:.cv^ ^* **f* 'M'^n4Un ^ .»<: /:< ?-:..:^ ■■■'■, ;:■'■'.. • ■.:•'':!!l'.Av•.v•';J••;,'. "''.- ?.:■■ '-.i. ,r;'-". ff&r:v":!«; r,;vi;: ^22- :-:-,:-_ /{? 7r~L*jf7' Destined for waste. ) Conveying the means ) of repair. The Arrangement of Organs according to their relative Functions. ( Brain and cerebral nerves. < Spinal cord and its nerves. ( Sympathetic ganglia and sympathetic nerve I' Heart and its Pericardium. Arteries. Veins. Lymphatics. Lymphatic glands Lacteals. Lacteal glands. Mouth, stomach, intestine. Salivary glands and pancreas. Liver. Spleen. Larynx and vocal system. Trachea. Lungs. Diaphragm. ^ Muscles of thorax and abdomen. 5. System of voluntary muscles. C Derma, or main portion. J Papillary tissue. ] Rete mucosum. [ Epidermis. f Kidneys. 7. Urinary System. J ^^ [ Urethra. 0 o • i a •«.• ( Organ of hearing. 8. Special Sensitive \ ° . , 6 o < Sight. bystem. ) ° ,, J { smell. i Bones. Cartilage. Ligaments. Synovial capsules. Testes. ^ Ductus deferens. Seminal vesicles Prostate gland. Penis. ) ~ , . Muscles of perineum. } C°Pulatlve Ovaries. ) Fallopian tubes. Uterus. Vagina. Hymen. Clitoris. Nymphae. Labia. Constrictor vaginae L Mammae,—accessory parts. 10. Genital System. < > Formative. Formative. > Copulative. Male. > Female. 58 INSTITUTES OF MEDICINE. 126. The organic and animal functions are also naturally subdivi- ded 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 three 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). 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- eral individual organs possess distinct and specific offices that are more or less dependent upon the principle of sympathy (§ 222-233, 455). 129, e. The sympathetic relations are most strongly pronounced among organs which concur together in the performance of special functions, as the circulatory, the drgestive, the urinary, the sexual systems, &c. (§ 124). Other special relations subsist between the brain and the organs of animal life through the medium, in part, 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,/ Plants are devoid of all that intimate association of parts which is determined by the nervous influence in animals, as well as by 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 law of continuous sympathy, which as I have endeavored to show, depends upon the organic properties (§498). r ^ PHYSIOLOGY.--STRUCTURE. 59 129, g. 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, h. 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, b). The sympathies which grow out of morbific agents depend upon the natural principle, of which 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, therefore, to be a most important law, that mor- bid states call into operation the function of sympathy 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 sympathetic influences of a salubrious nature in organs not morbidly affected (§ 74, 117, 137, 143, 155, 156, 387, 422, 514 A, 524 d, 525, 528, 733 b, 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 corresponds with the union of the whole, 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 MKDICINE. lacious hypotheses. The whole history, of that instrument, so far as physiology 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 brevis, 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's 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 (§ 83 c, 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 article on the Microscope, in Medical and Physiological Commentaries vol i n 699-712; and my Examination of Reviews, p. 6, 89; also, this work, § 515, a. ' PHYSIOLOGY.--STRUCTURE. 61 distant when all this lumber will be excluded from practical works on physiology, and turned, at least, into a channel by itself. 132. Each simple texture, when united into compound organs, 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 very highest importance to the physiologist and phy- sician, they can be only advantageously studied 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 engage 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, b. 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 variety 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- portant 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 recoveiy from 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 (§ 717). This is even true of different parts 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 almost as striking peculiarities in the vital signs, and in their constitutional influences, as are the physiological 62 INSTITUTES OF MEDICINE. functions of the different compound organs which it traverses (§ 740, 752-754, 780, 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, no doubt, of all animals, while it can be generated by nothing but the mucous tissue of the stomach. Again, in the lungs we meet with this tissue per- forming 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 b). In the uterus, the same membrane appears as an organ of excretion in relation to the arterial 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. 135, b. 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 (§ 733, c). 136. In consequence, also, of the foregoing peculiarities of vital constitution, every tissue, and often continuous parts of a tissue (as in the last example), possess natural stimuli peculiar to each, and in cer- tain relative quantities. Each part, indeed, has as many stimuli as it possesses peculiarities of properties and functions. 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 of the arterial and yenous 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 irritability, many of these products may be offensive to other parts. Again, the special irritability of one part may be exactlv suited to some product of another part, and this may or may not be a natural vital stimulus, and perfectly inoffensive, to the second nart 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 lesstoa contractile action; but is rapidly fatal within the arteries (i S4QN Urine is the natural stimulus of the bladder, but will exroriail I other parts (§ 74, 188* d, 650, 847 e). exconate most 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 different parts of the or- ganism, that the differences 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 alimentary canal. Other agents affect the stomach, or intestines, or liver, or uterus, or bladder, &c, each organ more than the others, and more than other parts (§ 233|, 772 c, 838.) 137, c. From not duly regarding these important facts, or from 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 injuriously employed in pulmonary catarrh, phthisis even, diarrhoea, dysentery, &c, mostly for the reason that they exert a specific effect upon 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 physiology. 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, are 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). 137, d. Again, it is one of the most important 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, c. 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 system 64 INSTITUTES OF MEDICINE. of chemical physiology, the humoral pathology, and the doctrines of debility, 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 tha importance of the functions of the compound 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 deter- 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 affections of the mucous tissue of the throat; and no disease is 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, b. When one tissue of a compound is 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 rheumatism, &c. 142. For reasons stated in § 133-136, morbific agents may readily excite disease in one part of a continuous tissue when it would have PHYSIOLOGY.--STRUCTURE. 65 no 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 reme- 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 which are determined, also, by cer- tain special vital relations of the different 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 i). 143, a. Again, 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, b. 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, oi 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). 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). 143, c. In proportion, therefore, as the susceptibility of tke 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 influences 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 (§ 74, 80,117,129 i, 133-137, 143, 155,156,169/ 387, 399, 422, 514 h, 524 d, 525, ^28, 5 63S, 649 d, 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 b, 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 sympathy may be thus established throughout the system, by which all parts shall concur in the relief of the gastric irritation which had given origin to the whole. 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, oi 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. 144. Many acquired conditions may be transmitted from parents to child, and they then 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, 563). 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). 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 sympathy over the entire body (§ 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 rest 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, are 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 absolute disease by the reacting influence of the diseases which had been sympathetically produced through these parts. Very complex circles of sympathy may thus become established. 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). 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 b, 722 d, 725, 794, 795, 808). Hence it follows that many of the natural stimuli of life may become morbific. 150, a. It is a great fundamental law, that a general 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, b. 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- 233^, &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 difficult and dangerous voyage (§ 794, 795, &c). 68 INSTITUTES OF MEDICINE. 152, a. It follows, therefore, from § 150, 151, that the operation of all things upon the living organism, whether food, heat, cold, blood, poisons, the nervous 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 sympathetic in- fluences are transmitted to 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 principle, a salutary change in the same properties which other poisons had affected injuriously (§ 638, 642 b). 152, b. 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 theii 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 properties 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 progressive. 155. The changes of organization (§ 153, 154) are preceded by corresponding changes in the vital properties, upon which the former depend (§ 445,/). This principle, too, like all others which relate to organic life, whether in health or disease, is universally true 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, pari passu, with the natural changes in the properties of life; and remedial agents undergo corresponding modifications of action. 156, b. 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 h, 524 d, 525, 526 d, 528 c, 638, 733 b, 847 g). 157. Organs are softest and most fluid at the beginning of their de- velopment, and increase, progressively, in density through life. The animal ovum is scarcely more than an organic fluid. 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- hood. 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, the glandular function of that organ is especially liable to derange- ment in infancy, and its venous tissue to congestion at more advanced ages. 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 modifications of the vital con- stitution 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 effects of some remedial agent upon 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 previous 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 hemorrhage (§ 805). PHYSIOLOGICAL AND PRACTICAL SUGGESTIONS. Tissues most liable to disease, especially to inflammation, in the order of arrangement: TABLE I. 1. Mucous. 2. Venous (venous congestion). 3. Cellular. 4. Serous. 5. Ligamentous and dermoid (fibrous). 6. Glandular. 7. Lymphatic. 8. Nervous. 9. Synovial. 10. Periosteum (fibrous). 11. Osseous. 12. Tendons, cartilage, dura mater, and pericardium (fibrous). 13. Muscular. 14. Arterial. TABLE II. 1" of the nose. " lungs, fauces. " eyes. ( Ilium, 1. Mucous texture ... J sma11 "destine, j Jejunum, ( Duodenum. " stomach. " large intestine. " uterus and vagina. i " bladder. PHYSIOLOGY.--STRUCTURE. 71 f ° Venous texture (form- ing, mostly, venous congestion)..... 3. Cellular texture 5. Glandular texture 4 Serous texture . . . .< t 6. Lymphatic texture . 7. Fibrous texture . . . 8. Nervous texture- . . 9. Synovial texture . . 10. Osseous texture . . . of pia mater, in infancy and childhood. " liver. " small intestine. " pia mater of adults. " rectum (piles). " 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 pericardium. " 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. ganglia of sympathetic. spinal cord. of the knee-joints. " ankle. " joints of upper extremities. ( spongy bone. ( solid bone. 72 INSTITUTES OF MEDICINE. of the bram. H. Arterial .extare. } -h of aorta^^ rare in other parts. TABLE III. 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 (puerperal women). 5. Serous membrane of small intestine. 6. Veins of the liver (venous congestion in congestive fevers). 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 parietes (common inflammation). 17. Veins of lungs (low, 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 arrangement. The remedy is supposed to be applied early. 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). 5. Parenchyma of lungs. 6. Serous texture of stomach. 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. Utems. 13. Textures of kidney. PHYSIOLOGY.--VITAL PROPERTIES. 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 inflammation.) 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 as 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 groups of agents possessing, in their individualities, respectively, analogous virtues, their combinations, alternations, 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- ural 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 life, therefore, is a cause, and not an effect, as has been assumed by many distinguished physiologists. 74 INSTITUTES OF MEDICINE. 165, a. " Until it is proved," says Andral (the restorer of the hu- moral pathology), " that the forces which, in a living body, interrupt the play of 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."—Andkal's Pathological Anatomy. And, to the same effect, the distinguished organic chemist, Liebig, the chief of the school of pure chemistry (§ 4J): " 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 from 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 Muller, who leads in the school of chemico- 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 known 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 borrowed 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, fyc. 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, 8fc. 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 nature. 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 1 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 arrive 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? And do we not distinguish one from the other, and regard them as wholly distinct forces, by the dif- ference in their effects 1 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 argument, 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, bb). 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 4 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 of An- ima and Callidum Innatum. It was greatly 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 Archaus, 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 Archaeus. 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 Rcvieics," p. 43. J 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 Nervea. Here we enter into the midst of the profound theories of irritability and sensibility, which had been suggested by Galen (§ 476, b). Glisson, 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 great 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 t, Ionian Also, "Examination of Reviews," p. 43 ; "Notice of Reviews," p. 4: "Ess'nv*™ v,-f«i ity," &c, p. 17. e ' ^ssays on Vital- PHVSIOLOGY.--VITAL PROPERTIES. 77 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 external 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 this power* and thus to cause the death of the living bodies on which they operate." 167, c. Next came the illustrious Muller 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 Muller 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 Muller's view appears from another expression, that, " the formative or organizing principle is a creative power, modifying matter blindly and unconsciously•" 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. 167, 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 tpvx^], or the immortal soul. Upon the cerebrum 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 mandates, along the voluntary nerves, to muscles subdued to volition."f—t(Hall * See "Examination of Reviews," p. 26-28 ; also, this work,§ 189 h, 350| b. 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 theory, 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 the demoniacal mummery which has been acting in this country; it was, as usual with 78 INSTITUTES OF MEDICINE. 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 century, 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!" (§ 844.) I may also add the followiug extract 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 m 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 expres'sive languaee 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 sure-ery, especially amon~ females- and that, too, without mesmeric imposture. The same eminent surgeon, who operated in the case which is the subject of these remarks, will 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 heard 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- game 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; follow the able surgeon in'all the capital steps, anil in all the minor details of the operation, and watch attentively the ' deportment' of the sub- 'f, H^ £as, lal,d at a convenient elevation upon a table, his feet crossed upon each other, and Ins 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 throwin- and tvin- the ligature. It was, in itself, one of the most capital operations in surgery "but, owing to the dexterity with winch itwas performed, and with an operation still before us far ESTmnS f '■? i°U>' and danfrous'thi* g^nd 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 evident of nain "Next came the circular incision, reaching all the lay from the joint of tLmaxniarv bone down along its lower edge, up to tliS middle of the chirTnis was oWbv oZ rwt£eSLSL3^ 5^5-—^tfe^7f)d section, in which it became necessary to eiamer»t/ri?» .' yi?lon£ed' tedious, painful dis- ing vessels; till, finally, the operatoT was• ready*fo%'sfw^S nnri™^ T7 "fe* pened to elicit a single manifestation that the natie^wf* \ • notJlmS had yet hap- ceptmg that his eye? were open, and ttt toSS^^tf*"* slumber' «" hand of a capable assistant. Another p^ll however brou<^ wuf^ ^l* 1° ^ neither attempt was there any more indLtion of sufk^LlntawSt a°n£i Sma " Then came the process of sawing, and this wax r-nlmiotoii tn r__..i from a slight accident which happened to the 7aw, and whicl°£to the P^1 operation. Still, however, the same 'heroic depoZen!' dUtiSSffi fe?* ??" bearance of the sufferer, the same unexampled complacency continued to mtE ' r '" region.1118 ^ *" ^ ^ *"*** "*&* ^V^trt^Z^ PHYSIOLOGY.--VITAL PROPERTIES. 79 of the vital principle of animals, and whose modus operandi in devel- oping voluntary motion I have endeavored to expound in sections 233, 243, 500 d. 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, sec Essay on the Vital Powers, in Medical and Physiological Commentaries, vol. i., p. 1-119. 168. 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 Muller commends itself to every right-thinking mind. " Whether the vital principle," he says, "is to be regarded as im- ponderable 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."—Muller'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 performed with 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 sufferer 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 mesrnerite 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 beyond 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 affect the organs of circulation, whether the heart or blood-vessels. "Thus ended an operation, unequaled in the 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 reach of greater re- proof or mortification. " I remain, very truly, your friend and obedient servant, " Martyx Paine." 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 it behaves, in all its manifestations, 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 very imperfectly. 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 phonomena being wholly dif- ferent from such as appear in the inorganic world, it is prima 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 relative 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 proper 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. J ° Since, also, we seek, alone, for the existence and the nature of causes by means of their phenomena, 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 i game world, that has embarrassed the progress of medicine and cumbered it with a spurious philosophy. ' mor- en- PHYSIOLOGY.--VITAL PROPERTIES. 81 169, 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 of the highest moment. 169, f. 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 all together (§ 63, &c, 74, 80, 117, 137, 143, 155, 156, 266, 323-326, 387, 399, 514 A, 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 structure, 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. 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. 82 INSTITUTES OV 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. 170, b. 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 the manner in which their elements are united. 170, 6. The living principle appears, therefore, to be neither the result of organic compounds, as supposed by Hunter and others, nor, as stated by Prout, 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-operation 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 multiplication of polypi from portions of the animal. Muller, 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 m 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 parts 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 moral causes, 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 Physio. Comm., vol. ii., p. 123-140. Also, "Examination of Reviews p. 43; and "Notice of Reviews," p. 2, &c., in "Med. and Physiolog. Comm.," vol. iii. ' PHYSIOLOGY.--VITAL PROPERTIES. S3 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 she 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, AVho 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, moral 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 parts, 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, I adverted to the manner in which they resist the decomposing effects 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 disappeared 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 properties. Thus, of the generic, wo 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 par- tial variations. These properties are also constantly varied m 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). . . . . j 175, b. 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 operations 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, 566-568). 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 has a multitude of distinct component parts, each of which is en- dowed with specific attributes. These component parts, however, are distinct entities, which I do not recognize in relation to the proper- ties of the vital principle, or of the soul. But the distinction is not im- portant to my present purpose. The materialists necessarily regard the properties of life and of the soul as so many separate existences, whether imaginary or real (§ d, 188^ d, 222, &c, 234 e). 175, bb. 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 have been discovered during the present century ?" " 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 which produce the Organization of Plants, p. 70, 71. Organic life, however, needs only a single principle, or " imponder- able," till it be shown that its supposed properties are individual ex- istences (§ 165, b). 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 generis 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 uninterruptedly secreted ; or, if arrested, 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 ] 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 irresistible, and the argument in favor ot materialism incontrovertible. 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 1 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 would be in vain to oppose Revelation itself to what is so fundamental in Nature. 175, d. It is assumed by many late physiologists, as Drs. Carpen- 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 are owing to the im- mediate acts of the Almighty (§ 64, h). This, therefore, as with the author of the " Vestiges of Creation," is only a circuitous method of confounding nature with God (§ 350f 7i-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 hypothesis. Organic beings are made up of matter, which, it will be conceded, is distinct from God, if we allow his 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, 350| #-350£ o, 3764, 733 d) ,L T1^7! "N?tlc'°f ^views" (in Comm., vol. iii.) I have shown hat the doctrine of » the properties of 'life in the elements of matter" is thoroughly material as it respects the soul (§ 14 c, 189 i 3503 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 oi lite. I his 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 apparenlarima Slsst :otrC:fofhpeotarnly bodies would be the *™d^de- Although therefore, the actions and phenomena of organic beino-s like the motions of the heavenly orbs, are merely the effects of a le culiar power which we call life, they are, nevertheless, the tmlv*" endants of life hat interest our senses beyond the physical stUc Lure. Hence, it is not remarkable, considering how liable S, are to take the lead of the understanding: thatTven tL "T68 minds have supposed that life consists ^HoST eThave overlooked the great efficient cause or power upon which the results PHYSIOLOGY.--VITAL PROPERTIES. 87 depend (§ 234 g, 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 depends 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 applied 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 (the vis medi- catrix natures), when they are driven by morbific causes 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, 893, 1041). 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 morbific agents. The salutary changes produced by remedial agents involve the same principles. But, these definite changes, and the ac- tion of morbific and remedial agents, are liable to contingent influen- ces from 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, b). 180. The vital properties are without renovation, or mutation in health, 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). 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). 1S2, 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, 855). 183. In their highest development, the properties of the vital prin- ciple are six; namely, irritability, mobility, vital affinity, vivification, 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. They 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. Comm., 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 diffi- 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 an element 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 are 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, f). 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 nervous influence, are better subjects for the experimental researches which concern the philosophy of life ; and the facts, therefore, which they supply may be carried up, for the PHYSIOLOGY.--VITAL PROPERTIES. 89 same general purpose, 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 b). 187. The vital properties co-operate together in their functions, more or less, as they exist in any given being. I875. 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 (fy 1041). irritability. 188, a. Irritability belongs to all tissues, and is the property upon which all vital agents, external and internal, physical and moral, nat- ural, morbific, and remedial, produce impressions in organic life ; ex- cept as sensibility is concerned in the function of sympathy (§ 201-203, 226). If motion follow, the impressions are transmitted to mobility, by which that property is roused into action, when motion ensues as a consequence. All actions or motions, in animal as well as organic life, are brought about by impressions on irritability (§ 205, 233, 257, 486, 500). 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 propagated to the muscular tissue of the organs (§ 201, 514 f). So, also, reme- dial agents operate upon the irritability of parts to which they are ap- plied, and thus affect their functions in a direct manner. But their influences are commonly more extensive, and then they call into op- eration the nervous power by their action upon sensibility (§ 201), thus giving rise to the function of sympathy (§ 222, &c, 500). When mental emotions affect the organic functions, it is by deter- mining the nervous power upon the irritability of the parts (§ 226, 227). And, although sensibility receives the primary impressions in the function of sympathy, the resulting influences upon organic actions are brought about by a determination of the nervous power upon the irritability of the affected organs (§ 201, 226, 227, 1041). 188, b. 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 doGtrine 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 sympathy is concerned. This demonstration, indeed, was made in 90 INSTITUTES 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 plants 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. . . . . 188^, 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. 188|, b. 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|r, 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 perhaps 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. But, thanks to my colleague, Professor Draper, whose name in early life glows, upon the sunbeam, organic science is supplied with PHYSIOLOGY.--VITAL PROPERTIES. 91 an adornment which vies in delicacy, yet sublimity, with the attri- butes of the nervous power (§ 222, &c, 234 e). The professor has obligingly furnished me with the following state- ment of the progress, 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 light 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 principles. 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 dose 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 light. " 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 yellow 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. The 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 shown that each particular ray of these principles exerts specific powers. The compounds in which silver enters are affected 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. " 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 extraordinary 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, 528). 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, &c). It is this which settles 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 alone had supplied the unerring, the "indisputable" requisite, the Vital Principle. And, although discovery is probably only begun, 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 supply a strong analogy for this conclusion. It only remains, therefore, for the experimenter to follow the path marked out by Draper; and if it do not conduct him to equal glory, he will increase that of the projector, and multiply facts for the great principles in- volved (fy 1072, a, note). 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, affects certain organs 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 ] 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- cation 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." 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 1 In whatever aspect, therefore, we may regard the chemical doc- trine of vision, it is every where shown to be untenable. But, from the close analogies between the relation of physical agents to sensi- bility m 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 latter, 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 too-ether either mechanically or chemically, a new agent is created, winch op- PHYSIOLOGY.--VITAL PROPERTIES. 95 erates either in an individual sense, or if by several virtues, as an en- tire whole. So, in respect 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). 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 according to the foregoing moral causes, and according, 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 c, 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, in his " Outlines of a Course of Lectures," 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 whole 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 inherent 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, Section 376.—See, also, this work, § 175 d, 167 d, 291, 350f b; and Examination of Reviews, 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 are devoted to the propagation of medical materialism. It will be seen 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 "irritability remains" after it is "destroyed." Finally, we have ad- mitted, " that the nerves have the power of conveying the stimuli which call the property [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 carry out the work of destruction, and more speedily resolve the organic fabric into its ultimate elements, than any inorganic compound (445, e) 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 thev 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 uponthmere structure than upon that living principle which imparts to the orLic kingdom all its peculiar characteristics 1 Or, as the blood or inv or anger, rouses the heart, or as fear brings on perspiration, micturition PHYSIOLOGY.--VITAL PROPERTIES. 97 &c, 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 proper- ties of life are something per se, 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 operandi 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 created 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, 441). 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 beinp;, and in undisturbed connection with the parent; but, in the 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 ego;, but heat and atmospheric air become necessary to restore 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, at least, that a partial development of the cvum takes place, though imperfectly, G 98 INSTITUTES OF MEDICINE. through 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 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 irritability (§ 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, energy, 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 every distinct species of animal and plant has, in a collective sense, its own special modification of irritability, through which 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 kine 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 peach 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 other 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, b. 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. (§ 49£, 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 PROPERTIES. 99 which transcends other affinities between the two great kingdoms of nature. Wo 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 1 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, thai, "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 chlorine. They are not, however, altogether the same. M. Berzelius infers that elementary bodies can assume, under varying cir- cumstances, dfferent 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, between these extremes there arc innumerable intermediate points. Be- tween the two views there is, therefore, this essential difference: From the former, it does not appear what the nature of the newly-assumed properties may be ; 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 Substitutions. 1845. 192. Irritability 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 derives its impor- tance from the high authority 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 possible destruction of the nervous communications, evince the clearest distinc- 100 INSTITUTES OF MEDICINE. tion between irritability and sensibility, however close their analogies in respect to the operation of physical agents. When nux vomica rouses spasmodic actions in a paralyzed limb, it is by its action on irrita- bility, for sensibility may be extinguished, and not reproduced (§500, d). 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. All the modifications of sensibility are designed for the transmission of impressions from the circumference to the nervous centres (S 437. 438). 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 called sympathetic sensibility ($ 1037, b). 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 greatly 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 morbid 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 ner 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 impressions 200 The foregoing (§197-199) are coincident with what we have seen of differences in irritability (§ 133, &c, 190, 191), though more strongly pronounced, and are clear examples of what is rrTeant 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 different 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 office 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 Muller, " 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 influences 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 k-m, 902). 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 Muller, " 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." 102 INSTITUTES OF MEDICINE. 201, c. Sympathetic sensibility appertains to what arc denominated the sensitive nerves, and the sensitive fibres of compound 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, b). 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 nervous 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 respiration, and in the concerted action with which the various organs carry on their respective functions. Through this modification, all 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 (§ 129, 464, &c). The special function of this kind of sensibility, and its co-operation with the nervous power in the function of sympathy, will be farther 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, b). 202, b. It may be now said, however, that when sympathetic sen- sibility gives rise to motion, whether in organic or animal life, or whether sensible or insensible, it is through impressions received and iransmitted by this property to the cerebro-spinal axis (unless the ganglia of the sympathetic be also 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 cerebro-spinal axis, 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, 542, 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. Comm., 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 always a correspond- 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. Comm., vol. ii., p. 147-156, 175, 176, 399-402). 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. Irritability 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 wo 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 irritability 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). 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 step in the process, mobility is roused into action. Then follows 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 organic life do not obey the stimulus of the nervous power when excited by the will (§ 486). 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 (§ 483, 486). * See SrALLANZA-Nis Experiments in Opusndi di Fisca Animate, Overe r vi n 482-556. y ' c* ™-' v' PHYSIOLOGY.--VITAL PROPERTIES. 105 4. VITAL AFFINITY. 216. It has been seen that the elements of organic compounds are 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 only operate upon com- pounds of this complexity. Vegetable organization is, therefore, more of a creative nature than animal (§ 13). 5. VIVIFICATION. 218. By vivification, 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 (§ 665, b). 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 (§ 5jr b, 53). 220, b. Changes in some of the secretions, or 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). There is no " putrescency," though otherwise averred in the late re- production of the humoral pathology. Living matter cannot generate dead organic compounds; nor can remedial agents reconvert the pu- trid into living solids and fluids (§ 17, 847, 901). 106 INSTITUTES OF MEDICINE. 6. THE NERVOUS POWER. 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 the room of this function, generally regarded as a property, I shall substitute the nervous power, upon which, in connection with sensi- bility, the former depends (§ 201). 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 actions (§ 202), in the phenomena of sympathy 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 affections 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. 223. The nervous power appertains to the vital principle, resides exclusively in the nervous systems, and is, therefore, peculiar to ani- mals (§ 184, b). 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 the function of sympathy, especially in organic life (§ 209). The nervous power is constantly, though, for the most part, in in- sensible operation throughout the organic mechanism, and is the pow- er which maintains all parts in harmonious action. For this special reason I 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 PHYSIOLOGY.--VITAL PROPERTIES. 107 affected organs, can hardly be traced through the mechanism of the cerebro-spinal system, though they may, perhaps, through the gangli- onic nerve. Again, also, the very division of a nerve will produce inflammation of the part to which it is distributed. In this case a shock of the nervous power must be determined by the nerve itself (§ 226). The experiment is precisely analogous to those in which Wilson Philip influenced the functions of various parts by irritants, &c, applied to the brain and to the spinal cord (§ 474 b, 480, &c). It is evident, however, that the nervous power is much less strongly pronounced in the nerves than in the brain and spinal cord ; just as sensibility is less in the brain and spinal cord than in the nerves of sensation, and less in the trunk of a nerve than in its ramifications ; or, as irritability and sensibility exist in very various degrees in numer- ous parts. 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 moral and physical, of being increased, or di- minished, 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, b). It is also liable to artificial modifications from the operation of physical and moral causes upon the nervous system ; and its influences upon irritability will correspond with the nature of its modifications ; be- ing thus rendered a vital stimulus, or a vital depressant, or a vital alterative (§ 150). When, therefore, this power operates in any un- usual manner, organic and animal motions, whether sensible or insen- sible, will be variously modified, or produced, by calling mobility into exercise, according to the nature of the influences exerted upon the power (§ 188, 205, 216, 492, no. 5). These facts are known by the endless variety of phenomena which are relative to the nervous pow- er (§ 165, 1881 d, 480, Exp. 12, 13, and 14, 503-505, 891'a k). 227'. The nervous power is brought into unusual operation very va- riously, according to the seat 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 will (§ 226, 486, 500 d, 940-951, 969 a, 974-977). 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 accordino- 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, ike, 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- markable when we regard their near coincidence with the natural results, 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 sympathetically (§ 500). These analogies will have been variously illustrated. They 108 INSTITUTES OF MEDICINE. evince the 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). 2d. The operation 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 moral causes, by disease, &c, upon the foregoing varie- ty of sensibility, and according, also, to its different modifications in different parts, and the nature of the operating causes. 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 external 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, 898J k 893 e, 902 g, 904 a). 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 part 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). 228, b. 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 moral 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 dosesi the respiratory movements are not affected, but only the condition of the skin, &c, and in lesser degrees. But, these examples embrace PHYSIOLOGY.--VITAL IROPLRTIES. 109 only certain parts 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, various circles of morbific or remedial sympathies may be instituted (§ 743). 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 upon 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, therefore, 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 nerves, 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 sympathetic sensibility. 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, depresses those 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 determined 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 af all parts, upon which nutrition, vital decomposition, &c, depend (SS 395, 1040). 232. The modifications of the nervous power now described (§ 110 INSTITUTES OF MEDICINE. 227-230) 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 treat natural purposes in the animal economy. This power is manifestly associated with the vital principle of animals (§ 184, b) 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 (§ 184). Volun- tary motion (§ 215, 486), respiration, a permanent contraction of the sphincters, are also other final causes of the institution of the nervous power. The 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, whether the general functions of a compound organ, or those of its individual economy, 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 moral causes; 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 great balance of functions, and to fulfill the office of restoration as well as of conservation, there is imparted to it, as to the other prop- erties of life, a partial mutability in its nature, conformable 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 (§ 1075). 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 irritability. 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 be 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). v vs 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, having no sympathetic relation of parts, the diseases of one part are felt by other parts only through the common laws of nutrition, while, also, remedial agents are curative by their local action alone. 233 £. The nervous power, in a manner analogous to its determina- 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^. 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 moral 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, 903). 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, 844). 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 parts 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. The fact may be regarded as fatal, in itself, to the doctrine of the op- eration of morbific and remedial agents by absorption, and to the hy- pothesis which identifies the nervous power with galvanism. 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. power in 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, and 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 b, 785). 234, b. 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. He, indeed, must have been a very imperfect spectator of human events, who anticipates the acquiescence of ignorance or prejudice, or the ready concurrence 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, Muller, 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 sympathies, 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 regarded as an accidental or as a superfluous appendage of the body, or thrown in to embarrass inquiry by multiplying the complex- ities of organic beings (fy 1039). Coming to the different 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 operation 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 bb) 1 Do you deny its several well- attested properties 1 Then why not deny the properties of the mind 1 Have you not, for the aid of the senses, a tangible analogy in the solar beam (§ 18Si 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) 1 Can * See Medical and Physiological Commentaries, vol. i., p. 397, 511, 512, 514 515 as to Magendie. PHYSIOLOGY.--VITAL PROPERTIES. 118 you see the Maker of the eye, or did the eye make itself (§ 74) 1 Do the muscles move without a moving power? 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 (§ 233|, 349 e, 500 i) 1 [s there nothing as improbable in all this as in the propositions of the vitalist 1 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 remedial 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,/*) 1 Will you consider an ar- gumentum ad hominem ? 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 Philip, Hall, Muller, Bell (§ 464, &c, 476, &c). Look at the nervous system, and there you shall absolutely see. Or, do you require other aid for your senses, 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, gazmg at the north for some sign that shall help the un- derstanding as to the nature of the mysterious agent. But you see and feel 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) 1 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 114 INSTITUTES OF MEDICINE. of such 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 affirmation be made of any other thing 1 But, you cannot see the modifications of the nervous 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 survey of the less tangible, but not less precise, and infinitely diversified, phenomena, that mark the artificial modifications of irrita- 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 (§ 188|-, d). 234, c. Do you marvel at the rapidity with which the nervous power moves in its operations'? 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. 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 reflect 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 philosophical 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 in tran- PHYSIOLOGY.--VITAL PROPERTIES. 115 situ, a movable substance, but, like the principle of light, 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, 188| d). Do you still marvel as to how the nervous power should induce or subvert diseases'? 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 1 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 I 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 1 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 only study 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- mit 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" (§ 188£, d). 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 interpreted without the agency of such a principle. 234, f. 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 hypotheses 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 1 Do you understand any better, or have you any better facts respecting, the relation of physical agents to the mind, in the phe- nomena of sensation 1 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, sensibility1? What intelligible connection is there, between the properties of mind and the motions of the brain'? 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 ? 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, per se, as the only medium. We therefore turn 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 attributes 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 parts of the organization; the nervous 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 perpetual operation of that power, the whole organic mechanism of animals moves on in a well-balanced, concerted action. Thus are the properties of the mind, the proper- ties of the vital principle, 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 great 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 their phe- nomena. 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 which different agents, powers, or causes, manifest, are so unlike 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 nature of a stone. And so of magnetism, galvanism, light, heat, and whatever else appertains to the inorganic world. We examine their manifestations, and compare them together, and distinguish different things from each other by the.manifestations or phenomena of each. But, there are groups of phenomena which have certain general re- semblances, and these we arrange 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 as 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. 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, 188-215). 234, h. 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 Lo^icl' 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 the foregoing agents ever produce, out of the organic being, a single one of the phenomena of life ] Did they ever give rise to one of those phenomena in a dead subject, although the organ- ized structure 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) "? 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 ] 234, /. 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). 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 ] 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. Wlroever 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 various 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 philosophical 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, ceteris par- ibus, 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 nature for its foundation, are owing to our inability to understand all the facts. If any remedial agent produce an effect 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, always 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 which 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 stability 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). 23S. I have said, that although instability is a prominent character- istic of the properties of life, and lies at the foundaton 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. 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 natures, 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 is one of the most remarkable exemplifications of Design, since, without it, the human race would become extinct. 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 moral, 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 preserve 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. Mind 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). 211, b. 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 centre, 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 affinity 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 particular, 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 ago ; nor does one generation of animals gain upon its predecessors. How different with reason, and with the instinct of man ! He passes through early infancy without a trace of the for- mer, and with only that helpless development of the latter which ena- * Hi-re I may say that analogy proves that there is but one species of mankind, since the manifestations of reason and instinct are the same in all. 124 INSTITUTES OF MKDICINE. bles him, with the foreign aid of reason, to imbibe the sustenance re- quired by organic life. 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 tanging 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). 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, 350f h-l). Perception and the will 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 nervous power. 243. The to ill, another property of the mind, upon which volition lepends, exemplifies 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 little or no 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 purposes, to stretch their influences to the deep recesses of life. 244. The will, a property of the mind, like the nervous power a PHYSIOLOGY.--FUNCTIONS. 125 property of the vital principle, is, therefore, a vital stimulus to the brain, whose chief office is the production of voluntary motion, by bringing into action the nervous 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 voluntary 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). 216. 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 are, indeed, the only useful ends of life; since, otherwise, all organic beings Would exist in the condition of the seed and egg (§ 235, 236). The terminating series of the capillary vessels are the im- mediate instruments of all the essential processes in organic life, and therefore, also, of all diseases (§ 109, 668, 679). 248. The functions are common and peculiar. 249. The common functions belong to all organic beings. They consist of, 1st. Motion; 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, 11S-123). ' 250. The peculiar functions belong to animals only. They are, I. Functions of relation ; comprehending, 1st. Sensation; 2d. Sym- pathy. 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 ca?ca; 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 twins';" 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, I). 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 other (§ 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, arc the natural stimuli in organic life. Indeed, the nervous power is not a natural stimulus to the viscera of organic life, but only super- added, in animals, for an incidental purpose (§ 215, 223, 226, 232, 455,1034,1051). 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 (§ 476, &c). 261. That motion does not depend upon the nerves, is shown 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 (§ 18, 409). Such analogies are always sound, being based on great fundamental laws. But there may be great variety of mechanism. The same independence is shown by the organic actions which continue in parts from which all the nerves are severed; by the regular action of the heart and intestines after their removal from the body, &c. 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." 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. It seems also to have been shown by the case of the monster 128 INSTITUTES OF MEDICINE. recorded by Dr. Clark, that while the foetus exists in utero, the nerves are no more necessary to its growth and maturity than are the glan- dular organs; simple nutrition being alone in progress. In that case, Dr. Clark had in view the importance of the principle now under con- sideration, and a faithful examination appears to have been made with a view to the nervous system, and which resulted in his failure to detect its existence (§ 461^).—Dr. Clark, in Philosophical Trans- actions, London, 1793, p. 154. 265. In the Medical and Physiological Commentaries I have set forth a variety of other important facts to show that motion, voluntary as well as involuntary, is essentially independent of the nervous sys- tem. (See vol. i., p. 17-29, 474-480, 571, 572; vol. ii., p. 385.) The Experiments of Philip are also conclusive upon this subject (§ 476, &c). 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 proceeding 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—this 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 its operation is determined through particular nerves either by an act of the will, or, in organic 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 (§ 473, no. 6). 267. All the foregoing are established facts, of perpetual occur- rence ; 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 (5 226-232, 893, &c). 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 upon principle alone—at least to such as recog- nizee 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- * See Medical and Physiological Commentaries, vol. ii., p. 170, note, 380, 394-396. PHYSIOLOGY.--FUNCTIONS. 129 tion, however that may be modified in different parts, as seen in the lymphatics and lacteals, in the terminal series of the capillary arter- ies 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, on the contrary, 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. 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 organic beings are the constant subjects of waste as well as of nutrition; the balance being maintained through the inlet supplied by the lacteals, aa-d the outlet provided by the lymphatics (§ 180-182, 286). Notwithstanding, therefore, the coinci- dence 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 cquilihrio. 274. No substances but such as exist in a fluid or very attenuated state are taken up by the lacteals and absorbents. 275. The lacteals have open orifices in the intestinal villi. I have shown the error of the microscopists who deny these orifices; and I have shown, also, that all vessels of secretion terminate in open ori- fices.t Physiologists, however, continue to copy the projectors of the mechanical theory of porous absorption and secretion. 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 exclusion of the red globules from the serous 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 * Sec Med. and Physiolog. Comm., vol. ii., p. 168,169, 171-173. t Ibid., vol. i., p. 683-690, 699-712. 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, as it is called, 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, b. 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 confirms, 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/, 266, 3031 a, 306, 310, 311, 325, 387, 399, 409/-422, 514 A, 524 d, 525, 526 d, 528 c, 638, 619 d, 764 b, 811, 847 c, 848, 902/, 905). 279. If, therefore, foreign agents affect the vital properties 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 (from five to fifteen minutes), 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 great 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 prooress from deep-seated parts toward the surface. 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 Pathology, 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 five years before the public, I know not that 1 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 turpentine, 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. It may be also advantageously stated in this place, that the insoluble nature of many substances, such as the hydrargyri chloridum, the hydrargyri pilula, the hydrargyri unguentum, &c, positively con- tradict the statements which have been made as to their presence in the circulation, and enforce the importance of receiving with greater caution the experiments which are put forth to sustain an hypothesis, or which may apparently aim at notoriety (§ 264). 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 restoration 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. 132 INSTITUTES OF MEDICINE. so 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, under 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 fundamental 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 capillary 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 a* 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 applied 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 doctrine nowa- days ; a part of the " new experimental philosophy." Iu 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 experience, 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 1" A mere bundle of dead, disorganized fibres, broken upon the card, and spun upon the wheel (§ 350£ n, o, 826 c). 291. But, the foregoing degrading doctrine 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 which imitates the (fleets 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 c).—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, a). 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 "in the living organism we are acquainted with only one. cause of motion ; and this is the same cause which determines the growth of living tis- sues, and gives them the power of resistance to external agencies. It if the 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 only 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 and Barbieii 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 prussic 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, applied 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 which prevail in organic compounds (§ 455, c). 295. Equally unfounded as the doctrine of capillary attraction are the supposed processes of endosmose and exdosmose. They are all alike 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 exdosmose, in the Medical and Physiological Commentaries, I shall not now resume the subject (§ 1052, 1053, 1054). 3. assimilation. 296. By the function of assimilation the 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 the alimentary canal of animals, and in the absorbing vessels of plants. PHYSIOLOG V.--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 of 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). 299. Assimilation, therefore, devolves especially upon the proper- ties vivification and vital affinity (§ 214, 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 there 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. 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 great means of nutriment to both organic kingdoms ; directly to the vegetable, and indirectly to the animal department (§ 298-300). The assumption as put forth in Liebig's Animal Chemistry, that " all matters which serve 136 INSTITUTES OF MEDICINE. as food to living organisms are compounds of two or more elements, which are kept together by certain chemical forces," must be aban- doned, and we must look 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 great 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, b. 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 whole essential elementa 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 imbodied 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 sempervirens, will grow as well when suspended by a string, as when connected by their roots with the soil. 303, d. The leaves of plants absorb carbonic acid mostly during the day, decompound it, as do the roots those binary compounds taken in from the soil, and otherwise prepare it as an important source of nourishment. Light is necessary to this function of the leaves, or, at least, to its proper performance; and it is remarkable that while in progress, it is attended by an evolution of oxygen gas, but that during its suspension, as in the night, oxygen gas is absorbed by the leaves and carbonic acid given out. This, however, is said by distinguished physiologists to be only partially true as it respects these processes at night; some affirming that they have witnessed the same results at night as during the day. The chemists have an interest in makino the light the agent of decomposition. But the light acts only as a vital PHYSIOLOGY.--FUNCTIONS. 137 stimulus to the leaves, by which their organic properties are rendered capable of overthrowing that most refractory compound, carbonic acid (§ 188J- d, 350, nos. 46, 47, 48, 49, 50, 51, 52, 53, 54). 303, e. The leaves of plants being the great organs of assimilation, and light the vital stimulus by which the function is maintained (§ I885, 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 vegetable 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\, 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). 303^, 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 affirms 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, &c, p. 70, 71. 303^, Cm The same mistake has arisen with the chemists as to the reciprocal 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 adduce 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 (§ 303J-). 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 TJL__th part of its weight 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 would, 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 1S00 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 of 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." Oxygen gas is a large and important element of vegetable substances, and a pro- portion, therefore, of the oxygen of the carbonic acid is evidently re- tained, and combined under a new form along with the carbon and other elements. In making all plants yield the whole of the oxygen of the carbonic acid to the air, Liebig sacrificed vegetable physiology to one of his favorite chemical assumptions. His hypothesis, also, as to the dependence of absorption upon the mechanical process of cap- illary attraction, has led him 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, b). Water, therefore, being composed of oxygen and hydrogen, furnishes 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 There are also other sources from whence vegetables derive their oxygen, namely, from some mineral compounds appertaining to the earth, and directly, by means of the leaves, from the air itself (§ 303). The latter process goes on, mostly, in the night, and the decomposi- tion of the carbonic acid is then, also, more or less arrested; or, as is generally supposed, a certain proportion is generated and emitted by plants ; and that those actions are analogous, to a certain extent, to the respiration of animals, having for their object, in part, the separation of carbon from some of the vegetable constituents. 303 J. Here, again, let us pause to observe the windings of the chemist and his conflicts with nature. "At night," says Liebig, "a true chemical process commences, 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 " the laws of life cannot be 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 be investigated in 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 ibregoin°- 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. 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, and 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. 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 greater is the development of the digestive system (§ 131, 251, 409 I). 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 greatest change. 307. 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, they would stultify physiologists with the pretense that many different processes of the laboratory will 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). 308. The plainest analogy leads us, therefore, to the conclusion that all animals possess a stomach ; while the universality of the gas- tric juice shows its fundamental importance in the animal economy. 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 absorbed 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 themselves 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 a, 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 known 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 great universality, 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 live 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 own 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 saliya; while the disappearance of some of the components of the bile, and other relative facts, show a direct connection of this fluid with the process 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, b). Connected with these important uses of the bile, is its well-known function of maintaining peristaltic action. Such, therefore, beino- 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. 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 of chyle. Nothing 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 right 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 said to exhibit globules under the microscope, which is probably true. Others affirm that they have seen them in the chyme ; but Muller 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 in the villi of the in- testines (§ 275). These questions as to the existence and shape of the globules of blood, chyle, milk, &c, are of no farther practical importance than as they 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). 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 degree 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 universality of four specific digestive fluids, and.each of these analogous in all an- imals, notwithstanding the variety in the structure of the secretino- 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 parts, 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 digestion 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 to every secreted solid and fluid, the derivation of the whole unique and for- ever exact variety (millions upon millions, § 41-46) from four ele- ments mainly, from one 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, or with the plainest rules of evidence (§ 638). But, let us analyze, in another section, the great plan of nature for the maintenance of organic life in animals. 323. Let us analyze, after the manrier 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 perfect 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 carry 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 break. All these circumstances will, in like manner, influence the de- PHYSIOLOGY.--FUNCTIONS. 145 velopment of all those parts which 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 structure without this also changes." Again, observe what may be inferred 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 l lie clavicle and acromion, and the straightness of 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,/). 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 (§ 18). 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, the final cause of the 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 now 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, sympathetic influences 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 gastric 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.—ru.NOTIONS. 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, Sec). 330. Now, suppose, instead of treating disease upon some broad principles, we were to undertake the specific object of the humoralists 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 produce, 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 deranged 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, to">, 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. 331. The condition, therefore, of the blood and of the products elaborated from it, in all cases of disease, should be regarded only as more 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- og v and Organic Cm-^.hstry, 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 of 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 148 INSTITUTES OF MEDICINE. the more so as it advances to the 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. 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. 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 con- tinued, by other analogous links, with elementary matter itself; but here, 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 of 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 kingdoms, 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^). Now, each of these denominations has interpreted the philosophy of di- gestion according to the general 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. " Chymification," 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 known as putrefaction, fermentation, or decay" (§ 365). It will be also seen from the foregoing quotation, that the chemist is 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 most remarkable characteristic of the writings of this distinguished 150 INSTITUTES 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 chemistry, 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 pervades 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 Animal Chemistry (§ 350). 339, b. 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 d, 676 b), 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).—Paris's Pharmacologia, 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, where 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 putrefy1? Why not any other animal or vegetable fluid 1 Why not any living animal or vegetable solid 1 340. 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'nature'slaws ;" "who," says another, " was neither anatomist, physiologist, surgeon, nor naturalist, alone, but the most remarkable 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 other 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 chemically, being ignorant of the principles of the animal economy, have erroneously referred the operations of the animal machine to the laws of chemistry." 341. The illustrious George Fordyce, after a thorough experiment- al 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 intestixkh 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, " whether 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 observations (§ 365). 312. 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 way 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. dergo in nutrition, chemistry has hitherto given us no satisfactory in- formation, simply because, being effects of life, such changes are 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 vegetables 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 intro-mechanicians and in- tro-chemists to reach this point (assimilation) have failed; and it is well 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 power peculiar to, and inherent in, organic bodies."—Tiedemann's Physiology. 343. Turning to the greatest of French physiologists, we hear from him the same general protest against the corruption of medicine by ingrafting upon it the physical sciences (§ 5J, 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 oi 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 alimentary 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 process, function, or result of living beings. 317. Nor is that all. For the chemico-vitalist, the same eminent chemist whom I have just quoted, goes on to say, that " with the liv- ing, 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 ;" 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."—Dn. Prout's Bridgewater Treatise. 348. And, to the same effect may be quoted Dr. Carpenter, one of the foremost, as we have seen, in the school of pure chemistry (§ 64, g). " 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,/) : "Vital chemistry," he says," is too subtle a power forhuman 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. 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- 154 INSTITJTES OF MEDICINE. escence with those consistent principles of nature which exact his con- sent, but not his compliance. 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 Philosoj)7iy 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,, thai 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 " Animal 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, b, 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 be replaced by the chemical forces;" 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 we regard as the ultimate origin of electrical phenomena." And again, " in the processes of nutrition 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 b, 4 b). 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- PHYSIOLOGY.--ORGANIC CHEMISTRY--FUNCTIONS. 155 tean character, too little unity of purpose, and demanded greater sta- bility. The learned men of a great Nation, The British Associa- tion for the Advancement of Science, united in the object, and be- Btowed the honor of achieving the enterprise upon a foreign Chemist. The note of proscription has been sounded in high quarters, in due conformity (§ 51 a, 350f kk), 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 I 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 which it was submerged. 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 motion, 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." And now may it not be reasonably asked, what is the cause of those chemical 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) ? 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 array of contra- * See Medical and Physiological Commentaries, vol. ii., p. 122-140. Also, the Essay on the Vital Powers, in vol. i. 156 INSTITUTES OF MEDICINE. dictory opinions on the physiology of digestion, and the general phi- losophy of life and disease, from the two brief National Essays by Liebig (§ 349, d), 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 following remarks from a letter addressed to myself by a distinguished writer, of Manchester (England) : "Manchester, May 5, 1846. " Dear Sir, " I made your pamphlet (a Lecture on Digestion) the subject of a Paper which I read before the Manchester Literary and Philo- sophical Society, and which provoked a discussion two nights. The result was almost unanimously in favor 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 in exact proportion to their ignorance of it."—Liebig's Organic Chemistry applied to PhyS' Mogy, &c. [See no. 2.]—(§ 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. 40). The oft-reiterated conclu- sion follows, 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 serve in the body, since organic chemistry has appliedto the investigation her quantative method of research" ! (§ 18, 409.) e. "The limited acquaintance of physiologists with the methods of research employed in chemistry 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. " What has the soul, what have consciousness and intellect to do with the develop- ment of the human foetus, or the fcetus 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-work. 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 mast always be borne in mind that, with all our discoveries, we shall never know what light, 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" (§ 168, h).—Liebig's Animal Chemistry. PHYSIOLOGY.--ORGANIC CHEMISTRY--FUNCTIONS. 157 g. " A writer, who can so contradict himself, scarcely needs to be exposed by us."— Carpenter's Review of Paine's " Commentaries." See Paine's " Examination of Re- views," p. 12, 86. h. " Chemists and natural philosophers, accustomed to study the phenomena over which the physical 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 will become every thing. The mind will take such a tincture from a familiarity with that ob- ject, that every 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 nature 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 philosophers 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."—11kid, on 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."—Burke (§ 675). 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 ofchem- 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 we cannot doubt that we shall (See motto c.) have in that case a new physiol- 4S. "With all its discover- ogy and a rational pathology." ies, Modern 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 disease."—Liebig. ibid. chemistry, and in those days 50. "Mechanical philosophers the only philosophers ac- and chemists justly ascribe to quaixted with it."—Liebig's their methods of research the Animal Chemistry. (See mottoes greater part of the success which ^» e-) has attended their labors."—Lie- big's Animal Chemistry (a). 3. "In the animal body Ave rec- 51. "In the animal ovum, as ognize as the ultimate cause of all well as in the seed of a plant, 158 INSTITUTES OF MEDICINE. CHEMICAL DOCTRINES. force only one cause, the chemical 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. If this be p>revented, the phenom- ena of life do not manifest themselves. If the chemical ac- tion be impeded, the vital phenom- ena must take new forms." " All VITAL ACTIVITY ARISES from the mutual action of the oxygen of the atmosphere and the elements of the food."—Liebig's Animal Chemis- try. 4. " The life of animals exhib- its itself in the continual absorp- tion of the oxygen of the air, and its combination with certain parts of the animal body."—Liebig's Animal Chemistry. 5. " Physiology has sufficiently decisive grounds for the opinion, that EVERY MOTION, EVERY MANI- FESTATION OF FORCE, IS THE RE- SULT OF A TRANSFORMATION OF THE STRUCTURE OR OF ITS SUB- STANCE ; that every conception, ev- ery mental affection, is followed by changes in the chemical nature of the secreted fluids; that every thought, every sensation, is accom- panied by a change in the composi- tion of the substance of the brain" ! —Liebig's Animal Chemistry (no. 41,18-J). 5\. Nevertheless, " we ascribe the higher phenomena of mental exist- ence tO AN IMMATERIAL AGENCY, and that, in so for as its manifes- tations are connected with matter, an agency entirely distinct from the vital force, with which it has nothing in common."—Liebig's Animal Chemistry. vital doctrines. we recognize a certain remark- able FORCE, THE SOURCE OF growth, or increase in the mass, and of reproduction, or of supply of the matter consumed ; a force in a state of rest. By the ac- tion of external influences, by im- pregnation, 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 itself in the production of a series of forms, which, al- though occasionally bounded by right lines, are yet widely distinct from geometrical forms, such as we observe in crystalized miner- als. This force is called the vi- tal force, vis vitce, or vitality." " The increase of mass is effect- ed in living parts by the vital force."—Liebig's Animal Chem- istry. (See my Essays on Vitali- ty,^., p. 13-18.) 51i. " The oxygen of the at- mosphere is the proper, active, ex- ternal cause of the waste of mat- ter in the animal body. It acts like a force which tends to disturb and destroy the manifestations of the vital force at every moment. But its effect as a chemical agent (in producing waste), the disturb- ance proceeding from it, is held IN EQUILIBRIUM BY THE VITAL force."—Liebig's Animal Chem- istry. 52. " The vital force is manifest- ed in the form of resistance, in- asmuch as by its presence in the living tissues, their elements acquire the power of withstanding the dis- turbance and change in their form and composition, which exter- nal agencies tend to produce; a power, which, as chemical com- pounds, THEY DO NOT POSSESS." —Liebig's Animal Chemistry. 53. "The vital principle must be a motive power, capable of PHYSIOLOGY.—organic chemical doctrines. 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- CHEMISTRY--FUNCTIONS. 159 VITAL DOCTRINES. IMPARTING MOTION TO ATOMS Al 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 phenom- 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 consider the properties and laws of light to be dependent on 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 their existence." — Liebig's Animal Chemistry. 5.6. " We may communicate motion to a body at rest by means of a number 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. ids proceeds from distinct organs, which, as in the case of the heart and intestines, do not generate THE MOVING POWER IN THEM- SELVES, BUT RECEIVE IT FROM OTH- ER quarters."—Liebig's Animal Chemistry (no. 3, 4). 10. " Now, since the phenome- na of motion in the animal body ARE DEPENDENT ON THE CHANGE of matter, the increase of the change of matter in any part is fol- lowed by an increase of all the motions. Consequently, if, in con- sequence of a DISEASED TRANS- FORMATION OF LIVING TISSUES, a greater amount of force be gener- ated than is required for the pro- duction of the normal motions, it is seen in the acceleration of ALL OR SOME OF THE INVOLUNTARY motions, as well as in a higher TEMPERATURE OF THE DISEASED part."—Liebig's Animal Chem- istry. [Such, with § 3504;, no. 11, and a, is the chemical substitute for the medical aphorism, " ubi irrita- tio ibi affluxus." It will be also seen from 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 hearty 11. " The powERto effectTRANS- formations does not belong to the vital principle. Each transforma- tion is owing to a disturbance in the attraction of the elements of a compound, and is, consequently, a PURELY CHEMICAL PROCESS." -- Liebig's Organic Chemistry ap- plied to Physiology, &c. 12. " The combinations of the chemist relate to the change of matter, forward and backicard, to THE CONVERSION OF FOOD INTO THE various tissues and secretions, and to their metamorphosis into lifeless compounds ; his investiga- tions ought to tell us WHAT HAS VITAL DOCTRINES. Every kind of motion may be pro-. duced by the electric or magnetic force, as well as by chemical at- traction ; while we cannot say, as long as we only consider the man- ifestation of these forces in the phe- nomenon or result produced, which of these various causes of change of place has set the objects in mo- tion. In the animal organism we are acquainted with only one cause of motion, and this is the same cause which determines the growth of living tissues and gives them the power of resistance to ex- ternal agencies. It is the vital force."—Liebig, ibid. 57. " In order to attain a clear conception of these manifestations of THE VITAL FORCE, SO DIFFERENT in form, we must bear in mind, that every known force is recog- nized by two conditions of activi- ty," &c.—Liebig's Animal Chem- istry. 58. " Our notion of life involves something more than mere repro- duction, namely, the idea of an ac- tive power exercised by virtue of a definite form, and production and generation in a definite form. The production of organs, and their power not only to produce their component parts from the food presented to them, but to gen- erate themselves in their orig- inal form and with all their prop- erties, are characters belonging exclusively to organic life, and constitute a form of reproduction INDEPENDENT OF CHEMICAL POW- ERS. The chemical forces are sub- PHYSIOLOGY.--ORGANIC CHEMISTRY--FUNCTIONS. 161 CHEMICAL DOCTRINES. VITAL DOCTRINES. TAKEN PLACE AND WHAT CAN TAKE ject TO THE INVISIBLE CAUSE BY PLACE IN THE BODY."--LlEBIo'S WHICH THIS FORM IS PRODUCED. Animal Chemistry. Of the existence of this cause 13. " How beautifully and admi- itself we are made aware only rably simple, with the aid of these by the phenomena which it pro- discov(;iies (chemical), appears the duces. Its laws must be inves- process of nutrition in animals, tigated^'w^ as we investigate those the formation of their organs," of the other powers which effect &c. motion and changes in matter."— 14. "In the hands of the physiolo- 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- motest intention of undertaking the explanation of any really vital phenomenon, upon chemical prin- ciples. The only part which chemistry now, or for the future, can take in the explanation of the vital processes, is limited to a more precise designation of the pheno- mena, and to the task of controll- ing the correctness of inferences, and insuring the accuracy of all observations by number and 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|-350f). 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 animal body." 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 of chemical 16. "The vital force unites in action with thf phenomena of its manifestations all the peculi- motion, which we can produce aritif.s 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 orioin of electrical phenomena." bodies the power of exerting an —Liekig's Animal Chemistry. enormous pressure on surround- 17. " The mysterious vital ing objects. We know not even 162 INSTITUTES OF MEDICINE. CHEMICAL DOCTRINES. VITAL DOCTRINES. principle can be replaced by the how this something itself is pro. chemical forces."—Liebig's Or- duced when we burn wood or ganic Chemistry applied to Phys- coals. iology, &c. " So il is witn THE yITAL 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. 17 a. " The high temperature of 6l£. "Certain other constitu- the animal body is uniformly and ents of the blood may give rise to under all circumstances the result the formation of carbonic acid in of the combination of a combusti- the lungs. But, all this has no ble substance with oxygen." connection with that vital pro- " The carbon of the food, which cess by which the heat necessa- is converted into carbonic acid ry for the support of life is gen- within the body, must give out ex- erated in every part of the body." actly as much heat as if it had been —Liebig's Animal Chemistry. 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 meta- morphosed tissues, the tempera- ture NECESSARY TO THE MANIFES- TATIONS of vitality is produced in the carnivora."—Liebig's Ani- nal Chemistry (§ 440, nos. 17 and 18. " The nerves which accom- 62. " In the present state of our plish the voluntary and involunta- knowledge, no one, probably, will ry motions in the body (no. 7-9) imagine that electricity is to be are, according to the preceding considered as the cause of the exposition, not the producers, phenomena of motion in the but only the conductors of the body." " Every thing in the ani- vital force (§ 59). They permit mal organism to which the name PHYSIOLOGY.—organic 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.^ ISj. " If CHEMICAL ACTION be excluded as a condition of nervous agency, it means nothing 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 generated 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 characeae, 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 rowER, capable of re- newing itself at every moment of their existence."—Liebig's Ani- mal Chemistry. 21. "While the assimilation chemistry—functions. 163 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). 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 Animal Chemistry. 64. "Although plants requirt light, and, indeed, sun light, it h not necessary that the direct ray.- 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 acticn ALREADY EXISTING." -- LiEBIG'k Organic Chemistry applied to Physiology, &c. 65. " The vital principle is only known to us through the pe- culiar form of its instruments 164 INSTITUTES OF MEDICINE. CHEMICAL DOCTRINES. of food in vegetables, and the WHOLE PROCESS OF THEIR FORMA- TION, arC dependent on certain EXTERNAL INFLUENCES which pro- duce motion, the development of the animal organism is, to a certain extent, independent of those exter- nal influences, just because the animal body can produce within ITSELF THAT SOURCE OF MOTION WHICH IS INDISPENSABLE TO THE VITAL PROCESS."--LlEBIG's Ani- mal Chemistry. 22. " Neither the emission of carbonic acid nor the absorption of oxygen (by plants) has any con- nection with the process of assim- ilation ; nor have they the slight- est relation to each other. The one is purely a mechanical, the other a purely chemical process. A cotton wick, inclosed in a lamp, which contains a liquid sat- urated with carbonic acid, acts ex- actly in the same manner as a liv- ing plant in the night."—Liebig's Organic Chemistry applied to Physiology, &c. 23. " At night, a true chemical process commences, in conse- quence of the action of the oxygen of the air upon the substances 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 exact- ly as in a living one" ! Nevertheless, 23|. " What value can be at- tached to experiments, in which all those matters which a plant requires in the process of assim- ilation, besides its mere nutri- ment, have been excluded with the greatest care ] Can the laws of life be investigated in an organized being which is dis- eased or dying?"—Liebig's Or- ganic Chemistry applied, &c.—Or, can those laws be investigated in VITAL DOCTRINES. that is, through the organs in which it resides. Hence, what- ever kind of energy a substance may possess, if it is amorphous and destitute of organs from which the impulse, motion, or change, proceeds, it does not live. Its energy depends, in this case, on a chemical action. Light, heat, electricity, or other influences [justly considered here by Liebig as vital stimuli and not forces] may increase, diminish, or arrest this action ; but they are not its efficient cause." " The vital principle opposes to the continual action of the atmosphere, moisture, and temperature, upon the organism, a resistance which is, in a certain degree, invincible. It is by the constant neutralization and renewal of these external in- fluences that life and motion are main*'lined." — Liebig's Organic Chemistry applied to Physiology, &c. (§ 188^, d). 66. " An abnormal production of certain component parts of plants presupposes a power and capabil- ity of assimilation, to which the most powerful chemical action cannot be compared. The best idea of it may be formed, by con- sidering that it surpasses in power the strongest galvanic battery, with which we are not able to separate the oxygen from carbonic acid, as is done by the leaves of plants," " and without the direct solar rays." 67. " All that we can do is to supply those substances which are adapted for assimilation by the power already present in the or- gans of the plant."—Liebig's Or- ganic Chemistry applied to Phys- iology, &c. 68. " The living part of a plant acquires the whole force and di- rection Of its VITAL ENERGY from the absence of all conductors of force. By this means the leaf is PHYSIOLOGY.--ORGANIC CHEMICAL DOCTRINES. ' a cotton wick, inclosed in a lamp]" And so of animals. 24. " The permeability 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 (§ 350 2, n, and Medical and Phys- iological Commentaries, vol. i., p. 565, 569, notes, 683-690, 1052, 1054). 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 alt, that it contains, without SELECTION," and " THEIR ASSIMI- LATION is a PURELY CHEMICAL PRO- CESS."— Ibid. (no. 22, § 289-291). Nevertheless) CHEMISTRY--FUNCTIONS. 165 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 worthy of investigation."—Lie- big's Organic Chemistry applied to Physiology, &c. 70. " In the living plant, the in- tensity of the vital force far ex- ceeds that of the chemical action of oxygen. We know, with the utmost certainty, that, by the in- fluence of the VITAL FORCE, OXYGEN 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 is 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. 26£. " When roots find their more appropriate base in suffi- cient quantity, they will take up less of another."—And, again (in opposition to the simile of the " sponge," and " lamp-wick") : "It is thought very remarkable, that those plants of the grass tribe, the seeds of which furnish food for man, follow him like the domestic animals. But saline plants seek the sea-shore or saline springs, and the Chcenopodium the dung- hill from similar causes. Saline plants require common salt, and plants which grow on dung-hills, only, need ammonia and nitrates, and they are attracted whither these can be found, just as the dung-fly is to animal excrements." " The roots of plants are con- stantly engaged in collecting from the rain those alkalies which form- ed part of the sea-water, and also those of the water of springs which penetrates the soil." 27. " Each new radical fibril which a plant acquires may be re- garded as constituting, at the same time, a mouth, a lung, and a stomach. The roots perform the functions of the leaves from the first moment of their formation ; ihey extract from the soil their proper nutriment, namely, the car- bonic acid generated by the hu- mus."—Liebig's Organic Chem- istry applied to Physiology. 28. [" Nature speaks to us in a peculiar language, in the language of phenomena. She answers, at all times, the questions which are put to her ; and such questions are exper- iments. An experiment is the ex- pression of a thought. We are near- er the truth, when the phenom- enon, elicited by the experiment, corresponds to the thought ; while the opposite result shows that the question was falsely sta- ted, and that the conception was VITAL DOCTRINES. the formation of vegetable and an- imal substances, the vital prin- ciple opposes, as a force of re- sistance, the action of the other forces," &c.—Liebig's Lectures for 1844. 73. " The force which gives to the germ, the leaf, and the radi- cal FIBRES of the VEGETABLE THE SAME WONDERFUL PROPERTIES (di- gestion, circulation, and secretion), is the same as that residing in the secreting membranes and glands of animals, and which en- ables every animal organ to per- form its own proper functions."— Liebig's Animal Chemistry. 74. " In the animal organism the VITAL FORCE EXHIBITS ITSELF AS in the plant, in the form of growth, and AS the means of RE- sistance to external agencies." —Ibid. 75. " If we assume that all the phenomena exhibited by the or- ganism of plants and animals are to be ascribed to a peculiar cause, different in its manifestations from all other causes which produce motion or change of condition; if, therefore, we regard the vital force as an independent force (no. 3), then, in the phenomena of organic life, as in all other phe- nomena ascribed to the action of forces, we have the statics, that is, the state of equilibrium determ- ined by a resistance, and the dy- namics of the vital force" !— Ibid. 76. " Vegetables produce in their organism the blood of all animals."—Liebig, ibid. To occupy space, nos. 26^ and 27 are contrasted with nos. 25 and 26 in the same column. And so with 5^, 23^. But here is more in the more appropriate place, upon this fundamental point. Thus : 77. " When it is considered, that sea-water contains less than PHYSIOLOGY.--ORGANIC CHEMICAL DOCTRINES. erroneous."—Liebig's Organic Chemistry, &c. ($ 1052,1054). 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, OT 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 as fermentation, putrefaction, and decay."—Lie- chemistry—functions. 167 vital doctrines. to olo o o of ^s own weight of io- dine, and that all combinations of iodine with the metallic bases of alkalies are highly soluble in wa- ter, some provision must 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 medium. 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."--LlEBIG's Or ganic Chemistry applied to Physi- ology, &c.—(§ 1054). 78. " The equilibrium in 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 new combinations and 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, Sec. 79. " The vital force causes a decomposition of the constituents of food, and destroys the force of attraction which is continually ex- erted between their molecules. It alters 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. big's Organic Chemistry applied to Physiology, &c 31. " In the same way as mus- cular fibre, when separated from the body, communicates the state of decomposition existing in its elements to the peroxide of hydro- gen, so a certain product, arising by means of the vital process, and by consequence of the transposition of the elements ofpatts of the stom- ach and of the other digestive or- gans [ ! ] while its own metamor- phosis is accomplished in the stom- ach, acts on the food. The in- soluble matters are digested" !— Liebig's Animal Chemistry. 32. " Is it truly vitality, which generates sugar in the germ for the nutrition of young plants, or which gives to the stomach the power to dissolve and to prepare for assimilation all the matter in- troduced into it 1 A decoction of malt possesses as little power to reproduce itself, as the stomach of a dead calf. Both are, un- questionably, destitute of life. But, when starch is introduced into a decoction of malt, it changes, first into a gummy matter, and lastly into sugar. Hard-boiled albumen, and muscular fibre, can be dis- solved in a decoction of a calf's stomach, to which a few drops of muriatic acid have been added, precisely as in the stomach it- self."—Liebig's Organic Chemis- try, &c. (no. 11). 33. " All substances which can arrest the phenomena of fermen- tation and putrefaction in liquids, also arrest digestion when taken into the stomach" !—Liebig's An- imal Chemistry. 34. " In the natural state of the digestive process, the food only undergoes a change in its state of cohesion, becoming fluid without any other change of properties."— Liebig's Animal Chemistry. VITAL DOCTRINES. ly, that is, without resistance."— Liebig's Animal Chemistry. 80. " It is well known that in many graminivorous animals, where the digestive organs have been overloaded with fresh juicy vegetables, these substances un- dergo IN THE STOMACH THE SAME decomposition as they would at the same temperature out of the body. They pass into fermenta- tion and putrefaction, whereby so great a quantity of carbonic acid gas and of inflammable gas is generated, that these organs are enormously distended, and sometimes even to bursting."— Liebig's Animal Chemistry. 81. " The vital force appears as a moving force or cause of mo- tion, when it overcomes the chem- ical forces, cohesion and affini- ty, which act between the con- stituents of food, and when it changes the position or place in which their elements occur. The vital force is manifested as a cause of motion in overcoming the chemical attraction of the constituents of food, and is, far- ther, THE CAUSE WHICH COMPELS them to combine in a new arrange- ment, and to assume new forms." —Liebig's Animal Chemistry. 82. " It will be shown in the second part of this work, that all plants and vegetable structures undergo two processes of decom- position after death. One of these is named fermentation, the other decay or putrefaction."— Liebig's Organic Chemistry ap- plied to Physiology, &c, (§ 349, c,e). 83. " The individual organs, such as the stomach, cause all the organic substances conveyed to them, which are capable of trans- formation, to assume new forms. The stomach compels the ele- PHYSIOLOGY.—organic 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 constitutionr— 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."-- LlEBIG's Organic Chemistry applied to Physiology, &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, Sec 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 CHEMISTRY--FUNCTIONS. 169 VITAL DOCTRINES. ments of these substances to unite into a compound fitted 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 of ac- tive chemical properties, and the capability of yielding to trans- formations." — Liebig's Organic Chemistry applied to Physiology, &c. 86. " All 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. 86|. " It is only with the com- mencement of 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 course, op- posed 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 acts as a poison." — Liebig's Organic Chemistry applied to Physiology, Sec 87$. "The vital power in veg- 170 INSTITUTES OF MEDICINE. CHEMICAL DOCTRINES. elements. Whatever we regard as the cause of these transforma- tions, the act of transformation is a PURELY CHEMICAL PROCESS. It will be shown, when considering the processes of fermentation and -putrefaction, that any disturbance of the mutual attraction subsist- ing between the elements of a body gives rise to a transforma- tion."—Liebig's Organic Chem- istry, &c. 39. "By chemical agency we can produce the constituents of muscular fibre, skin, and hair" ! " We are able to form, in our la- boratories, formic acid and urea, &c, all products, it is said, of the vital principle. We see, there- fore, that this MYSTERIOUS VITAL PRINCIPLE CAN BE REPLACED BY THE CHEMICAL FORCES" ! !--LlE- big's Organic Chemistry (no. 16, 51, § 53). 40. " The influence of poisons and of remedial agents on the liv- ing animal body evidently shows that the chemical decompositions and combinations in the body, WHICH MANIFEST THEMSELVES IN THE PHENOMENA OF VITALITY, may be increased in intensity by chem- ical forces of an analogous char- acter, and retarded or put an end to by those of opposite character; VITAL DOCTRINES. etables accomplishes the trans- formation of mineral substances into an organism endowed with life." — Liebig's Animal Chem- istry. 87f. " The cause of waste of matter is the chemical action of oxygen. This waste of matter oc- curs in. consequence of the absorp- tion of oxygen into the substances of living parts. This absorption of oxygen occurs only when the resistance which the vital force of 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, 86^). 88. " The constituents of veg- etable and animal substances having been formed under the GUIDANCE AND POWER of the VITAL principle, it is this principle which determines the direction of their molecular attraction." " The vi- tal principle alone is capable of restoring the original order and manner of the molecular arrange- ment in the smallest particles of albumen."—Liebig's Lectures for 1844 (§ 48-50). " We cannot expect from or- 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. 89. " From the theory of dis- ease developed in the preceding pages, it follows, obviously, that a diseased condition once establish- ed, in any part of the body, can- not be made to disappear by the chemical action of a remedy."— Liebig's Animal Chemistry. 90. " The vital force is sub ject to the action of a blister.' —Ibid. physiology.—organic chemistry--FUNCTIONS. 171 CHEMICAL 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 be 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 of fat, of membranes, 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, Sec, physiologists and pathol- ogists entertain no doubt that it is exerted 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 considerations, viewed chem- 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, structure, 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 membranes, alters the color and other qualities of the blood." —Liebig's Organic Chemistry ap- plied to Physiology, Sec. 93. " Every substance may be considered as nutriment, which loses its former properties 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 by the vital princi- ple."—Liebig's Organic Chemis- tryr Sec. 172 INSTITUTES OF MEDICINE. CHEMICAL DOCTRINES. namely, that these compounds, by means of their elements, take a share in the formation of new or the transformation of existing BRAIN AND NERVOUS MATTER" ! !-- Liebig's Animal Chemistry. 43. " Owing to its volatility and the ease with which its vapor per- meates animal tissues, alcohol CAN SPREAD THROUGHOUT THE BODY IN ALL DIRECTIONS" !--LlE- big's Animal Chemistry (§ 350J, n). 44. " It is impossible to mistake the -modus operandi of putrefied sausages, or muscle, urine, cheese, cerebral substance, and other mat- ters, in a state of putrefaction." " It is obvious that they communi- cate THEIR OWN STATE OF PUTRE- FACTION TO THE SOUND BLOOD, from which they were produced, exactly in the same manner as glu- ten in a state of decay or putrefac- tion causes a similar transforma- tion in a solution of sugar" ! 