give any thing like a sat- 
 isfactory analysis of this profound and inestima- 
 ble work. We will only say that if our whole 
 system of medical philosophy has escaped being 
 
 overwhelmed by the confident dogmas of the 
 chemical school ; if we have learned to look for 
 perverted forces rather than vitiated material in 
 pathology; if our younger writers see more of 
 the nerves in diseased and healthy action and 
 less of ferments and catalyses than they did a 
 few years ago, then he who desires to assign the 
 palm to him who wielded the sword while there 
 were none to stand by him, should cast a glance 
 back at the Commentaries and Institutes of Mar- 
 tyn Paine before pronouncing his decision." 
 
 From the Kashville Jouriml of Medicine and Surgery, July, 1858. 
 
 " The Institutes of Medicine, the Medical and 
 Physiological Commentaries, and Essays on Vi- 
 tality and Remedial Agents, are the titles of some 
 of the works which have obtained for Dr. Mar- 
 tyn Paine the well-earned name of the great New 
 York Physiologist. The first of these is a work 
 of no ordinary merit, filled with the marks of 
 profound scliolarship and genuine philosophy, 
 
 covering the entire field of medicine, and teach- 
 ing it as a harmonious whole. * * We can confi- 
 dently recommend the Institutes as a treasury 
 of learning and invaluable Cyclopa-dia of medi- 
 cal knowledge, well calculated to lead the stu- 
 dent into paths of logical instruction and habits 
 of sound reasoning, as well as instructing him in 
 medical science." 
 
 From the New Hampshire Journal of Medicine, July, 1858. 
 
 "It would be impossible to review this im- 
 mense book in less than one hundred pages. It 
 is a monument of the learning and industry of 
 its author, and is full of valuable facts and prof- 
 itable suggestions." 
 
 The August Number of the same periodical 
 copies from the Virginia Medical Journal an 
 able, elaborate, and thorough defense of Dr. 
 
 Paine against the misrepresentations of an En- 
 glish Reviewer, with the following prefatory re- 
 mark : "No apology is necessary for occupying 
 our pages with this long article. The justice of 
 the views here expressed, both in relation to Dr. 
 Paine' s works and the English reviewer will be 
 apparent to all." 
 
 From the Atlanta (Ga.) Medical and Surgical Journal, September, 1S58. 
 
 "In these works (the Institutes, Commenta- 
 ries, &c.), are embodied the views of one of the 
 most laborious and learned medical philosophers 
 of this or any other country upon the complicated 
 theories in physiology, pathology, and therapeu- 
 tics, in reference to the great principles and laws 
 of organic being. * * We commend their contents 
 in the most decided manner, as in the highest de- 
 
 gree worthy of the most thorough investigation. 
 'f * Notwithstanding, however, our great respect 
 for the author of these works, we do not desire 
 to be understood as committing ourselves to his 
 views, being, as he is, the peculiar defender in 
 this country, of what we conceive to be (as we 
 understand them) the erroneous doctrines of Sol- 
 idism and Vitalism." 
 
 From the College Journal of Medical Science, Cincinnati (O.), July, 1S53. 
 
 "However much we may differ with the au- 
 thor upon some points, we feel that the I)istitutes 
 contains a mine of knowledge within itself, and 
 bears the imprint of the close student and original 
 
 thinker. We think, in recommending the book 
 to our readers, that we are conferring upon them 
 a personal favor." 
 
 From the Oglethorpe Medical and Surgical Journal, Savannah (Ga.), June and August, 1858. 
 
 " This work enjoys celebrity among the grad- 
 uates of the University of New York, and has 
 been favorably received by the profession gener- 
 ally." 
 
 The same journal says of Dr Paine's Medical 
 and Physiological Commentaries that " No work 
 
 written in this country has fallen under our ob- 
 servation, to which the terms learned and able 
 could be more appropriately applied than to this 
 production of the mind and pen of its accom- 
 plished author." 
 