45. " The mode of action of a morbid virus exhibits such a STRONG SIMILARITY TO THE ACTION of yeast upon liquids containing 6ugar and gluten, that the two processes have been long since compared to one another, although merely for the purpose of illustra- tion. [They have often been rep- resented as identical.] But, when the phenomena attending the ac- tion of each respectively are con- sidered more closely, it will in re- ality be seen that their influence DEPENDS UPON THE SAME CAUSE." " Ordinary yeast, and the virus of human small-pox, effect a violent tumultuous transformation, the for- mer in vegetable juices, the latter in the blood" ! " The action of the virus of cow-pox is analogous to that of low yeast [ / ] It commu- nicates its own state of decomposi- tion to a matter in the blood, and from a second matter is itself re- VITAL DOCTRINES. 94. " According to all the obser- vations hitherto made, neither the expired air, nor the perspiration, nor the urine, contains any trace of alcohol, after indulgence in spirituous liquors."—Liebig's An- imal Chemistry. 95. " The vivifying agency of the blood must ever continue to be the most important condition in the restoration of a disturbed equilibrium, and the blood must, therefore, be considered and con- stantly kept in view, as the ulti- mate and most powerful cause OF LASTING VITAL RESISTANCE, as well in the diseasrd as in the un- affected parts of the body."— Liebig's Animal Chemistry. Nevertheless, " No other component part of the organism can be compared to the blood, in respect of the fee- ble resistance which it offers to exterior influences." " The chem- ical force and the vital principle hold each other in such perfect equilibrium, that every disturb- ance, however trifling, or from whatever cause it may proceed, EFFECTS A CHANGE IN THE BLOOD." —Liebig's Organic Chemistry ap- plied, Sec. But, again, nevertheless, " It is obvious, moreover, that in all diseases where the forma- tion of contagious matter and of exanthemata is accompanied by fe ver, two diseased conditions simul- taneously exist, and two process- es are simultaneously completed; and that the blood, as it were, by reaction, that is, fever, becomes a means of cure."—Liebig's An- imal Chemistry. PHYSIOLOGY.--ORGANIC CHEMISTRY--FUNCTIONS. 173 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 FEEiiLE individual, and may be one of the sources of consump- tion" !!—Liebig's Organic Chem- istry applied to Physiology, Sec. (§ 821). " From the unequal degree of the conducting power in the nerves, we must deduce those conditions which are termed paralysis, syn- cope, and spasm "!—Liebig's An- imal Chemistry. 46. " In all chronic diseases, death is produced by the same cause, namely, the chemical action of the atmosphere." " tlie true cause of death is THE RESPIRATORY PROCESS, [ ! ] that is, the chemical action of the at- mosphere." — Liebig's Animal Chemistry (§ 674-676), • **j* Jhe 440^ nos. 17 and 18, 447i_/*]. 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," retorts, 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 the 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 bb, no. 10). But since animal food, especially fat. contains more of the " fuel" than vegetable food, how does it hap- PHYSIOLOGY.--FUNCTIONS. 253 pen, according 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 Burpass 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 (§ 54j. 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 irritation, in rousing the calorific func- tion, operate as a stimulus to the vital properties, 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 (§ 188^, 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 particular species of organic beings (§ 191, 446 d, 500 o). The impression of cold, or mechanical irritation, 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, Sec, 638, 1044, b). 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 appears 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. " We 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, c. That is a test. If the heat rises without oxygen, it certain- ly does not, in such a case, depend upon combustion. The "carriers" 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 warm-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 the 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 powen 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 heat."—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. 171, &c). The cause depends upon the effect, and the effect depends upon the cause (§ 440, f). And how could it be otherwise with an hypothesis so estranged from nature 1 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 fif 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,/. Again, it is reiterated, that " the mutual action between tho PHYSIOLOGY.--FUNCTIONS. 255 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 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 hypothesis as to the " carriers of oxygeri," not only in its relation to animal heat, but other important matters, such as the production of force, of motion, Sec (see § 350, nos. 3, 4, 8). Spallanzani, for instance, eviscerated the heart, large blood-vessels, &c, of a number of frogs and toads, 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 their 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 (§ 44l£ 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 oxyger 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 of 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. 44l£, 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 vertebrata. " 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 Ih- 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^, b. 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 1° 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 instructive 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). 441|, 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 bearing of the following 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 animals, is invariably th6 same."—Liebig's Animal Chemistry. 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). 4411, j/m Nor may I neglect the striking characteristic of the egg, 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,/), 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- pose of the internal source of heat in the egg t 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 integrity of organic processes, and, therefore, a uniform tempera- ture of non-hibernating 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 tho 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 b, 1047,1048). 4 42, b. 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 fs owing to the power of habit in rela- tion to the forces of life, and is utterly insusceptible of explanation on any other principle."—Commentaries. On the other hand, an individual froze to death in the woods of Peacham, Vermont, on the night of the 7th of June, 1S17; 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, and 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 in connection with what has been ascertained by Dr. Edwards as to the 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 and Physiological Commenta- ries, 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 Fahrenheit."—Barrow's Zincali of Spain. No two individuals under apparently equal 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 gfow 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). 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, 450f ,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^). 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 transplanted 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 I 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 to a temper- ature of 260° Fh."— Comm., vol. ii., p. 61, 62. physiology.—functions. 259 442, c. We see, then, in the various demonstrations, which have now been made, of the power of all warm-blooded, non-hibernating 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. " We 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 philosophical 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 from 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 (§ 441/, 441£ a). 443, b. Frogs and other coid-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 temperature principally regulated by that of the surrounding 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. \1\, and § 440, no. 10). And what will chemistry answer to the exalted temperature which attends the inflammations of the cold-blooded vertebrata1? 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 occurs in the ratio of that combination. "In the animal body," says Liebig, "the food is the fuel; with a prop- er supply of oxygen ice obtain the heat given out during its combus- tion." (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 260 INSTITUTES OF MEDICINE. surrounding medium, but which 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- gree simple (§ 409, e) 1 444. 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, Sec, 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, Sec, is sufficiently conclusive that it extends to every part of the plant, and " the Reformer" could not have been ignorant that the very egg 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 " carriers 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 world that possess " an independent Bource of heat." The secret of all this will be farther seen in the fol- lowing passage: 445, 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, Sec. 445, c. Thus is the problem solved. There is either no heat gen- crated 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 enlargim Do. do. « 6 49° do. Fagus sylvatica, " 10 " 49° Buds swelling. Quercus tinctoria, " 7 " 49° No budding. Castanca Americana, 12 " 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 « 55° Rotuna pseudacacia, " 3 " 62° do. Populus laevigata, " 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. " 1$ " 68° do. " Believing that if the vital doctrine of the generation of animal heat 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 19th 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°. 262 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. Betula nigra, diameter 15 inches, 54° Buds swelling. Platanus occidentalis, 6 59° do. Cluercus virens, Do. do. Do. tinctoria, Do. da 8 24 " 18 6 62° 73° 65° 66° do. Buds much more advanced Buds swelling. do. Juniperus Virginiana, Do. do. Acer rubrum, Castanea Americana, Oornus Florida, 5 " 2 " " 12 " 4 "2 64° 79° 65° 66° 68° In bloom. Buds swelling. 5 Flower-bads advancing"; no I leaves. Fagus sylvatica, Juglans alba Do. do. Do. do. 12 4 " 1 68° 75° 83° 82° Buds opening. Buds swelling. Buds larger. Buds opening. 445, f. " 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 preceding 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 periods of life."—Commentaries (§ 153-155, 441 b—i, 1054). 445, g. It is a fundamental principle, therefore, that " the general phenomena of the disengagement of heat remain always the same in, an- imals with lungs, in those without them, and in plants, all of which have an independent temperature."—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 hibernating 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 now say that the elaboration of animal heat does not depend on the nervous 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, are 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 cerebro-spinal axis. We have seen, too, that analogy, as supplied by the vegetable kingdom, affords the strongest presumptive evidence that the nervous system may have no active participation in the elab- TUVSIOLOGY.—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, is, prima facie, conclusive that they have important offices in relation to animals, and that their pres- ence, in the natural state of the complex being, is indispensable to the integrity of every function. This, as will have been seen, has been ex- perimentally ascertained fn 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 the medium of sympathy, as in blows upon the stomach, sur- gical operations, the action of medicines and of poisons upon the in- testinal canal, &c. (§ 1043 b, 1044). Assuming, then, that animal heat is also a secreted product, it would come philosophically under the common law; and since it ap- pears from experiment, 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 remarkable effect of a low atmospheric temperature in developing heat in the torpid hibernating animal (§ 441, 441^ a); and thus conducts us, also, to the philosophy of the operation of oth- er causes in modifying animal temperature. 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, b. 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 phenomena 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 facts 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 Laws of the Vi- tal Functions, Exp. 77. (Also, § 437, c.) 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 gastric juice are arrested." The juice is only modified in quality, while 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 in the animal organism to which the name of motion can be ap- plied proceeds from the nervous apparatus;" and we are also told that without this motion there can be no animal heat (§ 350, nos. 3, 17i 6, 7, 18i, 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 living organism, 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 difficulties (§ 222, &c, 451 f, 500 n). 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, 44l£ 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, o£ the production PHYSIOLOGY.--FUNCTIONS. 265 of heat 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 in 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 organic 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. 417, 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 greater 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 then foundation. The student of organic nature, therefore, appreciates, as he deplores, the ignorance which is received as the light of knowl- edge (§ 349, d). 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. 417, 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 104-88°-to 78-8° F., in ten hours. On the other hand, there is a remarkable exaltation of temperature in 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 five 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 temporary 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 may ap- 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 has 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 process. " 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. 267 before death takes place; and this, too, while the circulation is such as to admit of blood-letting. Two cases of violent apoplexy (" vio- lcnto paroxysmo") are recorded in the Ephemendes ^ermanlli m which the blood, as it flowed from the veins, was actually cold. Mor- gagni mentions an instance of another affection m 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 hot in the skin, but breathed remarkably slow, only half the common frequency." Other injuries exalt the temperature 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 inter.ded 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 half inspirations, or even less, in a minute. Pulse sixty, faint, 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. Body purplish, especially the lips. He had a fine warmth on the skin 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 seems 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 hear But, standing alone, they must either subvert the hypothesis 268 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 are 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 hurried ; 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 stage 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, refers 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 1 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 respiration ] * I commend, also, to our minute philosophers Mr. Hunter's experiment upon the carp. It was partly intended to illustrate a vision of our author, by which, as he says, " like other schemers, he thought he should make his fortune." But our author had not only the good sense to abandon it, but the magnanimity to hold it up as a weakness of the human un- derstanding. > PHYSIOLOGY.--FUNCTIONS. 269 Why do the palms of the hand " burn" when the rest of the surface is cool'f 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 with its doc- trine, that these periodical evolutions of heat are due to paroxysmal combustions of the tissues, especially where little remains to undergo the process, respiration 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 scrobiculus cordis at 106° and up- ward 1* 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 impres- sion determined upon the vires vita, by which a sudden change of action is induced in the elaborating vessels. 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, ao-ain, 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) 1 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 restored. It is here, animating these minute vessels, that we shall find the principles residing, by which we are to account for all the remarkable 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 true * See my Letters on the Cholera Asphyxia, and other authors upon this disease. t Edwards, on die Liflueuce 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 ai;ds, like the chylopoietic viscera, in perfecting the great 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 greatest 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 1 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 secretions 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. I 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 Congestion, § 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 contrary, 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 from 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.--FU NCTIONS. 271 fore, in cases of this disease that the four instances of slight action (on the air) formerly mentioned have occurred. On all these four occa- sions 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 Btream 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 respiration 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 natur-al character, the former is liable to corresponding variations, which can only be explained 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 temperature." 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. \\re 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 hypothesis. 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. * Dr. Christison, in Edin. Med. and Surg. Journ., 1831, p. 101, 103. 272 INSTITUTES of medicine. Just so is it with all the varying conditions of animal heat. In 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 our deriving conclusions from them."—Op. oil. 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, diminution 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; which maintain an almost unaltered state of heat when the respiratory movements are greatly accelerated by external heat, and resist equally the heat of the surrounding me- dium ; which actually abate the exalted heat of fever; which are 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 change the relation;" which is so modified in the cholera asphyxia, that the temperature may greatly fail while respiration is accelerated, and the lungs 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 that the heat has been known to remain very high in these cases, as in npoplexy, for many hours after death.—Sur VApop. PHYSIOLOGY.--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 peculiar 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 lain 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. 1 Ins appears to me to be fatal to a late doctrine 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 tem- perature rises after apparent death (§ 447, d) ? Where is oxygen gas 1 o 274 INSTITUTES OF 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 of 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). It is not, therefore, remarkable that " the Reformer" should have considered animal heat as life itself,—both the cause and effect of life (§ 441 g, 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 formed 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 (§ 440/, no. 18, and h). 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 the lungs, an exchange takes place between this carbonic acid and the oxygen of the atmosphere." " The organic compound of iron, which exists in venous blood, 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- plier! by the latter."—Animal Chemistry (§ 438, b, c). 447-j, b. 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, 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 carbonic 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 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 the 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 with fuel," § 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). 447£, c. 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 of endosmose and exdosmose (§ 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^,/. It remains now to notice, of the foregoing quotations (§ 447^- a, nos. 3 and 4), another of those extraordinary mistakes in fun- damental principles, and where pure chemistry is concerned, which so much abound in our author's work on Animal 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 kept 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 ofoxy- 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, tn spite of the degree of cooling, and of the increased evaporation which takes place there, the constant temperature of the lungs is kept up; 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, b, c, d, e), and a farther recognition of the justice of the rebuke administered by Hunter (§ 350, no. 95). 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," Sec, 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±, 376f b, 820). Chi: mis try as founded on the basis Physiology as founded on the ba- of" Experimental Philosophy." sis of" Experimental Philosophy." " Vie 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 of permeating animal tissues, cing wines, beer, or mineral wa- as water permeates unsized paper. 278 institutes of medicine. ters, more carbonic 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 disengaged, penetrates through —Liebig's Animal Chemistry. the parietes 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 1 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, he satisfied with the simple 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 products contain much more insen- sible heat than the substances from which they were formed. 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, e). 4 48, c. 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 arrest 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, f. 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 moral and physical 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 mammae 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. 4 49, J. What may be the extent in which the male participates in producing the 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 carry 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 likq coincidence in the vital character of all the organic functions of both animated kingdoms (§ 185). 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. II. 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 sympathetic, 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 b). 450, b. 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 termi nation, 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). PHYSIOLOGY.—FUNCTIONS. 281 450, d. Common 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. (§ 198). 450, c. 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 superfluous to say, are supplied with auxiliary means, Buch 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 critical 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 wnth 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 iEolian 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, but in either of which no such impressions can be originally excited; their 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, n) 1 450, / 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 upon the voluntary muscles (§ 227, 1st, 233), bring the laws of organization and those of t*>3 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 greater ingenuity than those objections to a vital principle which are regardless of all its unique phenomena. 451, c. It has been seen that perception 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 oi 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 perception, 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 identity 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 determined 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 (§ 473 c, no. 5), 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 b). 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 sufficiently described in the preceding sec- tion, and in what has been said of sympathetic sensibility (§ 201-204). 451,/. 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 facts in tho 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 moral and physical results of specific sensation, place 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 (§ 1881, d). Other demonstrations to the same effect will be presented in another section (§ 500, n). 2. SYMPATHY. 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. Although it have no existence in the vegetable kingdom, where its anatomical medium is also want- ing, it docs not bestow those striking 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 to the various tissues and organs, and only influenced through the function of sympathy in animals (§ 185). 452, b. Nevertheless, it is a function of wonderful characteristics, and can only be appreciated by an extensive investigation of its endless vari- ety of phenomena. And yet is this function extensively ridiculed by enlightened men ; and even Muller, 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 exdosmose 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, in its proper acceptation. All other functions correspond, respective- ly, with individual properties, as sensation with sensibility, motion with mobility, &c, though the various properties may be necessarily instrumental to each other. In the farther prosecution of this subject, I shall consider, I. The general uses of the nervous systems. II. The different orders of nerves (§ 462, &c). III. Experiments to determine the Laws of the Vital Functions (§ 476, &c). IV. The varieties or kinds of sympathy (§ 495, Sec). V. The laws of sympathy, and their application to pathology and therapeutics (§ 512, &c). 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 science of life in its varied aspects of health and disease. 454, b. The nervous system having no existence in plants, has giv- en rise to the fundamental distinction of " animal and organic life" (§ 96-123). 454, c. The cerebro-spinal system appertains particularly to the or- gans of animal life, though it contributes largely to the organic viscera (§ 111-117). The ganglionic system is universally appropriated to the organs of organic life, and pervades every part of the animal; since organic actions are carried on as well in the organs of animal life, as in the organic viscera (§ 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 b, 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 gang- lionic, has been established, with intimate connections with the cere- bro-spinal ; while the brain itself contributes nerves directly to the most important 6f the organic viscera. The principal relations to the great final cause of the brain are determined by direct prolongations of the organ to the different parts of animal life ; but those which are more especially designed to answer its secondary uses belong to the- ganglionic system, which binds together, in harmonious action, every part of the complex organization^ and influences the organic functions of every part (§ 129, 523, 1058). 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. 285 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 indispensabio 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, either directly, by causes that may interrupt 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 nervous centres, and consequently give rise to remote derangements1, in other ways, according to their 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. New circles of sympathy, however, 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 same demonstrations of sympathy 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- ria ; operating uniformly and equally on all the organic viscera, and thus maintaining among 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 power in connection with the instability of the organic properties, nor can it be otherwise. The principle is absolutely ingrafted upon the constitution of animals. 455,/ I say, therefore, that when unusual causes operate, whether upon the nervous centres or upon remote parts, they necessarily de- velop the nervous 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 OF 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, in the performance of which no assistance is wanted from each other or from other organs (§ 383, 394). And this leads us to observe the reason of the absence of a nervous system in plants, while it is more or less necessary 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 organization adequate, or nearly so, to its independent exist- ence. It is otherwise, however, with animals. Here, other essential parts are superadded to the simpler mechanism, are made dependent on each other, and a certain correspondence of action rendered ne- cessary to the integrity of the whole. For the fulfillment of these ends the nervous system is also superadded, with its wonderful attri- bute, the nervous power, that a perpetual change of influences shall be maintained among the great organic viscera (§ 222-233). But not so with the capillary vessels, since the functions of these may go on independently of the nerves, nor is a consent or correspondence of action among them at all necessary (§ 257, 233). 456, b. Slight influences, however, 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 oper- ation of disease, and of morbific and remedial agents, we have con- stant demonstrations of the great susceptibility of these vessels to the action of the nervous power, and of strong reciprocal sympathies among them (§ 394, 1040). 457. One of the most striking 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 op- erate more powerfully through the ganglionic than through the cere- bro-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 its special office must be that of maintaining a harmony of actions among these parts; and experimental observation confirms this induction. Nevertheless, 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 is made to exercise a certain, but scarcely appreciable, influence upon their organic actions (§ 456 b, 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 remote sympathy, 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 systems 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, b. 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 of 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 (§ 480, c,f). V\ bile, therefore, the brain remains, experiments upon the spinal cord are entitled to much less confidence than those which 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 from subsequent experiments (§ 476, 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 (b). 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 marrow. 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 the 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, f. 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 state of integrity (§ 201, 515 a, 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 Ihe brain and of the superior parts of the spinal cord (§ 461£, a). These 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 has any fundamental agency in the organic processes; for the mo- ment any unusual impressions are made upon it, the nervous influ- ence is unnaturally excited, and determined with more or less vio- lence upon the organic properties, and thus deranges the functions. 461. It is an assumption to say that the nerves have any generating effect upon the secreted products, however probable it may be that they influence the organic processes and their results. If the prod- ucts are altered by impressions made upon the brain or nerves, it is because the nervous influence is preternaturally determined, as a mor- bific agent, upon the Organic viscera, or because the influence is with- drawn, or a violence done by interrupting the relation of parts; as when the pneumogastric nerve is divided. Such division of nerves 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 distributed. But, in the instance of dividing the pneumo- gastric nerve, the gastric juice, and the pulmonary mucus, are secret- ed in preternatural abundance. Digestion, however, becomes at once greatly impaired ; but even that may be more or less restored by rousing the nervous influence in the divided portion of nerve leading to the stomach, by means of galvanism, or other irritants applied to the nerve (§ 446 c, 473 a, no. 2, 473 c). 461£, 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 foetus (§ 459, f). It is possible, as supposed in Dr. Clark's case, that even the sympa- thetic nerve may be absent; organic life being carried on in the foe- tus mainly by the simple vessels of nutrition, and without any action, concerted or otherwise, of the great organic viscera (§ 109 b, 264). No concerted action is necessary. The principal organs carry on alone the vegetative process. This, therefore, is a negative demon- stration of the final cause of the nervous system, and co-operates with its absence in plants in demonstrating the essential independence of organic life, in animals, of the nervous influence. 4614, b. The functions of the sympathetic nerve are, 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. 461 i, c. Nevertheless, 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 n?rvc, 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. II. OF THE DIFFERENT ORDERS OF NERVES. 462. Corresponding with the two important functions of the brain and spinal cord, those of receiving impressions from 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 the 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. 463, a. The foregoing anatomical discovery only establishes what was before known of the laws of sympathy by accurate observers of nature. The general attributes 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 important 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 corpus sine ani- mo, aiebat medicus quidem apud Platonem." 463, b. 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 carried 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 Muller, 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- I'll VS10L0GY.--FUNCTIONS. 291 est moment in organic life, and mainly important to the purposes of these Institutes, these nerves contribute to the great sympathetic (§ 111-117, 129, 1037 b). 466. The motor and sensitive fibres of a common nerve do not unite, but are even distributed separately in the organs which they supply. They have, therefore, no action upon each other except through the nervous centres (§ 514). 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. 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, 1037 b). 169. 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 cither compounded, as in the spinal nerves, or make up, respectively, distinct nerves 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 arc 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. 170. The nerves of the sympathetic system are exquisitely endow- ed with that modification of sensibility which I have denominated sympathetic sensibility (§ 201-203, 495, &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 inlluence upon the parts to which they are distributed. " It being shown that the sympathetic regularly receives fasciculi >f motor and sensitive fibres from the spinal nerves, as their motor 292 INSTITUTES OF MEDICINE. and sensitive roots, the existence of a similar relation between it and those cerebral nerves which are analogous to the spinal nerves, in hav- ing double roots, becomes very probable."—Muller. Laws of the Action of Motor Nerves of the Cerebro-spinal System. ill. 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 power of the whole 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 import 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 the Action of Sensitive Nerves of the Cerebro-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 different 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 it, 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 differs 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 nerves 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 the 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 tho brain and of volition, and,, when irritated, give rise to sensation." 473, r. " The parts of a nerve below the injured point preserve, 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 intercourse 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 relation 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- atelv, 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-451f, 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 pf 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 urinaria?, the muscular coat of the intestines, &c."—Mui.i.er. 474. 1. "The activity of all the special functions of the nerves is 294 institutes of medicine. determined by the central organs, partly under the influence of the 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 sensorium commune (the part of 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 and periodical 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 are 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, in part, 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. 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 I 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 generated in the central organs." This is not universally true, since "The maintenance of the excitability in the nerves does not, however, depend solely on the continuance of the influence of the central organs on them, but 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 of 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 sensitive it might be diffi- cult to improve. PHYSIOLOGY.--FUNCTIONS. 295 There is this among other distinctions of voluntary and involuntary motions: the nervous power is always necessary to the development of the former, but not always to the latter, though involuntary muscu- lar motion in all the muscles that are more or less subject to the will is always excited by the stimulus of the nervous power. In organic life, the blood is the stimulus of the heart and vascular system, but the nervous power is one of the stimuli of the muscular coat of the intesti- nal canal, &c. (§514/, 1040, 1041, 1058). III. Experiments to determine the Laws of the Vital Func< tions. 1st. On the Principle on which the Action of the Heart and Vessels of 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, 350f 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 experiments to the laws Of sympathy as they govern the operation of morbific and remedial agents, having partially 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). 476, b. 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. power, 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, 256, 486, 487 h, 492, no. 7, 500 d-k, 976). 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 is exactly the same as that which I have shown to relate to the sever- al rays of the sunbeam. The facts in both the cases mutually illus- trate and support the philosophy of each (§ 188| d, 1072 b). 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. 476£, b. he 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 (1841), inculcates the following doctrines: " The spi- nal marrow," says Dr. Hall, "exclusive of the cerebrum, is the source PHYSIOLOGY.--FUNCTIONS. 297 of animal life?'—" The irritability of the muscles of organic life de- pends, probably, on the ganglionic system" (§ 188-193. Also, my Es- say on the Modus Operandi of Remedies, p. 42, in Med. and Phys. Comm., vol. iii.).—§ 1041. 4761, 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, and that plants have the same great organic processes as animals. 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 (§ 5£). 176^, d. Tho foregoing conclusion was inferred 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 destroy life in those parts of the body which correspond to that part (§ 507-510). 476 j, 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. Hut, 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 which the motion of the heart depends, resides in the whole 298 INSTITUTES OF MEDICINE. of the spinal marrow; since the destruction of either cervical, 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 heart being in the least dependent for its motions upon any part of the spinal marrow (§ 458, 459). 476!,/. 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 corresponding 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^,g-. 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 actionsj 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 moral 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 *o suddenly curative in croup, &c.; all having their as- tonishing foundation in a common principle. 477, a. I now approach the important experiments which overthrow 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. 299 interpret all the laws of remote sympathy, all the effects of morbific 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, of any un- usual phenomenon which can be supposed to happen through the agency of the nervous power. It will be seen, also, that they corrob- orate, and are corroborated by, all the conclusions which I shall have drawn as to the nervous power, and the laws of remote sympathy, 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 vertebrae. 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 vertebrae. 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. 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 marrow, from the base of the skull to the beginning of the dorsal vertebrae, 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, per saltum. E.rp. 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 carot- 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 vertebra?, were laid bare. The thorax was then opened, and the heart found acting vigorously. The part of the spinal marrow which had been laid bare was then removed, but without at all affect- 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 marrow 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 wire. 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 is independent both of brain and spinal cord ; and the proof extends equally to the blood-ves- sels. " From various trials," says Dr. Philip, " we found that the circulation ceases quite as soon without, as with the destruction of the spinal marrow. Loss of blood seems to be the chief cause which de- stroys the circulation." " The result is still more striking in cold- blooded animals, in which death takes place so slowly, that the circu- lation continues long after the total destruction of the brain and spinal marrow" (§ 257). 478, b. The experiments prove, what will be more fully shown, that, to influence the action of the heart through the nervous centres, some impression must be made either upon the brain or spinal cord, since their mere removal does not affect the action of the heart, nor of the blood-vessels ; and this will be seen to be essentially true of all other organic actions, not excepting even the peristaltic motion of the intestines. In this last instance, however, a constant determination of the nervous power upon the intestinal muscular tissue, by irritation propagated to the nervous centres from the mucous coat, operates as a stimulus in maintaining, in part, the muscular action. 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 powers or properties inherent in each part (§ 184). 478, d. They prove that when death suddenly follows a division of the medulla oblongata, or a simple removal of the brain and spinal cord, it does so essentially from abolishing respiration. 479. A practical consideration of great moment grows out of the difference in the modes in which the foregoing experiments were 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 PHYSIOLOGY.--FUNCTIONS. 301 the spinal cord, as well as the sympathetic; while in Philip's, it was so gradual 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£ h, 509, 510, 947). 2d. On thv Relation which subsists between the Heart and Vessels of Circulation, and the Nervous System ; and the Influence of the Ner- vous System upon 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 Nervous System. 481, a. Experiment 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 foregoing 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 nerves 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. As to the passions, they are exactly equivalent to the action of agents applied directly to the brain, and develop and modify1 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, &c. (§ 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 indirect; 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. 481, c. It is now important to observe in the relative experimenti upon the brain and spinal cord, that when they exist in connection the influence of agents applied to the cord, in developing the nervoui pow<^r, may be mostly exerted upon the brain (§ 459). Exp. "!2. " Preparation the same as in Exp. 10 and 11, excepting only the interior part of the brain was laid bare. The spirit of wine applied *o thv1 part of the brain produced as decided an effect on the motion of the hea*,<". as in Exn. 10 and 11. The spirit of wine was washed off, and a watery solution, first of opium, then of tobacco, was applied, with the effect of an increase, but of a much less increase oi the heart's action, than arose from *he sp'rit of wine. Th? increased action was greater from the opium than fvom £be tobacco. The first effect of both was soon succeeded by a more languid action ef 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 fhere was always observed, for the experiment was frequently repeat- ed, an evident increase in the action of the heart when the tobacco ivas washed 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 only returned to 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 off of the stimulant and sedatives were frequently repeated in this experiment with the same results. PHYSIOLOGY.--FUNCTIONS. 303 [t 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." 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 cause of the re- sults ; from which 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. 4S1, c. The foregoing Exp. 12, 13, and 14, independently of the multitude of other facts, also completely refute the doctrine of the op- eration of morbific 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, Sec (§ 945). Exp. 15. " The spine of a rabbit was divided near the head, and the spinal marrow destroyed by means of a wire. Spii* t of wine was then applied to the brain, which influenced the action v»f the heart as readily, and to as great a degree, as it does when the spinal marrow is entire." 481,f. 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. 304 INSTITUTES OF MEDICINE. 481, g. 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 : Exp. 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 marrow 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 tc 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, h. 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 upon the actions of the heart and blood-vessels, as in Experiment 7. By this, and other considerations, I have endeavored to show that when syncope arises from loss of blood, it is not owing, as has been supposed, 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 Commentaries, 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 be 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. 4S3, 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 circulation arc 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 sufficiently certain (§ 392, 393. Also, Med. and Phys. Comm., vol. ii., p. 145-151, 398, 122, Sec). But we now arrive at the same knowl- edge by another process. 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 found 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 observed 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 306 INSTITUTES OF MEDICINE. same result. If the brain be not completely crushed, the blow increases the rapidity of the circulation in the web." The next experiment corresponds with those of the foregoing, which denote that the effects of the nervous power upon the organic proper- ties and functions depend upon the manner in which it is developed, modified, and reflected. •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 was 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 more effectually^ It is this dif- ference which makes all the difference in the results. 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. Hall 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 beeri 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-known effects of cerebral hemorrhage, and blows upon the head. It is suffi- cient, notwithstanding the removal of the brain, and the destruction of 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, tbrouo-h the whole of the anancephalous system of nerves (§ 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. But, as I have said, slight blows over the stomach of a man may destroy his life in an instant, when they would be harmless 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 sympathy was propagated from a finger 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 arrive 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 direct 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. 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. Exp. A. " I conveyed," says Alston, " through a small glass tube a few 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 ; but we very distinctly saw a surpris- ing diminution of the blood'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 blood 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: PHYSIOLOGY.--FUNCTIONS. 309 " I applied laudanum," he says, " over the back part of a frog, care- fully avoiding its contact with 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 had 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 be- 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 were not retracted on being touched. The recovery was prompt and complete." 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 one (§ 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). 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 determination of the nervous power upon distant parts (§ 226, &c). Here, then, wc see, more and more clearly, the propriety of the ap- plication which I have made of Philip's experiments, and which will >ecomo more strikingly obvious by connecting them with the sequel, * Hall, on the Influence of the Brain and Spinal Marrow upon the Circulation, p. ill. 310 INSTITUTES OF MEDICINE. and with the results 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 first look at 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 (§, 226-233, 494 c). 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). 3d. On the Principle on which the Action of the Muscles of Voluntary Motion depends, and the Relation which they bear 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; bdt 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 voluntary motion, except their being fitted to obey different stimuli; a difference which we find in the two sides of the heart itself" (§ 136, 188|-190, 487 e). PHYSIOLOGY.--FUNCTIONS. 311 4th. Interesting Experiments were made by Philip to ascertain the comparative Effects of Stimuli applied to the Brain and Spinal Mar- row on the Heart and Muscles of Voluntary Motion. 147, a. I shall state only a few of the important practical conclu- sions. Thus : " Another circumstance, which appears to be of great 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." 4S7, b. The foregoing shows us the distinction between the irrita- bility of the heart and voluntary muscles, &c, how it is differently affected in organic and animal life by the same agents, how the ner- vous 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, 1882-190, 222- 233, 205, 206, 208, 209, 256, 484). 487, c. But, it is remarkable, that, although the voluntary muscles may be much more sensibly affected by agents applied to the brain, or spinal cord, than the organic actions, yet, 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 muscles of voluntary motion, both chemical and mechanical stimuli, so applied, still increased the action of the heart; and the irritating agents more than the mechanical." 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." 4S7, c. 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 excitein the muscles of voluntary motion; that their effect on those muscles is felt chiefly on their first application, but continues on the heart (and blood-vessels) as long as the stimulus is applied" (§ 233£, 506, 516, no. 6). 4S7,y! In connection with this comparative inquiry, Philip has a remark which is worthy of deep consideration. " It is true," 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 ^rticn is confined to a small por- 312 INSTITUTES OF 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 nervous influ- ence from every part of the nervous system, and not very remarkably from any one part; a circumstance which particularly corresponds with the results of the foregoing experiments,"—and with the phe- nomena of sympathy as manifested in disease. The same observations are also applicable to all the other organic viscera; which farther proves that the great final cause of the gangli- onic system is to unite the organs of organic life in one concerted action ($ 1040). 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 sum 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. 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 every part of the brain and spinal marrow, while others are influenced by only small parts of those nervous centres 1 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 nerves 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 from any part in animal 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, nervous PHYSIOLOGY.—FUNCTIONS. 313 centres may be influenced in their organic condition by impressions upon any distant part (§ 230). This application, too, of the foregoing philosophy is divested of prejudice, since it was not contemplated by the experimenter fy 1038). 487, gg. " The following case, related by the distinguished Dr. 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' " (§ 399). 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 he so modified as to require the application of remedies from which we might shrink if we regarded alone the prostration of the voluntary muscles. It is an ignorance of the principle which operates ih these cases (as in the vast range of congestive fevers), and reasoning from tho 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, &c). 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 arc 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). _ 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 physiolojrv 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. 48S. 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 drawn 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 subjected to this system in the same way in which they are subjected 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). 488J. I shall now advertence more, to the remarkable distinction between the operations of the nervous power as manifested in animal and organic life (§ 96-110). 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 h). 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 provided. 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. Every fact is here demonstrative that the actions of organic life are essentially independent not only of the influences of the brain and spinal cord, but of the ganglionic system itself; and confirm the suggestion which is made by the distribution and arrange- ment of the sympathetic nerve, that its great final cause is to preserve a harmonious action among the organs of organic life. 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 ner- vous power is equally capable of influencing its operation, though in different modes (§ 226-233, 454-461^, 500). 489. The question is investigated by Philip, "whether the power of secretion is also independent of, though influenced by, the nervous sys- tem." The subject is fully settled by experiment; though the analogies supplied by the vegetable kingdom are amply conclusive of the essen- tial independence of the function of secretion, and its products, of the nervous system in animals; 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 stomach;" and "the lungs are found distended with a frothy fluid, which fills the bronchi and air-cells." It follows, therefore, that the function of secretion, and its products, are independent of the nervous system, but may be more or less in- fluenced through that system. Such is the inevitable conclusion from the experiments themselves ; and yet their author was led into an im- portant error by his hypothesis of the identity of the nervous power and galvanism (§ 493, 1040). 5th. On the Principle on which the Action of the Alimentary Canal de- pends. 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 tho 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." But, a better experiment, not only in respect to the intestinal canal, but the heart also, as it relates to the foregoing independence, consists in removing both from the body ; as indicated in § 476^, c. 6th. On the Relation which the Alimentary Canal and Lungs bear to the Nervous System. 491. Direct experiments, as in the foregoing cases, by agents ap- plied to the brain and spinalcord, show that the stomach, intestines, and lungs, may be influenced through the nervous centres. " It often appeared," says Philip, " that spirit of wine applied to the brain and Bpinal 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. Rcvieio 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 without objection, 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. 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 differences in the modes in which vital agents affect the heart and voluntary muscles. A com- mon principle is at the foundation of the whole (§ 500, h).] 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 heart 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 marrow 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. 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 that of the heart." PHYSIOLOGY.--FUNCTIONS. 317 493, a. It is remarkable that the sagacious mind of Dr. Philip should nave fallen into the error of deducing from 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 Bays, " only convey the fluids to be operated upon by the nervous in- flnenre." 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 1 )esign which prevails in the fundamental constitution of all organic beings, 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 govern the action of the secre- ting vessels, are independent of the nervous system, and yet that the formation of the secreted products is dependent on 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 may be involved in the Plans of the Cre- ator (§ 350%, 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 error, which had been long propagated, of regarding the brain as a mere galvanic battery, and the nervous power as identical with the 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 errors 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. 493, c. Again, having assumed that "the brain and spinal marrow are necessary to the function of secretion," Philip raises an objection which he foresaw would prevail. This objection consists in the ma- • See Medical and Physiological Commentaries, vol. i., p. 52-68, 107-119, where the •ubject of galvanism is fully examined. 318 INSTITUTES OF MEDICINE. turity of the fcetus without brain and spinal cord; and to defend the chemical hypothesis, and the assumed identity of the nervous power and galvanism, he endeavors to avoid the obstacle by assuming 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 greater plausibility to the hypothesis, Philip remarks that "no writer has before attempted to explain the difficulty." In the mean time, however, Philip very justly, however inconsist- ently, objects to the assumption which has been made by others, that secretion, and consequently the growth of the fcetus without brain and spinal cord, is supported by the nerves, and says, rightly, that "it is not only a gratuitous supposition, but opposed by almost every fact on the subject relating to the perfect animal" (§ 63-81, 257, 409 k, 455, &c, 516, no. 8). Yet is there greater plausibility in this doctrine than in the uterine philosophy; since there is an appropriate analogy between the nerves and the brain and spinal cord. 493, d. We may not, in justice to a subject so important as medical philosophy, disregard the influences that may be exerted by any error proceeding from one who has contributed so largely to that philoso- phy as Dr. Philip. I shall therefore say, and with a view, also, to my remarks on the physical theories of inflammation, that this eminent man, to advance his chemical theory of secretion, falls into a 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 way. 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 living, organized vessels, whose actions are proved by Dr. Philip to be influenced by the nervous power, to a set of dead, inorganic tubes; what more adverse to our natural conceptions of life; what more strongly opposed by facts than the assumption that one part of a con- tinuous living vessel acts as a " strainer" of the blood from another.part having a vital function ] In consequence of the foregoing physiological doctrine, 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 (§ 453, 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\, 1881 d). 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. PHYSIOLOGY.--FUNCTIONS. 319 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; showing 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. The late experiments by Van Deen and Stilling are of the same nature 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. It should be premised, that when all the viscera, the heart, blood- vessels, Sec, arc 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, f.) 494, c. Exp.—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. Exp.—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, dd. 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 the 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 skin as when the 320 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. 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 Muller'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 physiological 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 Physiology. Thus : " The rapid effects of prussic acid can only be explained by its pos- sessing great volatility and power of expansion, by which it is enabled to diffuse itself through 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," Sec. 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 d, 827 d. Also, Med. and Phys. Comm., vol. i., p. 565, 569, text and notes). And again, says Muller, " 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." Muller's doctrine, I may also say, that the absorbent vessels have no open terminations, 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 the permeation 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, 5\\\ a. 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 with 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. It will be observed, also, of Budge's experiments, that they are anal 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 irritated, 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. 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 continuous (§ 452, &c). 4!>6. 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 moral, 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). 497. Contiguous sympathy is probably a modification only 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 often some part of the ganglionic system, or perhaps some plexus of nerves, or some parts of the sympathetic nerve itself (§ 473, no. 2, c; § 474, no. 5, 520). It should be observed, however, in these cases, that remote sympathy, in its clear acceptation, is brought into action (§ 1038). The apparent effects of contiguous sympathy, however, may be sometimes explained, especially in consecutive morbid processes, by 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, and be- longs to plants as well as animals. 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. 498, b. 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 parts continuous with it, in uninterrupted succession; though the changes maybe 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- ler'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). 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 the nervous system, take another fact from the animal kingdom. Thus : 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 Physiology. 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 (§ 189, 494 e, 516). 498,/. Continuous sympathy is an important element in the physi- ology of disease and of therapeutics. This is conspicuously seen in PHYSIOLOGY.--FUNCTIONS. 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 impression 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 tlie liver, skin, rj9, 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 sympa- thetic developments 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 arid 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 virus 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 more worthy than ever their 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 sympathy to the most important problems in 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 MEDICINE. the sick. The physiological laws of sympathy 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, I 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 greatest of the age, and to the invaluable experiments by Wilson Philip. I commend them ao-ain and again to all those who would study medicine as founded in Na- ture, and escape the temptations which ha_ve been devised for the gratification of indolence, or for the accommodation of imbecility. We have seen it said, in high quarters, that " the time is approaching 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-376f, 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 (§241,500o,^). 534, b. 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 funotions 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 Phys. Comm., vol. ii., p. 139, note.) PHYSIOLOGY.—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 c, no. 6; § 545). This simple principle is at the foundation of some of the most pro- found and comprehensive laws in medicine. 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 physical 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, &c). 53!), 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 refers to the organic properties and functions of every part, whether organic or animal, and takes in their sympathies, and, of course, sympathetic sensibility (§ 110-117, 201, 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 concems 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, S55, 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). 511. 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 acrrds, 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 (§ 139, 552 c, 654 b). 546. The law of habit applies extensively, also, to remedial agents; these having the effect, 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 sympathetic influences, and that they do not operate by absorption. Introduce the agents with any frequency into the cir- culation, the same, or greater effects, will progressively ensue. 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 inefficiency 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 (§ 136, 137). PH VSIOLOGY.--FUNCTION-. 365 54S.'„ b. Nevertheless, certain kinds of food, and analogous stimuli, as wine, &c, come within the law of habit. This is where the kind 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 irritability 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 (§ .139 c, 857). And so of the causes of relative pleasure and pain, physical and moral (§ 543). In a practical sense, I am here, again, upon ground of the very highest importance (§ 516 d, no. 6, 558 a, S57). ' 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 tartarized 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 relation 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). '">52, 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, Sec, 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. Or 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~with great rapidity in the same subject if the ■gradual acclimation be negleeted (§ 514 g, 516 c, 518 b, 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 in 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. 555. 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 moral. 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 repeating 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 fiftieth 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 (§ S41). 556, b. 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, d). What I have thus stated in this section involves some of the most important philosophy in medicine. In its practical nature it takes in a wide range of therapeutical problems, some of 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, e. 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. Just 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). 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 sofne climates cer- tain remedies, as antimony, is 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 maybe variously applied. 557, a. The difference in the results 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 morbid 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. Here, 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 immedi- ate instruments of disease is greatly advanced by reflected sympathies from all parts of the capillary blood-vessels (§ 921, 931-934). There is, therefore, a clear analogy in this case 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. 55$, a. The principle involved in § 556 embraces what is called the 368 INSTITUTES OF MEDICINE. cumulative effect of remedies, and of which digitalis, hydrocyanic acid 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, or mercury, or cantharides, for instance, establishes progressive impres- sions on the vital states, proportioned to the amount and frequency of the dose, ceteris 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 progressive operation of miasmata (§ 552, b). 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, again, 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 vital sympathetic action of reme- dial agents by the process of removing the morbid effects of the fore- going cumulative remedies (b), we have but to interrogate the only possible manner in which we may speedily subdue those effects by other remedies. 559. Exactly the same philosophy (§ 558) is applicable to what is called predisposition to disease (§ 148, 503, 538, 539, 544, 547, 552 b). 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 greater 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 intervals of months, even after the subject shall have removed to a climate exempt from the causes. Here the original impression remains (§ 514, g), 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 which 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 b, c, 535, 539). Where the pecu- liarity of constitution is transmitted from parent to child, the modify- ing causes have, of course, operated 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 b, 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 or 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). 5G4. 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 b, 241). 565, 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 sio-ht, 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, b. 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. 5G6, a. This chain of exact analogies brings us to the properties of the mind, which are improved upon the same principle (§ 175 b, 241, 5G5). Here, as in the foregoing instances (§ 565), one or more of the properties is apt to be exalted at the expense of the rest (§ 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 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 1 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. 566, b. 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 forrrier 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 b, 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 lie deeply at the foundation of a proper elementary education of the mind (175 b, 548 d, 567). STRENGTH, AND WEAKNESS OR DEBILITY. 569, a. Mueh of what has been now considered under the various aspects of habit is often vaguely defined by the terms strength, and weakness 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, debility, 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, l>. Strength and debility are, also, often confounded, leading to still greater confusion and error. Thus, manifestations of full muscular power arc said to denote strength, while the high vascular action of inflammation is supposed to depend on debility. The for- mer 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 maybe 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 premises 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 water. Strength was implied in the former in- stance. 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 o-reatest 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. Tho 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 maybe 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. I he food escapes from this organ in a half-digested state, in which chemical changes have also occurred. These chano-es beget acids and flatulence, and, as the crude mass traverses the intestines it irritates 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. rhcea, &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 turbid 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, the 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 weak, to be de- bilitated. There is, however, no truth in this construction, as it is ordinarily understood. The powers may be all exalted; and 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 irritability, 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 properry applied, consists in the exhaustion of the organic pow- ers that attends the advanced stages of prolonged disease. (See this subject considered in § 487, h.) 569, e. Finally, I may conclude this subject with the nervous lan- guage of Southwood Smith. Even " in the intense forms of conges- tive fever," says Dr. Smith, " 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- eminence as bad as that of the very disease of which it is supposed to constitute the essence, it at least entitles it, in comparison with every other error in medicine, to the distinction recognized in society be- tween the hero and the murderer. The one destroys a single human being now and then, but the other numbers its victims by thousands." —Smith, on Fever. PHYSIOLOGY.—AGE. 373 FIFTH DIVISION OF PHYSIOLOGY. MODIFICATIONS OF THE VITAL PROPERTIES AND ]'UNCTIONS 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 of 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). 1. INFANCY. 576, a. Infancy extends from the time of birth to the end of the first dentition. 576, b. 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 irritability, 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 branch, but dull in the olfactory. Taste indiscriminate. . Sensibility and irritability 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 predominance 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 irri- 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, r. Diseases being rapid and active in infancy, and injurious sympathies 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- e ise.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 bo 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, wo 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 whero it may be required, but delayed, the chance of its useful application may be lost, not only through the advances of disease, but bv the prostrating effects of other remedies (§ 155, 156, 925 a, b, c, 974 c). 516, f. It may he finally said of the characteristics of infancy, that the first few weeks of independent life are marked by peculiarities which go to illustrate 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 m 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 bb, 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 apt to result in disorganization, from which infancy is greatly exempt. We 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, b. 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 ordination 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 original model (§ 63, 64, 155). The most remarkable peculiarity by which youth is introduced is PHYSIOLOGY.--AGE. 377 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 soHd 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] Do we not constantly find that the knowledge which has been acquired is perverted to the worst conclu- sions 1 Are not the phenomena of nature which are opposed to each other made to assume resemblances, and such as are clearly allied equally estranged 1 And do we not then, by this abuse of reason, proceed to refer these incongruous results to common laws and com- mon causes 1 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- 378 INSTITUTES OF MEDICINE. ress as at every ubsequent stage of life. The same powers, there- fore, and no others, are alike at all times the causes of the coincident results. 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 hoarse and rough voice. The body spreads, becomes firm and erect, and often shoots up, in early youth, with amazing rapidity. So much development of structure, and the institution of the gen- erative functions, cannot fail, according to our doctrine of life, of fill- ing the system with many new sympathies, and 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 the 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 not only ordained 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 maybe 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 sympa- thetic 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. 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 has had no specific function, and its organic properties have 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, by-the-way, does this illustrate the law of sympathy in its application to disease, and expose 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 liable to sympathetic de- rangements 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 sympathetic 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 dea'd 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 mammae and that of the uterus. The development of the latter takes the lead, while that of the mammae 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 morbid sympathies 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 sway in determining some of 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 spermatic vein, also, is quite apt to become the seat of that sub-in- flammatory condition known as circocele; this vein having now ac- quired, along with the testis, its full development of structure. And so of the cutaneous and hemorrhoidal vessels, in their relation to varix and the piles (§ 500, n). From the vital developments 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, when 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 Btate, 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. 4. ADULT OR MIDDLE AGE. 579, a. Manhood begins at the age of twenty to twenty-five, and reaches to about sixty years. 579, b. 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 little 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 embarrass 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 study, 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 carries 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 interrupted, 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 occurring 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. 382 INSTITUTES OF MEDICINE. 5. OLD AGE. o80. The last perfod 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, as 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 wrinkled; the fat retires from the circumference to the internal organs, by which the superficial veins are rendered more prominent, and the eyes sunken. 581, b. 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 embarrassed by the foregoing physical changes. 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 wears out. It sparkles as bright as ever, when the flickering lamp of life is but dimly seen. 581, d. The decline of the mental powersris 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, c. 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 crative, nature less recuperative, diseases less easily arrested, are sooner 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. 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. 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. II. 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, Sec, 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- quired 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 INSTITUTES OF MEDICINE. tion, by the physical agencies of life. This is the true tempeianient, and belongs to masses of mankind. 585, 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 irritability; 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 mercury, 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 vernix ; but now and then an in- dividual handles it with impunity. Muscles, and some other animals, are 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 fercnt 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. 5SM. 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- Bpects the operation of physical agents in modifying the properties of life, to those more remarkable peculiarities which spring up 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). 594. The temperaments, as designated by the ancients, and re- tained by the moderns, are divided into the sanguine, the melancholic^ Bb 386 INSTITUTES OF MEDICINE. the choleric, and the phlegmatic. The artificial habits of the moderns 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 irritability 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 with 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, are 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 are soon regretted. A chal- lenge to a duel would be gladly abandoned, did not a sense of pride PHYSIOLOGY.--TEMPERAMENT. 387 urge him on to the combat. Revenge and envy have no hold upon this constitution. 597, d. It is evident, therefore, that the prevailing diseases of the sanguine: temperament are active and inflammatory; that the organs sympathize readily and greatly with each other, and that the sympa thetic affections are disproportionately greater than the primary af- fections. Infancy ;.«.ways 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. 597, 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 first 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). 2. THE MELANCHOLIC TEMPERAMENT. 59S, a. The melancholic 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 than in the sanguine ; and, unlike the latter, the skin is darkish, or inclinino- 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 often 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. 114,, 441 c). 598, b. It is easily seen, therefore, that irritability 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)- 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 of 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 struggling with those adversities which arrest the ambition of other temperaments. The melancholic is forever indomitable; rising in determination as obstacles rise before him. Inflexible in purpose, 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, grave, 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 irritability 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 (§ 150, 191). PHYSIOLOGY.--TEMPERAMENT. 389 It is easily inferred that the diseases of the melancholic are mostly of the digestive organs, and that their removal 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 with 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 Choleric 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 correspond 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- bility is also obtuse, and perception weak, which greatly circum- scribes the senses as an avenue to the mind; while " Fat holds ideas by the legs and wings" (§ 440 bb, 440 c, no. Hi, 441c). 390 INSTITUTES OF MEDICINE. But, with all the intellectual dullness and bodily indolence, which distinguish this temperament, it is obstinate, fearful, suspicious, and avaricious. 600, b. The organic properties of the phlegmatic are easily liable to interruption, 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, b. 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. An unusual predominance of sympathy is 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- ondary 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 or 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 morbific 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 Gmeral 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. 60.:!, 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, Sec. 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 difficult 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 (§ 655). 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 (§ 350f, kk). But, with ex- actly the same reason may we assume 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 properties and functions of life ; but all the races are liable, individually, to the physiological conditions of tem- perament. The general attributes, therefore, admit of no physiolog- ical, pathological, or therapeutical applications. 605, b. 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. 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 (fy 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 Arab 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 European Arab comprises the people of Europe, Egypt, Syria, Arabia, Barbary, Tartary, Persia, the North American In- dians, &c. The fundamental characteristics are an oval face from forehead to PHYSIOLOGY.--SEX. 393 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 woolly 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, b. 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 undergone in this degraded race (degraded as well by nature as by man) a large extent of that mutation, which, in a far inferior degree, stamps the white man with intellectual imbe- cility. 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 more 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, Samoiedes, Ostiacs, Tschutski, &c. They have broad 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 impressed 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, this has no bearing upon the physiological developments that may be in progress during 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 bb, 440 c, no. Ill, 441 c)t which gives greater rotundity to her limbs and greater concealment to the muscles. Her mind is quick in its operations, arrives at earlier 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 reproduction 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 (§ 604-606). 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 formation 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 (ceteris paribus) great capability of resisting morbific causes, and a gradual recovery from disease. The temperate climates, holding 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, b. 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). 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 grand 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. 619-6-2-2). 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 army sta- tistics, and other hospital reports, as forming any proper foundation for great pathological and therapeutical conclusions; and have endeavored to show that all such conclusions should be drawn exclusively from the private walks 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 physiolog- 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 important 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 third 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" (§ 1065 c, 1068 a). 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 various 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 chose 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 effects of climate, incom- patible habits may establish permanent and transmissible changes of constitution. The glass-blower, the brazier, the painter, the type- PHYSIOLOGY.—HABITS. 397 setter, &c, have, respectively, modifications of a common disease, which 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. 613. 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. 398 INSTITUTES OF MEDICINE. SIXTH DIVISION OP 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 the 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, b. 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 allowing 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 tho 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 (§ 1SN, Sec, 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, Sec). Owing to chiinges 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. 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 particular 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 numerous accidental influences by which every 400 INSTITUTES OF MEDICINE. individual is surrounded. It is these fluctuating influences which render measles, scarlet fever, the intermittent 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 irritability, and corresponding influen- ces of various causes. 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. 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 ] 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, I 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 unimpregnable. 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 at least, having been intro- duced since his creation, the properties of life must have undergone some miraculous change. INI an was created imperishable. By sin came death, and 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, b. 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 arc 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 will obliterate all common ground between the disputants. 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 the same creative operations that developed the ovum into the new-born offspring,—that continued the same process through the various stages of life up 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 of 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- sciousness, 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 water, the reflections which occupied 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 extrication 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 progressively 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. 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 the circulation. The effect is nearly as gre;.t 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 (§ 17N-182, 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 *n the brain itself (§ 129, 455, 456, 476£ h, 478, 479, 489, 507). 636. Death from disease generally depends upon complicated causes, and upon profound affections 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" (Med. 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 (§ 384 ; also, Comment., vol. ii., p. 401, 402, Sec). In my work on the Cholera As- phyxia of New York, 1S32, I have spoken, of contractions of the vol- untary muscles which continued in progress, drawing up the legs, ■xt., for an hour and a half after apparent death (p. 141). These con- tractions took place without the application of any exciting cause, and it may be difficult to say whether, as in the case of the extirpated heart and intestine, they were alone due to the independent exercise of mobility in its connection with irritability, or whether the nervous power operated as a stimulus, through a preternatural development which may be 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 300, are strongly in favor of the latter construction, while the inde- 404 INSTITUTES OF MEDICINE. pendent action of the extirpated heart and intestine may seem to fa- vor the other. But the analysis 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 mostly a regulator of inde- pendent organic actions; in the latter it is an indispensable stimulus (§ 188, 205, 215, 222, &c, 261, 500, 526 d). If the foregoing 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 possible mode of propagating the impression upon the skin to the muscles, excepting through the nervous power. 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. 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 (§ 54 a, 56, 62 e). PHYSIOLOGY.--ITS UNITY OF DESIGN. 405 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 Design, which is the grand characteristic. The foundation is laid in the Prin ciple of Life, and its various attributes. The demonstrations of thai 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 springs 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 may be ingrafted 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 perfect 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 different 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 harmony of the whole; or how the nervous PHYSIOLOGY.--ITS UNITY OF 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; or, 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, &<•., 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 corresponding 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, Sec, 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 canine and feline tribes; or, whether the poison of the rat- 408 INSTITUTES OF MEDICINE. tie-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, wb.etb.er 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, we 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 in 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 their 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 determined 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 propagation 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 smalbpox, 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 treir 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 speedy 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 passive in- flammation ; or whether it be the abrupt 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 arrest 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 " sudorifics," 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 former 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 tribe, 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 OF DESIGN. 411 bernating group, and see how that temperature, which is equally uni- form under all toirid and temperate degrees of the ciicumambient 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 performing, 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,—rising, in one case, to a degree of intensity 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 different, 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 sim- 412 INSTITUTES OF MEDICINE. plicity, jet 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 life are exposed to no influences that shall affect their instable nature, till we have traversed the animal kingdom in all its exposures to those influences, and have witnessed the incalculable 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 in- fluences of external and internal causes upon the properties of life, and that slight changes in those properties, like the differences which prevail among the results of their natural modifications in different animals, and in different parts of a common or a continuous tissue, give rise to all the differences between health, disease, and convalescence; —in the contemplation 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 sci- ence whose foundations are laid in the most Consummate Wisdom (§ 892). pathology. 413 PATHOLOGY. 639, a. Having now laid a broad foundation for the superstructure 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 art is immediately interested. I say, to go on; for in all my physiological inquiries, I have endeavored to indicate the relations of 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 vari- ous methodi, 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- oase; 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 1 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, 485, 1067). 639, b. Pathology concerns the changes which the vital proper- 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, Sec). 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^). 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, and 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. I. 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 protective nature. 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- oosing and exciting causes. 646, a. Remote causes are either internal or external. 646, b. The internal consist, for example, of the passions, laborious PATHOLOGY.--REMOTE CAUSES. 415 study, retention of the faeces, hereditary predispositions, &c. (§ 75-80, 144, 561). 6 Hi, c. The external consist, 1st. Of such as are ordinarily salutary, 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. 2d. 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 mcdica, when exceeding the thera- peutical doses, or when employed in these doses under circumstances of health. 647. Among the most important of the internal remote causes of disease are 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. They are the great fountain of sympathetic developments; and, as one springs up after another, each in its turn, and all together, contribute toward new complications and the difficulties and danger of the case (§ 117, 129, 227, 501). 648, a. The predisposing causes are general and specific. 648, b. 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 predisposing 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, therefore, 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). 64S, d. The predisposing causes of sporadic diseases are apt to be more numerous than those of epidemics. 619, 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 hydrophobia virus, the poison of serpents, the wourari poison, &c. 649, b. Some parts of a continuous mucous tissue are more suscep- 416 INSTITUTES of medicine. tible than other parts of the same tissue (§ 133-137). And so of the skin. A current 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). Menstruation is most readily suppressed by cold applied to the feet, &c. The foregoing facts depend upon a principle of vast importance, in every 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 a special vital process, &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 morbific 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 philosophical 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, 514 A). 649, c. There are probably but iew 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 either affect 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, whose active principle is insoluble, 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 (§ 655). And since the insoluble 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 organic properties of the skin. 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.--UEMOTF CAUSES. 411 morbid susceptibilities, but only certain parts in the vicinity of its ap- plication, and then only when those parts are preternaturally suscep- tible (§143). It then operates, like blisters, through contiguous sym- pathy (§ 497). 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. Sympathetic 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 acquired modifications of the vital states in either part (§ 150, 649 b), just as one moral emotion or another will, respectively, and habitu- ally, 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. 619, 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 the sup- posed impervious 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. 650. Every distinct morbific agent (and every remedy), however allied to others, has its peculiar virtues, which produce, cozteris 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 (§ 18S1, 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 fn each of the cases, respectively. Thus, the poisons of small- pox, of measles, of scarlet fever, Sec, 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 different predisposing causes It appears, also, to be well ascertained that these causes are of vege- Dd 418 INSTI1VTES OF MEDICINE table origin, and that the differences in their nature depend upon differ- ent combinations of their elementary principles, that take place during 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, b, 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, b. 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 affected by the simplicity or the variety, and intensity, of the causes, as, well as by their nature (§722). 652, b. 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 (§ 663). 652, c. The precise vital influences of any remote cause, their de- pendence upon the exact nature 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 prevail, 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, mercury, the virus of snakes, of the mad dog, of small-pox, measles, scarlatina, Sec 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, " the 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 its depressing effect 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, b. 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, Sec, may be unusually epidemic and malignant. 65^, 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 regarded 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). 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 others, since the poison depended originally upon vegeta- ble decomposition (§. 657 b, 741 b). But, independently of this incontrovertible law which is predicated of numerous facts in physiology and pathology, and without one to invalidate its force, the whole of this question as to the contagious- ness of fevers is settled negatively by a great variety of direct obser- vations. (See Objections to the supposed Contagiousness of Yellow Fe- ver, Sec, in Med. and Phys. Comm., vol. i., p. 445-453, note, 532-534 ; vol. ii., p. 511.)—Also, $ 1068 b, note. 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" (§ 5\,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 1 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, b. The foregoing, however, is not equally true of morbid ani- mal poisons, which are alike specific. I may also say, as farther il- PATHOLOGY.--REMOTE CAUSES. 421 lustrative of great vital laws, that morbid animal poisons have, com- monly, the remarkable attribute of producing their sensible effects at more determinate periods than any other predisposing causes, with a few exceptions like the hydrophobic virus. It is also another striking fact, that natural small-pox occurs in about fourteen days after expo- sure, but that 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 in 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, 651). 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 different 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. Comm., vol. ii., p. 184, 195-200). 654, c. Again, there may be an interval of weeks, months, and years, 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 uno ictu, although the cause be no longer applied. Nei- ther is it increased, diminished, or altered, by the farther application of its cause." 654, d. Where the sensible effects 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. 655. 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 (§ 551). 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 sympathy in the remote parts ; 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 iuvolved 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 h, 524 c, 743). This is especially true of the alimentary 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 (§ 136, 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 sympathetically 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 part, 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 Commentaries, vol. i., p. 499-505). 657, b. It will have been seen that a peculiarity attends idiopathic fever in its universal invasion of the body (§ 148, 757, &c.); and this leads me to indicate, a certain difference in the sympathetic propaga- 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 impression which is propagated 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 sympathetic impressions is equivalent, in principle, to a specific universal action of the original predisposing cause (§ 228, 653, 516 d, no. 6). 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, vesicants to the skin, &c. But, PATHOLOGY.--REMOTE CAUSES. 423 it more commonly happens that the reflected nervous power is the immediate agent in the production or cause 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, 222-233J, 475, 476-492, 500, 514 b, 657). 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- utive 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 inflammations, 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 smpkers, opium eaters, &c.; the poison being slowly morbific in all the cases, but aided in its operation by many concurring causes (§ 543, 5 14, 562). 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, Sec, 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 sym- pathetic influences, leading to various sympathetic diseases, then fall within the category of predisposing causes; as do 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 b, 222-232, 514 h, 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 scrofula, or phthi- sis, it should awaken all our vigilance for its removal. The reason is obvious. In the ordinary catarrh, 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 temperaments (§ 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. 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, Sec In all these cases, the congestive affection is peculiarly modified by the nature of the predisposing cause (§ 816, 817). PATHOLOGY.--REMOTE CAUSES. 425 662, c. Again, it has been always found, on dissection, that delirium a potu was attended with venous congestion of the brain; and such is tho modifying influence of the remote cause, that one of its principal remedies is opium, and in quantities that would induce another modi- fication of the same disease if administered in healthy 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 (§ S59, 861). 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, therefore, 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. 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 b). 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 to 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). 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, 652). 665. Predisposition often remains after disease shall have been ap- parently eradicated ; as seen particularly in intermittent fever, and in chronic indigestion (§ 515 g, 560). This persistence of predisposi- tion is most likely to. occur where some organic derangement may have supervened, or where a low chronic state of disease may estab- 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 (§ 806). 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 appears to be almost as firmly ingrafted upon the constitution as those of an hereditary nature, with intervals of apparent absence of all disease (§ 535, &c). 666, a. Predisposition to disease consists in some indefinite change which has befallen the organic properties, and corresponds, in a gen- eral "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 impression Upon the properties of life. Close observa- tion, indeed, will generally detect, especially in predispositions to fe- ver, many obscure symptoms which denote a change in the organic properties and functions, some time before the sudden and full explo- sion of disease. 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 properties of life (§ 514 g, 516 c, 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 g; 657 a). 666, b. 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 (§ 578, 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 are 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. But, in scrofulous subjects, it is generally otherwise; since in those who are naturally predisposed to scrofula, the tendency to the disease 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 now with morbific effect (§ 1 43-150). 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, 578 c). II. PROXIMATE, OR PATHOLOGICAL CAUSE. 6(>7. The proximate 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 terra pathological for proximate, and have since retained it as more expressive than the original name. , 66S. 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 properties preside, arid 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, Sec, are only consequences, more or less remote, of those 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 tho predisposing, must vary in a corresponding 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 due to a more inflammatory 428 INSTITUTES OF MEDICINE. state 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). 671. Summarily, then, the precise nature of the pathological cause will depend upon the nature and action of the remote cause, or then 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. 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 properties 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 great 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. vBut, 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 kind (§ 177, 666). What that change is it is impossible to comprehend, though it PATHOLOGY.—PATHOLOGICAL CAUSE. 429 be the essential part of the disease. We know not, 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 (§ 231). 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, b. 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. Abetter 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 change in the organic 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. 