 From the New Orleans Medical News and Hospital Gazette, July, 1S5S. 
 
 "In our last number (which we have not seen) 
 we noticed Professor Paine's Institutes of Medi- 
 cine. We have now to make our acknowledg- 
 ments of the foregoing valuable works (the Med- 
 ical and Physiological Commentaries, and Essays 
 
 on Vitality and Modus Operandi of Remedies), 
 which are most welcome to a place in our library. 
 We only regret that the size and objects of this 
 journal preclude our giving a more extended 
 notice of the whole of these valuable works." 
 
 From the Peninsular Journal of Medicine and Collateral Sciences, Detroit, March, 1S53. 
 
 'We bespeak for this enlarged edition of the I Institutes of Medicine a hearty reception and a 
 
 1 studious reading."
 
 PE0FE3S0E PAINE'S INSTITUTES OF MEDICINE. 
 
 From the Cincinnati Lancet arid Observer, October, 1S5S. 
 
 " No name in American Medical Literature oc- 
 cupies a more prominent or worthy position just 
 now than that of Professor Martyn Paine ; no 
 M'orks have been reviewed in our medical jour- 
 nals which have exhibited such profound learn- 
 ing, such industry, such extended research. The 
 works, whose titles are given above (The Insti- 
 tutes, Commentaries, and Essays on Vitality and 
 Jievicdial Agents), embrace a period of almost 
 twenty years, from their first to their last dates 
 of publication, and the most superficial reader 
 can not but bear witness to the singular unity of 
 design in the entire series of works, as well as to 
 their careful maturity, for which so few medical 
 writers of the old or new world have labored, and 
 to which so few arrive. This testimonial to the 
 genius of Paine, in which tlie medical press of 
 America so cordially unite, is the more memora- 
 ble when we call to mind the obstacles which he 
 has encountered, the elements of opposition 
 
 From the Maine Medical and Surgical Rejiortcr, January, 1859. 
 
 " Dr. Paine discusses (in the Institutes) with | sophical, and, if we admit the premises of our 
 marked ability the points of difference between i author, we are forced by his admirable and logri«- 
 the vitalisls, of whom lie is the most distinguish- al reasoning to admit the coiTectness and truth 
 ed exponent, and the chemical physiologists." of his conclusions." 
 
 *■• The arrangement (of the subjects) is philo- | 
 
 From, the Peninsular and Independent Medical Journal, Detroit, Michigan, February 7, 1S53. 
 
 through which he has advanced to such honora- 
 ble position. Twenty years ago the mechanical 
 and chemical doctrines of physiology, whereby 
 it was sought to abandon the idea of a distinct 
 Principle of Life, were largely adopted by lead- 
 ing philosophers of the world ; but, in the very 
 face of those prevailing doctrines, Paine became 
 at once, always — and always consistently — emi- 
 nently the champion of vitality and solidism. 
 These two ideas are the fonndation and key-stone 
 of all his views. He had the wise foresight to 
 anticipate that the prevalent opinions of twenty 
 years ago were unstable; and though slowly 
 working his way onward and upward, his ulti- 
 mate triumph has proved the highest tribute to 
 his genius and scholarship." 
 
 " To the labotH|iU8 thinking student of medi- 
 cine eveiy where we commend the writings of 
 Martyn Paine." 
 
 " We may safely say that this work (the Insti- 
 tutes of Mtdiciiw) is not second to any one of the 
 kind in the language, if any can be found of equal 
 merit." 
 
 " A profound and methodical thinker and an 
 
 erud'ite philosopher. Dr. Paine has shown con- 
 summate skill in presenting his favorite and 
 truthful theory of ['italisrm, as opposed to the 
 chemical and mechanical doctrines of life." — 
 
 N. D. S. 
 
 From the New York Medical Press, January 22, 1859. 
 
 " This elaborate work (the Tnatitutes) displays I and distinguished author. It is, at the same 
 in every page the profound learning, immense time, a triumphant refutation of the false doc- 
 research, and sound philosophy, of the venerable | trines of materialism, and other kindred theories." 
 
 From the Pacific Medical and Surgical Journal, San Francisco, California, December, 1858. 
 
 "Is there a science of Medicine? We think 
 there is, but it is, like the tomb of Moses, un- 
 known to this day." " The facts e.xist ; but they 
 are not acknowledged by all ; they are not classi- 
 fied," &c. 
 
 " Our author has attempted, in these Institutes, 
 to give the philosophy of medicine, lie has suc- 
 ceeded in giving more of the true philosophy of 
 
 medicine than lias ever before been given in anj- 
 work. There is order, sequence, and harmony to 
 an eminent degiee In this work. It is an edifice, 
 and though not an Fgyptian pyramid, it is still a 
 magnificent structure, which few men in our pro- 
 fession could make in greater perfection, or in 
 more ample proportions." 
 
 From the Medical Journal of North Carolina, Ai.ril, 1859. 
 
 " These are works (The Institutes of Medicine 
 and the Med. and Physiolog. Comm.) of vast re- 
 search, of the most extensive erudition, and of 
 wonderful ability, reflecting the greatest credit 
 on their author, his country, and the profession 
 of which he is a member. They embrace, in 
 fact, the whole arcana of medical science, con- 
 taining full expositions of every department in- 
 cluded in the professional curriculum, presenting 
 learned and erudite treatises on all topics of in- 
 terest to the physician, and offering eo wide a 
 field for contemplation and study as to fill us 
 with surprise that one man could have accom- 
 plished so much. Thire is an unpretending sim- 
 plicity in his style, too, which is very pleasant 
 and attractive, especially in these days of bom- 
 bastic inflation and pedantic superfluities. In 
 
 fact, Dr. Paine's work? are a success, and not even 
 the most carping critic can deny the fact without 
 proving himself too ignorant and malicious for 
 his office. As regards the great subjects of ' sol- 
 idism,' 'humoraiism,' 'vitalism,' &c., which are 
 so extensively discussed in these books, we have 
 neither the time nor space to consider them at 
 present, but can only say that Dr. Paine sus- 
 tains his views with wonderful plausibility, eru- 
 dition, and ability. No physician should esteem 
 his library complete until these three admirable 
 works have been added to it, not as a mere or- 
 nament or for the name of the tiling, but to be 
 studied carefully and continuously, as well as in 
 that spirit of exultation which the pre-eminent 
 success of a fellow-countryman must engender 
 in every patriotic bosom." 
 
 From the Baltimore (Md.) Journal of Medicine. 
 
 Pi'ofessor E. Waeeen, M.D., tlie editor, remarks 
 that "Dr. Martyn Paine is, by all comparison, 
 the moit able and enidite of American authors. 
 
 and the special champion of those great doctrines 
 of Vitalism and Solidism, to the advocacy of which 
 we stand at all times committed." 
 
 From the Cincinnati Lancet and Observer, September, ISCS. 
 
 "The magnificent achievement before us con- ] "We know of no book in our language which 
 tains the labor and brains ordinarily spread over gives evidence of such extended learning." 
 the construction of a whole library of medicine." | 
 
 From the Detroit Review of Medicine and Pharmacy, July, 1S6S. 
 
 "The volume is a library of philosophical and I stand the test of time like the old granite hills 
 practical medicine." " The Doctor's Note, Rights of New Hampshir.\ It can never meet with any 
 vf Authors, settled the question. The work will I successful opposition — N. D. S."
 
 PROFESSOR PAINE'S INSTITUTES OF MEDICINE. 
 
 NOTICES BY DISTINGUISHED 
 NON^-PROFESSIONAL JOURNALS. 
 