1 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. 67 I, d. The vital states of a part or of the whole system may be variously 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 mostly depends. This prominent demonstration of sympathy by the heart may be carried to all other organs, which, in like manner, are liable to sustain sympathetic disturbances short of disease, but according to their own 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, aud 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, 741 c). Again, certain morbific causes, acting upon the stomach, make their principal demon- strations in remote parts ; as the narcotics, cantharides, Sec. A sim- ple element of this is constantly seen in the manrier in which cold on striking the skin will develop catarrh, pneumonia, Sec ; though, in the former cases, there may be specific relations of the morbific agents to particular parts, while in the latter, other predisposing causes may have operated (§ 147-151, 649 c, 657, 722 b). This principle lies at the foundation of all the consecutive developments which may sprint 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, sympathetically, into the foregoing condition, and how, in consequence, remedial agents will 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 a reacting salutary effect upon the primary dis- ease; as may, also, such as have not sustained a morbific influence (§514 h, 657 b). 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 through 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 principle, 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. 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 different 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 intermission, 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 sta 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 bed-side, he FORFEITS ALL HIS CLAIMS TO OUR RESPECT AND HIS TITLE TO OUR CON- i idence" (§ 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 intangible, invisible 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 pur- pose of adding another,—that it is of incomparably greater importance to ascertain the former than the latter. When 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.--SYMPTOMS 435 that gave to matter its being, or 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. We 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 phenomena, 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 king- 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 (§ 237, 4 47 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 Mid touch. The first three of the foregoing classes of symptoms may I ■• denominated primary, the last two secondary. 436 INSTITUTES OF MEDICINE. 681, b. The five divisions into which I have distributed the symp- toms of disease, and the remaining facts which we derive from mor- 1»id 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. 682,6. 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 hardness 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, d, 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 Benso, 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 terms favorable and fatal, 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 sympathetic influences, 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 sympathetic 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 such 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, Sec 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 of 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. We 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 predisposing 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 natural 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 (§ 660). The disease being typhus, the brain, or its membranes, are probably the scat of inflammation or venous congestion. We inquire PATHOLOGY.--SYMPTOMS. 439 as to headache, whether obtuse or acute, in what part of the head, Sec. ; whether there be drowsiness or wakefulness ; whether there be 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 tbe eyes, observe how their lustre 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 retina, or how 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, Sec 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, Sec.). 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 inflammatory 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. From 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 deeply, 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 the heart sym- pathizes with these local inflammations, since the extent of the influ- ences determined upon the heart may show us considerably the sever- ity of the local inflammations. But this organ 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 local burdens of disease. 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, b). 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 hepatic 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 the 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 morbid spmpathies, great 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 morbid sympathies (§ 514 h, 647, 660). 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 been 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 (§ 694^). 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 contracted, 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 congestion, or other derangement 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, warm, 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,"* Sec 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 huffy coat, be indented or cupped in its centre, or fimbriated at its edges; and, that these observations may be perfect, we take an ounce in a wine-glass for examination (§ 682 c, 688 e). 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 in the 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, i\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 the Writings of Louis, in Medical and Physiological Commentaries. vol. ii., p. 721, &c. 442 INSTITUTES OF MEDICINE. foregoing 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, and what oth- ers are more or less affected by sympathetic influences. 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 (§683, no. 9, 762). 686, d. In proportion 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. We must therefore await the development of its characters, 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 profound. 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 them, 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. 6^71. There is one system of organs, particularly, whose actions are so constantly modified by sympathetic influences, 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 i" denoting the effects of remedies, especially of loss of blood, that 1 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, and the pulse, therefore, may be sometimes deceptive in one or in both radial arteries. 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 common 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. (See Medical and Physiolog. Comm., vol. i., p. 236.) 6SS, a. When the radial pulse is examined, the four fingers should be applied along the course of the artery, and various degrees of pressure should be made. The blood taken for examination should be received into a wine-glass, and, if possible, in a full stream. 6SS, b. Certain general conditions of the pulse worth noticing are the following :—its quickness, slowness,frequency, hardness, softness, in- compressibility, compressibility, fullness, smallness, strength, weakness, obstruction, freedom, intermission, redoubling, trembling, and other ine- qualities. 68S, e. Quickness.—This term does not stand in opposition to slow- ness, although it is generally so considered. Frequency is the opposite of 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 tern 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 a 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 hecome 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 and fullness; but the three symptoms are very different from each other. A hard pulse is perfectly compatible with smallness and weakness ; the former of which is seen especially in peritoneal inflammation of the intestine, and in 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). 688, c. 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 invade the general circulatory system by sympathetic influences. 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 degrees, unless the remedies be very depressing, or the powers of life verging toward a state of extinction. But, as might be ex- pected from 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. 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. 688, ec. Coincident with hardness and incompressibility of pulse, and almost peculiar to inflammation, is the buffy 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 is the ground- work of 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. 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. The fimbriated edge is most common where inflammation is se- vere, and has established a strong sympathetic influence 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 strongly marked in venous congestions than in membranous inflammations. The formation of the buff, and the central depression, and the fim- briated edge, are remarkably affected 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 wine-glass the best. 6SS,yi Fullness and Smallncss 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 sympathetic influ- ences determined both upon the heart and arteries. The extent of these influences upon each other is very variable, and must be judged of by direct examination of the pulse at the heart and extremities. It docs 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. It 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 action is accelerated; or, if not accelerated, then the blood accumulates in the venous system, especially about the right cavities of the heart. In all these cases there is a profound interchange of sympathies 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 aho frequent. 688, g. Strength and Weakness.—I have already remarked that these symptoms are often mistaken for hardness and softness. They depend, principally, upon sympathetic influences that are exerted upon the heart by remote organs, though certainly not altogether. It is doubtful, indeed, whether any sympathetic influences 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 maybe sensibly affected and not the rest, as in blushing, and as in § 687, c. 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 a frequent and slow pulse as Dr. 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 oi its birth, is between 130 and 140 in a minute; and the mean rate ot the first month is 120. I have never found it beat slower than 10S. During the first year, the limits may be fixed at 108 and 120. J?or the second year at 90 and 108. For the third year at 80 and 10U. 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 7^, thouo-h 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 frequently 10 or 12 in a minute, after a lull m »aff the pulse either of a child, or an adult, be quickened so as to PATHOLOGY.--SYMPTOMS. 447 exceed the utmost healthy limit 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- ble 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 great 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 jiulse 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 nature, 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 symptoms. 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 moral 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. 688, k. 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, b). 688, I. Irregularities of pulse.—These consist of irregularities 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 brain. 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 excreted 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, b. 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 papilla? 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 (i). But, the vital relations of the tono-ue 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 PATHOLOGY.--SYMPTOMS. 449 the morbid and intense influences from these two sources are exerted by abdominal disease '(§ 129 i, 135, 142). 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 bo 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, e. 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, f. It would be in vain to attempt a definition of the various 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. Experience, therefore, is indispensable to enable us to appreciate the morbid states of tho tongue in an advantageous manner; but as observation enlarges, and the depths of physiology are explored, we shall find the morbid signs of the tongue a luminous index of disease. 6^1), 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. 6S9, 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 450 INSTITUTES OF 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 apthae arise ; the coat, too, varying according to the varying states of the intestinal canal, or of the liver, &c. 689, k. If the tongue be very red, it denotes more or less active in- flammation of some part df 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 preternaturally 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. 689, I. In connection with the foregoing subject I may advert to an inflammatory state of the mucous tissue of the fauces which ensues 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 I would rather place it among the symptoms, than designate it, in its true character, as a sympathetic form of disease. This inflammatory affection is commonly of an erysipelatous nature, attended by more or less tumefaction 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 forms, 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, 713, 970 b). 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. The Urine.—No product is so variable as the urine, both iu 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 redundances in the blood, and 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 mutable states of the body in regard to nutrition, or of morbid sympathetic influences, short of disease, wbieh 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 1 have 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 cantharides. 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). 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 the consequent reflected sympathies from the organ. 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- 452 INSTITUTES OF MEDICINE. sensible, 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 perspiiation 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)3 693. 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, therefore, 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 maybe 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 b). 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. Comm., vol. ii., p. 197, note). 694, a. Alvine Discharges.—The faeces 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 faeces in their natural state. Combined, however, with the faeces, they offer a general natu- ral standard for comparison with the morbid conditions. 694, b. In disease, the foregoing natural conditions as to quantitv 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 difficult than it is, in reality, to derive any just conclusions as to the nature of disease from 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 sym- pathetic influences, or liable to irritation from solid food in the absence of those conditions (§ 512, 514 h, Sec). We may be thus guided, also, as to the food which should be avoided. 2d. The nature and 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 sufficient (§ 856, a). Again, a redundancy 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 or arrested by injurious sympathies 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. When the 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, cathartics 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 color.—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 blackisli, or of a deep green, then changing to brown, or to a dark yellow, till it finally becomes of a lightish yellow. Calomel and acids are 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, b). No quantity of calomel will impart a green color to tbe 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. 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, out of the body show us how fallacious are all such pursuits. The worst appearance of the b'ile, per se, 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- orrhage 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 hemorrhage 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 suffer- PHYSIOLOGY.--SYMPTOMS. 455 ing, however, generally arises from an acrimony of the bile. Aloes will, doubtless, produce irritation of the anus in some degree; 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. 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 citadel 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, we may depend upon it that more work is to be done. But, on the other hand, if we find in the third evacuation that the green or the black has diminished, in the fourth it is paler, and the fifth has become yellow, we may be sure that art has greatly triumphed 456 INSTITUTES OF MEDICINE. PATHOLOGICAL INDICATIONS FROM MORBID ANATOMY. 695. Lesions of organization, and all deviations from natural condi. tions which occur during life and are obvious to the senses 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 bronght 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 of disease ; not unfrequently confounding the results of putrefaction with those of vital actions. Such was the general state of this branch of science, upon which, also, humoralism had again reared its venerable form, along with many other physical and chemical doctrines, when I 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. 699, a. There has constantly been, however, a group of medical philosophers who have remained true 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, b. 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 tho foregoing. If, for example, a case of inflammation of the 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). It has no place among the " Vestiges of Creation" (§ 350|, h). The London Lancet has a more proximate philosophy. Thus : " Inflammation consists in this, name- ly, that the fibrin, Sec, which should -pass from 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." 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 life, 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 nothino- through all the intermediate changes ; and what, therefore, is its positive benefit in any given case of disease at its invasion or ter- mination, if it supply us nothing throughout its progress 1 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, b. 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 b, 863). On the contrary, 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 1 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 b). 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 maybe great disorder in the functions of the body without real inflammation, or any fixed 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 solitary 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 those which spring from sympathetic influences, 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- logical ; could he even begin to consider the condition of disease, or the nature of its treatment1? 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 sequelae 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 are 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 series 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 just conclusions can be formed, either as to the nature of disease, or the 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, b). 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, b. 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 parts, 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 therapeutics 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 has 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 ih 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 my 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 Merits 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." 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 you 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- edge on thiit 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 febres 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 countries. " 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 pnictici! 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 English and Scotch practice, would it be easy to refute the assertion. It is a well-known truth, that European phy- sicians of every nation, who migrate to America, are, on their first removal, incompetent to the successtul treatment of the complaints of the country; nor can any thing but expe- rience 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 'mili- um' will be found to be positively and strikingly the reverse; a very ordinary body, pos- sessing not on 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 classe.s ; the foremost, I mean, in every es- sential attribute of standing. Of this they were themselves confident and proud; and so was I. " It is not true, then, that the 7nass 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 west not less than the east, there exist in the Faculty the eminent few, 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. " While I yield to no one, therefore, 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 1 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 independence of thought is wanting, so are vigor and efficacy of thought." '• An overwhelming majority of the physicians of Europe reside and practice in country places, villages, and small towns. And, as already alleged, they are, ab origine, more or less of an inferior caste. Their education is also inferior. Hence, conscious of their inferior- ity, they look upward for light and direction, and follow those whom they acknowledge as their superiors. In this they but conform to the European fashion, according to which the lower orders of society do a sort of homage to the higher, and walk in their footsteps. So true 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 can be much better educated in their own country than in any foreign one. Yet is the fact un- questionably true. I mean that it is a Jact, and not a narrow-minded, selfish assertion. The real proximate elements of medicine are more thoroughly taught in some American 462 INSTITUTES OF MEDICINE. obliterating unmerited reproach, and in inspiring my medical coun- trymen 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 remark 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 undertook 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 • r and so it progressed under the blandishments of diplomatic skill. I will not point, in tes- timony of this, to the " London Quarterly," 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 Reviero, 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 magnitude, 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. 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 -ichness of materials," the veteran editor aims his Lancet at the very foundation. "Look," ne says, " at the state of British pathology ! Of what does the great majority of our books Dn 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 surrender of British medicine to the laboratory of a German chemist (§ 349, d, 376£, 676, 878) ? Shall 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- ture 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 polish 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 like 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 climes. 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 begun to trample upon the past, to reject its experience, and to strike 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 Kpanarov r?jg q)iXooo(j>iac"—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, that, 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 literature 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 the PATHOLOGY.--MORBID 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 draggea 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 carry 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 writings 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 that I have now said, I may not be suspected of undue partialities, for I am un- der no obligation to any portion of my profession in America, or of the American Repub- lic ; while I am nctuated 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 learning and philosophy. 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 primary 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 con- clusions at which I have arrived. 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 inflamma- tion and 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 knowledce 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). 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 the predisposing, cause of it (§ 645, 650, 651, 653). More frequently, however, inflam- mations spring up during the progress of idiopathic fever, and often attack and disorganize 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 (§ 589 b, 764, &c). PATHOLOGY.--INFLAMMATION--DESCRIPTION. 465 714. Inflammations of much activity generally disturb, but very va- riously, the functions of many distant organs; but the sympathetic developments which spring up 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 forms would occa- sion great constitutional disturbance; even when the brain or other important organs may be the seat of the chronic variety (§ 14 o). Acute inflammation, on the other hand, is prone to give rise, at its early stage, to what is called febrile action, or fever (§ 134, 139, 140, 150). But this kind of "fever" is purely sympathetic, never pre- cedes tb.e 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 organs appear to have become involved in a morbid process; and now, also, inflammation may as suddenly supervene (§ 143 b, 148). The febrile condition proves an exciting cause of the other mode of disease, in some part predisposed to the inflammatory process (§ 674, d). It appears, therefore, that great confusion has prevailed upon this all-important subject, and that causes have been mistaken for effects, and effects for causes. The excitement of the heart and arteries at- tendant on inflammation 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 inflam- 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, 685, 686). 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 not only disappears 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. 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- Ga 466 INSTITUTES OF MEDICINE. fleeted upon the heart and capillary blood-vessels of the whole system. That power, thus reflected, proves a 6timulant to these organs, by which their action is increased, and otherwise modified (§ 188, 205, 226, 480-485). Again, the same primary inflammation which thus 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 remote sympathy. That second part 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-operatino- with it (§ 143-150, 226, 484 b, no. 6, 645, 652). This second par? thus sympathetically influenced, then becomes the source of other sympathetic influences; 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, arid interwoven with each other (§ 148); and yet, through the same principle of remote sympathy, 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 maybe done by an active cathartic, combined with a nauseating dose of tar- tarized antimony. The pathological states of the various inflamed organs are every where nearly or considerably alike. A single rem- edy may, 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, 948). What I have now said of the modus operandi of sympathy in rela- tion to inflammation 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). 716. The general sympathetic excitement is supposed to often con- stitute a state of 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 is 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 of fever when owing to the sympathetic influ- ences of inflammation. But, unlike idiopathic fever, per se,\t embra- ces a variety of morbid conditions in different parts. 717. Inflammation occurring in one part may induce the same dis- ease in another, and this last in a third, Sec, independently of the fore- going affection of the heart and arteries. .It often happens, also, that some 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). 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 pleuritis 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 (§ 589, b). The 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 as readily institute reacting sympathies among each other, and throughout the body (§ 514 h, Sec\. The general constitutional affectic-n 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, Sec). 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 their natural sympathies. Thus, inflammation, or any affec- 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. 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 (§ 447- 461*). 719. Violent sympathetic disturbances which are especially relative to the nervous system often spring up from simple irritation of the nerves of a cornparatively unimportant part, as convulsions from 468 INSTITUTES OF MEDICINE. teething, &c. These conditions have been confounded with absolute inflammation of the nerves (§ 526, d). 720. Having now endeavored to define the outlines which distinguish fever and inflammation from each other, and indicated, at the same time some of the important general attributes of inflammation, I shall proceed to examine the more direct characteristics of this Protean disease • when, also, other and more radical contradistinctions from the pathology of fever will necessarily arise. 721, a. Inflammation is a very comprehensive genus; or, perhaps, it should be rather said, it is a species of disease which embraces a multitude of varieties. 721, b. According to the varieties, it is divided into common and specific. 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- lishing the morbid change, the modification thus induced will be de- termined more or less according to their combined virtues (§ 652). Thus, cold applied to the surface 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 sympathetic in- fluences 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 from the general denomination of in- flammation by Louis, Andral, Marshall Hall, &c, and arranged un- der the designations of hyperaemia, hypertrophy, lesions of nutrition, irritation 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. 1.13, b. 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, tu- mor, heat, and pain. 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 little 470 INSTITUTES OF MEDICINE. or no pain. 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. But the reverse of this last is true of the skin (§ 052, 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 sensibility (§ 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 d, 746c,d). 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 only white blood, have become enlarged, and admit the red globules. This transmis- sion, however, of the red globules is not due to the enlargement, but 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 great 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 already 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; always accompanies 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 (§ 132 f, 740 b, 764 e, 863 a). 732, b. 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- sical 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 b). Nature, however, has no such inconsistencies (Med. and Phys. Comm., vol. i., p. 180-182; vol. ii., p. 187, 199, 556, 557, note). At the first reference here made, I have quoted the me- 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 b, 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 formation of lymph is a part of the natural process of cure (§ 732 a, b, 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 does not step aside 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 bv the function of ab- 472 INSTITUTES OF MEDICINE. sorption (Med. and Phys. Comm., vol. i., p. 371-384; vol. ii., p. 546- 566, 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 organization occurring in pneumonia is, as in § 732, d, an apparent though not a real departure from the great law of recuperation. Being a law of Nature for reparation in other parts, it must, under equal circumstances, prevail in all .parts. 732, f. It appears, therefore, that the adhesive proles 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, which 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 great 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 effused 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, reparation or the granulating 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 instinct- 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, b). 733, d. Who shall resolve the foregoing wonderful processes and results, their exact concurrence, their united object for one 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 aspects, and least of all as it may conflict with the fundamental principle of mate- rialism. When error is bold in its demonstrations, it is studious of consistency, and therefore regardless of facts (§ 5$, 5£, 40, 80, 117 137, 113, 155, 156, 169/, 172 b, 226, 3031 a, 306, 310, 311, 350? g-o, 376£, 384, 385, 387, 399, 409/, 422, 500 n, 514 h, 524 d, 525, 526 d, 528 c, 638, 649 d, 733 b, 764 b, 811, 847 c, 848, 902/ 905, 943 c, 980, 1019/). 733, c. 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 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 makin^ 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). . . 733,/ 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, b). 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 regeneration of entire parts in the lower animals, nor in the reparative process of plants. The properties ol 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 ot 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 corresponding 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 ol 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 unerring 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 b, 133, 135 a, 409 e, 411, 7-tt, 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 stags horn where some of the most characteristic marks of inflammation PATHOLOGY.--INFLAMMATION--DESCRIPTION. 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 pleune 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. 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\, b), they have endeavored to array an argument against the Hunterian doctrine of the dependence of the union of wounds, by the first intention, upon 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 effusion 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 mitrlit 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 Physiolog. Comm., vol. i., p. 696-698). 733, h. 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, Sec.; 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 (§ 1S5, 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 effusion of lyteph, and mean by the term resolution a simple restoration of the morbid properties and functions of an inflamed part to their natural 8tate, without any other supervening result beyond the formative stage (§ 729, b). 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 formative 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 alsocertain 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- vergence 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 the 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 'lamination 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 profound 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). 7 ."JO, a. Opposed to the termination of inflammation in resolution is that of mortification, which is the greatest irregularity 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 the 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 effusions are more or less attendant on this mode of termination. 736, b. 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, are 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 Physiolog. 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 a vis a tergo ? 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 the 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 one of its worst results is an effu- sion of coagulable lymph, but in some modified condition. It has been lately denied by the physical theorists that scirrus is an imflamma- tory affection (Med. 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,/). 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 over 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, 709, 733/ 830, 847 d). Thus have I quoted from Andral a luminous confirmation of the doctrines of vital action, of sympathy, &c, as laid down in these In- stitutes; 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.--INFLAMMATION—DESCRIPTION. 479 »he peculiar modification is which the texture of an organ undergoes, bo that in one case it allows the blood determined toward it to escape from its vessels; in another it forms pus, or exhales only a thin se- rum ; while in a third, 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 unfrequently 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 hypcrcemia, 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, apply to all other actions and results which deviate from the natural condition of the body (§ 64, 345-350, 350£ n, 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 irritant. 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 irritant applied to the ulcer, would determine the same physical changes. 741, b. 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 hypothesea to each particular occasion (§ 42-52). 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, 780). 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 amona 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 remote sympathy (§ 134, Sec, 500, 674 d). The foregoing general limitation of any given form 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 (§ 644-666). 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, Sec, 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 upon 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 affections 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 produces 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 (§ 1024, 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 tho 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 affected 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 during this stage; and when the hot stage supervenes, and when, also, in progressive 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 (§ 188.1, 4S7 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 Phys. Comm., vol. ii., p. 213, 241-248, 277- 2S0, 2SS, &c). Hh 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 be contraction of the vessels; but I have shown 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, Sec. "The blood," says Magendie, "traverses with ease the infinitely more minute tubes that abound in our tissues. There must be some 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 extravasaled 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 lake fire?" [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 which I called into being before you."—Magendie's Lectures.—And that, too, upon animals. " Pythagoras," says an ancient philosopher, " looks at the sun very 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, ?09, 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, \ 1034). 745. No subject has excited more discussion, or more deservedly, than the pathology and 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 difficulty 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 ate 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 form, 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 generaltruth, 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 ot the changes, we find them different in the different cases; and they PATHOLOGY.--1 VFLAMMATION--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 oi vessels are the immediate instruments of inflammation. They are en- dowed with muscular fibres, and possess, 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 known of the greater development of the properties of life in the extreme vessels; which, it may be now said, supplies an important proof of their increased action in inflammation (§ 407 b, 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 important 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 general 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. 716, b. 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 (§ 188, &c, 194, &c, 205, &c, 222, &c, 526 d). From all that has been said, it is evident that the nervous power can only act as an exciting cause of inflammation, 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 organic properties, that the morbid processes are carried on by these proper- ties, as in the vegetable kingdom, and that the nervous system is not 484 INSTITUTES OF MEDICINE. necessary to the disease, however it may have an accidental participa- tion (§ 183, 184, 222, &c, 476, &c). The nervous power, it is true, is the immediate remote cause of all inflammations which spring up sympathetically, 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, 500, 715, 725 c, 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 inflammation consists, or how it co-operates either with mechani- cal or chemical agencies. 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 or- 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 moral agents are more or less altered; and upon this turns, mostly, the curative action of medicine, &c. (§ 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, arid mechanically ob- structed, 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 the Nature of Inflammation," by Mr. Wharton Jones, in British and Foreign Medical Review, April, 1844.) 749. Such is the prevailing mechanical doctrine of inflammation, which, 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. in, 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 \s 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 arriving 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. 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). 150, 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, Sec, 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 ] 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\, 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 shown 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 frequent!) 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. (fy 1056). 750, b. 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 antimonmls; 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, guaiacum, veratria, quinia, &c, according to the special modifications of the disease by its various remote causes (§ 150, 650-653, 662 b, 668, 669, 672, 674, 742) 1 751. 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 ol 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 Com- 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 fovm of inflammation there appears to be a vague recognition, so far as the verbal distinction goes, of the morbidly-in- PATHOLOGY.--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 hypcrcemia in the place of inflammation. But the epithets are as much in direct opposition as active and 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, b). 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. 155. 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 c, 150-153, 639, 746 a). 156, 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. 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, indispensable. 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, while, as with inflammations, it will 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 frequently'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 b-d, 1008). 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, Sec.; 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 1 On the contrary, it has most fear- fully increased (Medical and Physiological Commentaries, vol. ii., p. 622-633, 743-752).- 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 be no principles, and of course no science. Medical learning would PATHOLOGY.--FEVER--DESCRIPTION. 489 be useless, and experience would only suit 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 science 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 only see when seeing is useless, and bring upon art and philosophy the derision of the crowd (§ 704). A sound principle 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, Sec, 570, &c). And, although there be one leading principle in the treatment of such cases, there are other subordinate ones founded upon 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 sufficiently 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 again, 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, &c, and other lesions of inflammation, may happen to appear red or white, they are denominated, as by Louis, inflam- matory or contra-inflammatory. 757, b. Many of the ordinary and most characteristic symptoms of inflammation 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). 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, bilious, yellow fever, plague, Sec 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 6ince the same morbid predisposition, in which the first paroxysm originated, remains, and is the cause of each succeeding paroxysm, and, therefore, a connecting link 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 co-operation with Nature, 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). 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 accidental cause, as errors in diet, inflicting mor- bid sympathies, 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. 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 fit, 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 broad 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, of irritability (§ 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 predisposition; 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 natural. 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 corresponding sympathetic 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 sympathy 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 that the last is no more a chemical product than the other secretions (§ 419, 447, &c). 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 ether 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, 770). 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 paroxysm takes place in the middle of a crisis, the disease is called a remittent. When the disease continues without much abatement of symptoms, or, rather, if a new paroxysm set in during the hot stage of a prece- 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 progress of continued fever. Remit- tents and intermittents are, also, rare in climates where the continued fever occurs, while the former go together, 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. There are, indeed, no two cases precisely alike in their pathological condi- tions ; and there is scarcely a principle of greater importance (§ 673, 857). 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 passing 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, particularly, 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 great length of time (§ 535, Sec, 768 a). Much, however, 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, Sec). 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 type. 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- mittents. In a majority of the cases of intermittent fever, the parox- ysms are repeated at the end of twenty-four hours, and hence the name of 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- viates 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, a), 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, a3 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 which enables them to take on the recuperative pro- cess; just as we 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. 116. 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. Tho predisposing causes of idiopathic fever probably consist, in all cases, of the results of vegetable decay (§ 652, 653). The spe- cial typo 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 although the causes may have long ceased to operate; which is commonly dif- ferent with inflammations (§ 711, Sec). 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 b). 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 their pathological conditions as fever and inflammation should be produced by the same predisposing causes. But this only I i 498 INSTITUTES OF MEDICINE. shows that there are analogies among all diseases. All depend upon certain states of the properties of life ; and as these properties 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 b, 161 a, 786, &c). A\rhat 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 no 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 parts. 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, nothing tangible, after life has become extinct. The knife of the anatomist goes down PATHOLOGY.--FEVER--PATHOLOGICAL CAUSE. 499 to the smallest fibre, and tne aid of the eye-glass is summoned in vain. And yet do we know about as much of the pathology of fever, for practical purposes, as of inflammation, and the treatment of one is as well determined as of the other (§ 234). 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 theii invasion (§ 743, 744, &c). But that is all we can learn 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 observation, enable 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 attempted 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 properties 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 (§ 467 c, 487, 488£). I shall therefore proceed next to the subject of Congestion. 500 INSTITUTES OF MEDICINE. VENOUS CONGESTION. 786. 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 of 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. 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 which 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 veins 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 principle. 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 is universal, but peculiar to a few. 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, Sec; 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 arrive 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. 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 degree 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 altered 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. Why % 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. 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- PATHOLOGY.--VENOUS CONGESTION. 503 etrates the substance; and this whether warm 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 1 794. The venous tissue is composed of three coats ; the inner, which resembles considerably a serous membrane, 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 determined 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, Sec, 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 which the blood has, also, a preternatural effect (§ 143, &c). 795, b. 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, Sec). 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 (§ 3501). 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). 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, unembarrassed circulation, their ultimate disorganization, pain, soreness, 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.--VENOUS 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. 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 theoretical principles, and none where the therapeutical facts settle more conclusively the nature of the dis- ease, and the principles which should guide the treatment. 801, b. The method of cure had been either empyrical, or without 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. 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). 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 debility. We regard the prostrated muscular strength 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 Commentaries, 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 processes, 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 or by remote sympathy (§ 498-500). 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. 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 the laws of sympathy. 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 spring up, sympathetically, from 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, PATHOLOGY.--VENOUS CONGESTION. 507 when the artificial disease subsides, its abatement accelerates the decline of the natural affection, and thus exemplifies the law in its compound aspect (§ 7.53 e, 905). 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. Nevertheless, it will be seen, from the nature of the interchanges now stated, that venous congestion and inflammation of other associate tissues should often coexist. N05. 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 own facts ; that it is very rare that ruptured vessels have been detected by the microscope, and that no vessels admit the transudation of their fluids till putrefaction has opened the way. I shall now only add, that I have variously shown 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. 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 nature 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 powers of the system are very liable to be prostrated, and along with them the general circulation. This is generally true when either form of the disease exists in its greatest intensity ; and the phenome- na of excitement obtain, more or less, when these forms of venous in- flammation are less violent, or when on the decline. Its remote sympathetic influences, whether the disease be acute or sub-acute, are of a compound nature; partly the exciting influences of inflammation when affecting other tissues, and partly the depress- ing effects which are peculiar to morbid changes in the venous tissue. 508 INSTITUTES OF MEDICINE. These are the most visible results, though more profound changes take 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 b, 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 office 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 b, 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 pathology of venous congestion, and tho general principles which I 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 its inflammations of every degree are apt to be unattended with much pain, or tenderness on pressure ; though most so 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, not unfrequently betray the unwary into a false security, or beguile him into the fatal belief that " debility" 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 affection 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," Sec, 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 observations, which betrayed Magendie into the experiment- al fallacies recorded in a foregoing section (§ 744). 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 salutary effects upon the various parts that may be partially influenced by some local malady, the morbidly sympathizing parts may then become reacting saurces 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 sympathetic 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 different 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 the sympathetic 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 form 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 (§ 814). 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. (§ 800, 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. Here there is no complication with fever, or with inflammation of other tissues, but the disease is constituted by very extensive congestion of the veins (805). 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 prevail, 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, b. Since, therefore, miasmata are so extensively the cause of venous congestion, it is important to consider that its exact patholog- ical character will depend, ceeteris 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 (§ 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, has 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 intermittents of Africa are more pernicious than those of other countries. 815. When venous congestion so far disguises the attributes of idio- pathic fever as to present the constitutional phenomena of venous in- ilammation, 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 muscular strength 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, andin 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 b, 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; particularly south of the lat- itude of forty degrees. It seems then dependent, also, upon malari- ous causes; and, although it sometimes occurs epidemically in such places, especially among children, there may be a general absence of fever. These places, however, are commonly within the range of congestive fevers, but where the intensity of the predisposing causes is kept down, or the causes otherwise modified by the hand of art, or by local situation, &c. 816, b. 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 predisposing 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 affec- tions of the peritoneum, or of the cellular tissue of the surface, which ends in dropsical effusions ; 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 scarJatina (§ 5S9, 1). 0 astric 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 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-pox, 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 reserve as contributing largely to the com- prehensive philosophy 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 stim- ulants (§ 662, 1056). 818. I now dismiss the great subject of venous congestion; than which none greater can undergo the attention of the philanthropist or the medical 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 therapeutical 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 eleva- ted 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. Kk 514 INSTITUTES OF MEDICINE. THE HUMORAL PATHOLOGY. 819, a. "To what errors have not mankind been led in the employment and denomina- tion of medicines ? They created deobstruents when the theoiy of obstruction was in fashion; and incisives when that of the thickening of the humors prevailed (§ 748, 789). The expressions of diluents and attenuants were common before this period. When it was necessary to blunt the acrid particles, they created inviscants, incrassants, &c. Those who saw in diseases only a relaxation and tension of the fibres, the laxum and strictum as they called it, employed astringents and relaxants (§ 569, b). Refrigerants and heating remedies were brought into use by those who had a special regard in dis- eases to an excess or deficiency of caloric (§ 433, &Ct). 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 in a bad state; the whole blood must be altered, or corrected; and a variety of such expres- sions -without meaning. They even 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 the 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. Negative. 1. "Various animal poisons, such as those 4. "The vital forces appear to be af- of the snake tribe, and different mineral poi- fected primarily by a great many poisons, sons, as mercury, for instance, act upon the by the vegetable or animal emanations, blood. Those derangements of functions and kLown by the name of miasmata, and by organs produced by the experimenter, when various modifications of the external agents he introduces different deleterious substan- which are incessantly acting upon us, such ces directly into the blood, are likewise those as a want of due exposure to the sun, too that are produced by the sting or bite of cer- damp an atmosphere, and an unwholesome tain animals ; they are also those that take diet." place in small-pox, measles, and scarlatina, 5. " In every disease not immediately pro- of a malignant nature, as it is called. They duced by external violence, the symptoms are the same derangements that appear in that occur depend either on a lesion of the persons exposed to putrid emanations, vege- forces that animate every living part, or on table or animal, and to miasmata from the a lesion of organization (§ 177, 189 b). The bodies of other persons that are themselves former is primary and constant; the latter diseased and crowded in confined places, is secondary, variable in its nature, and in- &c. Lastly, they show themselves, also, in constant in its existence." individuals whose blood is only imperfectly 6. " No one solid can undergo the slight- or badly repaired by insufficient or unwhole- est modification without producing some de- some diet." rangement in the nature or quantity of the 2. " There takes place a vitiation of the materials destined to form the blood, or to blood by the commixture of deleterious sub- be secreted from it." stances; next, in consequence of such vitia- 7. " Until it is proved that the forces tion, an alteration of the functions of the which, in a living body, interrupt the play nervous system; and, lastly, the blood that of the natural chemical affinities, mam- supports the organs, and the nervous sys- tain a proper temperature, and preside tem that animates them, having suffered a over the various actions of organic and ani- geneial injury, a constant, though not al- mal life, are analogous to those admitted by ways appreciable, modification of these or- natural philosophy, we shall act consist- gans in their functions, or in their texture." entlY with the principles of that science, 3. "Diseases, resembling many of the by giving distinct names to those two kinds preceding (no. 1) in their symptoms, or in of forces, and employing ourselves in cal- the appearances discovered after death, are culating the different laws they obey." not unfrequently occurring where no delete- " The qualities of pus are modified by rious substance has been introduced into the every alteration, whether physiological or blood, and in which there is no direct proof pathological, which takes place in any other that any alteration of that fluid has been the organ, even though it have no particular con- primary cause of the morbid phenomena, nection either of function or tissue. Thus, Here, as in the preceding case (no. 1), it ap- we have all seen instances of the pus se- pears that the primary cause of the disease creted by the surface of a sore becoming should be referred to the blood, which, in this suddenly altered in quantity and quality PATHOLOGY.--HUMORALISM. 515 Affirmative. Negative. case, has altered its nature under the influ- under the influence of a simple moral emo- cncc of unknown cause*, as it has in the oth- tion, of the process of digestion, or, in short, ers, in consequence of the commixture of of any supervening 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 and determinate character."—An- dral's Pathological Anatomy. 819, b. I have thus brought into contrast the prominent doctrines of the distinguished individual who 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, 3501, 350%, 350|, 350£ a-gg, 438-442, 447 f-i48f). 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, kk, 709, note). In eonsider- ing the causes which have led to the subversion of medical pbilos- 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 difficulty 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 b, 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. tive in its plan, should all regard be neglected for a doctrine so widely embraced by the educated physician in common with the io-. norant pretender, and so broadly opposed to the solidism which lies at the foundation of these Institutes (§ 1 b, 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, b. The restoration of humoralism is an impressive 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 parent 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, 350%). 820, c. Without, however, attempting now, as on a former occasion, to assign more extensively the ground of the foregoing conclusions, I shall briefly add that I know of no recent attempted innovation upon the philosophy of organic nature, whether under its healthy or mor- 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 they come to us again without having changed in one essential aspect their old thread-bare livery. That this should be so is owing to the absence of all efforts to refute the errors, 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 b, 3501). 821, b. In the brief review which I now propose, the question should be first settled as to the main doctrine of the present humor- alists. 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 surprised 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 morbific 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,' fyc, and whether we are ' the parents of our own humors, and that we breed bad humors,'' " &c.—Med. and Physiolog. Comm., vol. i., p. G36. 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" (§ 5.}, 350, 350^). 821, c. It may be interesting to some should I annex the precise modus 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 great care of the Dutch in their 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," Sec 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, b). 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- 518 INSTITUTES OF MEDICINE. ural state, without reference 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 its 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). 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- ple fact affirmed by each proposition (§ 5i). 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 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 (§ 51). 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 prin- 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 wo 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 inflammations. Bile, Sec, 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 the laws of sympathy, 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. 826, b. 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, according 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, Med. and Phys- 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 agents which have been said to gain a ready admittance to the circulation, and that the most positive affirmations predicated of elaborate exper- iments, like those of Orfila in respect to arsenic and antimony, have been shown to be false by their cotemporaries, and through improved means of observation. The foregoing substances, for example, were given to dogs in large doses, by Flandin and Danger ; but " at what- ever time, subsequent to the administration of the poisonous doses of arsenic or antimony, blood was drawn from the arm for examination, they never found either substance in the blood." It is also worth adding, that Orfila remarks that, " I shall only say, in reply to Flan- din's charge that I consider the animal body in the light of a mere sponge, that I follow Magendie and Fcedre entirely in their theory of absorption" (§ 289-293, 350% n, o, 744, 841. Also, Med. and Phys- iolog. Comm., vol. i., p. 529, note, Sec). 826, d. I may also contrast the facts, that many of the most virulent poisons, such as the virus of the viper, of the rattle-snake, of the mad dog, of the wourari, &c, are perfectly innoxious when swallowed, or when applied to any sound part of the body, even to the brain (§ 828), while a vast variety of other agents, far less offensive, will immedi- ately affect those parts, and through them the system at large (§ 150, 494 d). Mercury, in its metallic or oxydized state, and, of course, insusceptible of absorption, will affect the universal system through the medium of the skin; and if the latter organ sustain any corre- sponding or other effects, they arise not from the direct action of the agent, but from reacting sympathies. These problems have been ex- PATHOLOGY.— HUMORALISM. 521 plained in preceding sections, where fcome important experiments oc- cur (§ 133, &c, 150-152, 177-184, 222-233^,283,452, &c, 476-493, 491, 500, 514 d, h, Sec, 650, 657, 666). The student 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 Muller's misapprehension of the subject. " The narcotic action of opium," says Muller, " 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, Sec, 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 the fact 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 exdosmosis. 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; but that this is 522 INSTITUTES OF MEDICINE. disproved by all organic nature,* I think the reader will concede after consulting the following references (§ 135, &c, 350% n, o, p, 350^ 3761, 398; 408, 409, 419, 420, &c, 423, 500, 805. Also, Med. and Phys. Comm., vol. i., p. 565, 683, &c). 827, b. 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 control 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 organi- 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, Ul%a-f). 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, with impunity, 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 corresponding to that fundamental law; whether the process be the result of chemical or vital actions, or both united (§ 447^,/). 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, Rccherches, Sec, p. 88. PATHOLOGY.--HUMORALISM. 523 Here, then, we have the principle demonstrated, which is of uni- versal application 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 only then 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. Comm., vol. i., p. 443, &c. This lets us into the secret why many poisons, as that of the viper, of the mad dog, of the wourari, &c, 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 vernix, &c, will affect the skin when applied only superficially (§ 135-137, 140, 150). 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, or to the absorption of the agent. We have already variously seen how the morbific impression may be produced without exciting any manifest disease in the part upon which the pri- mary 'impression is produced. The example of cold in producing pneumonia, or rheumatism, &c. (§ 649 c, d, 657, 666), the fatal action of hydrocyanic acid, aconitina, strychnia, &c, the remedial influences of tartarized antimony, of the mercurials, and of numerous other al- terative agents, concur in one general illustration of this subject (§ 494 dd, 550-563). The philosophy relative to the nervous power conducts us through all the labyrinth of the wide-spread influences that radiate from a given point which may seem almost alone exempt from the general invasion of disease (§ 222, Sec, 500, 512, &c). 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 from 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 OF 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 of prussic acid after the stomach had been emptied of its con- tents (§ 657). Intestines healthy. Vessels and sinuses of the brain filled with a dark-colored fluid blood. No smell of prussic acid. Blood every where fluid" (§ 494, 904 b).—Mr. Pooley, in London Medical Gazette, 1845. 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, bloodletting, &c. (§ 556 c, 837 b); while, on the contrary, had humoralism any foundation, cathartics and bloodletting should di- minish the chances of mercurial action, nor should that action increase long after profuse ptyalism has been established. (See Modus Ope- randi of Remedial Agents, § 892, &c, and Vital Habit, Constitution, Sec, § 535-638.) 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 b); and since, therefore, the blood is the pabulum 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). 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. 827, g\ Again, however, most of the substances whose presence in the blood or secretions can be detected (a) are either innoxious, or undergo chemical decomposition as soon as they come in contact with the circulating 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-q). 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). 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 denuded 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 propagated sympathetically over the system. It will be also observed that in these experiments the agents are brought into direct 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 (§ 350% p, 494, 743, 826 b-d, 827 d, 904 b), 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, Sec 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 years, or for months. It is either washed away from the former, or carried off by the latter. 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 come 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 h, 509-511). The principle is the same as when the division of a nerve excites inflammation in the part to which it is distributed. Now 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, b. " 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, 826 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 minute. 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. 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 course, 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 c, 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 supersede 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 wound, as at the eighth of an inch. No sooner, also, does the inflammation begin than remote sympathies may come into play; 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, See). 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 1 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 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 b, 509, Sec). 82*, 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 (§ I882 d; 527 b, 902 m, 905). 829. " When we consider," says Pereira, " 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 whoso branches the bile is secreted,—our astonishment is great that this secretion is not more frequently affected by 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) ] 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 absoiption; 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 most powerful irritants are empti- ed into its right 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 the most irritable organ of the body compared with their dilution in other parts, except the lungs, as 1 to 50, or more. And yet the heart 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. S30, a. The 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 animals, and their effects carried up to the natural morbific causes on man. 528 INSTITUTES OF MEDICINE. Strange as is this analogical ground of induction, it is, nevertheless, 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 same 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 show themselves, also, in individuals whose blood is only imperfectly or badly repaired by in- sufficient or unwholesome diet" (§ 744, 819 b). 830, b. 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 fever, typhus, &c, in the brute race (§ 744, 810, &c). These devices of art are very extensively considered in my Essay on the Humoral Pathology, where I have endeavored to show that they all go to the proof of solidism (§ 827, f). 832. For an examination of what I have designated as the fifth prop- osition in humoralism (§ 823), I must refer the curious reader to the Commentaries, vol. i., p. 401-408, 431-451). 833. The sixth 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 Commentaries, vol. i., p. 417, &c. 834. The seventh fundamental assumption goes with the fifth, and the reader, by the references there, may satisfy himself of their degree of importance. S35. The eighth bulwark of the doctrine is the important fact,—im- portant to the solidist,—that morbid changes occur in the secreted PATHOLOGY.--HUMORALISM. 529 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." 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, &c). 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 effects 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, " Pathology of Tubercle 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, yellow fever, typhoid fever, Sec, not to mention a number of 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 like the " Secretary," it " stands alone." What though, however, it rewarded the gentleman with a few moderate evacuations, I have never yet seen it affirmed by L L 530 INSTITUTES OF MEDICINE. the pathological chemist, not even by Orfila, 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, b. 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 analooous 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 b, 827 e). 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 mucous tissue or to the skin. What, for example, would be 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 insoluble substances applied to the skin ; as the insoluble preparations of mercury 1 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 remedial agents, when he mingles them with the blood. The experiments, therefore, have no tendency to prove the doc- trine of absorption. On the contrary, they go to substantiate what I 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). 837, cc. But, after all, the foregoing experiments are worthless in a practical sense, since they have been made (unless in rare and unsuc- cessful instances) upon a very few individuals in health; and there- PATHOLOGY.--HUMORALISM. 531 fore prove nothing as to their action upon diseased conditions (§ 137, 143, 149, 150, 152 b, 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. Those 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 (§ 18, 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 each one produces disease in all 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, 233f, 526). 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 ? 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 1 How is it with small- pox, and measles, and other self-limited diseases 1 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. S40. 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 transmitted to the mucous tissue of the "rgan (§ 514 b, 516 d, nos. 6, 12, 657, 65S). Circulating within the organization, remedial agents of an irritating i 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 furunculus, &c, are relieved by the transmission of the various substances, which may yield relief, to the very organization of the parts affected ? 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|). 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, f, &c). Its several relations, therefore, should be regarded in connection. 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). 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 influences upon other parts 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. 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. 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 b, 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 my 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 of cold, of ipecacuanha, of muriate of soda, and analogous agents^devoid of true astringency, in arresting hemorrhage; or how sulphuric acid checks the colliquative sweat, or what would be its condition, or that of acetate of lead, on coming in contact with the circulating mass of blood 1 The force of necessity which applies to the answers will be very likely to extend its sway throughout the classes of astringents and tonics. 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, Sec, 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 (he 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 blood is changed to a vermilion hue by adding saline cathartics to 534 INSTITUTES OF MEDICINE. that which is abstracted ; from which the conclusion is drawn that the 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 strenu- 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 >nd practical medicine. 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 (§ 161 f, note). An empyric 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 vrind, 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 the like affection in another? How does one man's yawning make another yawn ?—one man's p—ing provoke a second many times to p ? Why does scraping of trenchers offend a third, or hacking of files ? Why do witches and old women fascinate and bewitch children, but, as Wierus, 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 hominis, 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 f, note, 227, 234 e, 500 f, o, 509, 638, 1072). 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 pri- mary 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 by the morbid action of the solids. PATHOLOGY.--HUMORALISM. 535 816. No one will deny what is affirmed by Andral, that 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). I also agree with Andral, that any primary alteration of the 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 : 1st. Every morbid change in the action of the solids is followed by some change in the blood. 2d. Every primary 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. 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 normal state, the subject of its morbific ac- tion ; and, according to the premises of humoralists and solidists, when 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 blood must be 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 ofthe morbid state which it sets up in the solids, it is plain, if the doctrine of humoralism were true, there could never be a recovery from disease. It follows, therefore, 1 say, that the solids having been brought into 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 premises, 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. Better had the chemist attempted the manufacture of blood, and eliminated from it an " artificial gastric juice," than the conversion of fermented, vitiated, or otherwise dis- eased, into healthy, blood. 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 of 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 ofthe solids in the natural condition, should receive a morbid impress from a part or the whole, which would not only defeat its great final purpose, but give to it an ascendency over those powers and actions to which it is entirely submissive, for the great end of life, in their natural state (§ 43, 277, 278, 3031, 303£, 322-326, 385, 409/-i, 411, 422, 424, 449 a, 464, 638, 733 d). There is an ever-varying adaptation of the state of the blood to PATHOLOGY.--HUMORALISM. 537 the varying 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 during 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 Bcnse (§ 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, 710, 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, wheD 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 ofthe part. Now it is, indeed, that not only is this resistance made, but Nature may set in with her recuperative process. It is hardly 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, c. 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 syphilitic and small-pox virus (§ 847, d), since no part is capable 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. 538 INSTITUTES OF MEDICINE. And just so with the ordinary forms of disease, if excited in the sol- ids by a primary diseased state ofthe 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. The principle is deeply founded in organic nature, and is one of the most important in its practical application (§ 847, b), 847, f. But, again, on the other hand, in the sense of solidism, if the alterations of the blood depend on an antecedent morbid state of the solids, the changes of the blood will be always suited to the exist- ing condition of the organic properties and actions, of which the mor- bid state ofthe blood has been only a consequence, as in the forego- ing analogous cases (§ 847, e). And since the changes are thus exert- ed, the same organic properties and actions, whatever their condition, can, either unassisted or by the aid of remedies, replace, by their own improvement, the morbid changes ofthe blood by others, of any degree of approximation to the healthy standard (§ 672, 676 a); just as was seen of a part in relation to the syphilitic or small-pox virus. 847, g. Is it asked why the blood, when it becomes 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 the sympathetic 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 sympa- thetic effect 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. 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 ofthe 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 processes 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- rious 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, h. Were not the foregoing all-wise provisions established in PATHOLOGY.--HUMORALISM. 539 the constitution of 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 to 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. 818. 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 reacting sympathies various parts of the body not affected by disease, but whose susceptibilities are increased by morbific sympathies re- flected from the seat of absolute disease, 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 h, 674 d). Whatever, too, may be the complexities of disease, the right remedy will be at least compatible with the whole condition (§ S70 aa, 891 g, 891£ e,f, 892 c, d, 8921 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 effect, while, also, a corresponding quantity of morbid blood flows out of the veins, such healthy blood would aggravate the disease (§ 136, 137 b, 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 (§ S47, 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 present 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 ofthe 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). 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 insoluble 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 blood-making faculty of calomel, opium, and nux vomica. The treatment, therefore, is apt to be governed by this in- dication. 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 ofthe 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. 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 medicatrix Natures is like the mid- night darkness to a blind man (§ 240, 839). 851, b. 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 regret the necessity ofthe parallel and the contrast. But I speak of facts and philosophy ; nor should I be true to my duty did I not speak with honesty and frankness. 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 ofthe 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, b. 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, 63') 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 element 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 Therapeutics, 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 (§ 1S9). S54, 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). S54, b. The most violent poisons are among our best remedies. " Ubi virus, ibi 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, Sec). 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, bb. 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 OF 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, 8921 b, 855, 856) 1 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, b). Not till a proper decision can be obtained between the two methods of considering disease as propounded in sections 5% a, 675, 686 b. 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, b). 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, &c). 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 Arrangement ofthe Materia Medica. 854, d. The difference, in principle, 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- cording to the existing condition of the vital states (§ 137^,149,150, 854 bb). The Materia Medica is necessarily founded upon the fore- going principles, however it may have been hitherto unexplained, or however it may not be now admitted (§ 2 b, 143c, 895, 902 j). 854, e. In the treatment of disease, therefore, we do but substitute one morbid action for another. Nature does the rest. 854, f. In consequence ofthe laws of organization, the approxima- tions of morbid conditions are such as to enable us to establish upon a certain combination of phenomena certain general principles of therapeutics. 543 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 cases 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 circumstances 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 effects, they co-operate in a direct manner with the ten- dency to restoration which had already begun (§ 672). 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). 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 tho 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. They consist, there- fore, merely in removing or withholding the exciting causes of disease. 856, b. 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 where 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. 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 efforts of na- ture. 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- itive remedies determine morbid changes that are embarrassing to 544 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 ofthe properties 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 temporary prevalence in some foreign countries (§ 621, a). 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 (§ 5% 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 perfectly 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 d, no. 6, 550, 552, 556 b, 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 Nature 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 state to exert their recuperative principle than had been already done by the very causes ofthe 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. Nowhere, however, is the recuperative tendency of nature, the vis medicatrix naturce, so forcibly displayed as in the brute creation, where instinct-alone obtains, and where organic life moves on unshackled by artificial habits (§ 856, b). 859, a. We see, therefore, more and more, that, in therapeutics, we should cautiously avoid those fallacious inductions which have been drawn from the action of remedial agents upon man in health, and even upon animals and plants, and which constitute a part ofthe " ex- perimental philosophy" ofthe age (§ 854). It is, however, one ofthe 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, b. 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 sympathetic 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 ofthe intensity of disease. This grows out ofthe con- stitutional nature of the organic properties, as already variously con- sidered. 860. All remedial agents of positive virtues, like all morbific ones, alter the properties and actions of life, cceteris paribus, according to the nature of each agent (§ 652). Each one affects them in kind, 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 the case before us. 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 great number of instances of any given disease, while a greater 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. New 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 carrying 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 ofthe nature ofthe 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 ofthe 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 cure (§ 733, e). 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 ofthe 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, b, 756 b, 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. 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 ofthe 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. 863, 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 (§ 662). 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; but the main effect will be now due to sympathies reflected 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, Sec, 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 inefficient, 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 ofthe 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 transmitted to 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 remote 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- 548 INSTITUTES OF MEDICINE. 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 send abroad morbific 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 throughout, and there are none of greater import- ance in medicine. 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, 500 n). A great variety of other practical conclusions follow in the train of the foregoing principles. We see, for example, from what is known ofthe 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 nausea, therefore, 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 intermissions 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, therefore, is per- fectly simple. The morbid change, in one case, having but just be- gun, and Nature, in the other, being inclined to restoration, the sym- pathetic 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 therefore 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, sisce the artificial change being made about the time of the access, the predispesition is so crippled at this particular 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 ofthe 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 access ofthe 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 with the emetic before the access of the cold stage. The same philosophy 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 greatly started along in her recuperative process, and often obtains an impulse by which she passes on triumphantly through an uninterrupted series of 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 the most profound sympa- thetic effects 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. 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 feet of the emetic. It is the same principle which is concerned when 550 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 ofthe 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, I say, lessen or prostrate, at first, the organs of circulation throughout their widest range, establishing 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. 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, d), 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 ofthe part. It is most curative in inflammations of the lungs, far less in intestinal inflammation, and still less so in inflammation ofthe 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%, 349 d, 851). 863, f. But Nature has one means of depletion which stands for ail 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 both 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. THERAPEUTICS. 551 S63, g. What we have now seen of Nature and of art, in respect to inflammatory diseases, is equally true of fever. The effusions, 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 remcdium principalc as she does in obstinate affections of the lungs, or the stomach (§ 805). 863, h. 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 more 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 errors in food, there may be yet remaining hope from emaciation. Sfil. 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 tho organization, of which effusions 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. 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, Sec, will generally remove intermittent inflammation; but cases occur in which the special 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 itsfebrifuge. The former of this remarkable combination of virtues may be the best for enfeebled states ofthe system, or ofthe 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 progressive. 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. uninterrupted 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. S68, 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 ofthe 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, Sec. 868, b. 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 negative abuse of bloodletting. Being sure of the right,, 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 variety of circumstances; but mainly upon the period ofthe disease. All diseases being most easjly 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 oth- THERAPEUTICS. 553 ers ; 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 greatest certain- ty ; ipecacuanha comes next; but most of the other emetics would be perfectly useless or detrimental. The union, however, of antimony and ipecacuanha improves the useful alterative virtue of each, and lessens the chance of morbific action from the antimonial (§ 150). 870, aa. Remedies sometimes operate with great 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 their want 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 a, 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 grains, 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 tfye 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 mind, Sec, 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). 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 of 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 554 INSTITUTES OF MEDICINE. che stage' 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 mhdit be otherwise injurious. A remedy which is curative under one combi- nation of circumstances may aggravate disease when that combination is a little varied. The cathartic which would not irritate intestinal inflammation immediately after bloodletting, might greatly 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, Sec). 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 spience. 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 be 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 influences may spring up, of great power and extent; each ingredi- ent, and according to the proportion of each, modifying, increasing, and extending the alterative action of each, but in such a combined manner that the compound acts as a whole, and not by its individual parts (§ 188$ d, 511 h, 889 k). 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 liver. 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. Now, 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 ofthe intestine, and are 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 ofthe Rochelle salts, and neutralizes any acid that may exist in the primae 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 ofthe saline substance, and imparts to the whole compound a sympa- thetic influence over the liver, by which a free secretion of bile is maintained till health is established. 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, t.V-c., by which greater simplicity is obtained. It is not unusual to meet with prescriptions in systematic, labor- 556 INSTITUTES OF MEDICINE. saving 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, 188$ d). And so with the agreeable emotions of the mind (§ 500, 539 c, 855). If the reader will now attend, in connection with the foregoing principle, to what has been said of the nervous power (§ 222, &c), of the laws of sympathy (§ 500, 512, &c), and to other special cir- cumstances which favor the operation of remedies (§ 143 c, Sec, Sec), he will readily perceive the extent of his power in the 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. 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 of 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 groups, 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 so in regard to children, who are generally insusceptible of salivation. 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 th6 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, b. 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 (§ 556, b). 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 potu. 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 fajniliarly known as the active and the watching or expect- ant (§ 853). 876. The active method consists 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 patholog- ical conditions which are most conducive to the salutary efforts of Nature (§ 150, 854 b, 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 ofthe 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 watch. 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 ofthe 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 a sis- ter state, 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 (fiat justitia ruat ccelum), that the physiol- ogist concede to the homoeopath that his hypothetical views may be di- rected by an enlightened understanding ofthe 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 health and to life, than any or all the tenets ofthe 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 ofthe 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. Forbes's " Young- Physic.;" also, Prof. Lawson's, and MedicoChirurgi- lal's Reviews ofthe same, 1846. THERAPEUTICS. 559 880. Having, I say, placed the morbid conditions in the right way for the salutary efforts of Nature, 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. 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 ofthe contingencies that may arise after the restorative process shall have been introduced. 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 ofthe 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 pro- longed life, enjoy an exemption from corporeal and moral 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 only flow 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 rigor 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 OF MEDICINE. ture of all things, and from the nature of every individual; from the disease, the patient, the things that are administered, and the person 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" (§ 5% a, 350|, 821 e-823). 884. When the foregoing indications are subjects of attention, we pursue the rational system, which is so called in contradistinction to the empyrical. The rational treatment looks, also, at the physiological states of the system, 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, lakes in its scope afl the principles of medicine (§ 639, a). The empyrical practice, on the contrary, discards every 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 empyricism. 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 b, 744, 821, 824, 830, 835). 885. Symptoms, however, are the most essential, in their relative bearing, in the series of indications. They inform us of the organs affected, conduct us to a knowledge of the pathological cause, and fre- quently contribute 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, b). 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 ofthe 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, Sec). It is evi- dent, therefore, where 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 remote 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 ofthe tonic and stimulant school (§ 476 c, 487 a, 488J, 569, 621 a). 8SS, 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 difficult, 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, b. 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 conducive to the restorative process (§ 752-756, 870- 672). 888. r. There are a few fundamental points to be carefully consid- N N 562 INSTITUTES OF MEDICINE. ered in all cases in relation to the effects of remedies. They refer to the principles and details already propounded. 1. The direct local effect of remedies upon the part to which they may be applied. 2. Their sympathetic effects upon remote parts. 3. Their ultimate effects after their direct action is 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 are either within the direct reach of medicine, or they sympathize with such more powerfully and more readily than do the less impor- tant (§ 129, &c.) 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. 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 ofthe Materia Medica. Before proceeding, however, to the summary consideration of the modus operandi 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 important and most neglected of all—neglected practically as well as philosophically—loss of blood. Those agents may consist of cathartics, astringents, tonics, narcotics, antispasmodics, arsenic, Peruvian bark, or, rather, the alkaloid quinia, 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 intesj 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 which I have hitherto spoken, 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). 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 cathartic .s about operating, for nausea or vomiting to take place ; which, how- aver, 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, f, 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 resulted 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 that cathartics not only throw their powerful influence, by remote sympathy, 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. 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 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. This may re- move the embarrassment which the liver has offered to the mechanical philosophers as expressed in section 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 radiates, as in the case of the stomach, other important 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). From the foregoing phenomena relative to the effects of cathartics upon the stomach and liver, we reason in the same way to the various results which those agents exert upon other organs ; and this reason ing is corroborated by all that is known of the laws of organic beings, whether in health or disease, as well as by the consistency of nature, and unity of design. 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 contemplated, they are given mere- ly because it is customary to do so; always excepting the humoral interpretation (§ 819, &c). 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 inferior. 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. We thus see how liable definitions are to lead us astray; and this is true of most ofthe designations which I have retained in my Phys- iological Arrangement, and more particularly so of those general de- nominations, such as demulcents, revulsives, deobstruents, Sec, which I have excluded (§ 729 b, 819 a). 889, d. We may make up our minds, therefore, that the mere pur- gative effect, or the evacuation of the fecal matter, abstractedly con- 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 irritation, 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 ofthe others where gastric ir- ritability is rendered obtuse by narcotic poisons. S89,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 ] 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 sympathetic influences in 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 all 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, sympathetically, 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 relations between the mucous tissue ofthe 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 exert 566 INSTITUTES OF MEDICINE. powerful sympathetic effects 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. 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 ofthe 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. There are some great errors, however, 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 production of morbid bile which aloes elicits by its special influence upon 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 ofthe anus in the ab- sence of hepatic derangements ; and then, also, there is comparatively little bile evacuated. The great 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 ofthe intestinal canal, they will be often liable to the worst practical consequences unless the philosophy which I have set 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). 889, k. From what has been hitherto said ofthe 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. The combinations of which I speak act as a whole upon the prop- erties of life; just as the various rays of the sun in producing the seusation of white light (§ 188|, d). But, like the rays of the solar beam in their action upon life, there is nothing in inorganic nature which offers a similitude ; while, also, it is worth saying, in farther il- lustration of the whole subject, that the rays of the solar beam never act collectively on inorganic matter. 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 remote sympathetic influences of all the agents which are thus employed (§ 227, 228, 500, &c). 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 cathartic 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, 1S9, 191, 872 a). 889, /. 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- though 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 ofthe cathartic, or time for repetition, by considering the existing condition ofthe 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 prob- 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. 568 .TTUTES OF MEDICINE. There is another ' mportant 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 (§ 155-158). 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, 415^, 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 (§ 890g, 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 quantity 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 re- mote sympathy. 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 ofthe cumulative effect of cathartic remedies ; 2d. To establish a free secretion of bile, which is commonly deficient in these cases. 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 ofthe 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, b). 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, /j /, alone) 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, I). 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 ofthe bile and the mechanical irritation of the alimentary matter supersede the farther use of the medicine ; or, the minute doses may now become morbific. It not unfrequently happens, that, at the beginning ofthe 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 enough that a change is established in the condition ofthe liver; but a not less important one occurs in the vital state ofthe intestine (§ 107, c). 889, mm. 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. Nor is it alone the intestine which fails of being diverted 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, b), or associated with them, or ipecacuanha sometimes intermingled. Or, at other times, it maybe greatly best to substitute mild enemas, whose action is explained in section 498, or again to depend upon diet, ex- ercise, running especially, Sec 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 (5 863, d). 