 The Physiological Articles in this work having attracted attention beyond the limits of the pro- 
 fession, the following extracts from Notices are selected from distinguished journals which are not 
 medical, hut in which the Notices were evidently written by those who had studied the work, and 
 which, therefore, embody public opinion. 
 
 From the Norlh American Reviev.\ April, 1S63. 
 
 "This work covers the entire ground of physi- 
 ology, pathology, and therapeutics, and, logical in 
 arrangement, minute in subdivision, affluent in 
 references to other books, and continually refer- 
 ring back and forward to its own pages, it consti- 
 tutes an admirable system of medical science. 
 This were ample praise. But in addition to this, 
 the successive subjects are treated by Dr. Paine 
 with great conciseness, indeed, but with great 
 vigor and earnestness, with frequent originality. 
 
 and in a style which shows that, when his opin- 
 ions coincide with those of others, they are yet hia 
 through the independent action of his own mind. 
 Then, too, if he agrees with no one else, he is 
 uniformly consistent with himself, his conclusions 
 following legitimately from his premises, and his 
 views on allied departments of science or art bear- 
 ing tokens that they belong to the same system, 
 and rest on parity of reason." 
 
 From the Methodist Quarterly Review, April, 1863. 
 
 " Of the two great schools, namely, the Chem- 
 ical and the Vital, Dr. Paine is a leader if not the 
 head of the latter." ''From the high character 
 of the chemical theorists, and the plausibility of 
 their pretensions, they seemed, for a while, to 
 carry with a rush pvery thing before them. Med- 
 ical science was thus tending to a system of low 
 
 theoretic materialism. Against this torrent Pro- 
 fessor Paine has stood firm as a column of ada- 
 mant." " Whatever may be his peculiarities of 
 belief, all parties must bear testi ony to his learn- 
 ing, genius, individuality, and pure independence 
 of mind." 
 
 From the American Quarterly Church Review, April, 1S63. 
 
 "In the Appendix the Author attempts to de- 
 monstrate the substantive existence of the Soul 
 and the Instinctive I'rin iple upon physiological 
 grounds. The demons truiion is exceedingly able, 
 
 and refutes effectively, we think, the materialism 
 of the day, by which infidels would rob the soul 
 of its immortality." 
 
 From, the Boston Review, March, 1S63. 
 
 "Its strong points are a broad and thoiough 
 treatment of the whole science of physiology, 
 pathology, and therapeutics ; a sturdy conviction 
 of the soundness of its positions; a clear under- 
 standing of the opposing tlien'ies ; and a vigorous, 
 classic, concise, and unflinching style of writing." 
 
 " In a labored supplementary di-ssertation he 
 contends with great cogency for the distinct ex- 
 istence and immortality of the soul, against th ; 
 materialists and all who, confounding reason with 
 instinct, push us downwai-d toward annihila- 
 tion." 
 
 From the New York Evening Post, August 8, 1S63. 
 
 "Dr. Paine' s works are of the highest order of 
 medical scholarship. The volume before us re- 
 quires no praise. It is a most valuable magazine 
 of therapeutical sciences, containing, as it does, 
 the results of thorough investigation which are 
 here carefully digested and applied. The learn- 
 ed author discards utterly any dependence upon 
 organic chemistry for the prosecution of physio- 
 logical or pathological research, and proves his 
 positions by quotations from Lehmann. 
 
 "The most curious chapter, for metaphvsi- 
 cians, will be found in the Appendix, where Dr. 
 Paine has embodied an essay on the 'Soul and 
 Instinct, physically distinguished from material- 
 ism.' 
 
 " Many of the positions taken by Dr. Paine are 
 original with him. He is a physician of extraor- 
 dinary attainments; and his wo-ks have been 
 liberally copied from at home and abroad." 
 
 From the Neio York Daily Times, February 7, 18G3. 
 