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 ofthe 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 natural 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 sympathetic influence to parts that are diseased, and both the impression upon the skin and its salutary sympathetic influences 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, h). 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, b). 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 they be administered internally, or applied to the external THERAPEUTICS.--ASTRINGENTS. 571 Burface; that they operate by so modifying the living properties and actions ofthe secerning vessels, that redundant secretions of blood, oi of other fluids, are arrested in virtue of that change of vital action. 890, b. Let us now look for an illustration ofthe 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 is a powerful 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 diarrhoea, yet, in an opposite state ofthe bowels, as in constipa- tion, proving an admirable laxative in the same small and repeated doses (§ 889, m, mm); 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- tradictory effects owing] They depend upon the natural susceptibil- ity ofthe organic properties to changes according to the virtues ofthe 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- uresses 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 a way that the unnatural secretion is arrested; while the change which is thus established in the mucous tissue is a removal of a morbid stimulus from the muscu- lar tissue of the intestine, upon which the diarrhceal 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 (v 1062). 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 OF 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. Nevertheless, it ar- rests them in nearly the same way as the pure astringents effect the re- moval of hemorrhage, diarrhoea, gleets, &c. And what lets us particular- ly into the philosophy of this subject is the coincidence in the effects of opium as it respects the simultaneous diminution ofthe 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 diarrhceal product of the intestine. 890, b,b. 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 the me- dium of the nervous power. 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, 228, 855). 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 nature, cold, which often surpass the pure astringents in arresting ef- fusions of blood, &c, may be brought to the same interpretation of the modus operandi of those astringents. 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 another class of remedial agents 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, leucorrhcea, &c„ are treated by vast numbers according, alone, to the physical conceptions ofthe action of astringents; and those agents, therefore, 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.--ASTRINGENTS. 573 without any antecedent treatment by other remedies. It is a common practice, for example, to exhibit the acetate of lead, or some other pure astringent, for a moderate haemoptysis. 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 the astringent not only inflicts that evil, but is also apt to increase the pulmonary affec- tion by its 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 ofthe 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 desire a better proof of the import- ance of rendering 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). 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 arrest 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 ofthe hemorrhage may be equally the result of either meth- od of treatment (§ 150, 151, 732 b, 733 e, 862-864). 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, See, 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 (§ Q0> 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 574 INSTITUTES OF 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 here 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 dozert-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 outpouring 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 effusions, 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, 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. The 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, f. 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 effusion on account of its connection with a serious lesion of organization. These, therefore, are cases THERAPEUTICS.--ASTRINGENTS. 575 which Sometimes prove suddenly fatal by the quantity of blood ef- fused, or by its choking up the air-cells. 890, g. Oases of the foregoing nature (§ 890,/) 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 ofthe 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 ofthe 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. As in the foregoing case of haemoptysis, therefore, we should have recourse to direct 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 tho best (Paine's Materia Medica, p. 37). 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. S90, 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, 670-671, 733/). 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 a neutral salt within the alimenta- ry canal. Saline cathartics are, therefore, also improper, and, more- over, scarcely extend their salutary permanent effects beyond tho in- testinal canal. 890, k. But, even in the simple forms of diarrhoea, there is variety as to the exact nature ofthe morbid condition, which demands, in dif- ferent cases, a choice of astringent remedies (§ 150, 672-674, 733 f, 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 OF MEDICINE. cases, the acetate of lead may be best adapted ; and to others the pure astringents, such as kino, catechu, geranium, Sec, 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). 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 irritability 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- rhcea, go to confirm the same philosophy (§ 150, 151). This sub- stance has 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, n. And then as to leucorrhcea. 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 strengthen (§ 409 i, 410, 569). But, if we look at the inflammatory nature of this affec- 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 leucorrhcea, another luminous guide will be obtained to a right apprehension 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, o. 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 the nature of astringents, and their modes of operating; and thus be guided to the only intelligible purposes for 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 impressions. 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). 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 ofthe best remedies, exter- nally applied, for inflammation ofthe skin, ofthe eyes, &c. Sulphate of zinc, also, for conjunotivitis, 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 wouid be greatly aggravated by the sulphate of zinc* 578 INSTITUTES OP MEDICINE. but, in another case apparently alike, the sulphate of zinc will answer a better purpose. The nitrate of silver, however, or blisters, or leech- es, may answer well for all the modifications. But here 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) % 890, p. It is important, therefore, to consider, 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 greatest determination to the na- ture of the impressions that may be produced (§ 188^- d, 889 k, 892). This variety, therefore, adapts these agents very variously to differ- ent forms of disease. When, therefore, a pure astringent is only re- quired, such 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 may be regarded as a counterpart of the antiphlo- gistics. From 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. [ndeed, 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. No remedial agents, however, have been more extensively employed, and therefore none which have been so extensively injurious (§ 569, e). This misapplication ofthe 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 bb, 863 d, 892 b, 904 d). 890J, 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. By now resfardinsr 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. 8904. 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 operation of tonics in its proper aspect. 8901, d. Thus : on referring 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 ofthe stomach, and their transmission by the nervous power 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 dem- onstrations take their rank among the violent phenomena of disease. Now, here is the whole principle which is relative to the action of 580 INSTITUTES OF MEDICINE. tonics. 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 at once relieved by nourishment or by wine. The influences 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 eases the voluntary muscles are suddenly or grad- ually invigorated by sympathetic influences 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 offered by tonics falls within the philosophy of vitalism (-§ 500, 516 d, no. 6). 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 purpose 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 spates of indigestion as the tonics, and bring about the same results (§ 904, d). Or, take a moral cause for an exactly simi- lar parallel, which maybe 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 c, 227', 512, 514 h). 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). 890£, 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 forms 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 ofthe 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 we 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 ofthe 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 ae useful if it can be prevented from stimulating injuriously. This object may be often attained by uniting a mild saline cathartic, or, perhaps, a little tartarized antimony with the tonic remedy. This practice, in respect to antimony, is often highly useful in the treat- ment of intermittent fever, where the tonic virtueof 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 a salutary demonstra- tion. 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 b). 890\,f. 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, S63 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 great 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). 890i, 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 can they be alone 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 diffusible stimu- lants ; observing, in this respect, the same distinction that subsists be- tween animal and vegetable food (§ 441 c, 89"0* d). When, also. 532 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 chronic diseases when tonics or stimulants prove morbific (§ 137, d). The foregoing peculiarity of tonics fits them admirably to certain chronic 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. Or, more strictly speaking, the morbid conditions are brought more speedily by the stimulant into a close relation with the virtues of the tonic (§ 137 d, 889 Jc, I). Again, however, some of the tonics possess, also, the virtues of transient 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£, h. 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 are 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 toqics 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 bb). Nevertheless, the same principle of diversity applies to the several members of the classes of tonics and stimulants; but it reaches them in a very inferior degree (§ 52, 650). Since, therefore, there are no 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 closely resemble each other (§ 863, d). THERAPEUTICS.--NARCOTICS. 583 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 subordinate 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 nervous centres, and are, therefore, also denominated cerebro-spinants. In my Arrangement of the Materia 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-paralyzants, senso-paralyzants, and cerebro-spino-de- prcssants. These distinctions are more or less observed by others. Some of the narcotics, however, possess also the virtues 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. 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 it is obviously relative to different virtues in each individual sub- stance, whatever may be their resemblance. 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 (§ 188, &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 remedium principale. 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 584 INSTITUTES OF MEDICINE. 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, Sec, 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 medicine we possess, we may safely consider the narcotics, skillfully, judiciously, and watchfully adminis- tered, the most important."—Sigmond's Lectures in London Lancet, 1836-7, 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 bb, 857). 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 ofthe 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 cf 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 ordinary doses, of so injuriously modifying the action ofthe glandular organs, that the secretions ofthe 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 influences thus reflected upon all diseased parts, and upon the whole organism (§ 862, 863). Should there be simultaneously set up in the skin a perspirable ac- tion, it is not of a salubrious nature; and here, again, we see demon- THERAPEUTICS.--NARCOTICS. 585 Btrated 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 still inflicts its morbific effects upon the glandular organs and nervous system; being scarcely modified for the J*etter through its union with ipecacuanha, even in its greater determination of diaphoresis. 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^ h, 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 five drops ofthe tincture of opi- um administered by the 6tomach will afford more relief to one man than fifty drops will to another, or how the five 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 in the constitution of the two individu- als,—just as common sense does when an oyster is nutritious to most people, but poisonous to a few (§ 191, 447, 585, 904 b). 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 humoralism, 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, Sec). 891,/. 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 sympathy. 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, or 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 hyoscyamus, or coniuni, or lactucarium, or lupulin, or churrus, &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 of narcotics upon that principle of indirect effect. 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 pernicious 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 ofthe 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 ofthe 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 preliminary 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. 587 891, i. The next great use of narcotics, in an absolute remedial Bense, relates to their power of diminishing the irritability of disease; whether local or general (§ 188, &c). Irritability is augmented in inflammations, and it may be important to allay it by narcotics ; not only to enable Nature 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 are 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, k). 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, Sec). 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- gravate. In these cases, a moderate dose of opium may relieve the spasm, and result in free dejections. Hence opium, with some, has been actually supposed to be invested with the power of cathartics. 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. It should never be overlooked, that the most that is accomplished, in such cases, by opium, or other narcotics, is that of diminishing irritability; while the other means produce great remedial effects. At other times, morbid irritability may be general; but this is com- monly attended by restlessness, and watchfulness. We then employ narcotics with the double intention. S91, k. Next in order comes pain, depending on exalted or morbid 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 ofthe 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 increase and otherwise 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 great 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 atcute 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 generally for the suffer- ing attendant on the chronic maladies of most parts that have not strong sympathetic relations to important organs (§ 725, 859 b). 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 moral emotion, not the pain, which produces the phenomenon (§ 167/, note). Indeed, the true philosophy of life conducts us to the above conclusion, since the property upon which pain depends is-not an element in the organ- ic functions (§ 194, &c). In the foregoing manner, or through the medium of the various 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. The power of endurance, and, therefore, the degrees of injury which THERAPEUTICS.--NARCOTICS. 589 pain may inflict, depend greatly upon temperament, and the general condition ofthe constitution as arising from disease, habits, culture of mind, Sec, and these contingencies affect, also, the susceptibility ofthe vital states. Much, too, will depend upon the kind of pain; and the kind, also, has its important influence in directing the treatment. 891, n. 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, 89l£ 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 more 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 ofthe 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 differ- ent manner from narcotics. There are, also, other agents not ofthe class of narcotics, which are remarkable for their control over the pain of particular modifications of inflammation, such as colchicum, guaiacum, Sec 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 ofthe 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, ^?. There is one agent not yet mentioned, which is often veiy 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. 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 tlie mind arrest 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, the clanking of ma- chinery, the rocking of the cradle, &c. (§ 137 e, 150, 151, 227). 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 intervening 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. 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 corre- spondence between the general results and the amount of impression upon the stomach for an interpretation of the philosophy. 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 " Spasm may arise from excessive irritability, as from teeth- ing, wounds, worms, Sfc, in which case a narcotic would prove beneficial" (§ 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 may be properly employed. But, to my mind, all the con- ditions which are 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 concurring 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. 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, S91 n, 859 b, 863 d). S9l£, 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. 891J, 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.j, 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 affections, 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 ofthe brain with an overloaded stomach ; when a mild emetic is the sure antispasmodic. In other cases the sympathetic disturb- ance ofthe brain depends upon profound disease ofthe 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 ofthe 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). 891!,/ Congestive asthma, the usual form of the disease, has had its full share ofthe 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 ofthe lungs, consequent on disease of the abdominal viscera, involves many important organs, and 592 INSTITUTES OF MEDICINE. calls imperatively for bloodletting, and cathartics (§ 150, 786, &c, 847 g, 848, 859 b, 863 d, 870 aa). 89li_, g. Any empyrical practice is admissible in hydrophobia ; but the most empyrical of all have been the efforts to cure the disease by antispasmodics. 891!, ^- ^e may now call up our recollection ofthe various prop erties appertaining to the narcotics, as set forth in former sections, and we shall readily see that they must be commonly injurious in most of the diseases which give rise to spasms. 891!, *• 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 known 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 ofthe present inquiry (§ 891L, a). 8911, ^- 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 irrkation ofthe nervous centres may be either direct, as in severe forms of epilepsy (§ 891!,e), or indirect, as in the more compound and ordinary process of remote sympathy (§ 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 is to say, the nervous power is reflected through motor nerves, or motor fibres of compound nerves, upon the affected muscles, and thus are they thrown into spasmodic action (§ 230, 233, 500). 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 mild impressions only 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 mus- THERAPEUTICS.--CINCHONA. 593 cles in which it had developed the spasmodic action. In one case, therefore, it acts as a stimulant, in the other as a sedative. Nothing in mathematics can be more absolute (§ 150, 227-232, 233£, 481-491, 493, 494). The same results attain, also, when the narcotics operate in simply removing spasm. But these are agents which embrace oth- er virtues that are very apt to prove morbific (§ 891, d), anil 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 ofthe 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 6-232, 233^); or, on the other hand, the morbid change may be of such a nature as to break up the special condition ofthe nervous power which gives rise to the spasm, and thus put an end to that part ofthe malady, although there ensue a very aggravated state of disease (§ 890, 900, 901, &c). Thus we sec 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. We are, therefore, presented in the examples before us, as a general ground for the interpretation of morbific and remedial agents, the union of the physiological, morbific, and remedial processes. 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. Tuto, 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 ofthe tree appeared in the Memoirs ofthe French Acad- emy, along with the story about the lions. Condamine says that the Countess of Cinchona, wife of the Viceroy of Peru, carried 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 ofthe Corregidor of Loxa. She then transferred its patron- age to the Jesuits; when the bark dropped the name of the " Count- Pp 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- oacum. 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 east 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, artd 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, 350s). 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 warranted 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 ofthe 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 Dark by its partial failure in a case where it was important for the physician to have obtained more 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 opponents. 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- scribed 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 was reprinted in the languages of different European countries ; and, for awhile, the whole profession appeared to acqui- esce in the justice ofthe 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 ofthe remedy gradually established. But, this is only a passage in the early history ofthe 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 which 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 dispositioi 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 for 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 principale, in the treatment of inflammations and fevers, he was also employed in combating the opposition to the bark, which had become very general in England. He triumphantly set forth the advantages ofthe 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, eradicated exten- sively by the all-potent drug. S92, 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. T 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 indica- ted, that there may not be others that are more or less appropriate, but which are not included in the group before us (§ 137 d, 150). Cathartics, even, are liable to this qualification ; since, without pre- vious bloodletting, they will often aggravate disease. But, after ap- plying the former remedy, the cathartic may cease to be necessary. The loss of blood has accomplished all that was contemplated from the internal agent; but bloodletting cannot be arranged among the cathartics. So, again, in certain conditions of amenorrhcea, it may be obvious that guaiacum will establish menstruation after the loss of blood from the arm, or after a purgative, but would be injurious without. Either of the last remedies, however, may supersede the necessity for the first, or reputedly specific. And so of its special relation to gout, &c. It is the same as more extensively considered under the group of astringents ; and the same remarks are precisely applicable to the group of remedies now before us, of which cinchona and arsenic are the principal. I have thus shown the general bearing of special groups, that it may be seen tl ut there is nothing remarkably peculiar in the princi- ple which governs the applicability of specific remedies, as they are called, to intermittent diseases; unless it be, that, in these cases, the virtues of the remedies have a remarkable bearing upon the remote causes of intermittents. Nevertheless, it is here, as in all other cases where agents of special remedial virtues are employed, others of a more general nature are often indispensable to give effect to the spe- cial ones, and very often, very generally, I may say, to render them operative, or to prevent their detrimental effects. 892, b. But, as no intelligible use can be made of remedial agents without a knowledge of their mode of operating, and as we are sup- posed to be profoundly in the dark in relation to the therapeutical ef- fects of cinchona, I shall first have a'few remarks upon this important subject (§ 890!, a)- Our admitted ignorance ofthe rationale, as of all other remedies, aside from the chemical doctrines, is thus expressed by Pereira in his Materia Medica. Thus : " I have hitherto referred to those indications only which have an ob- vious relation to the known physiological effects of cinchona. But, the diseases, in which this remedy manifests the greatest therapeutic power, are those which assume an intermittent or periodical type. Now, in such, the meihodus medendi is quite inexplicable" (§ 904, c). Such, again, is the abandonment of physiological laws and princi- ples the moment we pass from the simple processes to others in which those processes undergo changes that are brought about by precisely the same causes (§ 493, 514! °, 530). But, cui bono % Where is the practical use of physiology, if we thus abandon Nature, and repose quietly in a state of ignorance as to their relations to disease and the manner of cure (§ 639, a) 1 I shall, therefore,.I say, bring up this subject, of which we are so confessedly ignorant, again and again, in the hope that, by thus presenting it in its proper connections with physiological and practical matters, we may gradually come to recog- nize its importance to the healing art. THERAPEUTICS.--CINCHONA. 597 I shall reserve, however, the critical analysis of the modus ope- randi of cinchona and arsenic for the general summary which is yet before us; and therefore will now refer the reader to a subsequent Kcction (§ 904, d) for that part of my inquiry which would otherwise be presented in this place. We discern, at once, from what is there said, especially in connection with all the other analogous facts, how strangely astray from Nature is every physical and chemical doctrine which now encumber the philosophy of medicine. 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 bring the philosophy with no little aid to our experience in the treatment not only of inter- mittents, but of all other diseases. 892, c. The considerations to which I have now referred, along with what is known of the peculiarities that appertain to the virtues of every remedy, and how those virtues 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, S48, 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, S92| 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! &)• 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, to remittent fever, or, at most, not till the febrile action has been mod- ified by direct antiphlogistic means (§ 150, 847 g, 848, 857, 859 b 870 aa). 598 INSTITUTES OF MEDICINE. Nor may we begin, precipitately, the treatment of intermittents 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 (§ 689 I, 890 d, 891 k, I). There maybe 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 ofthe 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, whether 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. 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 (§ 150, 569 e, 576 e, 847 g, 848, 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 ofthe 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 ofthe 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 grain 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 paroxysms may continue to recur an uncertain 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 the THERAPEUTICS --CINCHONA. 599 negative 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, 961-96 1, 967). Now, experience shows exactly what theory, suggested by the true operation of remedies, rendered more 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 die 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, S48, 857, 859 b, 870 aa, 878). 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 who discern in the philosophy of disease any other elements than de- bility and something in the blood to be expelled or neutralized (§ 569, 960). 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 while 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. Some 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 g, 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 fever, 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. The objectional food either stimulates injuriously if it be of an animal nature, or, if vegetable, it irritates the stomach mechanically; while- the erect posture, if long continued at least, proves in other 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 mucous 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, Ul h, 447!/ 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. 892, e. In the quotidian form, I commonly exhibit one grain, in so- lution, of the sulphate of quinia every two or three hours during the THERAPEUTICS.—CINCHONA. 601 intermission. In many ofthe cases the patient does not suffer anoth- er paroxysm after the preliminary treatment, and beginning the use of quinia; but, in a majority of instances, he has another paroxysm, but of great comparative mildness. This, however, is almost invariably the last ofthe 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 I 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,/ 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 now 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 half a grain of quinine at a dose; and, in remittents, ofthe 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. With the same counteracting in- fluence tonics may be sometimes brought usefully to the aid of Na- ture ; 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 some parts ofthe Uni ted States, ten grains ofthe sulphate of quinia at a dose is common and 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 dated, we should also hear of them much more unfavorable reports 602 INSTITUTES OF MEDICINE. 892, i. The celebrated French writer, and adn rable 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 subjected 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 ofthe 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 ofthe 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 dose 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 proportion 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 ofthe compound. But, in a great proportion of the barks in common use, there is not the quantity of one grain ofthe 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 great 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. 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, 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 effects 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 THERAPEUTICS.--CINCHONA. 603 . jnfidence of the public being thus more or less impaired in the whole profession, tlerc will not, of course, be wanting those who, as in Tis- Bot'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). S!):2, k. 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 are gravely told that, "AH the organs 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 ascertained 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 of 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 early 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 the 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, and 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 arc again reviving doctrines which time and experience 604 INSTITUTES OF MEDICINE. have already demonstrated to be erroneous. The disregard of physi- ology and pathology has been one of the great fallacies of the age in which 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. London, 1837. 892, kk. In what has now been said of the employment of cinchona with a special reference to chronic enlargements of the spleen (§ 892, k), 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 ofthe 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 internaluse 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 progress of the disease from its incipient to its aggravated form (§ 150, 548 a, 551 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 ofthe gas- tric region, nausea, griping, and purging. " 2. Excitement of the vascular system, manifested by increased fullness of pulse and augmented respiration. Furred tongue, and other symptoms of a febrile state, are observed. " 3. Disorder of the cerebro-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 variety 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 from five, 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 which I have spoken, pass unheeded, or are imputed to other causes. 892, m. Let us, then, look well to the preparatory treatment. Let us scrutinize the varied and exact pathology of the individual cases of intermittent fever; and clear up, at least, any local congestions THERAPEUTIC3.--CINCHONA. 605 that are so apt to stand in the way ofthe tonic febrifuge. But, let us not neglect the important consideration that these local states are 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, make their special demonstrations. 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, perhaps, 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 errors 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 moderate dose of qui- nine will often tell uc 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 hand, 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 very small and cautious doses ofthe 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 occurred 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 ofthe remote causes of intermittents (§ 150, 151, 813 a, 816). S92, p. Besides tho affections 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 OF 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" ofthe venerated father of medicine. The treatment of the foregoing cases is very embarrassing, unless we are prepared by a knowledge of their peculiar pathological char- 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 improved. If the affection was decidedly inflammatory, as in the case of the eye, he abstracted blood. Then he goes on to remark that, " There 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 I 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.; though it is proba- bly inferior to the cinchonas, especially their alkaloids. 892, q. 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, Sec. This form ofthe con- tinued fever is the typhus, and belongs to climates where the inter- mitting diseases are scarcely known to occur. In these cases, the THERAPEUTICS.--ARSENIC. 607 bark appears to act both as a tonic and febrifuge. But, it is only suited 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 sect ions, 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 coexisting virtues, while the limited advantages of one or its more frequent pernicious effects tell us, forcibly, to beware ofthe whole group of tonics. ARSENIOUS ACID. 8921, a. Arsenious acid, in the treatment 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 ofthe 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. But, 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. S921, b. 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 bend 608 INSTITUTES OF MEDICINE. our attention 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. 892i, c. Fowler's Report upon the effects of arsenic appeared in 1786, and subsequent experience has amply established its febrifuge virtue. It appears, indeed, not only to have succeeded 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 failure 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 early administration of bark. But this tonic febrifuge was administered without the requisite advantages of a preliminary treatment, and the 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 bb, 857, 863 d, 870 aa). However, therefore, the bark may have been thus baffled in its ef- fects as a febrifuge, and inflicted the evils of a tonic, it was no fault of the remedy, but ofthe 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. 6U9 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 ofthe 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- Bon. 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." 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, nexf, as to what conditions of inter- mittent fever arsenic is applicable in preference to cinchona. We 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 Bihgle 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, beyond a certain Qa 610 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 bark. 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 tho neglected cases, disease can, at .most, have been aggravated only by errors on the part of the patient, while art, with its powerful morbific agents, 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 (§ 8924_ 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 become the seat of enlargements and indu- rations, that iodine may be 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 very 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 ex- ists in that subdued form which inflicts no exciting sympathies upon the organs of circulation. Otherwise, that intensity should be first moderated by leeching, blistering, low diet, &c. AVith this qualifica- tion, and in the absence of fever, iodine has contributed not a little toward the exclusion of arsenic from the treatment of agues. THERAPEUTICS.--ARSENIC. 611 In some of the conditions of which I have just spoken, arsenic is 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{,/ 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. 892|-, 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 special 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 sinMe 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 ao-ent 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 pathological conditions and thus 612 INSTITUTES OF MEDICINE. to acquire a more distinct apprehension of the properties 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, cancer, noli-me-tangere, chronic rheu- matism, diseases of the bones, syphilis, elephantiasis, &c. In some of these conditions, especially in cancer, it is applied externally as well as internally. Iodine has been also advantageously associated with arsenic in the treatment of some of these affections. Of the foregoing diseases, those of the skin, lepra especially, are the cases in which arsenic is most efficient, and but for the discovery of iodine, would give to arsenic an invaluable rank as an alterative agent for many of these chronic conditions. IODINE. 892!, a. Considering the extensive and powerful nature of the al- terative effects 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 bb, 870 aa, 892|- b). Wnen 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 ofthe 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 propensities; 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 extremely 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 its alleged effects upon the healthy system. A remedy, therefore, so exempt from all untoward effects upon the healthy body, and, withal, as inoffensive in the hands of the toler- ably skilful, yet capable of a vast range of the most important reme- THERAPEUTICS.--IODINE. 613 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 effects of iodine upon the body in a state of health, in its ordinary doses, for the purpose of contrasting them with some ofthe remarkable therapeutical influences of which iodine is capable, and to show how the vital states are chan- ged in 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 striking at other alarming maladies, yet manifest no sensible effects upon the healthy organism (§ 137 d, 150, 870 aa). S921, 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 its own special virtues 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. I say, the common form of bronchocele; for there are some condi- tions ofthe 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, and where iodine has disappointed expectation, and has suffered the blame of another's fault. Among these intractable con- ditions are formations in the gland of other 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 ofthe general circulation, or functional derangement of the chylopoetic vis- cera. These, indeed, arc important objects of attention, whatever be the nature of the disease for which iodine may be prescribed. The 614 INSTITUTES OF MEDICINE. external use of iodine, in the treatment of goitre, is not 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 contiguous sympathy alone (§ 497). 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 memoirs 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 scrofula, 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 narrative is always due to the early founders of a remedy which has already bestowed incalculable bless- ings upon man; not short even of 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 countless numbers who have been already rescued from the grave by iodine alone, and when we attempt to think ofthe 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, ofthe Ma- teria Medica,—ay, the remedium principale 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] 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 energetic, 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 ofthe 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. I his, 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 from 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 tho 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 tho primary stages of phthisis pulmonalis, a tonic and stimulant treat- ment has been erected upon the new doctrine (§ 4, 5\. 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 5 while it will rarely fail to aggravate the disease if employed be ore 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 lr- ri tible stutc. • 8921 f Thirdly The power of iodine, and of its combinations, reaches vet 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 removed 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 (§ 733/ 738, 740 a, b); while, also, its san- ative effect must extend to the absorbent system of the part increas- ing its energy, and thus reducing the volume of the organ and restor- ing' it to its natural state. Mercury, it is true, will accomplish this m some instances, but is comparatively inoperative, and they are beyond the reach of quinine. . . . , ,. Comincr to those chronic 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 intrauctable1f^.efj 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 aa ague cakes. They have often yielded to its influence in this and in other countries ; and sometimes, indeed, where the splenic induration has been independent of fever, and where quinia is powerless (§ 662 a 813 b, 814, 816 b, 892 kk). 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 ofthe 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 form 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, too, it is mainly useful in the indurated enlargements ofthe 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 scirrous 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 helps 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 alterative influ- ence ofthe remedy of which cupping is incapable. '1HERAPEUTICS.--IODINE. 617 892!, g. Iodine has been employed internally and externally, with various degrees of advantage, in chronic affections ofthe skin, such as lepra, icthiosis, psoriasis, &c, and it has been applied in the same way 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. 892!, h. 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 rare 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 was probably 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 attend the 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 leucorrhcea, 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!, k. 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 peculiar 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). 892i, I. Iodine has been successfully employed as an emmenagogue by most ofthe physicians who have illustrated its uses. My own 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- 618 INSTITUTES OF MEDICINE. utary if not contra-indicated by irritable states of the stomach 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 moreor 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 I, 905). 892!, m. 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. 892i, 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 effected 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. 8924, 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 mellitus ; 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. 8921, P' 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. 892!, q. The ioduretted bath has been overrated, but, perhaps, is unwisely falling into disuse. 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.--IODINE. 619 892!, 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 eases, wc 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 fticus 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 ofthe calcined preparations, we may depend upon results, if 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, irri- 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 lettuce, &c. This interposition of narcotics, however, to 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, he 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 first 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 ofthe rem- edy upon the intestinal canal. 892!, I' 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 ofthe removal of disease from the abdominal viscera, by which the remote affections had been maintained (§ S03, 804, 905). 892.}, u- xn a general 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 ofthe morbid states to which it is 620 INSTITUTES OF 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, 556 c, 872 a). In such conditions, indeed, abstemiousness, in respect to food, is in itself directly curative (§ 150, 856, 863, 1007 b-d, 1008). But, there are some conditions to which iodine is peculiarly suited particularly bronchocele, when the general health is often sound, and when the ordinary diet may be pursued (§ 143 c, 150, 151, 892! 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- That iodine should sometimes fail of removing, or even of mitigating the diseases to which it is most appropriate, is certainly to be expected. This want of uniformity may be affirmed not only of all known remedies, but of such as are unknown. It results necessa- rily even from the different natural modifications of the vital states of different individuals. The principle is shown under various aspects in former sections (§ 585). But, it may be safely said, that the reme- dial power of iodine in numerous forms of disease that had baffled the most enlightened efforts, is fully established. ERGOT. 892f, 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 ofthe rye. 892|, 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, is 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 which this agent should be administered, but which have been most strangely violated by others. Til IMtAPEUTICS.--ERGOT. 621 The brief statement, which has now grown into volumes, of the wonderful properties of ergot, and ofthe 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 gigantic 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 ineffi- 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 parturiens, 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 fcetus. Previous to its exhibition, it is of the utmost consequence to ascertain the presentation, and wheth- er anv preternatural obstruction prevent the delivery; as the violent unci 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- ing. 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 sjmrious 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 your giving this any publicity you may think proper."—John Stearns, in Neto 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 ofthe 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 will be conceded, I cannot 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 demies, which the superstitious had charged upon rye, of which ergot was supposed to be the insidious cause (§ 892f, I). A more feeble 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. Comm., 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. Harvey lost all his practice because of the envy which was excited by his discovery of the circulation of the blood; and nothing but demonstration 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." And who among philosophers does not know that at this mo- ment a part of their corps are disputing with the amiable and unre- sisting Draper his great discoveries relative to the light of the sun .(§ 188!, d) 1 It was not so in the early,ages of our art; and had Harvey, or Jen- ner, or Stearns, have lived at that remote period, temples would have overspread the land for the perpetuation of their names, and as 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. Tn 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 TH ER APEUTICS.--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 injuiy." 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 five or six cases in which delirium or stupor are said to have resulted from doses of half a drachm to two drachms were 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 uterine 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, indeed, nothing known possessing 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 are every where involved in the principles now, again, under investigation (§ 137 d, 143 c, 150, 151, 650, 831, 836, 854 bb, 857, S59 b, 892 c, S92i b, &ec). S92£, 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 a). Experiments have been accordingly made upon animals to ascertain whether abortion Would be thus brought about; but Villeneuve, Warner, Chatard, 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 progress; 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. Its 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 necessary that the process of labor should have actually commenced. But, while we admit that it some- times fails, we have abundant evidence to prove that it frequently succeeds." Other able observers testify to this fact; Muller, 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 b). 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 knowledge 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 purpose, is the important fact, that, although now, as in former times, THERAPEUTICS.--ERGOT. 625 there can be no doubt that 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. 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 ofthe 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- \, 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). 8921,'/. The rapid and energetic action ofthe 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 ofthe circumstances which justify the use of ergot, it is evident that the discoverer considered a full dilatation ofthe os uteri of indispensable importance to any thing like a safe result. 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 practice; especially as it regards the fcetus ! 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 children, 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 oigot may be administered when the mouth ofthe 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 er^ot 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?-, a. " Previous to the exhibition of ergot," says the discoverer, "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 B R 626 INSTITUTES OF MEDICINE. appears to be conceded that ergot may be employed when the 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 appliod without the forceps. These instruments are always difficult but in the hand of experience, and are otherwise more or less liable to ob- jection. 892|, 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 be 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, however, the tampon is probably preferable, since it is always sure, and it is not certain that abortion will happen. 892|, k. 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 ofthe 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 the child is born, 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|, I. Again, ergot has answered a useful purpose in cases of puerperal convulsions, by effecting a speedy delivery. 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. Its virtues appear to be limited to the vital constitution of the uterus. 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 need 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 ourselves 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 of 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 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|, m. 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, however, 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 irritability undergoes changes very rapidly after the expulsion ofthe fcetus, and that, in the same ratio, the virtues of ergot lose their special relation to the organ (§ 150, 151). 892r, 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 orcran 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 ofthe mucous tissue of that organ (§ 150, 151). 892|, o. Our parturient agent has shown itself capable of arresting uterine hemorrhao-e in the unimpregnated state, and that it is a use- ful agent in menorrhagia. 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 INSTITUTES OF MEDICINE. ofthe phenomena of uterine contraction, while, moreover, the uterus is already in its contracted state. Its effect, in these cases, is like that of common salt, or of ipecacuanha, in restraining haemoptysis. That is to say, of the individual substances, each one exerts some chano-e 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 menorrhagia. It should be added, however, that the anti-hemorrhagic effect of ergot, except as it respects the uterus, has been overrated, 892|, p. There have been some speculations afloat, that a poison- ous influence is exerted by ergot upon the child, in utero. But, there can be no doubt that two errors are involved in this hypothesis. First, an. assumption that ergot is intrinsically poisonous, and in its thera- peutical doses; secondly, that an influence of the ergot is propagated from the parent to the child. EMMENAGOGUES. S92|, q. In the foregoing sections I have been so near upon em- menagogues, and as the right treatment of amenorrhcea 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 treated by some agent bearing the name of an em- menagogue. 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 amenorrhcea. 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 als© 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, amenorrhcea is consequent on chronic maladies of the chylopoietic viscera, and here it is that they are often administered with reference to the remote consequence; THERAPEUTICS.--EMMENAGOGUES. 629 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 ofthe humoral pathology, and is one ofthe every-day practical illustrations ofthe amount of its philosophy. But, menstruation has a totally different final cause than humoral- ism imagines (§ 428-432). The evils which may arise from the fail- ure of the evacuation depend but little upon this circumstance. They are due, on the contrary, to the morbid state of the organ through 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 dis- turbance it may inflict on other parts. 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 now under considera- tion. The state of the uterus, it is true, reacts upon the primary 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 multifarious aspects of amenorrhcea, 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 amenorrhcea 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, Sec, are the means when it is dependent on indigestion. 892=, t. Having accomplished the leading intentions in the chronic forms of amenorrhcea, if the uterus still fail of excreting the menses, 'hose agents which are known as emmenagogues may now 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 establish 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. But here, as in the more difficult cases, it is obvious that we should bring up the auxiliaries ; as diet, exercise, &c. (§ 892!, 0' 630 INSTITUTES OF MEDICINE. DIURETICS. 892^, a. Diuretics are agents which increase the urinary discharge, and are employed either for that purpose, or 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. 892f, b. 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- bid sympathetic influences which those or other diseases reflect upon the kidneys, and, thirdly, by exciting the kidneys to a freer production of urine. These remarks relative to cathartics lead me to advert to their con- trol over dropsical affections as one ofthe demonstrations that dropsy depends upon inflammatory conditions. That pathological cause be- ing removed by the antiphlogistic virtues of cathartics, the redundant effusions cease. Bloodletting, which is not among diuretic remedies, has often as great 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!, A-)- 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 (went 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 humoralism, and " dynamic" and " quantitive" chemistry, are upon the wrong track, and that the name of diuretics has been one ofthe causes of leading physicians to prescribe for a symptom, instead of seeking out and subduing disease by its appropriate remedies. 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 (§ 188!, d). Thus Sappho : " In 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, 2331, 234 e, 500 c,g, k, n, 512, 652 c, 827 c, 828 a, 841 a, 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, Sec). 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 the mood, Of what it likes or loathes." The last is analogous in its philosophy to what is said of light in section 511, 7. 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 o-irl." 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 anothci way, and to the easy comprehension of most people (§ 319, d, e), while the few take a more circuitous method (§ 222-233|, 500, 893- 905), although at no little peril (§ 5%, a). Again, cold, applied sud- denly to the surface of the body, is often a powerful diuretic (§ 422, 423). But, although neither this nor the preceding causes are ranked as diuretics, they are probably about as much entitled to this designa- tion as those agents to which it is specifically appropriated. 892f, 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 expose the fallacy ofthe humoral, chemi- cal, and mechanical interpretations. 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 organic properties of the kidneys, and mostly through the medium of the nervous power. 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). Nor is it at all surprising that the functions ofthe skin and kidneys should be so readily affected by the nervous influence, as developed by the foregoing causes, moral 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 ofthe organs (§ 423, 513, 902 f, g). 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, &c. 892f, d. The " diuretics proper" are the least useful of all the an- THERAPEUTICS.--EXPECTORANTS. 633 uphlogistics; 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 afid by ca- thartics. 892|, e. Some of the diuretics which possess compound virtues, such as squill, and Indian hemp (apocynum cannabinum), may 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 Bimple 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. 892|,/ Much has been said ofthe 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. 892f, £\ The greatest of all the errors in relation to dropsical affec- tions, is that which divides them into active and passive. This error 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. S92i, a. This group of agents have had too large a connection with disease to be neglected; or, at least, not to be held responsible for any mischief they may have done. Like many other denominations, the term is significant of their most visible effect, although, like many others, it is one ofthe 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 *>34 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|, b. In my Arrangement of the Materia Medica, 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 ofthe skin; while none but agents of considerable power will institute sympa- thetic actions in the lungs, or give rise to that expectoration which grows out of such actions. All the expectorants, therefore, of any im- portance are 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 their virtues. Again : sympathies, as.determined 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 tipon 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 the sympathetic effect 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 THERAPEUTICS.--EXPECTORANTS. 635 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 others, distributed them into five subdivisions. These I shall now state, along with the several agents embraced un- der each subdivision ; and, for the purpose of illustrating 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. Nod-stimulating.—1. Potassae antimonio-tartras. 2. Cephaelis 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. Stimulating and Narcotic.—5. Sanguinaria canadensis. Sedative and Narcotic.—11. Lobelia inflata. Stimulating and Antispasmodic.— 9. Ferula asafcetida. 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 only are wanted. Moreover, none of the expectorants are ever em- ployed 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 sequeke 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. 1 The answer is important, although the order of arrangement assumed that the reader was sufficiently conversant with the principles upon which it is founded. It assumed, in the first place,.that he was famil 636 .NSTITUTES OF MEDICINE. iar with the general structure of the lungs, that he had some ideas 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 ofthe inflammatory nature ofthe 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 increased by different expectorants, and according, also, as the premises might be, he fore- saw that this or that expectorant might develop tuberculous phthisis, or become the indirect cause of disease in other parts, &c. Proceeding, therefore, upon these hypotheses, 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, ofthe asclepias, are analogous to those of the great tenant 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 in its stead, and being of easy 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; but 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, however, 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, each, by their order, 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). 892f, 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 expectorants 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 group, should be avoided. Hut, 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, relieve 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 its indirect 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 even tend to lessen the quantity of mucus ; provided it facilitate its ejection and 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 ofthe 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 important 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. lating 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 universal influence may barely counteract the stimulant virtue, or it may be.useful. 8924,,/ 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 often 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 Compound 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 Goxe's Hive Syrup." Indeed, such is the translation of the original name. Thus: " Mel Scill^e 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. 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 b, 705, THERAPEUTICS.--EXPECTORANTS. 639 132 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 intentirm to which the expectorants are inadequate only from the force of disease, it will go with the many other analogous considera- tions which appear in this work toward clearing up the philosophy which relates to the operation of expectorants, whether in their cura- tive or morbific relations to disease. Or, again, if bloodletting fail of arresting 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 modified 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 ofthe disease. The expectoration, therefore, is a mere result, a mere symptom, of a certain change in the action ofthe 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. 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 stimulant 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. 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. 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 ofthe agents which are confined to this denomination of remedies. It is obvious, too, that 640 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 ofthe 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). 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 (v 137, c). 892|, h. The sympathies to which the lungs are liable from many diseases of other parts, especially of the digestive organs, and the more or less reciprocal effects of their own diseases, by which a vast complexity of sympathies may be set in operation, together with the situation ofthe 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 ofthe stethescope, the reign of mor- bid anatomy has surrounded it with many abuses; the vital signs are either neglected or held to be of very subordinate 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 sure to be found in some special region of the heart, or, others THERAPEUTICS.--EXPECTORANTS. 641 detect in the supposed organic lesions the cause of an intermittent or irregular pulse that depends on hepatic disorder (§ 390 b, 688 k, 806, 811). These mistakes are sometimes witnessed in this country as the consequences of Parisian and British pathology. 892|, i. The foregoing considerations appear to be indispensable to all who would enter understandingly upon the treatment of pulmonary affections, or to distinguish what is relative to the lungs 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 ofthe mucous tissue ofthe 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 affection 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 mrem- 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 strikingly 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. 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 Pulmonic Inflamma- 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 ofthe pleura, or, they may occur together, or in the form of pleuro-pneumonia. Very many turn directly 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 trial may awaken new views in pathology, and dis- sipate some ofthe 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 greater 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 b, 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 be 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 shalr"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 from 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, c,f,g, h, 1007 b, c, d, 1008). COUNTER-IRRITANTS. 893, a. I enter now upon the consideration of those remedial agents which estaolish 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 their origin in cerebro-spinal nerves along with the sensitive fibres of the sympathetic, and terminate in the mo- tor fibres of the ganglionic system. 893, b. In my Arrangement ofthe Materia Medica I have embraced counter-irritants, with numerous other agents, under the general de- nomination of Cutaneous and other Local Applications. This extensive group forms the eighth Order of the first Class, or Antiphlogistics. Very many of this order are purely local in their ac- tion, while others affect the constitution more or less at large. Such, therefore, as are relative to the skin I have subdivided in conformity with those local and general influences. These subdivisions are found- ed, like the other groups, upon certain special uses or effects, and give to this complex order all the analytical simplicity that can be wanted. The following are the various groups into which I have distributed the members of this general Order:—1. Vesicants. 2. Rubefacients. 3. Suppurants. 4. Escharotics. 5. Potential Cauterants. 6. Actual Cauterants. 7. Local Alteratives. 8. Local Sedatives. 9. Local As- tringents. 10. Simple Remedies. These are relative to the surface. Then follow Injections, which comprise Enemas, Uterine, Vaginal, and Urethral Injections. And then we have Gargles, and Injections for the Ear. Lastly, Collyria. Ofthe ten sub-groups which concern the skin, one is far more com- prehensive and complex than the rest; which, indeed, are sufficiently simple. That assemblage of greater variety and intricacy I have des- ignated as alterative; not because the agents of the other subdivis- ions do not operate more or less upon the same principles, but because these latter have prominent local effects upon which the several groups may be founded; while in respect to the Alteratives emphatically so called, their operation proceeds without any prominent local result. It appears, therefore, that the remedies under the present Order observe the same laws as those which are administered by the stom- ach, and are productive of analogous results. It is also remarkable, that, while all the agents of the several Orders, comprised under the various Classes, operate as alteratives, either locally or constitution- ally, the most comprehensive Orders, whether administered by the stomach, or applied to the surface, are, of necessity, designated as Al- teratives, on account of the general absence of any prominent effect upon which a more specific denomination might be founded. They embrace, also, all the most profoundly curative agents, the most vio- lent poisons in Nature; and yet do they generally bring about the restorative process without any other demonstration ; so only their employment be directed by sound therapeutical principles. And what a commentary this upon the doctrine of remedial action by ab- sorption, and upon those pursuits which would elicit therapeutical virtues from experiments upon animals or upon man in health, either with poisons or with agents which are inert in those relations ! Finally, I have carried out the same practical rule in the arrange- ment of the Cutaneous Alteratives, as I have employed in respect to such as operate through the intestinal mucous tissue; having subdi vided them into Constitutional Alteratives, or such as affect distant organs, or the constitution at large, sympathetically; and Local Alteratives, or those 644 INSTITUTES OF MEDICINE. whose action is either confined to the skin, or which operate upon parts beneath by contiguous sympathy. The Local Alteratives I have subdivided, again, into, 1. Such as are adapted to cutaneous diseases,' 2. Such as are adapted to scrofulous and other indolent tumors, chronic enlargements of the joints, &c. 3. Such as are adapted to rheumatic inflammation. 4. Such as are adapted to neuralgia and neuralgic rheumatism 5. Such as are adapted to certain conditions of erysipelas, and some other cutaneous inflammations of specific character. • 6. Such as are adapted to sprains, &c. 7, Such as are adapted to piles. 8. Such as are adapted to carcinomatous ulcers. 9. Such as are adapted to phagedenic and tuberculous ulcers, Sec. As in respect to all other general or partial groups, the several members of the eighth Order of Antiphlogistics are arranged in the order of their established therapeutical value, under the various de- nominations. 893, c. Vesicants are by far the most important in this Order of Antiphlogistics; though their importance scarcely extends beyond the genus cantharis. The next following five groups, however, namely, rubefacients, suppurants, escharotics, potential cauterants, and actual cauterants, operate more or less after the manner of the vesicants, both upon the skin and by sympathy. But, escharotics, potential and actu- al cauterants, are generally limited to simply local effects; and then their action is exerted directly upon the organic constitution of the part, and withe ut any reflections of the nervous power in the results which follow. When more extensive, the nervous power is called into operation, and the difference in results will depend much upon the manner in which the several applications are made. Whenever vesicants, or the other agents which are analogous to them, affect diseased parts which are more or less distant from the 6kin, their action upon such parts is mainly by contiguous sympathy (§ 497, 905). These agents, however, occasionally afford strong man- ifestations of a more extensive influence ; and this, especially, in irri- table habits, or where peculiar relations may exist toward the reme- dial virtues of any particular agent. It is in this way that cantharides will generally produce strangury in some constitutions, however re- motely from the urinary organs the application may be made. This, indeed, it will do as readily when applied to the extremities as over the region of the bladder; while, on the other hand, where that spe- cial susceptibility of the bladder does not exist, the vesicant maybe as safely applied in that quarter as in any other, even though the organ be the seat of inflammation (§137 d, 150, 233|, 585 b). Again, also, when irritations are established in the skin by vesicants, leading to irritative inflammation, which is often the case with children, and in the sanguine and nervous temperaments, or in others where gen- eral irritability is morbidly increased, the nervous power may be brought into general operation, and we may witness the full develop- ment of remote sympathies in one almost universal commotion of the body (§ 150, 151, 514 d). This may also follow too extensive an ap- plication of a blister, or of rubefacients, though no excessive irrita- tion be produced in the skin; just as a scald of limited extent maybe THERAPEUTICS.--COUNTER-IRRITANTS. 645 9alutary, 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 moral, 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. This is seen in the different results of the principal agent before us in its common opera- tion upon every individual, according as the vesicant may be duly prepared, or covered with dry cantharides, or wet with a saturated tincture of the same. In the long journey which I have thus far traveled, 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 ciatcs, 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, Sec, now and then become rem- edies for fever, and even for inflammation (§ 752, &c, 892 g,p). 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, 350!, 350f, 369 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 of 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, 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 effect, 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- 646 INSTITUTES OF MEDICINE. cipally, cantharides, issues, and setons. Their immediate action is strictly morbific; and they have no salutary effect upon existing in- flammations till they produce a corresponding disease, or, at least, that morbid irritation which forms the access of inflammation, in some part of the surface of the body. Then it is that this artificial inflam- 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 ofthe great principles of solidism and vitalism, and ofthe 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 ofthe 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, 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 directed upon remote parts, according to the na- ture of its exciting causes (§ 227, 228, 230, 233f, 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 going forward in the blad- THERAPEUTICS.--COUNTER-IRRITANTS. 64T rler, we shall see yet farther (something for the senses, something for "experimental philosophy") that the nervous power actually acquires 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 may not be assumed that the morbific action of cantharides upon the bladder is the result of absorption, since, if all its other remote in- fluences arc conducted through the nervous power, it would be a dis- creditable violation ofthe simplicity of causes, to assign such a medley for the same phenomenon. But, what settles conclusively the fallacy of the doctrine of absorption, is. the fact that the bladder is never irritated by cantharides, applied to the skin, until it establishes some manifest in- fluence upon this organ, however long it may remain upon the sur- face ; and, I may add, that, when the cutaneous irritation takes place, the cuticle remains equally as at first a medium of prevention, so far as this construction may obtain. It is the same as we have seen of tar- tarized antimony, in gradually-increased doses, when the manifesta- tions of its remote influences often keep pace with the amount of ef- fect exerted upon the stomach. But, though the cantharides supply an apt illustration ofthe whole philosophy of our subject, and, like the natural developments of in- flammation which follow each other as sympathetic consequences, de- note a modification ofthe nervous power in great conformity with the 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 of its own nature (§ 228, a). Finally, in respect to the modus operandi of cantharides, when con- sidered in its analogies to other vesicants, issues, &c, we have an in- teresting 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 remarkable manner in which the nervous power is directed with salutary or morbific effect through certain motor nerves by the peculiarities of each exciting alid modifying cause (§ 2332, 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). 893,/ From what has been now said, it is manifest that vesicants, 648 INSTITUTES OF MEDICINE. issues, setons, and other counter-irritants do not produce their favora- ble effects through the discharges^ which they give rise ; though this 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 times 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 where 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. 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. 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; but 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-IRRITANTS. 649 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 tfi£ obstinacy of morbid habit, and naturally suggest the long-continued and uninterrupted influence of issues, &c, experi- 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, Sec, 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 b, 889 m). The influence of habit of which I have now spoken, as it respects the artificial change induced in chronic 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 every 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). The same great principles are concerned 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, i. The principles to which I have just adverted (§ 893, h) lie at 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 disturb not only 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 ofthe 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 ofthe disease, &c. [f the usual agent, cantharides, be employed, and the surface irritated 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 sympa- thetic influence 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. But, there is a great difference 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 sympathetic influences, 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 is the consequence. In other words, the nervous power is developed in great intensity, with great suddenness, and prostrates, at once, the energies of organic life be- yond their recuperative nature (§ 150, 151, 228 b, 479, 509).- It is evident, 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 so 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, m). 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. Nevertheless, there are certain inflammations, especially of a neu- ralgic and rheumatic character, and not affecting important organs, in which a rapid and violent irritation 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. If the disease be of a different character from inflammation, as the suddenly painful affections ofthe stomach that are incident to indiges- THERAPEITICS.--COUNTER-IRRITANTS. 651 tion, 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. 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 dosperate practice of vesicating simultaneously the entire scalp and a large extent of surface upon the neck and shoulders. Where bloodletting has been thoroughly practiced, and inflammation remains obstinately seated in some great vital organ, a blister of twelve inches square will sometimes speedily extinguish the disease, when one of six inches would be insufficient. 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 shoulders. 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 652 INSTITUTES OF 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. Even erysipelas has been successfully treated in this manner; which 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 burn 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, 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 ofthe seat of disease. Their salutary effects, like their morbific, depend more upon this approximation than upon any special sympathetic relations between certain parts ofthe surface and the particular internal organs; since it is mostly by contiguous sympathy that these agents produce their curative effects (§ 497). It is also a remarkable fact, that it appears to be of no great moment in what particular tissue of compound 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 ofthe several parts (§ 150, 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 ofthe 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 parts 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 fected; and the disease is then said to have undergone a metastasis, or to have been virtually translated from one part to another. 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. Now, there is a prevailing error in the pathological construction of this extension and subsidence ofthe disease, which has led to a very com- mon error in practice. It is supposed that there is a translation ofthe disease from one part to another, an actual movement ofthe complaint —something, probably, after the manner of the gases, as represented in a former section (§ 350%, 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 stomach 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 ofthe 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 mamma?, 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 the ordinary operation of sympathy, 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, the sympathetic dis- ease propagates, after the manner of vesicants, curative impressions upon the primary seat of the disease. 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 foregoino- practice, as founded upon the doctrines of metastasis and revulsion, is contra-indicated not only by physiological laws, but 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- clusions 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, 51, 5%, 349 d, 350i-350f). T?ut, let us have an example in rela- tion to vesication or counter-irritation by cantharides, as propounded by the great head ofthe Necroscopic School. Thus : "Blisters," sayrs M, Louis, "ought to be 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 by 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 1" ! " In thoracic inflammations, their usefulness is neither strictly demonstrated (according to the numerical method), nor even probable." " One thing is most assuredly beyond 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 known 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| kk. Also, Med. 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. ftammation, &c, let them be directed to the organs which are the seats of disease, by applying them over, or in the vicinity of, their respective regions. As to the doctrines of metastasis and revulsion, which have had their origin in the phenomena of the laws of sympathy (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. 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. Nevertheless, such is the analogy between the sympathetic influ- ences 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. But 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-eminently distinguished by the violence of its purgative effect."—Pereira's Materia Medica. 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 656 INSTITUTES OF MEDICINE. when the juice is applied to 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 Medica,—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 counter-ir- ritation." That is the doctrine. A metastasis of the inflammation to the in- testinal canal; and such is the virtual effect. The reader will readily supply corresponding examples, and, as he meditates upon the philos- ophy and its bearings upon mankind, he may come to the conclusion, if not already in the way, that some practical advantages may yet accrue to the world from a knowledge of the modus operandi of reme- dial agents (§ 904 c, 960). Opposed to metastasis, revulsion, derivation, &c, is the doc- trine ofrepulsion. Thus, in respect to the utility of vesicating the joints in acute forms of rheumatism 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 ofthe tissues about the heart is a very 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 organs, disproves the assumption as to the tenden- cy of blisters to produce these results. But, I am not 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. 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 heart 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 ofthe remedy. If loss of 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- sponding effect upon the main source ofthe circulation. THERAPEUTICS.--COUNTER-IRRITANTS. 65*7 893, 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 owing 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 do not often seriously exasperate the disease. The urinary bladdei 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, o). 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 irritation of the skin, or from creating the irritation un- der unfavorable circumstances. 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 irri- tability, the diseased parts arc 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 circles of sympathy may be 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 its fearful ef- fects in the complicated malady which will be long celebrated in the annals of medicine, T T 658 INSTITUTES OF MEDICINE. The system, in the advanced stages of fever, is generally in an irri- 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 congestions 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, ofthe 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 completely 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. 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 chronic states of inflammation, whether of important or un- important parts, a frequent renewal of blisters may effectually sur- 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, denoted by tenderness over the region ofthe 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 the 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 sequelae of fevers is constantly' before us a variety of phases of indigestion in which vesi- THERAPEUTICS.--COUNTER-IRRITANTS. 659 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 ofthe skin by the leeches, being analogous to the irritative pro- cess which is set up by the true counter-irritants (§ 498). But there are great modifications, in these respects, between the lo- cal influences of leeching, and the effects ofthe 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 peculiar 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 ofthe 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 irritant, and affording relief to chronic inflammation of the joints more in virtue of this counter-irritation than of alterative properties peculiar to the agent. 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 ofthe 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. In connection with the foregoing subject, it may be useful to some who mav be baffled in their attempts upon indolent tumors of low in- flammatory growth, 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, Sec, 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 (§ 556, 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). 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 remaining 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) THERAPEUTICS.--REMEDIAL ACTION. 661 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."—LiNN-EUS. "Natura malum sentiens gestitat magnopere mederi."—Galen. "nattjra refugnante, nihil prof1c1t med1cina."—celsus. "Natura deficiente, quicquam obtinet medica ars, perit ^eger."—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 been also presented, incidentally, 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 nummary 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 ig a real substantive agent, of which the vital properties, irritability, mobility, Sec, are elements, superadded to organic beings after the cre- ation of their structure ; that the nervous power was superadded only 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, when the nervous power is not 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 1 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 moral, 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 property of animal life, 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. changes, &c, in those parts upon which its impressions are made; that the nervous power is susceptible of modifications by the causes which bring it into universal operation, whether physical or moral, and thus partakes, under the influence of its own nature, of the special virtues of each exciting cause, to which prjnciple is due its alterative effects according to the nature of the exciting causes; and, finally, that a common principle is at the foundation ofthe philosophy, wheth- er the manifestations of the nervous power be displayed in maintain- ing the concerted action of the healthy organism, or in deranging that action, or in restoring disordered movements, 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. 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 are 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 ofthe virtues of foreign agents which are capable of inducing modifications of the or- ganic states of every part, and according to the nature 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 the laws of sympathy, 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 distinct 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, 855, 895, 902 /). 896. The whole philosophy ofthe 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 moral 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 ofthe iris, the irritation of faeces or of urine which maintains a contraction ofthe 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 the 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 THERAPEUTICS.--REMEDIAL ACTION. 663 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, that 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 irritation, 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 hour'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 through one common law which is relative to the nervous power. 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 tc 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 moral causes ; but it is this very principle which enables them to receive salutary impressions from remedial agents (just as they do from morbific), 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 establish a peculiar morbid change in diseased conditions that shall favor the operation ofthe 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 another, 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 variety 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 morbid 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- 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. 901. Nevertheless, a distinction is very properly made into curative and 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; and 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 be°-Un; 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 (§ 893, c, d). 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 rightly apprehended by all. 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 pleuri- sy and 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, continuous, or contiguous sympathy; the agents exerting their direct impression upon the parts with which they are in contact. Re- mote, and probably, 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 primary connections may be wholly severed, and disease may be yet propagated continuously along the 666 INSTITUTES OF MEDICINE. part to which they appertained; as we observe, also, in plants. I appears, therefore, that in these examples, the morbid condition is extended, in a continuous manner, from the organic properties of one point to the next in apposition. 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 ofthe 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. 902, c. The type ofthe 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 ofthe finger in the fauces, and the mind may determine all the sensible results of an active emetic. There is the great principle. It is greatly the work ofthe 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 ofthe 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 every part but the intestinal mucous tissue, except as continuous sympathy may contribute a part of the influences which extend to the liver, Sec 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 ofthe 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 mucous 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, Sec).. 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 ofthe action of light Hpon the eyes (§514,7), the process is more complex, and shadows forth the far more intricate movements that are in progress,—the almost end- less circles of sympathy which are talcing place,—during the progress or decline of disease, or those which are set up by the operation of an emetic, a cathartic, &c. (§ 1040). 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 ofthe circles of sympa- thy 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 the latter cases, is transmit- . ted to the cerebro-spinal axis, 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. 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 stomaoh, 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 ofthe 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 ofthe nervous power is propaga- ted upon the muscular coat ofthe intestines (§ 233f). 902, f. 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 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 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, ofthe 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). 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. 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 sympathy of the same nature 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). 902, g. We thus see that when vomiting springs from the operation of tartarized ^ntimony, and often from ipecacuanha, it is only one ofthe 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 effect 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, call- ing up a magnificent play of sympathies for fke evacuation ofthe flu- ids, after the manner of an active purgative,—these very effusions, also, instituting other circles of sympathy, which join in the great THERAPEUTICS.--REMEDIAL 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 se- ries of sympathies,—may require less time than I have hastily em- 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 phenomena 1 902, h. 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 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 sights, 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 gradually induces salivation, 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 power is developed and modified at each suc- cessive dose, and the repetition of its influence upon the organic prop- erties of diseased parts remote from the stomach establishes progres- 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 ofthe 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 consideration; and therefore is it, that sal- 670 INSTITUTES OF MEDICINE. ivation may be speedily induced in one subject by less than a grain of calomel, while no amount ofthe remedy will produce this effect in others. And so of the morbific effects of digitalis; an agent, also, which exemplifies the instantaneousness with which alteratives 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, &c. 902, k. The permanent operation of the nervous power in particu- lar parts ofthe animal fabric, as in the sphincters, supplies an elegant parallel with the foregoing uninterrupted influences ofthe 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 blood does to theheart and capil- lary arteries. And now, if we mutilate the inferior part of the spinal cord, or observe 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 independent influence (§ 473-475, 476^-481, &c, 514 g, Sec). 902, I. When moral 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 first determined with a fa- tal effect upon the organic properties of the nervous centre. 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-cough1? 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, e). 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 operandi 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 ofthe utmost im- portance in medicine. Its laws are. precise. Their knowledge will lead to. a greater dependence upon the curative efforts of Nature (§ 878, 905b,905% b). 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 determina- 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£, 1037, b). The foregoing is the only 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 mobility. 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, where 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. If the brain, or any part of the nervous syrstem, be the seat of dis- ease, of irritation, &c, the preternatural development of the nervous power is, as we have seen, direct, and propagated directly, and with very various effects, upon distant parts. In this process the motor nerves 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. 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 moral. 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 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 which 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 b-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 morbific or remedial sympathies may be instituted. Narcotics induce peculiar modifications 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 (fy 1040). 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 the odor of the acid, when swallowed by man in speedily fatal doses, is indistinguishable in the blood, or within the organism (§ 350 £ p, 827 d). Wedemeyer and Muller testify to the fa- tal effect of one drop ofthe hydrocyanic acid, within a single second, when introduced into the eye of a rabbit. And so of strychnia. It is also allowed by Muller, who defends the doctrine of absorption in all cases, that from a minute to two minutes are necessary to the absorp- tion of all other substances. 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 drop ofthe 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 ofthe 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 poisons seems THERAPEUTICS.--REMEDIAL ACTION. 673 almost incompatible with the idea of their absorption."—Pereira's Mat. 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 mucous tissue of the intestine, and the local impression is such lhat 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 substantia], physical fact, as supplied by the advocates of absorption. Thus: "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, Sec The doctrine of sympathy which I have propounded clears up the obscurity, and admits ofthe only explanation (§ 512, b). "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 ofthe 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 gastric 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, 826 b).* 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 sympathy. Thus : "An imponderable quantity of atropia," says Pereira, " is. sufficient, when applied to the eye, to cause dilatation ofthe 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 liquors, 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 irritability, according to. the nature of the remote cause, but also the special 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). 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 affection, 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 ofthe 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 ben- eficial ; but we must be sure of the right, or we shall be' sure to go wrong. U u 674 INSTITUTES OP MEDICINE. ic sensibility as pronounced in an expanded nerve and as implanted in the skin of the eyelid, or in the tunica conjunctiva, and therefore through 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 (§ 233f). 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, 188|- d, 514, I). " 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 weeks." 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. 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, in doses that are inoffensive when admin- istered by the stomach. 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 rectum1? Most remedial agents, indeed, produce con- stitutional effects according to the natural vital modifications not only ofthe mucous, and other tissues of different parts, but of one contin- uous tissue, as the mucous membrane ofthe 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 ? 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 1 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 ofthe natural modifications of irritability in the mucous tissue of different organs 1 If opium offend the stomach, the principle is the THERAPEUTICS.--REMEDIAL ACTION. 675 same as when urine excoriates the mucous membrane of the lungs, and thus produces the most violent constitutional effects. 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 ofthe 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. Should we not rather say, through the medium of the brain in its connection with the spinal marrow, while other parts may be sympa- thetically affected through the spinal marrow, or even the ganglionic system alone. And now contrast with the foregoing peculiarities of tobacco and opium, the fact that the 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 ofthe 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 ofthe 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 ofthe pupils (§ 1066). Again, 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 croup and 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. Now were the physical, and n6t the physiological, doctrine true 676 INSTITUTES OF MEDICINE. there should be no necessity for this regular and rapid increase of the doses. The nearer, 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. 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 dose, 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. We 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 grain 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 irritability 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 contrary, 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. 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, " 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 1 The fact is," he continues, " that in the present state of our THERAPEUTICS.--REMEDIAL ACTION. 677 knowledge, we cannot explain the modus medendi 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- servers as explain their modus operandi on other principles, and in conformity with well-established facts 1 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 disregard ofthe great principles in medicine, and to the revival ofthe exploded creeds of the iatro-chemical and iatro-mechanical philosophers 1 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 ? 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, b). 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 formed 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 mnjiite proportions of medicines, which may steal 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 ofthe operations ofthe 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 ofthe 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 1 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, Seel If we refer, as does Pereira, to the effects 678 INSTITUTES op medicine. of cinchona as a tt nic, upon the healthy system, we must explain the methodus operandi before we can apply it in the least to any parallel effects upon morbid and enfeebled states of the system. But we may not speak of " augmentation of cohesion of the organic mass," &c. (§ 890, 890£).—Ibid., 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 produces 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 is 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 profoundly, and in virtue ofytheir 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 healtby 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. Thus we get at a common principle of the methodus operandi of^ cin- chona as a tonic, as a 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, moral emotions, and almost every thing else, are, like cinchona, more or less curative of intermittent fevers; and though the alterations which are directly 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 existing 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 morbid 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, b). 905, a. I will now present a comprehensive example which illus- trates the foregoing doctrines. A seton, passed through the skin of the neck, removes inflammation ofthe 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 the medium of the brain and spinal cord. 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 primary diseases. Like the seton, all others act upon the irritability of parts, directly or sympathetically, 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 the cere- bro-spinal axis, where it develops and modifies the nervous power, which is then reflected upon various parts. But 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 preternaturally susceptible in the inflamed eyes, the nervous power operates with effect upon it, and alters the nature of that and other properties so as to enable them to return to their nat- ural state; and thus the inflammation subsides (§ 150, 151). We will next see how this seton may become the cause of sympa- thetic diseases in remote parts, 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 ofthe 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- 680 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, h). 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 sympathies propagated from 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 the nervous influence; which, being determined with a morbific effect upon the eyes, produces the ophthalmic inflammation ($ 1040). 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 effects are 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 ofthe 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 penological 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 nature may rauiire no other assistance from art. 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 THERAPEUTICS.--REMEDIAL ACTION. 681 may be applied. If an emollient poultice, 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 morbid sympathetic influence over the seton, and thus complicate the principle as to exciting causes, and institute a mixed condition of sympathetic 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 ; whi|e 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). 905, b. 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 lead not only 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 682 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 asthenic, conditions (§ 733 f, 752-756). The example supplied by erysipelas, in which blisters and leeches may afford relief, when ap- plied to the inflamed surfacej 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 go 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|, b). These principles enable us to understand how a great va- riety of physical and moral 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. 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 inferior reme- dies. But this arrangement, like that of all other groups, is founded upon the supposed relative usefulness of the several agents in fulfilling the ibjects 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 ofthe 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 many of the local sedatives go far- ther than this. They also affect irritability and sensibility, especially the former property, in their existing nature or kind, and, of course, induce a corresponding change in the kind of action. Now, it is this alteration in kind, beyond the mere sedative effect, which makes up the differences between the various agents ofthe 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, I 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 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). If local inflammations, to which poultices and warm fomentations are applicable, have given rise to constitutional disturbance, 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 mostly upon the prin- ciple of keeping exciting causes out ofthe way of Nature (§ 856, a). Finally, a,word as to the contribution which is made by these great remedies 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 work 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 consideration of what I have said of 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 which 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. Secale cornutum. 2. Oleum ergotcv. 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. Iodinium. 13. Potassii bromidum. 14. Ferri bromidum. 15, Ipomaea purga. 16. Juniperus Virginiana. 17. Aristolochia serpentaria. 18. Ruta graveolens. 19. Ferula asafcetida. 20. Sodae biboras. 21. Mentha pulegium. 22. Helleborus niger. Genito-Urinary Agents, in the order of their value (numerically).— 1. 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, in no. 20 ofthe same class, an inferior substance occurs which has been sup- posed to promote the effect of ergot as a parturiant agent. The other members ofthe Class of Uterine Agents are such as are denominated emmenagogues, with the exception of the fourth. But, leeches should evidently follow cantharides, in the order of importance, as capable of yielding relief, not only in the next greater number of cases, but in very difficult pathological conditions ofthe 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 ofthe other agents which follow. It is not, however, to such cases alone that leeches to the perinaeum ara 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 fore, fail, it -is appropriate that an emmenagogue which may now suc- ceed, and often by itself, should stand next in the order of arrange- 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 892f, q, that I mean alone those which have been hitherto grouped together with a special reference to the symptom, and upon which the denomination has been founded (E?', in, u-nv, month, and ayo), 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 b, 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 ofthe 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, or to a more rational view of the pathological state ofthe uterus alone. 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 ofthe liv- er (§ 129). Aloes, therefore, properly follows next in the order;. and, although this is down in the books as an emmenagogue from its sup- posed propagation of special influences from the rectum to the uterus, I apprehend it is in no other way a uterine agent than by contribu- ting relief to hepatic disorder, augmenting the natural stimulus ofthe intestine, and, in other ways, removing constipation, and thus, also, the symptom (§ 889 i, 889 I, 902 b). The simple mercurial preparations, which follow as the tenth in order, equally admonish us, also, to keep our attention upon the path- ological condition, and away from the symptom, excepting as it is very vaguely significant of some morbid state ofthe uterus which can only be known 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 may be 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 treatment. 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 ] 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 b, 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; and this is about the amount of its bearing upon the symptom. 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 ofthe uterus as a primary affection (§ 892£). 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 sympathetic in- fluences are withdrawn. The bromide of iron may be often now call- ed in advantageously (§ 150, 151, 894 b, 901, 902 b). Jalap is wanted to carry out a decisive antiphlogistic treatment, which is occasionally demanded; sometimes for primary inflammation ofthe uterus, or again for some general plethoric habit, or some ob- stinate chronic gastritis, and where the functional derangement ofthe 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 b, 892f b, i). 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, bow it has happened that asafcetida is the only agent that has been introduced with a specific reference to the symptom in this class of remedies. The whole body is so alive to sympathetic influences, as disease may touch upon one part or an- other, and more profoundly as it may plant itself in greater force, that nothing can be now accomplished but through the precepts of the most enlightened medical philosophy. It is here, too, that we see most distinctly pronounced the complete possession which gastric derange- ments may take ofthe uterus, and overthrow its function, or where it may be interrupted by a sudden reduction 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, Sec). 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 these 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 ofthe failures of art, and have contributed to swell the nomenclature of" nervous diseases" (§ 659, 855, 356, 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 liberal contribution to the very errors 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- Urinary 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 employed 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%, b). 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, arid 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, Sec; 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 OF 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 b, 863 d, 867, 871, 905% b.) Take, next, the same agent as the best internal remedy for leucor- rhcea. 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 ofthe 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 four 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, are 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 ofthe science. Th;s last remark leads me to another more important than the rest; namely that all the pathological varieties which go to constitute the symptom, maybe variously complicated with morbid affections of oth- er important organs, especially those of the abdomen ; just as we have seen of the symptom in amenorrhcea (§ 905%, b). This, indeed, is always the case in- the watery 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 6, 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. 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; arid 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 gonorrhoea. Here we have rarely 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 ofthe patient may be always moderated, or conquered, by firm- ness in the appropriate 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 gonorrhoea 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. Xx 690 INSTITUTES OF MEDICINE. THE INFLUENCES AND MODUS OPERANDI OF LOSS OF BLOOD, Considered with a Reference to the practical Application ofthe Reme- dy and the various Circumstances of Disease. 906, a. "The serous portion ofthe 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 he 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- tier purely mechanical, by removing from the vessels the fluid by which their parietes were kept in a state of over-disteution."—Andral's Pathological Anatomy. b. " 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 the 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 faintness, 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 in 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 -r we place the patient in an erect posture, and endeavor to produce deli- quum. It sometimes happens that the patient faints fro'tn 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 exlrema remedia exquisite optima."—Hiptocrates. 906, f. Whether the father of medicine, or his modern descendants, oe right or wrong in the foregoing precepts, especially in relation to the therapeutical uses of bloodletting, it will be an object ofthe pres- ent inquiry to ascertain (§ 376f, 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 ofthe 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 wre 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 mecbanica'l interpretations, and to place it upon that dignified ground surrounded by those hallowed laws of the God of Nature, which, if unacceptable to the materialist, will, at least, rebuke his errors. 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 OF 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 Foreign Medical Review, and the Medico-Chirurgical Review, of London, entitle me fully to all the proprietorship. Whatever is said ofthe vital influences ofthe loss, and of the whole theory ofthe 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 ofthe 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. 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. 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 bloodletting are wholly incapable of-explana- tion upon any principles in physics. Like the action of all other rem- edies, there is nothing mechanical appertaining to any part ofthe pro- cess, excepting the escape of the blood from the orifice. 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 ofthe 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 doctrine of debility (§ 569), pass- ive relaxation of the vessels, and stagnation of blood, correct, it is ev- ident that not only such .conditions, 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 remedy (§ 935, 977). 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 or 692 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 1 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 ofthe 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 (§ 889,1) 1 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 corresponds with all that I shall say ofthe 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 of 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 effects of which may be divided into seven stages. 915, 1st. The earlist effect of loss of blood consists in a contraction ofthe blood-vessels. This is universally true of all modes of abstract- ing blood. 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 vittv, 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). 916. 2d. A vital contraction follows immediately, as the conse- quence, 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 (§ 189, 931, 935 b). THERAPEUTICS.--LOSS OF BLOOD. 693 917. 3d. Then follows, by continuous and remote sympathy (§ 498, 500), 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 b). 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. 919. 5th. A partial sympathetic impression 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. The effect, as expressed in section 917, is originally propagated along the extreme vessels by continuous sympathy, but remote sympathy is soon brought into operation, when both modifications concur together; but it is chiefly through remote sympathy that the heart is influenced (§ 933). 920. 6th. Such are the simple elements ofthe processes which take place in leeching. But, during their progress, they become more or less compounded. The sympathetic 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 sympathetic 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, Sec, 526 a, 934). This complex, or double circle of sympathies, continues to ad- vance till the heart becomes overpowered in its action, and syncope takes place (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 exert a powerful sympathetic influence upon the whole capillary system, and thence upon the heart, long af- ter the blood has ceased flowing (§ 514 g, Sec, 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 be 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 g, 930). 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). 694 INSTITUTES OF MEDICINE. 922, a. It is owing to the peculiar nature of the change established in the vital condition of the extreme 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, b. There is, however, a remarkable difference between the direct effects of leeching and spontaneous hemorrhage, 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 prodigious- ly great that it cannot be safely imitated by art under the same cir- cumstances of disease. Although, therefore, in these cases, nature institutes a change stri- kingly analogous to that of leeching, it is not of the same 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 a, no. 3, d, 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 ofthe liver, four ounces of blood taken from the verge ofthe anus by means of leeches may break up those obstinate hepatic affections, when twen- ty ounces from the skin over the region of that organ may produce far less effect. Here the specific impression is propagated, in part, along the mucous tract of the intestines, in the manner expressed in sections 4=98, fig ; remote, as well as continuous sympathy, being brought into operation by this general impression on the mucous tissue. 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 obtained 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 when applied to other parts. 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 THERAPEUTICS.--LOSS OF BLOOD. 695 head-affections. The leeches have sometimes relieved the headache, when general bloodletting, cathartics, &c, had failed, while the gas- tric 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 remote sympathy, through the instrumentality of the mucous mem- brane, to the viscera ofthe 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). 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 contiguous sympathy, as in the case of blisters, &c. (§ 497). 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 m 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 ofthe uterus than upon any other part 1 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 ofthe feet to cold, or by the production of catarrh 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 bead 1 " 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 t^efeet." The philosophy is the same in all the cases, and revulsion is nothing but sympathy. 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 amenorrhcea, the remedy has the greatest effect when ap- Dlied to the perirraeum, or to the upper part ofthe thighs. 696 INSTITUTES OF MEDICINE. 925, a. What has been now said of disease supposes that leeches are applied 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 bloodlettino-s be likely to be wanted, the leeching should be delayed (§ 893 g-i, p 927). 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 infants, 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 advantages of general bloodletting 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 (§ 961, c). 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 ofthe 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 h). 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 carry 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 organ- 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). It throws back its light, also, on the modua operandi of the other agents. 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, efforts 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, b. 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 the constitutional disturbance has 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 system (§ 889 m, 889 mm). 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 ex- ceeds that degree which is necessary to determine a change in the part inflamed. It may even follow from very copious leeching in acute 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 leechino- 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 peculiar 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, or wherever leeches may be applied, in in- fancy, when this remedy has been carried far beyond any useful de- 698 INSTITUTES OF MEDICINE. gree in inflammations of the nature now under consideration, and 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 change which has been induced in the extreme vessels to which the leeches had been applied, and which, indeed, has been, more or less, sympa- thetically propagated over the system (§ 921). 928. From what has now been said, the reason is apparent why cautious leeching is one ofthe best 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. There should not be one drop of blood too much, nor one too little. 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. 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: 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). 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, b. The contraction thus instituted is vastly greater in the small than in the large vessel*, mainly because of the greater endowment of the former with irritability and mobility (§ 188, 205, 482). 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 sympathetic influences are determined upon the for- mer by the changes which take place in the larger series of vessels (§ 920'). 933. 4th. As soon as the foregoing change begins in the vessels, it throws a sympathetic influence 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 sympa- thy (§ 919). 934. 5th. As the heart becomes influenced, it reflects a powerful sympathetic impression back upon the extreme and capillary vessels; between which and the heart there exist, very strong vital and sympa- thetic relations (§ 385, 526 a, 920, 1039). THERAPEUTICS.--LOSS OF BLOOD. 699 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, the play of sympathy 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, in the former case, is exerted by the small vessels upon the centre of circulation (§ 921). 935, a. That the failure ofthe 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). 935, b. 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 moral 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 sympathetic influences which it exerts upon the heart (§ 916, 917, 932, 937). 935, c. In like manner, the diminution ofthe 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 ofthe 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 ofthe 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 ofthe sys- tem, and extending to the most remote extremities. I suffered the blood to flow, however, but the pain increased instead of diminish- 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). 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. 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 improves 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. 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 moral 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 suspend- 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. 936, a. When general bloodletting is practiced in health, the action ofthe 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 moral or physical. 936, b. Again, it frequently happens, after the action ofthe 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 depressing form of disease, and perhaps as soon as the blood begins to flow from the vein (§ 938, b). 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 ofthe whole capillary system, however small the quantity, syncope will approach (§ 935). 937, b. 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 appear hereafter, 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). 937, d. It is also another important practical, as well as phil- osophical, consideration, that if the 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 the position ofthe 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). 938, b. 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 ofthe mind, intestinal irritation, &c. When these accidental and transient causes contribute to the prostration of the circulatory organs, they should be carefully noted; since it is commonly 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 prostrating effects ofthe 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 702 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 general sense, six ounces of blood taken by leeching is probably equal in its curative ef- fects to nearly twice that quantity abstracted by cupping. 939, b. 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 ofthe general and local effects depend (§ 921, 922). 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 the operation of cupping, and in which last 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 the great influences upon the whole circulatory 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, f. It becomes more and more apparent, therefore, that gener- al bloodletting, cupping, and leeching are in some respects distinct remedies, and that cupping 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 severel modes. Some of these differences appertain to the cerebro-spinal system, which is far more THERAPEUTICS.--LOSS OF BLOOD. 703 concerned in the phenomena of general bloodletting than in the usual effects of leeching, at all stages of the operation. It appears, howev- er, that the effects of general bloodletting may be obtained in an infe- rior degree by cupping, through more inconsiderable degrees of the same influences, as, also, in a still lesser degree by applying cupping- glasses in the operation of leeching; though, where leeching is appro- priate, it must be often at the expense of a greater loss of blood, and at a loss, more or less, of the specific effects of leeching. Ofthe Nervous Power in its Relation to the Effects of Loss of Blood. 940. Another important element in the phenomena which arise from loss of blood must now be considered. This is the nervous power, to which are owing all the remote sympathies that are in active progress after the beginning of the constitutional effects of bloodletting, 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 6ame power that exerts so vast a range of influences in directing the effects of all other remedial, as well as morbific agents, and whose characteristics have been already extensively considered. The same philosophy, too, is here applicable as in all other cases in which the nervous power is instrumental in organic actions, or in modifying, or in propagating disease (§222-234, 450-530). 941. The development of the nervous power from loss of blood is owing to the vital contractions of the small vessels, especially of the brain and spinal cord, and to the necessary change in the vital con- dition of the vessels of those parts (§931, 935). An influence is thus exerted upon the nervous centres analogous to that which we have seen to arise from direct experiments (§ 476-494), from the operation of the passions (§ 227, 230), and from remedial and morbific agents (§227, 500, 1039, 1040, 1056). 942, a. Now, therefore, in view of the extensive premises before us, loss of blood, by establishing a universal contraction of the small vessels ofthe nervous centres, and by its sudden impression upon the organic properties of those centres, develops the nervous power in a peculiar manner and in unusual intensity (§ 227, 232). This influ- ence of this power, reflected abroad, increases that contraction ofthe general capillary system which is at first instituted, in all parts, in gen- eral bloodletting, by the direct effect of loss of blood upon the organ- ic properties ofthe whole system of blood-vessels (§ 930, 931). 942, b. In leeching, the first sympathetic influences are propagated continuously from the part to which leeches are applied (§ 498), but are soon extended to the brain and spinal cord, the nervous power excited, and spread abroad over the system, as in general bloodletting (§ 464, 465, 500 b). 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. 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(§ 1040). 943, a. Again, it has been shown by Le Gallois, 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 vessels of the nervous centres begin to contract, 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 on the contraction of the cerebral and spinal vessels, or as syncope approaches (§ 902, g). It is for this reason that cathartics often operate during the operation 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 important to the practitioner when he is deliberating whethei 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 (§ 892f, 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 embarrass '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), 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 prosfrated through t»he nervous influence, and indirectly by its sympathy with the stomach; while a certain 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 sympathetically to the heart. The succession of changes then, as re- spects the heart and blood-vessels, begins mote 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 nervous 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 wrhen 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 ofthe prostrating ef- fects of nausea, and many other accidental influences which spring up during the operation of bloodletting. 944, b. Since, therefore, in the case of bloodletting, its influences THERAPEUTICS.--LOSS OF BLOOD. 705 are profound, not only on the instruments of disease, but upon the whole capillary system, and the failure ofthe heart's action is greatly due to this deep impression on their vital constitution, while in the case ofthe 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. Is it asked why the failure of supply to the capillary ves- sels when the heart is suddenly depressed by the foregoing accidental causes is not even more efficient in disease than the artificial method of abstracting blood from the same vessels ] I answer, summarily, that it depends on the nature ofthe exciting cause, and on the universal law of adaptation, which is every where conspicuously designed for the preservation of organic beings (§ 137 c, 150, 151, 733 d, 847 g). 944, d. Syncope is often consummated by removing the ligature. In this case the action of the heart had been enfeebled almost to an accession of the paroxysm, and the additional quantity of blood sud- denly thrown upon the heart, so far from rousing the organ, overpow- ers its action. It is in this way, in part, when the heart has been gradually prostrated during the access of congestive fever, that a sud- den development of the attack sometimes produces syncope. Some- thing, however, is evidently owing, in this case, to the sympathetic influence of the extreme vessels upon the heart, but probably more to the sudden determination of blood from the circumference at the access ofthe cold stage. 945. If syncope be obstinate, the means of relief will be such as operate through the medium ofthe 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 corresponding kind, as well as perfect rest, will therefore be the proper remedies (§ 481, e). 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), I see in the Annali Universali 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 man 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- Y y 706 INSTITUTES OF MEDICINE. bility to continue the circulation, and thus to supply the brain and all 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. 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 suffice 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" (§ 943). 946, b. Examples of the foregoing nature admit but one interpre- tation. They are clear illustrations of the peculiar properties 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 ofthe alcohol- ic solution of the extract of nux vomica, applied to the tongue, or by a blow on the epigastrium, by surgical operations, &c. (§ 177, 222, &c). ■' * 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 be its cause, consists in a suspension or diminution of cerebral action. If it take place spontaneously and from a moral cause, it is the action ofthe en- cejmalon 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 concert of 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 when it is preternatu- rally affected by physical and moral causes (§ 177-191, 223, 226, 227, 232, 476, &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). Nay, the heart often continues to pulsate long after its removal from the body (§ 489 e, 516 d, no. 7). When we consider, also, how powerfully the heart may be influenced by slight mechanical or other agents applied to the brain, or spinal cord (§ 4S0, Sec), 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 moral causes, produce syncope, than by supposing that it is through their direct suspension of the cerebral THERAPEUTICS.--LOSS 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 death ofthe brain, while in syncope the action ofthe 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 extinction 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. 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 upon the 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 of the nervous centres, 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 sympathy become thus established; that the nervous influence is now, also, exerted with a depressing effect upon the heart, and intes- tinal canal, and that this effect is thrown back upon the brain and spi- nal cord, by which the intensity of the nervous influence is farther in- creased ; that the play of sympathies, 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 (§ M6% h, 481 h). 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). And now I say, if the foregoing results of loss of blood be com- 708 INSTITUTES OF MEDICINE. pared with 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 far overrated 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 bloodletting not appropriate to the case, a sudden and violent impres- sion is made by 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 in- crease the inflammation which the remedy was intended to subdue, but may become the foundation of disease in other parts (§ M6% h, 479, 965 b, 982-1001, 1005 e). 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- termined upon them by the violence inflicted on the extreme capil- laries ofthe brain. Inflammation, therefore, may be lighted up, as a consequence, 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, retchings, and involuntary intestinal evacuations; some of which so frequently follow excessive loss of blood. Although bloodletting, therefore, be a remedy for inflammation, the excessive use of it, as will be farther shown, may induce that affection; and even then, the cautious abstraction of blood by leeches still proves, by its curative influence, the nature of the affection, and the sanative power of the remedy when well directed (§ 901, 997, (§1040, 1057). 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 bloodletting. It will be observed that they conform to the experiments of Philip on the brain and spinal cord (§ 476-492). Thus : " It is certain," says Muller, " 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 phenom- ena are evidently induced by the nervous influence. The active con- gestion of certain organs of the brain, for example, while they are in a state of excitement, is a similar phenomenon." These several examples, however various maybe the remote causes of the phenomena, are so nearly alike that they may be regarded as one, and it is not less obvious that they equally correspond with that of inflammation when induced by excessive loss of blood. 951 b. And now for the opposite result, which is brought about THERAPEUTICS.--LOSS OF BLOOD. 709 by precisely the same immediate exciting cause, the nervous influ- ence. " When a patient," says Dr. Armstrong, "had lost only an ounce of blood, from the shock of the operation, syncope came on and ef- fectually 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 ofthe pleura." 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- mation 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 ofthe brain being overthrown in the former case, and an inflammation ofthe pleu- ra in the latter. The common nature of the immediate 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 not only admit the common nature of the immediate 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 immediate 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 ofthe whole is in the examples before us (§ 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 tbe 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. 952, a. Some ofthe finest illustrations of the effect of bloodletting 710 INSTITUTES OF MEDICINE. upon the organic properties of the extreme vessels of the arterial sys- tem, either directly through the loss of blood, or, indirectly, through the nervous power, 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 reversed; 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 measure, 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." 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, f. 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 ther solids ; as may be readily seen in slaughter- houses. But, again, on the other band, when death is suddenly pro- duced through the nervous system by blows on the stomach, apoplexy, Sec, or by running, lightning, organic affections of the heart, &c, or when the powers of life are greatly reduced by malignant fevers, the blood remains fluid. These seeming paradoxes are resolved by supposing peculiar influ- ences ofthe 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 bloodletting produces its effects upon the vires vitce 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 take place in the blood during the operation of general bloodletting, re- THERAPEUTICS.--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." 952, h. How futile, therefore, the recent observations of Andral as to the relative quantity of lymph in inflammatory diseases ! The blood to be inspected must be drawn from the subject, and the loss of one or two ounces may affect, essentially, the proportion of lymph in the next two ounces, and so on. 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 (§ 688, e). GENERAL AND PRACTICAL OBSERVATIONS ON BLOODLETTING. Ofthe General Extent of the Remedy. 953. The vital influences of loss of blood are owing to the vital re- lations ofthe blood to the organic properties of .the solids. The blood being the pabulum 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 steps in 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 ofthe remedy during its application, which should, of course, be superintended by the physician (§ 675). 954, b. 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 erroneous 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. Amott, 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 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, Sfc. 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. 955, a. It should be said, therefore, in qualification ofthe statement in section 951, b, 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 iu 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 with small doses of calomel and opium" (§ 892}, i). 955, c. Examples ofthe 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). 955, d. Hero 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 cerebrorspinal 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-down 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 maybe present, whether acute or chronic, we shall scarcely go wrong in abstracting more or less blood, and often largely, 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, often much experience, and an unremitting attention to medical pursuits. It will be often, otherwise, 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, proficerunt." 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 the nature and existing condition of the pathological states. 2d. To carry them as for as, and no farther, than the institution of such a change as will enable Nature to take 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 powerful sympathetic influence which is determined upon the instruments of disease by a great and Budden change of action throughout the arterial system, as well as from influences exerted upon the general vital conditions of numer- ous organs ; the very effect upon the skin, for example, and especially upon the intestinal canal, throwing a general 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 more direct manner through the intestinal mucous tissue, or call up the co-operation of the skin with that tissue in subduing pulmonary inflammations (% <)14, h). 714 INSTITUTES OF MEDICINE. 957. On the other hand, if the treatment have been begun by other 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 down spontaneously, or, in neglected cases, under the influence of remedial agents, even of loss of blood, and however sud- denly, the results in the preceding section can only be obtained 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 efficient than venesection (§ 892| i, 1008). 958, a. In the ordinary forms of active inflammation, and where practicable in fever (§ 961-970), the first bloodletting should be the largest, 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 were; 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. 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 moral 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 OF BLOOD. 715 ease, and which were there introduced for the purpose 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 ofthe quantity of blood, to be ab- stracted, and which the nature of the case may demand," is fallacious. Dr. Wardrop gives us the same rule. " The state of fainting," he says, " is to be considered an index of the quantity of bipod which is necessary to be removed for the relief of 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 may be appropriate, are, also, the very ones which most demand repeated abstractions of blood; and the effect produced at each application ofthe remedy should be the measure ofthe quantity to be abstracted (§ 682 c, 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). 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 of 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 ofthe Writings ofM. Louis, in Med. 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- ment'' 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 OF MEDICINE. When Pereira undertook 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 (§ 892£ I, 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; though con- fessions here would have been some atonement to science and hu- manity. 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 worst practices humanity is called upon to encounter ; and to contrast the tacit experience of all in commendation of poisons which operate with deadly effect in their authorized doses (so only they be administered by the stomach, that galvanic trough ofthe Chemist), 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. [ts internal use, however, requires great caution, since patients have, THERAPEUTICS.--LOSS OF BLOOD. 717 in 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 v 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" could be truly affirmed of bloodletting, as is conceded, in reality, by the 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 inflammations 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, a). 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 ofthe 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 great 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- 718 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 without 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 reduction 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, 350| 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 important 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 gastro-intestinal 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, also;-that of il- lustrating yet farther certain peculiarities of remedial agents in relation to vital habit (§ 535, &c). j 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. i 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, aa well as observation, enable us, also, to know that the habitual, is safer than the inter- rupted, use of tobacco; so, only, there be no excess. The insusceptibility, which the continued 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 dose, 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 ofthe poisonous agents ofthe Materia Medica (including tobacco), they exert their influences upon the mucous tissue of the stomach 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 b, &c). Tobacco is also another wit- ness, in its associated aspects as a luxury and as a poison, against the doctrine of operas tion by absorption. THERAPEUTICS.--LOSS OF BLOOD. 719 remedy ofthe whole 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 by any other arti- cle ofthe 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 former 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 ofthe great injustice inflicted upon himself, as an atonement for the injury he might have done. Nor did I scarcely do justice to the cause which I endeavor to ad- vocate, when, in a former section, I spoke ofthe influence ofthe 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, tho work on " Animal Chem- istry applied to Pathology and Therapeutics," was "communicated to the British Association for the Advancementof 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 nonsense (§ 350^, 350|, 447^y). 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 ofthe 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. 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 the 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 probable 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 fluid" 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 treatment, 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 ofthe heart." 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 ofthe tincture in four days, in augmented doses varying from five to ten drops, for the re- lief of simple, chronic pain in the back, from the recommendatioR 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. Nor will I neglect this opportunity of objecting to the proposition THERAPEUTICS.—LOSS OF BLOOD. • 721 of Dr. Graves, of Dublin, that belladonna, instead of bloodletting, should be employed in those congestive fevers in which cerebral 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 ofthe 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, 488J, 500 h, 569, 892 d, 906, mot- to, d). 960, b. 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 generally 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 n). 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 partial philosophy of 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 from 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 ofthe kid- neys." Medicine was cut up, in the Parisian hospitals, into numerous fragments, and brought under all the details ofthe mechanical princi- ple of " a division of labor." The practical results which have fol- lowed upon an extensive scale require no farther exemplification. But, it is also to the same system, 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 722 INSTITUTES OF MEDICINE. when he attempted the dislodgment of intermittent fever from an in- durated spleen (§ 892, k). 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 oand 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 disturb the peace of society. 960, f. 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 must set him upright 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 deliquium. 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 ofthe immediate importance ofthe " 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 ofthe 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 which 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, h. Let us, finally, have a word upon the doctrine laid down and so well understood by Hippocrates, that, " Severe diseases require severe remedies" (§ 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, f). 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 kind, 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 ofthe 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. Then we have the varieties and gradations of febrile and inflamma- tory diseases, which, according to the nature ofthe predisposing causes, either yield spontaneously, or submit readily to appropriate remedial agents. 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, 615, 685, 686, 847 g, 854 d, 856 b, 857, 858, 859 b, 861, 863, 868 b, 870 aa). The application ofthe 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, again, there are maladies of great violence, as in the examples already mentioned of small-pox, measles, scarlatina, Sec, 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 ofthe 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). 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, a profound sympathetic impres- sion seizes 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 force of the sympathies 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 b). But, these cases are apt to be com- plicated with obscure, though severe congestive disease ofthe 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). 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 ofthe 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-k, 786, &c, 978). But, when venous congestion becomes sud- denly aggravated, or other causes may increase the susceptibility of the 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. It is, however, in congestive fever that we witness the strong dem- onstrations of venous congestion in generating extensive and profound lesions of the organic functions throughout the body. This is espe- cially true if the local disease exist at the invasion ofthe 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 h, 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 ih overthrowing the organic functions ; nor with- draws 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 ofthe 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 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 all its sym- pathetic influences result, 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 h, 569, 639, 743, 746, 780, 915-921, 999 b). 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, 416% h, 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 ounces 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." 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, and thus 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 ofthe 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 t even opposite causes (§ 150-152, 650, 1039, 1040, 1056J. THERAPEUTICS.--LOSS OF BLOOD. 727 961, f. 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 [ bled him again, and he did not fall into a state of syncope until he had lost about thirty ounces of blood." Many examples of the foregoing nature occur in the " Commenta- ries." 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 moral causes, or intestinal irritation, have contributed to early syncope, we may generally proceed to the farther abstraction o. 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). 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, b). 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 instaurentur 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 corresponds with the best philosophy of our own day. " So soon," he says, " as the heart is strengthened and corroborated with 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 slow 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). 964, b. No injury can grow out of the use of stimulants in these cases, while the powers and actions of life are so morbidly affected 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 vitae, 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 foregoing, disease is so intense at its invasion, 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). 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 try 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. 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 powers, that it rouses them into greater energy; the whole circulation becomes released from its embarrassment in the capillary system; THERAPEUTICS.--LOSS OF 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 an exciting sympathetic 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). 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 general 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 sympathetic influence, by which the heart is farther roused into increased action (§ 921, 934, 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 h, 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 efforts of art (§ 863, d). 968. Since, therefore, it is always important to do as much as may 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 cf blood which the exi- gencies of the case may seem to demand. It \ i astonishing how soon, in congestive fevers, the morbid powers of 1 ife will rally under the 730 INSTITUTES OF MEDICINE. 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 propagate modifying influences upon each other, and these modifications are as constantly varying, either sponta- neously, or through the operation of foreign causes. 969, b. 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-fi k, 806, 978). 969, c. Although it be generally 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, Sec, 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); or, rather, since 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). 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, Sec. Here the powers of life are actually and simply reduced; certainly not modified as by the action of specific morbific causes (§ 790 b, 961 b). 970, b. In the latter instances, the abstraction of blood has been often fatal, and should never be practiced unless some inflammation THERAPEUTICS.--LOSS OF BLOOD. 731 subsequently sj ring up. On the contrary, if the depression of life 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 watei 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 firrt. The morbid state ofthe 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 Phys. Comm., 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 diffuse 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 demonstrations of cure should be made upon the primary and principal seat of dis- ease (§ 689,1). In the cases supposed, many different tissues may be affected, and there may be, also, much variety in the morbid states. There is inflammation, more or less active, of the venous tissue of the liver, &c, more active inflammation of the fauces, or of the 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 then 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 referrino- to what I have said of the influences of remote causes (§ 644, &c). I am now brought to the application of the foregoing remarks. We see, therefore, from the analogy which prevails throughout the morbid 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 mi lor affections. But loss of blood is far from being always necessar y in these complex conditions; and we may then find that some internal remedy, as, for example, a compound of six or eight grains ofthe submuriate of mercury, twelve or twenty of jalap, and one to five of ipecacuanha, will stretch its way 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 (§ 514, 1056). 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, thouo-h 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 Cono-es- 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 ofthe 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 midst 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 constitutional or sympathetic effects of all local inflammations. But these constitutional results, although de- pendent upon the same processes of sympathy as those which 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, ofthe 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). TilKRAPEUTICS.—LOSS OF BLOOD. 733 973, b. The point, therefore, to be now observed is an apparently oposite effect of sympathy as exerted by local inflammations upon the organs of circulation from that which 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 ofthe 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 great losses of blood; especially if the chief dependence be placed upon this remedy. Owing to the same pertinacity of local dis- ease, and its general influences, cathartics make less impression than in most other active inflammations, unless ofthe 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. 974, b. 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 ofthe 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 (§ 9o0). 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 b, c, 951 b, d, 955, 992, (§ 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 refuse to contract, the whole series throughout the body are thus, also, maintained 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 refusal to contract, 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, 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 contraction of the vessels of the brain is partly prevented by their peculiar relation to the organ which is the principal centre ofthe nervous power, and in part by the. tendency of that condition to prevent a contraction ofthe 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 influence of the law 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). 975, b. 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 contract at the moment, at least, that contraction begins in the instruments of disease ; and the depress- ing nervous influence then becomes a powerful co-operating cause of the general contraction (§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, the contraction of its highly-excited capillaries must be effect- ed, and that opposite state of nervous influence which arises from their excitement must be first overcome (§ 230). This influence 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 b, 955 b, 1056). 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 salutary 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 las without any sense of faintness. Similar cases are recorded by the East India surgeons. 976, b. 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 ofthe system has been erroneously compared to that of debility (§ 569, d). In these particular cases, bloodletting is imperfectly borne ; evidently from its strong impression upon the nervous centres. In the case of drunk- THERAPEUTICS.--LOSS OF 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 b, 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 ofthe 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 he useless, or hazardous, to bleed a patient far advanced in typhoid pneumonia, or in the pleurisy of confirmed phthisis, or in less serious inflammations incident to the scrofulous diathesis, or 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 prop- agated with varying effects upon other parts, according to the natural constitution of each individual, the nature, extent, force, duration, and organic 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 morbid sympathies which may be exerted by this and by other parts (150, 151, 892f 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 thus, also, to maintain the action of the general circulatory system (§ 933, 936), We shall not obtain a proper amount of this general contraction, so 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 degree. 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 OF MEDICINE. is especially true not only of chronic, but of the more rapid form of the disease, when affecting the brain. The chronic conditions, however, 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-k, 7S6, &c, 976 b). 979. From the foregoing considerations it appears that general blood- lettino- 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. 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 organs 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 andhighly 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 b, 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 more or less as an exciting cause of the supervening affection (§ 714, 715, 779). If the general affection 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 ofthe successive explosions of disease, and mutually aggrava- ting each other (§ 137 d, 714, 715). 983. From what has been now said, and ofthe 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 better. 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 await 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 analogous means, may be useful, or necessary, in subduing the local affections after a due impression has been made by loss of blood, cathartics, &c. (§ 1003). 984, b. The foregoing reference to the remote causes of disease with a view to some special deviation from the general principles of treatment is exactly on a par with the antidotal treatment of poisons. The quinia, which may be ultimately necessary to overcome intermit- tent fever, or its associated inflammations and venous congestions, is parallel, in principle, with the ammonia which is administered in cases of poisoning by hydrocyanic acid, and with other analogous examples. It is true that, in the latter cases, the counter-agent acts in a purely 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 mi- asmatic poison. Now 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 1 But, I may be mistaken ; and there- fore will rest my conclusion upon the restorative effects of the cold dash (§ 828 d, 905 a). I need not add that the modus operandi of A A A 738 INSTITUTES OF MEDICINE. quinia, in the cure of intermittents, is exactly equivalent to coffee and the cold dash in that of poisoning by opium (§ 137 e, 150-152, 662 a, b, 892 b, c, 904 c, d). 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 suited 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 ofthe 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 ofthe predisposing cause, which is here implanted in the constitution ofthe 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 grades of the disease, whatever be the part invaded, and may place every part, and the whole system, in a condition for the salutary ef- fects of iodine (§ 137 e, 143 c, 150, 151, 163, 870 aa). Again, if the inflammation be syphilitic, and the constitution be in- vaded by its predisposing influences, bloodletting, Cathartics, &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. 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 THERAPEUTICS.--LOSS OF BLOOD. 739 nature (§ 862, 863, 892f i). I am now led to recur to the subject on account of the great abuse of the principle in the treatment of acute inflammatory affections of the lungs by stimulating expectorants; which are administered for the reason alone that expectoration is one of the consequences of the natural process of cure. On looking a little 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 remedy 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, f). 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. 986, b. That the disease should be thus suddenly arrested is entire- ly conformable to what I have said ofthe modus operandi 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, through other and very different in- fluences, so to modify the morbid state as to interrupt the succession ofthe 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). 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 % The quantities, also, necessary to success depend, in part, 740 INSTITUTES OF MEDICINE. upon the precise period of the cold stage ; whether at its beginning, or near its termination in the hot stage. Less is necessary, cceterii paribus, 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 remedy during 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 readily 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). 988, a. Here, also, may be shown absolutely the error of all the mechanical hypotheses which have beeu 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 ofthe 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 ofthe 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, however, 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 ofthe 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 ofthe agency ofthe 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 ofthe 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 ofthe 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 other stage 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 ofthe 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 beginning to decline than during its rise, and leave a more permanent impression upon disease. 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, 863 d, 1003). 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 through the instrumentality ofthe nervous power, may be now advantageously considered by contrasting its results in certain states of apoplectic affections with what has been said ofthe counter- acting nature of inflammation, and of the nervous influence, in prece- ding sections. 990, b. 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 effusion 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 ofthe 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- ample, to understand the exact pathological condition of the brain, upon which the due regulation of bloodletting will essentially de- 742 INSTITUTES OF MEDICINE. pend. If there be hemiplegia, it is almost certain that extravasation of blood has taken place. This condition, with the rare exception of the rupture of a diseased artery, is indicative of venous congestion ofthe 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 ofthe disease at its invasion. In the first 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- sult. 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 unmitigated 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). 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, f. 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, Sec). 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. 743 The cerebral lesion 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 strokes in a minute, while in another it is as suddenly raised to more than a hundred. In one, it beats with 6taid 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). 990,2. 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)- 990, k. It should be also considered that effusion probably exists within the brain, and that bloodletting cannot reach this part of the exciting cause ; thatthe effect ofthe effusion, although it be diminish- ed, must continue for an indefinite time, and that if we lessen too much the energies ofthe 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. Dr. Cheyne and others consider the ratio ofthe 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 hemorrhage, 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 may be for the weal or the woe ofthe 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 ofthe organ may be so withdrawn from the system that the rem- edy may be soon repeated, and to a greater extent (§ 961, d). 990, j). Having brought 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 r irely depend, even within the crani- um, 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 ofthe 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, iq 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. 990, q. We may conclude, then, that with all the advantages ofthe 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; there to remain, quivering like the arrow of death, till it is slowly removed by a system of vessels, which, it is supposed, because unseen, have no existence. 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 ofthe 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 the influences of the brain upon other parts, and their reaction upon the 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 great final cause is to subserve the function of sympathy, and to thus maintain all parts of the organism of animals in harmonious action; 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, moral, vital, and physical; that these in- 746 INSTITUTES OF MEDICINE. fluences result in preternatural developments and various modifica- tions ofthe nervous power, under the influence of its own nature, but corresponding, also, with the nature of the remote causes, respectively; that it is then determined in a preternatural manner 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, moral 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 ofthe influences which may be exerted upon it. 9901, b. Now, therefore, in view of all these things, as well as of what has been hitherto said ofthe functions of organic life, and ofthe consequences which have befallen the philosophy and the practice of medicine from the prevalence ofthe 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. 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 tho 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, since there is no anatomical union what- ever between the extreme fibres of the sensitive and motor nerves, nor be- tween them 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 agent 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 impressions by the nervous power upon the organic properties of such tissues, and not upon the physical structure itself. Lastly, it neces- THERAPEUTICS.-—LOSS OF BLOOD. 747 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 power 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 (§ 170-185, 190-192, 200, 208, 215, 217, 219, 220, 226, 228, 230, 233, 233J, 234 c, d, e,f, 500, 1040, 1056). It is scarcely necessary toi.add that it does not affect the induction from the physical fact, whether the tissues be separated by minute distances, or be removed from each other as far as the equator from the magnetic poles (§ 234, c). The Experience and Opinions of Distinguished Physicians as to Blood- letting in 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 bloodletting, in the treatment of inflammatory, 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 ad- miration of ages. But great controverted questions call for some- thing more than annunciations of opinion, however great the au- thority, or however those opinions may imply all the requisite expe- rience. 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 ofthe attack?" Mr. Bampfield exposes the origin and fallacy ofthe objections that have been made against bloodletting. He " has been astonished and shocked to find bloodletting in hot climates condemned ;"—while oth- ers, ofthe temperate climates, think it only adapted to the tropics, or condemn it universally. 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 ofthe 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 wa3 remarkably distinguished for its decision and success in various parts ofthe globe, while it is sustained by many ofthe 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 bloor 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, d). Such, also, was Jackson's practice in other countries (5 973 b). 992, b. 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 maybe abstracted in cerebral inflammation, without even compromising the safety ofthe 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 appear- ance, implied no danger. It saved life by direct effect (§ 938 b, 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 be measured by the effect which arises under the abstraction, not by an opinion 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 most cases, returned to his duty within eight days" (§ 974). 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 iufluence 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 theRVLE 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 tne 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- sion, 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 1 How for- cibly does it refute the humoral pathology, and that not less errone- ous assumption that disease is constituted by some positive change of structure, or the yet more glaring fallacy that it consists in debility! 992, 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 ofthe loss according to the rel- ative ages and size. The most remarkable 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). 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, c). _ 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 be kept, until the period of danger is over, in a condition that will render a renewal of that action unlikely to occur" (§ 954, b). 994, b. 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, b). Bleeding must not be discontinued so long as the symptoms which first denoted its necessity continue." In very prostrating forms of fever, he says, that " bloodletting les- sened the sensible debility ofthe system. Hence patients frequently rose from their bed, and walked across the room, a few hours after the operation" (§ 569 e, 898, 992). 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, b). 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. Aud so Mr. Lawrence, who says, that, " In cases of inflammation, where the blood comes freely out ofthe vein, I generally let it run on till it stops; for that seems to me the only way of doing good" (§ 960). 997. 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 bleeding, in inflammation, or at a second depletion quickly succeed- ing, 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 commencement ofthe 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 Jcindly from 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 b, 942, 944, 948, 940, 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). 999, c. The foregoing reference to Rush's doctrine of " debility" (§ 999, a) 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 ti.e 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 nervous 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. predated from what has been variously said upon relative topics in former sections; but the whole principle may be seen by referring 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 corresponding illustration from the subject embraced in this section (§ 916-922, 929-938, 942-949). The heart, being prostrated in the foregoing manner, increases, by reacting sympathies, 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 symptoms 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 ofthe instruments which are the absolute seat of difficulty and danger, will as surely eno-ender, sooner or later, increasing embarrassment of the heart, and a conse- quent multiplication ofthe morbific influences which radiate from tho centre of the circulation (§ 892 c, 965 b, 966-968). 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, 8921 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 dol 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 b). 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). 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, b). But shall physicians deliberate when inflammation is careering in the great organs of life 1 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). 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, affirms, 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, b. 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 affection 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 and 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 petechiae (so much dreaded by the opponents of bloodletting) disappeared after the second bleeding; an effect I daily witness from the use ofthe 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 hemorrhagica. 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, Pine], 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. 1002, f. What shall be said ofthe celebrated jail fevers, where ev- ery body now stimulates 1 Let us hear the illustrious 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, professor, physician-general of the British forces, and studied and treated diseases in Edinburgh, 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 eminere 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 putrid and malignant fevers, even when there is a tendency to hemorrhage from dissolution ofthe 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- 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 most of the distinguished practitioners from the earliest ages of philosophical med- icine, and it may be there seen that the most distinguished have con- curred in their testimony as to the remedial nature of bloodletting. 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- tratino-, 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, Aretseus, Trallian, Paul, Aureli«n Avicenna, &c. 1004, c. Oribasius, about three hundred years 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 of some of its principal 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. 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 know nothing of its nature (§ 363-365), and we are wholly ignorant ofthe proximate met- amorphosis of albuminous 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 past epoch of Organic Chemistry? (§ 38-51, 3501 n, 376^, 409 a, b.) When such is the state of Organic Chemistry, 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, trusting 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 wrong track.— Professor Lehmann's Physiological Chemistnj, vol. i., p. 19, 23, Philadel- phia, 1855. 1030. Again, we have a summary admission from 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 ofthe tissues in their natural condition. Thus: " The theory ofthe 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 axe 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 prepared for chemical analysis by a previous mechanical separation. This separation ofthe 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 ofthe blood and secretions, § 1029. (Professor Lehmann's Physiological Chemistry, vol. ii., p. 174.) Amon"- 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, 782 institutes of medicine. " We have often had occasion to comment upon the inefficiency and imperfection of our chemical knowledge, when compared with the great expectations 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, 316%, 676 b, 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 we can only take this view) all substances, as transition stages from the protein-bodies of a plastic exu- dation, are wholly 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 which we have quoted a luminous remark of Tiedemann in § 54, a. " In a word," says our Author, "while eyen 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."—-Lehmaxn, 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 ofthe 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 difficulty (§ 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 b, 819 b.) Organic Chemistry.—APPENDIX.—Animal Sugar. 783 production of animal sugar. 1031, a. It is now my purpose to bring under the test ofthe 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 mammae. But, independ- ently of this great incongruity between the supposed catalytic action of the liver and the mechanical office 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 secrete d'une part du sucre, de l'autre de la bile."—Cl. Ber- nard, Lecons 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 ofthe 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 mere filter- *n9 °ff of certain constituents of the blood through the liver is not to be thought of." And so Muller, § 42, and Mulder, § 350| e, and Liebig, § 53 c, 409 e. 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 hlood has occunied the attention, of Chemists as well as Physicians, but 784 institutes of medicine. it does not appear to have been thoroughly solved by either."—Bec- querel and Rodier's Pathological Chemistry, 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,"protein, 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 mav 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, vol. 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.") Organic Chemistry.—APPENDIX.—Animal Sugar. 785 Nor can the 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 off," 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 difference 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 somewhere 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 (Valimenta- tion mixte)".—Bernard's Lecons de Physiologie Exp., appliq. a la Medi- cine, p. 69. 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 embarrasses the phenomenon of lacta- tion in carnivorous 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. 240. Nevertheless, there appears to us no difficulty in accounting for the production of sugar either by the mammae 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 Ddd 786 institutes of medicine. of carbon, hydrogen, and 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 livin"- 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 suoar. 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 isvit 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 (ut 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 finds 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 ofthe 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 Medical and Physiological Commentaries (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 Chemistry.—APPENDIX.—Animal Sugar. 787 that, " the results 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 affected in this distressing malady."—Kane, in Dublin Journ. of Med. and Chem. Science, vol. i., p. 24. 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 area 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 Rodier remark that " urea probably exists iri 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." 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.) 788 institutes of medicine. But Lehmann 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 which he affirms " that a mere filtering off of certain constituents of the blood through the liver is not 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" (uramia), 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; Liebig), but, in common with other distinguished Chemists, is led to regard the kidney as a mere strain- er. (§ 409 e, 422, 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 the 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 operandi; 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, 376g, 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 j, 1029.) But urea is not introduced from with- out, and holds the same relation to the urine as cholesterin and the resi- nous principle 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 nutrition 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 perform habitually 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. 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 ofthe 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 e). 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 h«° c?,^iIJn,t1he same emp3-rical formula as anhydrous glucose, so that it therefore co^""3 eClual e1U1'-1—*- -* —K«n, hydrogen, and oxygen." 790 institutes of medicine. inconsistent as to justify the supposition that 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 nutri- 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 (§ 409,5-411); 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. 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 probable," he says, "that the albuminous sub- stances of the blood, on reaching the hepatic cells, separate into two compounds, a hydrocarbon, destined to form sugar, and a nitrogenous one for bile? 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." (Lecons,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 ofthe 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. 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 we go on believing with Puzas, Leveret, Sauvages, Van Swieten, Selle, Astruc, Raulin, 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 h*J Joto„t-a semen in tho \>iar>A, or in the saliva of 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, b, 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, f, 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 Reviewer, 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 hamia- 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 haematin might be 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 Lecons, 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, but in the hepatic tissue itself, that we must search for the substance which 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 requisite con- ditions are present; in the other they are not. This is obvious enough from the quantity of bile elaborated from the portal blood. Again, this kind of " experimental philosophy" will explain the reason why, according to Vernois, "sugar may be found in the liver of the fcetus 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 which 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 physic- logical problems alone, under the direction of the leading facts. But I may say of Bernard'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 ofthe nervous system in its influences upon or- ganic functions, especially so in connection with 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 quantity, and yielded an abundance of albumen; while a little variation of the place of puncture rendered the urine small in quantity, and restricted the organic matter to sugar alone. (Bernard, Lecons, &c., 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 appeared in a natural state. But 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 varied (ut 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\, 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 ofthe 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, when, as affirmed by Bernard, 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 ofthe indications of cure as supplied by Organic Chemistry, when we contemplate the successful treatment, by bloodletting, of the remarkable case recorded in § 1007, c? 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 ofthe respiratory function, which is rendered farther probable by the injury being inflicted at the origin of the pneumogastric nerve. 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 are the complete contradistinc- * " Quand, apr£s avoir pique chez un Chien ou chez un Lapin l'origine des pneumo- gastriques, nous lui avons ouvert la ventre au moment oa la surexcitation portee sur la foie presentait son summum d'intensite, nous avons vu qu'alors il y avait une plus grande activite de la circulation abdominale, le systeme capillaire etait gorge de sang, et les vaisseaux de la surface du foie plus apparents qu'a l'etat normal. Les reins sont alors eux-memes tres surexcites, les ureteres sont tres irritables; il suffit de la toucher avec la pointe d'un bistouri pour les voir se contracter energiquement."—Bernard, Lefons, &c, p. 331. 1854-55. 794 institutes of medicine. tions between organic and inorganic beings, that it may be safely con- cluded 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, 376A, 409 / 417, &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 spirit 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- morphosis of any dextrine that might be present, and then examined for 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, clue to the combination of albumen with ulmate of potash." Becquerel and Rodier say, that the chemical processes relied upon are " almost exclusively" tho last two—B. and R.'s Patholog. CItem., 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, suppose 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 ofthe 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 ofthe 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, 039, 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 effects 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, b, 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 where is it now ? Dissipated by Liebig as by an enchanter'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 answers, 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 Wwoui 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 (%l,b, 350, Mottoes). And I may be now permitted to at least correct a misapprehension of Professor Lehmann's, who, in the seclusion ofthe Laboratory, like all others ofthe same laborious and abstract pur- suits, is evidently uninformed ofthe 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 thoroughly 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;" 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 with 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 Hegel and Schelling, are yet unwilling to relinquish their less elevated position. If these happy admirers of their own 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 whatever 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 between organic and inorganic bodies. A Chemist, totally unacquainted with organic matter, would a priori have deduced all these incidental 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 few 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 Chemistiy, vol. i., p. 33, 34. 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 ' Gegenwart.' " At another time, also, he caricatures the doctrine of vital solidism as " a belief in supernatural forces of mat- ter."-—/Jitf., 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, Muller, 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, Areta:us, 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^\g, 351, 360-364, 366, 376^, 376| b, 744, 1006 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 priori 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 differ- 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 are 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 we 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 supposed to depend upon certain physical laws." — Lehmann's Physiological Chemistry, vol. ii., p. 376-399. 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, who 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 ofthe 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 inagic, from the chemical changes effected by the rays of light on 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 strong light, gives only faint and half-effaced images, is wearied like the retina, when, after repeated and continuous per- ception of an image, it gives back only the faint outlines ofthe object?" !! —Ibid., vol. i., p. 30. (Also § 349 e, 350% n,p, 350§ 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 (§376i). ' ' 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 unweaving ly occupied for years 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, k, I, and No. 1)7 of parallel columns. Our Author's error, therefore, as will be readily seen, proceeds from an unceasing devotion to the phenomena of dead matter (§ 376^), 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 b, 167, 191, 234-235, 237, 285, 303f, 3761, 376f, 447 a, b, c, 516 d, No. 6, 676 b, 801 a, 819, 1006 a, 1029, 1030). But our Author has now the consolation of knowing that he has achieved his object of convincing a multitude of Physicians (§ 51, 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 ofthe 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 endeavours to uphold a single fact (§ 5i a, 530).—Lehmann, ibid., vol. 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- ence between organic and inorganic bodies," or, especially, if " a Chem- ist, 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 ?" 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 ofthe past, whether the phrensy of a morbid ambition is not most likely to react upon themselves % (§ 6, 376-1.) 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;" 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 (§ 3761 530, 819 b)."—Medical and Physiological Commentaries vol. ii., p. 684. 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 awakened the deepest sensibility. And, while thus employed in this very personal manner, he will not forego the gratification of uniting to that ofthe 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 of 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 what 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 normal 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 connection 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 (§ 413-463, 639-709); 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^?*?/?, 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 nature, 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 ofthe 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). PKOGRESS 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 kidney, whose rank in organic life I have advocated in foregoing sections (§417, 422-427, 892J a-c, 1032), has been subjected to much critical inquiry, and although the exposition of its elaborate organization call up an as- tsociation 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-Sequard, 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 e e 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-Scquard whose genius and industry have also enlightened the physiological world upon special influences ofthe nervous system, which, if not as important in their relations to the laws of that system, are more attractive. Anion"- these may be mentioned his remarkable experiment of producing epilep- tiform convulsions, through a special association ofthe nervous influence with a particular point in the skin by sections of the spinal cord, and an extension ofthe 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 Hesearches applied to Physiology and Pathology, p. 18, 30, 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 new 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). § 1037, b. Brown-Sequard's discovery relative to the spinal cord modi- fies the statement made in the brief sections 465, 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 b, 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 ofthe 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 Reflex Action.—appendix.— Organic Properties. 803 not entirely, from the posterior roots ofthe 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 these sensitive fibres decussate very 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 Review, 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 ofthe 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- Sequard 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. § 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, appear to me important as supplying indications through which we may be enabled to comprehend the philosophy of contiguous sympa- thy. The plexuses, also, if not the ganglia, are thus rendered more prob- able media through which, in part, the phenomena are brought about (§487 g, 497,499 a, 516 d, No. 9, 520-523,524 d, No. 4). THE NERVOUS POWER; ORGANIC PROPERTIES. § 1039. Moreover, we are indebted to Brown-Sequard for a multitude of experiments illustrative of the laws of reflex action, as hitherto ex- pounded (the Author's remote sympathy, § 222-233f, 452-530), 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 organic 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 Ufe 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), and, together 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-Sequard, " that the bloodvessels 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-Se'quard 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. p. 9-10, 75. Experiments of the foregoing 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 were 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 Med. arid Surg. Journ., July, 1857, p. 477.) This fact alone is evidently fatal to the catalytic and every other chemical doctrine of secretion. 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, 456, 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 Reflex Action.—APPENDIX.—Organic Properties. 805 otherwise affecting 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 vasorum, and as well, in all these respects, to the nervous system itself, when the Nervous Power is determined upon it (§ 230, 509, 950); or, if it affect the voluntary 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- untary motion, are carried on by the latter, to which 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 ofthe right posterior limb. fifteen minutes after the beginning ofthe injection" local life, i. e., irritability, was restored in the limb receiving blood, and cadaveric rigidity had disappeared."—Experimental Research- es, fa, ut cit, p. 15, 92. Also, § 171, 1072 a, note. Corresponding with these observations are many others, in a chapter " On apparently spontaneous actions of the contractile tissues of the animal body" (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 system." 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 ofthe nervous power," to express conditions ofthe system which 806 INSTITUTES OF MEDICINE. are especially due to its powerful operation (§ 940-952). The expres- sion is evidently without any meaning. § 1042. But, as I apprehend, the foregoing phenomenon, in being anal- ogous to the movements ofthe 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" (§ 205- 215, 233). 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 very slight one" (§ 188^, d). "From these experiments it follows that 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 ofthe iris to contract when stimu- lated by light lasts extremely long, particularly in certain animals. In eels it lasts sixteen clays in eyes taken out of the orbit." Muscular fibres, therefore, "may be stimulated without the intervention of nerves. In the 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 in twelve or fifteen days after extirpation, i. e., at a time when muscular irritability is sometimes still existing."—London Philosophical 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 Medical and Physiological Commentaries, particularly the pulsation of an extirpated heart of a sturgeon after "the auricles had become so dry as to rustle 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 affected 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, [ 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 Reflex 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-Se'quard, " 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 atmosphere 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 ofthe mouth has been nearly 1° F., and this only in one case."— (Exp. Researches, &c, p. 33.) Now, in the first place, is seen in the foregoing paragraph a strong ex- emplification ofthe law of sympathy 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." (Exp., &c, p. 9.) Indeed, our Author remarks, that " Dr. Tholozan and myself have observed that the greater the pain felt, the more the temperature was diminished in the hand left in the air" (p. 34). § 1044, b. The foregoing experiment was 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 808 INSTITUTES OF 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 ofthe body (as related to the sympathetic reduction of tempera- ture in the hand that was not immersed in water, § 1044, a), 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. 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 surface, 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 which 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, b) in their only intelligible import, and bear a general correspondence with those to which 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. Se'quard 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, d). This very palpable proof has hitherto received no attention at the hands of the Chemist; 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). 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 Dr. Kane is the latest, most capable, and has supplied ample mate- rials. I shall also dispense with farther comment, which has been fully provided in the earlier pages. But I shall do the work 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 winter expeditions. § 1047. In the first plaee, 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 5-442 c, 443 c, d, 447 g, h, 535-540, 615-619, 626 b, &c). Thus, our Author: " The mysterious compensations by which we adapt ourselves 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 hardly 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 with, a fire. Another of our party, George Riley, with a vigorous constitution, established habits of free exposure, and active cheerful temperament, has so inured himself to the cold, that he sleeps on our sledge-journeys without 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, I 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 (§ 250f/, 438 b, c, 440 bb, 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 liquors." 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 " Robinson 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 several 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 60D 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 very 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 forward to another year of disease, and darkness, to be met without fresh food and without fuel." " Moss was gathered fpr 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 26th, 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 meat, and can not get along without it. Our sick have fin- ished the bear's head, and are now eating the abscessed liver of the animal, including some intestines 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 80th, he says, " I gave Wilson one raw meal from the masseter muscle which adhered to another old bear's head / was keeping for a specimen''' (Vol. ii., p. 17, 34.) Reflex 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 ofthe 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 pair, 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 circum- 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 whole story of this winter illustrates 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. 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 tallow 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, they " 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 b, 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, 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 were 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 ofthe 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 very 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 pork, which is their favourite food. Their hogs are remarkably fat, and they eat their pork almost raid" (§ 440 bb, 441 c).— Asiatic Researches, vol. ii., p. 382. London, 1799. "THE PRIMORDIAL CELL." § 1051, a. The present inquiry refers specifically to what is said at pages 36-49 (§ 63-81), 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 structure of the cells or their endowments of life; and this assumption professes to be predicated ofthe 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 doctrine (§ 350J-356). Upon this hypothesis, there- Structure.—APPENDIX.—Primordial Cell. 813 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 (§ 72-76, 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 b). 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' (§ 260-265). 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 what lies the essential difference between them. '• One of the humblest known Protophytes, the Palmogl&a macrococca, whose multiplication gives origin to the green slime that 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 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 Algae ; but the study of the development of new organs in Phanerogamic plants leads to the same conclusions, and the results at which Mr. Wcnham has lately arrived, from observations chiefly made on the newly-imported aquatic weed, Anacharis alsinastrum, are so instructive that we shall sub- join a brief summary of them. Pie 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, which make their 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 etivities 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 Amoeba, 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 Palmoglaaa, although placed on the other side ofthe 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 ' sarcode,' 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 sarcode 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 surface." "In these creatures, although they have neither digestive cavity, mouth, nor anus—although they are, to all appearance, nothing else than ■particles of animated jelly not even confined within 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 animals" (§ 14, b). Continued in § 1052. 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 wrill readily distinguish the lowest species of one kingdom from the lowest ofthe 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 ofthe 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 ofthe 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 Ama-ba or an Actinophrys, in its quiescent state, with a Palmoglaa, or an equally simple Protophyte, we can scarce- ly assign any structural characters by which one could be differentiated from the other. But when wre 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; but 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 theWegetable kingdom" (§ 13-14, 17, 303-304). "Again, the Proto- phyte obtains its nutriment by the absorption of liquid and gaseous mole- oules 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 Review, p. 3-7, April, 1856 ; New York edition. The italics are generally mine. And now, will Organic 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," 816 INSTITUTES OF MEDICINE. and that " a Chemist, totally unacquainted with organic matter, would a 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, starch, 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 V And be- fore taking leave of our able Author, 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, 22 x65, 23x66, 23^x67, 68, 69, 70, 25, 26, 2G-J, 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'?" (§ 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. When 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, G64M366, 670. Also Index, Vital Proper- 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 properties of the hybrid animal have under- gone such a mutation, and in striet 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 (§ 654 b, 664). Absorption.—APPENDIX.—Circulation. 817 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 we have seen, of the most compre- hensive grasp. For the same reason, therefore, we may conclude that the varieties which may arise 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. § 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. Vie 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 staminate, and therefore unproductive flowers (§ 5^ b, 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 ofthe 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 Index). § 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 references there. Also § 350, Nos. 26, 26±-, 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- Fff 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- ance from 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 of Motion is to be found in a series of changes which the food undergoes in the organism, and. these are the results of pro- cesses of decomposition, to which either the food itself, or the structures form- ed from it, or parts of organs, are subjected" (§ 350, No. 7, 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 (§ 350f). 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 with which this Appendix ends. 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 afl 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 ofthe 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 ofthe 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 ofthe 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 ofthe food." The same order of events ob- tains in the liver—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 the action of the heart," and that it "is the chemical substitute for the medical aphorism, ' ubi irritatio ibi affluxus,' " and that it is made the grand basis of all Pathology and Therapeutics (§ 350, No. 10, § 350£—350f). The latter, indeed, should naturally flow from the main physiological doctrine, if Nature be truly represented by this (§ 1 a, 2 b, 638). 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 leaves, or even buds, when vegetation starts from its hybernating state in northern countries ? Observe the Acer saccharinum—the remarkable 820 institutes of medicine. rigour 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 ofthe 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 363-370. Such, mainly, is also true of the Vitis vinifera, 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, therefore, 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 stump alone wras 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 regards the ascent of sap. Take, as an example, Exp. 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 plainly owing 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 ofthe sap 38 inches, equal to 43 feet+3 inches+^- 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 was 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 the water went the wrong 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 has 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 wras 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 Exp. 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, when less is evaporated." In Exp. xlvi. he says, " It was found that the trunk and branches of vines were always in an imbibing state, caused by the great perspiration 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.xxwi.). 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 othersci- 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- ^sortt^m.—appendix.—Circulation. 823 losophy of life, and turn against the conclusions of the original ob- server. 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 ofthe 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 " Researches on the Chemistry of Food, and the Motion of the Juices in the Animal Body," 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^, 676 b, 1006 a, 1034, &c), and that it may be compared with § 350,par- allel columns, and § 350^ 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 from 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 " American Journal of Science and Arts" (May, 1848, p. 415), and which I quote for the brevity ofthe 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 ofthe bloodvessels, and the cause of their distribution through the body. We know now what important function the skin fulfils through evaporation" ! (§ 350|, n-q.) Our Author did not even think so far as to consider the perpetual vicissitudes ofthe 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 have 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, we 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. EXPERUVIENTS BY MYSELF TO ASCERTAIN WHETHER THE QUANTITY OF BLOOD CIRCULATING IN THE BRAIN MAY BE REDUCED ARTIFICIALLY. § 1056. 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, &c.), 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 Review, 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. Review, 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 brain 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, &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 ofthe 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.—Experiment. 825 cranium in consequence ofthe 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 Kellie'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 ofthe 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 Ave shall always find the cavity ofthe 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 xiescending 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 ' unifonnly found the vessels ofthe brain and ofthe 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 : ozs. drs. grs. 1. Brain—skull trepanned......................... 10 4 20 . Water—distilled................................ 10 4 10 2. Brain—skull trepanned......................... 9 4 25 Water—distilled................................ 9 2 0 3. Brain—skull trepanned......................... 10 3 26 Water—distilled................................ 10 2 6 1. Brain—skull entire............................. 11 1 5 Water—distilled................................ 10 7 20 2. Brain—skull entire............................. 10 G 10 Water—distilled................................ 10 4 50 3. Brain—skull entire............................. 10 2 40 Water—distilled................................ 10 0 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' (ix); 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 their 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 than 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, however, the necessary limits allotted to his Article only permit us thus to glance at. " 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 course 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-c, 938 b, 944 a-c, &c). 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 body, an influence rendered still more probable by the propagation of the sympatlietic 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?' (§ 516 d, 756 b, 893 d-i, 915-921, 939, 974, &c.) " 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 admirable 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 increased 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 nerve, &c, are, in Dr. Paine's opinion, so many powerful motives for believing that the circulation in the brain is especially dependent on a specific action ofthe vessels themselves (§ 392c, &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 inquirers, 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- 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 more 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 b, 968, 969 c, 990 i). " 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 Donder 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 under1 such circumstances, it is a law which must operate in the natural con- dition.—Donder's Physiologic des Menschen, p. 138,140. SEDATIVES- § 1057, a. 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. I understand by Sedatives those remedies whose general tendency is to diminish vascular action in a direct manner; though in some instances Therapeutics.—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 effects upon the system at large until the cerebral affec- tion gives rise to constitutional excitement (§743, 817, 827 c/, 950, 974b, 1024). 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, wc are presented with agents which illustrate, by their opposite virtues, the common attributes ofthe 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 reckoned as standards of comparison for Sedatives, and alcoholic licmOrs, 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, Irideed, the 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. 