 "Professor Paine's Institutes of Medicine are 
 based on broad and prominent principles of Na- 
 ture." " ' Solidism and vitalism,' the book opens, 
 'will form the basis of these Institutes;' and to 
 the elucidation of these time-tried doctrines, and 
 to their defense against Chemical Philosophy and 
 kindred neologisms, he brings the results of long 
 and severe investisation and eminent knowledge. 
 lie does not scruple to enter the lists and tiy his 
 lance against the glittering armor of I.iEniG and 
 lICMBOi.DT, and it is apparent to every one that 
 the blows are well aimed, and the weapon impelled 
 by a stout arm, guided by a clear eye. with a vig- 
 orous brain behind it." " We do not pretend to 
 
 commend the work to the Profession. It is already 
 thoroughly appreciated there. Rut theve are now 
 such a large number of nnn-professional students 
 and invcstig.itors in this field of research that we 
 wish to call attention to this new edition of a 
 standard professional book." "In a very enter- 
 taining chapter on the ' Rights of Authors.' in 
 which Professor Paine dissects the claims of those 
 who jiretend tn have antedated him in the discov- 
 ery of some valuable principles, and in the state- 
 ment of some important theoiies, he clearly shows 
 his priority in research, discovery, and promulga- 
 tion of the doctrines in question."
 
 8 
 
 PROFESSOR PAINE'S INSTITUTES OF MEDICINE. 
 
 From, the Taunton (Mass. 
 " This massive work is alike remarkable for the 
 range of its learning and the vigor of its logic. 
 We feel, as we read, that Professor Paine is not 
 only vast in his sweeps, but uneiTing in the return 
 of his cui-ves. As an inquiry into what is so far 
 known of the treatment of diseases as to have been 
 demonstrated by long and enlightened practice, 
 this elaborate work is most thorough in its array 
 of facts, and singularly vigorous in its reasoning. 
 It is emphatically a student's book ; and yet no 
 one capable of drawing an inference from premises, 
 
 ) Gazette, February, 1863. 
 
 and of understanding how premises should be es- 
 tablished, can read these 'Institutes' without 
 growing in wisdom on the subject, if he do not 
 find cause to cast out some crude and perilous 
 opinions which he had previously entertained. 
 Certainly, so antagonistic are curative theories, 
 tliat it behooves every man to inquire for himself; 
 and nowhere can he look with more satisfaction 
 for the legacies which all the ages have bequeathed 
 to the healing art than in this volume." 
 
 From the Philadelithia Presbyterian Standard, February, 1803. 
 
 " Dr. Paine does not do himself justice, as this, 
 instead of the seventh, is really the eighth edition 
 of his great work." 
 
 "After twenty years' acquaintance with the 
 schools of Edinburgh, Dublin, London, and Phila- 
 delphia, we feel warranted in saying that we have 
 seldom met with any single work that is_ better 
 calculated to stimulate an active mind that is real- 
 ly and earnestly engaged in the pursuit of medical 
 knowledge than in this work of Dr. Paine now be- 
 fore us. Dr. Paine grasps eveiy subject with the 
 
 hand of a giant." "The student who masters 
 this book, if he have a capacity to comprehend 
 demonstration, will never confound our material 
 organization with that wliich dwells within it." 
 
 "• We commend this really learned, manly, and 
 wonderously suggestive treatise to all our young 
 medical friends ; and in order that some hundreds 
 of them may know our estimation of its value, we 
 shall take care to have this, our judgment of its 
 merits, made known to the medical schools of this 
 city." 
 
 From the Atnerican Presbyterian, Philadelphia, 18C3. 
 
 In a second notice of the seventh edition of the 
 Institutes, the writer says that: "A careful ex- 
 amination of this work shows the author to have 
 a fine mind, highly cultivated, and ardently de- 
 voted to the advancement of his profession, lie 
 seems to have read and carefully digested almost 
 every thing of value written upon it. Truth is 
 
 ever the object before his mind, and while he states 
 his own opinions strongly, we admire the fairness 
 with which he presents the views of those opposed 
 to him." "The principles of the work will be a 
 safe guide to the active physician, and may be 
 trusted in cases of doubt arid danger." 
 
 From Zion's Herald and Wesleyan Journal, January, 1863. 
 
 "We commend the 'Institutes' to physicians 
 and to scholars of all professions. It should be in 
 every public library." 
 
 "The arguments to show from physiology that 
 
 the mind is a spirit, and the revelation of its im- 
 mortality is reasonable, are original and profound, 
 and very strongly expressed." 
 
 From the New York Observer, January T, 1863. 
 
 "The medical student makes the Institutes of 
 Medicine his text-book, and every intelligent per- 
 son who reads it with attention finds a field of 
 knowledge opened up to his mind that constantly 
 furnishes him most important and useful instruc- 
 tion. It is often said that when a man begins to 
 
 read medical books he imagines himself the vic- 
 tim of all the diseases he reads of. Such a philo- 
 sophical work as this will not leave him liable to 
 an evil like that, but he will learn those great 
 principles on which health and life depend." 
 
 From the New York Sunday Times, January 11, 1863. 
 
 relative br.inches of study, are elaborately treated 
 in these ' Institutes,' and an extraordinary amount 
 of infonnation is given on the subject of physio- 
 logical and pathological chemistry, the production 
 of animal sugar, the absorption and circulation of 
 plants," (fee. 
 
 "Dr. Paine's discussion of the vital principle 
 and its properties will deeply interest many a read- 
 er besides medical practitioners and students, and 
 his whole treatment of the subject of organic phi- 
 losophy will be found at once able, eloquent, eru- 
 dite, and full of remarkable onginality ." " Phys- 
 iology, pathology, and therapeutics, with all their 
 
 From the New York Evening Express, January 10, 1803. 
 " A most valuable book the ' Institutes' must I amusing and instructive one for the general read- 
 be for the practical physician, as well as a most I er." 
 
 From the New York Christian Times, January 22, 1863. 
 
 authority among medical men. Its author is both 
 known and honored as the patriarch of American 
 physicians, and as a savan of whom the profession 
 
 " Criticism is not the thing required in respect 
 to this learned and philosophical volume. It is 
 sufficient that we call attention to this as the sev- 
 enth edition of an 02nos magnum of the highest 
 
 is justly proud.' 
 
 From the Neio York Commercial A dvertiser, January 13, 1863. 
 "This seventh edition of the ' Institutes' is the I brother physicians and their successors. Successfiil 
 author's legacy, more valuable than rubies, to his ] will he be who studies and follows its teachings. 
 
 From the Congregationalist, Boston, January, 1803 
 
 "The Institutes of Medicine is an invaluable 
 repository of scientific inf irmation and a lasting 
 monument of the .nuthor's industry, skill, le.arn- 
 JncT, and genius, lie enters on his work with the 
 facility of an adept and the vigor of an athlete. 
 Entertaining a lofty scorn of empiricism, he slow- 
 
 foundation for the temple which he would rear, 
 who^e solidity, proportions, and effect, we can not 
 fail to admire." " To his opponents, as well as to 
 his adherents, the book must be of an inestimable 
 value. Symmetrical in plan, exhaustive in de- 
 tail, clear in style, devoted in spirit, it is at once 
 
 J'.ntertaining a loity scorn oi empiricii'in, iil- mu"- i-i", ^■^■•' •■ ^-j —■,_-- — -- - 
 ly gathers fact on fact, piling them up into a firm I suggestive and satisfactory.
 
 PROFESSOR PAINE'S INSTITUTES OF MEDICINE. 9 
 
 From, the Christian Intelligencer, New York, February, 1863. 
 "The ' Institutes' is a monument of learning ; I promise of the wide and lasting influence it is yet 
 and the reception it has already had is no empty | to exert." 
 
 From the Chicago (Illinois) Journal, February, 1863. 
 