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 ofthe body. There must be a pathological condition which shall be in relation to the peculiar virtues which are denominated sedative, or no sedative effect maj arise from the action of the remedy, and even an opposite result maj 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 term 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 ofthe 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 (§ 662 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, while 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 intermittents. The latter is then so completely in relation to the spe- cial modifications of disease that it transcends or counteracts the mor- bific action ofthe former (§ 150-151, and references there). § 1057, c In my " Therapeutical 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 sub- divisions, namely, 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, Hydrocyanic 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, and four ofthe "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 mych use in medicine as nauseants; but, on the contrary, they are 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, e. 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, Therapeutics.—APPENDIX.—Sedatives. 831 however allied as 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 strong 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 ofthe 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. 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 correspond- 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). § 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 power has little or no participation in the effects. (See Index, Nervous Power, Sympathy, Ch^ganic Properties.) 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 furv is expended upon the organic constitution of the brain, and venous congestion of that organ is one of the invariable consequences. Hut thic, ;<* offfpfPrJ through a very different process from what has been 832 INSTITUTES OF MEDICINE. hitherto supposed. The result is partly due to the determination 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 upon important organs remote 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 determin- ation 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. (§ 476J 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 the determination of the power upon various parts, which lessens and otherwise modifies the irritability, sensibility, and, of consequence, the organic actions, of all parts of the body (§ 904, a, b). § 1057, g. 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 effect that its operation as a sedative is witnessed. Its constitutional effects 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 exceptions to this, as when a current of cold air striking the neck or chest occasions rheumatism, catarrh, pneumonia, &c., or when ex- posure of the feet to cold arrests menstruation. There is, also, a still more remarkable and very uniform effect of exposure to the cold air, but not of a morbific nature, in suddenly increasing the excretion of urine; and, if with this phenomenon be associated the powerful effect of fear as a diuretic (§ 892f, b), and taking along the morbific action of cold as applied to the surface, the physical philosopher of life will find, as with a thousand other analogous facts, that his doctrines are liable to very insuperable difficulties (§ 422, 441 d, 649 c, 657 a, 892| c, 896, 902 m). Again : when cold operates with great intensity upon the whole surface of the body, it occasions lethargy and venous congestion of the brain. The philosophy is the same as when hydrocyanic acid produces cerebral congestion. (See Essay on the greater action of Cold in Medical and Physiological Commentaries, 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 many things which illustrate the important agency of the nervous power in transmitting the influences of remedial agents from the direct seat of their operation to distant parts, and show us how readily and with what intensity this power may be brought Therapeutics.—APPENDIX.— Castor Oil. 833 into operation by 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. § 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 ; though great variety 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, 854, 857, 863 d, 892| g, 902 g, 904 b, p. 675). § 1057, i. Finally : the group of Sedatives is designed mainly to bring into connection a number of remedies which 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, k. 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, where 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 G G G b31 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 upon 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 lur^e 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 only hope for a palliating effect. § 1057,1. Of Castor Oil I remarked, in the same work, 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 the 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 m, mm). Other comments follow upon its important uses as a ca- thartic for children, and for pregnant women, 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, espe6ially if seated in the alimentary canal. I 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.—A Iterative. 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 influence; often calm- ing 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 d, 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- in" 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 z, 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. § 1057J. 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 repetition. 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 prominent 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 g). 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 Passions. 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 we have variously seen, all agents which exert effects upon parts remote from the seat of their direct operation, transmit their influences through the medium 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 great 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 (§ 222-233f, 516 d, No. 6, § 551, 552, 556, 841, 863, 867, 894-896, 902 e-g, 904 b, p. 675, § 905, &c). Therapeutics.—appendix.—Alteratives. 837 It will be seen, therefore, that the distinctions which are made of remedies into Cathartics, Emetics, Expectorants, Astringents, &c, 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. 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 the Orders ofthe 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 injlammaiory 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, 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 Cutaneous and other Local Affections. (See p, 643, 644.) These Alteratives (p. 643), which are employed locally, may operate either constitutionally, through reflex nervous influence, like the internal alteratives, or may exert their effects in a peculiar local manner, and without the intervention of the nervous power. Such, for example, may often be the case with Suppurants, Escharotics, and Sedatives; but Ves- icants, which are embraced in the group, always exert their effects upon internal maladies through the reflex action of the Nervous System (p. 646-648, § 893 e,f, p. 652-655, § 893 m, p. 657-659, § 893ja, p. 679- 681, § 905 a). Other remedies included in the group appear to 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 relieved a very painful neuralgic affection of the whole extent of the sciatic nerve in fifteen minutes by rubbing along its course an oint- ment of aconitin, which had refused to yield to other remedies.—The ex- tensive subdivision which is designed for diseases of the skin supplies examples 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 effects through reflex nervous in- fluence, such as the mercurial ointments (§ 514 d, 826 d, &c). Reme- dies of that nature, therefore, are arranged also in another subdivision, indicating their extensive constitutional influences through the medium of the skin and nervous system. 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 Medica. § 1057f. 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 work 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 effect; 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 Alteratives). 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 comes next in utility on account of its adaptation to a great range of chronic affections of the di- 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). 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 gerierally surpasses all others (§ 1057, I); and, next to this, in a general sense, we may reckon Jalap combined with Tartrate of Potash (§ 1060); 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 that 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, 886 b). ' 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 reaches 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 sympathetic influ- ences 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 suit- ed to diseases of that organ in many of their phases. But its action upon this, and other organs remote from the stomach, will depend upon the manner in which they may be affected by disease; for we have various- ly seen that the susceptibility of organs to the action of remedies is not only increased by disease, but will be influenced by its exact condition— than which there is nothing more important to be known (§ 129 h, i, 134, 137 d-151, 548, 556 c, 650, 662, 674 d, 675, 854 bb, 855, 859, 870 aa, 871, 888, 892 c, 892^ a, b, 892| d, 970 c). When the whole system is invaded by disease, as in idiopathic fever, we may anticipate a universally favourable 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, we 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 Bloodletting have been premised (§ 672, 868, 871, 889 g). And yet, under circumstances of health, the same dose mi»ht have no 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, where 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 this 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, 938 e, f 956-958, 966, 968, &c.). From these analogies in their useful effects, and from their powerfully alterative virtues, it is evident that the same coincidences will be likely to obtain in their bad effects (§ 854 c d, 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 will 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 ofthe 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 ofthe 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— will arrest 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 ofthe remedy, as will be more distinctly seen in the entire failure of such doses, and of others far more moderate, in the ordinary 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 power. 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, 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 all 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 ofthe 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 preceu^d 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 b, 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 ofthe 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 differing, 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 ofthe patient for one or more months anterior to the attack. Its principal causes 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 be also premised that the miasmatic form is attended with a special condition 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 formerly 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 Bloodletting. Calomel, however, does not irritate in the same way as other cathartics. But it will often do what is much worse in rnuco-intestinal inflammation. It may not only in- crease its severity,, 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 ofthe 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 the 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. When 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 Bljie 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 of the disease, will be very likely to destroy the patient. Or, if he de- pend upon astringents, or administer Rhubarb as is often done (§ 1062), 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. As to Loss of Blood, Nature also proclaims in this variety of dysen- tery, more distinctly than in the sporadic, the true nature of the treat- ment, for here the effusion of blood from the intestinal mucous membrane is greater; and this is plainly the remedy which Nature institutes for her own relief (§ 805, 862, 863 e,f, 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 take the place of 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,/?. 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, 861). 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- 844 INSTITUTES OF MEDICINE. tions, and often convert a mild into a malignant form. And here, 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 secondary results of a far more alarming condition of disease in the ab- dominal organs.i+The swelling of the glands, in these cases, is not at all owing to the direct specific effect 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, so 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. 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 ofthe abdominal viscera (§ 1057, /). 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 these 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 (§ 173 c, 524 d, 847, 858, 870 aa). § 1058, i. As to the treatment of measles and small-pox, I do not recol- lect to have witnessed any injurious effects 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 whooping-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 erysipelas, a disease which is often sadly managed by tonics and stimulants (§ 1005,/). 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, the 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 j), 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 ofthe 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 ejects of Calomel and Blue Pill; and no fatal case has occurred in my practice (§ 1005,,/). § 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 docs any harm. But, in all severe cases, a free abstraction of blood should be the first 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 next 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 be affected, the Loss of Blood will 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, ?in. 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 ofthe abdominal organs. But here, if the paroxysm be at all severe, and we would most speedily relieve the patient, he should be first bled. Lastly, if necessary, and often pretty early, Colchicum may be exhibited. § 1058, o. 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 b, p. 675, § 1068 c). Leeches and Blisters may ultimate- ly be wanted, and perhaps more or less opium to tranquillize the cough. But of this I have spoken in other places (§ 8921- g, 1005 h, k, 1017 c). § 1058, p. 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 Ipecacuanha 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 Bloodletting is applied early. But the disease ad- vances with great rapidity, and may quickly reach a stage when all remedies will fail. The bane of our practice in acute diseases that may call for active treatment, and where the remedies are right, is procras- tination (§ 869). Bloodletting has been often useless in severe disea- ses when it would have saved life had it been applied a little earlier, and to a proper extent. 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 great- er interest, however, that the child was rather the victim of the purga- tive action of a divided dose of Tartarized Antimony. The croupy 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 purging, 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 g, &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 inflammation 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 are now con- sidering, especially if all purgative effect be restrained (§ 516 d, 860, 863 d, 890 /, 902 i). 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 sympathy to the brain (§ 889, /, g). Calomel, Blue Pill, Jalap, and Castor Oil are alone Avanted, so far as cathartics are concerned. The Drastics have been commended upon the fearful doctrine of counter-irritation, supplying an impressive contrast with the objections alleged against Bloodletting. 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). Leechino-, 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 was 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). § 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 here there is but little chance for other remedies until the disease has been broken down by loss of blood (§ 960/, 995,1005 e). . , § 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 those 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 (§ 426, 427, 691, 905| b, 960 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 mellitus. § 1058, t. Where inflammation of any ofthe tissues ofthe 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 with 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, &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 § 990-990J. § 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 the.se 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 ofthe 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 regarded 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."—Transactions,. &c, p. 8, 40, Indianapolis, May, 1857. § 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 (§ 891j,/). § 1058, re. 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. But they are rarely of any use, and generally injurious in these diseases, which are constantly supplying instances ofthe importance of addressing our remedies to the exact path- ological conditions (§ 668, 672,673, 675, 681 c, 685,891J b, 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 Opium or Morphia; or, at other times, the Calomel combined with the Opiate. 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 a full dose of Calomel, opium, 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. 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. § 1058,5-. 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,/). But a prompt and large abstraction of blood, as we have already abundantly seen, is the only reliable means (§ 1005, b-g). 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 Hhh boO 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 alterative (§ 672, 867, 871, &c). 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 a>f variously presented in the following sections: 129, 130, 137 «V, 143- I 1ltl, T67fnote, 188a, 188**1, &S, §215 227-230 232,234 c,c>g m 239 240 241-246, 266, 285, 330, 422 b, 423, 446 a, 4o0 e-4ol a, mflT^c, 479, 481 b, 485, 486 487. 488| 492f, p. , UOOd-n 509 510,512, 514c, 564-568, 577 c, 578 c, 579 b, 581 c-e, 593, 5 H 598 M00 » 601 c, 631, 740 a, 844, 853 863 d 890* d, 891L,, , 892f 902 A/,m, 904a, 938 6, 943&,944a, 947,951d, 976c 10401072. §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 throu-h 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 nerv- ous power into action (§■ 1039-1041, and references there), then «^B influences will, as in the case of the passions, depend upon their^piesrce nature, and the special manner in which they modify the nervous pow eV^^Z^^~^ ofthe coincidences between the effect's "of thTmlntal emotions and remedial and^orbiflc agen s a d that they all operate upon a common pnncip e (§ S5f*f°Jt£^v ^ 894-905), and as the former are in perpetual operation, either tor good 868 INSTITUTES OF MEDICINE. or for evil, it becomes evident that the Practitioner may be as intelligi- bly and as much interested in regulating the moral as the physical treat- ment of disease. The latter generally preponderates, often greatly, in importance; but occasions are constantly arising in which the former should take the lead, while it has at all times the advantage of being converted to the salutary effects of physical remedies. Would our limits admit, we could draw upon the histories of lunacy for a vast amount of materials to illustrate the philosophy and practical importance of our subject. But all this will readily suggest itself to those who may study the phenomena of insanity in connection with the philosophy of the mind in its relations to the organic life of man. § 1067, d. What we have now and hitherto seen ofthe precise corre- spondence between the effects of the passions and of physical agents in the organic life of man may be carried with the effect of the clearest demonstration in proof of the substantive, self-acting nature of the Soul (§ 1069-1077). This must be conceded by Philosophers of every school; and those who agree with the present writer in his construction ofthe operation of the nervous power will see how greatly the demonstration is extended by regarding that power as the medium through which physical agents exert their effects upon parts remote from the direct seat of their operation. Here we have a common efficient cause for the com- mon phenomena. The mental emotions, in one case, bring the nervous power into action by their direct influence upon the great nervous cen- tre, while physical causes, in the cases supposed, develop the power in- directly, and in all the cases each agent modifies the power according to its own special nature, and directs it in so complicated a manner, and ac- cording to an incalculable amount of contingent circumstances, through a labyrinth of nerves, as to form the most difficult problem in Physiolo- gy (§ 233|, 894, &c). But to the mere practical man, who aspires beyond the walks of em- piricism, the effect of the passions in the production and cure of disease, and their undeniable operation through the nervous power, supply a ready apprehension of those analogous problems which attend the opera- tion of morbific and remedial agents of a physical nature, and a fruitful means for contesting with the Chemist the field of Physiology. HAVE DISEASES UNDERGONE CHANGES OF TTFE WITHIN THE LAST FORTY YEARS, OR HAVE NEW ONES APPEARED1? § 1068, a. By change of type I mean that radical change which is supposed to justify the substitution of the stimulating for the antiphlo- gistic treatment of inflammatory and febrile diseases. In this accepta- tion I answer the interrogatory as it has been in all past time by every truly enlightened and impartial observer. John Brown, the great An- tagonist of Nature, and who leads a host in his train, is in no respect an exception ; for, whatever may have been his genius, he had very little practical knowledge, was intemperate in his habits, and the revolution which he achieved was prompted by animosity towards Cullen and other early friends. As it is important to understand the ground upon which this School originally stood, I shall introduce a brief sketch of its origin from the "American Encyclopaedia" Thus : "Brown was admitted, as an indigent scholar, to a gratuitous attend- ance on the lectures (Edinburgh), and obtained the patronage of Dr. Cul- len, who employed him as a tutor in his own family. During this course Diseases.—appendix,—Change of Type. 869 of study, he married, and set up a boarding-house, but failed, and became bankrupt. About this time, by a long course of meditation on the ani- mal system, and the vigour of his own mind, directed by some reading, but seconded by little or no aid from practical observation, he elaborated a new theory of medicine. The result was, the publication of his Ele- menta Medicincv, which he farther explained in a course of private lec- tures. Brown scrupled at no means to push his doctrines. A new med- ical language was introduced; ideas totally at variance with former opinions were maintained; and the most virulent abuse of the regular Professors of the University was perseveringly uttered. At length, ru- ined in reputation, he repaired, in 1786, to London. Here he endeav- oured to excite attention by his Observations on the Old Systems of Physic, but without success."—The day of success, however, was not long delayed. The Elements of Medicine had the advantage of being written in Latin; and as the simplicity of its doctrines, and the practice incul- cated, were novel and fascinating, all Europe soon became ensnared by the charm (§ 621 a, 890^/, 960 a, p. 717, 719, § 1006/, 1065 c). § 1068, b. Under my own observation there has been no change in the character of diseases, with the simple exception that some forms have been less unyielding within the last twenty years than during the pre- ceding twenty. But this qualification is mostly limited to the common forms of local venous congestions and congestive fevers (§757-785, 786- 818, 961-970). These affections have yielded, during the latter period, to rather smaller abstractions of blood, and smaller doses of medicine, particularly cathartic's. But precisely the same general mode of treat- ment has been indispensable to an early recovery, or to a complete re- moval of the disease, or to the preservation of life; while, on the con- trary, the prevailing Brunonian treatment has been distinguished by its former disastrous effects (§ 1068, a). In proof of this, I need only advert to the excessive mortality which has attended the yellow fever within a few late years, and in the treatment of which the stimulating plan has been generally practised (Indexes, article Loss of Blood). As an exam- ple of the mortality, though perhaps rather excessive, it is stated in the able Report of a Committee of six Physicians on the "Yellow Fever at Norfolk, Virginia, in 1855," that " The number of deaths was about 2000, or one fourth of the entire population remaining in the city. When we consider that half of this population was black, among whom there were few deaths, it seems probable that more than one third of all the whites attacked, died."— Report, &c, p. 38; Richmond, Virginia, 1857.* * In the same Report it is stated that the yellow fever "in its symptoms was much the same as all the great epidemics that have occurred either here or elsewhere" (p. 38). It was early in this epidemic that some physicians entertained the hope that the Muri- ated Tincture of Iron would prove a specific for the disease. Here, also, we meet, among other important statements, with an observation of crush- ing weight to the doctrine of contagiousness of yellow fever. Thus: In no case that we have known or heard of was there the least reason to suspect that the disease was contagious. Many hundreds of our people, flying from the pestilence, sickened and died in the neighboring counties and cities, in hotels and private houses, in infirmaries and hospitals, under all possible,varieties of place and circumstance, and yet we have not heard of a single instance in which it was ever alleged that the disease was communicated to the attendants or friends" (p. 38). This important Report is signed by William Selden, M.D., Robert B. Tunstall, M.D., William J.Moore, M.D., S. D. Campbell, M.D., Robert H. Gordon, M.D., A. B. Williman, M.D. It should be said, however, that Dr. Williman dissents from the foregoing statement, and believes that "the cause of yellow fever is some minute material germ, capable of reproducing itself when given off from the human body suf- fering under this disease" (p. 44). 870 INSTITUTES OF MEDICINE. As to the acute and chronic forms of inflammation, I have observed still less of the modifying effects of remote causes (§ 644-676, 710-756). In the acute form, as affecting 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, inflammation of the brain, peritoneal inflammation of the intestines, puerperal peritonitis, rheumatism, &c, have remained without modifica- tion, or with the exception only that Cathartics require a more careful regulation of their doses (§ 857, &c). In these conclusions I am also sustained by what I have learned of the histories of disease throughout the United States (§ 969 d, 1005 I, 1005 J, 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, 10051). It may be also proper, in consideration ofthe 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 effects 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. § 1068, c. Moreover, having adverted in this work to the treatment which I pursued in a case of inflammation affecting one of my own fam- ily (§ 992, d), and a case of remittent fever of which another member was the subject (§ 870, aa), I shall state briefly the practice which was pursued 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 grains 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 the 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 had inculcated in my medical writings, and which I taught my Medical Class." I had then in mind, Similar facts have been accumulating since the Author of this work endeavoured to settle the question of contagion upon philosophical grounds (§ 650, 653 a-d). Diseases.—appendix.—Change of Type. 871 also, the experience which prompted the remarks just antecedently pub- lished in § 892| i, 1006 b, c. I was accordingly bled to the extent of about 20 ounces, when the symptoms vanished entirely and permanently (§ 955, b). 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 usual morning exercise of sawing wood (§ 992, b, c). No other medicine was taken, and no blister was required. It should be said, also, that my general health had been infirm for a long time antecedently, and that it became subsequently much improved (§ 1007, b). § 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 was surrounded; while it will go to show what have been the practical habits of the writer, and that he has inculcated nothing upon the subject of Bloodletting that has not been warranted by his own experience. The patient was one of our medical students, the now Dr. Johnson, 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 was great constitutional irritation, much restlessness, pulse rapid, hard, and small. Strength prostrated. No difficulty in respiration (§ 140, 525-530, 579 d, 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 their 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, p). 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, for 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. That 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, and the same apprehension that it might hasten death. The Soul.—appendix.—Instinct. 873 PHYSIOLOGY OF THE SOUL AND INSTINCT. DEMONSTRATION OF THE SOUL. § 1069. In the year 1849 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 is essentially subservient to the Soul and Prin- ciple of Instinct (§ 455), or to materialism. 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 (§ 473-475). 3. The ganglionic or sympathetic nerve is designed particularly to connect together, in harmonious action, the involuntary organs, or those upon which life essentially depends. It is also through this nerve, espe- cially, that the passions display their effects (§ 96-108,113-117,126-130, 455, 523-524, and references there, and Index IL, 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 supposed, also, by many, 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 ofthe 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.,Men- tal Emotions). The influence of irritations ofthe expanded extremities of the sympa- thetic nerve may be also transmitted to the voluntary organs through the circuit of this nerve and the great nervous centres, as seen in the 374 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 (§454-475, 500-524). 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 excito-motory 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 when propagated through the nerves which supply the organs of sense (§ 201-204, 227, 451-453, 462-475, 500, 1037 b). It should be also remarked that, while some ofthe 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 office. It is also important to understand that my demonstration is concerned particularly with the system of excito-motory nerves, both voluntary 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 bbth 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. § 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 ofthe 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 ofthe 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, which are then reflected from those centres upon other parts through excito-mo- toiy nerves or the motor fibres of compound nerves (which are also called, in such cases, nerves of reflexion). The palpable exceptions to these re- flected influences, and where 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 there alone are the impressions felt (§ 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 phrenic 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 pneumogastric 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-n; 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 contraction of the iris, and is so far unobserved, it will be readily understood by the uninformed how a similar impression upon the pneumogastric 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 ofthe Will- But, in the case of the direct im- pressions, it is particularly important to remember that the motions which are produced by the 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 arise as the effect of impressions propa- gated from distant parts upon the nervous centres. It may be finally added that the two nervous centres, and both orders 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-motory nerves are concerned in developing the mo- tions which 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 lungs to the nervous centres; but in voluntary respiration the pneu- mogastric nerve is not concerned, but only the neiTous 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-Sequard 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 the 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 su,ch 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 cbVust, and the coincidences, also, between the effects 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, 476 c, 50.0 f-n, 844, 1067 a). § 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, m 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). 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 ot 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 b, 183, 188 a, 227, 230, 232, 241-245, 476 c, 500 f-p, 902 1,1067. Also Indexes, article Will). 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 characteris'tic 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 variously brought into action either by physical or moral 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 b'e 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, Organic 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 ofthe analogy between the effects of those elements ofthe mind (or emotions, if it be preferred, § 1072, b), 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 when 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 anal- ogy in 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 irritants 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 whose brain is shocked by a blow or irritated mechanically, and spasms follow in the voluntary muscles; and you sec 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 seethe 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 depressed 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 ofthe 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 paroxysms 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 ofthe Mind 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- untary 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 ofthe skin and the copious perspi- ration, the flood of urine, the hurried movements ofthe 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 CJrief, 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 b, 944 b, 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 are totally distinct and different from those nervous centres; and, can any one be so regardless of the plainest rule of philosophy 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 pursuit of a common proximate 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 b, 234 a); and, from the analogy in the effects of the Will and Passions, it is equally clear that these elements or emana- The Soul.—APPENDIX.—Instinct. 881 tions of the Mind are not transmitted to the parts affected, but that they must operate through the same intermediate proximate 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 efficient 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 other. (See Indexes, Articles Nervous Power, Sympathy, Remedial Agents, Will, and Mental Emotions.) It is also evident from my premises, that, if the movements which 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, primary 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! Here the causes are entirely self-acting, originating their own actions in the Sensorium Commune. This, in itself, establishes a radical distinction between the nature ofthe 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 the 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 K K K 882 INSTITUTES OF MEDICINE. so 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 forth 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 Adoration of the Deity, are results of " the chemical action which the ele- ments 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, v, 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, b. 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 the 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 affect. 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 j, 550f a-e). In this only view of the sub- ject, the chemical tendency of the Soul would no more react upon itself than that of platinum, and the only result would be (in chemical phrase- ology), a combustion ofthe elements ofthe 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 with 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. 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 "Siamese twins"), should it be attempted to call in the aid of the Soul, or the Principle of Life, in any of the manipulations ofthe 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 difficultyin 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). , , - .. 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. 11 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 ot mankind —no gilding the material device —no concession to what may be considered the innocent but obstinate belief of the spiritual theorist, in the trust that he may finally discern the reality of his delusion. Again farther: the Organic Chemist maintains that all the processes of life are owino- 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 ^™mJ ™ the accommodating Chemico-Spiritualist, I may ask, if the Soul or Instinct make all the difference as regards intellectual and instmctive maruJesta- tions, what makes the difference in respect to the corporeal P^me"a. Nor is that all. If the brain be considered the source of ^elkction in its organic condition alone, how are facts treasured up, and everpresent from childhood to decrepit age? As the bra m, like all other parte^ 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 ofthe 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 § 350f 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 present demonstration, 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 ofthe 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 sid generis in all their characteristics. But there are other more absolute characteristics which completely destroy the supposed analogy. What, for example, is the ef- ficient cause of the production of bile, saliva, &c. ? Certainly the blood, in connection with 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 the 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 part 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 organic 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 result 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 cultivation of the spiritual part, which enables it to spring into active operation from a dormant condi- tion in habitually exhausted states of the body, while the brain, accord- ing to materialism, should resist all wakefulness till that organ, and all other parts, are fully recruited by repose (p. 329—332, § 500, n-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 Infinity, precisely analogous to those which are everywhere seen as the offspring of an Infinite Intelligence ? But, if you admit a God, you will 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 Lord 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, where 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. seen 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 determined with various effects upon distant parts, are all upon a par, in principle, whether they 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 both voluntary and invol- untary. 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 the 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 physical causes are brought into immediate co-operation in rousing the brain and spinal cord. The physical cause is insufficient to 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 the 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? Why is there at one moment only a moderate degree ofthe 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 ofthe 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 d, 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 I would ask the Materialist what other con- struction he can apply to the cases of sudden death from joy 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\ h, 478,479, 500 f-n, 507-509, 634, 902 J, 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 effect 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 were not per- ceived, no syncope might follow. Thus, again, are associated the phys- ical and moral 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. Let us now connect with the foregoing facts the syncope which 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, 892J b, 944 b, 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, brain, or nerves—at least cerebro-spinal nerves (§ 264, 455 a, 461£ a, 1042). I have said that in the several modified movements of the respiratory muscles mentioned at the beginning of this section, all but two depend upon irritations of the nervous centres 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 fibres 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, writh 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 ordinary yawning. Just so, too, in respect to offensive odours, when they produce vomit- The Soul.—APPENDIX.—Instinct. 889 ing instead of syncope. In the former case the Mind is far 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 nervous 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 (§ 514 m, 844, 892|). 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 mucous 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 diaphragm,* abdominal muscles, 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 Mind, 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 first development of the nervous power is produced by the irritation ofthe throat (§ 233f, 500 e-k, 514 b, c, 894-896, 902 e-g). 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 * Probably. 890 INSTITUTES OF MEDICINE. part exerted directly upon the brain itself. In these instances, however, 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 ofthe 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 when memory 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 with the same physical causes in other cases. In section 514, I, 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 how 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). 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 ofthe substantive, self-acting nature ofthe Mind (§ 451, c, d). Let us next suppose that the Materialist will demand of us an expla- The Soid.—APPENDIX.—Instinct. 891 nation, upon our general facts, of the influences which are concerned in sleeping in the erect posture, which is common to many animals. The physiology of voluntary and involuntary respiration, and particularly of the action ofthe constrictor muscles, and the exact coincidences between the voluntary and involuntary acts in 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 g, 516 d, No. 6, § 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 different 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 exact 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 (§ 233f); 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). We draw to a close. If the discussion have been protracted, it has been due to the magnitude and the novelty ofthe 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. 892 INSTITUTES OF MEDICINE. And let us consider, also, as we ponder upon these things, *iow 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 Reason 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! DEMONSTRATION OF INSTINCT, AND ITS DISTINCTION FROM THE SOUL. § 1078, a. In what I have said in the former part of this work ofthe 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, there 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 perception, 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. 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 wants and the uses ofthe body. Whatever may be the fundamental cause, it is in complete operation at 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 the 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 ofthe 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 ofthe 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 when 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 human 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 our knowledge, been hitherto indicated. It is only, however, a display ofthe 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.* * As an example of the assumptions and sophistry of those who reject the Soul, tako 894 INSTITUTES OF MEDICINE. § 1078, b. I am finally conducted to other and still more definite con- tradistinctions between the Soul and the Instinctive Principle, and where it will 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 oro-an, 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 form 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. 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" by the able and eminent Mr. Law- rence : " If the intellectual phenomena of man require an immaterial principle superadded to the brain, we must equally concede it to those more rational animals which exhibit manifestations differing from some ofthe human family only 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 equallj7 reject it in man." This argument is often staring us,in the face, and it is quite time that it should be Bilenced, 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 analogy fails as soon as we reach those animals which exhibit no rational manifestations. So the 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 says 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 dawning 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." I 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 ofthe primary causes, or their equivalents, and then always in exact conformity with the nature ofthe 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 appropriate 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 infancy 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 when hunger is unappeascd. 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- 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 Reason, 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 perfect 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 ofthe 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 every 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, &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 ofthe stomach and the peculiarities ofthe 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 ofthe stomach, and special con- stitution of the gastric 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 foregoino- is also true of man as it relates to organization, tfut 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 $819 o. who are its projectors, p. 516, $ 820 4. its perseverance under defeat, p. 153, $349 a; p. 516, $ 820 c. an important cause of its prevalence, p. 184, $ 3503 j.. p 515; $ gig 0 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. Exdosmose. See Endosmose Expectorants, p. 633-644, $ 892f. many of them being stimulant to the extreme vessels, as well as to the general organs of circulation, are Expectorants—continued. morbific in active forms 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, *'4ia\ a mistaken view of the pathology ol 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, $ 5! e, f; p. 148, $ 334; p. 518, $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, $ 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, $ 74. its rudimentary state, p. 46, $ 74. Author's explanation of its develop- ment, p. 46, $ 74; p. 671, $ 903. action of light upon, analogous to that of all other vital agents, p. 46, $ 74; p. 90-95, $ 188* d. See, also, Anal- ogies. Author's explanation of action of light in animal and organic life, p. 90-95, $ 188* a". F. Facts, importance of, p. 10, $ 5J; p. 515, $ 819 4. in medicine, the phenomena of organic nature, p. 10, $ b{ b; p. 202, $ 376* ; p. 519, $ 824 a. who may apply them best, p. 10, $ 5£ a ; p. 115, 116, $ 234 e, f; p 119, $ 235 ; p. 202, $ 376*; p. 207, $ 376! 4 ; p. 247, $ 440 h. how employed by the vitalist, p: 10, $ 5! a, 4; p. 14, $ 6; p. 75, $ 165 4; p. 279, $ 448 /; p. 330, $ 500 n; p. 515, $ 819 4. how far neglected by the Chemical Physiologist, p. 10, $ b\ 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, $ 5! ; p. 202, 203, $ 376*. See, also, Error, Organic Chemistry. and Humoralism. INDEX. 931 Facts—continued. often just otherwise, p. 10, $ 5| a; p. 19, $ 18 c, A. C. ; p 157-173, $ 350, Nos. 1-46 ; p. 189, 190, $ 350! n; P- 191, $ 351 ; p. 238, $ 438 ; p. 246, $ 440/; p. 277, 278, $ 447*/; p. 433, 434, $ 676 4; p. 460, $ 709 note; p. 482, $ 744; p. 514, $ 819 a, Nos. 1-3 ; p. 518, $ 823. relative to organic beings, can not be found in the laboratory, p. 10, $ b{ 4 ; p. 14, ,$6; p. 202, $ 376*; p. 519, ■ $ 824 a. each one too apt to be regarded ab- stractedly, p. 10, $ 5! 4. should be compared, p. 10, $ 5! 4. See, also, often just otherwise, as above. the importance of one among many, p. 10, $ 5i 4. when plausible, can not contradict es- tablished ones, p. 10, $ 5$ 4. See, also, often just otherwise, as above. mutilated to suit hypotheses, p. 10, $ 5| c; p. 519, $ 824 a. See, also, often just otherwise, as above, and Or- ganic Chemistry, its Recommend- ations. greatly neglected, p. 112, $ 234 4. between the physiologist and physical philosopher of life, p. 115, $ 234 e; p. 519, $ 824 a. how to employ them to the best ad- vantage, p. 515, $ 819 4. 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, $ 350, Nos. 44, 45. See, also, Humoralism. Fever, p. 489-499. description of, p. 489—197. 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. 36-19, $ 63-80. its animal and mental faculties pass- ive See Mind and Instinct. early development of its nerves, like that ofthe liver, kidneys, organs of animal fife, &c., consistent with their dormant state, p. 284, $ 455 a, b; p. 286, $ 456 ; p. 289, $ 461* a; p. 342-353, $ 516-524. physiological distinction between the Fcetus—continued. ova of mammiferous and oviparous animals, p. 56, $ 122. Food, of Animals, known only by experience, p. 17-20, $ 18 ; p. 200, 201, $ 366,367. can not be shown by chemistry, p. 17- 20, $ 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, $ 18 e. importance of a right quality of, in dis- eases, p.- 250-252, $ 441 c; p. 543, $ 856 ; p. 600, $ 892 e. Fomentations. See Poultices. Forces of Nature, prove a Creator, p. 16, $ 14 c; p. 81, $ 170. See, ,also, Design, and Na- ture contradistinguished from Creative Power. Fourcroy, sixty years ago, p. 8, $ 5; p. 203, $ 376*. Functions of Life, p. 125-372. effects only, p. 86, $ 176; p. 120, $ 235 the great ends 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 PrINCIPLc, 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, $ 234 d: their extended' application to the phi- losophy of life, p. 93, 94, $ 188 d; p. 112-121, $ 234-237; p. 323-332, $ 500. Gamboge. See Cathartics, and Thera- peutics. Ganglionic or Sympathetic System, general-Facts and Laws relative to, and to the Cerebro-Spinal, p 335-341. its Laws of Action, and Propagation o) 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 932 INDEX. Gases, and Ethereal Vapor, effects of their respiration disprove the doctrines of Humoralism, p. 522, 523, $ 827 4, c. their behavior in chemical physiology, p. 175, 176, $ 350* n-p. See, also, Endosmose and Exdosmose. 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, $ 827 ; p. 672, $ 904 4. Gastric Juice, can be generated by nothing in Nature but the mucous tissue ofthe stomach, p. 62, $ 135 a; p. 141, $ 307; p. 191, 192, $ 353 ; p. 201, $ 374, 375. See, also, Digestion, Physiology of, and Mucous Tissue. its manufacture, p. 197-199, $ 362-364*. Generation, p. 279-280, $ 449. its physiology, p. 36^9, $ 63-81. illustrates the organic properties, p. 44, $ 72 ; p. 97, $ 190 4. proves a coincidence in the life of plants and animals, p. 56, $ 121- 123 ; p. 280, $ 449 d. Generation, Organs of, p. 55, $ 118-121. their influences in organic and animal life, p. 56, $ 120 ; p. 376-380, $ 578. their importance in organic Design, p. 56, $ 121-123 ; p. 280, $ 449 d. Generation, Spontaneous, how it happens, p. 178-184, $ 350! a- 3b0$g; p. 186,189,$ 350! M-350!m. disproved, p. 16, $ 14 c. inconsistent with Creative Power, p. 81, 82, $ 170. Genito-Urinary Agents, p. 683-689, $ 905*. Germ. See Ovum, and Seed. Germinal Disk, the potential whole, p. 41, $ 65. Gillenia. See Expectorants, Emetics, and Therapeutics. God and Nature, confounded, p. 40, $ 64 h; p. 46, $ 74 a; p. 76, $ 167 4; p. 86, $ 175 d; p. 178-189, $ 350! a-350! 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, $ 350! gg; p. 189, 190, $ 350| n. See, also, Vital Properties in the Elements of Matter, and Problems. contradistinguished, p. 16, $ 14 c; p. 25, $ 43 ; p. 46, $ 74 a; p. 81, $ 170 a; p. 83, $ 172 ; p. 124, $ 241 ; p. 227, $ 411. the Latter the Interpreter of the For- mer, p. 186, $ 350! kk; p. 227, $ 411; p. 317, $ 493 a. See, also, Design. Graduates, Medical, their disproportion in Europe and the United States, connected with a greater disproportion of Medical Colleges, and other facts adduced by the Author, evince the great superiority ofthe 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 Pf./siological Commentaries, vol. ii., p. 676, 677, $ 801-815. Granulations, their office, p. 473, $ 733 c. Growth, its philosophy sought 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, Cob- 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 e; p. 587, $ 892 c; p. 676-679, $ 904 c. See, also, Remedial Action, As- tringents, Alteratives, and Ad- aptation, Law of. H. Habit, Vital, its physiological and moral laws and 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. experiments relative to its Connection with the Nervous System, p. 301-305. Heart and Arteries, * sympathize more than other parts with local inflammations, especially acute, p. 354, 355, $ 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. INDEX. 933 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, $ 433-448. external, resisted in the same way as chemical agents, p. 30-33, $ 59, 60 ; p. 258, $ 442 d. internal, how generated, p. 262-273, $ 445 /-447 h. See, also, Combus- tion, and Organic Heat. Hemorrhage, Spontaneous, 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 44 ; 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, p. 420, $ 654 a; p. 482, $ 744; p. 457, $ 699 c; p. 460-463, $ 709 ; p. 573, $ 890 d; p. 603, 604, $ 892 k; p. 721, $ 960 c. See, 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, $ 330 ; p. 558, $ 878. author's physiological objection to, p. 534-540, $ 845-851. Humoral Pathology. See Humoralism. Hybrids, illustrate the philosophy of life, p. 44, $ 72. Hydrocyanic Acid, its mode of operating, rapidity of its effects, &c, p. 318-321, $ 493 d- 494; p 523-525, $ 827 tf-828 c; p. 673, $ 904 4. Hyoscyamus. See Narcotics, and Therapeutics. Hypotheses, the ground of, p. 10, $ b\ b; p. 202, $ 376* ; p. 518, 519, $ 823, 824. Idiosyncrasy, p. 383-385. Ignorance, opposes itself to knowledge, p. 112, $ 234 4. Imagination, power of as a remedial agent, p. 534, (j 844; p. 541, 542, $ 854 44; p. 558, $878. Imponderables, any number, p. 84, $ 175 44. agents, not the causes, in organic be- ings, p. 46, $ 74 ; p. 90-95, $ 188* , p. 113, $ 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 slow result of a long series of causes, p. 423, $ 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. $ 2 e ; p. 417, $ 650. Infancy, its physiological characteristics, p. 373 375, $ 576. Infidelity, its exposure, a duty of the Physiolo- gist, p. 6, $ 4 4. See, also, Design. and Nature contradistinguished from its Author. Inflammation, p. 464-489. 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 disease* 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 modifications of their common properties and func- tions of life, and ofthe near identity of their properties and functions, p 88, $ 185 ; p. 474-476, $ 733 f-k; p 485, 486, $ 749-751. See, also, Plants. excited by dividing nerves, p. 107, o 224. its sympathetic or constitutional ef- fects ; see above, and Fever. I add, that the dependence of the " fever" 934 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. distinguished from Fever. I add to the distinctions which I have set forth in sections 141 4, 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. 160, $ 350, No. 10; p. 175, $ 350* h-l; p. 176, 177, $ 350§ a, 3501 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 with mutually illustrative analogies in the relative conditions of the principle of life in animals and plants, p. 123, $ 241 a; p. 88, $ 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 4. 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, $563. scarcely susceptible of cultivation in man, but remarkably so in many ani- mals, ibid. proof from, along with reason, of one species of mankind, p. 123, $ 241 c, note. developed before reason, p. 123, $ 241 c. 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 preservation of life. Institutes of Medicine, their objects, p. 2, $ 2. their consistency, a test of their truth, p. 1, $ 1 ; p. 3, $ 2 c ; p. 81, $ 169/; p. 331, $ 500 o; p. 405^412, $ 638. their foundation, p. 1, $ 1 ; p. 22, $ 31. conducted analytically, p. 1, $ 1. a connected chain throughout, p. 1, $ 1 ; p. 405-412, $ 638. should be studied progressively, p. 1, $ 1. now first attempted in their proper ob- jects and natural relations, p. 1, $ 1. will be contradicted by collisions of principles or facts, p. 1, $ 1 ; p. 3, $ 2 c; p. 259, $ 442 e. See, also, Theories, Rival. pervaded by the spirit of the Medical and Physiological Commentaries, p. 2, $ I a. should form one great symmetrical whole, p. 3, $ 2 c; p. 405-413, $ 638, 639 a; p. 541, $852. when founded upon any other than a simple principle, the superstructure must be incongruous, chaotic, p. 2- 4, $ 2, 3; p. 173-178, $ 350|-350|. See, also, Organic Chemistry and Physiology, contrasted. fundamentally distinct from all other inquiries, p. 5, $ 4 4; p. 8, 9, $ 5 ; p. 14, $ 6; p. 19, $ 18 e; p. 157-182, $ 350-350! g; p. 189, 190, $ 350! n; p. 191, $ 351 ; p. 246, $ 440/; p. 277,278, $447^/ Intestinal Canal, potential whole of digestive system, p. 41, $ 65. Iodine, p. 612-620. Also, Therapeu tics, and Remedial Action. Iris, physiology of its contraction, and ap- plication of in medicine, p. 328, $ 500 I; p. 340, $ 514 k. See, also, Remedial Action. Irritability, an important property of the Vital Principle, p. 88, $ 183 ; p. 89, $ 188 a INDEX. 935 [rritabdity—continued. common 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, $ 136, 137 ; p. 88, $ 185 ; p. 89-99, $ 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, $ 149, 150 ; p. 68- 73, $ 152-163 ; p. 89-99,$ 188-192 ; p. 210, $ 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, $ 137 d; p. 65-68, $ 143-152 ; p. 98, $ 191 4. according to its natural modification in a general, or local, sense, will be the operation of natural, morbific, and remedial agents, p. 61, $ 133 4, 134 ■ p 62, 63, $ 135-137 ; p. 64, $ 138 ; p. 66-68, $ 148-152 a; p. 73, $ 163 ; p. 97, 98, $ 190, 191 ; p. 99, § 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, $ 149-152 ; p. 73, $ 163 ; p. 98, $ 191 4 ; p. 541, 542, $ 854 44. its morbid changes generally increase the" susceptibility of organs to the action of natural or remedial agents, ibid, and p. 661-664, $ 894 4-900 ;— 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, $ 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, ibid. 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, $ 188-204 ; p. 104, $ 210; p. 107, $226; p. 110, $ 233 ; p. 323-332, $ 500. Irritability—continued. distinct from Sensibility, p. 99, $ 193 ; p. 104, $ 110. its natural modifications like those of Sensibility, p. 98, $ 191 ; p. 100, $ 200 ; p. 102, $ 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, $ 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*. Jalap. See Cathartics, Therapeutics, and Remedial Action. K. Kingdoms of Nature. See Nature, Kingdoms of. Kino. See Astringents. Knowledge, its limits and objects, p. 120, $ 235 , p. 185, $ 350| k. its accumulative nature, p. 206, $ 376!; 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. Leeching, its uses and peculiar effects, p. 692- 698. Life, a cause, p. 30, $ 57-59; p. 83-88, $ 175-185 ; p. 96, $ 189 c; p. 120, $ 236 ; p. 401. $ 631 ; p. 435, $ 680 ; p. 474,475, $ 733/-«. essentially the same in plants and ani- mals ; see Plants. its philosophy learned from a wide ob- servation of Nature, p. 4, $ 2 e; p. 14, $ 6 ; p. 207, $ 376! 4. "discovered in dead matter," p. 179, $ 350! c. See, also, Vital Proper- ties in the Elements of Matter. its phenomena seen distinctly or con- fusedly, p. 4, $ 2e; p. 157-173, $ 936 INDEX. Life—continued. 350 ; p. 189, 190, $ 350! n; p. 276- 278, $ 447*/; p. 777, Pomfret. a knowledge of, requires habits of an- alytical observation, p. 4, $ 2 e ; p. 14, $ 6 ; p. 313, $ 487 h. See, also, Observation. its study compared with that of botany, p. 4, $ 2 e. simple in fundamental laws, complex in its phenomena, p. 4, $ 2 e ; p. 662 -664, $ 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, $ 4* 4; p. 8, $ 5 ; p. 11, $ 5£ c ; p. 13, $ 5* a; p. 16, $ 14 c ; p. 46, $ 74 ; p. 84-86, $ 175 c, 175 d; p. 95, 96, $ 189 4 ; p. 135, 136, $ 303 a; p. 137, 138, $ 303J 4, c; p. 141, $ 307 ; p. 155, $ 349 e; p. 178, $ 350! a; p. 181-189, $350!/-350! m; p. 234, $ 433 ; p. 458, 459, $ 701, 704. See Organic Life, and Plants. Life, Animal, connects us sensibly with external ob- jects, p. 53, $ 100 ; p. 399, $ 628. ; requires repose, p. 53, $ 102. not pronounced in the fcetus, p. 53, $ 103. See, also, Nerves, Sensibil- ity, Nervous Power, Sympathy, and Organic Life. " animal life " is employed in its popu- lar sense, at p. 135, $ 301 ; p. 137, $ 303! a; p. 140, $ 304. Life, Organic and Animal, their distinctions and relations, p. 53- 56, $ 96-120. diseases of, coincident, p. 55, $ 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 d;—modified in each, p. 54, $ 107 ; p. 88, $ 185. has no repose, p. 53, $ 102. necessary to animal life, p. 54, $ 108, 117. See, also, Plants, Organic Life, Organic Properties, and Vi- tal Principle. its condition in the fcetus. See Blood- vessels. Light, discoveries in, p. 90-92, $ 188* d. applied to illustrate the philosophy of life, p. 46, $ 74 ; p. 90-95, $ 188* d; p. 112-117, $ 234C-234/; p. 328- 331, $ 500 m-500 o ; p. 654, $ 872 a; p. 556, $ 872 a; p. 567, $ 889 k; p. 671, $ 903. Light—continued. a vital agent, p. 46, $ 74; p. 90-95, $ 188* d; p. 134, $293; p. 137, $303 e; p. 164, $ 350, No. 65 ; p. 281, $ 450. analogous to all other vital agents, p. 46, $ 74 ; p. 90-95, $ 188* d ; p. 281- 283, $ 450 d-451 /; p. 328-331, $ 500 m-500 o; p. 671, $ 903. See, also, Analogies. important in vital philosophy, p. 92 95, $ 188* d; 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, $ 188* 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, $ 188* d; p. 566, 567, $ 889 k. its velocity, undulations, and mode of excitement, illustrative of the nerv- ous power, p. 114, $ 234 e. rate of its velocity, and of its undula- tions, p. 114, $ 234 e. its modus operandi in physics un- known, p. 115, $ 234 e, f its laws known, p. 115, $ 234 e. its undulations aid not our knowledge of its laws, p. 115, $ 234 e. develops the rudimentary eye, by its action upon irritability, p. 46, $ 74 a. comparison of its action upon irrita- bility in producing organic results, and upon sensibility in the process of vision, embarrassing to chemis- INDEX. 937 Light—continued. try, p. 46, $ 74 a ; p. 92-95, $ 188* d; p. 281-283, $ 450 e-451/; p. 330, $ 500 n. Liver, developed from the intestinal Canal, p. 41, $ 65. See Assimilation. Loss of Blood, Influences and Modus Operandi of, p. 690-777. See Blood-letting. Lobelia, preferable to tobacco in strangulated hernia, p. 717, $ 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, $ 447*. 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, $ 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. races of, p. 391-393. Materia Medica, objects of, p. 3, $ 2. the organic, composed of three or four elements, p. 25, $ 47; p. 27, $ 52. each article of,, has virtues peculiar to itself, p. 27, $ 52 ; p. 417, $ 650 ; p. 545, $ 860. its members often embrace two or more virtues, p. 555, $ 872 a; p. 571, $ 890 4 ; p. 597, $ 892 c; p. 599, $ 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, $ 854 ; p. 545, $ 859. Pereira's, the best, p. 676, $ 904 c. author's Arrangement of, p. 542, $ Materia Medica—continued. 854 c; p. 564, $ 889 c ; p. 583, $ 891 a; p. 634-646, $ 892* 4-893 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, $ 175 c-175 d. 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 4. Matter, author's proof from, of a Creator, p. 16, $ 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, $234d; p. 120, $ 237. its final cause, p. 23-25, $ 34-43, 46. Mechanical Relations, in organic beings, p. 59, $ 129 A:. Medical Education and Practice in Europe and the United States,* comparative view of, p. 13, $ b\ a ; p. 28, $ 53 c; p. 43, $ 64; p. 50, $ 83 k; p. 60, $ 131 ; p. 86, $ 175 d; p. 133, $ 291; p. 136, $ 303 a; p. 139, $ 303§ ; p. 148, $ 334; p. 149, $ 338 ; p. 154, 155, $ 149 c-e; p. 174- 182, $ 350*-350! /; p. 185-187, $ 350! kk; p. 197-199, $ 362-364; p. 202, $ 376*; p. 219, $ 408 ; p. 220, 221, $ 409 4 ; p. 226, $ 409 ;'; 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 4; 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, $ 819 4; p. 518, 519, $ 823-825; p. 540, $ 851 a; p. 573, $ 890 d; p. 584, $ 891 c ; p. 603, $ 892 k; p. 654, $ 893 n; p. 690, $ 906 a-d; p. 715-722, $ 960 a-d; p. 760, $ 1005 k; p. 762, 763, $ 1006 a. See, also, British and * " About thirty 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, 20,000,000.) In France, with a population of 35,000,000, there are but three Medical Schools, which graduate only about 700 annually!" — Boston Medical and Surgical Journal, Dec. 2,1846, p. 365. 938 ' INDEX. Medical Education—continued. Foreign Medical Review, in advo- cacy 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. Medical Profession -of the United States, Defense of, p. 460-463, $ 709, and note there. Medical Science, '.'The Progress of," p. 13, $ 5* a, b. See, also, Medi- cine, Medical Education, Organic Chemistry, and Humoralism. Medicine, philosophy of, p..l-, $ 1. the necessity of consistency in its principles and details, p. 1, $ 1. the work of observation, p. 3, $ 2 c; p. 11, $5Je,/. its elevated nature, p. 122, $ 240; p. 186, $ 350! kk; p. 412, $ 638. See, also, Design. its ground-work simple, p. 4, $ 2 d, e; p. 40-49, $ 65-80 ; p. 87, $ 177-182 ; p. 88, $ 185. its details complex, p. 109, $ 232; p. 120-122, $ 237-240; p. 405-412, $ 638. its difficulties, p. 11,12, $ 5} e; p. 121, $ 237 ; p. 383, $ 584 ; p. 397, $ 623 ; p. 545, $ 859 4, and -references there ; p. 662-664, $ 895-899. See, also, Physicians and Surgeons. its branches, a cemented chain, p. 3, $ 2d; p. 131, $285; p.405-412,$ 638. the relations of its branches, ibid. theories of, p. 5, $ 4. chemical, physiological, and chemico- physiological schools of, p. 6, 7, $ 4* a-e. vitiated by Experiments under the dis- guise of "Experimental Philosophy" p. 11-14, $ 54 e-6; p. 17-19, $ 18 4-e; p. 26, $ 48 ; p. 28, $ 53 c; p. 50, $ 83 a, b; p. 60, $ 131; p. 132, 133, $ 289-292 ; p. 148, $ 334 ; p. 164-170, $ 350, Nos. 23*, 28, 29, 31, 39,44. 45 : p. 175, 176, $ 350* n, o; p. 177-182, $ 350|/, 350! o-~g; P-197- 203, $ 362-376* ; p. 371, $ 569 4; p. 434, $ 676 4 ; p 457, $ 699 c ; p 482, $ 744; p. 484, 485, $ 748, 749 ; p. 489, 490, $ 757 a; p. 509, $ 810 ; p. 515-519, $ 819-825 ; p 528, $ 830 a-831; p. 541, 542, $ 854 44; p. 573, $ 890 d; p. 603, 604, $ 892 k; p. 711, $ 952 4; 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, 54 c; p. 202, 203, $ 376£ ; p. 434, $ 676 4. contradistinguished from chemical and mechanical philosophy, p. 7, $ 4* d ; p. 8, 9, $ 5; p. 8, $5; p. 10, $54 a; p. 11, $ 54 c, e; p. 14, $ 6; p. 19, $' 18 e; p. 21-36, $ 20-62; p. 40-42, $65, 66; p. 99-111, $ 188d-233f ; p. 135-139, $ 303-303? ; p. 149-203, $ 337-376* ; 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, $ 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* d. 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, $ 188 a; p. 95, $ 188i d; p. 107, $ 227; p. 108, $ 228 4; p. 109, $ 230, 232; p. Ill, $ 233f ; P- 326-330, $ 500 /-500 n p. 670, $ 902 /. elect certain metor nerves, like the will and physical agents, p. Ill, $ 233| ; p. 113, $ 243 c ; p. 326-330, $ 500/- 500 n. designed for moral and physical good, p. 113, $ 234 c. morbific and curative, and analogous in their influences with physical causes INDEX. 939 Mental Emotions, &c.—continued. and with the will, p. 92-95, $ 188* d; p. Ill, $ 233!; P- H3, $ 234 c; p. 296, $ 476 c; p. 326-330, $ 500 /-500 n; p. 534, $ 844 ; p. 670, $ 902/. chemical theory of, p. 155, $ 349 e. See Mind, and Instinct. Mesmerism. See Animal Magnetism. Metaphysicians, regard the operations of the mind 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. 143, $ 320 ; p. 219, $ 407 4 ; p. 342, $ 515. Mind, and its Properties, p. 122-125. riot 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 4; p. 88, $ 183, 184; p. 89, $ 186 ; p. 98, $ 191 c; 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 p. 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/ its advancement in successive genera- tions, p. 206, $ 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, $ 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, $3034. its final cause. See Minerals. Mobility, . a property of life common to animals and plants, p. 88, $ 183, 184 a. Mobility—continued. a preferable term to contractility, p. 103, $ 205 4. . . . 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, $ 461* 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, $ 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 through irritability, p. 103, 104, $208,215; p. 107, $226; p. 110, $ 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 4; p. 62-68, $ 135-155; p. 110,111, $ 233, 233!; p. 295, $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, 719, $ 960 a. See, also, Nar- cotics, Antispasmodics, Therapeu- tics, and Remedial Action. 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, $ 891. never to be employed for the relief of pain when it may aggravate disease, p. 587, 588, $ 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, $ 871, 872 a; p. 561, $ 888 4; 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, $ 946 INDEX. Opium—continued. 668-670 ; p. 428, $ 674 a; p. 430- 433, $ 675, 676 a; p. 543, $ 856; p. 553-557, $ 870-874 ; p. 561, $ 888 4; p. 566, 567, $ 889 k ; p. 570 $ 889 «; 0 571,572,$ 890 4; p. 575,576,$ 890 k I; P- 577, 578, $ 890 o; p. 583-590, $ 891 a-s; p. 592, 593, $ 891* it; P 718, $960 a. Organic Analysis, difficult in its elementary aspect, p. lb, $ 15 ; p. 18, $ 18 d. proximate, hypothetical, p. 14, $ 6 ; p. 27-29, $ 53 ; p. 221, 222, $ 409 4 ; p. 228, $ 417 a. See, also, Protein. its artificial transformations, p. 28, $ 53; p. 228, $ 417 a. elementary, the legitimate objects of, in respect to science, p. 202,203, $ 376$. Organic Beings, their general structure, p. 20, $ 19 ; p. 50-61, $ 83-133. their composition, p. 15, $ 12; p. 23- 49, $ 38-80. how distinguished from minerals, p. 15-22, $ 7-30 ; p. 23-49, $ 38-80 ; p. 112-125, $ 234-246; p. 157-173, $ 350. their peculiar properties, p. 73-125, $ 164-246. their peculiar functions, p. 125-372, $ 247-569. their relations to external objects, p. 398^100, $ 626-630. generate motion, p. 21, $24; p. 31, $ 59 ; p. 89, $ 188 a; p. 345, 346, $ 516 d, No. 7. their waste and renewal, p. 21, $ 27 ; p. 53, $ 104; p. 129, $ 273 ; p. 217, $ 401 4. their seventeen elements, p. 23, $ 34, 35 ; p. 225, $ 409. their four principal elements, p. 23, $ 37; p. 33, $61, 62. how their elements combine, p. 23, $ 38, 39 ; p. 26, $ 48, 49 ; p. 30-32, $ 58, 59. the vital. power combines their ele- ments, p. 30, $ 58, 59 ; p. 36-47, $ 63-74. remarkable contrast in the number of their compounds and those of the globe, p. 24,25, $41,46; p. 227, $411. their vis vita succeeded by vis inertia, p. 30, 31, $ 59. nitrogen gas, a remarkable element of, p. 34-36, $ 62. a knowledge and just appreciation of their properties, functions, and laws, indispensable in medicine, p. 4, 5, $ 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, $ 14 4; p. 16, $ 15 p. 18, $ 18 ; p. 24, $ 42 ; p. 25, $ 44 , p. 27-29, $ 53, 54; p. 29, $ 54 4; p. 161, $ 350, No. 59. contradistinguished from Physiology and Medical Philosophy, p. 7, $ 4* d; p 8, $ 5; p. 10, $ 54 a; p. II, $ 54 c; p. 14, $ 6; p. 19, $ 18 e; p. 21-36, $ 20-62 ; p. 40-42, $ 65, 66 ; p. 92-111, $ 188* d-233! ; p. 135- 139, $ 303-303§; p. 149-203, $ 337- 376*; 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, $ 623 ; p. 398,'$ 626 ; p. 401, $ 631, and so on. school of, p. 6, $ 4* 4. declining, p. 6, 7, $ 4* 4; p. 203, $ 376*. inapplicable to medicine, p. 8, 9, $ 5; p. 13, $5*4; p. 434, $676 4. its foundation, p. 10, $ 54 a, c; p. 13, $ 5* a; p. 154, $ 349 c; p. 155, $ 349 e; p. 156, $ 350, mottoes; p. 182, $ 350! g; p. 197, $ 362; p. 202, $ 376* ; p. 221, $ 409 4 ; p. 235, $ 433 ; p 238, $ 438 ; p. 239-248, $ 440-441 4; p. 274-278, $ 447* ; p. 456, $ 698 ; p. 519, $ 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 4-c ; p. 156, $ 350, motto d; p. 235, $ 433. may indicate the food for plants, p. 20, $ 18 e. applied to physiology, p. 7, $ 4* 6; p. 13, $5i; p. 14, $ 6; p. 19, $ 18 e; p 29, $ 54; p. 38-40, $ 64 e-k; p. 152-203, $ 345-376*; p. 226, $ 409 ; ; p. 234-248, $ 433-441; p. 274- 278, $447*. its summary exhibition by Mulder, p. 180-183, $ 350! e-gg; p. 189, 190, $ 350! n. its own statement of its ability and ob- jects, p. 18, $ 18 c; p. 161, $ 350, No. 59; and how far observed, p. 157- 178, $ 350-350! ; p. 197, $ 362; p. 202, $ 376*. its moral and religious tendencies. See Life. the judgment of posterity upon, p. 9, $ 5 ; p. 203, $ 376*; p. 434, $ 676 4 ; p. 762, $ 1006 a. how far substituted for medical philos- ophy, p. 8, $ 5 ; p. 13, $ 5* 4; p. 174-178, $ 3504-3503 ; p. 197, $ 362 ; p. 202, 203, $ 376*; p. 234, 235, $ 433 ; p. 456, $ 698 ; p. 515, $ 819 4. how far tolerant, p. 13, $ 5* a; p. 156, $ 350, mottoes, a, b, c, d, e; p. 185, i 350! kk; p. 515, $819 4. INDEX. 947 Organic Chemistry—continued. causes of its success, p. 11, $ 5| e • p 17, $ 18 c; p. 133, $ 292; p. 154^ 155, $ 349 c, d; p. 202, $ 376* ; p. 234, 235, $ 433; p. 515, $ 819 4. See, also, Analogies, False. its recommendations, p. 6, 7, $ 4* 4, d ■ p. 8, 9, $5; p. 11, $ 54 c; p. 13, $• 5* 4; p. 14, $ 6; p. 17, $ 18c; p. 19, $ 18 c; p. 26, $48, 49; p. 28, $ 53 c ; p. 30-32, $ 59 ; p. 36, $ 62 i ; p. 38-40, $ 64 e-h;' p. 43, $ 67 ; p. 85, $ 175 c; p. 132-134, $ 289-293 • p. 136-139, $ 303-303*; p. 152-192, $ 345-352 ; p. 197, $ 362 ; p. 199, $ 364* ; p. 202, 203, $ 376, 376* ; p. 220-222, $ 409 ; p. 226, $ 409 ; ; p 234-260, $ 433^45; p. 274-279, $ 447*-448 ; p. 434, $ 676 4; p. 456, $ 698; p. 515, $ 819 4; p. 519, $ 824 a; p. 763,,$ 1006 a. the Author's Motives for investigating its merits, p. 7, $ 4* 4, d; p. 8, $ 5 ; p. 13, $ 5* a; p. 148, $ 335; p. 154, 155, $ 349 ; p. 156, $ 350, mottoes, a, b, c, d, e; p. 173-178, $ 3504~350§ ; p. 191, $ 351 ; p. 197, $ 362; p. 202, $ 376* ; p. 234, $ 433 ; p. 239, $ 438 d; p. 241, $ 440 4; p. 254, $ 441 e ; p. 265, $ 447 4 ; p. 277, $ 447*/; p. 345, $ 516 d, No. 6 ; p. 362, $ 530 ; p. 456, $698; p. 515, $819 4; p. 540, $ 851 c ; p. 542, $ 854 44. its advantages to medicine, p. 171-173, $ 350, Nos. 41-46; p. 174-178, $ 350*-350J. its confirmation or overthrow, p. 148, $ 335 ; p. 542, $ 854 44. problems for its solution, p. 16, $ 14 c; p. 85, $ 175 c; p. 94, $ 188* d; p. 155, $ 349 e; p. 281-283, $ 450 d- 451/; p. 330, $ 500 n ; 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, $ 350 ; p. 189,190, $ 350! n; p. 191, $ 351 ; p. 246, $ 440/; p. 277, 278, $ 447*/; p. 514, 515, $ 819. one destructive, the other formative and conservative, p. 8, $ 5; p. 13, $ 5* 4; p. 18, $ 18 c; p. 24, $ 42 ; p. 33, $ 60 ; p. 34-36, $ 62 ; p. 37-40, $ 64; p. 135, $ 301. Organic Compounds, their four principal elements, p. 23, $ 37 ; p 27, $ 53 4 ; p. 33, $ 61, 62 ; p. 44, $ 72. always consist of three or more ele- ments intimately combinedj p. 16, $ 17; p. 227, $411. Organic Compounds—continued. formed of combustible substances, proper, of supporters of combustion. and nitrogen gas, p. 33, $ 61. formed out of a homogeneous fluid of seventeen elements, p. 24, $ 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, $ 48; p. 27, $ 51, 52, 53 4; p 44, $ 72. contradistinguished from mineral com- pounds, p. 20-27, $ 19-51 ; p. 221- 227, $ 409 4-411. progressively advanced, p. 24, $ 42. hold different ranks, p. 24, $ 42. different in every part, p. 25, $ 44; p 27, $ 53 4; p. 222-225, $ 409. variety of, p. 24, $ 41; p. 44, $ 72 : p 221-227, $ 409 4-411. not formed in the blood or sap, p. 24. $ 42 ; p. 28, $ 53 4, c; p. 44, $ 72 ; p. 217, $ 401 4, 402 ; p. 218, $ 404 : p. 219-227, $ 407-411. See, also, Protein. confounded by chemistry, p. 29, $ 54-4. uniform in health, p. 21, $ 22 ; p. 24, $ 42 ; p. 25, $ 44; p. 26, $ 48 ; p. 27. $ 53 4; p. 44, $ 72; p. 223-^27, $ 409/-411. exactly variable in disease, p. 21, $ 22 : p. 25, $ 44; p. 87, $ 182 a; p. 105, (, 220, 221 ; p. 435, $ 680 ; p. 452, t; 693 ; p. 473, $ 733 c; p. 474, $ 733 /; p. 478, 479, $ 739-741 ; p. 517. 518, $ 822 ; p. 536-538, $ 847 c-f fundamental cause of their differences. p. 27, $ 52, 53 4. their chemical analysis uncertain, p. 16, $ 15; p. 18, $ 18 d; p. 26, $ 48 ; p. 27-29, $ 53, 54. their complexity, p. 24, $ 41, 42 ; p. 25, $ 43 ; p. 26, $ 49 ; p. 32, $ 60 p. 44, $ 72. their putrefaction and fermentation, p, 28, $ 54; p. 30-32, $ 59 ; p. 34-36. $62; p. 96, $ 189 c. their elements united by vis vita, p 30-32, $ 58, 59 ; p. 33, $ 60; p. 36 $ 62 i; p. 37-44, $ 64-72. when dead, vis inertia succeeds to vis vita, p. 30, 31, $ 59. their artificial transformations, unnat- ural, p. 28, 29, $ 53 4-54 4; p. 228 $ 417. chemical influences upon, suppose chemical decompositions and re- combinations, p. 28, $ 53 4; p. 228, $ 417 a. their nature disturbed by any chemical influence, p. 28, $ 53 4; p. 29 SO, $ 56,57; p. 228, $417 a. 948 INDEX. Organic Compounds—continued. ° when dead, their condition affected by pre-existing vital influences, p. 28, $ 54 a. . . ., their chemical decomposition rapid, p. 29 30, $ 54 a, 56; p. 34-36, $ 62. their'dissolution greatly owing to nitro- gen gas, p. 34-36, $ 62. their dissolution promoted by the com- plexity of their elements, p. 36, $ 62 h, 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, $ 4* d; p. 84-86, $ 175 c, d; p. 90, $ 188} d; p. 154, 155, $ 349 c, e; p. 254, $ 441 e; p. 274, $ 447* a. See Vital Principle, and Vital Properties. Organic Functions, their general consideration, p. 126-280, $ 251-449. common to plants and animals, p. 125, $ 249. their designations, motion, absorption, assimilation, distribution, appropria- tion, excretion, calorification, genera- tion, p. 125, $ 249. the most essential carried on by the extreme vessels, p. 36-41, $ 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 abarfuoned to chem- istry, p. 234, $ 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, $ 447 d; p. 270, $ 447 d. Hunter's theory of, p. 237, $ 437 4. Philip's theory of, p. 237, $ 437 c; p. 263, $ 446 4. Moore's theory of, p. 237, $ 437 d. Muller'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, $ 441 4; p. 255, $ 441* a; p. 271, 272, $ 447 g. Elliotson's theory of, p. 273, $ 447 h. Billing's theory of, p. 238, $ 438 4. Roget's theory of, p. 238, $ 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 •ganic Heat—continued. hydrogen, p. 239-248, $ 440-441 4, p. 252, $ 441 c; p. 254, 255, $ 441 e, f; p. 260, $ 445 4; p. 264, $ 446 c; p. 274-278, $ 447*. conflict in the chemical statements of, p. 239, 240, $ 440 a, 4; p. 252, $ 441 c; p. 246, $ 440/; p. 254, 255, $ 441 e,f; p. 260, $ 445 4; 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, 11*, 12, 13, 14; p. 245, $ 440 e; p. 247, $ 440, No, 19 ; p. 248, $ 441 a-c; p. 252, $ 44] c; p. 254, $ 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, $ 440a,No.3; p. 243,244. $440cc, No, 12 ; p. 248, $ 441 4 ; p. 275,.$ 477* 4. in its relation to the law regulating the interchanges of caloric among inanimate objects, p 244-246, $440e. chemical parallels of, with inorganic processes, and artificial mecha- nisms, p. 177, 178, $ 350! ; p. 238, $ 438 4, c. its supposed connection with exercise, p. 240, $ 440 a, No. 8 ; p. 243, 244, $ 440 cc, No. 12. its supposed connection with alcohol 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 alcohol than water, and in their connection with different climates, explained against organic chemistry, p. 240, $ 440 4; p. 245, $ 440 c; p. 250-252, $441c; p. 257, $442 4; p. 335, 336, $ 512, 513 ; p. 394-396, $ 617-621. chemical philosophy of, in relation to meat, fat, tallow, wine, and bile, and objections, p. 67, 68, $ 151, 152 ; p. 240-243, $ 440 a-c; p. 247, $ 440 i. supposed dependence of, upon clothing, p. 239, $ 440 a, No. 3 ; p. 241, $ 440 44, No. 9 ; p. 242, $ 440 c; p. 245, 246, $ 440 e; p. 249, 250, $ 441 c ; p. 256, $ 441* 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. 949 Organic Heat—continued. ' $ 440 e; p. 249, 250, $ 441 c ; p. 258, 259, $ 442 d, e. more uniform in warm-blooded verte- brata than any other product, p. 245, $440 e; p. 253, $ 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, $ 57 ; p. 97, $ 190 4; p. 256. $ 441* d; p. 260, $ 445 4. generated by plants, p. 256, $ 441* a; p. 260-262, $445. a product of secretion, p. 263, $ 446 ; p. 273, $ 447 h. influenced by age and constitution, p. 68, 69, $ 153-156 ; p. 248, $ 441 4 ; p. 255, $ 441* a; p. 257, 258, $ 442 a, b; p. 259, 260, $ 443-445 4; p. 262, $ 445 /; p. 271-273, $ 447 g, h; p. 275, $ 447* 4; p. 384, $ 585 c, d, 586 ; p. 391, $ 603. its vital nature shown by hereditary constitution, p. 257, 258, $ 442 4. 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 4 ; 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, $ 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 4; p. 264-270, $ 447a-d; p. 272, $ 447g. 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, $ 442 4, 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 ch- ;anic Heat—continued. mates, by the rapidity with wnich the tropical may be made to endure a frosty atmosphere, by the ever- greens of northern latitudes, &c, ibid, and Vital Habit. its relation to vital habit explains the dissemination of animals from the region ofthe Ark, p. 258, $ 442 4, c ; p. 363, $ 537-540 ; p, 364, $ 544, 548 ; p. 369, $ 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, $ 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, 4; p. 264, $446 d. supposed dependence of, upon the red globules of blood, and objections, p. 255, $ 441 /; p. 260, 261, $ 445 4-e ; p. 274-278, $ 447*. generated according to the nature of the part, p. 61, 62, $ 133 4, 134-136 ; p. 67, $ 150, 151 ; p. 97, 98, $ 190, 191 ; p. 260, $ 445 a, 4; p. 268, 270, $ 447 d. why it sometimes rises just antece- dently to death, p. 269, $ 447 d. why it rises after death, p. 266, 267, $ 447 d. has one provision for the lungs, and another for " the rest of the body," p 276, 277, $447*/ 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, $ 62 c. its organs, p. 54, $ 105, 107, 111 ; p. 57, $ 125. its most essential organs, p. 40, $ 65 , p. 42, $ 67; p. 54, $ 109, 110 ; p. 55, $ 115; p. 56, $ 122; and are blended in all parts, p. 54,$ 109 4, 110; p. 55, $ 113417. See, also, Capilla- ries, and Circulation, Capillary. its great immediate office nutrition and vital decomposition, p. 53, $ 104; p. 129, $ 273. 950 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, $ 105. See, also, Organic Functions. begins in plants, p. 15, $ 10, 14; p. 16, $ 16, 17 ; p. 135, $ 298-301, 303 ; p. 137, $ 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, $ 13, 14; p. 24, $ 42 ; p. 30, $ 59 ; p. 33, $ 60 ; p. 135, $ 301 ; p. 196, $ 360 ; p. 201, $ 374, 375. its simplicity in plants in respect to organization, p. 54, $ 107; p. 58, $ 129/; p. 135, $ 202 ; p. 136, $ 303. in plants the whole being, p. 55, $ 114; p. 88, $ 184, 185. complexity of its organs in animals, p. 54-56, $ 111-120; p. 57, $ 125; p. 135, $ 302 a; p. 140-143, $ 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. indispensable to animal life, p. 54, $ 108, 110; p 55, $ 115. subordinate to animal life, in its com- prehensive Design, p. 15, $ 10-14; p. 55, $ 113. 114; p. 135, $ 298, 300. gives rise to the same diseases in the organs of animal as of organic life, p. 55, $ 117. the whole life ofthe fcetus, p. 53, $ 103. See, also, Nerves., has no repose but in the germ. p. 30, $ 57; p. 53, $ 102; p. 97, $ 190 4. harmonious in its laws and phenome- na, p. 1, $ 1 ; p. 3, $ 2, 4, d ; p. 14, $ 6 ; p. 41, $ 65 ; p. 44, $ 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, $ 185-188 ; p. 90, $ 188* a-d; p. 93- 95, $ 188* d; p. 96-99, $ 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- 233!; 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 c, 3034 a; p. 140-147, $ 304-330; p. 148, 149, $ 336 ; p. 191, 192, $ 351-353 ; p. 209, $ 384, Organic Life—continued. 385 ; p. 212, $ 392 ; p. 216, $ 399 , p. 217, $ 401 4; p. 222-234, $ 409 c- 433; p. 271, $ 447/; p. 272, 273, $ 447 A; p. 279, $ 449 ; p. 282, $ 451 ; p. 283, $ 452 a, c; p. 284-287, $ 454 -458 ; p. 290, $ 464, 465 ; p. 323- 332, $ 500 ; p. 405-412, $ 638 ; and 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, $ 237; p. 227, $ 411 ; p. 405-412, $ 638 ; p. 442, $ 686 d; p. 489, $ 756 4; p. 619, $ 892* r. See, also, Harmonious in its Laws, 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, $ 185. See Vital Properties, and Vital Principle. Organism, the universal body, p. 52, $ 89. radiated, p. 53, $ 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, $ 108, 110, 111 ; p. 55, $ 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, $ 302. and vital properties, mutually depend- ent, p. 16, $ 14 c; p. 81, $ 170. its most essential part, p. 54, $ 109 4. Organized Structure. See Struct- ure. Organs, Development of. See Devel* INDEX. 951 Ovum—continued. its peculiarities in different tribes, p 56, $ 122; p. 97, $ 190 4. oviparous and viviparous, distinctions between, p. 45s $ 73 a; p. 97, $ 190 4. 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, $ 67; p. 54, 6 109 ; p. 284, $ 455 a, b; p. 286, $ 456; p. 289, $461*a; p. 342-353, $ 516-524. its power of resisting external in- fluences, p. 30, $ 57; p. 56, $ 123; p. 256, $441* d. evinces great Design, p. 56, $ 123; p. 97, $ 190 4. See Nerves, their early development, &c. OxYDATION OF THE BlOOD AND BoDY. See Combustion, and Organic Heat. Oxygen, its relative connection with animals and plants, p. 137-139, $3034-303|. its connection with respiration, p. 229, $ 419 ; p. 266, $ 447 d; p. 268, $ 447 d; p. 270, $ 447 e; p. 274-278, $ 447*. a test ofthe assumed dependence upon, of motion and animal heat, p. 255, $ 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. Organs of Animal Life, their designation, &c., p. 54, 6 106 ■ n 58, $ 127. ' p' their subserviency to organic life p 54, 55, $ 111-117 ; p. 106, (, 223 • p 108, $228; p. Ill, $233!; P, 144- 146, $ 323-326 ; p. 282-289, $ 451 c-461*; p. 325, $ 500 e; p. 332, $ 501 c ; p. 338, 339, $ 514/, g. not 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, $ 89, 92. their sympathetic relations, p. 58, $ 129 c-fi their relations liable to derangements, p. 59, $ 129 g-i; p. 361, 362, $ 529. See, also, Laws of Sympathy, and Nervous Power. their mechanical relations, p. 59, $ 129 £. 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 life, p. 55, $ 111-117. Ovum, its state of life, p. 30, $ 57; p. 36-42, $ 63-66 ; p. 97, $ 190 4; p. 104, $ 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, $ 350! n. special circumstances attending its condition and development, p. 56, $ 122 ; p. 97, $ 190 4; p. 104, $ 212. its vital modifications, p. 44, $ 72; p. 56, $ 122, 123 ; p. 97, $ 190 4; p. 104, $ 212. how impressed in fecundation, p. 44, 45, $ 72-73 ; p. 97, $ 190 4; p. 104, $212. its development a type of all organic processes, p. 45, $ 73 4; p. 68, $ 153-156 a. its development supplies a type of all diseases, p. 45, $ 72; p. 47-49, $ 75-80. transmits disease, p. 47, 48, $ 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, $ 441* d. illustrates the philosophy of hybrid an- imals and hybrid plants, p. 44, 45, $ 72. its supposed nucleus of a cell, p. 42, $ 67; p. 50, $83 4; p. 60, $ 131. P. Pain, rarely a cause of disease, p. 588, $ 891 m. does not affect organic actions in health, p. 79, $ 167, note; p. 588, $ 891 m. should not be prevented, nor assuaged, by means which may endanger life, p. 584, $ 891 c, d; p. 587, $ 891 k; p. 593, $ 891* 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. 952 INDEX. Pathology, its general survey, p. 413-540, $ 639- 851; comprehending Remote Causes, p. 414-427, $ 644-666 ; Proximate or Pathological Cause, p. 427-434, $ 667-676 ; Symptoms, p. 434-455, $ 677-694* ; Morbid Anatomy, p. 456- 463, $ 695-709 ; Inflammation, p. 464- 489, $ 710-756 ; Fever, p. 489-499, $ 757-785; Venous Congestion, p. 500-513, $ 786-818 ; Humoralism, p. 514-540, $ 819-851. objects and nature of, p. 3, $ 2 ; p. 413, 414, $ 639-642. to the physician the great final object of physiology, p. 3, $ 2 4; p. 413, $ 639 a. reflects light upon physiology, p. 73, $ 163; p. 107-111, $ 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, $819 4; p. 517,$ 821c. Pancreas, developed from intestinal canal, p. 41, $ 65. See, also, Assimilation. Passions. See Mental Emotions. chemical theory of, p. 155, $ 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- pathy, p. 54, 55, $ 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 philosophy, 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 4. 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, $ 4* 4; p. 8, 9, $ 5; p. 14, $ 6 ; p. 174, $ 3504 ; p. 203-207, $ 376!; p. 460- 463, $ 709, note. See, also, Physi- ology and Organic Chemistry, con- trasted. neglected, p. 112, $ 234 4; p. 154, $ 349 d; p. 202, $ 376* ; p. 219, $ 408 ; p. 234, 235, $ 433 ; p. 434, $ 676 4 ; p. 457, $ 699 c; p. 482, $ 744; p. 484, $ 748 ; p. 515, $ 819 4; p. 715- 721, $ 960 a. its limits, p. 185, $ 850| k; p. 206, $ Philosophy—continued. 376! a ; p. 317, $ 493 a; p. 719, 720, $ 960 a. See, also, Science. true 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*- 350J; p. 484, 485, $ 748, 749 ; p 515-519, $ 819 4-825. Phlebitis. See Venous Congestion, and Venous Tissue. Phthisis Pulmonalis, an 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 4; p. 459, $ 705 ; p. 471, $ 732 d; p. 546-551, $ 862-864; p. 573, $ 890 e; p. 338-341, $ 892* g-i; p. 765, 766, $ 1007-1008. See, also, Medical and Physiological Commen- taries, vol. ii., p. 608-634; p. 743-746. Physiologists, their duty to their own science, p. 2, $ 14; p. 8, $ 5 ; p. 122, $ 240 ; p. 202, $ 376*; p. 207, $ 376| 4; p. 277,$ 447*/; p. 429. $ 674 a; p. 762, $ 1006 a. their proper vocation, p. 2-4, $ 2; p. 10-14, $ 54-6; p. 202, $ 376*; p 207, $376| hi P-239, $ 438 d; p 279, $ 448 ; p. 330, $ 500 »; p. 429 $ 674 a. the proper ground for their inductions p. 10, 11, $ 54; p. 115, $ 234 e; p 429, $ 674 a; p. 434,435, $ 679, 680 See, also, Facts. Physiological States, inferred from morbid states, p. 61, $ 134; p. 64, $ 140; p. 73, $ 163 ; p. 107-111, $ 225-233!; p. 265, $ 447 o-c; p. 272, $ 447 #; p. 501-512, $ 791-817. inferred from the natural products, p. 62, $ 135. inferred from natural stimuli, p. 62, $ 136; p. 97, $ 19Q; 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, $ 149, 150; p. 107-111, $225-233!. do not teach the morbid states, only as they are illustrated by the morbid, p. 3, $ 2 c, and as above. See, also, Remedies, their Capabilities and Effects. not taught by Anatomy, p. 3, $ 2 c; p. 50, $ 83 c; p. 59, $ 131. See, also, Morbid Anatomy. INDEX. 953 Physiology, its general survey, p. 15-412, $ 7-638. objects of, p. 3, $ 2. regards Nature according to her ordi- nations, p. 3, $ 2 4; p. 11, $ 5 4 e; p. 12, $ 54/ 5* a; p. 330, $ 500 n. schools of, p. 6, $ 4*. considered under seven divisions, p. 22, $ 31. not learned from anatomy, p. 3, $ 2 c; p. 50, $ 83 c; p. 59, $ 131. its relations to pathology and therapeu- tics, p. 1, $ 1 ; p. 2, 3, $ 2 ; p. 55, $ 115-117; p. 58, $ 129; p. 61-70, $ 133-160; p. 98, $ 191 ; p. 102, $ 202 ; p 107-122, $ 225-240 ; p. 131, 132, $ 284-288 ; p. 331, $ 500 c ; p. 398, $ 626 ; p. 405-113, $ 638, 639 ; p. 541, $ 852. vitiated by experiments, p. 11-13, $ 54 c,/, 5* a; p. 14, $ 6 ; p. 17, $ 18 e i p. 26, $ 48 ; p. 28, $ 53 c ; p. 132, 133, $ 289-291 ; p. 148, $ 334, 335 ; p. 173, $ 3504 ; P- 179-182, $ 350| c-g; p. 196-198, $ 360-364 ; p. 200, $ 366 ; p. 202, $ 376* ; p. 485, $ 749 ; p. 518, $ 823. how far surrendered to Chemistry, p. 8, 9, $ 5; p. 13, $ 5* a ; p. 148, $ 335; p. 155, $ 349 d; p. 176, $ 350* q; p. 202, $ 376* ; p. 235, $ 433. the qualifications of chemists for its investigation, p. 7, $ 4* d; p. 8, 9, $ 5; p. 11, $ 54 c, d; p. 157-173, $ 350, Nos. 3-46 ; p. 174-182, $350*- 350! g; p. 202, 203, $ 376* ; p. 239, $ 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. 260, $ 445 4 ; 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, $494. See, also, Com- bustion. Physiology and Organic Chemistry Contrasted, p. 19, $ 18 c; p. 157- 173, $ 350 ; p. 189, 190, $ 350! n; p. 191. $ 351; p. 246, $ 440/; p. 277, 278, $ 447* /; p. 514, $ 819 a, Nos. 1-7. See, also, Organic Chem- istry, contradistinguished from, cfrc. 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, $ 298—303. Plants—continued. subsist on mineral substances, p. 15, $11, 14; p. 16, $ 16; p. 20, $ 18 e, p. 135-139, $ 298-303*. their food originally from the atmos- phere, p. 16, $ 16; p. 135-138, $ 303-303*. have greater organizing power than animals, p. 15, $ 11; p. 24, $ 42; p. 105, $ 217 ; p. 135, $ 298, 300. their simplicity of life, p. 55, $ 114 ; p. 58, $ 129 /; p. 88, $ 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 ; p. 15, $ 8-10. 12-14; p. 21, 22, $ 19-30; p. 23J 24, $ 34-42 ; p. 26, $ 47-49 ; p. 27, $ 52, 53 ; p. 29, $ 54 a; p. 30-36, $ 56-62 ; p. 44, $ 72; p. 45, $ 73 4; p. 48, $ 77; p. 49, $ 80 ; p. 51, 52, $ 84, 85 ; p. 54, $ 107-109 ; p. 55, $ 112-115; p. 56, $ 121-123; p. 58, $ 129/; p. 68, 69, $ 153-157; p. 82, $ 170 a, 171; p. 83, $ 172-174; p. 86, $ 176; p. 88, $ 184 a, 185; p. 89, $ 188 a; p. 90, $ 188* 4, c; p. 93-95, $ 188* d ; p. 98, $ 191 a; p. 103, $ 207 ; p. 104, $ 214 ; p. 105, $ 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. 26*, 27, 51 ; p. 207, 208, $ 381 ; p. 224, 225, $ 409 g-i; p. 226, 227, $ 410, 411 ; p. 260 -262, $ 445 a-f; p. 273, $ 447 h; p 280, $ 449 d; p. 283, $ 452 a; p 284, $ 454, 455 ; p. 286, $ 456 a; p. 289, $ 461* a; p. 345, 346, $ 516 d No. 7; p. 391, 392, $ 603-606; p 395, $ 618 4; p. 435, $ 680; p. 442 $ 686 d; p. 474, 475, $ 733 f-i; p. 619, $ 892 r; p. 746, $ 990^4- their creation before animals, Author's proof of, p. 135, 136, $ 303 a; p. 137, 138, $ 3034 h c. essentially independent of animals, p, 15, $ 11-14; p. 16, $ 16, 17; p. 135 136, $ 303 a; p. 137, 138, $ 3034 4, c the beginning of organic compounds, p. 15, $ 10, 13, 14; p. 135-139, $ 298-303§. their manifestations of vital motion, p. 103, $ 207; p. 134, $ 293, 294; p. 163-167, $ 350, Nos. 63-77. illustrate continuous sympathy, p. 58, $ 129 /; p. 322, $ 498 c; p. 351, $ 524 a, No. 2. the action of light upon, p. 46, $ 74 a; p. 90-95, $ 188* d; p. 136, 137, $ 303 d, c; p. 163-165, $ 350, Nos 64-70. their diseases, p. 93, $ 188* d; p 98, 954 INDEX. Plants—continued. $ 191 a; p. 322, $ 498 c; p. 474, 475, $733/-* analogy traced between the process of regeneration in inferior animals, ofthe 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, $ 729 a ; p. 471-476, $ 732-733 ; p. 479, $ 741 4. Plants and Animals, their fundamental distinction, p. 15, $ 11-14 4; p. 17-20, $ 18. their composition, p. 15, $ 12; p. 17- 20, $ 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. Potash and Soda, Tartrate of. See Cathartics, and Therapeutics. 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, $ 902 i. Principles, importance of, p. 4, $ 3, 4; p. 331, $ 500 o; p. 489, $ 756 4f consistency, a test of, p. 1, $ l ; p. 3, $ 2 c ; p. 331, $ 500 o; p. 489, $ 756 4. 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 ofthe medical profession, p. 77, note; p. 515, $ 819 4; 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 d-451 /; p. 330, $ 500 n. another for Mental Materialism, p. 84, 85, $ 175 c; p. 155, $ 349 c; p. 281, $ 450 e; p. 329, $ 500 n. another for 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, $ 409 a, 4 ; p. 763, $ 1106 a. See, also, Mulder's Re- play to Liebig, concerning Truth and Protein. London, 1846. Proximate or Pathological Cause of Disease, general consideration of, p. 427-434, $ 667-676. constitutes the disease itself, p. 427, $ 668. undergoes a constant succession of spontaneous or artificial changes during the progress of disease, p. 428, $ 672. the various changes result from the natural instability of the properties of life, ibid. is the special object of all remedial agents, p. 428, $ 673, &c. See, also, Vital Properties, Remote Causes, and Therapeutics. Proximate Principles of Organic Com- pounds, their reputed nature, p. 29, $ 54 4. are chemical transformations, p. 18, 19, $ 18 ; p. 28, 29, $ 53 4-54 a. their true nature, p. 24, 25, $ 42-44; p. 27, $ 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 peculiarities, p. 28--31, $ 54-59 ; p. 34-36, $ 62. See, also, Nitrogen. its principal cause evinces that it is not concerned in digestion nor in INDEX. 955 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 bodies, p. 35, $ 62 e. See; also, Digestion, Chemical Theory of, and Physiology of, and Decomposition, Vital. incompatible with life, p. 16, $ 17; p. 105, $ 221 ; p. 533, 534, $ 843. Stahl and Junker define "life as a state opposite to putridity." rapid in dead animal compounds, p. 34, $ 62 c; p. 96, $ 189 c. takes place under organic conditions, p. 28, $ 54 a. promoted mostly by nitrogen gas, p. 34-36, $ 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, $ 350! c; p. 181, $ 350! 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 4; p. 124, $ 241c. the peculiar attribute of the soul, p. 123, $ 241 a; p. 124, $241 c. contrasted with instinct, p. 123, 124, $ 241 4, 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 instinct, of the identity of mankind Reason—continued. in respect to species, p. 123, $ 24! c, note. See, also, Instinct. Reflex Action5 its general philosophy known in former times; its mechanism and physio- logical laws lately determined, p 290, $ 462-465 ; p. 320, $ 494 dd; 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, $ 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, $ 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 4; p. 59, $ 129 g-i; p. 66-69, $ 144-156 ; p. 73, $ 163; p. 98,$ 191 4; p. 122, $ 240 ; p. 437-442, $ 685- 686. See, also, Pathology, and Therapeutics. analogous in action to-morbific causes, p. 542, $ 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, $ 2 c ; p. 63, $ 137 d ; p. 65, $ 143 c ; p. 67, $ 150, 151; p. 122, $ 240 ; p. 148, $ 334 ; p. 417, $ 650 ; p. 428, $ 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 4; p. 488, $ 756 4 ; p. 528, $ 831 ; p. 541, 542, $ 854 ; p. 543, $ 857 ; p. 545, $ 859 ; p. 547, $ 863 d,«. p. 565, $ 889/ g; P- 567- 569, $ 899 l-mm; p. 572-574, $ 890 d, e; p. 575, 576, $ 890 h-l; p. 577, 578, $ 890 o-q; p. 580, 581, $ 890* e-g; p. 584, $ 891 d; p. 586-589, $ 891 A-p; p. 590-593, $ 891*; p 597- 600, $ 892 c, d; p. 608-610, $ 8924 c, d; p. 613, $892*4; p. 615, $892* e,f; p. 619, $892* r; p. 623, $ 892§ c; p. 625, $ 892§/; p 628, 629, $ 956 INDEX. Remedies—continued. 892? a-s; p. 630, $ 892! ; p. 633- 635, $892$ a-c; p. 637-639, $ 892* e-g; p. 645, $ 893 c; p. 649, 650, $ 893 h, i; p. 652, 653, $ 893 m, n; p. 657, 658, $ 893 p; p. 662, 663, $ 895- 897; p. 664, $ 900; p. 679-683, $ 905 ; p. 684-688, $ 905* 4, 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 4; p. 27, $ 52; p. 44, $ 72 ; p. 45, $ 73 ; p. 55, $ 117 ; p. 59, $ 129 h; p. 61, $ 133 c; p. 63, $ 137; p. 65, $ 143; p. 67, $ 149- 152 ; p. 73, $ 163 ; p. 87, $ 177-182 ; p. 89, $ 188 a; p. 98, $ 191 a, 4; p. 99, $ 192; p. 101-104, $ 201-204; p. 100-111, $ 223-233! ; 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. shown 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 liver, &c, p. 133, $ 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 application, ut supra. See, also, Therapeutics, and Adapta- tion, Law of. action of, often 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. 326-328, $ 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, $ 350, No. 46. See, also, Combustion. Respiration—continued. the death of organic chemistry, p. 243, $ 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, $ 14 c ; p. 23, $ 34-36 ; p. 34, $ 62 c; p. 46, $ 74 ; p. 49, $ 81 ; p. 86, $ 175 d; p. 135-138, $ 303-303!; p. 174-192, $ 350*-353 ; p. 317, $ 493 a; p. 401, $ 632 4. See, also, Design. Revulsion, objections to the doctrine of, p. 653- 656, $ 893 n. Rochelle Salts. See Cathartics, The- rapeutics, &c. Rheubarb. See Cathartics, Astring- ents, Tonics, Alteratives, Thera- peutics, and Remedial Action. object of its arrangement among the Group of alteratives; see Oil, Cas- Saline Cathartics. See the severas Denominations. Sap, composed of the same seventeen ele- ments as blood, p. 23, $ 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,$ 409 #-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. Scammony. 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, $ 4* a; the Chemical confound organ- ic and inorganic Nature, p. 6, $ 4* 4 ; 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, $400-411. INDEX. 957 Secretion—continued. chemical philosophy of, p. 168-170, $ 350, Nos. 31, 32, 37, 38, 39 ; p. 180- 182, $ 350! e,f. See,also,CoMBusTioN. Secretions and Excretions, terms applied to the products of the functions, and used, at present, in their morbid acceptation, and as supplying symptoms, p. 450-455, $ 690-694*. Sedatives, their uses and mode of action, p. 583- 593, $ 891-891* ; p. 681-683, $ 905 4. See, also, Narcotics, Hydrocyanic Acid, and Analogies. Seed, its state of life, p. 30, $ 57 ; p. 97, $ 190 4. evinces great Design, p. 56, $ 123 ; p. 97, $ 190 4. See, also, Ovum. Semen, a vital stimulus, p. 44^6, $ 72-73 ; p. 47-49, $ 75-80 ; p. 97, $ 190 4. acts upon the ovum, p. 44, $ 72 ; p. 97, $ 190 4. transmits disease, p. 47^19, $ 75-80. its analogies with other vital agents, p. 45, $ 73, 74 ; p. 97, $ 190 4. imparts constitutional peculiarities, p. 44, $ 72. vicarious, p. 50, $ 83 4. See, also, Ovum. Seneka, its merits in croup, p. 638, $ 892 j / Senna, objections to its common use ; see Cathartics, and Therapeutics. Sensation, its philosophy, p. 89, $ 186, 188 4; p. 100-103, $ 194-204 ; p. 280-283, $ 450-451. of three kinds, common, specific, and sympathetic, p. 280-283, $ 450-451. common, the cause of pam, and uni- versal, p. 100, $ 198 ; p. 281, $ 450 d. specific, the function ofthe 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 m the brain, and end in exciting percep- tion, p. 100, $ 196, 199* ; P- 101, $ 201 • p. 280-282, $ 450 c-451 4. common and specific require the exer- cise of perception, p. 124, $ 241 a ; p. 281, $ 450 c. sympathetic 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, $ 451-459 a; p. 321, $ 497 ; p. 323-332, $ 500 ; p. 342, 343, $ 515, 516 d, Nos. 3, 4; p. 349, $ 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, $ 233; p. 126, 127, $ 258-260 ; p. 323-332, $ 500 ; p. 349, $ 519 ; p. 671, $ 903. See, also, Nervous Power. common and specific depend mostly upon cerebro-spinal nerves, p. 101, 102, $ 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 sys- tem, 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, $ 175 c; p. 155,.$ 349 e; p. 281, $ 450 ; p. 329, 330, $ 500 n 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, $ 188 4 ; p. 93-96, $ 188* d-189 c; p. 100, $ 195; p. 101-103, $ 201-204; p. 281-283, $ 450 e-451 ; p. 671, $ 903. its organs, the nerves, p. 100, $ 196; p. 280, $ 450 4. 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. 958 INDEX. Sensibility—continued. specific, peculiar to the senses ; exqui- sitely susceptible, but rendered ob- tuse by disease, p. 100, $ 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 4; p. 100, $ 199*; p. 280, $450. sympathetic, an element of remote sympathy, p. 46, $ 74 a; p, 89, $ 188 a; p. 101-103, $201-204; p. 104, $ 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, $ 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, $ 201 c; p. 104, $ 209; does not involve true sensa- tion or perception, p. 101, $ 201 4; p. 103, $ 204. possesses modifications analogous to those of irritability, p. 100, $ 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, $ 224 ; p 347, $ 516 d, No. 11; p. 521, $ 826 d. its general relations to external ob- jects, p. 53, $ 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, Ac, p. 55, 56, $ 118-121. See, also, Youth. Sleep, how explained in materialism, p. 85, $ 175 c;. p. 329, 330, $ 500 n. 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, $ 188J d; p.. 115, $ 234 c. Solar Spectrum—continued. its invisible rays, p. 91, $ 188* d; 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, $ 175 c. that judgment, reflection, and percep- tion, require, for their exercise, the co-operation ofthe brain, is analogic- ally inferable from the manifest con- currence ofthe 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. 687, $ 905£ 4; p. 721, 722, $ 960 c, d. Specific Action, illustrated by remedial and morbific agents, p. 417, $ 650 ; p. 424, $ 662 a; p. 430, $ 675, 676 a; p. 487-489, $ 754-756 ; p. 542, $ 854 c; p. 553, $ 870 aa; p. 562, $ 888 c; p. 587, $ 892 c; p. 662-665, $ 895-901; p. 676-679, $ 904 c. See, also, Altera- tives, and Analogies. Spermatozoa, the supposed germ, p. 42, $ 67. Sphincter Muscles, held in contraction by the nervous power, p. Ill, $ 233*; p. 339, $ 514^. illustrate the law of prolonged influ- ence, ibid, and p. 344, 345, $ 516 d, 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, $ 473-175. Sponge, Burned, Vegetable ^Ethiops, and Cod's Liver Oil, p. 619, $ 892*. Spontaneous Generation. See Gener- ation, Spontaneous. Squill. See Expectorants, Thera- peutics, Emetics, Diuretics, and Remedial Action. Stethoscope, its advantages, p. 640, $ 892 j h. Stimulants, their uses, &c., p. 579-583. Stimuli, Vital, p. 21, $ 21 ; p. 62, $ 136, 137 ; p. 90, $ 188*. every part has its own, p. 62, $ 136. INDEX. 959 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, $ 188*c; p. 107-111, $ 226-233!. 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, $ 135 a; p. 191, 192, $ 353 ; p. 229, $ 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, $42; p. 30, $ 59 -, p. 33, $ 60 ; p. 135, $ 301; p. 143, $ 322 ; p. 196,,$ 360,361 ; p. 200,,$ 374, 375. chemical theory of its function of diges- tion, p. 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, $ 376! a- Stramonium. See Aconite,_&c. Strength and Weakness, or Debility, in what they consist, p. 370-372, $ 569; p. 312, 313, $487#, A. Structure, its physical and vital characteristics, p. 50-73, $ 83-1-63. important to be known in its sensible and functional character, p. 51, $ 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. in plants and animals, how different, p. 54, 55, $ 107-117; p. 134-140, $ 293-304. See, also, Plants. of organic beings, heterogeneous, p. 20, $ 29. its ultimate intricacy, p. 59, $ 130. created before life1, p. 81, $ 170. Strychnia, effects on the nervous system, see Ac- onite, &c. Sudorifics, the term objectionable, p. 250, 251, $ 441 c; p. 335-341, $ 512-514; p. 547, $ 863 d; p. 550, $ 863 e ; p. 630, Sudorifics—continued. $ 892! 4; p. 661-664, $ 894-900 ; p. 666-669, $ 902 4, i; p. 678, $ 904 d, &c.; p. 704, $ 943 a, 4, 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 their opera- tion 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, " and his sweat was, as it were, great drops of blood falling down to the ground." In this case the emo- tions were peculiar and violent, and operated in their compound aspect, according to the explanations which occur at p. 631, $ 892! h and ut supra. See, also, Nervous Power, Mental Emotions, Analogies, 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 spontane- ous hemorrhage); p. 083-690, (en- dosmose and exdosmose); 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, $ 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, $ 420^22. 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. 56, $ 120, 124 ; p. 57, $ 125 ; p. 58, 59. 960 INDEX. Sympathetic Influences—continued. $ 129 ; p. 63-66, $ 137-143; p. 67, 68, $ 149-152; p. 106-111, $ 222- 233!; p. 321-341, $495-514; p. 405 -412 $ 638 ; p.661-689, $ 894-905*; p 692, 693, $ 914-921 ; p. 698, 699, $ 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, $ 140-142 ; p. 67, $ 150-152 ; p. 73, $ 163. See, also, Tissues. Sympathetic Nerve, pervades all parts, p. 54, 55, $ 111, 113 ; p. 58, $ 129 ; p. 284-289, $ 454-461*. 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, $ 113 ; p. 321, $ 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 are greatly the medium of contiguous sympathy, and more or less of remote, in the higher ani- mals, p. 323, $ 499 ; p. 349, $ 520 ; p. 353, $ 524 d;—the only centers of sympathy in the inferior animals, ut cit, &lc. ;—shown to be centers of sympathy by their resemblance to brain ;—shown by the ramifications, and the interchanges of their nerves; —shown by the absence of brain and spinal cord in ail but the higher animals ; ut cit, and passim. not necessary to organic life, as nu- trition in the fcetus requires not the action of the compound organs ; is said to have been absent in the foe- tus, along with the brain and spinal cord, but is probably indispensable in the anencephalus to the action of the sphincters, p. 284-287, $ 454 -458 ; p. 289, $ 461* a ; p. 338, 339, $ 514/ g. See, also, Nerves, Cap- illaries, Plants, and Organic Life- appreciated by a few only, p. 112 $ 234 4. See Ganglionic System. Sympathetic Relations, such as are natural, p. 58, $ 129 ; p. 63, $ 137. morbid, p. 59, $ 129 i; p. 64-66, $ 14C - -143, 14.7. See, also, Adaptation, Law of. Sympathies, Morbid, of the Individual Tissues ; see Tissues. of the Compound Organs ; See Organs, Compound. Sympathy, its general consideration, p. 283-362, $ 452-530. of three kinds, continuous, contiguous, 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, $ 234 a. See, also, Humoralism, and Organic Chemis- try. its natural conditions neglected or rid- iculed, p. 111, $ 234 4; p. 283, $ 452 4. 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. 