 " To the unprofessional reader the essay on the 
 Soul and Instinct, in which the substantive ex- 
 istence of the fonner and the principle of the lat- 
 ter are demonstrated, is one of abounding inter- 
 
 From the Maysville (Kentucky) Eagle, February, 1S63, 
 "The 'Institutes' is a monument of his learn- 
 ing and industry. Although differing widely with 
 the prominent modern pathologists in regard to 
 many views of medicine, he does so with manli- 
 ness and candor, and his own opinions are urged 
 
 From, the Presbyterian Witness, Cincinnati, Ohio, 1863. 
 " ' My aim,' says Dr. Paine '• is truth.' To what I his Institutes a vast amount of truth, sufficient to 
 extent he has succeeded in his .aim, there will, of entitle the work to the confidence, and secure it 
 course, be difference of opinion. In our judg- the patronage, both of the Profession and of a 
 ment, however, he has succeeded in embodying in | generous and appreciating public." 
 
 est. Materialism will find many difficult prob- 
 lems to solve in the erudite and scientific argu- 
 ments of the Author." 
 
 with great learning, and with the utmost sincerity 
 and fairness. It should be in the library of every 
 reading physician, and especially prized in that, 
 in addition to its being elaborate, vigorous, and 
 leanied, it is a home book." 
 
 From the Buffalo (N, 
 " Even to non-professional eyes a cursory glance 
 over the pages of this great work reveals, to some 
 extent, the herculean labor which its preparation 
 must have involved. The work before us i.s not 
 only a complete digest of all that is known of the 
 limitless subjects it discusses, but, venturing bold- 
 ly beyond the sphere of previous explorations. Dr. 
 Paine has brought in a hai-vest of discoveries, by 
 
 Y.) Journal, 1863. 
 
 which science is enduringly enriched." "It is 
 not necessary that we should say more in com- 
 mendation of so noble a contribution to science. 
 We make but few books like this in America, and 
 such as are produced on this side the Atlantic, for 
 the sake of our National fame, if for no higher 
 reason, should be received with due pride and ap- 
 preciation." 
 
 From, the Worcester (Mass.) Palladium, February, 1S63. 
 
 " The excellent portrait, prefixed to the ' Insti- 
 tutes,' indicates the character of the man; one 
 who is an acute observer, who takes no superficial 
 view of subjects, but investigates deeply and wide- 
 ly, finding the causes of phenomena, however pro- 
 found may be the research required, and tracing 
 those causes to all their consequences, however in- 
 timate or remote ; with that moral courage, none 
 too common among men, that reaches conclusions 
 
 From the Detroit (Mich.) Daily Tribune. 
 
 with the abstruse principle of instinct and the 
 
 emphatically its ovtfu, and has no hesitation in the 
 avowal of convictions deliberately formed. From 
 such intellectual power, cultivated mainly by its 
 own effort, and acting upon the dictates of its own 
 independent judgment, such a volume as this, 
 where there is the requi.-ite mental activity, comt s 
 as naturally as the ripe corn comes from the prin- 
 ciple of life in the germinating seed." 
 
 " We may safely say that this work is not sec- 
 ond to any of the kind in the language, if any can 
 be found of equal merit. It shows that the au- 
 thor is an indefatigable student. Nothing in Phys- 
 iology or Philosophy, or any thing belonging to 
 the subject, has escaped his eye. A profound and 
 methodical thinker, and an erudite philosopher, 
 Dr. Paine has shown consummate skill in pre- 
 senting his favorite and truthful theory of Vitnl- 
 ism, as opposed to the chemical and mechanical 
 doctrines of life, frequently bringing his subject 
 to bear in favor of revealed religion, as opposed 
 to materialism and sensualism. He has grappled 
 
 substantive immateriality of the human soul, 
 which has escaped the notice of his reviewers. 
 In proof he has brought to bear arguments entire- 
 ly new, and we think unanswerable. The Dr., 
 in placing this work before the public, has done the 
 professors of medicine and theology great service. 
 On this account the work should ho found in ev- 
 ery clergyman's library as well as that of the phy- 
 sician. The profound scholar and painstaking 
 lover of truth will find a rich treat in reading this 
 work. 
 