335-353, $512-524. physiological Laws of, luminously ex- pounded by the great Prussian Phys- iologist, p. 341, $ 514* i; p. 362, $ 530. Symptoms, the index of disease, p. 434-445. certain special ones, p. 442-445. mode of investigating, p. 430-433, $ 675, 676 a; p. 437-442, $ 685, 686 ; p. 561, $ 888 a. Syncope, produced, not as supposed, by deficien- cy of blood at the center of the cii 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, $ 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, $ 226, 227; p. 705, $ 945. Tables, of Organs according to their relative functions, p. 57, $ 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. 961 Tables—continued. of the fluid products of secretion, p. 218, $ 406. Temperament, physiological, pathological, and thera- peutical considerations relative to, p. 383-391, $ 585-603. Five, the sanguine, melancholic, choleric, phleg- matic, and nervous, ibid. philosophy of, shown by impregnation, p. 48, $ 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, $ 350! n; p. 191, $ 351 ; p. 208-217, $ 382-399; p. 219-227, $ 408-411 ; p. 238, $ 438 ; -p. 246, $ 440/; p. 277, 278, $ 447*/; p. 433, 434, $ 676 4; p. 456, 457, $ 699 ; p. 463, $ 709 ; p. 482, $ 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, $ 4 a ; p. 10, $54c. inculcated by the Creator, p. 5, $ 4 a. founded in Nature, p. 5, $ 4 a. implies the greatest reference to facts, p. 5, $ 4 4. should be studiously considered, p. 5, $44; p. 10, $ 54 c. undervalued by the ignorant alone, p. 5, $ 4 4. true, or false, always guides the igno- rant practitioner, p. 5, $ 4 4. how to make one, p. 10, $ 54 4, c. Therapeutics, considered in its various aspects, p. 541-777, $ 852-1027. the chemical system of, p. 176-178, $ 350?. 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§ 4. Tissues, ofthe animal body, p. 52, $ 86. their individuality important, p. 52, $ 88; p. 61, $ 133; p. 70, $ 162; p. 416, $ 649 4-d.. See, also, Venous Tissue. theii distinctions physical and vital, p. 52, $ 89 ; p. 61-73, $ 133-163. their union, p. 52, $ 89-92. a knowledge of important in medicine, p. 50, $83; p. 61, $132-134; p. 67, $ 149-152 ; p. 69-73, $ 160-163!; p. 353-362, $ 525-530 ; p. 468, $ 722 c. their respective modifications of lite, Tissues—continued. p. 61-64, $ 133-138 ; p. 64, $ 142; p. 416, 417, $ 649 4-d. their special products, p. 62, $ 135; p. 141, $ 307. their special stimuli, p. 45, $ 73 ; p. 62, $ 136; p. 92-95, $ 188* d. their relative liability to disease, p, 70- 72, $ 162. their relative force of disease, p. 72, $ 162. inflamed, their relative demands for Dloodletting, p. 72, $ 162. Tissues, Sympathies of, of the individual, p. 353-361. 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, $ 960 a,g; p. 515, $ 819 4; p. 527, $ 829 ; p. 529, $ 835 ; p. 540, $ 851. exemplifies the laws of vital habit, p. 364, $ 542-548* ; 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, $ 2 4; p. 238, $ 438 d; p. 463, $ 709 ; p. 515, $ 819 4. See, also, Error, and Facts. its compass and nature, p. 11, $ 54 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 ap- 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, 471v, $729 a, 4; p. 472-475, $ 733; p. 477, $ 736 c, 737 ; p. 478, $ 740 a. Understanding, a property of the mind and of the in- stinctive principle, p. 123, $ 241 6, See Mibe. P P 962 INDEX. Unity of Design. See Design. Urea, its importance in organic chemistry, p. 228, $ 417. Urinary 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, £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, $ 425-427. but little subject to disease, p. 450, 451, $ 691. adaptations to, of urinary agents, p. 683-689, $ 905*. 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, sufficiently recognized by inspection, p. 233, $ 427 ; p. 451, $691. Uterine Agents, considered in their various therapeuti- cal aspects, p. 683-689. See, also, Emmenagogues, and Ergot. Uva-Ursi. See Genito-Urinary Agents. V. 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- 303*. - 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 4, c; p. 128-134, $ 269-295 ; p. 210, $387; p. 527, $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, ous 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 different from those of inflammation of other tissues, p. 507, 508, $ 806 ; p. 724- 726, $ 961 a-e. 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 4. insidious, p. 508, 509, $ 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 4. See, also, Will. illustrates the sway of theory in the treatment of disease, p. 500, $ 789 ; p. 501, $ 790 4; p. 729, $ 967; p. 4, 5, $ 4 a, 4. 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 4; p. 416, $ 649 4, c ; p. 424, 425, $ 662 4, c; p. 440, 441, $ 686 4 ; p. 444, 445, $ 688 c, e; p. 447, 448, $ 688 i, k; p. 450, $ 689 4 ; p. 453-455, $ 694, 694* ; p. 468, $ 722 c ; p. 500-513, $ 786-818 ; p. 724-732, $ 961-970 ; p. 735, $ 978 ; p. 756-762, $ 1005. Vis Medicatrix Naturae, what it is, and what its advantages, p 87, $ 177 ; p. 122, $ 239, 240 ; p. 457, $ 699 c; p. 470-475, $ 729-733 /; p. 476, $ 735 a; p. 489, $ 757 a, p. 492, 493, $ 764 4, 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 4. not recognized in the chemical and humoral pathology, p. 169-173, i INDEX. 963 Vis Medicatrix Naturae—continued. 350, Nos. 36-46 ; p. 176-178, $ 350|; 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 Vita, p. 30, 31, $ 59 ; p. 105, $ 216. Vision, vital and Chemical Theories of, p. 92- 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, $ 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 affinity, p. 30 -33, $ 59, 60. VirAL Agents, whatever acts upon life, p. 21, $ 21 ; p 45, $ 73 ; p. 46, $ 74 ; p. 62, 63, $ 136, 137 ; p. 90-95, $ 188l; &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 remqte parts to the nervous centers, whether relative to animal or to organic life, p. 21, $21; p. 45, $73; p. 46, $74; p 86, $ 175 d; p. 89, $ 188 ; p. 95- 102, $ 189-203 ; p. 107-111,. $ 226- 2333 ; p. 112, $ 234 c; p. 114, $234 e • p 119, $ 234 i; p. 280-283, $ 450 451 • p 284-287, $ 454-458 ; p. 289, $461; p. 296,$ 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, $ 973 ; p. 746, $ 990* a. See, also, Analogies. philosophy of their operation, p. 47-49, Vital Agents—continued. $ 73-80 ; p. 89, $ 188 ; p. 90-99, $ 188*-193 ; p. 106-111, $ 223-233! p. 296, $ 476 c; p. 313, $ 478 h; p. 321-335, $ 495-511; p. 661-664, $ 894-901 ; p. 692, 693, $ 915, 920 See, also, Remedial Action. internal and external, p. 21, $ 21 ; p 45, $ 73 ; p. 62, $ 136 ; p. 90, $ 188* p. 106, 107, $ 223, 226 ; p. 110, 111 $ 233, 233! ; p. 296, $ 476 c ; p. 313. $ 487 h ; p. 398-400, $ 62Q-630 ; p. 405-412, $ 638. how necessary to life, p. 21, $ 21 ; p. 30, $ 57 ; p. 45, $ 73 ; p. 46, $ 74 a.; p. 62, $ 136; p. 63, $ 137 d, e; p 65, $ 143 c ; p. 67, $ 150,151 ; p. 90, $ 188* ; p. 106, 107, $ 223, 226 ; p. 110, $ 233 ; p. 285, $ 455 c; p. 398 -400, $ 626-630. act and acted upon, p. 2.1, $ 25 ; p. 24. $ 42; p. 90, $ 188 c; p. 108-110, $ 227-232; p. 134-144, $ 296-322; p 227, $411. do not act upon the structure, p. 95-97, $ 189; p. 107-111, $ 226-233!; p. 112, $ 234 c ; p. 282, $ 451 4 ; p. 330. $ 500 n; p. 746, $ 990* a. their action conforms to the kind of ir- ritability and sensibility, p. 43-47, $ 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* 4. and as above. See, also, Analogies their most comprehensive relations to organic states, p. 21, $ 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 4; p. 47-49, $ 75-79 : p. 59, $ 129 g-i; p. 61, $ 133 c; p. 63-68, $ 137c-152 ; p. 73, $ 163 ; p 98, $ 191; p. 108, 109, $ 227-230. p. 120-122, $ 237-240. See, also. Remedial Action, Therapeutics. general, and Adaptation, Law of. analogies between the physical and moral, p. 111, $ 233! ; p. 296, $ 476 c p. 313, $ 487 h; 323-332, $ 500 ; p 662-665, $895-901. See, also, Anal- ogies. each one has special virtues and ex- erts special influences, p. 21, $ 21 25 ; p. 30, $ 57; p. 45-49, $ 73-80 . p. 62-64, $ 135-140; p. 65-68,$ 143 -152; p. 73, $163; p. 87, $ 179 ; p 90, $ 188* a-c ; p. 92-95, $ 188* d; p 98, $ 191 ; p. 100, $ 198, 199 ; p. 101 -103, $ 201-204; p. 104, $ 215 ; p 107-111,$ 226-233! ; p. 119,$ 235 p. 417, $ 650; p. 662-665, $ 895-901 See, also, Remote Causes of Dis 964 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 physiologv, pathology, and therapeu- tics, p. 290-321, $ 462-494. Vital Habit, its laws and phenomena, physiological and moral, p. 363-370, $ 535-568. Vital Principle, has various properties, p. 83, $ 175 ; p. 88, $ 183, 184. See, also, Vital Properties. has remarkable analogies with the soul, and with the principle of instinct, p. 84, $ 175 4; p. 281, 282, $ 451. illustrated by light, &c, p. 79, $ 168 ; p. 84, $ 175 4; p. 114, 115, $ 234, e, /; p. 330, $ 500 n. a whole, p. 41, 42, $ 65-67 ; p. 56, $ 122; p. 82, $ 171; p. 97, $ 190 4 ; p. 435, $ 680. recognized at all ages, p. 73, $ 164. recognized by all who deny its exist- ence, p. 6, 7, $ 4* 4, d; p 19, $ 18 c ; p. 30-33, $ 59, 60 ; p. 38-40, $ 64 e- h; p. 95, 96, $ 189 b; p. 157-173, $ 350; p. 189, 190, $ 350! n. history of its vicissitudes with medical philosophers, p. 73-79, $ 164-168. opinions respecting, p. 24, $ 42 ; p. 37 -41, $ 64, 65 ; p. 74-79, $ 165-167; p. 132, 133, $ 289, 290; p. 149-155, $ 337-349 ; p. 157-173, $ 350 ; p. 189, 190, $ 350! n; p. 514, $ 819 a. its existence and laws variously attest- ed, and by adequate phenomena, p. 36-49, $ 63-80; p. 75, $ 165 4; p. 80, $ 169 ; p. 84, $ 175 44 ; p. 111- 122, $ 234-240 ; p. 182, $ 350! g; p. 330, $ 500 n. 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 4; p. 79, $ 168 ; p. 80, $ 169 ; p. 84, $ 175 44. proved by the function of appropriation, p. 24, 25, $41-43; p. 227, $411. proved by the nervous power, p. 106- 111, $ 223-233! ; p. 323-332, $ 500 ; p. 746, $ 990* 4. 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 £•; p. 152, $ 345; p. 428, 429, $ 674 a; p. 499, $ 785. Vital Principle—continued. inseparable from living organic matter, p. 81, $ 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, $ 171. summary definition of its characteris- tics, p. 82, $ 172. fundamental cause of all phenomena of organic beings, p. 24, $ 42 ; p. 30 -49, $ 57-81 ; p. 73, $ 164; p. 96, $ 189 c; p. 115, $ 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,$ 173; p. 135-139, $ 298-303i See, also, Plants. modifies and appropriates organic com- pounds in animals, p. 15, $ 11, 14 a; p. 83, $ 173 ; p. 143, 144, $ 322 ; p. 196, $ 360, 361. re-arranges the elements of organic compounds, p. 24, 25, $ 40-45 ; p 30, $ 58 ; p. 40-49, $ 65-80 , p. 150, $ 339 a, b; p. 152, 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 4; p. 79, $ 168; p. 80, $ 169 4; p. 81, $ 170 a; p. 84, $ 175 64; p. 99, $ 191 d; p. 112-120, $ 234 c-237; p. 330, $ 500 n; p. 746, $ 990* 4. • how far creative, p. 25, $ 43; p. 37- 40, $ 64 c-h; p. 81, $ 170 ; p.- 82, 83, $ 172 ; p. 149, $ 336 ; p. 169, $ 350, No. 84; p. 227, $ 411. See, also, Nature, contradistinguished from Creative Power. resists chemical agencies, p. 30-33, $ 57-60 ; p. 194, $ 358 ; p. 1136, $ 360. See, also, Digestion! the source of growth, p. 30, $ 57; p. 36-44, $ 63-72; p. 227, $ 411 ; p. 435, $ 680. See, also, Plants. develops the germ, p. 36-49, $ 63-81 ; p. 97, $ 190 4. strongly pronounced in the ovum, p. 42, $ 67; p. 44, $ 71 ; p. 97, $ 190 4. laws of, deduced from the ovum, p. 30, $ 57, 58 ; p. 36-19, $ 63-81 ; p. 97, $ 190 4. presides over organic processes and results, p. 30, $ 58 ; p. 31-32, $ 59 ; p. 37^9, $ 64-80 ; p. 148-154, $ 335 -349 c; p. 196, 197, $ 360, 361 ; p. 227, $ 411 ; p. 273, $ 447 h; p. 405- 412, $ 638 ; p. 435, $ 680 ; p. 474, 475, $ 733 f-i; p. 062-664, $ 895- 900. makes no demands on chemistry, p INDEX. 965 Vital Principle—continued. 15,$ 13, 14; p. 16, $ 16-18; p. 24, $ 42 ; p. 30-33, $ 59, 60 ; p. 42, $ 66, 67; p. 44, $ 71 ; p. 84, $ 175 44; p. 135, $ 301 ; p. 143, $ 322; p. 194, 195, $358, 359 ; p. 196, 197, $ 360, 361 ; p. 201, $ 374, 375; p. 203,-$ 376*; p. 227, $411; p. 276-279, $ 447* /; 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- 2331; 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, $ 301 ; p. 196, $ 360; p. 227, $411. its nature altered in man since his Creation, which proves the Mosaic statement, p. 401, $ 632. subject to extinction, p. 11, $ 5| e; p. 30, 31, $ 58, 59 ; p. 83, $ 174 ; p. 87, $ 176 ; p. 96, $ 189 6, c ; p. 189, 190, $350w; p. 401, $631. by its formative action its own de- stroyer, p. 382, 383, $ 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, $350! e-gg; p. 189, 190, $350! n. See, also, Vital Properties in the Elements of Matter, and Problems. I^jtal Properties, elements or properties of the Vital Principle, just as judgment, reflec- tion, understanding, the will, &c, are properties of the 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, $ 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, $ 51- 53 ; p. 28-45, $ 54-73; p. 54-56, $ 105-124 ; p. 68, $ 155 ; p. 88, $ 185 ; p. 89, $ 188 ; p. 90, $ 188* a-d; p. 93-95, $ 188* d; p. 97, 98, $ 190, 191 ; p. 99, $ 192 ; p. 103-105, $ 205 -221 ; p. 118, $234g-; p. 120, 121, $ 236-238 ; p. 125, $ 249 ; p. 127, 128, $ 260-266 ; p. 134, $ 293-295 ; p. 135 -138, $ 298-303* ; p. 140, $ 304 ; p. 163-167, $ 350, Nos. 64-77, 26*, 27 ; p. 203, $ 376*; p. 224-229, $ 409 g- 419 a; p. 260-263, $ 445-446 ; p. 271 -278, $ 447/-447*/; p. 279, 280, $ 449 ; p. 284, 285, $ 454-455 e; p. 286, $ 456 a ; p. 322, 323, $ 498 ; p. 398-400, $626-630; p. 473-476, $ 733 e-k. possess natural modifications in differ- ent organs and tissues, and in the conditions ofthe ovum, p. 30, $ 57 ; p. 43, $ 70 ; p. 44, $ 72 ; p. 46, $ 74 ; p. 61-63, $ 133-137; p. 64, $ 138; p. 67-73, $ 149-162; p.-82, $ 172; p. 88, $ 185 ; p. 97, 98, $ 190, 191 a; p. 100, $ 197-200; p. 102, $ 203 ; p. 105, $ 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, $ 350! /, g ' p. 662-665, $ 895-901. See, also, Vis Medicatrix Naturae. mutable in their nature, p. 3, $ 2 4; p. 11, $ 5! e ; p. 47-49, $ 74-80 ; p. 61, $ 133 c, 134; p. 68, 69, $ 153-156 ; p. 87, $ 176-182 ; p. 98, 99, $ 191 4- 192; p. 105, $ 220; p. 107-110, $ 225-232; p. 121, 122, $ 237-240; p. 352, $ 524 d; p. 376-380, $ 578 ; p. 405-412, $ 638; p. 417, $650; p 428, $ 672 ; p. 435, $ 680; p. 478, 479, $ 740, 741 ; p. 662-664, $ 896- 900. their mutability has corresponding changes in the properties of the 966 INDEX. Vital Properties—continued. \ mind and instinct, p. 98, $ 191 c; p. 123, 124, $ 241 c ; p. 369, 370, $ 564- 568; p. 374, $ 576 4; p. 376, $ 577 4; p. 377, $ 578 c; p. 380, 381, $ 579 ; p. 382, $ 581. their natural modifications in different parts shown by natural stimuli, p. 46, $ 74 a; p. 62, $ 136; p. 97, $ 190 4-191 a; p. 100, $ 199, 201 ;— by natural products, p. 24, $ 42 ; p. 50, $ 83 ; p. 62, $ 135 ; p 97, $ 190 ; p. 227, $ 411 ; p. 229, $419 ; p. 233, 234, $ 428-432 ; p. 378, $ 578 c ;— by action of foreign agents, p. 61, $ 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 4; p. 375, $ 577; p. 376-380, $ 578 ;—by the ovum, p. 42-45, $ 67-73 ; p. 97, $ 190 4;—by comparison of plants and animals, p. 15, $ 10-14; p. 16, $ 16, 17; p. 20, $ 18 e; p. 54, 55, $ 107- 117 ; p. 56, $ 121-123 ; p. 88, $ 185 ; p. 97, $ 190 4, c; p. 135-140, $ 298- 305; p. 223-227, $ 409 e-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 4 ; p. 62, $ 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 4- 191 a; p. 99, $ 192; p. 100-102, $ 199-203 ; p. 104, $ 212, 214; p. 105, $ 217; p. 352 $ 524 d; p. 375, 376, $ 577 4; p. 376-381, $ 578-579. their mutability designed for useful purposes, p. 3, $ 2 4; p. 61, $ 133 c; p. 63, $ 137 e; p. 68, 69, $ 153-156; p. 87, $ 180 ; p. 120, $ 237 ; p. 352, $ 524 d; p. 376, $ 578 4; p. 378, $ 578 c; p. 435, $ 680 ; p. 662, $ 895. their mutability the fundamental cause of disease, p. 3, $ 2 4; p. ll, b\ e; p. 47-49, $ 74-80 ; p. 61, $ 133 c ; p. 87, $ 177-182 ; p 98, $ 191; p. 121, $ 237, 238 ; p. 352, $ 524 d; p. 662- 664, $ 895-900. ital Properties—continued. their mutability the ground-work of cure, p. 61, $ 133 c; p. 89, $ 177- 179 ; p. 119, $ 234 i; p. 122, $ 239 ; p. 428, $ 672; p. 544, 545, $ 858 ; p. 546-551, $ 862-864 ; p. £62-664, $ 895-900. their mutability the great cause of dif- ficulties in medicine, p. 120, 121, $ 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, $ 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, $ 350| a-g; p. 186-192, $ 350! M-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!/. Vital Properties and Functions, modifications of, arising from Age, Tem- 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, $ 1. deduced from the seed and ovum, p. 30, $ 57; p. 36-49, $ 63-81 ; p. 56, $ 121-123; p. 97, $ 190 4; p. 279, 280, $ 449. their doctrines virtually conceded by their opponents, p. 19, $ 18 e; p. 22, $ 29 ; p. 30-33, $ 57-60; p. 38-40, $ 64 e-h ; p. 95, 96, $ 189 4 ; p. 152- 154, $ 345-349 c ; p. 157-173, $ 350 ; p. 189, 190, $ 350! n; p. 191, $ 351 ; p. 478, 479, $ 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,' $ 500 o; 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 4; p. 194-197, $ 358-361 ; p. 234, $ 433; p. 264, 265, $ 446 c, 447 a, b; p. 271, $ 447/; p. 276- 278, $ 447*/; p. 331, $ 500 *; p. INDEX. 967 Vitalism and Solidism—continued. 405-112, $ 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, $ 821, 822; p. 535-540, $ 846-851 ; p.550, $ 803 e; p. 662-664, $ 895-900. "Vitality seen in Dead Matter," p. 179, $ 350! 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, $ 183, 184 a; p. 105, 218-221. with vital affinity, bestows life, p. 105, $218. belongs to the assimilating organs, and to their subsidiary fluids, p. 105, $ 219. liable to morbid changes, p. 105, $ 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 Remedial Action. Will, The, its relation to motion, p. 89, $ 186, 188 a; p. 95, $ 188* d; p. 97, $ 190 a ; p. 104, $ 215 ; p. 107, $ 227 ; p. 110, 111, $ 233, 233*; p. 113, $ 234 ; p. 124, 125, $ 243-246 ; p. 210, $ 486 ; p. 282, $ 451 c; p. 284, $ 454; p. 288, $ 459 d, e; p. 296, $ 476 c; p. 313, $ 487 gg, ft; p. 314, $ 488* ; p. 324-328, $ 500 d-l; p. 357, $ 526 d. presides in animal life, p. 124, $ 243; p. 296, $ 476 c,- p. 313, $ 487 gg,h; p. 314, $ 488* ; p. 327, 328, $ 500 k; p. 357, $ 526 c. scarcely reaches to organic life, p. 124, $ 243 ; p. 282, $ 451 c; p. 284, 285, $ 544-545 c; p. 296, $ 476 c; p. 313, $ 487 gg, h; p. 314, $ 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. bility," p. 296, $ 476 c; p. 313, $ 487 gg, h; p. 370-372, $ 569 ; p. 481, $ 743 ; p. 483, $ 746 c; p. 498, $ 780; p. 724, $ 961 a; p. 751, $ 999 4. 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, $ 175 t; p 93-95, $ 188* d; p. 97, $ 190 a; p. 104, $ 215 ; p. 107-111, $ 226-233* ; p. 113, $ 234 c; p. 124, 125, $ 243- 246 ; 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. 323-332, $ 500. See, below, Its elective power, tf-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, $ 459 d, e; p. 296, $ 476 c ; p. 326, 327, 328, $ 500 ft, k. See, also, Nervous Power. being shown to prove the distinct na ture of mind, and its possession ot 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, $ 526 d. controls other properties of the mind, and the passions, p. 88, $ 184 4; p. 124, $ 243. its elective power in animal life analo- gous to that of the passions and physical agents in organic life, p. 110, 111, $ 233, 233! ; p. 113, $ 234 ; p. 125, $ 245, 246 ; p. 327, 328, $ 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. HI, $ 233! ; P- 114, $ 234 e; p. 125, $ 245, 246 ; p. 281, 282, $ 451 a ; p. 296, $ 476 c; p 324-328, $ 500 d-l. Worms, how they produce convulsions, p. 356- 358, $ 526 d. 968 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. Y. Youth, its relations to childhood, p. 376, $ 578 a, 4. its prominent characteristic, the full development of the organs of gener- ation, p. 377, $ 578 4. distinguished by many physiological changes, and corresponding suscep- tibilities to morbific and remedial agents, p. 27, $ 52 ; p. 68-70, $ 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, $ 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 ofthe vital and intel- lectual properties, p. 68, 69, $ 153- 159 ; p. 374, $ 576 4-d; p. 375, 376, $ 577 4-d; p. 380, $ 578 d; p. 381, $ 579 4. See, also, Vital Proper- ties, their mutability j &c, Ovum, and Plants. the period of life when the development of special functions displays the con- stitution of the nervous power, the natural office 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 offices and as a morbif- ic and curative agent, its direct ex- citement by mental emotions and passions, and how the principle of life is a bond of union between the corporeal and the intellectual part; ibid, and Nervous Power, Moral Emotions, Analogies, and p. 284^- 292, $ 454-470; P. 361, 362, $ 530. offers problems to chemical physiology, p. 377, 379, $ 578 c, d. See, also, Problems. Z. Zinc, Sulphate of, its uses and special influences as an emetic and astringent, p. 547-549, $ 863 d; p. 553, $ 870 a; p. 571, $ 890 4; p. 577, 578, $ 890 o; p. 582, $ 890* A; p. 63, $ 137 d; p. 65, $ 143 a p. 67, $ 150, 151; p. 365- 368, $ 549-558 ; p. 566-568, $ 889 k,h p. 582, $890*^. INDEX II, A. Acclimation, philosophy of, p. 364-366, $ 544-556; p. 425, $ 664. 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 ofthe former must continue to reside in the malarious climates, or the original susceptibility will return, p. 364-366,. $ 544-556; p. 425, $ 664. Also, 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. See Causes, Morbific, Index II Adaptation, Law of. See Index 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, $ 579 4; p. 865-868, $ 1067. Also, Mental Emotions, and Remedial Action, subdivision Mental Emotions, Index II. 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, $ 581 4-584; p. 401-402, $633; p. 768-770, $:i014-1017. Age, Stages of; the periods which mark the times when the greatest physiological changes take place, with corresponding fluc- tuations in disease and in mental characteristics—all depending upon natural modifications or mutatibns of the Vital Properties and Functions, p. 37$ $ 574, 575. Also,Vital Proper- ties, Index I.; Infancy, Childhood, Youth ; Age, Adult ; Age, Old, In- dex II. Aloes, its physiological and therapeutical in- fluences, p. 366,$ 556 4; p. 547, $863 d; p. 566, $ 889 i; p. 568, $ 889 m, p. 856-857, $ 1063. Alteratives, Modus Operandi of—con- tinued from Index 1. made a distinct group by the Author, and why, p. 835-837, $ 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- 970 INDEX II. Alteratives,Modus Operandi of—continued. es changes in conformity with the vir- tues of each, p. 107-112, $ 227-234 ; p. 303, $ 481d; p. 323-336,$ 499-512; p 661-663, $ 894-896 ; p. 665-670, $ 902 a-m; p. 679-681, $ 905 a. Also, Sympathy, Sensibility, Sensation, Sympathetic Influences, Nervous Power, IndexI; Remedies; Causes, Morbific ; Nervous Power, Reflex Action of Nervous System,Mental Emotions, Remedial Action, sub- division Mental Emotions, Secre- tion and Excretion, Counter-Irri- tation, Blood-letting, Index II. a 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 are employed for only a present or an interrupted effect; and the same is true of Morbific Causes, as their ef- fects may be suddenly or gradually produced, p. 65, $ 123 4, c ; p. 66-67, $ 148 ; p. Ill,$ 233*. 233J ; p. 285- 286, $ 455 d-f; p. 333, $ 503-506 ; p. 339-340, $ 514 g-k; p. 344-345, $ 516 d, No. 6; p. 365, $ 551 ; p. 366, $ 556 ; p. 416-417, $ 649 c; p. 420-424, $ 654-661 ; p. 426, $ 626 ; p. 497, $ 777 ; p. 532, $ 841 ; p. 547, $ 863 d ; p. 551, $ 887 ; p. 568-569, $ 889 m, mm; p. 646-649, $ 893 c-A ; p. 661-663, $ 894-896; p. 668-670, $ 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 subside 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, $ 428-432 ; p. 629, $ 892f r ; p. 684-687, $ 895* 4. Also, Nervous Power, Index I. and II.; Reflex Amenorrhcea—continued. Action of Nervous System, Index II. Amylene, peculiar effects of, on inhalation, p. 863- 864, $ 1066 4. 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 4. 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, $ 697- 699 ; p. 460-463, $ 708 ; 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, $813 a. comes in at the close of life, p. 457-458, $ 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 fever, p. 489-490, $ 757 a. its legitimate objects, p. 458-459, $ 703, 705; p. 460, $ 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 II. Animals, fundamentally distinguished from Plants, p. 815, $ 1052 a. Also, An- imals and Plants, Index I. hybrid, why incapable of procreating, p. 816, $ 1052 4. 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. 971 Antimony, Tartarized—continued. i modifying the nervous influence, and as an alterative agent through reflex action of the nervous system, p. 532- 533, $ 841 ; p. 557, $ 873 ; p. 668, $ 902 g; p. 675-676, $ 904 4; p. 833, $ 1057 h. Also, Alteratives, In- dex II. its action illustrated through law 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 4-841 ; p. 557, $ 873 ; p. 675-676, $ 904 4. effects of, compared with analogous ones of other agents, p. 547, $ 863 d ; p. 557, $ 873; p. 637, $ 8924 e; p. 849-851, $ 1059. its law of operation in small alterative doses, p. 344-345, $ 516 d, No. 6 ; p. 431, $675; p. 851, $ 1059. Also, Alteratives, Index II. its results as an expectorant, p. 639, $ 892|^. its fatal effects in small doses, 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 effects 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 A, i; p. 63, $ 137 d; p. 65-66, $ 143 c-145 ; p. 67-68, $ 149-152 ; p. 170-173, $ 350, Nos 40, 41, 42, 43, 44, 45, parallel columns; p. 176-178, $ 350f a-f; p. 541-542, $ 854 44; p. 607, $ 892* 4; p. 612, $892* a. Antispasmodics, the group introduced to illustrate the philosophy ofthe modus operandi of morbific and remedial agents through reflex action of the nervous system, p. 590, $ 891* a ; p. 592-593, $ 891* 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, $ 891* k. Case of epilepsy stated, to show how in this affection the nervous influence is sometimes developed in a direct man- ner by disease ofthe nervous centres, and at other times how the point of departure is from some distant part, when reflex action ofthe nervous sys- tem is brought into operation, and how, in either case, convulsions en- ispasmodics—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 showihg, 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 11. Although Narcotics relieve spasm in the 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 Refer- ences. 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, $ 891* 4-A; p. 593, $ 891 k: feebly endowed with curative virtues, p. 592, $ 891* i. Apoplexy, bloodletting in, and the principles by which it should be regulated, p. 741- 746, $ 990 ; p. 848, $ 1055 u. sanguineous, depends upon capillary hemorrhage arising from congestion, p. 740, $ 990 4, c, m. Also, Medical and Physiological, Commentaries, 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, $ 990 d-ii p. 745-746, $ 990*. 972 INDEX II. Arsenic, destitute of a tonic virtue, p. 607, $ 892* a ; p. 608-609, $ 892* c. inferior to cinchona as a febrifuge, but next in value, and has done less mis- chief, ibid, and p. 610-611, $ 892* d, e. 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 ofthe 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, $ 892* a, b. Also, p. 63, $ 137 d; p. 65, $ 143 c ; p. 67, $ 149-151 ; p. 68, $ 152 4; p. 122, $ 240 ; p. 465-466, $ 715; p. 482, $ 744 ; p. 541-542, $ 854 44; p. 545, $ 859 4; p. 612, $ 892* a; p. 623, $ 892| c. its accidental superiority to Cinchona in Autumnal intermittent fever, while not so in the Vernal, and why, p. 608-609, $ 892* c; p. 597-598, $ 892 c. when preferable to Cinchona, p. 609, $ 892* 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, $892* A, j. its morbific effects in therapeutical doses, in morbid states of the body, p. 608, $ 892* 4. Asthma, treatment of, p 337, $ 514 ; p. 591, $ 891*/; p. 848, $ 1058 w. 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. 570-572, $ 890 a, b, c. Also, Remedies, Remedial Action, Re- flex Action of Nervous System; Causes, Morbific, Index II.; Nerv- ous Power, 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, $ 890 4. applied to outward surfaces, some op- erate mechanically, $ 890 c. much abused in hemorrhages, dysen- tery, &c, p. 572-575, $ 890 d-k. Astringents, &c.—continued. Also, p. 507, $ 805 ; p. 509, $ 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, $ 890 d-ee, o. Also, Hemorrhage,Spontaneous; Secre- tion and Excretion, Index II. the symptom the thing considered, p. 572, $ 890 d; p. 590-591, $ 891* 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 ofthe operation of astringents upon parts distant from the seat of their appli- cation through alterative action ofthe reflex nervous influence, ibid. no two exactly alike in effects, and re- quire discrimination, p. 578, $ 890 p. of very limited uses, $ 890 o; but in- flict great injuries in various mala- dies, p. 572-576, $ 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, $ 452 4 ; p. 290-321, $463-494; p. 336-353, $ 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, of which there are nearly five thou- sand in the first two volumes. 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, uraemia, urea, diabetes, &c, p. 785-787, $ 1031 4. belong to the School of Vitalists, p. 800, $ 1035. Bernard, Cl., experiments on nervous system, p. 792, $ 1032 d; p. 804, $ 1039. produces diabetes mellitus by pricking themedullaoblongata,p.792,$l032d. alleges the production of sugar by the INDEX II. 973 Bernard, CI.—continued. liver, &c, and Author's opinion, p. 783, $ 1031 a; p. 785-786, $ 1031 4; p. 790, $ 1032 4; p. 793, $ 1032 d. Bile—continued from Index I, none of its constituents detected in the blood, p. 783, $1031 4. 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 ofthe cathartic, and bow the nervous power is the immediate remote cause of the variable phenomena relative to the secreted product, p. 366, $ 556 4; p. 554-556, $ 872 ; p. 563-564, $ 889 a; p. 566, $ 889 i; p. 568-569, $ 889 m, mm; p. 668-669, $ 902,g; p. 834, $ 1057 Z; p. 854, $ 1061 ; p. 856-857, $ 1063 4; 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, $ 1054—con- tradicted by circulation of in Plants, p,820-823, $ 1054-1055. nothing can make healthy blood but the healthy action ofthe solids, p. 192, $ 354; p! 535-539, $ 847-848. occupies from one to two minutes in goinor the round of the circulation, p. 672, $ 904 4; p. 863, $ 1066 4. Bloodletting,General—continued from Index I, varied from effects of Leeching, p. 698- 703,$ 929-938. considered under five stages, p. 698-702: 1st, earliest impression isexerted 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 ofthe cerebral vessels— thus establishing the compound in- fluence of direct and reflex nervous action, p. 698, $ 933; p. 703, $ 940- 942 a; p. 707, $ 948-949; p. 709, $ 951 c,d. Also, Nervous Power, Index 1. 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 ofthe brain, increases in a still more rapid ratio\he foregoing compound influence of the nervous power, when syncope hastens on as a con- sequence, p. 693, $920; p 698-699, $ 934-935 ; p. 701, $ 937 c-938 4; p. 703-707, $ 940-949 ; p. 709, $ 951 c, d; p. 824-828, $ 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 ut 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, $ 946 ; p. 712, $ 955 4; p. 726-731, $ 961 c-970 ; p. 733-736, $ 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, $ 940-944. blood excluded from the vessels by their vital, not a physical contraction, p. 692, $ 912; p. 699, $ 93.5 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 974 INDEX II. Bloodletting, General—continued. in inflammation and venous conges- tion, p. 485-486, $ 750 ; p. 488, $ 766 4; p. 505, $ 801 ; p. 700, $ 935 d; p. 724-730, $ 961-970 ; p. 740, $ 988 a. objections to, contrasted with other means as substitutes, p. 372, $ 569 e; p 396, $ 621 a; p. 544, $ 857 ; p. 558, $ 878 ; p. 579, $ 890* a; p. 584, $ 891e ; p. 602-604, $ 891 i-l; p.638, $ 8924/; p. 715-722, $ 959-960 ; p. 751-752, $ 999 c; p. 754, $ 1002/; p. 756-757, $ 1005 b-g; p,759-760, $ 1005;,k; p. 760,$ 1005 k ; p. 763- 766, $ 1006 c-1008 ; p. 857-861, $ 1063-1065 d. philosophy of its operation subordinate to other considerations, p. 691, $ 907. illustrates the modus operandi of other remedies, p. 691, $ 908. effects 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, $ 675 ; p. 444-445, $ 688 e, ee; p. 700-701, $ 935 e-938; p. 704,$ 943-944 ; p. 709-711, $ 951c -952; p. 713-714, $ 956-958 4; p. 724-731, $ 961-970; p. 741-745, $ 990 ; p. 756-759, $ 1005 a-h; p. 765- 766, $ 1007 4-d. of its proper extent, p. 711-715, $ 953- 959. general rules to be observed, p. 711- 714,- $ 954-958 ; p. 748-753, $ 992- 1001 ; p. 756, $ 1004 d; 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, $ 892|i; p. 712-713, $ 955 b-e; p. 714, $°957; p. 726-728, $ 961c-964 c; p. 729, $ 967 ; p.734- 735, $ 976 4-977 ; p. 741-745, $ 990 a-s; p. 765-766, $ 1007 4-1008 ; p. 871-872, $ 1068 d. syncope 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 powei- ful alterative effect of reflex nervous influence, p. 704, $ 943 4; p. 709, $ 951 4-d. proposed substitutes for, such as tobacco, aconite, belladonna, veratrum viride, dry cupping, &c, p. 711, $ 954 4; p. 715-721, $ 960; p. 860, $ 1065 a. causes of objections to, p. 722, $ 960/; p. 729, $967; p. 752, $ 1000, 1001. general bloodletting the proper method in all active inflammations of internal organs, p. 713, $ 956 ; p. 729, $ 965 4, 966; p. 736,"$ 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 ofthe brain generally requires a greater loss of blood than other parts, p. 508, $ 806 ; p. 696, $ 925 c ; p. 733-736, $ 974 4- 979; p. 748-749,$ 992; p.774-776, $ 1024 a-g; p. 872, $ 1068 d; p. 824- 828, $ 1056 ; p. 847, $ 1058 q. borne to a great extent in hydrophobia, on account of the same 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-A; p.602, $ 892 i; p. 638-639, $ 892| g; p. 638-642, $ 892|/-i; p. 738, $ 984 4 ; p. 749, $ 992 d; p. 750, $ 995 ; p. 757-760, $ 1005 h-k; p. 770,$ 1017c; p. 846, $ 1058 o; p. 870, $ 1068 c. in apoplexy, embarrassing on account of a prostrating nervous influence, p. 741-747, $ 990-990*. in dysentery, and an opposite practice, p. 573, $ 890 ; p. 575, $ 890 A; p. 747, $ 991 4; p. 842, $1058/ in.erysipelas, p. 759-760, $ 1005 j. in purpura hemorrhagica, p. 754, $ 1002 d, e. in venous congestion and cpngestive fever, p. 724-731, $ 961-970. why its effects are modified by venous congestion, and why Physicians, in such cases, are deterred from its ap- plication, p. 724-726, $ 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, $ 961 c-965, 968; p. 735, $ 978, 979—previous stimula- tion may be necessary; p. 727, $ 964 a, 4—well borne as soon as reac- tion takes place, p. 730, $ 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, $ 806 ; p. 730, $ 969 4; p. 733-734, $ 974 c-975 4. its depressing effects 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, $ 795-818 ; p. 724- 726,$ 961 a-e; p. 729-730, $ 967- 969. Also, p. 444-445, $ 688 d-ee. INDEX II. 975 Bloodletting, General—continued. fatal, in supposed but mistaken cases of venous congestion, p. 730, $ 970 a, b. in yellow fever, p. 747-748, $ 991 4-992 a, c ; p. 749-750,$ 993-994 ; p.751, $ 999 ; p. 753-754, $ 1002 a-c; p. 869, $ 1068 4. in typhus fever, p. 754, $ 1002 d; p. 755, $ 1004 4. in jail fever, p. 754, $ 1002/—and pu- trid fevers, ibid. in intermittent fever, p. 63, $ 137 c, d ; p. 65, $ 143 4, c; p. 424, $ 662 4 ; p. 430-433, $ 675 ; p. 553, $ 870 aa; p. 570, $ 889 n; p.597-598, $ 892 c; p. 600, $ 892 d ; p. 605-606, $ 892 m-p; p. 608-610, $ 892* c, d; p. 737-739, $ 983-985 ; p. 740, $ 989 ; p. 754-755, $ 1003; p. 756-757, $ 1005 a-g ; p. 829, $ 1057 4. in plague, p. 755, $ 1002 d, e. in reduced and emaciated subjects, p. 765-766, $ 1007 4-d. in simple continued fevers, p. 491-495, $762 4-768 a; p. 736, $ 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, $ 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 4- 1006 a; p. 868-870, $ 1068 a, 4. 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, $ 1068 when appropriate, the earlier the better, and decisively at once, p. 642, $ 892* i • p 711, $ 954 4 ; p. 712, $ 954 c ; d' 713, $ 955 c; p. 714, $ 957 ; p. 729 $968; p. 749, $ 992 d; p. 750, $997; p. 751,$ 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 4; p. 728-729,v 965 4,-p-751-752, $999- 1000. . . when excessive, may maintain or pro- duce inflammation, and why, p? 697 6 927 4; p. 708, $ 950; p. 733,$ 974 4 • p. 773-774, $ 1023 a, 4-for Bloodletting, GeneTal—continued. which Leeches may be a remedy, p. 774, $ 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, $ 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, $ 8924i; 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, $ 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, $ 569 c; p. 395, $ 621 a; p. 572-576, $ 890 c-n ; p. 579, $ 890* a ; p. 581, $ 890* /; p. 584, $ 891 c; p. 590- 591, $ 891* a-f; p. 603-604, $ 892 k; p. 637-639, $ 892|- e, /; 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, $ 1005 A; p. 872, $ 1068 d. effects of, different in General Bloodlet- ting, Cupping, and Leeching, p. 691, $911; p. 713, $956; p. 729, $ 966. effects of, as manifested in Leeching, p.692-698, $ 912-928; p. 729, $ 966. Also, Leeching, Index II. effects of, as manifested in Cupping, p. 702, $ 937. Also, Cupping, Index II. general conclusions as to Bloodletting, p. 776-777, $ 1027. 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. 976 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 4, c; p. 774-776, $ 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, $ 806 ; p. 732-734, $ 973.-975 ; p. 735, $ 977; p. 736, $ 979, 980— and to this stimulating nervous in- fluence upon the bloodvessels is due the inco-mpressibility of the pulse in inflammations, p. 445, $ 688 ee—and to its modified condition the hardness is owing, as, also, the changes which the blood undergoes, p. 444-445, $ 688 d-ee—while, also, the influence is so variously determined as to occa- sion intermission ofthe heart's action, various inequalities in action of the radial arteries, p. 512, $ 390 4—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, c ; p. 504, $ 798 ; p. 505, $ 801 4, c; p. 696, $ 925 4, c; p. 724-731, "$ 961-970. owing to the natural constitution ofthe 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, pi 61-63, $ 133 4-137 c; p. 64, $ 140 ; p. 67, $ 149-151 ; p. 503- 505, $ 794-801 ; p. 507-508, $ 806 ; p. 509-511, $ 811-815 ; p. 724-730, $961-969; p. 733-734, $ 974 c-975 a. Brown-Sequard, his experiments on the nervous system modify those by Sir C. Bell in relation to spinal nerves, p. 802-804, $ 1037- 1039. observations upon the iris, p. 806, $ 1042. C. Calomel, considered as an alterative in all its doses, p. 838-850, $ 1058-1059. its effects, where most strongly pro- nounced, p. 839, $ 1058 4—and its extensive sway, p. 839-840, $ 1058 4 —powerfully alterative, p. 564, $ 889 c; p. 839, $ 1058 4. 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, $ 1059. does not impart a green color to intes- 'tinal fluids, p. 454, $ 694 4. in malignant cholera, p. 841, $ 1058 d— in cholera infantum, p. 841, $ 1058 d— in dysentery, sporadic and epidemic, p. 842-848, $ 1058/— in fevers, p. 843, $ 1058 g—in scarlet fever, p. 843, $ 1058 A—in measles and small-pox, p. 844, $ 1058 i—in whooping-cough,. p. 844, $ 1058 k—in jaundice, p. 844- 845, $ 1058 I—in erysipelas, p. 845, $ 1058 m—in acute rheumatism, and acute gout, p. 846, $ 1058 nn—in pneumonia, p. 846, $ 1058 o—in croup, p. 846, $ 1058 p---in inflammation of brain, p. 847, $ 1058 q—in inflam- mation of serous tissues, p. 847, $ 1058 r—in inflammation of kidneys, p. 847, $ 1058 s—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, $ 1058 x—in de- lirium tremens, p. 849, $ 1058 y—in puerperal fever, p. 849, $ 1058 z. Cantharides. See Counter-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 d; p. 65, $ 143 a-c; p. 67, $ 149-151 ; p. 542-543, $ 854 c-857; p. 645-646, $ 893 c, d; p. 652, $ 893 I. their remedial and morbific effects, 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, $ 905 a. Also, Reflex Action of Nervous System, Reme- dies ; Causes, Morbific, Index II.; Nervous Power, Index I. and IL in producing inflammation ofthe bladder without injuring the stomach, and as the stomach may subsequently become INDEX II. 977 Cantharides—continued. ( diseased through a morbific reflex ac- tion ofthe nervous system determined by the vesical inflammation—shows how many morbific causes, such as miasmata, cold, &c, 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, $ 129 A; p. 63, $ 137 d; p. 65, $ 143 a-c; p. 66-67, $148-151; p. 101-102, $201- 203 ; p. 332-334, $ 502-506 ; p. 339- 340, $ 514 g, A ; p. 347-348, $ 516 d, No. 13 ; p. 351-352, $ 524 c; p. 367- 368. $ 558 a; p. 4ld-417, $ 649 c; p. 421-423, $ 657-658, 660 ; p. 426, $ 666; p. 429-430, $ 674 d; p. 465, $ 714 ; p. 522-523, $ 827 4, c; p. 539, $848; p. 862-864, $ 1066. demonstrate, like Arsejiic, Tartarized Antimony, Iodine, &c, the modus operandi of remedial and morbific agents through alterative influence of reflex nervous action, and the fal- lacy ofthe 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. Casein. -See Milk, Index IL . Castor Oil. See Oil, Castor, Index II. QQ 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 ofthe nervous system is brought into alterative effect upon morbid parts, and according to the nature and dose ofthe cathartic, and involve, also, continuous sympathy, p. 101-102, $ 201-203; p. 107-110, $ 227-232 ; p.303, $ 481 d; p.322- 324, $ 498-500 c; p. 339, $ 514 /; p. 563-567, $ 889 a-k; p. 661-663, $ 894-896; p. 835-841, $ 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. no two alike in effects, p. 564, $ 889 c. Also, p. 27, $ 52; p. 63, $ 137 b-d; p. 64-65, $ 138-143 c; p. 67-68, $ 149-152 4; p. 73, $ 163; p. 400, $ 630 d; p. 417, $ 650; p. 418-420, $ 652 c-653 d; p. 424-425. $ 662-663 ; p. 545, $ 860; p. 547-550, $ 863 d; p. 838-843, $ 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 effects with- out purging, p 564, $ 889 4. the evacuations the least important ot the effects, yet often a necessary re- sult 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-fi the principal objects contemplated, p. 566, $ 889 A. 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, $ 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, $ 227-234; p. 284-285, $ 455 a-f; p. 323-341, $ 499-514 ; p. 347-348, $ 516 d, No. 13; p. 361, $ Q 978 INDEX II. Cathartics—continued. 529 ; p 563-564, $ 889 a, 4; p. 565- 566, $ 889 fig; p. 592-593, $ 891* k ; p. 661-664, $ 894-900 ; p. 665- 671, $ 902 a-l; v. 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, $ 889 i; p. 856-857, $ 1063 4. Also, p. 59, $ 129 g-i; p. 61-73, $ 133- 163 ; p. 98, $ 191 4—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 ft; p. 543-544, $ 857; p. 548-549, $ 863 d; p. 648-651, $ 893 g-k; p. 657, $ 893 p; p. 696, $ 926 ; p. 838- 849, $ 1058 a-z. often cumulative in effect, important, and illustrated, p. 567-569, $ 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, $ 889 m, mm. Also, p. 344 -345, $ 516 d, No. 6 ; p. 532, $ 841 ; p. 365, $ 551; p. 646-649, $ 893 e-ft; p. 667-669, $ 902,/, g; p. 679-681, i$ 905 a. the most appropriate time for exhibi- tion, and why, p. 570, $ 889 n. Also, p 547-549, $ 863 d; p. 740, $ 989. three principal objects contemplated, p. 566, $ 889 A. Cathartics, 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, $ 129 A; p. 61, $ 133 c; p. 63-73, $ 137 d-l63 ; p. 87, $ 177-182; p. 89, $ 188; p.101- 102, $ 201-203; p. 107-112, $ 226- 234 4; p. 131-132, $ 285-288; p. 265, $ 447 4; p. 285-286, $ 455 d- 456 ; p. 323-341, $ 499-514; p. 365- 366, $ 551-556; p. 373-390, $ 574- 601 ; p. 399, $ 630; p. 415-418, $ auses, Morbific—continued. 649-651 ; p. 421-423, $ 657-658; p. 424, $ 661 ; p. 426, $ 666 ; p. 445, $ 688 ee; p. 451, $ 691, 692 ; p. 465- 467, $ 714-719 ; p. 475, $ 733 ft ; p. 478-479, $ 740-741 ; p. 483-484, $ 746 c; p. 525-527, $ 827 e-828 e; p. 530-533, 837 4-841 ; p. 538-539, $ 847 ^-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, $ 889 mm ; p. 571-572, $ 896 4; p. 574-576, $ 890 ee-n; p. 580, $ 890* e; p. 592-593, $ 891* k; p. 644-651, $ 893 c-i; p. 657-658, $ 893 o,p; p. 661-663, $ 894-896 ; p. 665-670, $ 892 a-m; p. 679-681, $ 905 a; p. 802-804, $ 1039 ; p. 862- 864, $ 1066. 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, $ 75-80. reflect light upon pathological condi- tions, p. 414, $ 642 a; p. 424, $ 662 a-c, p. 396, $ 621 4. two kinds, predisposing, and exciting or occasional, which are both exter- nal and internal, physical and mental, p. 414-415, $ 645-648. the predisposing, general and specific, p. 415, $ 648. the predisposing, most important as lay- ing the foundation of disease, p. 414, $ 645 4. the exciting, develop disease after the predisposition is formed, p. 414, $ 645c. 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 sys- tem, p. 415-416, $ 649 a, 4; p. 421- 423, $ 657-658. Also, Alteratives, Reflex' Action of the Nervous System, Remedies, Remedial Ac- INDEX II. 979 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 ofthe nerv- ous system, or subsequently upon their direct seat of action by reflex influences propagated by the primary derangements, p. 59, $ 129 A; p. 63, $ 137 d; p. 65, $ 143 a-c; p. 66-67, $ 148-151 ; p. 332-334, $ 502-506 ; p. 339-340, $ 514 g, ft; p. 347-348, $ 516 d, 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, $ 714 ; p. 522-523, $ 827 4, c ; p. 539, $ 848 ; p. 862-864, $ 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, $ 499-530 ; p. 415-417, $ 649 a-c; p. 421-423, $ 657-658 ; p. 661-663, $ 894 4-896 ; p. 665-670, $ 892 a-m; p. 679-681, $ 905 a. Also, Remedies, Thera- peutics, Reflex Action 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, $ 573-625; p. 399, $ 628,630; p. 415- 416, $ 649 a-c; p. 418, $ 851 4; p. 423-425, $ 659-663 ; p. 428,$ 671; p. 507-512, $ 806-817; p. 524, $ 827 e; p. 767-770, $1009-1017. effects of, according to one or more, each one or according to the number, cateris paribus, producing special in- auses, Morbific—continued. fluences that result in particular forms of disease, and so of remedies, p. 27, $ 52 ; p. 400, $ 630 d; p. 417-420, $ 650-653 ; p. 423-425, $ 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 4; p. 419- 420, $ 653; p. 423, $ 659 ; p. 545, t> 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, $ 892 J 4, c. the predisposing, often obscure, p. 423. $ 659. there may be a long series of predis- posing causes, each one progressively affecting 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 4, 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 4; p. 542, $ 854 c, d. Also, Vital Properties, Index 1. hereditary predisposition equivalent to remote predisposing causes, p. 424, $ 661; p. 560-561, $ 886. one disease becomes a predisposing cause ofthe same or of other diseases in other parts, or may act simply as an exciting 980 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 ofthe 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. 61- 68, $ 133-152 ; p. 75, $ 165 4; p. 89, $ 188 a; p. 101-102, $ 201-203; p. 95, $ 189 ; p. 107-122, $ 226-240 ; p. 282, $ 451 e,f; p. 284-286, $ 455- 456; p.323-361, $499-529; p. 415,$ 647 ; p. 422, $ 660; p. 424-425, $ 662; p. 428, $673; p. 450, $ 489 I; p. 465- 467, $ 714-719 ; p. 483, $ 746 c; p. 497, $ 779 ; p. 506, $ 803,804; p. 508 -512, $ 807-817; p. 561, $ 886, 887; p. 592, $ 891* k; p. 661-663, $ 894- 897; p. 665-670, $ 902 a-m ; p. 679- 681, $ 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, $ 743 ; p. 487-489, $ 756 ; p. 497-498, $ 779-780 ; p. 510 -512, $ 813-817; p 523, $827; p. 708, $ 950; p. 733, $ 974 4; 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 Seton, p. 679-681, $ 905 a. may extinguish the susceptibility to their action, p. 364-366, $ 544-556 ; p. 425, $ 664. Also, Small-pox, Index 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, $811; p. 510, $813 4; ^p. 545, $ 859 A; p. 560-561, $ 886. do not operate upon large numbers in times of epidemics, and why, p. 394, $615,616; p. 397, $ 623-625 ; p. 415, $648 4; p.425, $663. predisposition, in what it consists, p. 426 -427, $ 666. Also, Predisposition, Index II. Cause, Pathological. See Pathologi- cal Cause, Index II. Cell, Primordial, differs in organization in each species of animals and plants, as shown by microscope, p. 812-814, $ 1051. wanting in low organic beings, p. 813- 814, $ 1051 4. shown to be radically different in ani- mals and plants by the difference in the means of their subsistence, p. 15, $11; p. 135-138, $298-303*; p. 815, $ 1052. Also, Cells, Index I. 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, p. 2, $ 1 4; p. 6-14, $ 4*-6 ; p. 19, $ 18 e; p. 24, $ 42; p. 30-32, $ 57-59 ; p. 33, $ 60 ; p. 38-40, $ 64 c-A; p. 43, $ 67; p. 86, $ 175 d; p. 95-96, $ 189 4; p. 132- 133, $ 289-292 ; p. 139, $ 303|; 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 g- 445 d; p. 274-279, $ 447*-448 ; p. 482, $ 744 ; p. 484-489, $ 747-756; p. 514-540, $ 819-851; p. 690-691, $ 906-910; p. 779-782, $ 1028- 1030 ; p. 794-799, $ 1033 4-1034. Also, Organic Chemistry, Index I and II. Chemistry, Medical — continued from Index I, i continues to offer its testimony in be- half of rational medicine, p. 779-782, $ 1028-1030. Also, p. 433-434, $ 676 4 ; p. 762, $ 1006 a. why incapable of yielding any light to the different branches of Medicine, p. 8, $5 ; p. 157, $ 350, mottoes, ft, i, k; p. 191, $ 351 ; p. 202-203, $ 376* ; p. 207, $ 376£ 4; p. 798, $ 1034. where Fourcroy left it seventy years ago, as admitted, p. 9, $ 5; p. 202, $ 376* ; 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 4—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. 981 Chorea, I treatment of, p. 590, $ 891* 4, d; p. 848, $ 1058 c. Also, Antispasmodics, In- 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, $ 662 a-c ; p. 430-433, $ 675 ; p. 508-511, $ 807-816; p. 547-550, $ 863 d; p. 553-556, $ 870 aa-872 a; p. 571-572, $ 890 4; p. 597-598, $ 892 c; p. 605-607, $ 892 m-r; p. 730, $ 967 d; p. 737-738, $ 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, $ 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, $ 892 d; p. 676-679, $ 904 c, d—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 d; p. 592-593;$ 891* k; p. 737-738, $ 984 4. 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 of direct in the case of the Passions, and the consequent nchona and its Alkaloids—continued. substitution of more favorable patho- logical conditions according to the nature of the remedy, p. 597, $ 892 c. Also, p. 69, $ 149-151 ; p. 87, $ 177- 182; p. 107-110, $227-232; p. 426, $ 666 ; p. 430-433, $ 675-676 ; p. 473 -474, $ 733 e; p. 542, $ 854 c-e; p. 545, $ 860 ; p. 547-550, $ 863 d ; p. 661-670, $ 894-902 ; p. 704, $943 4 -944 a; p. 707, $ 947. Also, Reme- dies, Remedial Action, subdivision 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. 598-604, $ 892 d-k. [rculation of the Blood—continued from Index I, a right estimate of the powers which carry on the circulation important in philosophical and practical medicine, p. 208, $ 382 ; p. 214-215, $ 393-396 — prevailing errors in regard to it prolific of evil, p. 208, $ 383 ; p. 215, $ 394. Author assigns seven elements, which concur harmoniously together, p. 209, $ 384. 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, $ 394, 395 ; p. 216, $399; p. 286, $ 456 a, 4; p. 340, $ 514 k. 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 contractile power ofthe veins, p. 210-211, $ 388, 389,390 4; p. 212-213, $392; p. 215, $396. objections answered, p. 211, $ 389, 390 4; 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 experiments, p. 215, $ 294^296; p. 982 INDEX II. Circulation ofthe Blood—continued. 216, 6 398-399 , p. 227, $ 411 ; p. 485, $ 750 a, and references there. 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 Article The- ories of Inflammation, p. 141-207. Coffee, its modus operandi through alterative action of reflex nervous influence as an ahtidote for poisoning by opium, and illustrated by analogous effects of cold dash through the same influ- ence, p. 338, $ 514 d; p 592-593, $ 891* k; p. 737-738, $ 984 4. 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 4 ; p. 230, $ 422, p. 245, $ 440 e; p. 253, $ 441 d; p. 323-324, $ 499- 500 c; p. 338, $ 514 d; p. 339-341, $ 514 g-m; p. 359, $ 527 4 ; p. 360, $527d; p. 416-417, $ 649 c ; p. 421 -422, $ 626 ; p. 661-663, $ 894-896; p. 670-671, $ 902 m; p. 880, $ 1074. Also, Skin ; Causes, Morbific, In- dex II 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 4. Also, last pre- ceding references, and Ipecacuanha. Index II. Colocynth, its therapeutical and morbific effects, p 856, $ 1063. Combustion, Spontaneous, ofthe human body, p. 863, $ 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 4, and references there ; p. 567-569, $ 889 l-mm. Also, Alteratives, Cathartics, Exer- cise, Index II. Consumption. See Phthisis Pulmona- lis, Index 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 be 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 ofthe 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 affections are diseases of the true spinal or excito- motory system ;" they are commonly owing to simple irritation propagated from distant parts both upon the 4ram 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, $ 891* 4; p. 592-593, $ 891* L 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, $ 458-461*; 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. 983 Cotton Wool, a sedative, and curative of inflammations and ulcers, p. 833, $ 1057 k. Counter-Irritants, belong to Author's eighth order of Anti- phlogistics, and consist of Vesicants, Rubefacients, Suppurants, Escharot- ics, 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, $ 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 Cantharides, Seton,Cold, &c,IndexII), that reme- dies do not operate by absorption, but through alterative action of the nerv- ous influence, and according to the nature ofthe remedy or mental emo- tion and the existing susceptibilities of organs that may arise from disease, &c,°p. 338, $ 514 d; p. 359-360, $ 527 4; p. 644-659, $ 893 c-q; p. 679-631, $ 905 a.* Also, Remedial Action, Therapeutics, Reflex Ac- tion of Nervous System, Remedies ; Causes, 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 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 prod- red 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, $9054. 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. Also, Therapeutics, Remedies, Remedial Action ; Dis- eases, S&lf-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. 646-647, $ 893 c ; p. 679-681, $ 905 a. Also, foregoing references to Index. 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 Cantharides, ibid., and p. 564,.$ 889 4; p. 565, $ 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 by one ortheotherof acute 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 Also, p. 642-643, § 893 a. 984 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, $ 893 g; p. 650- 651, $ 893 i. Also, p. 296, $ 476 c, 476* 4; p. 298-299, $ 476* A-477 a ; p. 300, $ 479; p. 304, $ 481 g; p. 319-320, $ 494; p. 334-336, $ 509- 511 ; p. 523-524, $ 827 d; p. 525, $ 828 4, 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, $ 893 g, A; 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, Index II. the extent and part of the surface vesi- cated, and the intensity ofthe 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 plaster generally too small, and may be useful only from a determ- ination of a powerfully alterative in- fluence of reflex action ofthe 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, $ 893 p; p 765-766, $ 1007 4-1008 ; 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, ft; p. 659, $ 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 metastasis 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, Index II.; Nervous Power, Index I. and II. Croton Oil, Modus Operandi oj. See Oil, Croton, Index II. Croup, illustrates differences in the vital con- stitution of parts, p. 61-62, $ 134, 135. its disappearance in early life owing to changes in the constitution of tissues, p. 374, v 576 d; p. 376, $ 577 e. Also, Structure, Index II treatment of, by bloodletting, &c, p. 375, $ 576 c; p. 638, $ 892A /; p. 696, $ 925 4 ; p. 766-778, $ 1009- 1013 ; p. 846, $ 1058 p. Cupping, intermediate in effects 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 ofthe same influence which forms the great advantage of general bloodletting, and can therefore rarely, INDEX II. 985 Cupping—continued. if ever, supersede the other methods, p. 702-703, $ 939 e, f. Also, Gener- al Bloodletting, Leeching, Nerv- ous Power, Index II. difference 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, $ 925 4'; p. 703, $ 939 / Cutaneous Eruptions. See Skin, In- dex II. D. Death—continued from Index I., physiology of, p. 401, $ 631; p. 402- 404, $ 634-637. when natural, the result of progressive changes incident to organic functions, p. 401^102, $ 633. Also, Structure, Childhood, Youth, Index II. life maintained after apparent death, p. 403, $637; p. 805, $ 1041. rise of heat after. apparent, p. 266, $ 447 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 L, doctrine of, and its fatal tendencies, p. * 313, $ 487 ft; p. 371-372, $ 569 4-c ; p. 396, $ 621 a; p. 480-481, $ 743; p 486-489, $ 752-756; p. 499, $ 785; p 511, $ 815; p. 715-721, $ 959- 960 4; p. 722, $ 860 g; p. 729,.$ 967; p. 730-731, $ 969 c-970 4; p. 735-736, $ 977-990 ; p. 749, $ 992 c ; p. 751, $ 999 c; p. 753, $ 1001 4; p. 756-757, $ 1005 b-g; p. 759^760, $ 1005 7, k; p. 764, $ 1006 /-1007 4; p. 856-861, $ 1063-1065; p. 868- 869, $ 1068 a, b. 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, perineal, 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 c ; p. 326, $ 500 A. Also, p. Ill, $ 233|; 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, $ 876 4; p. 849, $ 1058 y. Also, Bloodletting ; Brain, Inflamma- tion of, Index II. Diabetes, produced by pricking floor of fourth cerebral ventricle, p. 792, $ 1032 d. the only disease in which sugar is said to be found atlarge in the blood, and this questioned by many Chemists, p. 786, $ 1031 ; p! 789, $ 1032 4. blood in, said by Chemists to be per- fectly natural, p. 786-787, $ 1031 4. vegetable food in, said to be conducive to the disappearance of saccharine matter from the urine,p. 784, $ 1031 4. Diarrhcea, and Cholera Infantum, their principles of treatment, p. 567, $ 889 k ; p. 571-572, $ 890 4; 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, $ 296. chemical changes arrested in stomach, p. 134, $ 297 ; p. 135, $ 301 ; p. 150, $ 339 4. food of animals organic, of plants inor- ganic, p. 15, $ 11-14 ; p. 20, $ 18 c; p. 135, $ 300 ; and Index I. and II, 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, $ 303* a-c— plants the providers — animals the consumers, p. 15, $14; p. 137, $ 303* a. assimilating organs very simple in plants, p 135-137, $ 302-303. food of plants mostly from atmosphere, and comments upon, p. 135-137, $ 303- ,,■ -u i office of roots and leaves, and light and IX II. 986 INDE 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-303* 4; p. 138, $ 303*. 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. 139, $ 303f. 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 4; p. 200, $ 366. Spallanzani, Hunter, Fordyce,. Tiede- mann, their vital doctrines of, p. 150- 152, $ 340-344. Prout's and Carpenter's reasoning upon, p. 152-153, $ 145-148. Roget and Wagner doubtful about it, p. 153, $ 348. Mulder's application of Chemistry, p. 179-183, $ 350f 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, $ 350J gg ; p. 189-190, $ 350| n; p. 277-278,$ 447* 4. organs of, in animals, complex and va- rious, with a corresponding variety in functions and gastric juice, and food, p. 140, $ 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, $ 356. varieties as to stomach, salivary glands, liver, and organs of mastication, p. Digestion (in Animals)—continued. 140-141, $ 306, 309-311; p. 192, $ 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, $ 42; p. 30, $ 59 ; p. 33, $ 60 ; p. 135, $ 301; p. 143, $ 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, 7X54; 8X55; 11, 12x58; 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, $ 363-376*; p. 781, $ 1029; p. 784, $ 1031 4. 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 4-411. 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. 222- 226, $ 409 c-)'. the whole of the foregoing united, and, INDEX II. 987 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, $ 107-117; p. 106- 112, $ 222-234 4; 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 ofthe 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, $ 1029. Disease—continued from' Index I., conceded that Chemistry reflects little or no light upon it, p. 433-434, $ 876 4 ; p. 762, $ 1006 a; p. 779-782, $ 1029, 1030. remains without essential change at all times and in all climates, p. 401, $ 632 4; p. 761, $ 1005 /-1005* a, 4; 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, Re- flex Action of Nervous System, Index II.; Nervous Power, Index I and 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 ft; 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 4-1065—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, $ 524 a-c ; p. 360-361, $ 528 ; p. 421- 422, $ 657 a; p. 423, $ 660 ; p. 473- 474, $ 733 e; p.506, $ 804 ; p. 679- 681, $ 905 a. 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 4-d. Also, Symptoms, Index II. important in leading to a knowledge of physiological statesand ofthe proper- ties and laws of organic beings, p. 265, $ 4474; p. 413, $ 639 4; p. 798, $ 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 ft, i; p. 61, $134; p. 63, $ 137 4, c; p. 65, $ 143 c; p. 67-68, $ 149-152 ; p. 69, $ 156 4 ; p. 73, $ 163 ; p. 430-433, $ 675-676 a; p. 508-509, $ 809-811 ; p. 531, $ 839; p. 538, $ 847 g, ft ; p. 539, $ 848 ; p. 544-545, $ 858 ; p. 553, $ 870 aa; . p. 597-599, $ 892 c, d; p. 732, $ 970 c; p. 733-736, $ 973 4-980. Also, Law of Adaptation, Index 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 4 ; p. 425, $ 664. Also, p. 170- 173, Nos. 40-45, parallel columns. Disgust, determines vomiting by first propagat- 988 INDEX II. Disgust—continued. ing the nervous influence upon the 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 the 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, $ 500 c; p. 340- 341, $ 514 k-m; p. 547-550, $ 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, Index I. and II. 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, $ 892J. Also, p. 364, $ 545 ; p. 419-420, $ 653; p. 421, $ 654 4; p. 563-564, $ 889 a, 4; p. 665-669, $ 902 ar-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, $ 892J 4, 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, $ $ 892J 4. requires a variety of treatment, accord- ing to its stage and complications, p. 617, $ 892* k; p. 632-633, $ 892| c-e. no essential difference in the pathology Dropsy—continued. of' what is called active and passive, p. 633, $ 892|^. Dysentery, its antiphlogistic treatment, and objec- tions to Astringents in, p. 573, $ 890 d, e; p. 575, $ 890 A; p. 747, $ 991 4; p. 842, $ 1058/ 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, $ 1063-1065. Emetics—continued from Index I, their therapeutical as well as phvsiolog- ical effects take place through reflex action ofthe 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- 110. $ 227-230 ; p. 323-324, $ 500 c; p. 326-328, $ 500 h-k; p. 333, $ 504 ; p. 336-337, $ 514 a-c; p. 532-533, $ 841 ; p. 547-550, $ 863 d; p.661- 663, $ 894-896; p. 666-669, $ 902 c-i; p. 675-676, $ 904 4; p. 876- 877, $ 1072 a; p. 879-880, $ 1074; p. 886-891, $ 1077. 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 Uterine Agents, which are distinguished by a variety of virtues in relation to the uterine system in its morbid or pre- ternatural states, p. 628, $ 892f q ; p. 684-687, $ 895* 4. inadmissible in inflammatory and irrita- ble states ofthe uterus, ibid. amenorrhcea apt to be a sympathetic consequence of abdominal derange- INDEX II. 989 Emmenagogues—continued. ments, and maintained by them; but this morbific effect of reflex nervous influence is also apt to be overlooked, and the uterine affection 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, $ 892| r; p. 684-687, $895* 4. 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 multir farious conditions attending amenor- rhcea, p. 545, $ 859 4, and references there; p. 616-617, $ 892*/, k; p. 628-629, $ 892f r-t; p. 684-687, $ 895* 4. 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, $ 1034. Also, Anjes-- thetics, Index 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, $ 891* e; p. 592- 593, $891*/.-; p. 848, $ 1058 v. Also, Reflex Action of the Nervous System, Antispasmodics, Remedies ; Causes, Morbific ; Remedial Ac- tion, Mental Emotions, Bloodlet- ting, Index 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, $ 892f a, 4 ; p. 625, $ 892§/ g—encountered opposition, ibid., and p. 626, $ 892f l. 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 effects 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, $ 892| c ; p. 626-627, $ 892|-1. 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-j 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, 4; p. 625-627, $892/-w. 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, $ 8921 o. Also, Astringents, Cold, &c, Index II. fatal to some small animals—illustrating distinctions in vital constitutions, p. 622, $893| c. Also, p. 61-63, $ 133- 137; p. 88, $ 185; p. 98, $ 191 a. Erysipelas, treatment of, p. 450, $ 689 I; p. 731, $ 970.c; p. 759, $ 1005 ;'; p. 845, $ 1058 m. employed to show that remedies operate by substituting one pathological con- dition for another, p. 646, $ 893 c-e. 990 INDEX II. Erysipelas—continued. Also, Counter-Irritants, Remedies, Therapeutics, Index II. 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 Exc re- 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, $ 902 m. Also, Constipa- tion, Habitual ; Friction, Respira- tion, Heat, Cold, Skin, Phthisis, Food, Whooping-Cough, Altera- tives, Reflex Action of Nervous System, Index II Expectorants—continued from Index L, the name objectionable, as diverting at- tention from the pathological states, and thus leading to errors in practice, p. 633-634, $ 892| a; p. 641, $ 892-|- 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, $ 892£ 0 . p. 641, $ 8924 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, $ 492| 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, $ 892 c-i. sustain special relations to the pulmo- nary mucous tissue in its morbid states —illustrating the difference 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 ofthe nervous system, through which their effects are exerted, p. 634 -637, $ 892-| 4-d. Also, p. 62-64, $ 136-140 ; p. 65, 66, $ 143 , p. 67, $ 149-151 ; p. 73, $ 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, $ 892-| 4, c. why Squill is ranked before two of the non-stimulating, p. 635-636, $ 892|c. the best effects, 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, $ 892| i. Also, Pneumonia, Index II. resolution, not expectoration, is wanted, if possible, in all 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, $ 892|- d-i. Also, p. 428, $ 674 a; p. 437-442, $ 684-686; p. 456-460, $ 695-708 ; p. 479-480, $ 741 a, 4; p. 541-542, $ 854 44; p. 548-550, $ 863 d; p. 551-554, $ 867-871; p. 572- 579, $ 680 d-n; p. 587, $ 891 k; p. 663-665, $ 897-901 ; p. 738-739, $ 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, $ 892| a; p. 637, $ 892* 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. 991 Ether, Sulphuric. See Anesthetics, Index II. F. 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 ofthe 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 ofthe 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| ; p. -666-669, $ 902 b-i; p. 703-705, $ 943-944 4; p. 708-710, $ 951-952; p. 866, $ 1067 a; p. 877, $ 1072 4; p. 880,'$ 1074; p. 891, $ 1077. Also, Mental Emotions, Remedial Ac- tion, subdivision Mental Emotions, Reflex Action of Nervous System, Secretion and Excretion, Loss of Blood, Bloodletting, Generaliza- tion of Reflex Action of Nervous System, Cold, Skin, Kidney, Joy and Anger, Grief, Hope, Love, 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 ofthe 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 different 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, $ 141-143 c; p. 66-67, $ 148 ; p. 429, $ 674 c, p. 367, $ 557 a; p. 444-445, $ 688 d-ee; p. 465- 467, $ 714-718 ; p. 489-490, $ 755 ; p. 493, $ 764 c; p. 495, $ 770; p. 496, $ 775 ; p. 497-498, $ 779-785; p. 733-736, $ 974-980. Also, In- flammation, Index I. and II. many varieties of, and corresponding names, p. 490, $ 758. is not contagious, p.' 419-420, $ 653; p. 537, $ 847 d, e; p. 869, $ 1068 4, 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, $ 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, $ 986-989. hot stage manifests the recuperative tendency, and the crisis still greater, p. 430-433, $ 675 ; p. 492-493, $ 764 4-e; p. 548-549, $ 863 d; p. 740, $ 989. secreted products advance the crisis, p. 450-452, $ 690-693; p. 453-454, $ 694 4, Nos. 2, 3 ; p. 471-474, $ 732- 733 e; p. 493, $ 763 c-e; p. 546-551, $ 862-864 ; p. 740, $ 989. access, symptoms of, p. 492, $ 764 a. when the paroxysms take place, and in obedience to a law ofthe constitution, p. 494-496, $768-771; p. 570, $889 n. 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, $ 765- 768 ; p. 496, $ 773, 774. 992 INDEX II. Fever—continued. natural duration of, p. 496, $ 774; p. 545-546, $ 861. vegetable miasmata the predisposing 4 causes, p. 497, $ 777—also, among ' the causes of inflammation, $ 779— and of venous congestions, p. 510- 512, $813-817. Also, Causes, Mor- bific, and Predisposition, Index 11. 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 4, 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.; Debility, 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 4, 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 4-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, $ 892* d-f; p. 648-652, $ 893 g-m; p. 713- 714, $ 955 c-958 4; p. 724-732, $ 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, $ 137 c, d; p. 65, $ 143 4, c; p. 430-433, $ 675-676 a; p. 505, $ 801 c; p. 508- 509, $ 809-811; p. 512, $ 817; p. 535-539, $ 847; p. 548-551, $ 863 d-g; p. 552-553, $ 868-870 aa; p. 570, $ 889 n; p. 597-607, $ 892 c-r; p. 609-611, $ 892J d-A; p. 724-732, $ 961-970 ; p. 736-739, $ 981-985 ; p. 740, $ 989 ; p. 754-755, $ 1003 ; p. 757-759, $ 1005 A. 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, $ 1000 b-g. Also, p. 72, Table III. question as to cathartics in, p. 849, $ 1058 z. Also, p. 63, $ 137 d; p. 64, Fever, Puerperal—continued. $ 140; p. 67, $ 150-151; p. 73, $ 165. Fever, "Putrid," treatment of, by bloodletting, p. 754, $ 1002/ Fever, Scarlet, treatment of, p. 843, $ 1058 A. Fever, Typhus, pathology of, and treatment by blood- letting, p. 754, $ 1002 d, c; p. 755, $ 1004 4. Fever, Yellow, and Pestilential, bloodletting in, p. 747-748, $. 991 4- 992 c; p. 749-750, $ 993-994; p. 751, $ 999 ; p. 753-755, $ 1002-1004; p. 869, $ 1068 4. not contagious, p. 27, $ 52 ; p. 418-420, $ 652-653 ; p. 537, $ 847 e; p. 869, $ 1068 4. Also, Contagion, Index II Fibrin, its formation as a coat upon blood ab- stracted in inflammations, in preg- nancy, &c.—denoting, also, a greater fluidity of the blood than natural, p. 445, $ 688 ee; p. 710, $ 952 4, 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, $ 952 A. Also, p. 535-536, $ 846-847 c. Also, Pulse, Index II. " cannot be chemically exhibited in a pure state," p. 780, $ 1029. Simon's vital exposition of, p. 800-801, $ 1035. Fomentations, their modus operandi in relieving pain and diseases. See Poultices, Heat, Warm Bath, Index II. od—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 effects 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 ofthe 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, INDEX II. 993 Food—continued. $ 152 a ; p. 245, $ 440 e ; p. 250-251, $441c; p. 262-263, $ 446 a ; p. 335- 336, $ 512 a, 4; p. 339, $ 514 A; p. 565, $ 889 g ; p. 579-580, $ 890* d. 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 4-1073 a; p. 879-8S2, $ 1074-1075. Also, Fear, Joy and Anger, Jealousy, Disgust, Love, Mental Emotions, Remedial Actiqn, subdivision Men- tal Emotions ; Brain, Inflamma- tion of ; Secretion and Excretion, Index II.; Nervous Power, Index I. and II. what is above said ofthe contact of food with the stomach resolves the paradox ofthe " vomited pill of opium," and of the " scarlet efflorescence," as set forth at p. 673, $ 904 4; though we may bring to the aid of our interpretation what is said of Idiosyncrasy at p. 384, $ 585 4. 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 4 Also, Opium (the pill and " scarlet efflorescence"), Skin (eruptions), In- dex II; Nervous Power, Sympathy, Index I. and II. 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, Whoopino-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, gcner< ation, p. 125, $ 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, $ 1053-1055 — assimilation (includ- ing physiology of digestion), p. 134 -207, $ 296-373J—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, $ 412-432—calorifica- tion, p. 234-279, $ 433-448; p. 807 -812, $ 1043-1050—generation, p 279-280, $ 419 , p.816-817, $ 1052 4, c. peculiar functions—sensation, p. 280 -283, $ 450-451—sympathy (reflex action of the nervous system), p. 283-362, $452-530. 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,$ 1069-1083. G. Gases and Fumes, supposed absorption of. See Humoral Pathology, Anaesthetics, 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 ofall 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 ofthe 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 ofthe 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. R R 994 INDEX II. Generalization, &c.—continued. of which the following are some of the illustrations of the foregoing imputed effects 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, Anasthetics, Ela- terium; Antimony,Tartarized; To- bacco ; Oil, Croton; Hydrocyanic Acid, Plasters; Hydrophobia, Vi- rus of, Predisposition to Diseases; Self-limited Diseases, Convulsions, Phthisis, Asthma, Inflammation; Brain, Inflammation of; Amenor- rhcea, 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- neity of Being—continued from In- dex I., advocated by Physiologists, p. 86, $ 175 d; p. 188-189, $ 350 /, 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, 4; p. 687-889, $905*c. Also,p. 634-636,$892|4,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, $ 143 a; p. 66, $ 143 d; p. 545, $ 859 4; p. 584-585, $ 891 d; p. 592, $ 891* i; p. 623, $ 892f c; p. 634, $ 892* 4. Geology, Theoretical, the Author's work upon, p. 908, $ 1079 4. Gonorrhoea, 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 ofthe Soul, p. 326-327, $ 500 /, i,j; p. 331, $500 o; p. 341, $514 m;p. 534, $844; p. 630-631, $ 892|; p. 703-705, $ 943 a, 944 4; p. 709, $ 951 c ; p. 866, $ 1067 ; p. 877, $ 1072 4; 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, SoulandInstinct,IndexII.; 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, 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 4-484—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, $514* 4. 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 Scion 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. 995 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 irrita- bility of the muscles of organic life depends probably on the ganglionic system," p. 296, $ 476*4. Also, p. 88, $ 183, 184 a; p. 89, $ 188 a; p 100-102, $ 194-202 ; p. 284-290, $ 455-461*. Also, objections to, in Essay on Modus Operandi of Reme- dies in Medical and Physiological Commentaries, vol. iii (1842). supposes " all convulsive affections to be diseases ofthe true spinal or exci- to-motory system," and Author's ob- jections,?. 357, $ 526 d; p. 467-468, $719 Also,Convulsions,Hysteria, Whooping-Cough, Index II. his contributions toward the laws of re- flex action of nervous system, p. 290, $ 463 4. 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 ofthe blood independently of the sym- pathetic system, p. 127, $ 263. his opinion upon bloodletting as to rule of practice, and Author's objections, p. 712-713, $ 955 d; p. 7l"5, $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, $ 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," arid Author's ob- jections, p. 469, $ 722 d ; p. 772-776, $ 1020-1026. Also, critical objections to, in Medical and Physiological Com- mentaries, vol. i., p 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 ofthe mind, p 363-370. relates to the modifications of functions, and the variations of their results as 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, $ 891 /; p. 648-649, $ 893 g, A; p- 675- 676, $ 904 4. 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 4, c; p. 364-369, $ 542-563; p. 425, $ 664 , p. 532-533, $ 841 ; p. 567-569, $ 889 l-mm, p 585, $ 891 /; p. 648-649, $ 893 g, A; p 675- 676, $ 904 4; p 809, $ 1047 Also. Acclimation, Index II. manifested by the Mind and Instinctive Principle, p 369-370, $ 564-568 ; p. 894-895, $ 1078 4. 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, with il- lustrations, p. 366-367, $ 556 a-d- p.532-533, $ 841; p.567-569, $ 889 l-mm; p. 585, $891 f. always relative to impressions, more ox less durable, upon the vital, mental. or instinctive constitution, p. 363, ( 540 ; p. 894-895, $ 1078 4. liable to obtain under the repeated or continued operation of almost all agents capable of affecting the vital or mental properties, p. 364, $ 543. through which miasmata, tobacco, crude food, &e., cease to be injurious,p. 364, $ 544. Also, Acclimation, Index II. or may obtain from one application of particular causes, so as to render them inoperative afterward, p. 364, $ 545. lessens or increases the susceptibility of organs to the action of remedies p. 364, $ 546 ; p. 532-533, $ 841 , p 542, $ 854 c,d; p. 665, $901. demonstrates the operation of remedies and morbific causes by alterative in- fluence of reflex action ofthe nervous ° system, p. 364, $ 547; p. 532-533, o 841 ; p. 649, $ 893 A. its effects generally most prominent in organic life when causes are long m operation—a law of great practical bearing, p. 364, $ 548. a, h not much applicable to food and other perfectly natural stimuli—showing Design; though some kinds liable to, p. 364-365, $ 548* a, b. 996 INDE X 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, $854c-d, 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, $ 841; p 569, $ 889 mm; p. 649, $ 893 A. its effects vary according to the exact nature of its causes, p. 366, $ 553. allied to the principle which lies at the foundation of disease and its cure, p 366, $ 555 , p 542, $ 854 c-/. liable to be influenced by accidental causes, and to thus affect the treat- ment of disease, with examples, p 367, $ 556 d-557. embraces the cumulative effect of reme- dies, and predisposition to disease, with illustrations, p. 368, $ 558 a, 4, 559 ; p 568-569, $ 889 m, p 669- 670, $ 902 i; p. 675-676, $ 904 4 Also, Predisposition, Remedies, In- dex II. relates to the tenacity of many diseases, p 368, $ 560—and to many acquired natural habits of the constitution, $ 561—and to luxuries and customs, $ 539 a, 543, 548* 4, 562—and to the periodical desire of food, and many little usages, $ 563—and to the culture ofthe 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 of the mind, p 370, $ 568; p. 894, $ 1078 4 Heart. See Heart and Arteries, In- dex I., constantly influenced, and the 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 ofthe 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, 4; p. 443-448, $ 687*-688. Also, Causes, Morbific ; Remedies, Remedial Action, Pulse, Respiration, Structure, Skin, Cold, Phthisis, Whooping-Cough, Exercise, Heat, Friction, Sea- Sickness, Secretion and Excre- tion, Emetics, Bloodletting, Kid- ney, Mental Emotions, the several Passions, Reflex Action of the Nervous System, Tongue, Index II; Nervous Power, Sympathy, Index I. and II Heat—continued from Index I, applied to the surface, or intestinal canal, by stomach or rectum, and, whether dry or moist, illustrates, like Cold, the operation of remedies and mor- bific causes through alterative in- fluence of reflex action ofthe 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, $441 d; p. 351, $ 524 a; p. 589, $ 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 the man- ner in which Croton oil, and leeching the anus, will develop a powerful re- INDEX II. 997 Heat—continued. flex nervous influence through the mere propagation oi continuous sym- pathy along the mucous tract of the intestine, p. 249-250, $ 441 c; p. 256-259, $ 441*-442 c; p. 809-812, $ 1046-1050. Also, Organic Heat, Index I and II ; Hybernating Ani- mals ; Oil, Croton; Leeching, Sup- positories, Sympathy, 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 ofthe intestine and ab- dominal muscles, shows that if Croton Oil, or other cathartic, be added to the water, the alterative effects 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 Author 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 ^W,&c.),Reflex Action of Nervous System, Remedial Action, Index II.; Nervous Power, Svmpathy, Index I and II. Heat, Animal. See Organic Heat, Index I. and II. Hemorrhage, Spontaneous, philosophy of, practically* very important —not owing to ruptured vessels, but morbid vascular action, p. 507, $ 805 ; p: 509, $ 812 ; p. 533, $ 842 ; p. 572, $ 890 a-h ; p. 694, $ 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 ofthe 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 4—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 imitated 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-f; p. 770-772, $ 1019. 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-A; p. 771-772, $ 1019 g, A. Also, " Debility," Index I. and 11. 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- qents, Pneumonia, Index II. all preternatural effusions 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 4-733 ; p. 546-547, $ 862-864 ; 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 effect 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 ih 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 ofthe nervous system, and the differences among other things to the 998 INDE3 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 with 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 ofthe 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 thus develop the 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 ofthe-Sow", 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 II.; 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 doeth 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 modi- 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 effects, and as it may be rendered £ II. 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 ofthe 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, $227-233 J; p. 324,$ 500c; p. 326, $ 500 g; p. 327, $ 500 j; p. 333, $ 503; p. 534, $ 844; p. 661- 664, $ 894 4-900; p. 667, $ 904 c; p. 865-868, $ 1067; 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, Reflex Action, &o, Index II; Nervous Power, Sympathy, Soul and Instinct, Index I. and II. Humoral Pathology, inconsistent opinions of its intelligent Advocates, p, 156-173, parallel col- umns; p. 614-515, parallel columns; p. 519, $825; p. 520, $ 826 c ; p. 754, $ 1002/; p. 755, $ 1004 c. Author's motives for the inquiry, p. 515, $819 4. 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 4. 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 from yeast, 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. 529, $ 836. argument from remedies injected into circulation, p. 529-530, $ 837 a, b; p. 677, $ 904 c. argument from Astringents and Tonics, p. 533, $ 842. general argument from putridity, p. 533, $ 843. curious inductions from injections of INDEX II. 999 Humoral Pathology—continued. morbific matters into the circulation, and examined, p. 527-528, $ 830-831. action of poisons inserted in wounds, against 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, $ 422 4; p. 519-521,$ 826-827. their absorption disproved by the refusal ofthe absorbents-to admit bile, intes- tinal acids, and all other things that may undergo fermentation in the in- testine, urine, &c, p. 62-63, $ 136- 137; and ut supra. Also, Absorp- tion, Index I. 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, $ 837 c; p. 577, $ 890 o. 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, $ 826 d; p. 525, $ 828 a. contrast between effects of poisons as applied to different surfaces and as inserted in Wounds, p. 520-521, $ 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, $ 1031 4; 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 4; 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, p. 524, $ 827 c; p. 795, $1033 4. what 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 11. 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 ofthe organism respectively, by which they are rendered inoffensive to the respective parts, p. 62-63, $ 136 -137 c; p. 536-539, $ 847 e-850. Al- so, p. 62-63, $ 136,137, Adaptation, Law of, Index I. dependence of all morbid products, in each instance, upon special physio- logical changes, fatal to Humoralism, p. 479, $741. Also, Secretion and , Excretion, Index II. Author tesolves 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 aetion of the nervous system, and which he has equally applied to all the problems an 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, $ 826 a, 4, d; p. 523, $ 827 4, c; p. 525-527, $ 828-829 ; p. 530, $ 837 4; p. 532-533, $ 841 ; p. 534, $ 844 ; p. 538, 539, $ 847 g, 848. See Medi- cal and Physiological Commentaries, vol. i., p. 569-574(1840), where occurs a distinct and anatomical exposition ofthe reflex action ofthe nervous sys- tem, which the Author there arrays against the doctrines in Humoralism. Also, Institutes, Pathology, Reflex Action of Nervous System; Causes, Morbific ; Remedies, Remedial Ac- tion, Therapeutics, Seton, Coun- ter-Irritants, Mental Emotions, 1000 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; Nervous Power, Sympathy, Index I. and II.; Vital Properties, Law of Adaptation, Index 1. 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, $ 1066— Liebig's hypotheses of, p. 175-176, $ 350* n-p. Also, Anaesthetics, Hydrocyanic Acid, Index II. miasmata produce disease through alter- ative influence of reflex action of the nervous system, p. 522-524, $ 827 4-e. Also, Predisposition; Causes, Morbific; Hydrophobia, Virus of ; Seton, Alteratives, Anaesthetics, and the preceding references to Index II. and to Medical and Physiological Commentaries. a great and prevailing error to confound the altered states ofthe blood with the pathology of disease,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 other parts—being on common ground in all the cases as merely effects or symptoms, and all referable to altera- tive influence of direct or reflex action ofthe nervous system beyond the di- rect seat of operation of any physical agent, p. 478-480, $ 740 ; p. 551, $ 839 ; p. 535-539, $ 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. illustrations from Tartarized Antimony and other remedies, p. 530, $ 837 c; p. 531-532, $ 840, 841 ; p. 533, $ 842. its special objects in the treatment of dis- ease, and the difference in the practical habits ofthe Humoralist and the Vital Solidist, p. 356, $ 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 ofthe nervous system, to illus- trate the modus operandi of morbific and remedial agents upon parts beyond their direct seat 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 ofthe 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 ofthe nervous system, p. 249, $ 441 c; p. 253, $ 441 d; p 255-256, $ 441* a; p. 257, $ 442 a; p. 262-263, $ 446 a; p. 264-265, $ 446 d, 447 a; p. 332, $ 500 o. Also, Organic Heat, Index 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, $ 441 c; p. 253, $ 441 d; p. 262- 263, $ 446 a; p. 264-265, $ 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, $ 1052 4. Hydrocyanic Acid, Nux Vomica, Strych- nia, exert their destructive effects through reflex action of the nervous system, INDEX II. 1001 Hydrocyanic Acid, &c—continued. to which they impart a pernicious modification ; and compared with other things, p. 176, $ 350* p; p. 296, $ 176 c; p. 298, $476* A; p. 318-320, $ 493 d-494 dd; p. 323- 324, $ 500 c; p. 334, $ 509 ; p. 368, $ 558 a, b; p. 481, $ 743; p. 521, $ 826 d; p. 523, $ 827 c, d; p. 525- 526, $ 828 a-c; p. 672-675, $ 904 4 ; p. 706, $ 946 4. 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 4. Hydrophobia, Virus of, its morbific effects propagated from bit- ten part through alterative influence of reflex action ofthe 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. $ 516 d, No. 6 pp. 356, $ 526 c; p. 368-369, $ 558-561 ; p. 421-423, $ 654 4-659 a; p. 520, $ 826 4; p. 523, $ 827 4, c; p. 525, $ 828 a; p. 526, $ 828 d; p. 661-663, $ 894-896 ; p. 666-670, $ 902 4-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 ofthe nervous system is fully applied to this problem. Also, Insti- tutes, &c, Predisposition ; Causes, Morbific, Index II. 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 4. Also, Medical and Physiological Comment- aries, vol. i., p. 498-506. Hysteria and Hiccough, depend upon reflex action ofthe 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—continued. 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, &c, 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, $ 2332; P- 326, $500 g, p. 337-338, $514 c,d; p. 358, $ 526 c. Continued under Hiccough, Index II. Also, Convul- sions, Antispasmodics, "Whooping- Cough, Mental Emotions, Index 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 Soul, p. 384, $ 585 4; p. 631-632, $ 892| 4, c. Also, Opium (the "pill," and " scarlet efflorescence"); Causes, Morbific ; Food, Mental Emotions, Soul and Instinct, Fear, Index II.; Nervous Power, Sympathy, Index I. and II; Irritability, Vital Prop- erties, Index I. 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- 1002 INDEX II. Imagination—continued. other, according to its nature, inten- sity, concurring causes, &c, p. 631- 632, $ 892| 4, c—and to what is there said, it may be worth adding that I know an individual who is purged at the sight of a pill-box. Will Chem- istry resolve these problems! Also, Mental Emotions, the individual Passions, Bloodletting, Remedial Action, Soul and Instinctive Prin- ciple, Index II.; Nervous Power, Index I and II. Infancy, extends from birth to end of first denti- tion, p. 373, $ 576 a—-its various characteristics, physical and mental, $ 576 4, 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, $ 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, $ 143 «; p. 63-67, $ 148 ; p. 70-73, the Tables; p. 367, $ 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 c; p. 495, $ 770 ; p. 497-499, $ 779, 780, 784 a, 785. Also, Fever, Index II. nevertheless, is generally confounded with fever, p. 464, $ 713. Also, Fever, Index 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 4; p. 489, $757. its general characteristics, p. 469, $ 725 -728. Also, p. 444-445, $ 688 d-ee. its four principal stages, formative, sup- Inflammation—continued. purative, 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, $ 733 ; p. 546, $ 862. involves reparation, p. 474, $ 733 /— which is analogous to regeneration, p. 474-475, $ 733—but controverted by physical theorists, p. 475, $ 733 . e~k- ... its termination in resolution during the formative stage, which it is the great aim of art to effect, p 470, $ 729 a; p. 476, $ 735; p. 638,639,640, $ 892J g; p. 642, $ 892i i. the suppurative stage the next most fa- vorable termination of, p. 471, $ 730 ; p. 472, $ 733 a, b. . secretions of lymph, serum, mucus, &c, may take the place of suppuration, but are analogous in principle, p. 471, $ 732—all acting as depletory means, ibid., and p. 546-548, $ 862-863 d. what Nature contemplates besides, in effusions of lymph and pus, p. 472, $ 732 e-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, $ 733 g-L 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. ulceration more or less attendant on suppuration, and its objects and laws, p. 471, $730; p. 472, $ 733 4. granulation, 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, $ 735 4. in its different stages being accelerated or protracted, which is often true in the latter respect of the formative and restorative, p. 477, $ 737. in the products of the second stage, when pus, or lymph, or serum de- viate from their natural standard, Inflammation—continued. and from certain peculiarities in the nature of particular tissues, or as arising 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 4; 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, parihis) upon precise pathological conditions, respectively, p. 478-479, $ 740-741. Also, p. 222-227, $ 409 c-411 ; p. 228, $ 415 ; p. 436, $ 682 4; 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 4; p. 354, $ 526 a; p. 480, $ 741 c; p. 652-653, $ 893 n. Also, . Structure, Index II. Its remote causes, p. 414-427, $ 644— 666 ; p. 480-481, $ 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, $ 827 ; p. 70S, $ 950 ; p. 733, $ 974 4 ; p. 773-775, $ 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 different 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 4, c; p. 641, $ 892| i; p. 664, $ 900; p. 669, $ 902 A; p. 671-672, C II. 1003 Inflammation—continued. $ 904 a. Also, p. 61-67, $ 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 ofthe Materia Medica, and hereditary predispositions, of the last, p. 419-421, $ 653 4-655; p. 424, $ 661 ; p. 468, $ 721 ; p. 641, $ 892-i 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, $ 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, $ 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, $ 662 4; p. 487-488, $ 756 a, 4; p. 605-606, $ 892 p ; p. 609, $ 892|: c ; p. 611-612, $ 892i A, i; p. 615-616, $ 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, $ 756 a, 4; p. 561, $ 888 4; 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, $ 756 a, b; p. 561, $ 888 4; p. 615, $ 892* e; p. 619-620, $ 892* u; p. 664-665, $ 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, $ 410,411; p. 355, $ 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 1004 INDEX II. Inflammation—continued. respects acts only as an exciting cause of inflammation by direct or reflex ac- tion, p. 475, $ 733 A; p 483-484, $ 746 c. Also, Reflex Action of the Nervous System. Index II ; Nerv- ous Power, Sympathy, Index I. and 11. its proximate or pathological cause con- sists of two fundamental elements— 1st, an increased action ofthe vessels; 2d, and by far the most important, a change in kind, p. 484, $ 747 ; p 485- 486, $750-751. involves the whole philosophy of all other diseases, p. 482, $ 745. the prevailing mechanical doctrine of, which supposes a passive relaxation ofthe vessels, and stagnation of blood, considered, p. 484-485, $ 748, 749. always a local disease, while fever affects the system universally, p. 65, $ 143 a,b; p. 66, $148; p. 417-418, $ 650; p. 422, $657 4; p. 464, $712; p. 489- 491, $757-760; 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, $411; p. 355, $ 526 a; p. 464, $711-713; p. 481, $743; p. 498, $ 784 ; p. 506, $ 803, 804; p. 508-509, $809-811; p. 510, $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, $, 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 ofthe 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, $411; p. 355, $ 526 4; p. 465-468, $ 714- 719 ; p. 804-805, $ 1040, and rtfer- Inflammation—continued. ences there. Also, Brain, Inflam- mation of ; Joy and Anger, and the other individual Passions, Fever, first subdivision, Index 11. 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 ofthe 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, $ 411; p. 355, $ 526 o? p. 465- 466, $ 715 ; p. 467-468, $ 718, 719; p. 506-509, $806-811; p. 511, $815; p. 679-681, $ 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,ReflexAction; 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, $ 143c, and references there; p. 66-67, $ 148; p. 465—466, $ 715, and references there; p. 498, $ 784 4, 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 ofthe 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. 1005 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, $806-811; p. 511, $815 p. 724-726, $ 961 ; p. 730, $ 969 p. 731, $ 970 c; p. 732-734, $ 973- 975. Also, Structure, Index II.; Nervous Power, Index I. and II.; Venous 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, $ 411 ; p 355, $ 526 a; p. 444-445, $ 688 a-f; p. 708-710, $ 951-952 4; p. 804-805, $ 1040, and references there. develops an exciting nervous influence which sustains the system under the loss of blood, though of some tissues, and in their connexion with compound organs, more than others, while the loss of blood so modifies the alterative influence ofthe 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, $411; p. 355, $ 526 a ■ p 444-446, $ 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! when affecting the brain, the exciting nervous influence is greater than ot 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, $ 137 b-e ; p. 65, $ 143 c ; p. 67, $ 150-151 ; p. 69, $ 156 4; p. 73, $ 163 ; p 227, $411.; p. 355, $ 526 a; p. 538-539, $ 847 g--849 ; p. 542-543, $ 854/; p.544-545, $ 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 ofthe 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.; Nervous Power, Sympathy, Index I. and II; Vital Properties, Index I. 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, $ 409 4-411; p. 355, $ 526 a. irritability and mobility increased, p. 484, $ 747. Also, p. 89, $ 188 ; p. 103-104, $ 205-215 ; Organic Life, Vital Properties, Vital Principle, Index I. 1006 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- 396; p. 216, $ 399; p. 305-310, $ 483-485; p. 485-486, $ 750-751; p. 503, $ 791; p. 792-793, $ 1032 d; p 803-804, $ 1039. 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, $ 744. active and "passive" shown to be essen- tially the same, p. 486-489, $ 752- 756. Inflammation, Treatment of, discussed under the several practical subjects, Bloodletting, Cathartics, Tonics and Stimulants, individual Remedies, &c, Index 1. and 11. 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 effects of some remedial agent, as bloodletting, upon the va- rious tissues of organs, p. 70-73, $ 160-162—and another ofthe relative liability of different tissues ofthe same nature remote from each other to sym- pathize together injheir diseases, re- spectively, through reflex action ofthe 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, $ 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 11.; Nervous Power, Sympathy, Index I. and II. Instinct. See Soul and Instinctive Principle, Index II.; and Instinct, Index 1. 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 stine—continued. temporary suspension ofthatinfluence 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 ft; 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;—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 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 ofthe 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 ofthe nerv- ous system when cathartics operate, p. 467, $ 718 ; p. 565, $ 899 ; p. 856- 857, $ 1063 4. Also, p. 62-67, $ 135- 151; p. 70, Table II. ODINE, its introduction into practice, p. 614, $ 892* 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 chemical interpretation, p. 612, $892*. Also, p. 3, $ 2 4; p. 120-122, $ 237- 240 ;. p. 352, $ 524 d ; p. 435, $ 680 ; Arsenic,-; Antimony, Tartarized ; INDEX II. 1007 Iodine—continued. Remedies, Therapeutics, Index Vital Properties, Index I. II; 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 ofthe nervous system, p. 613, $ 892* c; p. 619, $ 892* t. Also, Counter-Irritants, Sedatives (Aconite), Alteratives, Index II; Nervous Power, Sympathy, Index I. and II. adapted only to bronchocele, and not to other affections of the thyroid gland, p. 613, $892*c. its uses in scrofula, &c., depend much upon other appropriate treatment, p. 615, $ 892* e; p. 619, $ 892* s, u. 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, $ 892* e; p. 619-620, $ 892* u—and a neglect of which in early phthisis cuts off the chance of recovery, $ 892* c. its uses in skin diseases, secondary syphilis, &c, p. 617, $ 822* g-i. in amenorrhcea-of scrofulous subjects, and how it relieves, p. 685-686, $ 905* 4. 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. 61.7, $ 892* k; p. 630, $8921 a. fucus vesiculosus, burnt sponge, cod- liver oil, how did they get into prac- tice 1 p. 619, $ 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 the 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 44; p. 573, $ 890 d; p. 576-578, $ 890 l-o; p. 634, $ 892| g; p. 641, $ 892-J i; p. 851, $ 1059°. Also, Alteratives, Astringents, Cold, Opium, Ergot, Index II. as an alterative in small doses, p. 557, $ 873; p. 851, $ 1059. Also, as above, and Antimony, Tartarized; Alter- atives, Index II. its action in emetic doses quickened by the union ofthe 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, $ 889 I. Also, p. 63, $ 137 d, e; p. 65-66, $ 143 c, d; p. 67, $ 149-151 ; p. 73, $ 163; p. 367, $ 556 c; p. 567-568, $ 889 /. unlike Tartarized Antimony, is accumu- lative in its small therapeutical doses, and requires a different mode of ad- ministration, p. 557, $ 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. 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 Anesthetics, ut supra, and Anaesthetics, Antispas- modics, Reflex Action of Nervous System, Sympathy, Index II.; Nerv- ous Power, Index I: and II. Ibis—continued from Index I, 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 ofthe nervous . system, p. 340, $ 514 k—and in illus- trating the substantive existence and self-acting nature ofthe Soul, p. 875- 876, $ 1072,a. Irritability—continued^from Index I, Dn: Carpenter arraigned upon, p. 95- 96, $ 189 4—and upon development 1008 INDEX II. Irritability—corc/injfcd. ! of the Ovum, p. 39-40, $ 64 g— and Digestion, p. 153, $ 348 —and Ab- sorption, p. 133, $ 291—and upon the opinion that the " tendency to decom- position after death bears a very close relation with the activity ofthe 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, $ 350J/, note. J. 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 ta remedial ac- tion, p. 547-550, $ 863 d; p.686,$ 905* 4; 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, $ 227-233!\; p. 324, $ 500 c; p. 326, $ 500 g; p. 327, $ 500;; p. 333, $ 503; p. 631, $ 8921 4; p. 661-664, $ 894 4-900; p. 709, $ 951 4-d; p. 865-866, $ 1067; p. 879-882, $ 1074- 1075; p. 886-891, $ 1077; p. 901, $ 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 SvsTEM,IndexII.; 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 ofthe nervous system as to affect the secretions in a different manner from either of the individual agents, Jealousy—continued. and which furnished a theme for Sappho, p. 631, $ 892J 4. 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 ofthe 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 arid morbific agents through alterative influence of reflex action of nervous system—contradict the physical hypotheses—and con- tribute in establishing demonstration ofthe substantive existence and self- acting nature ofthe Soul, p. 95, $ 188*; p. 107-111, $ 227-2331; p. 284-286, $455-457; p. 298, $ 476* A ; 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, $ 944 a; p. 707, $ 947 ; p. 709, $ 951 4-d ; p. 865-868, $ 1067; p. 879-881, $ 1074 ; p. 887, $ 1077. Also, Stom- ach, Blows upon, and the several references to Articles 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 differently 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 of Nervous System, Index II. Also, p. 324, $ 500 c; p. 326, $ 500 g; p. 865-868,' 1067 ; p. 879-882, $ 1071- 1075. K. Kidney, effect upon, in producing saccharine urine, by pricking medulla oblongata, p. 792, $ 1032 d. its diseases, treatment of, p. 450, 451, $ 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 from slight causes, and, INDEX Kidney—continued. like the 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 effects 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 ofthe 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 itinvolves both orders of nerves, p. 107-111, $ 227-233 J ; p. 230-233, $ 422^27 ; 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, $ 902-904; p. 679-681,$ 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 II not a " strainer," as commonly supposed, p 222-227, $ 409 c-411 ; p. 230-233, $ 422-427; p. 318, $ 493 d; p.631- 632, $8921; p. 788, $ 1032 a; p. 801, $ 1036 ; p. 910-911, $ 1083, and con- firmed particularly through the last preceding references. its^modified action, as denoted by fluc- tuations ofthe urine, generally owing to diseases of other organs, especially ofthe digestive, and induced by reflex action of the nervous system, which disturbs its functions without indue- in^ absolute disease, when the urine i ii. 1009 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, $ 426, 427. Al- so, Pulse, Tongue, Amenorrhea, Urine, Index II. ; Menstruation, Index I. Kiestine, declared, on authority, to be a "pure illusion," p. 787, $ 1032 a. L. Lactation, exemplifies the natural.instability ofthe properties of life, which, in being de- signed for useful ends, becomes the occasion of diseases and of their cure, ■ p. 3, $ 2 4; p. 61, $ 133 c; p. 68-69, $153-156; p. 87, $180; p-,120-122, $ 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 ofthe nervous system, excited by the uterus, the efficient cause, ibid., and p. Ill, $ 233£; p. 351, $524 4. 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 ofthe 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 AIental Emotions; the individual Passions, Secretion and Excretion, Reflex Action ,IndexII. proof derived from, that sugar does not exist in the blood, p. 785, $ 1031 4; p. 790, $ 1032 4. Lacteals, 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- 1010 INDEX II. Lacteals—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, $ 892J c. Also, Lymphatics, Veins, Index II. allusion to, in connexion with the ana- tomical relations ofthe intestinal canal to the nervous system, and Author's doctrine ofthe operation of Cathartics through alterative influence of reflex action ofthe nervous system, p. 565, $889^. Liebig's and Carpenter's mechanical doctrine ofthe function of absorption, p. 132-133, $ 289-292. Lactic Acid, not found in the blood, and physiological conclusions, p. 784, $ 1031 4. 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 ofthe 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,$ 947; p. 709, $ 951 A-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 Powee, Index I. and II. 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, $ 837 c; p. 577, $ 890 o. the modus operandi of Astringents and of other remedies illustrated in the foregoing manner, and by other reme- dial influences ofthe acetate of lead, and by comparison with other Astrin- gents and with other things, p. 577- 578, $ 890 o. Also, Astringents, Index II. Leeching, the philosophy of its effects divided into seven stages, p. 692-698, $ 914-928. :hin g—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, $ 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, $ 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 ofthe 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. 1011 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. direct and reflex action of the 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. the effusion 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, $ 922 a; p. 702, $ 939 4, c. hence it is evident that cupping-glasses should not be applied in leeching, and for other reasons, p. 702, $ 939 d. a remarkable difference, also, between 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 ofthe reflex action of the nervous influence in the two cases, p. 694, $ 922 4. Also, Hemorrhage, Spontaneous, Index 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 ofthe nervous system, but may itself be thus relieved, of dis- ease more effectually 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 ofthe organ while also the liver is not only thus relieved and brought to institute salutary reflex 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, $ 923 a-d. Also, p. 64, $ 141 4; p. 322-323, $ 498 ; p. 343, $ 516 d, No. 2 ; p. 344- 345, $ 516 d, No. 6; p. 349, $ 520 ; p. 350, $ 523, No. 7 ; p. 351, $ 524 a, No. 2; p. 355-359, $526 4,c; p. 526. $ 828 d; p. 563-564, $ 889 a; Oil, Croton; Suppositories; Sympathy. Continuous ; Alteratives ; Anti- mony, Tartarized, Index 11. for the 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 affected part, p. 694-695, $ 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 11. 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 4-924. 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 q; p. 696-697, $ 926, 927 a—and the philosophy considered ofthe 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, A. Also, p. 649, $ 893 A; 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, $ 893 q ; p. 684, 905* 4. 1012 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, $ 476* A; p. 658, $893 p; p. 697,$ 927a; p. 711, $953. Al- so, Bloodletting, General ; Habit, Vital, Index II—but often beneficial in certain mild, though chronic cases, without the general remedy, $ 927 4. should neverprecede general bloodletting when the latter may be more useful, as in allcases of severe inflammations, p. 696, $ 925 ; p.713-714, $ 956-958 ; p. 729, $ 966 ; p. 733, $ 974. Also, p 642, $ 892-| i ; p. 658, $ 893 p; p. 871-872, $ 1068 d; Bloodletting, General ; Inflammation, Index 11. 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 c—but never in the cere- bral inflammations and congestions of that age, p. 696, $ 925 c; p. 733-734, $ 974 c-975 4. 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 4, 966. the nature of its influences considered when excessive, having some pecu- liarities which differ from the inju- rious influences that arise from the excessive use of general bloodletting, p. 697-698, $ 927 4. 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 blcfodletting, 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 ofthe nervous influence, and, in the latter, the suddenness of its development, p. 298, $ 476* A; 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, $ 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 4; p. 714, $958 4. Lehmann, his admissions that Medicine has nothing to hope from Chemistry, p. 779-782, $ 1029-1030. his opinion of Vital Physiologists, p 795-799, $ 1034. avows that " there is no essential dif- ference between organic and inor- ganic bodies," i4id. Also, Mulder, Index II. his opinion upon the production of ani- mal sugar, &«., p. 783-795, $ 1031- 1033. affirms that the component parts of the bile are not found in the blood, in which he agrees with Mulder and Kane, p. 180, $ 350f e; p. 783, $ 1031 4—and from which, and other facts, the Author reasons to other secretions, p. 784-793, $ 1031 4- 1032. Leucorrhcea, its principles of treatment, p. 576, $ 890 n; p. 688, $ 905* c. best special remedies for, Cantharides internally. Nitrate of Silver externally, p. 688, $905* c. 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 4. Also, " Strainage," Index II. Loss of Blood, 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 INDE3 Loss of Blood—continued. repetition, p. 367, $ 556 c • p. 375, $ 576 c; p. 550, $ 863/; p. 552, $ 868 4 ; p. 572-574, $ 890 d-f; p. 641-642, $892|; p. 658, $893 p; p. 713-714, $ 956-958 ; p. 729-730, $ 968-969 ; p. 733-734, $ 974-975 ; p. 736, $ 979; p. 739, $ 985. Also, Bloodletting, Leeching, Index II. its management in Croup, p. 375, $ 576 c. 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, $ 974-975; p. 767, $ 1009 4, 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 Aard- 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- sions, Pulse, Secretion and Excre- tion, Inflammation, Remedial Ac- tion, Index II. i Nervous Power, Sympathy, Index I. and II. its effects through the nervous system illustrated by the Passions and other things, p. 666, $ 902 c; p. 667-669, $ 902 e-i; p. 704, $ 944 a; p. 706- 709, $ 946 4-951. 