 COMMUNICATIONS TO THE AUTHOR. 
 
 As an example of letters which the author continues to receive, we submit the following 
 extract of a letter from the eminent Von Dr. Professor N. Zdekauer, Physician to His Majesty 
 the Emneror of Russia, dated St. Petersburg, April 19, ISGT. , , , , ^, „ , , . 
 
 "yZ valuable works are very often studied by me, and I look on them as on an Enchi- 
 ridion of Medical Science and Philosophy. How wise and practical are your chapters on the 
 Remedial AcSou Sympathy, and all the chapters on Pathology ! But your greatest merit 
 ^ to have in a most rational n(inner treated about Vital Principles and Powers, contrary to 
 the most material and dead-born tendencies of the newest authors. 
 
 Published by HARPER & BROTHERS, 
 
 Franklin Square, Kew York 
 
 E^ HARrEii & BE0Tnr.P.s will send the sbovo \\-ork by Mail, post.-.ge paid, on receipt of $5 00.
 
 WORKS BY DR. PAINE, 
 
 I. 
 
 Medical and Physiological Commentaries. Octavo. Vols. I. and II., 1840; pp. 1531. 
 
 Vol. III., 1844. 
 
 II. 
 
 Institutes of Medicine. Octavo. First Edition, 1847. Ninth Ed., 1870; pp. 1151. 
 
 lU. 
 
 Materia Medica and Therapeutics. 12mo. First Ed., 1848. Tliird Ed., 1859 ; 
 
 pp.411. 
 
 IV. 
 
 On the Soul and Instinctive Principle, physiologically distinguished from Material- 
 ism. First Ed., 1848. Third Ed., Octavo, 1871, of about 600 pages; will 
 soon be published. 
 
 V. 
 
 Memoir of Robert Troup Paine. 1000 copies, illustrated ; Quarto; pp.524. One 
 copy, folio, for the library of Harvard University ; privately printed, 1852. 
 
 VI. 
 
 On the Cholera Asphyxia of New York. Octavo. 1832 ; pp. 160. 
 
 VII 
 
 On the Philosophy of VitaUty, and on the Modus Operandi of Eemedial Agents. 
 
 Octavo. 1842; pp. 70. 
 
 VIII. 
 
 Experiments to ascertain whether the quantity of Blood circulating in the Brain may 
 
 be reduced by Bloodletting. Published originally in the Medico-Ckirurgical 
 
 Review, London, 1834. 
 
 IX. 
 On Theoretical Geology, sustaining the natural inteipretation of the Mosaic Narra- 
 tive of Creation and the Flood, in opposition to the prevailing ge.jlogical hypoth- 
 eses. Octavo; pp.121. V\ih\is\iQA.or\gma[\y in the Protestant Episcopal Quar- 
 terly Review, New York, April, 1856. 
 
 X. 
 
 Organic Life as distinguished from the Chemical and Physical Doctrines. 12mo. 
 
 1849 ; pp. 53. 
 
 XI. 
 
 Examination of Reviews. Octavo. 1841 ; pp. 96. 
 
 xn. 
 Physiology of Digestion. Octavo. 1844. 
 
 XIII. 
 Defense of the Medical Profession of the United States. Octavo. 1847. 
 
 XIV. 
 Essays and Reviews in Medical and other Periodicals, among which are seventeen 
 articles showing the superiority of Medical Education in the United States over 
 that in Great Britain, founded upon Parliamentary Documents, and which ap- 
 peared editorially in the New York Medical Press from Jan. 29 to June 4, 1859, 
 
 ? -
 
 UNIVERSITY OF CALIFORNIA AT LOS ANGELES 
 
 THE UNIVERSITY LIBRARY 
 
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