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, $ 921-922 ; p.,703-705, $ 942 4-944 4; 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- c ii. 1013 Loss of Blood—continued. letting after the brain has sustained a shock ofthe nervous influence, and through that shock all other organs, in cases of falls, p. 769, $ 951 b-d. Also, Stomach, Blows upon ; Hy- drocyanic AdiD, 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, &c, 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 ofthe disease. and the relative proportion of loss of blood that may be required, as the disease may affect one part or another. p. 69-73, $ 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 (1840); Institutes, p. 705, $ 945. its operation expounded by Author in Medical and Physiological Comment- aries, altogether through direct and reflex action ofthe nervous system— Article Bloodletting, p. 121-362, vol. i. (1840). 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 ofthe mo- dus operandi of remedial and morbific agents, p. 95, $ 188*; p. 107-108, $ 227-228; p. 111,$233|; p. 326-328, $ 500 g-m; p. 335-336, $ 412-513 ; p. 417, $ 649 c; p. 631, $ 892f 4; p 1014 INDEX II. Love—continued. ■ 709, $951 4, 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, $ 1078 Lungs, the philosophy and treatment of their various maladies, p. 633-642, $ 892|. 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, 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, $ 136 ; p. 63, $ 137 4, c ; p. 210, $ 387; and Circulation of Blood, Index II.; Veins, Index 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, $ 892f c. participate in the ulcerative process, p. 129, $ 272; p. 472-473, $ 733 4-d; p. 483, $ 746 4, &c. like the veins, particularly liable to dif- fuse inflammation, and supplying in either 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, $ 136 ; p. 63, $ 137 4, c ; p. 210, $ 387, and Veins, Index I.; Circulation of Blood, Index II. his opinion of "Vitality" and Inflamma- tion, p. 482, $ 744. 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 Medica—continued from Index I, farther illustrations of the principles upon which the Author has founded his Therapeutical Arrangement of, p. 830-831, $ 1057 c; p. 835-838, $ 1057*; p. 851, $ 1060; p. 853, $ 1061 ; p. 855, $ 1062. 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 i— and what, also, is generally true ofthe 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 I, what is apt to be so denominated, p. 795, $ 1033 4. its future prospects at the hands of Chemistry, p. 8-10, $ 5; p. 14, $ 6; p. 203-204, $ 367* ; p. 779-782, $ 1028-1030. in its present state, intolerant of those who look upon Nature less super- ficially, p. 12-13, $ 5* a; p. 795-799, $ 1034—which explains the remote cause that has compelled the Article on the " Rights of Authors," p. 912 T920. Medicine—continued from Index I, sudden revolutions in, p. 795, $ 1035 4. Medicines, Combinations of. See Reme- dies, Index II. Memory, 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. 1015 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 ofthe 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 IL), 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 ofthe 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 ofthe 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 ofthe 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 mtal 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. Ill, $233|; p. 289, $461; p. 296, 476 c; p. 302, $4814; p. 315-316, $ 492 ; p. 321, $ 496, 497 ; p. 323- 330, (y 500 a-n; p. 333, $ 503-505 ; p. 336-337, $ 514 4; p. 338-339, $ 514 d-A; p. 347-348, $ 516 d, No. 13 ; p. 416-417, $ 649 c; p. 592-593, $ 891* k; p. 631-632, $892} 4; p. 661 -663, $ 894 4-896; p. 666-668, $ 902 l-g; p. 670, $ 902 I; p. 675-676, $ 904 4; p. 679-681, $ 905 a; p. 704, $ 944 a ; p. 707, $ 947-949 ; p. 709, $ 951 4, c; p. 865-868, $ 1076; p. 874-881, $ 1071-1075; p. 876-877, $ 1072a;. 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, Index I. do not operate upon the brain or other organs in the metaphysical manner as commonly supposed of all the attri- butes ofthe 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 themselves, 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 effectsof the 1016 INDEX II. Mental Emotions—continued. ft Will through the same causation con- curring in this demonstration, p. 107- 111,$ 226-233}; p. 266, $447 d; p. 289, $ 461 ; p. 296, $ 476 c; p. 298, $ 476* A; p. 300, $ 479; p. 301, $ 480; p. 302, $ 481 4; p. 304, $ 481 g; p. 306-308, $ 483 4; p. 324, $ 500 c, d; p. 335, $ 511 ; p. 402-403, $ 634-635 ; p. 534, $ 846 ; p. 606- 609, $ 947-951 ; p. 631, $ 892} 4; p. 661-662, $ 894 4; p. 745-746, $ 990*; p. 865-868, $ 1067 ; p. 878- 882, $ 1074-1075; p. 887, $ 1077. since, therefore, according to the fore- going references, the Mental Emotions and the Will develop th6 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 tq,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 ofthe secretions, p. 266, $ 447 d; p. 289, $ 461; p.296, $476c; p. 302, $4814; p. 631-632, $ 892} 4. 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- ental Emotions—continued. tres, give rise to alterative influences of reflex action ofthe 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, $ 234 c-237 ; p. 514, No. 7, parallel columns); and here the Author will extend the example which occurs at p. 866-867, $ 1067, in relation to the influence of Fear upon digestion, and suppose that one ofthe 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 ofthe 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 ofthe 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. 1017 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 effects 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, $ 1072 4-1075. 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, $ 476 c; p. 302, $ 481 4; p. 377-380, $ 578; p. 547- 548, $ 863 d; p. 664, $ 900 ; p. 666, $ 902 c; p. 667-669, $ 902 e-g; p. 679-681, $ 905 a; p. 707, $ 947; p. 709, $ 951 4; p. 866-868, $ 1067; p. 889-890, $ 1077. Also, the indi- vidual Passions, Skin, Cold, Seton, Counter - Irritants, Respiration, &c., Index II. 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, $ 222 4; 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 ofthe 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-A ; p. 344-345, $ 516 d, No. 6 ; p. 348, $ 518 d; p. 526, $ 828 d; p. 541, $ 853-854 4; p. 542-543, $ 854 c-857 ; p. 567-569, $ 889 l-mm; p. 645-647, $ 893 c-e; p. 661-663, $ 894 4-896; p. 664-672, $ 900-904; p. 678, $ 904 d; p. 679-681, $ 905 a. Also, Remedies, Alteratives ; An- timony, Tartarized ; Cantharides ; Hydrophobia,Virus of ; Skin, Cold ; Oil,Croton; Suppositories,Leech- ing, Index II. 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 /. 1018 INDEX II. Metamorphosis, philosophy of, p. 902, $ 1078 p. Metaphysicians — continued from Index 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, $ 1078 4; p. 889, $ 1078 A. 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 ofunsound doctrines, p. 351-352, $ 524 4-d; p. 652-656, $ 893 n; p. 695, $ 924. Also, Counter-Irritants, Elate- rium, 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, $ 662; p. 480-481, $ 743 ; p. 490, $ 758 ; p. 493-494, $ 765-767 ; p. 496, $ 773 ; p. 497-498, $ 777-780 ; p. 510-512, $ 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. 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 difference that the susceptibility is more likely to return in the case ofthe 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 4; 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 ofthe system, with illustrations from Cathartics, Bloodletting, &c.,p. 524, $ 827 e, and references there, 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, &c, p. 418, $ 652 4; p. 420, $ 654 a; p. 424, $ 662 4; p. 510-511, $813-816; p. 553, $ 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 4. may establish the predisposition quickly, 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, $ 892}; also, Jealousy, Mental Emotions—and when regarded in connexion with the corresponding effects 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. 1019 Micturition—continued. 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 4. 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, $ 1032 a. " we analyze healthy and morbid milk, and yet we are ignorant of the sub- stances whose admixture we term casiin," p. 780, $ 1029. , disquisition as to the origin of its sac- charine matter, p. 785, $ 1031 ; p. 788-791, $ 1032 a, 4. 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, $ 350} g. Also, p. 84, $175 44; p. 112-121,$ 234 4-237; Soul and Instinctive Principle, Mental Emotions, the individual Passions, Index II; 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 4. Buffers permanently from premature education, but not so with Instinct, and through reflex nervous influence Mind—continued. from too much or improper food in early life, p. 370, $ 568 ; p. 894-895, $ 1078 4. Also, Infancy, Childhood, Youth, Food, Uterus, Vomiting. what constitutes Ideas, and employed to illustrate the substantive existence and self-acting nature ofthe Soul, p. 906, $ 1078. its modus operandi inscrutable, ibid. contrast between, and Instinct, in the infancy of man and animals, p. 892- 895, $ 1078 a, b; p. 904-906, $ 1078 q. contrasted with the Instinctive Princi- ple as they respect the relative varie- ties in the main central portion ofthe nervous system, p. 896, $ 1078 d; p. 897-898, $ 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 4; p. 903-906, $ 1078 q. identified by metaphysicians with In- stinct, p. 895, $ 1078 4; p. 899, $ 1078 A. 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, Mor- 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, $ 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, $1042. 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, 4; p. 62-63, $ 135- 137. its varieties depend in its morbid as well as natural states upon the physiologi- 1020 INDEX II. Mucus—continued. cal peculiarities of different parts of the mucous tissue, and their exact modifications in disease, p. 436, $ 682 4; p. 452, $ 693. 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, $ 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, $ 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 ofthe 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, $715-719; p. 478- 479, $ 740-741. Also, Bile, Lacta- tion,Weeping, Food, Kidney, Skin; Water, Hot ; Antimony, Tartar- ized ; Fear, Mental Emotions, &c, Index II. a peculiar modification of, diagnostic of pneumonia, p. 436, $ 682 4. 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, $ 732 b; p. 546- 551, $ 862-863 ; p. 633-634, $ 892| a; p. 635-640, $ 892| A. 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 ofthe 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 difficult 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, $ 148; p. 359, $ 527 a, 4; p. 361, $ 529 4; p. 415-417, $ 649 a-650 ; p. 421-422, $ 657-658; p. 530, $ 837 4; p. 542, $ 854 c, d; p. 545, $ 860; p. 547-550, $ 863 d-e; p. 554, $ 871; p. 561, $ 888 c; p. 563-566, $ 889 a-i; p. 567-569, $ 889 l-mm; p. 571, $ 890 4; p. 575-576, $890g-n; p. 628-629, $ 892| q-t; p. 634-641, $ 892| 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 II.—another, showing its relative liability to that disease com- pared with other tissues, Table I.— another, showing the relative danger when affected 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 III.— 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 ofthe nerv- ous system, or through direct develop- ment ofthe nervous influence by the Passions, and according to the special modifications of disease ; and the va- riety in its vital constitution farther INDEX II. 1021 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, $ 227-233}; p. 374, $ 576 d; p. 415-417, $ 649 a-c; p. 436, $ 682 4; p. 452, $ 693; p. 522-523, $ 827 4-d; p. 547-550, $ 863 d; p. 555, $ 872 a ; p. 566, $ 889 i ; p. 571, $ 890 4; p. 575-576, $ 890 g-n; p. 634-641, $ 892| b-i; p. 661-663, $ 894 4-896; p. 666-672, $ 902 a-904, p 840-841, $ 1058 d, e; p. 854, $ 1061; p. 856-857, $ 1063; p. 862- 864, $ 1066. Table showing its relative liability with that of other tissues to sympathize continuously in their several parts, p. 354, $ 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, p. 359-361, $ 527 a-529; p. 634-641, $ 8924 b-i. Mulder, _ applies catalysis in expounding secreted products, in which he does not agree with Liebig, p. 178-182, $ 350} a-f; j p. 226, $409;. decides that the component parts ot 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, $ 350} e. Also Lehmann, Index II. maintains that there is no essentia difference between living and dead matter, p. 179-182, $ 350} c-f; also, Lehmann, Index //.—and yet he does not, p. 189-190, $ 350} n, parallel columns—but believes with Dr. Car- penter and others that Carbon, Oxy- zen Hydrogen, and Nitrogen are en- dowed with life, p. 178, $.350} a; p. 181-182, $350}/ upon the Soul, p. 183, $ 350} gg. Muller, „ , , • , • i the chief expositor of the physiological laws of reflex action of the nervous system, p. 341-342, $514* 4; p. 362, $ 530. , . ., nevertheless, fails of applying hem pathologically and therapeuticafly at faulClike Marshall Hall, in his physiological attributes ofthe nervous fnfluence8, adopts the physical doctrine of Absorption, and, like Dr. Hall, Muller—continued. patronizes the Humoral Pathology, p. 283, $452 4; p. 320, $494 dd. Mumps, occasions inflammation ofthe testes and mammse through alterative influences of reflex action ofthe 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, $ 129 i; p. 351-352, $ 524 4, c; p. 353-354, $ 5*25 ; 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! See, also, Opium, Index I. and II. limited in a group to such as relieve pain and induce sleep, p. 583, $ 891 a, 4. greatly overrated, p. 584, $ 891 c; p. 715 -720, $ 960 a. considerations relative to their injurious tendencies, and the neglect of more important means, ibid. very deficient in curative virtues, and illustrations, p. 584, $ 891 d. their modus operandi like that of al| 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 ofthe 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, $ 484 4, Nos. 5, 6 ; p. 321-341, $ 496-514 m; p. 567, $ 889 k; p. 585, $ 891 e; p. 589-590, $ 891 o, p; p. 592-593, $ 891* k; p. 661-663, $ 894-896 ; p. 665-675, $ 902-904; p. 679-681, $ 905 a. Also, Antispasmodics, Index II 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, $ 476 c; p. 302, $ 481 1022 INDEX II. Narcotics—continued. b; p. 589-590, $ 891 p; p. 592-593, $ 891* k ; p 670, $902/ Also, Hic- cough, Hysteria, Antispasmodics, Mental Emotions, Opium, Food, Index II.; Nervous Power, Index I. and II. the variety in their virtues, respectively, of much practical advantage, p. 585, $ 891/ 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 $ 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, $ 891* 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, $ 891 g,h; p. 715-721, $ 960 a, 4. their iiext great use, to relieve morbid states of irritability, through which opium arrests diarrhoea, &c, with practical illustrations, p. 572, $ 890 a; p. 576, $ 890 I; p. 587, $ 891 i. next in order comes pain, 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, 4. 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, $ 891 r; p. 734, $ 976 4. 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 d. 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 ofthe 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 ofthe larynx—while, also, the mineral and vegetable substance, in alike subduing the disease, demon- strates, like a thousand other analo- gous cases, the absurdity ofthe chem- ical and everv other physical rationale, p. 336-337, $ 514 4, c ; p. 365-366, $ 551-554; p. 486, $ 750 4; p. 532- 533, $ 841 ; p. 666-670, $ 902 4~m; p, 675-676, $ 904 4. Also, Antimony, Tartarized ; Alteratives, Disgust, Mental Emotions, Index II Negro, his color, and that of other races, con- sidered, p. 393, $ 610; p. 907, $ 1078 s. Also, Races of Mankind, Index I.; Medical and Physiological Comment- aries, vol. ii., p. 640. Nervous- Power, its existence, attributes, and functions, whatever it may be, 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, $ 167 a; p. 79-81, $ 167^-169/; p. 84, $ 175 4; p. 85- 87, $ 175 d-177; p. 88, $ 184 4, 185 ; p. 95-96, $ 189 4; 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 ofthe alimentary canal by food and bile, Ac.—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, $ 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. 1023 Nervous Power—continued. it be conceded that some other un- known influence (always 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 n; 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 term power is sanc- tioned by long usage and by late emi- nent writers, as Liebig, for example, when speaking ofthe functions ofthe 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- fluenbe (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 4; p. 107-110, $227-232; p. 112, $ 234 4 ; p. 302, $ 481 4; p. 305, $ 482; p, 309-314, $484-489; p. 323- 332, $ 500 ; p. 333, $ 503 ; p. 334, $ 509 ; p. 405-412, $ 638 ; p. 530, $ 837 4; p. 547-550, $ 863 d; p."661- 663, $ 894 4-896 ; p. 665-670, $ 902 a-m; p. 706-707, $ 947-949. 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 ofthe direct operation of all causes which disturb its natural action—all organs being rendered preternaturally sus- ceptible ofthe influences ofthe nerv- ous system by their morbid state; and where it is not directly affirmed that all the foregoing results are due to pous 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, $ 133 c; p. 63, $ 137 d; p. 65, $ 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, $ 441 c; p. 262, $ 446 a; p. 264-270, $446 d-447 d; p. 286, $ 456 a, 4; p.301-302, $ 481 ; p. 305- 310, $ 483-485 ; p. 323-336, $ 499- 512 ; p. 337, 338, $ 514 c, d; p. 339- 340, $ 514 A; p. 344-345, $ 516 d, No. 6 ; p. 347, $ 516 d, No. 10 ; p. 348, $ 516 d, No. 13; p. 351, $ 524 a; p. 356-358, $ 526 d; p. 359, $ 527 -a, 4; p. 421-423, $ 657-658 ; p. 451- 452, $ 692 ; p. 486, $ 750 4; p. 483- 484, $ 746 c; p. 506, $ 803, 804 ; p. 546-550, $ 862-863/; p. 563-566, $ 889 a-g; p. 585, $ 891e ; p.589-590, $891jt>; p. 592-593, $891*&; p. 612 -613, $ 892* a, b; p. 631-632, $ 892}; p. 637, $ 892i d, e; p.642-648, $ 893 a-g; p. 661-663, <■) 894-896 ; p. 666- 672, $ 902 4-904 a; v. 679-681, $ 905 a; p. 692-695, $ 915-924; p. 697- 701,$ 927-928 ; p. 703-710, $ 940- 952; p.831-833, $1057/-£; p. 862- 864, $ 1066 ; p. 865-868, $ 1067 ; p. 875-877, $ 1072 a; p. 886-891, $ 1024 INDEX II. Nervous Power—continued. 1077. Also, Reflex Action, Men- tal Emotions, Remedial Action, the individual Passions ; Brain, Inflam- mation of ; Inflammation, Syncope, Generalization of Reflex Action, &c, Index II ; Sympathy, Index I. and II.; Nervous Power, Vital Properties, Organic Life, Index I. explanatory specifications ofthe 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 ofthe Soul and Principle of Instinct, p. 101-102, $ 201-202 ; p. 108, $ 227, No. 2; p. 112, $234 4; p.' 116-117, $ 234/; p. 282, $ 451 d; p. 285-287, $ 455 d-459 a; p. 290- 295, $ 462-475; p. 300, $ 479 ; p. 309-310, $ 484 4, 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, $ 516 d, No. 6 ; p. 348, $ 516 d, No. 13 ; p. 416-417, $ 649 c; p. 421-423, $ 657-658 ; p. 465-466, $ 715; p. 483-484, $ 746 c; p. 592- 593, $ 891* k; p. 661-663, $ 894- 896 ; p. 665-670, $ 902 a-n; p. 679 -681, $ 905 a; p. 703-710, $ 940- 952; p. 873-881, $ 1069-1075; p. 886-891, $ 1077. Also, Secretion and Excretion, Index II nevertheless, the Author endeavours 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 ofthe nutritive J 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 ;rvous Power—continued. state ofthe body, no condition of dis- ease, no action of remedies, in which the nervous influence does not par- ticipate (p. 54-55, $ 109 4-117; p 284-287, $ 454 c-459 ; p. 289, $ 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 4; p. 66- 67, $ 148 ; p. 75-76, $ 167 a ; p. 110, $ 233; p. 222-227, $ 409 c-4ll; p. 284-286, $ 454-457 ; p. 289, $ 460- 461* ; p. 294, $ 475; p. 295-296, $ 476 4; p. 313-315, $ 488-489; p. 317-318, $493; p. 421-423, $ 657- 658; p. 483-484, $ 746 c. Also, Vital Properties, Organic Life, Index I ; Respiration, Sphincter Muscles, &c, Index II 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, Index 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 ofthe 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 ofthe 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. 1025 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, $ 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 A, i; p 61-68, $ 133-152; p. 73, $ 163; 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, $ 499-500 I; p. 331-334, $ 500 0-510; p 347-348, $ 516 d, No. 13, 517; p 429-430, $ 674 d; p. 526, $ 828 d; p 539, $848; p. 592, $891*/:; p. 646-648, $ 893 e-g; p. 661-663, $ 894-896; p. 665-676, $ 902 a-904 A; 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, $ 1057 /-A; p. 838 $ 1057*; p. 865-868, $1067; p. 874- 88? $ 1071-1075; p. 886-891, $ 1077. Also, Generalization of Nervous Power—continued. Reflex Action of the Nervou* System, Index II 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. 339, $ 514 g-h ; p. 416-417, $ 649 c ; p. 421-423, $ 657-658 ; p. 483-484, $ 746 c; p. 522-523, $ 827 4, 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. 111, $ 233*, 233}; p. 285-286, $ 455 d-f; p. 333, $ 503- 506; p. 339, $ 514 g; p. 344-345, $ 516 d, No. 6 ; p. 365, $ 551 ; p. 366, $ 556; p. 416-417, $ 649 c; p. 420- 424, $ 654-661 ; p. 532, $ 841 ; p. 547, $ 863 d; p. 551, $ 877 ; p. 568- 569, $ 889 m, mm; p. 646-649, $ 893 e-A; p. 661-663, $ 894-896; p. 668- 670, $ 902 g-m; p. 675-676, $ 904 A; p. 679-681, $905 a. Also, Sphincter Muscles, Alteratives; Hydropho- bia, Virus of ; Small-pox, Miasm, 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, $ 233*, 233} ; p. 285-286, $ 455 d-f; p. 333, $ 503-506; p. 339-340, $ 514 g, h; p. 344-345, $ 516 d, No. 6; p. 364, $ 545 ; p. 365, $ 549, 550; p. 368, $ 558, 560 ; p. 416-417, $ 649 c; p. 420-424, $ 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 T T 1026 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, $184-185; p. 101-102, $ 201- 202- p. 106-112, $222-234; p. 116- 117,' $ 234/ g; p. 253, $ 441 d; p. 262-268, $ 446 a-447 d; p. 284-290, $ 454-461* c; p. 296, $ 476 c; p. 323-341, $ 499-514; p. 344-345,. $ 516 d, No. 6 ; p. 348, $ 516 d, No. 13; p. 350-353, $ 524 ; p. 354-362, $ 526 -530; p. 508-509, $807-811 ; p. 537 -539, $ 847 c-848 ; p. 563-565, $ 889 a-g; p. 592-593, $ 891* k; p. 644- 650, $ 893 c-i; p. 657, $ 893 p; p. 661-681, $ 894-905; p. 692-709, $ 914-951 ; p. 745-747, $ 990* a, A; p. 804, $ 1040 ; p. 865-868, $ 1067; p. 874, $ 1071; p. 877-881, $ 1072 4- 1075 ; p. 886-890, $ 1077. 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 effects 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 afl the others is sustained by other special demonstrations in immediate connex- ion with a large number ofthe several things respectively, p. 66-67, $ 148; p. 110, $ 232 ; p. 323-341, $ 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, $ 841 ; p. 542-543, $ 854 c-f; p. 547-550, $ 863 d; p. 563-566, $ 889 a-g; p. 568-569, $ 889 m, mm; p. 592, $ 891* k; p. 631-632, $,892} 4; p. 661-663, $ 894-896; p. 666 -672, $ 902 4-904 4; p. 679-681, $ 905 a; p. 703-710, $ 940-952; p. 831-833, $ 1057 f-g.; p. 838, $ 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. 330- 332, $ 422 4-424 ; p. 335-336, $ 512 a, b; p. 630-632, $ 892} 4; p. 709- 710, $ 951 4-952 ; p. 865-868, $ 1067; p. 877-878, $ 1072 4. Also, Milk, Sweat, Urine, Food, Weeping, Mental Emotions, Index 11.; Su- , dorifics, Index I. is the exciting cause of all diseases which spring up as consequences of each other; but the secondary affec- tions, one or more, may be very dif- ferent from the primary, depending, in part, upon the peculiar constitution of different tissues, orpartsofatissue, p. 62-68, $ 135-152 ; p. 109, $ 229 ; p. 339-340, $ 514 A; p. 465-469, $ 715-722; p. 483-484, $ 746 c. Also, Causes, Morbific ; Inflammation, Skin, Tobacco, Seton, Index II. expounds the philosophy of Metastasis and Revulsion. See Metastasis, Index II. may operate upon the organic constitu- tion ofthe nervous centres, and thence upon the heart, stomach, &c, with a suddenly fatal effect, through reflex action ofthe nervous system, as with INDEX II. 1027 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, $ 226-233} ; p. 296, $ 476 c; p. 298, $ 476* A ; p. 300, $ 479 ; p. 301, $ 480 ; p. 302, $ 481 4; p. 304, $ 481 g; p. 306-308, $ 483 4; p. 320, $ 494 dd; 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 4-d; p. 831-833, $ 1057/-^; p. 858, $ 1057*; p. 862-864, $ 1066 ; p. 865-868, $ 1067; p. 878-881, $ 1074-1075; p. 887, $ 1077. Also, Joy and Anger, Mental Emotions; Serpents, Virus of; Stomach, Blows upon; Pain, Oxygen, Opium, Sedatives (Aconite), Neuralgia, Antispasmodics ; Brain, Inflammation of ; Bloodletting, Loss of Blood, Index II; Will, Index I. and II its opposite influences upon the sensi- bility of nerves through reflex action ofthe nervous system the cause and cure of pain (when not the direct result ofcauses operating locally) andaccord- ingtothe nature ofthe 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 4; p 323-324, $ 500 c; p. 584-585, $ 891 d, e; 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, Index 11 ■ ■ ■ a c applied 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 Nervous Power—continued. concerns their substitution of transi- tory pathological conditions for the more profound, is summarily present- ed, p. 596-597, $ 892 4, c; p. 676-681, $ 904 c-905 a. Also, p. 67, $ 149- 151 ; p. 73, $ 163 ; p. 108-110, $ 227 -232; p. 542, $ 845 c-e; p. 554, $ 871; p. 592-593, $ 891* k; p. 661- 663, $ 894-896 ; p.664-665, $ 900- 901 ; Bloodletting, Remedies, Re- medial Action, Index II; Nervou? 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, p. 66-67, $ 148 ; p. 230-232, $ 422-424 ; p. 289, $ 461 ; p.421-423, $ 657-658; p. 631-632, $ 892}; p. 668-669, $ 902 g, h; p. 704, $ 943 a, 4; Secretion and Excretion, Bile, Sweat, Milk, Weeping, 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, $ 1044-1045. Also, p. 68, $152a; p. 245, $ 440 e; p. 250-251, $ 441 c; p. 335-336, $ 512 a, 4; p 339, $ 514 A; 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 ofthe first act of respira- tion through reflex action ofthe 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 Emotions, Index H- exerts its effects, in modifying the con- dition of the solids and fluids, upon the capillary vessels, and in develop- in the occurrence of a secondary or sym- pathetic disease is sometimes follow- ed by a subsidence of a primary af- fection upon which the secondary de- pends, as a consequence not only of a withdrawal of a morbific reflex nerv- ous influence, but the substitution of a salutary one, 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, $ 148 ; p. 351-352, $ 524 c; p. 360, $ 528 ; p. 421-422, $ 657; p. 506, $ 804; p. ' 539, $ 848 ; p. 570, $ 889 n; p. 652- 654, $ 893 n; p. 679-681, $ 905 a. Also, Metastasis, Poultices, Index II 1056 INDEX II. Remedial Action—continued. 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 ofthe 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 acid ; and we unavoidably de- duce from the vast variety of effects 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 ofthe remote exciting cause, and looking alone at the mental emotions and those phys- ical causes which are 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 ofthe 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 ofthe heart through the same process of re- flex nervous influence, and so ofthe 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 develops 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 ofthe 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 staiting 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 ofthe 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 ofthe 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 ofthe Soul, p. 89, $ 188 ; p. 95, $ 188* d; p. 104, $ 215 ; p. 107, $ 227 ; p. 108-110, $ 228; p. Ill,$233-J; .p 124-125, $ 243 -246 ; p. 128, $ 226, 227; p. 230, $ 422 4; p. 263, $446 a; p. 281,$ 451 a; p. 296, $ 476 c; p. 298, $ 476* A; p. 300- 302, $ 479, 480, 481 4; p. 312-313, $ 487#, A; p. 314, $ 488*; p. 323-331, $ 500 c-o; p. 334-336, $ 507-513 ; p. 337, $ 514 c ; p. 338, $514/; p. 340- 341, $ 5141, m; p. 356, $ 526 c ; p. 369 -370, $ 565-568 ; p. 378-381, $ 578 d-579 ; p. 382, $ 581 c-e; p. 387, $ 597 d; p. 388, $ 598 d; p. 390, $ 600 4, 601 c; p. 417, $ 649c; p. 478, $ 740 a; p. 523, $ 827 c; p. 525- 526, $ 828 a-c; p. 527, $ 828 e; p. 530, $ 837 4; p. 534, $ 844; p. 547, $ 863 d; p. 580, $ 890* d; p. 586, $ 891 g, A; p. 589-590, $ 891 p; p. 592-593, $ 891* k; p. 624, $ 892£ d; p. 631-632, $ 892# 4, c; p. 662-663, $ 896; p. 664, $ 900 ; p. 671-672, $ 903-904 a; v. 674, $ 904 4; p. 675, INDEX II. 1057 Remedial Action—continued. $ 904 4; p. 681-682, $ 905 d; p. 701, $ 938 4 ; p. 704, $ 943 4-944 a; p. 707, $ 947; p. 709, $ 951 d; p. 714, $ 958 4 ; p. 733, $ 974 c ; p. 734-735, $ 975 4-976 ; p. 745-746, $ 960* a, b; 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 effects 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, $ 905 a; p. 668-669, $ 902 g—i. Also, Alteratives ; Antimo- ny, Tartarized ; Sphincter Mus- cles, Roosting, Index II. ii 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 A ; p. 483-484, $ 746 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- fluence 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 distinctions to be observed between im- pressions ^rnade on irritability, and common, specific, and sympathetic sen- sibility, and that the last only is con- cerned in reflex action ofthe nervous system, while causes affecting the nervous centres in a direct manner operate primarily through excito-mo- tory nerves alone, p. 671, $ 903. Also, p. 88-90, $ 183-188 e; p. 100- 103, $ 197-204; p. 280-282. $ 450- 451; Mental Emotions, Reflex Ac- tion, individual Passions, Disgust ; Brain, Inflammation of, Index II X x emedial 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, $ 2 4-d; p. 331, $ 500 o; p. 122, $ 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, $ 839 ; p. 535-539, $ 847-850; p. 541, $ 852- 854 4; p. 542, $ 854 c-e; p. 544- 545, $ 858-859 a; p. 592-593, $ 891* k; p. 662, $ 895 ; p. 663-665, $ 897- 901. Also, Vital Properties, In- dex I.; Remedies ; Causes, Morbif- ic ; Therapeutics; Diseases, Self- Limited ; Small-Pox, Structure, 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, &c), 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 Chemistry, p. 107-111, $ 227-2331; p. 333, $ 503-505; p. 417, $ 649 c, 650 ; p. 424-425, $ 662 a-e; p. 428, $ 671-674; p. 486, $ 750 4; p. 542, $ 854 c-e; p. 544, $ 857; p. 545- 546,'$ 859 4-861 ; p. 547-550, $ 863 d; p. 553, $ 870 aa; p. 596-597, $ 892 4, c ; p. 604-606, $ 892 m-p; p. 611-612,$ 892h f-i i p. 659, $ 893 q; p. 662-665, $ 896-901 ; p. 709, $ 951 4; p. 737-738, $ 984. Also, Reme- dies, Inflammation, Mental Emo- 1058 INDEX II. Remedial Action—continued. tions, Joy and Anger, Fear, Hope, DisgustJ &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 overthrow the entire as- semblage, p. 63, $ 147 c-e; p. 65, $ 143 c; p. 66-67, $ 148-151 ; p. 298, $ 476* A; p. 337, $ 514 4, c; p. 367, $ 557 a, 4 ; 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, Index II; 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,$ 675-676 a ; p. 437-442,$ 684-686 ; p. 456-460, $ 695-708 ; p. 479-480, $ 471 a, 4; p. 486, $ 750 4 ; p. 487-489, $ 756 ; p. 498-499, $ 785 ; p. 505, $801; p. 510, $813 4; p. 541 -542, $ 854 44; p. 545, $ 859 4; p. 548-550, $ 863 d; p. 551-554, $ 867 -871; p. 560-561, $886-888; p. 597 -600, $ 892 c, d; p. 603-604, $ 892 k; p. 606, $ 892 p ; p. 609-610, $ 892£ d; p. 613, $ 892* c; p. 615-617, $ 892* f-k; p. 636-642, $ 892± d-i; p. 663-665, $ 897-901 ; p. 724-728, $ 961 ; p. 729-732, $ 966-970; 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 through sensitive fibres of compound nerves (mainly ofthe sym- pathetic) to the cerebro-spinal axis, which 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, $ 188 a, b; p. 95, $ 188* d, 189 a; p. 96-98, $ 189 c-191 4; p. 101-103, $ 201-208 ; p. 106-112, $ 222-234 4; p. 230-231, $ 422-423 ; p.253, $ 441 d; p.262- 270, $ 446 a-447 d; p. 282, $ 451 /; p. 283-284, $ 452 c, 453 ; p. 285-286, $ 455 d-457 ; p. 289, $ 459 g; p. 295, $ 476 a; p. 296, $ 476 c, 476* 4; p. 298-299, $ 477 a; p. 301-303, $ 481 4-d; p. 309-310, $ 484 4-485 ; p. 312 -314, $ 487 #--488*; p. 315-318, $ 492-493; p. 320, $ 494 dd; p. 321, $ 496,497 ; p. 323-362, $ 499-530 ; p. 364, $ 547; p. 415-417, $ 649 ; p. 421 -423,$ 657-658 ; p. 430-432,$ 675; p. 451, $ 691-692 ; p. 478-479, $ 740 -741 ; p. 509, $ 811 ; p. 515-516, $ 819 4-820 ; p. 522-523, $ 827 4, c ; p. 530-533, $ 837 4-841 ; p. 534, $ 844 ; p. 541-542, $ 854 44; p. 544, $ 857; p. 545, $ 859 a-c; p. 547-550, $ 863 d; p. 551-553, $ 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. 724-728, $ 961-964; p. 732-736, $ 972-980; p. 745-746, $ 990 s-990* 4; p. 766- 767, $ 1009 a, 4; p. 862-868, $ 1066 -1067. operate through influences of reflex nervous action according to structure and special vital constitution of differ- ent parts (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 infahcy to adult age, and temperament, and especially as they may be diverted by morbid stales 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, $ 2 4; p. 55, $ 113-117; p. 59, $ 129 g-i; p. 61-73, $ 133-161; p. 98, $ 191 4; p. 120-122, $ 237- 240 ; p. 130, $ 278 ; p. 231, $ 422 c- 424 ; p. 284-289,$ 454-461 ; p. 352, INDEX II. 1059 Remedies—continued. $ 424 d; p. 354-361, $ 526-530; p. 364, $ 548; p. 365-368, $ 551-560 ; p. 373-390, $ 574-601 ; p. 399, $ 630; p. 415-416, $ 648 d-649 4; p. 418, $ 651 a, 4; p. 421-422, $ 657 a, 4; p. 424, $ 662 ; p. 425, $ 663 ; p. 428, $ 671 ; p. 435, $ 680 ; p. 467, $ 718 ; p. 468-469, $ 722; p. 502-504, $ 793- 798 ; p. 509, $811; p. 520-521, $ 826 d; p. 522-523, $ 827 4, c; p. 530, $ 837 4; p. 535-539, $ 847-850 ; p. 541 -542, $ 854 44; p. 543, $ 855 ; p. 545, $ 859 a-c; p. 553, $ 870 aa; p. 554, $ 871 ; p.565-566,$ 889 g, i; p. 579 -580, $ 890* d; p. 597-598, $ 892 c ; p. 612, $ 892* a; -p. 624, $ 892| d ; p. 634-636, $ 892| 4, c ; p. 647, $ 893 c ; p. 649, $ 893 h; p. 651, $ 893 k; p. 657-659, $ 893 p, q; p. 661-665, $ 894-900 ; p. 669, $ 902 i; p. 676-679, $ 904 c, d; p. 703-711, $ 940-952; p. 731, $ 970 c; p. 732-736, $ 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 4; 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, $ 889 i; p. 856- 857, $ 1063 4; 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 4; p. 575, $ 890 i; p. 838 -861, $ 1058-1065—and by Tartar- ized Antimony, Cantharides, Iodine, Ergot, and numerous other individual substances. See the Articles, Index 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, $ 160-162. emedies—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, $ 188* d; p. 107-111, $ 226-233J.; p. 253, $ 441 d; p. 296, $ 476 c; p. 301-305, $ 481 4-482; p.306, $ 483; p. 315, $ 492; p. 323-353, $ 500 c- 524; p. 365-366, $551-556; p. 427- 428, $ 670, 671 ; p. 430-433, $ 675; p. 480, $ 743 ; p. 509, $ 811 ; p. 512, $ 817 ; p. 523, $ 827 ; p. 534, $ 844; p. 565, $ 889 /, g; p. 570, $ 889 n; p 657, $ 893^ ; p. 661-663, $ 894-896 ; p. 666-672, $ 902 4-904 a; p. 724- 727, $ 961-963 ; p. 733-735, $ 974- 976 ; p. 773-775, $ 1023-1024; p 829, $ 1057 a; p. 865-868,$ 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, $ 512 a-513 ; p. 565-566, $ 889 g. Also, Mucous Tissue, first subdivision, Lacteals, 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 4-d; p. 540, $ 851 ; p. 543-544, $ 857 ; p. 545, $859 4 ; p. 556-557, $ 873-875 ; p. 560-562, $ 885-888 ; p.567-568, $ 889 I; p. 570, $ 889 n; p. 600, $ 892 d; p. 605, $ 892 to; p. 740, $ 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 formula, 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, $ 52 ; p. 94-95, $ 188* d; p. 107-110, $ 227-232; p. 340, $ 514 A; p. 417, $ 650; p. 418-419, $ 652 4-653 c; p. 422-425, $ 662-G63; p. 545, $ 860 ; p. 547, $ 863 d ; p. 554 1060 INDEX II. Remedies—continued. -556, $ 872 a; p. 566-567, $ 889 k; p. 661-662, $ 894; p. 838-841, $ 1058; p. 851-862,$ 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 effect 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, $ 662 4; p. 430-433, $ 675; p. 487-489, $ 756 a, 4; p. 553, $ 870 aa ; p. 554-556, $ 872 a; p. 571-572, $ 890 4; p. 575, $ 890 i, k; p. 581, $ 890* e; p. 597-598, $ 892 c; p. 605 -607, $ 892 m-r; p. 611, $ 892* A; 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, $ 841 ; p. 543-544, $ 857 ; p. 553, $ 870 aa; p. 566-569, $ 889 k-mm; p. 598-604, $ 892 d-k; p. 650-651, $ 893 i-k; p. 672, $ 904 a; p. 675-676, $ 904 4; 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 4, c ; p. 750-751, $ 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 d; p. 551-554,$ 867-871; p. 570, $ 889 n ; p. 595-596, $ 892 aa; p. 597-598, $ 892 c ; p. 600, $ 892 d ; p. 641-642, $ 892-| i; p. 648-649, $ 893 g, A; p. 658-659, $ 893 p; p. 728, $ 964 d. in disease, their action is on common ground with morbific agents, physic- al and mental, and the natural stimuli smedies—continued. oi Hie, 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 ofthe whole of which is seen in the failure of a mild solution ofthe 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 Seton upon the same disease when inserted in the nape ofthe 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 ofthe affected parts, p. 3, $ 2 4; p. 59, $ 129 A; p. 63, $ 137 d ; p. 65, $ 143 c ; p. 67, $ 149-151 ; p. 68, $ 152 4; p.120-122, $ 237-240; p. 332-334, $ 502-506 ; p. 339-340, $ 514 g, A; p. 352, $ 524 d ; p. 415-417, $ 649 a-d; p. 421-423, $ 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, $ 847- 850; p. 541-542, $ 854 44; p. 545, $ 859 a, I; p. 553, $ 870 aa; p. 607- 608, $ 892 a, b; p. 612, $ 892* a; p. 623, $ 8921 c; p. 665-671, $ 902 a- m; p. 709, $ 951 4-d; p. 724-726, $ 961 a-e ; p. 733-736, $ 974-980. from the foregoing and 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 nerves constitute a part of the structure, which is particularly true of a few remedies which are intended to be thus restricted, such as caustics, and many applications to cutaneous dis- eases ; but it is in respect to most INDEX II. 1061 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 effect 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, $ 188 a; p. 102, $ 203 ; p. 284-287, $ 453 c-459; p. 289, $ 461; p. 296, $ 476 c; p. 302, $481 4; p. 315-316, $492; p. 323 -324, $ 500 c ; p. 327, $ 500 i; p. 338, $514d; p.339-341,$514(o--TO;p.347 -348, $ 516 d, Nos. 11-13 ; p. 416- 417, $ 649 c; p. 421-423, $ 657 a- 658 ; p. 475, $ 733 A; p. 483-484, $ 746 ; p. 522-523, $ 827 4, c; p. 531, $ 840 ; p. 547-550, $ 863 d; p. 666- 672, $ 902 4-904 4. 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 effect 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 its influences upon disease may be shown to depend on its action upon the stomach and con- sequent reflex actions ofthe 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 maybe necessary to the same amount of impression upon the stomach, and without which the symptoms will again increase—and also exemplified to the same effect 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 exhib- 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 ofthe 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 4, c; p. 365-368, $ 549-559 ; p. 431, $ 675; p. 486, $ 750 4; p. 530- 533, $ 837 4-841 ; p. 547, $ 863 d ; p. 556-557,$ 873 ; p.567-569, $ 889 l-mm; p. 612-613, $ 892* a, 4; p. 634, $ 892| A; p. 638-640, $ 892| g; p. 641, $" 892| i; p. 666-670, $ $ 902 b-m; p. 675-676, $ 904 4; p. 833, $ 1057 A; 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, $ 892| 4. Also, Mental Emo- tions, Disgust, Cathartics, Emet- ics, Index II the usage of reasoning from the results of experiments with remedies upon man in health to their effects upon morbid conditions must be included among the important obstacles in the 1062 INDEX II. Remedies—continued. 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, eecond subdivision), 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, $ 2 4; p. 63, $ 137 d; p. 65, $ 143 c ; p. 67, $ 149-151 ; p. 68, $ 152 4; p. 73, $ 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. 531, $ 838-840 ; p. 535-539, $ 847-850 ; p. 541-542, $ 854 44; p. 545, $ 859 a, b; p.548-549, $ 863 d; p.607-608, $ 892 a, 4; p. 612, $ 892* a; p. 623, $ 892| 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, $ 830-831. 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, $ 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 in connexion with the variety of means that will subdue a given form of dis- iedies—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 off the 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, $ 149-151 ; p. 87, $ 177- 182; p. 122, $ 237-240; p. 147, $ 330; p. 333, $ 503; p. 417-418, $ 650 ; p. 424, $ 662 ; p. 426, $ 666 ; p. 428, $ 672; p. 430-433, $ 675; p. 438, $ 684, No. 9 ; p. 470-471, $ 729 -731 ; p. 473-474, $ 733 e ; p. 486, $ 750 4; 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, $ 888 a- d; p. 597, $ 892 c ; p. 606, $ 892 p; p. 637, $ 892| d, c; p. 648-649, $ 893 INDEX II. 1063 Remedies—continued. g; p. 661-665, $ 894-901; p. 679- 683, $ 905 a, 4; p. 696, $ 926. it follows, therefore, that one remedy prepares the way for another, and in a variety of respects, p. 367, $ 556 c ; p. 423, $ 659 ; p. 424, $ 662 4 ; p. 428, $ 672 ; p. 545, $ 859 4; p. 551-552, $ 867-868; p. 554-556, $ 892 ; p. 561, $ 888 ; p. 597-600, $ 892 c, 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 ofthe 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 with 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 ofthe 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- are abortive whenever the morbid changes transcend the recuperative law, P. 420, $ 654 a; v. 552, $ 868 4; p. 661, mottoes; p. 728, $ 964 c. Also, Recuperation, Law 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 $ 858,861; p. 551, $ 863 A—and bv the simple system of watching or expectant plan, p. 543, $855-857; p. 558-559, $ 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- incr ingrafted upon the constitution ofthe 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 of morbific, p. 63, $ 137 A-e ; p. 67, $ 149 ; p. 69, $ 156 4; p. 538-540, $ 847 g--848 ; p. 543, $ 855 -856; p. 551, $ 863 A; p. 558-559, $ 879-883 4; 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 superven- 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, $ 148 ; p. 351-352, $ 524 c ; p. 360, $ 528 ; p. 421-422, $ 657; p. 506, $ 804 ; p. 539, $ 848 ; p. 570, $ 889 n; p. 652-654, $ 893 n; p. 679- 681, $ 905 a, 4. Also, Metastasis, Index 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 1064 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, $ 233*,233£ ; p.285-286, $ 455 d; p. 333, $ 503-506 ; p. 339, $ 514 g, A ; p. 344-345, $ 516 d, 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, $ 889 m-mm; p. 592-593, $ 891* k; p. 599-600, $ 892 d; p. 646-649, $ 893 c-A; p. 661-663, $ 894-896 ; p. 668-670, $ 902 g-m ; p. 675-676, $ 904 4; p. 679-681, $ 905 a. Also, 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 fever, and the remedy may be ade- quate to the removal of all the func- tional 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 ofthe 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 affected 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-e; p. 65-67, $ 143 4, c-148-151; p. 298, $ 476* A; p. 304, $ 481 g; p. 309-310, $ 484 b, No. 5 ; p. 337, $ 514 4, c ; p. 361, $ 529 4; p. 367, $ 557 a, 4 ; p. 426, $ 666 ; p. 430-433, $ 675; p. 465-466, $ 715; p. 479-480, $ 741 a, b; p. Remedies—continued. 498, $ 784 4; p. 509, $ 811; p. 535- 539, $ 847-848 ; p. 542-543, $ 854/ and references there ; p. 552-553, $ 870 a, aa; p. 597-599, $ 892 c, d; p. 608-610, $ 892i c, d; p. 662-664, $ 895-900 ; p. 731-732, $ 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 4; p. 572-573, $ 890 d; p. 576-577, $ 890 l-o; p. 587, $ 890* 4; p. 590-593, $ 891* a-k ; p. €28-633, $ 892| a-892f d ; p. 636-640, $ 892| d-f; p. 669, $ 902 A ; p. 687-688, $ 905* c ; p. 857, $ 1063 4. 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, Index II variously influenced by Mental Emo- tions, p. 865-868,$ 1067. Also, Mental Emotions, the individual Passions, Remedial Action, subdi- vision Mental Emotions, Index II. ; Nervous Power, Index I. and II 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 A, and references there. contrast between Chemistry and Vital Solidism as practically applied to Therapeutics, p. 147, $ 330; p. 170- 173, Nos. 40-46; p. 176-178, $ 350f 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, $ 733 A ; p. 483-484, $ 746 c. Also Skin, Cold, Counter-Irritants, Plas- ters, Seton, Nervous Power, sub- division p. 1024, Index II; Vital Properties, Irritability, Nervous Power, Index I. INDEX II. 1065 Remote Causes of Disease. See Caus- es, Morbific, Index II. Reparation, a law prevailing universally in organic beings—analogies between its modi- 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 f-i. 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 ofthe nervous system by which it is determined, and associated with the 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 ofthe 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. HI, $ 2331 ; p. 290, $ 462 ; p. 296, $ 476 c- p 302, $ 481 4; p. 323-330, $ 500 c-n ; p. 333-335, $ 503-511 ; p. 336-338, $ 514 4-d; p. 413, $ 639 a; p 592-593, $ 891 * k; p. 666-670, $ 902 4-to; p- 671, $ 903. Also, Mental Emotions, Disgust, Reflex Action, Remedial Action, Index II.; W|ll, Nervous Power, Index I and 11. various modifications of, as in sneezing, coughing, yawning, laughing, asth- ma, hiccough, &c, employed for the foregoing purposes, p. 327, $ 500 i; 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 ofthe nervous influence either re- flex or direct, and that this considera- tion, as it respects the action ofthe 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 effect, 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 II. the coincidences between voluntary and involuntary, employed 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, Index II. Rheumatism, treatment of, by bloodletting, tartarized antimony, &c, p. 720, $ 960 a ; p. 733, $ 974 a; p. 845-846, $ 1058 n. considered in its relations to the doc- trines of metastasis and repulsion, p. 354, $ 525 a; 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, $ 893 n. Also, p. 353- 354, $ 525 4, 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 their effects through va- riously modified influences of the nervous power, p. 554-556, $ 872 a; p. 565-566, $ 889 g; p. 571, $ 890 4 ; p. 575-576, $ 890 i-l; p. 578, $ 890 p; p. 581, $ 890* e; p. 661-663, $ 894 1066 INDE Rhubarb—continued. 4; p.664-670, $ 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 A. Also, Dysentery, Index I. Roget, 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 determines, 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 effect of the voluntary act (and as seen also in voluntary and involuntary respira- tion and contraction ofthe 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, p. 890- 891,$ 1077. A1so,Mental Emotions, Index II; Will, Index I. and II. S. Saline Cathartics. See 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, $ 1067 ; p. 877, $ 1072 4—being exactly coincident with the flow of urine and sweat as occasioned by Fear, p. 630-632, $ 892£ 4, 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 X II. Salivary Glands—continued. reflex action ofthe nervous system p 335-336, $ 512 a, 4; p. 339-340, $' 514 A—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 4-424—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, Weeping, Parturition, Odors, Fear, Jeal- ousy, Kidney, Skin, Food, &c, In- dexII; Sudorifics, Index I. Sap, Circulation of, continued from In- dex I., chemical theory of, analogous to Lie- big's of the blood, p. 817-819, $ 1054. absorption,capillary attraction, and evap- oration inadequate causes, p. 817, $ 1054. the cause supposed to reside in the leaf, and of a chemical nature, p. 818, $ 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 ofthe circulation ofthe blood, p. 823, $ 1055. Also, p. 175-176, $ 350* n-q. ascribed by Professor Lindley wholly to vital action, p. 823, $ 1054. Scammony, its therapeutical and morbific effects, 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, $ 662 a; p. 615, $ 892* c; p 638-639, $ 892± g; p. 649, $ 893 ; p. 659, $ 893 g ; p. 684. $ 905* 4; p. 696-697, $ 926, 927 a. Scurvy, opinions of distinguished physicians as INDEX II. 1067 Scurvy—continued. 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 ofthe 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, p. 889-890, $ 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, $ 42 ; p. 219-227, $ 408- 411; p. 478-479, $ 740-741 ; p. 484, $ 748 ; p. 780, $ 1029 ; p. 783, $ 1031 4 ; p. 790, $ 1032 4; p. 791, $ 1032c; p. 800-801, $ 1035. 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, $ 412-417. _ 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 4; p. 107-110, $ 226-232 ; p. 193, $ 356 a ; p. 215, $ 395 ; p. 230-232, $ 422 4-424 ; p. 249, $ 441 c; p. 253, $ 441 d; p. 262-265, $ 446 a-447 a; p. 264-265, $ 446 d-447 4 ; p. 285-286, $ 455 d- 456 4; p. 289, $ 461 ; p. 310, $ 485 ; . p. 313-314, $ 488-489 ; p. 317, $ 493 a; p. 325-326, $ 500 ee ; p. 335-336, $512 a; p. 339, $514 A; p. 341-342, $ 514', 4; p. 344, $ 516 d, No. 6; p. 348, $ 516 d, No. 13; p. 350-351, $ 524, No. 1 ; p. 355, $ 526 a; p. 430- 433, $ 675, 676 a; p. 450-452, $ 691- 693 ; p. 478-479, $ 740-741 4; p. 483 -484, $ 746 c; p. 546-549, $ 862-863 ; p. 563, $ 889 a ; p. 565, $ 889 / g; p. 630-632, $ 8921 4, c; p. 634, $ 892| a, 4 ; p. 637, $ 892-| d; p. 662, $ 896 ; p. 666-672, $ 902 4-904 a; p. 704, $ 943 a, 4; p. 709, $ 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 ofthe 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 afundamental distinction drawn between what belongs to organic life and what is referable to its influences by the nervous system, p. 21, $ 22; p. 23-26, $ 37-48 ; p. 27-28, $ 52-53 ; 1068 INDEX II. Secretion and Excretion—continued. p. 30, $ 58 ; p. 193, $ 356 a; p. 220- 227, $ 409 4-411 ; p. 230-232, $ 422 4-424; p. 262-263, $ 446 a; p. 289, $ 461 ; p. 313-315, $ 488-489 ; p. 317 -318, $ 493 ; p. 335-336, $ 512 a, 4 ; p. 355, $ 526 a; p. 483-484, $ 746 c ; p. 547-548, $ 863 d; p. 563-564, $ 889 a; p. 630-632, $ 892| 4, c; p. 668-669, $ 902 g; p. 704, $ 943 a; p. 804-805,$ 1040; p. 866-867, $ 1067 a. Also, " Strainage," Index II by now taking in connexion what the Author has said under the sections in the two preceding subdivisions ofthe 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, however, for brevity's sake, has sim- ply employed the word Sympathy), 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, $ 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, turnins to the example ofthe 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, Index II, p. 1029, subdivision upon Animal Heat. 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 London Philosophical Transactions for 1815 and 1817, and to which there are summary references at p. 314- 315, $ 489 ; p. 317-318, $ 493 a-d— Secretion and Excretion—continued. and, therefore, long antecedently to the suggestions upon the same sub- ject by Henle, Donders, Ludwig, &c., while, also, Bichat had arrived at the same opinion without the aid of ex- periment, p. 270, $ 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,$ 691, 692 ; p. 471, $ 732 4 ; p. 473-474, $ 733 e; p. 546-551, $ 862-864; p. 637,$ 892| d; p. 639, $ 892| g; p. 647, $ 893/ Also, Sweat, Pus, Index n. 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, $ 1057 a-f; p. 838, $ 1057*. Also, p. 664, $ 900 ; p. 681 -683, $ 905 4. 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* A ; p. 300-301, $ 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, $ 891* k; p. 671-672, $ 904 a, b; p. 704, $ 943 a, 4; p. 706, $ 946; p. 831-832, $ . 1057/; p. 838, $ 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, $ 1057*. Also, Sympathy, Contigu- ous ; Counter-Irritants, Plasters, &c, Index II other examples ofthe external applica- INDEX II. 1069 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 4-dd ; p. 525-526, $ 828 4, c; p. 672-674, $ 904 4. may act as such only in special condi- tions of disease, p. 829-830, $ 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 e. 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,$ 817; p. 523, $ 827; p. 584, $ 891 d ; p. 708, $ 950 ; p. 733, $ 874 4 ; p. 773-775, $ 1024 ; p. 829, $ 1057 a. Self-Limited Diseases. See Diseases, Self-Limited, Index 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 fallacies 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, $ 289-291 ; p. 167, No. 29 ; p. 168, No 31 ; p. 172-173, No. 44, 45 ; p. 175-176, $ 350^ n-p ; p- 177-178, $ 850f /; p- 238, $ 438 4, 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, $ 188 a, &c. ; p. 101- 102 $ 201-202 ; p. 282-283, $ 451 d-.f; p. 671, $ 903. some new observations as to its relation to the posterior roots of spinal nerves, p. 802, $ 1037 4. sympathetic and other modifications far- Ver distinguished ^ Brown-Se- quard's experiments, p. 802, $ 1037 4. Also, p. 216, $ 399 ; p. 313, $ 487 gg. Serous Tissue, treatment of its inflammations, p. 727, $ 960/; p. 750, $ 995 ; p. 756-758, $ 1005 4-A; 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, $ 494 4-dd; p. 348, $ 518 a, 4; p. 525-526, $ 828 a-d. Also, Hydrophobia, 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 thaijs ever concerned in the operation of remedial and morbific agents, p. 679- 681, $ 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 seen 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, $ 118* d; p. 107-111, $ 227-233?; p. 245,$ 440 e, No. 14; p. 324, $ 500 c; p. 327- 328, $ 500 j, k; p. 332, $ 501 c; p. 333, $ 503; p. 339-341, $ 514 g-m ; p. 631-632, $ 892f 4; p. 661-663, $ 894-896 ; p. 665-670, $ 901-902 ; p. 1070 INDEX II. Shame—continued. 679-681, $ 905 a ; p. 704, $ 943 a, 4 ; p. 706-707, $ 947 ; p. 709, $ 951 4-d ; p. 879-882, $ 1074-1075; p. 891, $ 1077; p. 901, $ 1078 /. Also, Re- medial Action, Mental Emotions, Joy and Anger, Fear, 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 t 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 4-151. Skin, Cold, Ex- ercise, Friction, Amenorrhcea, In- dex II. Sigmond, his observations upon certain special ef- fects of Narcotics, p. 673, 674, $ 904 4. Also, Opium, Sedatives (Aconite), 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, $ 890 to ; 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 nervous action, p. 530, $ 873 e; p. 533, $ 842 ; p. 577, $ 890 o. Simon, his vital exposition of fibrin, p. 800, $ 1035. Also, Muller's and Hunt- er's, p. 24, $ 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- in—continued. flex action ofthe 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 by 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, and the not less insoluble chloride 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 system 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, $ 148 ; p. 107-112, $ 227-234 ; p. 230-232, $ 422-427 ; p. 245, $ 440 e; p. 253, $ 441 d; p. 308-310, $ 484- 485 ; p. 312, $ 487 g; p. 319-320, $ INDEX II. 1071 Skin—continued. 494 4-dd; p. 321, $497; p. 323-324, $ 499-500 c; p. 327, $ 500 i; p. 331 -332, $ 500 o-50l c, p. 333, $ 503; p. 335-336, $ 512; p.338, $ 514 d; p 339-341, $ 514 g-m; p. 343, $ 516 d, No. 4 ; p. 346, $ 516 d, 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, $ 527 a-d; p. 416-417, $ 649 c, d; p. 421 -423, $ 657-658 ; p. 424, $ 662 a ; p. 430, $ 674 d; p. 468, $ 722 4 ; p. 520 -521, $ 826 d; p. 523-524, $ 827 c-e ; p. 525-527, $ 828 a-d; p. 532, $ 841 ; p 592-593, $ 891* k; p 631-632, $ 892| 4, c; p. 634, $ 8924 4; p. 661- 663, $ 894-896 ; p. 665-676, $ 902- 904; p. 679-681, $ 905 a; p. 705, $ 945; p.803, $ 1038 ; p. 832, $ 1057 g; p. 838, $ 1057* ; p. 880, $ 1074. p. 642-643 $ 893 a, Sympathy, 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, $ 350* n-p ; p. 306-310, $ 483 4-484 ; p. 474-475, $ 733 f-i; p 520, $ 826 4-d ; p. 522-523, $ 827 4, c ; p. 530-531, $ 837 4-cc ; p. 827. $ 1055. . 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 ofthe nerv- ous system than other parts, p 61- 62, $ 133-136 , p. 415-416, $ 649 4; p. 695, $ 924, also Amenorrhea, Leeching, Index II—which reflects light upon Brown-Sequard's observa- tions upon epileptiform convulsions, as produced by irritation of particular parts ofthe skin, p. 802, $ 1037 a. its eruptive diseases often occasioned by a morbific reflex action ofthe 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 i, m ; p. 673, $ 904 4, 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 ofthe 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- 1072 INDEX II. Skin—continued. tion, p. 359, $ 527 a, 4. 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, In- dex II; p. 59, $ 129 A; 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, $ 527 4; p. 360, $ 527 d; p. 364, $ 545; p. 368-369, $ 559-563 ; p. 416^117, $ 649 c, 650; p. 420- 423, $ 654-660; p. 426, $ 666 ; p 429-430, $ 674 d; p. 465, $ 714; p. 522-523, $ 827 4, d ; p. 539, $ 847 A- 848 ; p. 546, $ 862 ; p. 553, $ 870 aa; p. 670-671, $ 902 m; p. 862-864, $ 1066. Also, Hydrophobia, Virus of; Serpents, Virus of ; Predispo- sition, Miasm, Whooping-Cough, Phthisis, Index II. chemical theory of, p. 172, $ 350, No. 45. essentially the same as the Vaccine dis- ease—extinguishes the susceptibility ofthe 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, $ 954 ; p. 419-420, $ 653 ; p. 421, $ 654 4 ; p. 425, $ 664 : p. 488, $ 756 a ; p. 544-546, $ 858, 861. Also, Diseases, Self-Limited ; Acclimation, Miasm, Contagion, In- dex II. 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, $ 858 ; p. 553, $ 870 aa; p. 665, $ 901 ; p. 722-724, $ 960 A ; p. 730, $ 969 a ; p. 732, $ 970 c; p. 733-734, $ 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, $ 652 4 ; p. 544-545, $ 858 ; p. 553, $ 870 aa. Also, p. 420, $ 654 a ; p. 424- 425, $ 662-663 ; p. 438-442, $ 686 ; p. 489, $ 756 4; p. 509, $ 811 ; p. 510, $814; p. 511, $816 d; p. 538, $ 848; p. 559-560, $ 883 4 ; p.723- 724, $ 960 4-961. 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 l,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 physi.ological demonstration of, and dis- tinguished from each other, p. 873- 911,$ 1069-1083. the premises, relative to the nervous system, p. 873-874, $ 1071. mechanism and phenomena of reflex nervous action as forming the basis of demonstration, p. 873-877, $ 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. 1073 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 4. Also, Mental Emotions, Remedial Ac- tion, subdivision Mental Emotions, Mind, Index II; Will, Index I. and II. office ofthe nervous influence in the demonstration—unimportant by what name called, or what its nature, or what the theory of its operation, p. 898, $ 1073 a; p. 880-881, $ 1075 a. Also, p. 117, $ 234 g; p. 330, $ 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 4; p. 892, $ 1078 a, also, p. 281, $ 450 c—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 between 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 4. the Soul in a perfect state in Infancy, p. 905, $ 1078 q—but its manifesta- tions may fail with the development ofthe brain, p. 906, $ 1078 a. 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 a; P 903-906,$ 1078 q. excessive exercise of Reason contrasted with the early discipline of Instinct, p. 894, $ 1078 4. 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, $ 1078 d; p. 898,$ 1078/; p. 903-906,$ 1078 a. 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, $ 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, $ 1078 4 ; p. 904, $ 1078 a—essentially subservient to organic life, p 896-897, $ 1078 e; p. 898, $ 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, $ 1078 e—its sagacity, p. 889- 890, $ 1078 g, A—philosophy of its "tricks" and imitations, p. 895, $ 1078 4—its acts often totally unlike those of reason, but precise, habitufil, 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-1080 —supplies a problem in a suppositi- tious case, p 897, $ 1078 c—most de- veloped in inferior animals, p. 896, $ 1078 d; p. 898, $ 1078/; p. 903, $ 1078 q—its full development in the infancy of animals contrasted with its condition in 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; v. 903-906, $ 1078 q. the Instinctive Principle holds a relation YY Y 1074 INDEX II. Soul, Sao,.—continued. to the bram or its equivalent and other organs corresponding with the anal- ogies which subsist among them and the products of the latter, p. 904-905, $ 1078 q—nor is there any good rea- son to suppose that the main central part ofthe 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 ofthe 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, $ 1078 k. the nature of Ideas, and how far they are related in man and animals, p. 906, $ 1078 r. fear distinguished between man and an- imals, p. 898-899, $ 1078 g; p. 901, $ 1078 /—displays of memory con- trasted, p. 901, $ 1078 o—and what of conscience, love of fame, Religious sentiment, p. 901, $ 1078 l-n. remarkable adaptations of Instinct to metamorphoses, 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. chemico-spiritual hypothesis, and objec- tions, p. 882-884, $ 1076 4. hypothesis of secretion as to Soul, and objections, p. 884-886, $ 1076 c. an argument of materialism considered, p. 894, $ 1078 a, note. the substantive existence of the Soul 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. Spallanzani, his experiments upon eviscerated frogs employed to show the independence of animal heat of chemical laws, p. 255, $441/ 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 ofthe physiological laws ofthe nerv- ous system to Pathology and Thera- peutics, and his demonstration ofthe 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, $ 494 dd; p. 331, $ 500 o ; p. 356-358, $ 526 d ; p. 590-593, $ 891* ; p 874-877,$ 1072 ; p.879- 881, $ 1075 a, 4. Also, Convulsions, Hysteria, Antispasmodics, Index II Specifics, no remedies are properly such, and in what light reputed specifics should be regarded, p. 597-598. $ 892 c; p. 600, $ 892 d; p. 605, $ 892 m ; p. 611-612, $ 892i A; p. 626-627, $ 892f-Z; p 677-678, $ 904 d, Also, Cinchona, Index II Sphincter Muscles employed to illustrate the slowly pro- gressive operation of remedies and morbific causes through an uninter- rupted alterative influence of reflex action ofthe nervous system, p. Ill, $ 233* ; p. 338-339, $ 514 /, g ; p. 344-345, $ 516 d, No. 6 ; p. 670, $ 902 k; p. 679-681, $ 905 a Also, Alteratives ; Antimony, Tartar- ized ; Hydrophobia, Virus of ; Pre- disposition, Miasm, Index II. although entirely dependent for their contraction, so far as respects the requisite stimulus, upon reflex action of the spinal cord after independent life begins, yet, if observation maybe trusted, it would seem to be otherwise in the foetus of malformation, and em- ployed as an incidental proof that the action of parts is carried on essen- tially, as in Plants, by inherent prop- erties, p. 284-289. $ 455 a-461* a ; p 745-747, $ 990*—which leads the Author to add, that he was not long in reaching the conviction that the statement relative to the foetus at p. 127-128, $ 264; p. 289, $ 461* a, involves a contradiction of Nature that invalidates the accuracy of the able observer in respect to the entire absence of the nervous system, and accordingly, in making out his first INDEX II. 1075 Sphincter Muscles—continued. Index he introduced, under the Arti- cle Nerves, the remark, "mostly im- portant to the sphincter muscles in the life ofthe fcetus, p. 339, $ 514/ g"—though it cannot be doubted that there was an entire absence of the spinal cord, and that the nervous in- fluence for the sphincter ani was de- rived from some part of the gangli- onic system, p. 287-289, $ 458-461. Spinal Cord—-continued from Index I, late discoveries relative to its struc- ture and functions, p. 802 - 803, $ 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, $ 476-494. Also, Reflex Ac- tion, Mental Emotions, the individ- ual Passions. Index II; Will, Index I. and 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, $ 8924 f,g- Stethosco pe, some of its contributions to Pathology, p. 640, $ 892| A. 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 ofthe nervous system p. 287-289, $ 459 c-g; p. 319, $ 494 Stimulants. See Tonics, Index II Stomach and Intestine, continued fiom Index I. See, also, Digestion, Index havhi'g 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 tire many in which the Author en- deavor"7 to show that all remedies faken internally exert their primary as issue and upon all other parts through alterative influences of reflex 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, $399; p. 229,$419 c; p. 289, $461, p. 335-336, $ 512-513 ; p. 417, $ 649 c ; p. 430, $ 674 d ; p. 563-565, $ 889 a-g; p. 668-669, $ 889 m, mm; p. 667-669, $ 902 e-g; p. 896-897, $ 1078 e—and considering with this the exquisite susceptibility of the gastro- intestinal mucous tissue in its sympa- thetic sensibility (scarcely inferior to that ofthe 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 ofthe tissue, as seen in the move- ments ofthe muscular coat, in the con- traction of the sphincter ani, in the act of swallowing (p. 338-339, $ 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 ofthe kid- ney, by offensive odours, disgusting sights, and by their recollections, and as constitutionally displayed in infan- cy (p. 250-251, $ 441 c; p. 327, $ 500 i-k; p. 336-338, $ 514 a-c; p. 339-340, $ 514 A; p. 355-356, $ 512 a, b; p. 374, $ 576, d; p. 579-580, $ 890* d; p. 590-591, $ 891* 4; p. 592-593, $ 891* k; p. 666-669, $ 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, 1076 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 ofthe 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 ofthe 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, $230; p. 114, $ 234 e; p. 296, $ 476 c; p. 297-299, $ 476* c-477 a; p. 300-301, $ 479-480; p: 304, $ 481 g; p. 307- 308, $ 483 c ; p. 319, $ 494 4 ; p. 334 -335, $ 509-511 ; p. 402-403, $ 634, 635; p. 525-528, $ 828 a-d; p. 670, $ 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 ofthe 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, $ 58 ; " Strainage"—con^?tued. p. 34-36, $ 62 a-i; p. 62-64, $ 135_ 138; p. 111. $233? , p. 128, $226- p. 193, $ 356 a ; p. 216, $ 399 p' 219-227, $ 407-411 ; p 318, $ 493 d ; p. 484, $ 748 ; p 783, $ 1031 4 ; 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 Structure — continued from Index 1.; also, Tissues, Index I.; Mucous Tis- sue, Index 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, m com- pound organs, has its own organic functions, p. 61, $ 132 structure of general body radiated and symmetrical, p. 53, $ 93-95 general division of organs and functions of animal life and of organic life, and their designations a: d uses, p 53-54, $ 96-106; p. 125, $ 248-250—those of organic life quite analogous in low- est plants and animals, p. 54, $ 107 ; p. 474, $ 733/—no organ of animal life necessary, p. 54, $ 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 organs are subordinate, p. 54, $ 109 4; p. 227, $411 ; p. 804, $ 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, $ 118-123 ; 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, $ 7-60; p 50-52, $ 83 c-84—and so allowed by Chemists who endeavoured to prove it otherwise, ibid., p. 189-190, $ 350| «, &c.—the pursuit now virtually dis- missed from the Laboratory, p. 779- 782, $ 1028-1030—though reluctant- INDEX II. 1077 Structure—continued. ly, p. 796-799, $ 1034. Also, Com- position, Organic Compounds,Vital Properties, Organic Life, Chemis- try, Organic Chemistry, Index 1. the same contradistinction shown by the incorporation of Nitrogen, p. 33-36, $ 61-62—and by the developmental his- tory of the Ovum, p. 36-49, $ 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 4. 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, $ 2 c ; p. 50-51, $ 83 c; p. 59, $ 130, 131 ; p. 86-87, $ 176, 177 ; p. 218, $ 406 ; p. 353, $ 525 a ; p. 354, $ 526 a; p. 801, $ 1036 — with analogies, also, ibid., and p. 223,$ 409 e — 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 4; p. 52, $ 85, 89 ; p. 61-70, $ 133-160 ; p. 73, $ 163; p. 82-83 $ 172, 173 ; p. 88, $ 185 ; p. 98, $ 191 a, 4 ; p. 138, $ 303* ; p. 140-141, $ 306, 307; p. 218, $ 406 ; p. 229- 230, $ 419 c-422 4 ; p. 353, $ 525 a; p 354, 526 a; p. 373-380, $ 576- 578; p. 473, $733 4; p. 480 $741 c- p. 522-523, $ 827 4, c; p. 671,$ 904 4; p. 815-816, $ 1052 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 4. mistakes in practice from not regarding Structure—continued. the foregoing modifications of vital endowments iri 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 4, and refer- ences ; p. 535-539, $ 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 ofthe 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 1078 INDEX II. Structure—continued. their relative functions, p. 57—anoth- er, of their secreted products, p. 218, $ 406. 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, $ 133-134; p. 63, $ 137 4, c; p. 64-65, $ 138-143; p. 67, $ 149-151 ; p. 467, $ 718, &c. upon the peculiarities in the special vital endowments of each tissue depends greatly- the character of disease and the effects of remedies and of morbific causes, as exerted through reflex nerv- ous action, p. 61-63, $ 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, $ 172; p. 87, $ 177, 182 4; p 414, $ 642 4; p. 665, $ 901. Also, Gestation, Lactation, Index II; Youth, Index I. and 11. 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 ofthe most important laws in medicine, p. 61-62, $ 133-134, 137 a-e; p. 63, $ 137 d ; p. 64, $ 138 ; p. 65, $ 143 ; p 67, $ 149-151 ; p. 73, $ 163—and so of morbific causes, ibid.—which presents a problem for Organic Chem- istry, p. 63-64, $ 137 e; p. 652-656, $ 893 n, &c.; p. 674, $ 904 4. 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, $ 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 4-d, 148 ; p. 367, $ 557; p. 464, $ 712 ; p. 465-466, $ 715 ; p. 535-539, $ 847-850 ; p. 664, $ 900 ; p. 713, $ 956 ; p. 731-732, $ 907 c, also, Remedies, Fever, In- flammation, Predisposition, 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 ofthe 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, $ 110-116 ; p 63, $ 137 e; p. 110, $ 232; p. 284-286 ; p. 290-295, $ 462-475 ; p. 326, $ 500 g ; p. 330, $ 500 n; p. 474-475, $ 733 f-i—from which arises a general coincidence in the patholog- ical as well as physiological condition ofthe whole, and renders them equal- ly amenable to remedies ; but altera- tive reflex nervous influence not equally reciprocal, p. 55, $ 117; p. 63, $ 137 e ; 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, $ 454-461* ; p. 295-335, $ 476-511 ; p. 335-362, $ 512-530. Also, Men- tal Emotions, Index 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. 1079 Structure—continued. Causes,Morbific; Remedies,Blood- letting, Index II the sympathetic 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, $ 149-151 ; p. 73, $ 163; p 107-110, $226-232; p. 110, $ 232 ; p 286. $ 456 4 ; p. 332, $ 501 c ; p. 661-663, $ 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 icfcr- ences there; p. 661-6G3, $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, $ 117; p. 59, $ 129 A; p 64- 65, $ 140-143 c; p. 107-108, $ 227 ; p. 332, $ 501; p. 339-340, $ 514 A, p 359-360, $ 527: p 361, $ 529 A; 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 ofthe 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, $233i; p. 319, $494, 4, dd; p. 334, $ 509 ; p 338, $ 514 d; p 525- 527, $ 828 a-d ; p 590, $ 891* 4; p 592-593. $ 891* k; p. 671-674, $ 904 a, b. Also, Convulsions, Opi- um, Remedial Action, Hydrocyanic Acid. Antispasmodics, Coffee, In- dex II Sudorifics. See Index 1. Also, Sweat, Skin, Antimony, Tartarized ; Wa- ter, Hot, Index II SThencAeTriv'ed, P-784-793, $1031 4- 1033. , , sugar of milk, a product of the mam- mary gland, and has no existence in Sugar, Animal—continued. the general mass of blood, p. 785, $ 1031 4; p. 789-790, $ 1032 4. does it pre-exist in any part of the cir- culation, and is it a product of the liver^ p. 783-793, $ 1031 4-1033. vegetable food not necessary to its pro- duction, p 785, $ 1031.4. diabetic, formed by kidney, p. 789, $ 1032 4—restricted to diabetes, p. 786, $ 1031 4—found in urine after pricking medulla oblongata, p. 792, $4032 d. saccharine matter not absorbed by lac- teals, p 788, 789, $ 1032 4. methods of searching for, p. 794, $ 1033 a. Sulphuric Acid, introduced as one ofthe 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 ofthe nervous system, p. 530, $ 837 c ; p. 533, $ 842 ; p. 577, $ 890 o. Also, Lead, Ace- tate of ; Silver, Nitrate of ; Opi- um. Cold, Ipecacuanha, Index II Sulphuric Ethfr, and other Anaes- 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, $ 827 4-d; p. 862-864, $ 1066, p. 671, $ 904 4. Also, p. 101-102, $ 201-202; p. 282-283, $ 451 d-j ; and Structure, Anaes- 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 agent, and give rise to a corre- sponding modification of the nervous influence, p. 666. $ 902 4; p. 673- 675, $ 904 4. Also, p. 107-109, $ 226-229 , p. 661-663, $ 894-896 ; and Oil,Croton ; Leeching, Heat; 1080 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 4-733 Also, p. 546-547, $ 862-863; and Mucus, Pus, Lymph, Inflammation, Index 11. 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 in 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, $ 514/ g. Also, Reflex Action, Mental Emotions, Respira- tion, Sphincter Muscles, Soul and Instinctive Principle, Index 11.; Will, Index I and II Sweat—continued from Index I. See, also, Sudorifics, Index I, an unimportant evacuation, abstractly considered, and not a reliable 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 the essential service, and very little so the evacuation, as may be readily seen in the differences 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. m $ 2331 ; p.230-232, $ 422 4-424; p 250-251, $ 441 c; p. 335-336, $ 512 a, b; p 338, $ 514 d; p. 339, $ 514 A; p.350-351, $ 524; p 355, $ 526 a; p. 451452, $ 692 a; p. 546-550, $ 862-863 f; p. 550, $ 863 d; p. 592 -593, $ 891* k ; p. 631-632, $ 892 J ; p. 634, $ 892A a, b; p. 661-664, $ 894 -900; p 665-669, $ 902 a-i ; p- 678, $ 904 d; p. 704, $943 a. Also, Secre- tion and Excretion, Skin, Struc- ture, Hybernating Animals, Rem- edies ; Antimony, Tartarized, Index II; Nervous Power, Index I. and 11. 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, $ 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 ofthe 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 ofthe 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, $ 454-461. On the different Orders of Nerves, p. 290-292, $ 462-470. Laws of Action of Motor Nerves of the Cerebrc-Spinal System, p. 292, $471. Laws of Action of Sensitive Nerves of the Cerebro-Spinal System, p. 292, $ 472; p. 802-803, $ 1037 4. On the Spinal Cord, p. 292-295, $ 473-475 , p. 802-803, $ 1037 4. 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, $ 1041. INDEX II. 1081 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. 3d. 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. ith. 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, $ 490. 6rA. 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, $ 492^94. on the Varieties or Kinds of Sympathy, and applied to Pathology and Thera- peutics, p. 321-335, $ 495-511. the Laws of Sympathy, or Reflex Ac- tion of the Nervous System, and their Application to Pathology and Thera- peutics, p. 335-362, $ 512-530. , 1st. 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, $ 514* a-515. 3d. Of the Action of the Sympathetic Nerve in Involuntary Motions, p. 342-349, $ 516-521. ith. Laws of the Sensitive Fibres of the Sympathetic Nerve, p. 350, $ 523 5th. Laws of the Organic Functions of the Sympathetic Nerve, p. 350- 353, $ 524. ofthe Sympathies ofthe Individual Tis- 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, v. 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 ofthe 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 Muller 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 ofthe iris at p. 673-674, $ 904 4, and of the sciatic nerve at p. 838, $ 1057*—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 ofthe 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, $ 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, $ 524 d, Nos. 4-7; p. 649-651, $ 893 i; p. 803, $ 1038 ; p. 838, $ 1057*, and p. 642-643, $893 a. 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 1082 INDEX II. Sympathy, Continuous—continued. incorporation ofthe nerves in all ani- mal tissues (p. 483-484, $ 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 ofthe 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, $ 141 4 ; p. 66-67, $ 148 ; p. 209-210, $ 387; p. 321, $ 494 e; p. 322-323, $ 498 ; p. 343, $ 516 d; p. 350, $ 523, Nos. 6, 7; p. 351, $ 524 a, No. 2 ; p. 355-356, $ 526 4, c ; p. 465-466, $ 715; p. 475, $ 733 A; p. 483-484, $ 746 c; p. 506, $ 803, 804 ; p. 524, $ 827 e; p. 526, $ 828 d; p. 563-564, $ 889 a; p. 694-695, $ 923. Also, Oil, Croton ; Leech- ing, Suppositories, Heat, Circula- tion of the Blood, Index II ; Ve- nous Tissue, Venous Congestion, Index 1. 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; 5th, of a physical nature depending on changes of structure, accumulated flu- ids, &c.—the first three being primary, the last two secondary, p. 435, $ 681 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 4; p. 545, $ 859 4; p. 561, $ 886. owing to the instability of the proper- ties of Life, see Vital Properties, In- 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 difficulties in Medicine their uses and abuse, practically consid- ered, p. 370-372, $ 569; p. 428-434, $ 673-676 ; p. 430-433, $ 675; p 436, $ 682 a, b; p. 447-448, $ 668; p 456-460, $ 699-708 ; p. 489, $ 756 4; 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, $ 891* a-f; p. 626-627, $ 892f /; p. 636-641, $ 892| d-i; p. 724-725, $ 961 a, 4; 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, $ 163 ; p. 464, $ 713 ; p. 570-576, $ 890 a-n; p. 579, $ 890* a; p. 584, $ 891 d; p. 587- 588, $ 891 k; p. 589, $ 891 n ; p. 590 -591, $ 891* A-/,- p. 599, $ 892 d; p 626-627, $ 892| I; p. 628^629, $ 892f r; p. 630, $ 892| 4; p. 633-634, $ 892| a; p. 637-640, $ 892| e-g; p. 684-688, $ 905* 4, c. diagnostic, and how far reliable, p. 436- 437, $ 682—prognostic, p. 437, $ 683 —other special ones—pulse, p. 443- 448, $ 687*-688—relative to tongue, p. 448-450, $ 689—secretions and ex- cretions, p. 450-455, $ 690-694*. 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, $ 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, $ 173 ; p. 73, $ 163 ; p. 428, $ 874 a : p. 437-442, $ 684-686 ; p. 456-460, $ 695-708 ; p. 479-480, $ 741 a, b; p. 541-542, $ 854 44; p. 548-550, $ 863 d; p. 551-554, $ 867-871; p. 572 INDEX II. 1083 Symptoms, Morbid—continued. -576, $ 890 d-n; p. 587, $ 891 k; p. 636-642, $ 892| d-i; p. 663-665, $ | 897-901 ; p. 685-686, $ 905* 4; p. 759, $1005;. 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 laws 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, ofthe 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, $ j 687-689 Also, Pulse, Tongue, Ski w ' 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 thino-s 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-; ;ope—continued. 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- (ncas of direct and reflex action ofthe 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 when, 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, $ 951 c, d. Also, p. 107 -111,$ 227-233J; p. 113-114, $ 234 d; p. 312, $ 487 g; p. 326-328, $ 500 g-m; p. 331, $ 500 o; p. 333, $ 503; p. 338, $ 514 d; p. 661-663, $ 894 4-896 ; 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, in Medical and Physiological Commentaries, vol. i., p. 178, note, 1840. T. 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 are 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 ofthe 1084 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, $ 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 beyond the se.at of their direct operation 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 4; p. 413,$ 639 a ; p. 541, $ 852. simple in principle, complex in details, p. 541,$ 852 4-853. remedies of positive virtues are morbific in action, and therefore operate upon the same principle as the remote causes of disease—the difference 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, $ 503-506 ; p. 417- 418, $ 650 , p. 430-432, $ 675 ; p. 541-543, $ 854 a-c, p. 544, $ 857; p. 547-549, $ 863 d; p. 551-553, $ 867-870; p.554-556, $ 872 ; p.644- 6£~. $ 893 4-c; p. 636-640, $ 892| c-A ; p. 643-652, $ 893 b-m ; p. 669^ $ 902 i; p. 675-676, $ 904 4; 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 4—the cure being therefore es- Therapeutics—continued. sentially the work of Nature, p. 65- 66, $ 143 c,d; p. 67-68, $ 149-152- p. 87,$ 177-182; p. 122, $ 239; p 542-543, $ 854 e, 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 A, and by the system of " watching," p. f.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 11.; Adaptation, Law of, In- dex I. 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, $ 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 ofthe dis- ease, &c, p. 27, $ 52 ; p. 479-480, $ 741 4; p. 544, $ 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, $ 149-151 ; p. 73, $ 163; p. 87, $177-182; p. 426, $666; p. 428, $ 672 ; p. 430-433, $ 675-676 ; p. 473-474, $ 733 c; p. 479-480, $ 741 4; p. 543-544, $ 857; p. 548- 549,$ 863 d; p. 553, $ 870 aa; p. 554, $ 871 ; p. 561-562,$ 888 a-d; p. 566-570, $ 889 k-n; p. 595-596,$ 892 aa ; p. 597-600, $ 892 c; p. 608, INDE 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, $ 960 ; p. 728, $ 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, $ 143 ; p. 67-69, $ 149- 156; p. 531, $ 838; p. 535-539, $ 847-850 ; p. 542-545, $ 854 /-858. Also, Adaptation, Law 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 4; p. 545, $ 859 4; p. 551, 6 865, 866 ; p. 561, $ 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 4-970. 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, $ 874 ; p. 587, $ 891 k; p. 590, $ 891 r, and the same by the delirium of drunkenness, p. 590, $ 891 r; p. 734, $ 976 4—all the variety in effects being due to dif- ferent modifications ofthe nervous in- fluence as brought into preternatural action by the several causes respect- ively. See Reflex Action, Mental Emotion?, the • Individual Passions, Index li- the curative effects of remedies upon the • seat of their direct operation, particu- larly in morbid states ofthe 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 ofthe same and more complex nature are involved in the salutary effects of exercise, change of air, &c, in dyspcpsy, whooping- x ii. 1085 I 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 are 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, Index 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 the morbific and curative effects being, that the reflex action ofthe 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 ofthe 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 dyspeptic 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 4-d ; p.360 -361, $528,529 4; p. 421-422, $ 657; 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 g; p. 856-862, $ 1063- 1065. Also, Cantharides,Counter- 1086 INDEX II. Therapeutics—continued. 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 4, c; p. 232-234, $ 425-428 ; p. 352, $ 524 c; p. 430-432, $ 675; p. 450- 452, $ 691-693; p. 471-476, $ 732- 733 ; p. 633-634, $ 832| a ; p. 635- 640, $ 892-| A. Also, Sudorifics, Index I. ; Antimony, Tartarized ; Diuretics, Index II. emaciation curative, p. 551, $ 863 A; p. 597, $ 892 c. Also, Remedies (Food), Index II. simplicity of treatment, a ruling princi- ple, p. 553, $ 870 4; p. 593, $ 892 a, motto. the active and expectant plans of treat- ment, p. 557-559, $ 875-882 —and the rational and empirical, p. 559- 562, $ 883-888 4. 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 ofthe disease, p. 562, $ 888 c. Thirst, its earliest deleterious influences are ex- erted through reflex and direct action ofthe nervous system, the centripetal source being 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 11. Thoracic Duct, and Absorbents, circulation in, depends upon suction power of the heart, and upon their own action, and upon that ofthe cap- illaries, p. 211, $ 389, 390 a. Also, Thoracic Duct, &c.—continued. Circulation of the Blood, Index II. Thunder, physiology of its effects in producing disease through alterative influence ofthe nervous system determined in a direct manner, p. 631-632, $ 892J 4, and references there; p. 886-887, $ 1067 a. Also, Reflex Action, Mental Emotions, Disgust, Index II. Tissues. See Structure, Index II; 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 ofthe paroxysm, and the coincidence in habit between the ultimate failure of chewing and smoking to affect the mouth, and snuffing 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 ofthe nervous system, and present a com- prehensive ground of analogy for sus- taining our interpretation of the mo- dus operandi of Anaesthetics, and its direct affinities 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 ofthe mouth and nose, &c, p. 61, $ 133, a, b; p. 62-63, $ 136-137 c; p. 67-68, $ 149-152; p. 107-110, $ 227-232; p. 323-328, $ 500 a-l; p. 333, $ 503-505 ; p. 338-341, $ 514 d-m; p. 347-348, $ 516 d, No. 13 ; p. 364, $ 543 ; p. 522-524, $ 827 b-e; INDEX II. 1087 Tobacco—continued. p. 527, $ 829 ; p. 661-663, $ 894- 896 ; p. 665-670, $ 902 a-m; p. 672- 676, $ 904 4; 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, Anaesthetics, Narcot- ics (Aconite), Opium, Suppositories, Antispasmodics, Sneezing, Disgust, Index II Tolerance of Remedies, illustrated under the law of vital habit. See Habit, 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 ofthe 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, $ 689. Also, Pulse, Sweat, Kidney, Urine, Heart, Structure, Index II Tonics ind Diffusible Stimulants, the counterparts of Antiphlogistics, p. 579, $ 890* a—and comparatively ol very limited importance, ibid. have been extensively injurious, from erroneous hypotheses of disease and of their modus operand, p^ 579 $ 890* a-c. Also, p- 371-372, $ 5by L?P 395-396, $621 a; p 433- 434 $676 4; p 541-542, $854 44; p. 572-576, $ 890 d-n ; p- 596, $ 892 Tonics, &c.—continued. 4 ; p.599-600, $ 892 d ; p. 715-722, $ 959-960 e; p. 748-749, $ 992 4; p. 752, $ 1000-1001 4 ; p. 756-766, $ 1005-1008; p. 772-776, $ 1020- 1026 ; p. 854, $ 1061 ; p. 857-861, $ 1063-1065 ; p.868-869, $ 1068 a 4. 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* d-A. 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, $ 889 d-k; p. 661-663, $ 894-896; p. 679-681, $ 905 a; p. 835-838, $ 1057*, and Remedies, Remedial Ac- tion ; Causes, Morbific ; Cinchona, Index II. 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 affinities 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, $ 900. Also, Remedies, Remedial Action, Cathartics, Index II. the only conditions under which they are applicable, p. 580-581, $ 890* e,f 1088 INDEX II. Tonics, &c.—continued. may be united with direct antiphlogis- tics, and why, p. 581, $ 890* e. Also, p. 487-489, $ 756; p. 561, $ 888 4; p. 727-728, $ 964 a, b. their occasional success in removing in- flammations is no proof of the accu- racy ofthe 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 at large, p. 581-582, $890* g. Also, p. 63, $ 137 d; p. 65, $ 143 c,d; p. 67, $ 149-151 ; p. 367, $ 556 c; p. 566-567, $ 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, Index II. Ulcers upon the extremities improved by open air through complex influences of re- flex action ofthe nervous system, and the influences traced out, p. 662-663, $ 896 ; p. 670-671, $ 902 m. Also, Skin, Phthisis, Whooping-Couch, Exercise, Friction, Index II. Uraemia. See Urea Diathesis, Index II. Ukea—continued from Index I, an artificial, not a natural product, p. 784, $ 1031 4; 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. Up.inary 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- J 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, $ 233| ; p. 230-231, $ 422 4; p. 347-348, $ 516 d, No. 13 ; p. 630-631, $ 892| 4; 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 I, analyses of, not reliable, and rarely of any importance, p. 228, $ 417 ; p. 232, $425-427; p. 450-451, $ 691; p. 780, $ 1029 ; p. 848, $ 1058 s— but divert attention from the patholo- gy of disease, and lead to imaginary evils, ibid., and p. 633, $ 8921/ 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-t. Also, " Strainage," Reflex Action, Fear, Index II the foregoing manifest exemplifications ofthe influence ofthe 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 ofthe Author's de- monstration ofthe 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. 1089 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, $ 422-424 ; p. 249, $ 441 c ; p. 253, $ 441 d; p. 262-263, $ 446 a; p. 264-265, $ 446 c, d; p. 289, $ 461; p. 313-314, $ 488 ; p. 317, $ 498 a; p. 325-326, $ 500, ee; p. 335-336, $ 512 a, 4; p. 338, $ 514 d; p. 339-340, $ 514 A; p. 347-348, $ 516 d. No. 13; p. 351, $ 524, No. 1 ; p. 352, $ 524 d; p. 450 -451, $ 691-692 a; p. 453, $ 694 4 ; p. 478, $ 740 a; p. 546-549, $ 863 a-d; p. 563-564, $ 889 a; p. 631- 632, $ 892} 4, c; p. 637,$ 892|d; p. 662-663, $ 896 ; p. 666-669, $ 902 c-i; p. 704, $ 943 a, 4 ; 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 svmptom truly originates, p. 232-233, $ 426, 427; p- 450-451, $ 691; p. 630-633, $ 892f. Also, Pulse, Tongue, Skin, Heart, 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, 4. 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, ^ 892^ ; p. 684-686, $ 905* 4. Also, Emmena- gogues, Amenorrhcea, Index II; Menstruation, Index I. T Jterus susceptible in its mucous tissue 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 4-d; p. 65, $ 143 c; p. 67, $ 149-151; p. Ill, $ 233|; p. 234, $ 429, 430; p. 624, $ 892* d; p. 628-629, $ 892| q-t; p. 684-686, v 90^ *• Als0' 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 emmenagogue, 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 A, i; p 61, $ 132-133 ; p. 62-63, $ 135 a- d; p. 65, $ 143 c; p. 67, $ 149-151 ; p 73,$ 163; p. 111,$ 133£; p. 231 -232, $ 424; p. 234, $ 429, 430; p. 352-353, $ 524 d; p. 366, $ 556 A; n 547-548, $ 663 d; p. 556, $ 889 i; p 624, $892Jd,-P-628-629, $892* q-t; o. 684-686, $ 905* 4; p. 856- 857, $ 1063 4. Also, Cantharides, Ergot, Index II its development, and that of the ovana at puberty, exerts a powerful influ- ence in advancing the maturity ofthe general organism, through an unin- terrupted reflex action ofthe nervous system, harmoniously with their rela- tions in the perpetuation of the spe- cies and this influence is forever aft- X II. 1090 INDE 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 reflex nervous action upon the mamma; 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 ofthe 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 world of dead matter, p. 68-69, $ 153 -159; p. 80, $ 169 d; p. 87, $ 180; p. 88, $ 185; p. 120-121, $ 237; p. 231-232, $ 424; p. 330, $ 500 n; p. 335-336, $ 512 a,b, p. 352, $ 524 d; p. 376-380, $ 578; p. 434-435, $ 680; p. 662-663, $ 896; p. 686, $ 905* 4; p. 279-280, $ 449 a-d. V. Vaccine 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 4-dd; p. 525, $ 828 4, 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, $ 790-798. Veins—continued from Index I, 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 4. Also, Sympathy, Continuous, Index II. the circulation in, depends upon several associated causes: 1st, the suction power ofthe 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 ofthe 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, $ 411 ; p. 355-356, $ 526 4, c. Also, p. 21, $ 22 ; p. 62, $ 136 ; p. 80, $ 169 d ; p. 88, $ 185 ; p. 223, $ 409 e ; p. 355-356, $ 526 4 ; 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 ofthe absorbents and umbilical vein, p. 211, $ 390 a; p, 214, $ 392 c, d; p. 212, $ 391 the intestinal do not absorb, p. 128, 129, $ 269, 277; p. 527, $ 829. Also, Magendie, Index II; Veins, Index I. Venous Congestion—continued from In- dex I, propagates, on account of the special vi- tal constitution ofthe 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 ofthe 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 ofthe INDEX II. 1091 Venous Congestion—continued. remarkable differences which exist among the tissues in their vital con- stitution, p. 61-63,$ 133-137; p. 64. $ 138-142; p. 67, $ 149-151 ; p. 72, Ta4/e 3 ; p. 355-356, $ 526 4 ; p. 444 -446, $ 688 d-f; p. 506-509, $ 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 1. Vesicants. See Counter-Irritants, In- dex II. Vessels, the most important are the terminating series ofthe 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 ofthe 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 4-411 ; p. 355, $ 526 a. Also, In- flammation, Structure, Index II.; Composition, Organic Compounds, &c, Index I. " Vestiges of Creation," introduced to illustrate the consequences of the Chemical doctrines of Life, p. 183-192, $350|/-353. Vision—continued from Index I, the latest interpretation of, as a chemi- cal phenomenon, p. 798, $ 1034. Vital Functions. See Functions of Life, Index I. and II. Vital Habit. See Habit, Vital, Index 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, $ 1028-1030; p. 796-799, $ 1034. Vital Principle—continued from Index continues to be the incubus in the dreams of Organic Chemistry, p. 796 -797, $ 1034. Vital Properties—continued from ln- lateTxperiments relative to, showing the 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 4. Volition. See Will, Index I. and II. Volkmann, 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, $ 891* k; p. 666-667, $- 902 4-904. 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 ofthe nervous system that ofthe true emetics, which, along with the pro- found physiological and therapeutical effects ofthe 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, $ 500 e-m ; p.333- 335, $ 503-511 ; p. 336-337, $ 514 4; p. 664, $ 900; p. 666-672, $ 902 4- 904 a; p. 704, $ 943 a-944 a. Also, Emetics, Stomach, Disgust, Sea- Sickness, Respiration, Reflex Ac- 1092 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, $ 891 p, exemplifying, also, the modus operandi of Narcotics, Antispasmodics, &c, and the great recuperative law, p. 592-593, $ 891* k; p. 681-683, $ 905 4; 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 j 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 ater, Hot, its effects in its action upon the stom- ach in producing free perspiration, like the glow and moisture ofthe 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. 1093 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 4-424; p. 289, $ 461; p. 296, $ 476 c; p. 301-302, $ 481 4 ; p. 335 -336, $ 512 a, 4; p. 339-340, $ 514 A; p. 351, $ 524 a, No. 1 ; p. 451, $ 692 a; p. 478-479, $ 740 a, 4; p. 483-484, $ 746 c; p. 534, $ 844; p. 563-565, $ 889 a-g; p. 630-632, $ 892* 4, c; p. 634, $ 892| 4; p. 662- 663, $ 896; p. 667-670, $ 902 d-i; p. 704, $ 943 a; p. 866-867, $ 1067 a. Also, Reflicx 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 ot circulation, since it determines the nervous influence mostly upon the lachrymal glands, as disgust does upon he mucous tissue ofthe stomach, and anger upon the voluntary muscles, while other emotions, like fear, im- part to that influence a more univer- sal direction-thus exemplifying, 1ike the physiology of respiration, ofthe contraction of the sphincter muscles &c,the manner in which morbific Tnd remedial agents direct the nerv- ous influence upon special parts, ac- Weeping—continued. 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, $ 8924 h; 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 demonstrations 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, $ 233J ; p. 336-338, $ 514 4, c. Also, Antispasmodics, Hiccough, Hyste- ria, Respiration, Stomach, Emet- ics, Index II.; Nervous Power, In- dex I. and II philosophy of effects of open air ahd 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 1094 INDEX II. Whoopin g-Cou gh—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. —all 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, $ 891* k. 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 4-1075 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 A. 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 ofthe violence which exce ssive Joy, An ger, Fear, blows u pon the epigastrium, surgical operations, prussic acid, the virus of serpents, &c, may inflict upon the organs of organic Hfe through the same medi- um, p. 89, $ 188; p. 103, $ 205; p. Will—continued. 107-111, $ 227-2331; p. 124-125, $ 243-246; p. 296, $ 476 c; p. 298, $ 476* A; p. 300-301, $ 479 ; p. 302, $ 481 4; p. 319-321, $ 494 4-e; p. 323-328, $ 500 c-m; p. 334-335, $ 509-511; p. 525-526, $ 828 a-c. 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, $ 1077. Also, Roosting, Index 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, not only 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 the exciting causes and modifying influences of the nervous agent and those of which Chemistry takes any cognizance, and INDEX II. 1095 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- i 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. Y. 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- i! The Chemist is desired to c< Yawning—continued. bific and remedial agents, and in de- monstrating the substantive existence and self-acting power of the Soul, p. 327-328, $ 500 j-m; p. 340, $ 514 k- m ; p. 534, $ 844 ; p. 631-632, $ 892 4; p. 888-889, $ 1077. Also, Dis- gust, Sneezing, Sea-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 ow- ing to the development ofthe 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, $ 117; p. 56, $ 120; p. 61, $ 133 c; p. 68-69, $ 153 -159; p. 121, $237; p. 352, $524 d; p. 376-378, $ 578. Also, Organs of Generation, Parturition, Preg- nancy, Alteratives, Predisposi- tion, Miasm ; Antimony, Tartar- ized ; Reflex Action, Index II; Vital Properties, Organic Life, Index I. er particularly this fact. 1096 P. S.—An important omission was made in that part of our Appendix which re- lates to the progress of "physiological and pathological chemistry" (p. 779) in not having converted to our purposes the doctrine ofthe "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 solidist. It is a full acknowledg- ment that the powers of nature, as they operate in the inorganic world, are entirely inapplicable to living beings, and that the assumption has hecome necessary that they are transmuted into something very different, but wanting 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 trans- mutation is therefore claimed by the vital solidist as his vital principle. But, cu- riously enough, the chemico-vitalist, in accepting this assumption, contends, also, for a vital principle. Finally, 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 "transforming 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 submission to the vitalizing power of the whole organic being; or, if this consistency be maintained, the manifestations, by this product of organiza- tion, of all the usual effects of caloric, both upon dead and living matter, equally consign the speculation to the same fate as is attending the physical forces in their less mystified application to the science of life. THE END. THE INSTITUTES OF MEDICINE. By MAETYN PAINE, A.M., M.D., LL.D., Professor of the Institutes of Medicine and Materia Medica in the University of the City of New York; Corresponding Member of the Eoyal Verein fur Heilkunde in Preussen ; Cor- responding Member of the Gesellsohaft fiir Natur und Heilkunde zu Dresden ; Member of the Medical Society of Leipsic; of the Medical Society of Sweden; of the Montreal Natural History Society; and of many other Learned Societies. With a Portrait. New Edition, Revised and Enlarged, with a Copious Index. 8vo, Sheep, Four Dollars. The Publishers, in offering to the profession a 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 the 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 that 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 the Institutes. October 8, 1S5S. From the Sew York Journal of Medicine, May, 1858. " 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- From the same Journal of July, 1858. " 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 ox- 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 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." the same doctrines. * * The author of the ' In- : 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 country. 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, 185S. That the 'Institutes of Medicine' and the 'Medical and Physiological Commentaries are nWacterized by great analytic power, profound i M^mTv rare eenius, and unsurpassed learn- „ nl° nPo candid3 reader can deny; that they will rank with the foremost works in our science, and enUtlltheir 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 discussed with the 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." 2 PROFESSOR PAINE'S INSTITUTES OF 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 Paine'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 has 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 nervous 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 From the Virginia Med'i "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 theoiy 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— From the American Journal of the Met " 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 false, are, nevertheless, based upon a system, the most important of which is its vari- ously alterative effects upon the organic func- tions ; or, in his own language, ' in all the cases the nervous power is rendered stimulant, 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 function 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 word 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." 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 still 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 believe 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 him 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 we 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. ical Sciences, Philadelphia, July, 1858. truly philosophical investigation, aided by all the 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 functions, 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, has sufficient courage to raise his voice in defense of the vitality of the system; in recognition of the fact that our or- cal Journal, July, 1858. PROFESSOR PAINE'S INSTITUTES OF MEDICINE. 3 gans are built up and maintained in a healthful condition for the regular performance of their 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 are pervaded, if they do not actually convey sound views on every 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 North American Medico-Chirurgical Review, September, 185S. "No one can read the Institutes of Medicine without being filled with respect and even ad- miration for the 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 which 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 many of its doctrines, the great questions in which it abounds, and the consummate skill and learn- ing with which tfhese 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, 1858. "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 we think we can not do better than lay his claims be- fore our readers. " Inhis Preface to this fourth edition Dr. Paine says : ' This work, originally published in 184T, 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. 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." From the Charleston (S. C.) Medical Journal and Review, July, 1858 " Few men have labored more constantly, more earnestly, and with more singleness of purpose than the venerable and learned author whose late edition of the Institutes of Medicine now lies be- fore u?. * * The 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 ndustry of the author, with his originality and ffi consistency, and if we »nrt* torn him in some of his views, we do so with the dim dencedueto 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- ^ff toE£S3*of D- P-e that arrests • \\. 1„ka methodical manner in which he us is the solid,, raeuioa thorou hdpinmb plants himself at^wor fbefore he which he establish; s ior assured plee with *» ^>^C V read. It is not goingVo"bel"any''triSng affair, you are at once such a manner as not to allow it soon to be 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, 1S58. 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 compauy 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 those from every walk of literature, giving us a high opinion of the author's cultiva- tion of pursuits too often neglected by medical 4 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, but 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 From the Montreal Medical " 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 surprising. It is not only the standard medical works in various languages that he has consulted, but periodical literature has been thoroughly ransacked to discover new here such a work as Dr. Paine's, but we may give an idea of some of its contents, &c, &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 volumes; 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." Chronicle, September, 1S58. 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 tlie Buffalo Medical Journal and Review, September, 1858. "The Institutes of Medicine first saw the light at a time when the humoral 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 modus operandi 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,1 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 form the foundation and substratum of the whole. There is no in- consistency, no contradiction, not even the shad- ow of any clashing throughout. Taking up each topic in its natural order, as each successive one emanates from, or depends upon, the preceding, there is a lucid order every where displayed—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 pofht 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 medicine. 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- viewer enters upon the author's original views of the nervous system, and more specifically as to the " excito-secretory system," showing that even the term itself was derived from writings of his as early as 1842, 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-secretory' is every where comprehended in what is set forth as to tlie general organic influences of reflex action. The grand doctrine is again and again reiterated in every part ofthe work, as on page 661," &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, 1858. " 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 learn- 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 he 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 age when Humoralism and Organic Chemistry are threatening to displace all other views of physiological and pathological ac- tion, this work, because it is ultra in its vitalism and solidism, must exert a most salutary influ- ence upon the history 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 has heen 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 ofthe author." PROFESSOR PAINE'S INSTITUTES OF MEDICINE. 5 From the Memphis Medical Recorder, March, 1853. "All praise, we say, to those pathologists, with Professor Paine at the head of them, 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, than 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 tlie 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, September, 185S. 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." After commending the Medical and Physiolog- ical Commentaries, Professor Wright remarks that: "It is in the Institutes of Medicine that the great principles of vital physiology 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 From the Nashville Journal 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 scholarship 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 Cyclopaedia 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. gree worthy of the most thorough investigation. * * 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." "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- From the College Journal of Medical Science, Cincinnati (O.), July, 1S5S "However much we may differ with the au thor upon some points, we feel that the Institutes 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, 1S58 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." " 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 From the New Orleans Medical News and Hospital Gazette, July, 1858. " 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, 1S5S. '-ivo hesnpik for this enlarged edition of the I Institutes of Medicine a hearty reception and a ■u v ' I studious reading. 6 PROFESSOR PAINE'S INSTITUTES OF MEDICINE. From the Cincinnati Lancet " No name in American Medical Literature oc- cupies a more prominent or worthy position just now than that of Professor Martyn Paine; no works 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 Remedial 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 matnrity, for which bo 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 the 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 and Observer, October, lSS^. 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 geuius and scholarship." " To the laborious thinking student of medi- cine every where we commend the writings of Martyn Paine." Published by HARPER & BROTHERS, Franklin Square, New York. flgp3 Haepee & Beotheks will send the above Work by Mail, postage paid (for any distance in the United States under 3000 miles), on receipt of $4 00. im>:Vi: From the Maine Medical and Surgical Reporter, January, 1859. " Dr. Paine discusses (in the Institutes) with marked ability the points of difference between the vitalists, of whom he is the most distinguish- ed exponent, and the chemical physiologists." "The arrangement (of the subjects) is philo- From the Peninsular and Independent Medical Journal, Detroit, Michigan, February 7, 1859. sophical, and, if we admit the premises of our author, we are forced by his admirable and logic- al reasoning to admit the correctness and truth of his conclusions." " We may safely say that this work (the Insti- tutes of Medicine) is not second to any one ofthe kind in the language, if any can be found of equal merit." " A profound and methodical thinker and an erudite philosopher, Dr. Paine has shown con- summate skill in presenting his favorite and truthful theory of Vitalism, 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 Institutes) displays in every page the profound learning, immense research, and sound philosophy, of the venerable and distinguished author. It is, at the same time, a triumphant refutation of the false doc- 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 exist; 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. He has suc- ceeded in giving more of the true philosophy of medicine than has ever before been given in any work. There is order, sequence, and harmony to an eminent degree in this work. It is an edifice, and though not an Egyptian pyramid, it is still a magnificent structure, which few men in our pro- fession could make in greater perfection, or in more ample proportions." Published by HARPER & BROTHERS, Franklin Square, New York. |^s-* Haepee & Bbotheks will send the above Work by Mail, postage paid (for any distance in the United States under 3000 miles, on receipt of $4 00. 3tas.tr.Trt-.-.,-; ;;^^.;.?r^^feiri!P55p 1 '.*J.„ ,* r*t.%'t:^.^V,;ct!^n»>-!(^TIr«r«Ag NATIONAL library of medicine NLfl 03nDA77 A NLM031908778